Substance dependence is due to all except

Aetiological Factors in Substance Use Disorders 1. Biological Factors i. Genetic vulnerability (family history of substance use disorder; for example in type II alcoholism) ii. Co-morbid psychiatric disorder or personality disorder iii. Co-morbid medical disorders iv. Reinforcing effects of drugs (explains continuation of drug use) v. Withdrawal effects and craving (explains continuation of drug use) vi. Biochemical factors (for example, role of dopamine and norepinephrine in cocaine, ethanol and opioid dependence) 2. Psychological Factors i. Curiosity; a need for novelty seeking ii. General rebelliousness and social non-conformity iii. Early initiation of alcohol and tobacco iv. Poor impulse control v. Sensation-seeking (high) vi. Low self-esteem (anomie) vii. Concerns regarding personal autonomy viii. Poor stress management skills ix. Childhood trauma or loss x. Relief from fatigue and/or boredom xi. Escape from reality xii. Lack of interest in conventional goals xiii. Psychological distress 3. Social Factors i. Peer pressure (often more impoant than parental factors) ii. Modelling (imitating behaviour of impoant others) iii. Ease of availability of alcohol and drugs iv. The strictness of drug law enforcement v. Intrafamilial conflicts vi. Religious reasons vii. Poor social/familial suppo viii. 'Perceived distance' within the family ix. Permissive social attitudes x. Rapid urbanisation. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 36