Historical and Social Context of Psychoactive Substance Use Disorders

JOSEPH WESTERMEYER

Historical and social factors are key to the understanding of addictive disorders. These factors affect the rates of addictive disorders in the community, the types of substances abused, the characteristics of abusive users, the course of these disorders, and the efficacy of treatment. Knowledge of these background features helps in understanding the genesis of these disorders, their treatment outcome, and preventive approaches.

Psychoactive substances subserve several human functions that can enhance both individual and social existence. On the individual level, desirable ends include the following: relief of adverse mental and emotional states (e.g., anticipatory anxiety before battle and social phobia at a party), relief of physical symptoms (e.g., pain and diarrhea), stimulation to function despite fatigue or boredom, and "time-out" from day-to-day existence through altered states of consciousness. Socially, alcohol and drugs are used in numerous rituals and ceremonies, from alcohol in Jewish Passover rites and the Roman Catholic Mass, to peyote in the Native American Church and the serving of opium at certain Hindu marriages. To a certain extent, the history of human civilization parallels the development of psychoactive substances (Westermeyer, 1999).

Paradoxically, these substances that bless and benefit our existence can also torment and decivilize us. Individuals, societies, and cultures began learning this disturbing truth millennia ago. We continue to rediscover this harsh reality today and will do so in the future, as though each new generation must learn afresh for itself. As our societies become more complex, so too do our psychoactive substances, our means of consuming them, and the problems associated with them. Preventive and treatment efforts, also age-old and wrought at great cost, are our forebears' gifts to us for dealing with psychoactive substance use gone astray (Anawalt & Berdan, 1992).

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