Other Theories

Weiss (1992b) suggests three additional mechanisms by which psychopatholo-gy can make an individual more vulnerable to SUDs.

1. Psychopathology may interfere with an individual's judgment or ability to appreciate consequences. Individuals with psychiatric disorders may be more vulnerable to SUDs, because impaired judgment is often present in many psychiatric syndromes and can interfere with the ability or willingness to understand or change one's behavior. For example, severely depressed patients may have insight regarding the destructive effect of their drinking but may continue to drink due to the pessimism about the possibility and value of change that is part of their depressive disorder. Similarly, the recklessness, irritability, and grandiosity of patients who are manic or hypomanic may interfere with their capacity to appreciate the harmful nature of their substance use.

2. Psychopathology may accelerate the process of substance dependence by leading to more dysphoria during either chronic use or early abstinence. It is possible that patients with underlying psychopathology may experience more dysphoria from chronic substance use or more severe withdrawal symptoms when discontinuing drugs or alcohol. Although this potential mechanism has received little study, there is some evidence that cocaine abusers with major depression compared to cocaine abusers without depression may report more severe mood symptoms during abstinence (Gawin & Kleber, 1986).

3. Psychopathology may reinforce the social context of drug use. Some patients with severe psychiatric illness may be drawn to a drug-using subculture, because they feel it facilitates socialization or a new peer group. For example, some patients with schizophrenia have described using substances to socialize or be accepted by peers, even though substances increased the risk of psychosis (Drake, Osher, & Wallach, 1989; Spencer, Castle, & Michie, 2002).

Thus, multiple possible motivations and causes contribute to the initiation and maintenance of problematic alcohol and drug use in patients with psychiatric disorders.

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