388 CHAPTER 9
(most frequently depression), posttraumatic stress disorder (PTSD), schizophre-
nia, andattention-defi cit/hyperactivity disorder (ADHD, discussed in Chapter 14),
a disorder marked by problems sustaining attention or by physical hyperactivity
(Brady & Sinha, 2005).
When substance abuse develops after another psychological disorder has devel-
oped, clinicians may infer that the person is using substances in an attempt to allevi-
ate symptoms of the other disorder—to self-medicate. John Lennon struggled with
depression at different points in his life; even at the height of Beatlemania, he had a
bout of depression (revealed in his lyrics for the song “Help!”). It is possible that his
drinking and later heroin use were attempts to alleviate his depression.Polysubstance Abuse
As was true of the Beatles, some people abuse more than one substance, a behavior
pattern that is called polysubstance abuse. One study found that among alcoholics,
64% also suffered from drug abuse or dependence (Staines et al., 2001). Polysub-
stance abuse is dangerous because of the ways that drugs can interact: One lethal
combination occurs when someone takes a drug that slows down breathing, such
as barbiturates (which are often used as sleeping pills), along with alcohol. A form
of polysubstance abuse that is seldom recognized is the combination of alcohol
and cigarettes (nicotine): Cigarettes are the biggest killer of all drugs, and this is
particularly true among alcoholics. Most alcoholics are more likely to die from
nicotine-related medical consequences, such as cardiovascular disease, than from
alcohol-related ones (Hurt et al., 1996). Elaine W., the subject of Case 9.2, abused
a variety of substances.Using or abusing more than one substance can
increase the risk of accidental overdose; actor
Heath Ledger died in 2008 from taking a com-
bination of drugs, reportedly for his chronic
insomnia. The autopsy results indicated that he’d
taken pain killers, several benzodiazepines (used
to decrease anxiety), and an over-the-counter
antihistamine that can induce drowsiness. He
may have developed tolerance to standard doses
of these medications; in combination, they
caused his heart or breathing to slow down so
much that he died (Falco, 2008).IMPictures/FilmMagic/Getty Images
Polysubstance abuse
A behavior pattern of abusing more than one
substance.CASE 9.2 • FROM THE INSIDE: Elaine W.’s Polysubstance Abuse
I remember my fi rst experience with alcohol like it was yesterday. It was prom night, May 1969,
and I was 16 years old. [My date had some wine he took from his house.] Although we had
not discussed this prior to the prom, and without even giving it a second thought I turned
the bottle up and drank when it was passed to me. I remember that warm, mellow glow that
accompanied that fi rst drink and the feeling of security in believing that I had found what I
had been searching for all my life; feeling like I belonged and that all was well with my world.
From then on, drinking on the weekends was a regular occurrence. I was always the one who
drank just to get sloppy drunk and pass out. I recognized even then that once I drank the fi rst
one I couldn’t stop. I didn’t see that as a problem though; just thought it was the way it was
supposed to be. One of my friends found out quite by accident that if she took a pain pill be-
fore drinking it made the high much better. Naturally when she shared that information with
me I had to try it. They were her mother’s pills and she was right—I loved it.
After graduation from high school, the love of my life went away to college. On one of his
weekends home he brought some pot with him and I smoked for the fi rst time. I thought it
was pretty cool because I could get really high and not have a hangover the next day. I still
continued to drink though. Because of the pot smoking, the good friends I had in high school
wouldn’t have much to do with me anymore, so I had found new friends that liked the same
things I liked; acid, pot, cocaine, and lots of alcohol.
Source: Faces and Voices of Recovery, 2007b.
Elaine took a variety of different drugs on different occasions, and she also took alcohol
and pain medication at the same time. Fortunately, Elaine’s sisters were able to get her
to seek treatment and her polysubstance abuse stopped.Prevalence and Costs
Substance abuse and dependence are among the more common psychological
disorders. In 2007, 9% of Americans aged 12 and older, or 22.3 million individu-
als, were estimated to have substance abuse or dependence (Substance Abuse and
Mental Health Services Administration [SAMHSA], 2008). Generally, men are more
likely than women to be diagnosed with a substance abuse or dependence disorder,