Abnormal Psychology

Substance Use Disorders 385

Use Becomes Abuse

People can develop substance abuse in three general ways. First, substance abuse

can arise unintentionally, as can occur through environmental exposure. Consider a

gas station attendant who daily inhales gasoline fumes.

Second, substance abuse (or dependence) can develop when the psychoactive

element is a side effect, and the substance is taken for medicinal reasons unrelated

to the psychoactive effect. For instance, former Chief Justice of the Supreme Court,

William Rehnquist began taking the sedative-hypnotic drug ethchlorvynol (Placidyl)

for insomnia and pain after back surgery in 1971 (Cooperman, 2007). Ten years

later, it was clear to many that something was wrong: Rehnquist had become de-

pendent on the drug, taking it in very large doses because he had developed a toler-

ance for it. In fact, the dose was so large that it impaired his speech. When he was

abruptly taken off the medication, his withdrawal symptoms included paranoia and

hallucinations; he was then put back on the medication and his use was gradually

reduced (Mauro, 2007).

Third, substance abuse can develop as a result of the intentional use of a sub-

stance for its psychoactive effect, as the Beatles did when they took the stimulant

Preludin during their nightly 8-hour gigs in Hamburg. The drug’s stimulant proper-

ties gave them energy to perform these grueling sets (Spitz, 2005). In this third path

toward substance abuse and dependence, someone may know the risks in using the

substance but nonetheless underestimate his or her own level of risk (Weinstein,

1984, 1993). It is this third path toward developing substance abuse that has been

the target of most research, and a number of different theories have tried to explain

this type of slide from use to abuse.

Common Liabilities Model

Thecommon liabilities model (also called the problem behavior theory; Donovan &

Jessor, 1985) was developed in response to the results from a study that followed

students from grades 7–9 into adulthood; the researchers found that adolescents

who later developed substance abuse were likely to exhibit “problem behaviors” such

as drug and alcohol use, early sexual intercourse, and delinquent behaviors

(e.g.,stealing and gambling). The researchers proposed that these various prob-

lem behaviors may stem from the same underlying factors—that is, the adolescents

hadcommon liabilities, related to neurological, psychological, or social factors or

to feedback loops among these factors—hence the name given to this approach to

understanding how use becomes abuse or dependence. Subsequent studies have sup-

ported this explanation (Agrawal et al., 2004; Ellickson et al., 2004).

Substance use can become abuse in different ways,

illustrated here left to right: through environmental

exposure; when the psychoactive component is a

side effect of a medication taken for medicinal pur-

poses; or when people set out to use a substance

for its psychoactive effects.

moodboard/Corbis Punchstock/BananaStock Chuck Savage/Corbis

Tolerance

The physiological response that arises from

repeated use of a substance such that more

of it is required to obtain the same effect.

Withdrawal

The set of symptoms that arises when a

regular user decreases or stops intake of an

abused substance.

Common liabilities model

The model that explains how neurological,

psychological, and social factors make a

person vulnerable to a variety of problematic

behaviors, including substance abuse and

dependence; also called problem behavior

theory.