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Although there are undoubtedly medical and psychological aspects to substance abuse, social factors influence the probability of substance abuse and the consequences. One obvious example is alcohol. In some countries, including many European ones, even those with quite limited or no regulation of alcohol sales, abuse is uncommon, whereas in other countries (Britain, US, Russia), binge drinking and other problem behaviors are common. Similarly, many hallucinogenic drugs that were used safely by Native Americans and similar cultures in religious rituals are abused in modern society. If substance abuse were purely medical or psychological, none of this cultural variation would be observable. Moreover, the likelihood that substance abuse will become abuse and that various other health and social problems will ensue is dependent on social variables, such as poverty, family situation, etc.
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