Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

562 V. TREATMENTS FOR ADDICTIONSabuse symptoms (Pollock & Martin, 1999). A 3-year follow-up study demonstratedthat this entity has a unique trajectory that is not dissimilar to eitherabuse or dependence.ETIOLOGY AND PATHOGENESISGenetic and biological factors, as well as environmental variables, have beenextensively researched to address questions regarding the etiology of SUDs.Most researchers acknowledge a multifactorial consensus, as presented in thebiopsychosocial paradigm for the etiology and pathogenesis of these disorders.Genetic and Biological FactorsMost of the data regarding the genetic and biological contribution to the developmentof substance abuse are derived from alcoholism research. It has beensuggested that individuals may enter life with a certain level of genetic predispositiontoward AOSUDs. Convergent evidence from twin, adoption, and biologicalresponse studies suggests that genetic factors may indeed play a rolein the etiology of alcoholism (Bohman, Sigvardsson, & Cloninger, 1981;Cloninger, Bohman, & Sigvardsson, 1981). Investigations of neuropsychologicaland physiological precursors or markers of alcoholism, conducted with sonsof alcoholics and nonalcoholics, suggest some possible biological differencesthat may increase vulnerability to alcoholism. For example, children of alcoholicsmay be deficient in serotonin or may have an increased level of serotonin inthe presence of alcohol (Goodwin, 1985). The “addictive cycle”—a pattern inwhich a person initially drinks to feel good and then later has to resume drinkingafter an abstinence period to stop feeling bad—may result from such a problemwith serotonin. Children of alcoholics are also suspected to have increasedtolerance to alcohol.There are indications that adolescent substance abuse may be part of abroader genetic constellation. Some theorists suggest that polydrug abuse(abuse of a wide variety of substances) constitutes evidence against a geneticinterpretation of addiction. Cadoret, Troughton, O’Gorman, and Heywood(1986) suggest instead that some underlying biochemical route may be involvedboth in substance abuse and in problem or deviant behavior, especiallydelinquency, and that at least one genetic pathway occurs through antisocialbehavior.Temperament deviations are associated with an increased risk for psychopathologyand substance abuse (Reich, Earls, Frankel, & Shayka, 1993). Forexample, children with a “difficult temperament” more commonly manifestexternalizing and internalizing behavior problems by middle childhood(Earls & Jung, 1987) and in adolescence (Maziade, Caron, Cote, Boutin, &Thivierge, 1990) compared to children whose temperament is normative.