Abnormal Psychology

390 CHAPTER 9

Various cultures use psychoactive

substances for different purposes. Some

Native American tribes, for example, use

peyote or psilocybin mushrooms (which,

when eaten, produce vivid hallucinations)

as part of sacred rituals. Similarly, tribal

people in the South Pacifi c use kava (a bev-

erage produced from the roots of a plant)

and other substances as part of their ritu-

als, which do not lead to substance abuse

and dependence. Within these cultures, the

use of psychoactive substances is strongly

regulated, and there are penalties for

abuse, including death (Trimble, 1994).

In addition, different cultures use alcohol differently. Patterns of use (or prohi-

bition) can be divided into four categories (Room & Makela, 2000):

• abstinence (for example, in Muslim societies),


• constrainedritual use of alcohol (for example, among religious Jews),


• drinking as a commonactivity (as in some Mediterranean cultures), and


• “fi esta” drunkenness during community celebrations (such as Mardi Gras).

However, not all cultures fi t neatly into one of these four categories, and within a

given culture, subcultures may exhibit different patterns.

In the remaining sections of this chapter we discuss specifi c substances that

are abused. We fi rst describe what they are and consider the ways in which they

have their effects. Because treatments for various types of substance abuse are

similar, we consider treatment for all types of substance abuse in the fi nal section

of the chapter.

Cultures may promote substance use

in some contexts and not others. These

Brazilian women are followers of Santo

Daime, a spiritual practice that involves

drinking hoasca, a tea made of plant-

based hallucinogens. Hoasca is legal in

Brazil and the United States when it is

used as part of a religious practice.

BrazilPhotos.com/Alamy

Key Concepts and Facts About Substance Use, Abuse, and Dependence

• The hallmark of substance use disorders is abuse of or depen-
  dence on a psychoactive substance.


• The term addiction focuses on the compulsive behaviors related
  to regular drug taking, but is not used in DSM-IV-TR.


• Substance abuse refers to the pattern of use of a psychoactive
  substance that leads to harmful effects; substance dependence
  refers to the persistent and compulsive use of a psychoactive
  substance, despite the ensuing negative consequences.


• Tolerance and withdrawal are common symptoms of substance
  dependence.


• Researchers have developed two compatible explanations of
  why substance use may lead to abuse. The common liabilities
  model focuses on underlying factors that may contribute to a
  variety of problem behaviors, including substance abuse. The
  gateway hypothesis focuses on factors that lead individuals to
  progress from using entry drugs to using harder drugs.


• In DSM-IV-TR, substance abuse and dependence are char-
  acterized as discrete categories; some researchers suggest

that they may be better conceptualized as being on a

continuum.

• Substance use disorders frequently co-occur with mood disor-
  ders (particularly depression), PTSD, schizophrenia, and ADHD.
  Many people with substance use disorders engage in polysub-
  stance abuse.


• Cultures can promote or regulate substance use through the
  use of rituals and penalties.

Making a Diagnosis

• Reread Case 9.1 about Butch Jamieson, and determine whether
  or not his symptoms meet the criteria for substance abuse or
  substance dependence. Specifi cally, list which criteria apply
  and which do not. If you would like more information to de-
  termine his diagnosis, what information—specifi cally—would
  you want, and in what ways would the information infl uence
  your decision?