CHAPTER 1
Why Worry About Substance Misuse or Substance Use Disorders?
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
• 1.1: Understand why substance misuse and SUDs are legitimate problems for society
• 1.2: Identify the scope of the problem of alcohol and drug misuse and SUDs
• 1.3: Understand the costs related to alcohol and drug misuse and SUDs
• 1.4: Describe those who encounter and treat individuals with SUDs
• 1.5: Comprehend the lack of education prevalent in those who encounter individuals
with SUDs
CHAPTER OUTLINE
Substance Use Disorders as Unsuspected Influences on Society
The Scope of the Problem of the Substance Use Disorders
Alcohol Use, Misuse, and Alcohol Use Disorder
Estimates of the Problem of Opiate Misuse and Opioid Use Disorder
Estimates of the Problem of Stimulant Misuse and Stimulant Use Disorder
Estimates of the Problem of Cocaine Misuse and Cocaine Use Disorder
Estimates of the Problem of Marijuana Use, Misuse, and Cannabis Use Disorder
Estimates of the Problem of Hallucinogen Misuse
Estimates of the Problem of Tobacco Use and Tobacco Use Disorder
The Cost of Chemical Misuse and SUDs
The Cost of Alcohol Use/Misuse/AUD
The Cost of Tobacco Use Disorders
The Cost of Substance Use Disorders
Who Treats Persons with an SUD?
Designer Drugs for Pleasure: A (Frightening) Brave New World
CHAPTER OVERVIEW
The purpose of this chapter is to introduce the subject of substance use disorders to the reader.
We will examine why it is indeed a problem in the United States at this time, and why, in this era
of budget reductions, the combined financial impact of substance use disorders is a significant
financial drain on the resources of this country. There is also a discussion concerning those who
diagnose and/or treat persons with SUDs.
,DISCUSSION QUESTIONS
Discussion #1:
Correlation and causality: One issue that is often a source of confusion for those of us who are
not statisticians is correlation and causality. Many of the research studies cited in this text will
utilize correlational data. To understand the conclusions of these research studies, you need to
keep in mind that correlation implies that two or more factors are commonly found together.
Causality implies that one factor causes the other. As statistics instructors repeatedly stress,
correlation does not imply causality! Correlation simply states that there is a statistical
relationship between the two factors being measured. However, if you interpret correlation as
implying causality, you are going to make some rather interesting logical errors.
For example: every person with an alcohol use disorder (AUD) consumed water before the onset
of their AUD. Thus the correlation between water consumption and the alcohol use disorders is
a perfect 1:1. Does this mean that water consumption induces alcohol abuse? While this
question appears silly at first glance, it also illustrates the admonition that correlation does not
imply causality! To take this absurd example a step further, you have to be alive before you
either drink water or engage in alcohol consumption. The relationship between being alive and
having an alcohol use disorder is also a perfect 1:1 correlation. Does that mean that being alive
causes the person to have an AUD? This is hardly the case since the majority of those persons
who are alive do not have alcohol use disorders.
Questions
1. What other “junk science” correlations can you identify? Think about your day-to-day life, and
also about advertisements and the media.
2. Compare your list with a classmate’s. Do you think most people believe that these
correlations are actually causations? Why or why not?
Discussion #2:
,Which is the greater issue? The problem of teen pregnancy has been discussed in the mass
media. In some cases, it would not be unreasonable to say that teens who choose to keep their
infants create a situation in which a baby is being raised by a child. The direct costs to society
are estimated to be about $9 billion/year. However, there are indirect costs as well, including
the loss of educational opportunities for the mother, who must care for her infant rather than
pursue higher education, resulting in underemployment if she should finally enter the
workforce.
Questions
1. What are different ways in which the issues of substance misuse and teen pregnancy might be
related? Do you think that substance use or misuse plays a role in many teen pregnancies?
How?
2. Do you think that reducing substance misuse would reduce teen pregnancy? Why or why not?
3. What are other indirect costs of teen pregnancy?
LO/STANDARDS CORRELATION CHART
A-head LO Standard 1—CACREP
Substance Use Disorders 1.1: Understand why 3d: theories and etiology of addictions
as Unsuspected Influences substance misuse and and addictive behaviors
on Society SUDs are legitimate
problems for society
The Scope of the Problem 1.2: Identify the scope 3d: theories and etiology of addictions
of the Substance Use of the problem of and addictive behaviors
Disorders alcohol and drug 3e: biological, neurological, and
misuse and SUDs physiological factors that affect human
Designer Drugs for development, functioning, and behavior
Pleasure: A 3f: systemic and environmental factors
(Frightening) that affect human development,
Brave New World functioning, and behavior
The Cost of Chemical 1.3: Understand the 3f: systemic and environmental factors
Misuse and SUDs costs related to that affect human development,
alcohol and drug functioning, and behavior
, misuse and SUDs
Who Treats Persons with 1.4: Describe those 1b: the multiple professional roles and
an SUD? who encounter and functions of counselors across specialty
treat individuals with areas, and their relationship with human
SUDs services and integrated behavioral
health care systems
1.5: Comprehend the 1e: advocacy processes needed to
lack of education address institutional and social barriers
prevalent in those that impede access, equity, and success
who encounter for clients
individuals with SUDs
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
Why Worry About Substance Misuse or Substance Use Disorders?
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
• 1.1: Understand why substance misuse and SUDs are legitimate problems for society
• 1.2: Identify the scope of the problem of alcohol and drug misuse and SUDs
• 1.3: Understand the costs related to alcohol and drug misuse and SUDs
• 1.4: Describe those who encounter and treat individuals with SUDs
• 1.5: Comprehend the lack of education prevalent in those who encounter individuals
with SUDs
CHAPTER OUTLINE
Substance Use Disorders as Unsuspected Influences on Society
The Scope of the Problem of the Substance Use Disorders
Alcohol Use, Misuse, and Alcohol Use Disorder
Estimates of the Problem of Opiate Misuse and Opioid Use Disorder
Estimates of the Problem of Stimulant Misuse and Stimulant Use Disorder
Estimates of the Problem of Cocaine Misuse and Cocaine Use Disorder
Estimates of the Problem of Marijuana Use, Misuse, and Cannabis Use Disorder
Estimates of the Problem of Hallucinogen Misuse
Estimates of the Problem of Tobacco Use and Tobacco Use Disorder
The Cost of Chemical Misuse and SUDs
The Cost of Alcohol Use/Misuse/AUD
The Cost of Tobacco Use Disorders
The Cost of Substance Use Disorders
Who Treats Persons with an SUD?
Designer Drugs for Pleasure: A (Frightening) Brave New World
CHAPTER OVERVIEW
The purpose of this chapter is to introduce the subject of substance use disorders to the reader.
We will examine why it is indeed a problem in the United States at this time, and why, in this era
of budget reductions, the combined financial impact of substance use disorders is a significant
financial drain on the resources of this country. There is also a discussion concerning those who
diagnose and/or treat persons with SUDs.
,DISCUSSION QUESTIONS
Discussion #1:
Correlation and causality: One issue that is often a source of confusion for those of us who are
not statisticians is correlation and causality. Many of the research studies cited in this text will
utilize correlational data. To understand the conclusions of these research studies, you need to
keep in mind that correlation implies that two or more factors are commonly found together.
Causality implies that one factor causes the other. As statistics instructors repeatedly stress,
correlation does not imply causality! Correlation simply states that there is a statistical
relationship between the two factors being measured. However, if you interpret correlation as
implying causality, you are going to make some rather interesting logical errors.
For example: every person with an alcohol use disorder (AUD) consumed water before the onset
of their AUD. Thus the correlation between water consumption and the alcohol use disorders is
a perfect 1:1. Does this mean that water consumption induces alcohol abuse? While this
question appears silly at first glance, it also illustrates the admonition that correlation does not
imply causality! To take this absurd example a step further, you have to be alive before you
either drink water or engage in alcohol consumption. The relationship between being alive and
having an alcohol use disorder is also a perfect 1:1 correlation. Does that mean that being alive
causes the person to have an AUD? This is hardly the case since the majority of those persons
who are alive do not have alcohol use disorders.
Questions
1. What other “junk science” correlations can you identify? Think about your day-to-day life, and
also about advertisements and the media.
2. Compare your list with a classmate’s. Do you think most people believe that these
correlations are actually causations? Why or why not?
Discussion #2:
,Which is the greater issue? The problem of teen pregnancy has been discussed in the mass
media. In some cases, it would not be unreasonable to say that teens who choose to keep their
infants create a situation in which a baby is being raised by a child. The direct costs to society
are estimated to be about $9 billion/year. However, there are indirect costs as well, including
the loss of educational opportunities for the mother, who must care for her infant rather than
pursue higher education, resulting in underemployment if she should finally enter the
workforce.
Questions
1. What are different ways in which the issues of substance misuse and teen pregnancy might be
related? Do you think that substance use or misuse plays a role in many teen pregnancies?
How?
2. Do you think that reducing substance misuse would reduce teen pregnancy? Why or why not?
3. What are other indirect costs of teen pregnancy?
LO/STANDARDS CORRELATION CHART
A-head LO Standard 1—CACREP
Substance Use Disorders 1.1: Understand why 3d: theories and etiology of addictions
as Unsuspected Influences substance misuse and and addictive behaviors
on Society SUDs are legitimate
problems for society
The Scope of the Problem 1.2: Identify the scope 3d: theories and etiology of addictions
of the Substance Use of the problem of and addictive behaviors
Disorders alcohol and drug 3e: biological, neurological, and
misuse and SUDs physiological factors that affect human
Designer Drugs for development, functioning, and behavior
Pleasure: A 3f: systemic and environmental factors
(Frightening) that affect human development,
Brave New World functioning, and behavior
The Cost of Chemical 1.3: Understand the 3f: systemic and environmental factors
Misuse and SUDs costs related to that affect human development,
alcohol and drug functioning, and behavior
, misuse and SUDs
Who Treats Persons with 1.4: Describe those 1b: the multiple professional roles and
an SUD? who encounter and functions of counselors across specialty
treat individuals with areas, and their relationship with human
SUDs services and integrated behavioral
health care systems
1.5: Comprehend the 1e: advocacy processes needed to
lack of education address institutional and social barriers
prevalent in those that impede access, equity, and success
who encounter for clients
individuals with SUDs
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
