Abnormal Psychology

(やまだぃちぅ) #1

386 CHAPTER 9


One particularly important common liability is a problem with impulsivity—
especially with diffi culty restraining urges to engage in potentially harmful behaviors.
Substance use disorders are not the only type of disorders that arise, in part, from
problems with impulsivity. A variety of DSM-IV-TR disorders are characterized by
impulsivity, including obsessive-compulsive disorder and the eating disorder, bulimia
nervosa. In fact, DSM-IV-TR includes a separate category of impulse-control disor-
ders that are not included in other categories. Such disorders involve compulsive or
impulsive behaviors such as stealing (kleptomania), lighting fi res (pyromania), and
gambling, among others. Common liabilities may account for the high comorbidity
between substance use disorders and these impulse-control disorders.

Gateway Hypothesis
Another theory that researchers have used to explain the progression from use to abuse
or dependence is the gateway hypothesis, and the related stage theory (Kandel, 2002;
Kandel & Logan, 1984). According to the gateway hypothesis, “entry” drugs such as
cigarettes and alcohol serve as a gateway to (or the fi rst stage in a progression to) use of
“harder” drugs, such as cocaine, or illegal use of prescription medication. Researchers
have found that some, though not all, adolescent users of entry drugs did go on to use
marijuana (White et al., 2007), and some of these marijuana users moved on to harder
drugs. Researchers have found that such adolescents usually fi rst use tobacco, beer, or
wine, and then progress to use marijuana and hard liquor (Kandel, 2002; Kandel &
Logan, 1984). Teens are unlikely to experiment
with marijuana unless they fi rst experimented
with legal—but restricted—substances such
as alcohol. Similarly, adolescents and young
adults don’t generally try other illegal sub-
stances without having used marijuana
(see Figure 9.2). The gateway hypothesis
illuminates cases like that of Butch Jamieson
(Case 9.1): He began with alcohol, moved on
to marijuana, and then to heroin.

9.2 • Stages of Drug Use


Figure 9.2g9

Nonuse Beer/wine

Marijuana

Stage 1 Stage 2 Stage 3 Stage 4

Marijuana Harder drugs

Marijuana

Cigarettes

Cigarettes
Hard liquor

Hard liquor

CASE 9.1 • FROM THE INSIDE: Progression from Alcohol to Heroin Dependence
My name is Butch Jamieson. This is my story. At this point in my life I have been clean 29 and a
half years; before this I drank and used drugs for 23 years of my life. My fi rst experience with
any type of drug was alcohol at the tender age of 5. I stole some wine my mother was saving for
some friends. I got extremely sick after drinking the whole bottle. From this point on I would
look for the chance to steal drinks that were left behind after my parents would have people
over for drinks. Everyone in my family drank, so I thought that this was normal behavior. My fa-
ther had problems with drinking and he died when I was 15 years old as a result of his drinking;
nine years later my mother died from the same thing. This did not tell me anything at all.
At age ten or 11, we moved to SE Washington DC where my drinking took off. At that time we
did not get into the other drugs, because the older guys would not give it to us. A short time
passed and this would soon change; the year was 1970, and pot was the big thing in town. We
soon started to smoke pot and drink, and then at 21 years of age I allowed a sixteen year old
boy to stick a needle in my arm and then my heroin addiction started.... Jails, Psych wards,
OD-ing a few times did not stop me.
Source: Faces and Voices of Recovery, 2007a.

This general pattern of progression has been found in various countries and
among different ethnic groups (Kandel & Yamaguchi, 1985). With any type of drug,
there is also a typical progression of stages of use: initiation, experimentation, casual
use, regular use, abuse, and dependence (Clayton, 1992; Werch & Anzalone, 1995).
However, experimenting with drugs does not necessarily mean that an individual
will march through this sequence to the end. Many people stop at one of the earlier
stages, and most people who use entry drugs do not go on to develop substance

Gateway hypothesis
The proposal that use can become abuse
when “entry” drugs serve as a gateway to
(or the fi rst stage in a progression to) use of
“harder” drugs.

Source: Kandel & Yamaguchi, 1999.

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