Abnormal Psychology

Substance Use Disorders 411

Changing Cultural Norms and Alcohol Abuse

Culture affects both the degree of alcohol abuse and the ways in which alcohol is used.

For example, the rate of alcohol dependence among American women has increased

over time. Historically, women in the United States had much lower rates of alcohol-

ism than did men, but as social mores and roles for women changed, the incidence of

alcoholism among women has come to approach that of men (Greenfi eld, 2002).

Moreover, cultures create social norms for appropriate and inappropriate use of

alcohol, such as allowing “fi esta” drunkenness on certain occasions (Finch, 2001;

Room & Makela, 2000). The media provide another source of infl uence. One cor-

relational study found that adolescents and young adults who saw more ads for

alcohol drank more alcohol (Snyder et al., 2006), possibly because seeing more ads

for alcohol led them to perceive the norm for alcohol use to be greater than it was.

Community Norms, Diversity, and Drinking

Some of the social factors that affect alcohol abuse may seem surprising at fi rst

glance. For example, in one study, researchers examined rates of alcohol use in the

highest-risk college-aged group (white men) and found that white men who attended

colleges that have more diverse students—minority, women, and older students—

were less likely to binge drink, even if they had been binge drinkers in high school

(Wechsler & Kuo, 2003). Moreover, white men who did not binge drink in high

school and went to colleges with more diverse students bodies were less likely to

start binge drinking than were their counterparts who attended colleges with less di-

verse student bodies. One possible explanation for this fi nding is that a more diverse

student body–with a wider range of views about binge drinking—prevented a social

norm of high levels of binge drinking from developing. The only ethnic group more

likely to binge drink and have an alcohol disorder than white Americans is Native

Americans. In contrast, Asian Americans and black Americans aged 20 and under

are the least likely to binge drink (SAMHSA, 2008).

Most of the factors that contribute to depressant and stimulant abuse and de-

pendence—and the mechanisms related to those factors—also contribute to abuse

of, and dependence on, other types of substances. For this reason, we explain the

feedback loops among the factors only after we discuss all types of substance abuse

and dependence.

Key Concepts and Facts About Depressants

• Depressants decrease arousal, awareness, and nervous system
  activity level. Depressants include alcohol, barbiturates, and
  benzodiazepines.


• Continued use of depressants leads to tolerance and with-
  drawal. Some withdrawal symptoms are potentially lethal;
  people with a dependence on depressants should be medically
  supervised as they taper off their use of the drug. Using more
  than one depressant at the same time is also potentially lethal.


• The effects of alcohol depend on its concentration in the blood. Re-
  peated binge drinking can lead to alcohol abuse or dependence.
  Long-term alcohol dependence is associated with a variety of cog-
  nitive problems, as well as atrophy of certain brain areas and en-
  larged ventricles. Withdrawal symptoms include delirium tremens.


• Depressants directly affect the GABAnergic system, which in
  turn dampens activity in key brain areas that give rise to anxi-
  ety; for this reason, people with anxiety symptoms are more
  likely than others to abuse depressants. Depressants also indi-
  rectly activate the dopamine reward system.
  
  
  • Psychological factors related to depressant abuse and depen-
    dence include observational learning to expect specifi c effects
    from depressant use and to use depressants as a coping strategy,
    positive and negative reinforcement of the effects of the drug,
    and classical conditioning of drug cues that leads to cravings.
  
  
  • Social factors related to abuse of and dependence on de-
    pressants include the nature of an individual’s relationships
    with family members, peers’ use of depressants, norms and
    perceived norms about appropriate and inappropriate use of
    depressants, and socioeconomic factors.
  
  
  
  

Making a Diagnosis

• Reread Case 9.5 about Caroline Knapp, and determine whether
  or not her symptoms meet the criteria for alcohol dependence.
  Specifi cally, list which criteria apply and which do not. If you
  would like more information to determine whether she has
  alcohol dependence, what information—specifi cally—would
  you want, and in what ways would the information infl uence
  your decision?

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