“I was in a terrible car accident shortly after my 18th birthday. I had three surgeries that were supposed to help relieve my pain. They didn’t. OxyContin, an opioid pain-relief medication, was my best friend until it was my only friend. By the time my doctor started suspecting an opioid substance use disorder, it was too late. I was already addicted.” (McDonald, 2018).

It is a common misconception that people who use drugs do so because of learning from bad friends. Substance use disorder results from a complex interplay of factors beyond simple peer pressure.

It is deeply rooted in a complex interaction of biological, psychological, and social/environmental factors that should be understood to prevent and treat it. (National Institute on Drug Abuse, 2018).

Let’s take a closer look.

Genetic factors

Genetic predisposition is a risk factor for developing substance use disorder. Research shows that a person who develops substance use disorder has a genetic predisposition of 40-60% likelihood of developing it (NIDA, 2020). This means that, when a person’s immediate family, like a parent or grandparent, has substance use disorder, it is 40-60% likely that they will also develop substance use disorder when they begin to use drugs.

The brain and the reward circuit

The human brain is wired to remember life-sustaining activities such as eating, drinking water, and reproduction. When we engage in such activities, the brain releases a chemical called dopamine, which causes us to feel pleasure; thus, the brain remembers and always rewards us with the pleasure chemical anytime we engage in any of these activities, so we repeat them to survive and thrive. (Watson, 2021).

Drugs of abuse work on this natural reward circuit in the brain by interfering with the brain’s normal pathways by either mimicking dopamine or causing dopamine to act for too long. The brain, which is now malfunctioning because of drug use over a long period, categorizes drug use as a life-sustaining activity because it is associated with pleasure and thus keeps trying to get the individual to continue using the drug by causing withdrawal symptoms and cravings (Pfizer, 2025).

Early exposure to substances

The human brain develops and keeps developing until an individual is in their early 20s (National Institute for Mental Health, 2023). The last part to develop is the prefrontal cortex, which is responsible for executive decisions such as planning and making good decisions. When children and adolescents whose brains are not fully developed are exposed to drugs, the damage is extensive, slowing down the development of the brain and greatly affecting their ability to make good judgement which leads them into engaging in continued drug use and engagement in other risky behaviour such as unprotected sex, reckless driving and others. (Jordan & Andersen, 2017).

Let’s explore psychological factors next.

Mental health disorders

People suffering from mental health disorders like depression and anxiety may take drugs to feel better so they can cope with the daily demands of life. This could lead to substance use disorder. (Australian Institute of Health and Welfare, 2025).

Trauma

Traumatic experiences such as accidents, experiencing war, sexual assault, the death of a loved one, and other violent and emotionally distressing experiences can cause people to seek relief through drugs, potentially leading to substance use disorder. (National Institute on Drug Abuse, 2024).

Poor coping skills

During crises (for example, disasters like floods) or when people are overwhelmed with the daily hassles (for example, having to manage a stressful job with raising little children while moving to a new city with no family support) of life and do not have healthy coping skills to deal with these stresses, they can resort to drugs to help them relax or temporarily escape the stress. (Stonebreaker, 2021).

Personality traits

Some personality traits are prone to impulsivity and risk-taking. Such people are more likely to try drugs just for the thrill of getting a ‘high’ (de Wit, 2009).

People with low self-esteem may also use drugs to perform in certain social or sexual situations. (Talbott Recovery, 2016).

Now let’s explore social/environmental factors.

Family dysfunction

When family systems break down and children are exposed to abuse and neglect, they may turn to drugs to relieve their emotional pain and suffering. (Elsig, 2024).

Socio-economic hardship and lack of opportunities

Poverty, unemployment, and a lack of opportunities for advancement in life can lead to hopelessness, which breeds despair and eventually the need to numb the pain. People in such a situation may resort to drugs or alcohol to take away the feeling of hopelessness and helplessness. (St Joseph Institute for Substance use disorder, 2025).

Cultural and community attitudes towards drug use

People who find themselves in communities where it is culturally accepted to use drugs or in communities that see drug use as normal are more likely to explore using drugs casually, and thus will be more likely to continue using drugs regularly. (Strickland & Smith, 2014).

Easy access to drugs in a community

When drugs are easy to access in a community, it becomes easier for individuals seeking to use drugs for any of the reasons already discussed above to find and use them. This situation increases their vulnerability to using drugs and developing substance use disorder more than an individual in a community where it is difficult to access drugs. (Warren et al., 2015).

Peer influence is real, there is no doubt about that. However, it is not the root cause of why people continue using drugs. Peers may introduce and encourage people to use substances, but ultimately, it is just a trigger or the last straw to tip someone who may already be in emotional turmoil and is looking for a way to cope with it.

That is why family, community, and religious systems need to strengthen social supports to offer strength and support for people who may be suffering and offer early intervention for persons in mental and emotional distress.

The situation in Ghana is no different. Research shows that most people who use substances in Ghana experience one or more of the situations discussed above. Young people, especially, engage in substance use because of the lack of opportunities and economic hardship, and the availability of drugs in their localities. (Editorial, 2025).

The situation is exacerbated because the community stigmatizes persons who use substances, thereby limiting their chances of gaining employment and other opportunities. Even persons who have gone into treatment also face such challenges, making their reintegration into society more difficult. (Amadu et al., 2024).

To prevent substance use disorder, we need to invest in educating the community about the causes of substance use disorder so that attitudes can be changed in the direction of care and support, instead of blame and shame.

We also need to invest in the creation of mental health awareness and the provision of quality mental health services so that persons with such issues can receive prompt and quality care.

Let us create avenues in the family and community to provide emotional, financial, spiritual, and physical support to one another. This is how we will strengthen the community ties and bonds. Let us educate our children on ethical and community values and encourage them to seek support and care in crisis.

Most importantly, let us change our attitudes towards substance use disorder. It is a mental health condition, not a moral failing.

Substance use disorder does not just happen because someone decided to follow their friends into drug use. Friends can and do influence others to use drugs, but drug use, which results in substance use disorder, is a complex interaction of biological, psychological, and social/environmental factors. To prevent it, let us strengthen our family and community bonds, educate our children, and provide them with the opportunities to have financial and economic success. As a community, let us support those who have already started using drugs. It is a disease, treatment is available, and recovery is possible. Let us provide hope and support, not judgment.

Amadu, P. M., Hoedoafia, R. E., Abem, V. K., Yakubu, N. D., Imoro, M., Sherif, A. M., & Razak, A. R. A. (2024). Substance Abuse among the Youth of Northern Region: The Realities of Our Time. Journal of Psychiatry and Psychiatric Disorders, 8(1), 15–23. http://www.fotunejournals.com/substance-abuse-among-the-youth-of-northern-region-the-realities-of-our-time.html

Australian Institute of Health and Welfare. (2025, April 22). Mental health and substance use—Mental health. Australian Institute of Health and Welfare. https://www.aihw.gov.au/mental-health/snapshots/mental-illness-and-substance-use

de Wit, H. (2009). Impulsivity as a determinant and consequence of drug use: A review of underlying processes. Substance use disorder Biology, 14(1), 22–31. https://doi.org/10.1111/j.1369-1600.2008.00129.x

Editorial, C. (2025, April 1). The Rise of Substance Abuse Among Ghanaian Youth: A Deep Dive into Music, Media, and Mental Health. CISA NEWSLETTER. https://cisanewsletter.com/index.php/the-rise-of-substance-abuse-among-ghanaian-youth-a-deep-dive-into-music-media-and-mental-health/

Elsig, C. M. (2024). The role of family dysfunction in addictive behaviours | The CALDA Clinic. https://caldaclinic.com/role-of-family-dysfunction-in-addictive-behaviours/

Jordan, C. J., & Andersen, S. L. (2017). Sensitive periods of substance abuse: Early risk for the transition to dependence. Developmental Cognitive Neuroscience, 25, 29–44. https://doi.org/10.1016/j.dcn.2016.10.004

McDonald, T. (2018). How Does a “Good Kid” Become a Drug Addict? My Recovery Story – California Health Report. https://www.calhealthreport.org/2018/02/08/good-kid-become-drug-addict-recovery-story/

National Institute for Mental Health. (2023). The Teen Brain: 7 Things to Know – National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know

National Institute on Drug Abuse. (2024, February 6). Trauma and Stress | National Institute on Drug Abuse (NIDA). https://nida.nih.gov/research-topics/trauma-and-stress

National Institute on Drug Abuse, N. I. on D. (2018, June 6). Understanding Drug Use and Substance use disorder DrugFacts | National Institute on Drug Abuse (NIDA). https://nida.nih.gov/publications/drugfacts/understanding-drug-use-substance use disorder

NIDA. (2020, July 6). Drug Misuse and Substance use disorder | National Institute on Drug Abuse (NIDA). https://nida.nih.gov/publications/drugs-brains-behavior-science-substance use disorder/drug-misuse-substance use disorder

Pfizer. (2025). Reducing the Pull of Memories to Fight Drug Substance use disorder Relapse | Pfizer. https://www.pfizer.com/news/articles/reducing_the_pull_of_memories_to_fight_drug_substance use disorder_relapse

St Joseph Institute for Substance use disorder. (2025, January 28). Understanding the Relationship Between Poverty and Substance use disorder. St. Joseph Institute for Substance use disorder. https://stjosephinstitute.com/blog/understanding-the-relationship-between-poverty-and-substance use disorder/

Stonebreaker, C. (2021). Stress and Substance use disorder: Can Stress Lead to Drug Abuse? – GoodRx. https://www.goodrx.com/conditions/substance-use-disorder/stress-and-substance use disorder?srsltid=AfmBOooZV39vdU7iNHSsib82QJhyIyyDlrP7twQwxWf-W1CiSQMc3yfH

Strickland, J. C., & Smith, M. A. (2014). The Effects of Social Contact on Drug Use: Behavioral Mechanisms Controlling Drug Intake. Experimental and Clinical Psychopharmacology, 22(1), 23–34. https://doi.org/10.1037/a0034669

Talbott Recovery. (2016, September 9). Low Self-Esteem and Drug Abuse: What’s the Connection? Talbott Recovery. https://talbottcampus.com/resources/low-self-esteem-drug-abuse-whats-connection/

Warren, J. C., Smalley, K. B., & Barefoot, K. N. (2015). Perceived Ease of Access to Alcohol, Tobacco, and Other Substances in Rural and Urban US Students. Rural and Remote Health, 15(4), 3397. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727394/

Watson, S. (2021, July 20). Dopamine: The pathway to pleasure. Harvard Health. https://www.health.harvard.edu/mind-and-mood/dopamine-the-pathway-to-pleasure