CHAPTER 2
The Nature of the Beast (Being an Examination of the Problem of SUDs)
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
• 2.1: Understand why individuals may use alcohol and/or drugs
• 2.2: Describe the cycle of drug misuse and the continuum on which individuals may fall
• 2.3: Understand the terminology used in the field and in this text
• 2.4: Consider the questions that remain unknown regarding SUDs
CHAPTER OUTLINE
Why Do People Choose to Use Drugs or Alcohol?
Drug Use/Misuse Cycles
The Continuum of Chemical Use
What Do We Mean When We Say That Somebody Is “Addicted” to a Chemical?
Definitions of Terms Used in This Text
Behavioral/Process “Addictions”
Unanswered Questions
CHAPTER OVERVIEW
The purpose of this chapter is to explore the concept of the substance use disorders. Many
students talk about drug misuse and addiction without an in-depth understanding of what they
are talking about. If, for example, a person remarks about another that “she is addicted to those
television programs,” she or he has probably misused the term “addicted,” although it is often
used this way by the general public. The fact that the substance use disorders fall along a
continuum will be discussed, along with a review of the terminology to be used in this text. A
secondary purpose of this chapter is to establish the fact that there are many unanswered
questions about substance use disorders, as well as non-drug “addictions,” that face clinicians
working in this field.
DISCUSSION QUESTIONS
Discussion #1:
What are the limits of the substance use disorders? One of the more frustrating and least
understood aspects of the substance use disorders (SUDs) is the nature of the disorder itself.
Consider the following example of a hypothetical person, “Joe.” If Joe were to use cocaine one
time out of curiosity, could he be said to have a cocaine use disorder? What if Joe were to
embark on a pattern of using cocaine one a week for a year, and then renounce further cocaine
use because he realized that it was “stupid” (in his words)? Could he be said to have a cocaine
use disorder?
Questions
1. What does it mean to misuse a substance?
2. What if the name of the individual in the example was Jane instead of Joe? Is the definition of
substance misuse the same for women as for men?
Discussion #2:
Social learning: We are immersed in a society in which behavioral norms are modeled for us in a
variety of ways, including through the mass media. The manner in which substance use
behaviors are portrayed by the media provides an unspoken message to the viewers about
Questions
1. Think about your own life. Where and how did you develop your views on substance use and
misuse? Do your substance use behaviors/beliefs differ from those of your family, favorite
media star, or peers?
2. Who were your main influences in developing these views? What expectations did family
members or peers provide for you?
3. Have you ever rationalized the use of alcohol (or illicit drugs) to yourself because a close
friend, family member, or favorite media star is reputed to use that same compound? Have you
4. If you have used alcohol, or an illicit drug, what were the reactions of friends or family
members who knew about this action on your part? Is a father who looks at his son after the
son’s first night drinking at a party with high school friends and says “well, we’re trying to grow
up in a hurry, are we not” encouraging future drug and alcohol use?
Discussion #3:
Conflicts of interest? Currently the American Psychiatric Association claims the right to diagnose
Diagnostic and Statistical Manual of Mental Disorders. This manual is developed by psychiatrists
Questions
1. What conflicts of interest exist for the psychiatrists or psychologists who create this manual?
2. Consider the following quote:
Most telling, if not chilling, 100% of the panel members involved in developing
diagnoses for the categories of mood disorders and schizophrenia and other psychotic
disorders had ties to drug companies. (Breggin, 2008, p. 378, italics added for emphasis)
What kinds of people/professionals do you think should be in charge of creating these
standards? Is it possible to have a panel without conflicts of interest? How?
Reference
Breggin, P. R. (2008). Brain-Disabling Treatments in Psychiatry (2nd ed.). New York: Springer
Publishing.
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard 1—CACREP
Why Do People Choose
to Use Drugs or
Alcohol?
2.1: Understand why
individuals may use
alcohol and/or drugs
3d: theories and etiology of addictions
and addictive behaviors
Drug Use/Misuse
Cycles
The Continuum of
Chemical Use
2.2: Describe the cycle
of drug misuse and the
continuum on which
individuals may fall
3d: theories and etiology of addictions
and addictive behaviors
What Do We Mean
When We Say That
Somebody Is “Addicted”
to a Chemical?
Definitions of Terms
Used in This Text
Behavioral/Process
“Addictions”
2.3: Understand the
terminology used in the
field and in this text
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
Unanswered Questions
2.4: Consider the
questions that remain
unknown regarding
SUDs
3d: theories and etiology of addictions
and addictive behaviors