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FIGURE 49–1. Theoretical model of the causes and consequences of drug addiction.

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FIGURE 49–1. Theoretical model of the causes and consequences of drug addiction.A three-stage model is proposed that entails the addiction process from initial drug use, the transition to chronic drug abuse and addiction, the chronically relapsing nature of addiction, and the social and personal costs of end-stage addiction. The roles of learning, memory, reward sensitivity, and emotion regulation are highlighted. Factors that positively and negatively modulate the addiction acquisition stage are shown. Psychosocial factors include the influence of peers, family, cultural variables, social and religious beliefs, socioeconomic status, drug attitudes, and the illicit versus licit nature of the drug of abuse. Genetic factors include allelic and haplotypic variation for genes regulating cognitive functions, drug pharmacokinetics and pharmacodynamics, and personality traits. Neurodevelopmental factors include risks posed by the adolescent period and by childhood maltreatment. Brain anatomical and neurotransmitter substrates are proposed for the different stages of the addiction process. CRF = corticotropin-releasing factor; OFC = orbitofrontal cortex; SES = socioeconomic status.

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