Substance Abuse: Etiological Considerations


Historically speaking, I was intrigued by the suggestion that discovery of the New World opened up new vistas of experience alteration.  (Blaney & Millon, 2009, p. 254)  I was surprised that caffeine (specifically, coffee) was not addressed in more detail.  Overall, the historical precedent is clear… substance use and abuse has been prevalent for most of recorded human history.

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I would not have considered alcoholism to be under-diagnosed until reading this chapter.  I knew the efficacy of treatment was modest, but the distinct absence of evidence-based practices was rather disturbing.  I was under the impression that we were more knowledgeable regarding the etiological foundation of substance abuse.  Although it is difficult to refute, I am starting to equate words like multifactor, interactional, and interdependent as “we don’t really know.”

“Drug abuse begins with drug use, and one can neither try nor abuse that which is unavailable or unaffordable.”  (Blaney & Millon, 2009, p. 255)  Consumption is inexorably tied to availability.  Despite that admonition, societal control is easier said than done.

The statement “economic success stories (hence models for youths) are often individuals engaged in illegal activities, including the selling of drugs” is both true and unfortunate.  (Blaney & Millon, 2009, p. 256)  The media increasingly glamorizes the use, abuse, and sale of drugs.  While teaching in the public school system, I once made the statement “who’s a kid going to listen to, me (24k a year) or Notorious BIG (24k a day).”  “The current mass marketing of prescription, over-the-counter, and social libations all promote the theme that drugs solve problems and improve quality of life.”  (Blaney & Millon, 2009, p. 257)  I couldn’t have said it better myself.

I have issues with the gateway model whereby use and abuse of drugs is seen sequentially.  “Cigarettes, alcohol, marijuana, stimulants, depressants, hallucinogens, cocaine, and heroin are seen hierarchically.”  (Blaney & Millon, 2009, p. 258)  Without, peer groups play a major role in the introduction of substances into people’s lives… however; those same peers can have a reinforcing effect when it comes to the negative consequences of progression.  I think eventually everyone reaches a threshold of risk they are willing to assume when it comes to mind altering substances… everyone just has a different threshold or process of risk assessment.

Sexual abuse rears its ugly head, again.  “In any treatment population of alcoholic women, the rates of a history of sexual abuse range from 24% to 85%.”  (Blaney & Millon, 2009, p. 260)  By now it is self evident that if we could limit exposure to that single environmental factor we could have a tremendous impact on the mental health status of society as a whole.

The concept of assortative mating, or the tendency for alcoholics to marry alcoholics, is an interesting concept.  Perhaps we could conclude that “social drugs” like alcohol (and to a lesser extent, cigarettes) are going to continue to be serious social issues that continue to plague an increasingly distinct segment of the total population.

The biochemical level seems to be the most logical and most effective way to determine etiological foundations of substance abuse.  Dopamine, Serotonin, GABA, glutamate, opioid, cannaboid, and nicotine systems are all implicated in the development of recurrent substance abuse.  Differential dopamine release, for example, represents a “positive reinforcing situation” which may explain the increased risk of abuse.  (Blaney & Millon, 2009, p. 265)

“The decline in marijuana and cocaine use in the United States during the 1980s resulted from an increased perception of danger.”  (Blaney & Millon, 2009, p. 268)  There has to be a more effective way to combat drug use than with general educational drug prevention programs?

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Reference

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

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