We know that some drugs appear to be more addictive in certain societies/environments, in certain individuals, at certain times. This is another way of saying that addiction is a complex and multifaceted condition involving factors internal to the individual (neurobiological; such as genetics, neurochemistry, cognitive-affective regulation, personality) and factors external to the individual (contextual; such as environmental, cultural, spiritual, situational). As such, we strongly support the suggestion that context has an important role in the addictive process. We would argue that neurobiological vulnerabilities set the stage for psychopathology, but they by no means determine its onset, nature and course. In support of this, we know that neurobiological vulnerabilities expressed in different contexts often lead to vastly different outcomes. An example of this might be that only 6% of American soldiers who had used heroin in Vietnam became re-addicted three years after returning to the United States of America, despite 75% feeling that they had been addicted in Vietnam (Robins 1993). However, heroin was certainly more available and acceptable in Vietnam, and the relative consequences of ongoing use (in the face of a constant external threat) were likely to be much less severe than on return to the USA. This suggests that ongoing drug use in certain contexts does not necessarily equate to intractable addiction, but rather addiction should include the notion of continued use in the face of severe adverse consequences that far outweigh the benefits of using.

Labels: addiction, drugs, heroin