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Perspectives on Substance Use, Disorders, and Addiction

Perspectives on Substance Use, Disorders, and Addiction
With Clinical Cases

Second Edition

October 2015 | 256 pages | SAGE Publications, Inc
Perspectives on Substance Use, Disorders and Addiction, Second Edition, is a philosophical and clinical text that suggests new ways to think about the relationships, enjoyment, and troubles with substances of pleasure. The book is designed for students and clinicians who come in contact with and treat individuals and families struggling with the causes and consequences of substance use disorders and addiction. The second edition of Perspectives presents a refreshing blend of ancient and contemporary ideas on the natural pleasures and potential powers of alcohol and drugs in our everyday individual and collective lives.

Part I: A Perspective on the World of Substance Use Disorders and Addiction
Chapter I: Philosophical Core
Philosophical Core

Chapter II: Ancient Desires and Symposiums
Ancient Desires and Symposiums

Chapter Summary and Reflections

Chapter III: Globalization and Addiction
Key Words: Dikaiosunê, Psychosocial Integration, and Dislocation

Daily Impacts and Everyday Stories

Addiction Symptoms as Social Adaptation, Not Individual Pathology

Clinical Cases

Chapter Summary and Reflections

Chapter IV: Cultural Stories
Cultural Prohibitions, Approvals, Disapprovals, and Treatments

Avoidance of Communication on the Topic of AOD and Their Problems

Chapter Summary and Reflections

Chapter V: Contemporary Concepts
Contemporary Concepts

Chapter Summary and Reflections

Part II: A Perspective on Diagnosis and Substance Classification
Chapter VI: DSM-5 and Fifteen Clinical Sketches of Using, Misusing, and Addiction
Recent DSM History

From Over- and Under-Diagnosing to Exploring Clinical Sketches

Reading the Clinical Sketches

Clinical Sketches (DSM-5)

Chapter Summary and Reflections

Chapter VII: Ten Classes of Substances and Gambling
Basic Neuroscience

Research Chemicals, Legal Highs, and Web 2.0

Gambling and the DSM

Reference Charts

Chapter Summary and Reflections with Further Study

Part III: A Perspective on the Suffering Behind Substance Use Disorders and Addiction
Chapter VIII: Self-Medication, Psychoanalytic, and Psychodynamic Theories
Self-Medication Theorists

Chapter Summary and Reflections

Part IV: A Perspective on Treatment
Chapter IX: They Symposium Approach: Use, Prevention, Education, and Treatment
Four Guiding Principles of the Symposium Approach

Reading the Case Studies

Chapter Summary and Reflections

Chapter X: Non-Problematic Use (Healthy)
Clinical Cases

Chapter XI: Mild Substance Use Disorder
Clinical Cases

Chapter XII: Moderate Substance Use Disorder
Clinical Cases

Chapter XIII: Severe Substance Use Disorder
Clinical Cases

Chapter XIV: Addiction
Clinical Cases





About the Author


"The human condition is one that destines us to alternate between states of contentment, discomfort, distress, and, worst of all, unbearable suffering.  Alcohol and other drugs (AODs) can enhance, alter, and relieve such feeling states. Margaret Fetting in this wonderfully nuanced and sophisticated book explores and explains how and why this is so dating back to ancient times up to the present. Professor Fetting richly explores the historical, cultural, social, and clinical contexts, and related theories, of intoxicant use in pursuing her special perspective. Throughout the book she provides compelling case vignettes that richly illustrate the various situations in which we use AODs adaptively and maladaptively. She is passionate about her subject matter; her writing style is evocative, and she builds a compelling narrative for why the desire for AODs is enjoyable for most, problematic for some, and devastating for a few. After pondering, studying, and treating these problems now approaching five decades I find her approach and perspective very refreshing because it takes me beyond my own models and paradigms for understanding, at the same time it provides me with a more flexible basis to better appreciate the wide range of use that AODs take in all its variant normal and pathological forms."

E. J. Khantzian, MD.
Professor of Psychiatry, part time, Harvard Medical School

  "Margaret Fetting has produced an excellent and encompassing harm reduction perspective on drug use, abuse, and treatment for the globalized twenty-first century.”  

Bruce Alexander, Simon Fraser University

"Perspectives on Substance Use, Disorders, and Addiction, by Margaret Fetting is a special textbook for the beginning student and the experienced practitioner alike. It is intended as a thought-provoking overview of what is most cutting edge in thinking and clinical practice about substance use along the spectrum from non-problematic through addictive. This book is radical in acknowledging what we all know, that people have used substances for their positive effects from the beginning of time. It is ambitious in suggesting that we must consider many factors in any honest, disciplined attempt to understand how and why substance use becomes so devastating for individuals and society: globalization and other socio-cultural factors, individual cultural and family history, learning, personal meaning and self-medication of suffering.  Fetting introduces each of these areas clearly and succinctly. Her overarching philosophy for helping is harm reduction, an approach that is fully committed to seeing each individual who struggles with substance use issues as a unique human in unique circumstances who needs help that is collaboratively tailored to them. The ideas in this book are brought to life with powerful case vignettes and student contributions that bring the reader into real people’s lives. I have learned much that I am already using in my teaching and clinical work. I know you will too. Enjoy!"

Andrew Tatarsky, PhD., Author, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems

"Dr. Margaret Fetting's book is essential reading for students, clinicians, and those who suffer from alcohol and substance use disorders. Fetting traces the ancient roots of the human wish to become intoxicated, and, without judgment, puts that desire into a modern context. For the past 80 years, the U.S. has relied on a one-size-fits-all treatment for a complex set of problems, and Fetting presents flexible and innovative approaches for addiction and substance-use disorders at a time when Americans are desperate for alternatives -- for themselves, their loved ones, and their clients. This highly readable, engaging book is essential for clinicians, faculty and students of addiction and also those who struggle with substance- and alcohol-use disorders themselves."

Gabrielle Glaser
New York Times bestselling author of "Her Best-Kept Secret: Why Women Drink -- And How They Can Regain Control."

I adopted this text without reading it yet based on the table of contents- there are other addictions besides chemical and it looks like this text at least will present those addictions for discussion- Thank YOU Fetting!!! 2nd edition

Dr karen sue linstrum
Behavioral Sciences Dept, East Texas Baptist University
October 3, 2016
Key features


  • New DSM-5 spectrum revisions coupled with 15 unique clinical sketches, as well as the introduction of the new DSM-5 substance classification and an overview of the 10 classes of substances (including the non-substance-related disorder of gambling).
  • New exploration of ancient Greek philosophies emphasizing our natural desires to escape consciousness
  • New symposium approach, including its four guiding principles and a focus on prevention and education. Also included is the “unstoppable fourth drive”, harm reduction, self-medication and contemporary psychoanalytic concepts.
  • Inclusion of new dislocation theory of addition, emphasizing the disorienting impacts of globalization and its contribution to rising worldwide substance use disorder and addiction rates


  • Author’s background brings a unique combination of academic and practical experience.
  • An exploration and contemporary analysis of our ancient human desire to escape reality with the use of drugs and alcohol.
  • Discussion of the ancient natural desire to escape consciousness is coupled with the contemporary concept of the “unstoppable fourth drive”.
  • A look at the nine self-medication theories describing the psychological suffering behind substance use disorders and addiction.

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