Abnormal Psychology

Substance Use Disorders 389

although women are more likely to be diagnosed with abuse of, or dependence on,

legally obtained prescription medications (Simoni-Wastila, Ritter, & Strickler, 2004).

The prevalence of drug use, abuse, and dependence varies across ethnic and ra-

cial groups in the United States. For instance, Asian Americans have the lowest rates

of alcohol abuse or dependence (4%), whereas Native Americans have the highest

rate (13%). Although African Americans are more likely to abuse or be dependent

on illegal substances, they are the least likely, after Asian Americans, to be diag-

nosed with alcohol abuse or dependence (SAMHSA, 2008). Note that these preva-

lence rates group people who have somewhat different ethnic backgrounds into the

same broad category, but this is a simplifi cation: Within each broad ethnic or racial

category, there can be signifi cant variation. For example, among Americans of His-

panic descent, the 1-month prevalence rate of heavy drinking (fi ve or more drinks in

a sitting) for Cuban Americans is 1.7%, whereas it is 7.4% for Mexican Americans

(NIDA, 2003). Therefore, prevalence rates of racial and ethnic groups provide only

a general overview, and do so only at a particular moment in time.

Substance abuse and dependence affects not only the user but also fam-

ily members and friends, coworkers and colleagues. Substance abuse and

dependence are associated with violence toward family members and ne-

glect of children (Easton, Swan, & Sinha, 2000; Gruber & Taylor, 2006;

Stuart et al., 2003). When the substance abuser is a parent, the abuse can

create chaos and stress in the family. Parents who abuse substances may feel

guilty and ashamed about their abuse, which ironically may lead them to

increase their substance use to cope with these feelings (Gruber & Taylor,

2006). Children may fi nd themselves shouldering adult tasks and respon-

sibilities (Haber, 2000). Children of parents who abuse substances are at

increased risk of developing emotional and behavioral problems (Grant,

2000; Kelley & Fals-Stewart, 2002).

A parent’s substance abuse can affect children in other ways. The par-

ent’s behavior ends up inadvertently providing a model of coping that the

child may come to imitate, as was the case for Barbara:

With over 15 years of continuous sobriety I am still amazed at how my life has

changed. As a young girl the message I received was: drinking, it was FUN, made

people laugh and joke, not a care in the world. Later I would see it destroy our

family due to an alcoholic mother. I swore I would never be like her. But I fol-

lowed in her path, step by step. From my fi rst drink to my last I was a blackout

drinker. Somehow I managed to keep a job (sometimes) but I lost friends, respect

and self esteem along the way. I never wanted to admit I had a problem, though

I knew it all along.

(Faces and Voices of Recovery, 2007c)

Substance abuse and dependence also have costs for society as a whole,

both fi nancially and in human capital. One estimate placed the total economic

cost of alcohol and drug abuse in the United States at around $250 billion a

year. These costs refl ect the money spent by users in procuring the drugs, the

government’s costs in apprehending, bringing to trial, and incarcerating illegal

drug users or dealing with the effects of illegal drug use (e.g., stealing in order

to be able to buy drugs or driving under the infl uence of alcohol or drugs),

and the costs of treating people for substance abuse and dependence (NIDA,

2006a). There is also a high correlation of substance abuse and dependence

with unemployment, as is evident in Figure 9.4.

Culture and Context

The line between use and abuse, as well as that between abuse and dependence,

shifts over time and across cultures and ethnic groups. For example, cocaine was

used legally as a remedy for many ills in the second half of the 19th century, but

it has now been illegal for decades. And, during the Prohibition era (1920–1933) in

the United States, alcohol use was illegal.

9.4 • Abuse, Dependence, and

Unemployment According to one national

survey, 3% of Americans were dependent on or

abused an illegal substance. Nine percent of those

surveyed had alcohol abuse or dependence. As

shown in the graph, a disproportionate number

of people with abuse and dependence problems

were unemployed at the time of the survey. The

survey did not determine, however, whether their

unemployment was a cause or a result of the

substance abuse or dependence (SAMHSA, 2008).

Figure 9.4

Percentage

0

5

10

15

20

Past-year dependence

on or abuse of an

illicit drug

Past-year dependence

on or abuse of

alcohol

Total population

Full-time workers

Part-time workers

Unemployed

Other