The cause of substance abuse is complex and involves many factors, including the type and availability of the drug, personality type, environmental factors, peer pressure, coping abilities of the individual, genetic factors, and sociocultural influences. Cocaine dependence is thought to be associated with a deficiency in dopamine and norepinephrine neurotransmitters. Use of narcotics and opiates may interfere with the biochemical factors that are related to the body's own production of opiate-like substances.

A psychological factor that seems common to all forms of substance abuse is low self-esteem. Also found are feelings of inadequacy, loneliness, shame, and guilt that lead to depression and a sense of hopelessness and despair. Sociocultural factors have significant influence. Increasing numbers of individuals experience family breakup and separation, school failure, poverty, unemployment, "living in the fast lane," and stressors related to highly competitive work environments. Teenagers and young adults often begin experimenting as a result of peer pressure and the easy availability of drugs.

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