the media, have a strong influence on drug use and abuse. For example, adolescents typically use drugs when with very close friends, and so the peer influence on drug use and abuse may occur in a cycle: a child chooses friends with similar interests and attitudes, and when one experiments with drugs, the others join in, and soon they are imitating each other's use or abuse. In addition, children are more likely to use drugs if drugs are used by other members of their families. In fact, a family history of drug abuse is the single most important indicator of risk for the children. Although some of this risk may be genetic, it is not clear either to what degree or how genetic vulnerability interacts with environmental factors in such families. The community environment is also crucial; children who live in communities with drugs readily available, drug-using peers, and where drug use is generally accepted are more likely to abuse drugs. Glantz and Pickens (1992) reviewed the literature on vulnerability to drug abuse and found complex relationships among family and community factors. For example, among Mexican Americans, the risks of drug abuse were higher for children from lower socioeconomic group families living in regions with high dropout rates from high school. In contrast, females from families who have a strong identification with Hispanic culture seem to be protected and to engage in drug abuse in lower numbers (Swaim et al., 1993).

Changing the environmental conditions or cues associated with drug use or withdrawal can assist an individual's efforts to abstain from drugs. For example, if drinking a cup of coffee after a meal is associated with smoking, it is important to break that association in the same way that the association between working and smoking is broken when the workplace forbids smoking in one's office. Further, it is well known among treatment providers that patients in recovery from addiction have a higher chance of relapse if they are in environments in which their previous drug use took place, or if they are associating with friends who continue to use drugs.

There has been considerable research on the personalities of alcoholics and individuals addicted to other drugs, but additional multidisciplinary research is needed to identify how specific risk and protective factors interact with biological vulnerability (Hawkins et al., 1992; IOM, 1994a,b; IOM, 1996a). Several studies indicate that children who are less conventional, more tolerant of deviant behavior, less religious, less oriented toward hard work, more rebellious, with lower expectations of academic achievement, and fewer negative beliefs about the harmfulness of drinking and more positive views of the social benefits of drinking are more likely to abuse alcohol as they become older. Similarly, adolescents who are unconventional and have low achievement in school or exhibit problem behaviors are more likely to start to use illicit drugs. Family factors, such as divorce or chronic stress, poor parenting, or a poor child-parent relationship, in addition to parent or sibling use of or attitude toward drugs, also may contribute to drug use.

There is a very high co-occurrence of alcohol and illicit drug dependence with psychiatric disorders, and some experts believe that the drug use amounts



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