The most fundamental components associated with substance-related disorders (SRD) are religious/ spiritual backgrounds. Such cultural foundations regulate job environments and the kinds of substances that can be used. Accordingly, somatic symptoms revealed by SRD patients might be biased since such patients are afraid of losing their jobs. Beside such ‘bottom-up’ influences, it is also plausible that substance use influences job environments and culture is affected by such job-related factors (‘top-down’ effect). Based on these simultaneous relationships, catastrophic accidents such as suicide or murder can sometimes happen.