Chapter 2

Why People Use

and Abuse Drugs
and Alcohol
A Better Understanding of
Models, Theories, and
Contributing Factors
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Learning Objectives

 Explain the relationship between the drive to

alter consciousness and alcohol/drug abuse
 Explain alcoholism as a disease
 Describe the key elements of the models and
theories of substance abuse disorders

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Drugs

 Have always been used to alter consciousness

 Open avenues to unconscious issues,
conflicts, and perception new to the user’s life
 Become traps that keep people from using
their minds in positive ways
 Drug use becomes unrealistic and neurotic
when it becomes an addiction

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Models and Contributing Factors
of Substance Use and Abuse

 No one theory or reason to explain the causes

of addiction and alcoholism
 Early models - Labeled alcoholics as inherently
weak or unable to control their consumption of
alcohol
 Other models - Argued that alcoholics used
alcohol in a pathological manner to block out
memories of unpleasant personal experiences

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Models and Contributing Factors
of Substance Use and Abuse (continued)

 Physiological model - Scientists searched for a

biochemical link to alcoholism
 Matrix of genetic, social, psychological, and
environmental factors can cause an individual
to develop problems with alcohol and drugs

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Tension-Reduction Theory (TRT)

 Early research focused on tension reduction

and relief from stress as a primary reason for
alcohol and drug use
 Considered as one aspect of drug use today
 Involves the concept of homeostasis
– Individuals use alcohol/drugs to balance out stress,
anxiety, emotional tension, and conflict

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Tension-Reduction Theory (TRT)
(continued)

 Major assumptions
– Alcohol reduces tension
– Individuals drink alcohol for its tension-reducing
properties
 Genetically predisposed individuals find that
alcohol or other drugs have effects that buffer
stress for them

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Etiological Model

 Focuses on discomfort and tolerance to stress

as a major factor in using alcohol/drugs
 Individuals have biological variations in their
levels of tolerance to stress and stimulation
 Alcohol is used to shut down the stimulation
overload from the environment

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Etiological Model (continued)

 Alcoholism - Biochemical defect

– Individuals are easily agitated by stimuli, become
uneasy, and use alcohol for its sedating effect
 Stress/tension causes reactive overreactions
and behaviors that contribute to relapse

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Trauma and Substance Use
Disorders (SUDs)

 Major hypotheses - Substance use and abuse:

– Is an attempt by the individual to assuage feelings
related to traumatic experiences
– Contribute to the development of post traumatic
stress disorder (PTSD)
 Lifestyle of substance abuse puts the individual
in situations that are traumatic
 Risk behaviors put the individual in situations
that have traumatic negative consequences
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Disease Model of Alcoholism
 Alcoholism - Declared a disease based on:
– Known etiology
– Symptoms get worse over time
– Known outcomes
 Genetic influence disease model - Assumes
multiple biological risk factors interact with
psychosocial factors
 12-step approach based on the disease model
– Assumes alcoholic/addict is predisposed to
addiction by genetically transmitted at-risk factors
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Table 2.1 - The Twelve Steps of
Alcoholics Anonymous

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Table 2.1 - The Twelve Steps of
Alcoholics Anonymous (continued)

SOURCE: The Twelve Steps are reprinted with permission of Alcoholics Anonymous World Services, Inc. (“AAWS”) Permission
to reprint the Twelve Steps does not mean that AAWS has reviewed or approved the contents of this publication, or that AAWS
necessarily agrees with the views expressed herein. A.A. is a program of recovery from alcoholism only. Use of the Twelve Steps
in connection with programs and activities which are patterned after A.A., but which address other problems, or in any other non-
A.A. context, does not imply otherwise.

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Genetic Model of Alcoholism

 Alcoholism - Group of illnesses in which the

influences of genes and the environment ebb
and flow over the course of the at-risk lifetime
 Adoption studies
– Adopted sons of alcoholic biological parents are four
times more likely to become alcoholics
– Sons of alcoholic biological parents are more likely
to be classified as alcoholics at an earlier age than
their peers
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Genetic Model of Alcoholism (continued)
– Daughters of alcoholic fathers exhibit a high
incidence of somatic anxiety and frequent physical
complaints
 Twin studies
– Higher rate of alcoholism in identical twins than in
fraternal twins

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Personality Traits and Personality
Disorders

 Addictive personality: Labels all alcoholics

and other addicts as possessing a particular
personality that:
– Leads to addictive and compulsive behavior
 Individuals have psychological vulnerability
– Psychological vulnerability - Personality traits that
make a pattern of substance dependence more
likely to develop

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Personality Traits and Personality
Disorders (continued)

 Three-dimensional model of personality

– Harm avoidant - Cautious, apprehensive, fatigable,
and inhibited
– Reward dependent - Ambitious, sympathetic, warm,
industrious, sentimental, persistent, and moody
– Novelty seeking - Impulsive, excitable, exploratory,
quick-tempered, fickle, and extravagant
 Narcissism and borderline personality disorder
have highest correlation with substance abuse
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Attachment and Substance Abuse

 Disruptions in attachment create problems in

connection
 Difficulty in interpersonal bonds disrupts self-
compassion and compassion for others
 Alcohol and drugs are used to compensate for
disconnection, dissatisfaction in relationships,
and to alleviate pain and suffering

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Self-Medication Motive

 Drug use - Purposeful attempt by the user to:

– Assuage painful affective states
– Manage psychological problems and disorders
 Explored to help users:
– Identify why they are taking drugs
– Learn how to better cope with the affective states
and psychological problems

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Mood and Affect Disorders

 Alcohol/drugs are used to alleviate and self-

medicate feelings of negative emotional states
 Primary affective disorders associated with
self-medicating with alcohol/drugs
– Major depression, dysthymic disorder, cyclothymic
disorder, atypical depression, bipolar disorder, and
seasonal affective disorder (SAD)
 Increased incidence of mania - Tenfold and
threefold in female and male alcoholics
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Factors Contributing to
Alcohol/Drug Use in the Family
 Imbalance in parenting  Significant trauma and
 Marital discord  stress in the family
 Alcoholic/addict behavior  Physical, emotional,
 Imbalanced and sexual, and
dysfunctional family psychological violation
interaction  Inappropriate boundaries
 Shame, abandonment,
and rejection

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Family Model

 Includes all aspects of family life

 States that alcohol and drug addiction and
dependence are family diseases
– Genetic predisposition to alcoholism
 Alcoholic parents’ parenting styles tend to be
rigid and insensitive to the needs of children
– Coercive or abusive in nature

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Factors in Adolescent Abuse of
Drugs

Pressure from peers

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Poor Self-Concept

 Generalized risk factor for problems with

alcohol/drugs
 Sense of self
– Less static, active, and involves more choices by
the individual
– Comes from within to the outside world
 Families that do not promote the child’s sense
of self cause them to be emotionally disabled

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Developing and Enhancing a Sense
of Self

Control destructive impulses

Understand values, needs, and desires

Make wise decisions

Resist peer pressure when it endangers welfare or inhibits growth

Find nonchemical means of fulfillment and satisfaction

Think intelligently and rationally

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Table 2.3 - Drugs and Their Effects

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Other Factors that Contribute to
Substance Abuse

 Boredom
– Existential boredom - Lack of purpose in life
– Interpersonal boredom - Being bored with small talk
versus having feelings of happiness with people
 Impulsivity/disinhibition
– Personality traits such as sensation seeking and
aggressiveness

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Social Learning Theory

 Alcohol use
– Socially acquired
– Learned behavior pattern
– Maintained by antecedent cues
– Consequent reinforcements
– Cognitive factors
– Modeling influences
– Interaction of behavioral and genetic mechanisms

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Social Learning and Cognitive
behavioral Patterns About Addiction

 Addictive behaviors
– Are learned maladaptive behaviors
– Occur on a continuum of use
– Determined by social, situational and environmental
factors, beliefs and expectations, family history and
prior learning experiences
– Exhibited under perceived stressful conditions
– Strongly affected by the individual’s expectations
– Can be changed by acquisition of new skills and
cognitive strategies
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Sociocultural Models

 Influence of a culture on rates of alcoholism

– Degree to which a culture causes acute needs for
adjustment of inner tension
– Attitudes toward drinking
– Extent to which the culture provides substitute
means of satisfaction

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Psychoanalytic Models

 Fixation at the oral stage of development

resulting in a narcissistic personality
 Strategy for allaying anxiety over masculine
inadequacy
 Abusers use alcohol/drugs to suppress latent
homosexuality and ego-dystonic feelings of
homosexuality

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Psychoanalytic Models (continued)

 Alcohol/drug use is caused by a structural

deficit in object relations
– Individuals have a hard time establishing effective
interpersonal relationships due to their difficulty in
managing their affect and impulse controls
 Drugs used to cope with overwhelming feelings
of rage and loneliness

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Alcohol/Drugs

 Frequently denote power or feeling powerful to

users
 Have a powerful meaning as weapons of self-
destruction and ultimately death
 Have important symbolic seduction and
sexuality meanings
– Exploited in advertisements for tobacco and alcohol
products

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Existential Issues

 Deal with the limitations of existence

– Limitations of life itself or how long we live, the
unknowns related to death and dying, the pain of
poor health, feelings of helplessness an loneliness
 Drugs - Way to escape existential issues and
to gain a temporary relief and change in focus

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Poor Future Orientation and Hope

 Individuals who see their future as negative

might abuse drugs
– Adolescents - Continued pattern of academic failure
or a difficult family situation
– Young adults - Frustration with career growth
– Middle-aged persons - Face limitations and do not
accomplish what they had intended
– Older adults - Existential despair about aging, future
health problems, or death itself

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Hopelessness

 Person gives up and stops trying to grow,

achieve, and develop due to:
– Poverty or financial disaster
– Frustration of blocked goals and aspirations
– Devastation of physical health
– Blocks in learning or achievement
– Continual shame and loss of pride from emotional,
physical, or sexual violation
– Continued exposure to a traumatic situation
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Table 2.4 - Optimism and
Pessimism

SOURCE: Learned Optimism by Martin Seligman, Pocket Press, 1991

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