"Well, how much time have you got?" I responded, because it's like that. To begin with, I don't think there's a person alive who sets out to become substance dependent. "Wait a minute," you say, "what about genetics? Doesn't that have something to do with it?" To a certain extent, yes, but it's not like having blond hair -- you're born with it so either deal or get acquainted with Lady Clairol. Instead, it's a case of a genetically-vulnerable individual being more susceptible to addiction when they expose themselves to a given chemical agent.
It's not automatic -- the nurse swabbing your arm with alcohol when you get a flu shot isn't going to turn you into an alcoholic. One current theory suggests that alterations in the enzyme that breaks down alcohol may permit some persons to imbibe greater amounts before experiencing adverse effects. People who seem to have low levels of this enzyme (see post of 5/23/09) are less prone to alcoholism because they experience those effects more easily. Drinking for them, especially to excess, turns out to be not a lot of fun.
Choice is definitely involved, but if a person is raised in a family where alcohol dependence is rampant, for example, their choices are highly influenced by parental/sibling modeling. Where there is chronic stress, psychiatric illness, or the message that drinking is appropriate and expected, it becomes more difficult to "just say no." And in some cases, "no" isn't even part of the vocabulary.
At the same time, I've known people who came from alcoholic families and never touched a drop. They'd experienced so much pain as a result of mom or dad drinking, they determined it would never happen to them and it didn't. They may have attended Al-Anon or Alateen, associated with non-drinking friends, gotten involved in spiritual groups, or a combination thereof. Just like attaining sobriety, avoiding dependence is easier with support.
I've been referring, mostly, to alcohol and, honestly, there are a number of theories out there to help explain who, when, how, and why substance abuse and dependence of all types develop. None of them are universally applicable but they don't have to be in order to be useful. We don't have to know everything to do something meaningful nor do we have to do everything right to make a difference.
(Image of DNA molecule via Wikipedia)
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