Magnitude of the problem: Painting the mosaic of substance abuse in a multiethnic society

J. Paul Seale, Myra Muramoto

Research output: Chapter in Book/Report/Conference proceedingChapter


Editor’s introduction The first component of the patient-centered model demonstrated and described for the first time by Levenstein in the 1980s (1984), involves exploring both the disease and the patient’s illness experience. The first step in this process is to understand the specific disease in question. Brown et al. (1995) describe ‘disease’ as medical science’s abstract description of what is wrong with the body as a machine. There are few diseases where genetic and sociocultural factors result in such a wide variation in disease presentation as in the disease of substance abuse. For example, the differences in presentation between an adolescent Native American male who presents with neutropenia from repeated experimentation with inhalants and an 80-year-old Caucasian socialite who suffers a fractured hip due to dizziness caused by her chronic benzodiazepine abuse is so marked as to appear to be two entirely different diseases. Upon closer examination, nonetheless, we find that both patients demonstrate the pattern of continuing use ofpsychoactive substances despite adverse consequences, which is the hallmark of this disease. In Chapter 1, we will focus primarily on the epidemiologic patterns of disease presentation of substance abuse as it spans the gamut of age, gender and ethnic background. Later, in Chapter 2, we will give greater attention to the illness experience of those affected by this disease, which represents the ‘other half of the first component of patient-centered medicine.

Original languageEnglish (US)
Title of host publicationSubstance Abuse
Subtitle of host publicationA Patient-Centered Approach
PublisherTaylor and Francis
Number of pages22
ISBN (Electronic)9781498793810
ISBN (Print)9781857759129
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • General Medicine
  • General Psychology


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