410 CHAPTER 9
summarizes the neurological factors that contribute to the abuse of and dependence
on depressants.Psychological Factors
Many of the psychological factors that contribute to stimulant abuse and depen-
dence also contribute to depressant abuse and dependence (see the starred items in
Table 9.7); in particular:- observational learning of depressant use, which promotes expectations about
experiences from such use and promotes such use as a coping strategy; - operant conditioning, in which
ºpositive reinforcement leads to positive expectations of depressant use and to
reward craving;ºnegative reinforcement can lead to relief craving and to depressant use becom-
ing a chronic coping strategy; and- classical conditioning, whereby drug cues elicit cravings.
Let’s examine in a bit more detail the role of coping strategies and expectations in
alcohol use.
Some people use alcohol as a way to cope with their problems. Consider
Charles’s experience:Charles, a high-school teacher with a long-standing problem of alcohol dependence,
identifi ed boredom and anger as key high-risk relapse factors. His problem with anger
involved a pattern of avoiding interpersonal confl icts and letting his anger build up.
Over time, Charles would reach a point of total frustration and use his angry thoughts
and feelings to justify drinking binges. [He had perceived his anger to be a] “bad feel-
ing that could only be expressed through drinking”... he often became upset and
angry because of certain beliefs he held about how others “should” treat him.
(Daley & Salloum, 1999, p. 258)Like Charles, some people use alcohol to try to cope with particular emotions. In
Charles’s case, it was anger; for other people, the emotions might be sadness, anxi-
ety, fear, shame, or any of a range of other emotions (Gaher et al., 2006).
Not all people use alcohol (or other drugs) to cope with life’s ups and downs;
particular factors lead some people to have a higher risk of using alcohol to cope.
One such factor relates to the trait of anxiety sensitivity (see Chapter 7): People who
are high in this trait fi nd alcohol to be very calming, which explains why an anxiety
disorder frequently precedes an alcohol use disorder in people who have both kinds
of disorders (Sher et al., 1999; Stewart, Zvolensky, & Eifert, 2001).
Finally, even when they are not related to a coping strategy, expectations of what
will happen as a result of drinking can also affect behavior after drinking (Kirsch &
Lynn, 1999): People who drink to get “wasted” are in fact more likely to have that expe-
rience than are people who drink while having dinner with friends in a restaurant, even
when people in both situations end up with the same blood alcohol concentration.Social Factors
A variety of social factors can contribute to substance abuse and dependence (see the
starred items in Table 9.8). For depressants, including alcohol, such factors include:- dysfunctional family interactions (such as child abuse or neglect);
- peers’ use of depressants;
- norms or perceived norms about depressant use (as in a subculture where drink-
ing is the norm or is perceived to be so); and - economic hardship and unemployment.
The relationship between alcohol use norms and perceived norms has been
studied in depth. In the next sections we examine how alcohol abuse is affected by
changing cultural norms about alcohol and differing community norms.Cultural forces can infl uence substance use. In the
reality television show The Osbournes, tobacco
and alcohol use were verbally discouraged, but
such substances were often apparent to viewers:
packs of cigarettes or wine bottles on the table, a
martini shaker in the background. These different
types of communication sent mixed messages to
viewers (Blair et al., 2005).MTV/Courtesy: Everett Collection