382 CHAPTER 9
All four members of the Beatles tried various psychoactive substances.
Apsychoactive substance is a chemical that alters mental ability, mood, or behav-
ior. Psychoactive substances, commonly referred to as drugs, can be used for thera-
peutic purposes (for example, taking an antidepressant to diminish symptoms of
depression), for nontherapeutic purposes (for example, drinking an alcoholic bever-
age to “unwind”), and for intoxication (for example, using a drug to get “wasted”).
Frequent use of a psychoactive substance can proceed to abuse or dependence.
According to DSM-IV-TR, substance use disorders are characterized by abuse
of or dependence on psychoactive substances. With substance use disorders, the
psychoactive substance is taken either because of its effect on mood, behavior, or
cognition or because it prevents uncomfortable withdrawal symptoms (American
Psychiatric Association, 2000).
Why does a book on abnormal psychology include a discussion of substance use?
For three reasons: First, when such use leads to abuse, it disrupts the individual’s nor-
mal functioning. Substance abuse can lead to decidedly abnormal cognition or affect;
not only can certain drugs produce delusions and hallucinations, but they can also
induce paranoia and fear. Second, when a person becomes drug dependent, he or she
may desire the substance to the point that the usual balance of motivations becomes
skewed. He or she may forgo eating, sex, productive work, and all the other things
that make life worth living in order to obtain the drug. Third, drug abuse may help to
trigger various psychological disorders or exacerbate symptoms of a comorbid disor-
der. For instance, as we’ll see, drug abuse is often comorbid with depression and other
psychological disorders. In short, chronic substance abuse can have a ripple effect on
a user’s life, leading to impaired functioning in work, school, and relationships.
Is simply the act of trying a drug enough to meet the criteria for having a
substance use disorder? What’s the difference between use and abuse or between
abuse and dependence? Moreover, does the context matter—does where and why
someone uses a drug affect whether he or she would be diagnosed as abusing it?
The answers to these questions help to determine whether drug use meets the cri-
teria for a disorder and help to make decisions about treatment. Let’s examine the
differences among intoxication, use, abuse, and dependence.Substance Use Versus Intoxication
The Beatles, individually and collectively, experimented with numerous drugs. Paul
McCartney is generally described as having been the most cautious about drugs,
whereas John Lennon used them regularly, sometimes continually. Lennon confessed
to being “a drunk” in art school, and he began taking “pills” (stimulants) at age
17, when he became a musician. Why pills? “The only way to survive in Hamburg
[Germany, where the band played at various periods in 1961, 1962, and 1963], to
play eight hours a night, was to take pills. The waiters gave you them—the pills and
drink” (Wenner, 1971). Lennon recounted how, during the fi lming of the Beatles’
second movie, Help!, he and his bandmates
turned on to pot, and we dropped drink, simple as that. I’ve always needed a
drug to survive. The others, too, but I always had more, more pills, more of
everything because I’m more crazy probably.
(Wenner, 1971)
At one time or another, each Beatle could have been diagnosed with sub-
stance intoxication: reversible dysfunctional effects on thoughts, feelings, and
behavior that arise from the ingestion of a psychoactive substance (see Table 9.1).
The specific effects of substance intoxication depend on the substance and
whether a person uses it only occassionally (getting drunk on Saturday night)
or chronically (drinking to excess every night).
In contrast to substance intoxication, substance use is a general term that
indicates simply that a person has used a substance—via smoking, swallowing,
snorting, injecting it, or otherwise absorbing it. This term does not indicate the
extent or effect of the exposure to the substance.Psychoactive substance
A chemical that alters mental ability, mood,
or behavior.
Substance use disorders
Psychological disorders characterized by
abuse of or dependence on psychoactive
substances.
Substance intoxication
The reversible dysfunctional effects on
thoughts, feelings, and behavior that arise
from the use of a psychoactive substance.
- The development of a reversible substance-specifi c
syndrome that arises from the recent ingestion of
(or exposure to) a substance.
Note: Different substances may produce similar or
identical syndromes. - The clinically signifi cant maladaptive behavioral
or psychological changes associated with intoxica-
tion (such as belligerence, rapidly changing mood,
cognitive impairment, impaired judgment, impaired
social or occupational functioning) are due to the
direct physiological effects of the substance on
the central nervous system and develop during or
shortly after use of the substance.
Source: Reprinted with permission from the Diagnostic and
Statistical Manual of Mental Disorders, Text Revision, Fourth
Edition, (Copyright 2000) American Psychiatric Association.
Table 9.1 • DSM-IV-TR Criteria for
Substance Intoxication