Abnormal Psychology

Substance Use Disorders 403

Sociocultural Factors

In addition to family and friends, other social forces can nudge individuals closer to

or further away from stimulant abuse and dependence as well as substance abuse

generally. People who are experiencing economic hardship and are unemployed are

more likely to develop substance use disorders (Reid et al., 2001; SAMHSA, 2000).

Consider that children who grow up in economically disadvantaged neighborhoods

are more likely to be exposed to ads for legal psychoactive substances (alcohol

and cigarettes) and to have easier access to these legal psychoactive substances as

well as to illegal ones. Children who live in such neighborhoods may also observe

more substance abuse among family members, peers, or adults; as noted earlier,

such modeling can have an adverse effect. Moreover, these children are also more

likely to experience or witness traumatic events and develop PTSD (see Chapter 7),

which is associated with substance abuse (Johnson, 2008; Stewart, 1996).

Society at large also infl uences substance use by establishing legal consequences

(Torrens & Martín-Santos, 2000). Society’s infl uence is also seen in how access to

drug treatment centers is regulated and in the national policies that direct resources

toward effective prevention and treatment programs.

Table 9.8 summarizes the social factors associated

with abuse of and dependence on stimulants.

As noted by the asterisks in Tables 9.6, 9.7, and

9.8, most of the factors that contribute to stimulant

abuse and dependence also contribute to abuse of

and dependence on other substances; the one excep-

tion is the specifi c neurological effects of stimulant

drugs. Because most of the factors contribute to sub-

stance abuse and dependence generally, we do not

examine the feedback loops among the factors un-

til after we review all types of substance abuse and

dependence.

• Dysfunctional family interactions are correlated with the presence of substance use
  disorders.*


• An individual’s substance use is related to that of his or her peers.*


• Norms and perceived norms infl uence substance use.*


• Substance use disorders are correlated with economic hardship and unemployment,
  perhaps in part because of easier access to drugs or more exposure to drugs in the
  environment.
  This factor is not unique to stimulant abuse and dependence.

Table 9.8 • Social Factors That Contribute to Abuse of

and Dependence on Stimulants

Key Concepts and Facts About Stimulants

• Stimulants, which increase arousal and brain activity, are the
  category of psychoactive substances most likely to lead to de-
  pendence. Unlike many other types of drugs, they act directly—
  rather then indirectly—on the dopamine reward system by
  binding to dopamine transporters in the synapse.


• Stimulants include cocaine and crack, amphetamines, metham-
  phetamine, Ritalin, MDMA, and nicotine. Crack use is associated
  with the most rapid progression to dependence. In high doses,
  most of these stimulants can cause paranoia and hallucinations.
  With continued use, stimulants lead to tolerance and withdrawal.


• Neurological factors that contribute to abuse of and depen-
  dence on stimulants include activation of the dopamine reward
  system, which involves the nucleus accumbens and the ventral
  tegmental area.


• Psychological factors related to substance use disorders in-
  clude learning: operant reinforcement of the effects of the drug,

classical conditioning of stimuli related to drug use (which

leads to cravings), and observational learning of expectancies

about both the effects of drugs and use of them to cope with

problems.

• Social factors related to substance use disorders include the
  specific nature of an individual’s relationships with family
  members, socioeconomic factors, and cultural and perceived
  norms about appropriate and inappropriate use of substances.

Making a Diagnosis

• Reread Case 9.4 about Mary Beth, and determine whether or not
  her symptoms meet the criteria for substance dependence on
  amphetamines. Specifi cally, list which criteria apply and which
  do not. If you would like more information to determine whether
  she has such a dependence, what information—specifi cally—
  would you want, and in what ways would the information infl u-
  ence your decision?