Develop an understanding of the major features and epidem epidemiolo iology gy of the substa substance nce-re -relat lated ed disorders. Understand Understand the major risk factors factors associated associated ith substancesubstance-relat related ed disorders! disorders! including including genetics and other biological factors as ell as cognitive and learning e"periences. Revie Revie method methodss of preven preventin tingg substa substance nce-related disorders. Recogn Recogni#e i#e differ different ent assess assessmen mentt method methodss pertinent to substance-related disorders. Understand major biological and psychological approa approache chess to treati treating ng substa substance nce-re -relat lated ed disorders as ell as long-term outcomes.
(his section covers substance use along a continuum! beginning ith typical behaviors such as drinking a glass of ine and progressing to more intense and fre*uent substance substance use. &hen daily functions functions are impaired! impaired! a person may have a substance abuse problem! hich is a substance-related disorder. Substance dependence is a particularly severe substance-related disorder.
' substance use disorder involves repeated repeated use of substances to the point that recurring problems are evident. mpaired control means the person has difficulty cutting don on his or her substance use! ingests more and more of the drug over time! spends a great amount of time looking for the drug or recovering recovering from its use! and
has intense cravings cravings for the drug. Social impairment impairment means the person is e"periencing key problems in his or her life because of substance use. eople ith substance use disorders often e"hibit tolerance and/or ithdraal. (olerance refers to the need to ingest greater and greater *uanti *uantitie tiess of a drug drug to achiev achievee the same effect effect.. +or e"ample! someone ho regularly drinks three beers a day ill find over time that the same physiological 0high1 no longer longer occurs occurs hen hen this this amount amount is consum consumed. ed. (hat (hat person must drink more beer or sitch to another! more poerful poerful drug to achieve achieve the same effect. &ithdraal &ithdraal refers to maladaptive behavioral changes hen a person stops using a drug.
Substance Substance into"ication into"ication refers refers to a reversible reversible condition brought on by e"cessive use of a drug! such as alcohol. nto"ication is not abnormal ithout maladaptive behavioral changes.
Substance Substance ithdraal ithdraal refers refers to maladaptive maladaptive behavioral changes hen a person stops using a drug. Substance ithdraal may be an aspect of substance dependence and a substance-related disorder in its on right. right. ' ell-k ell-kno nonn featur featuree of alcoho alcoholl ithdr ithdraa aall is delir deliriu ium m trem tremen enss 2D(s 2D(s3! 3! hic hichh invol involve vess seve severe re confusion confusion and autonomic autonomic overactivity overactivity in the form of seating! heart palpitations! and trembling. Drugseeking seeking behavior behavior sometimes sometimes relates relates to psychologi psychological cal dependence on a drug! meaning a person believes he or she needs the drug to function effectively. olysubstance refers to dependence on more than one drug.
Depressant or sedative drugs inhibit aspects of the central central nervous nervous system. system. 4ommon 4ommon depressants depressants include include alcohol! alcohol! anesthetic anestheticss for surgery! surgery! antisei#ure antisei#ure medications for epilepsy! barbiturate drugs people use to calm themselves! and hypnotic drugs people use to go to slee sleep. p. 'lco 'lcohol hol is the the most most ellell-kn kno onn and and used used depressant drug. 'lcohol inhibits a key inhibitory brain
system system 2disinhibition 2disinhibition3. 3. 'lcohol 'lcohol effects effects closely closely relate relate to blood alcohol level! or the concentration of alcohol in the blood. ' lethal dose 2LD3 is the amount of a substance that ill kill a certain percentage of test animals. (his section describes the common effects of alcohol. 5i"ing different drugs causes a synergistic or multiplicative! not additive! effect. 6inge drinking involves ingesting large amounts of alcohol in a short period and relates to many college student deaths and problems. ,"tensive alcohol use is also associated ith increased risk for suicide! homicide! unprotected se"ual activity! se"ual assault! and traffic and other accidents. eople ho chronically and e"cessively use alcohol also commonly commonly e"perience e"perience cirrhosis cirrhosis of the liver! hen scar tissue replaces liver tissue! leading to a loss of function and possib possibly ly death. death. 7orsak 7orsakoff off8s 8s syndro syndrome! me!inv involv olves es confusion! confusion! memory memory loss! and coordinatio coordinationn difficulties difficulties because of a thiamine deficiency resulting from e"tended alcohol alcohol use. +etal alcohol syndrome! syndrome! a condition condition in chil childr dren en hos hosee moth mother erss inge ingest sted ed alcoh alcohol ol duri during ng pregnancy! pregnancy! produces physical physical and cognitive cognitive problems. problems. 'lcohol use by pregnant mothers! particularly binge drinking! can produce more general fetal alcohol effects as ell.
Stimulant drugs activate or stimulate the central nervous system. 4affeine is a legal drug found in soda! coffee coffee!! tea! tea! and chocol chocolate ate.. eople eople genera generally lly ingest ingest nicoti nicotine ne via cigare cigarette ttess and other other tobacc tobaccoo produc products. ts. 4ocaine 4ocaine is a poerful poerful stimulant stimulant usually usually ingested ingested by sniffing or snorting crystals or smoking cocaine in the form form of crac crack. k. 4oca 4ocain inee stim stimula ulate tess dopa dopami mine ne!! norepin norepineph ephrin rine! e! and seroto serotonin nin system systemss to produc producee euphor euphoria! ia! high high energy energy simila similarr to mania! mania! and bi#arr bi#arre! e! par paranoi anoid! d! and and occa occasi sion onal ally ly viol violen entt beha behavi vior or.. 'mphetamines are also poerful stimulants that primarily increase increase dopamine dopamine and norepinephr norepinephrine. ine. 'ppro"ima 'ppro"imately tely 9:; 9:; of all all amph amphet etam amin inee abus abusee toda todayy is from from methamphetamines! or crank.
Opiates 2sometimes called narcotics or opioids3 are drugs! such as morphine or codeine! commonly used to relieve pain or coughs. 5orphine and codeine can be abused substances! but a related opiate! heroin! is abused more. 5odern-day painkillers are also related to morphine and can be highly addictive. O"y4ontin! Darvon! !?methylenedio"y-$ methylamphetamine3! acts as a stimulant and a hallucinogen.
5arijuana comes from 4annabis sativa! or the hemp plant! hich contains an active ingredient knon as (=4 2delta-9-tetrahydrocannabinol3. 5arijuana stimulates cannabinoid receptors throughout the brain! especially the corte"! hippocampus! basal ganglia! and hypothalamus. (he drug creates a dream-like state and feelings of joy! ell-being! and good humor. 5arijuana may not be physically addictive for everyone because tolerance is not alays present! but heavy users may become physically and psychologically dependent. 'ccording to the Office of $ational Drug 4ontrol olicy! ?9.@; of college students have tried marijuana and >>.>; have done so in the past year.
Designer drugs or club drugs represent manmade modifications of psychoactive drugs such as amphetamines and heroin. hencyclidine 243 induces strong perceptual distortions and often highly violent and dangerous behavior. 4lub drugs may also include date rape drugs. nhalants! or volatile li*uids in a stored container that contain strong fumes! are inhaled to produce feelings of euphoria and lightheadedness.
(he lifetime prevalence of any substancerelated disorder is @?.; and! for the past @B months! >.C;. (his is particularly true for alcohol abuse and dependence. 'ccording to the Department of =ealth and =uman Services! substance use disorders are more common among males
[email protected];3 than females 2.B;3 and among people aged @C to BA years
[email protected];3. Substance use disorders are higher among 'merican ndians/'laska $atives 2B:.B;3 compared ith multiracial individuals
[email protected] ;3! =ispanics 29.C;3! ,uropean 'mericans 29.;3! 'frican 'mericans 2C.>;3! and 'sian 'mericans 2?.E;3. Some 2BB.E;3 people ith a substance-related disorder sought treatment in the past year! especially for alcohol and drug dependence. Substance-related disorders are often comorbid ith an"iety-related! depression! and personality disorders.
Steroids are synthetic substances to enhance muscle groth and secondary se"ual characteristics and are sometimes abused by adolescents and athletes to gain a competitive edge.
'ppro"imately A:.>; of 'mericans aged @B years or older currently use alcohol and BB.C; have engaged in binge drinking in the past >: days. Recent alcohol use is more common among men 2A9.C;3 than omen 2?A;3 and among ,uropean 'mericans 2A.B;3 than =ispanics 2?>.B;3! 'frican 'mericans 2>C.9;3! 'merican ndians/'laska $atives 2>C.@;3! and 'sian 'mericans 2>?.@;3. n addition! @>.A; of 'mericans have recently driven a motor vehicle under the influence of alcohol. Of 'mericans aged @B years and older! B9.B; use some tobacco product 2CA.B; of this is cigarette use3. (his rate rises for adults aged @C to BA years 2>9.A;3 and males 2BE.E;3! compared ith females 2BB.>;3. Recent illicit drug use is particularly common among 'merican ndians/'laska $atives 2@@.B3 compared ith 'frican 'mericans 2.9; percent3! ,uropean 'mericans 2.C;3! =ispanics 2A.9;3! and 'sian/ndian 'mericans 2B.B;3. 5arijuana is the most commonly used illegal drug! but nonmedical use of therapeutic medications is also fre*uent. Drugs tried for the first time commonly include prescription medications and marijuana.
eople ith substance-related disorders often face social discrimination ith respect to employment and housing as ell as interpersonal rejection. One survey of people ith substance-related disorders revealed that many felt stigmati#ed 2Luoma et al.! B::E3. 5any in the sample believed that! once others kne of the person8s substance problem! they treated them unfairly 2:;3 or ere afraid of them 2?;3. 5any people in the sample also believed that some family members had given up on them 2?A;3! some friends had rejected them 2>C;3! and employers paid them a loer age 2@?;3. articipants in the survey reported that hearing others say unfavorable or offensive things about people in treatment for substance use as a common e"perience.
Fenetics influence substance-related disorders! especially alcoholism. =eritability estimates for alcoholism are :.AB to :.AE. ,arly family studies revealed that people hose family members overused alcohol ere three to four times more likely to overuse alcohol themselves compared ith people ithout such a family history. Fenetic influences may be stronger for males than females and for severe compared ith less severe cases of alcoholism. 'lcoholism is likely predisposed by many genes orking together. Fenetic models for alcoholism are modest! but variables related to alcoholism may have a stronger genetic effect. Fenetics may affect ho a person metaboli#es alcoholG some people process alcohol faster than others and may be less susceptible to alcoholism. Fenetics may also affect a person8s sensitivity to alcohol. Fenetics influence lo-level responses to alcohol! hich can predict alcoholism in offspring of people ith alcoholism. =eritability also plays a factor ith other substances and is strongest for dependence on cocaine and opiates 2such as heroin3 or prescription painkillers 2such as O"y4ontin3.
5any brain features are linked to substancerelated disorders. 6rain changes in substance-related disorders coincide ith several inducements toard compulsive drug use% priming! drug cues! cravings! and stress. riming refers to a situation in hich a single drug dose! such as a drink of alcohol or one snorted line of cocaine! leads to an uncontrollable binge. Drug cues refer to stimuli associated ith drug use! such as friends! favorite hangouts! and other things that stimulate further drug use. 4ravings refer to an obsessive drive for drug use. 6rain features related to each of these areas are primarily part of the mesolimbic system! a major dopamine pathay and one strongly implicated in sensations of pleasure! reard! and desire. (he mesolimbic system generally begins in the ventral tegmental area and ends in the nucleus accumbens. eople ho e"cessively use alcohol or nicotine for long periods also have a reduced brain si#e. 4hanges in brain function also occur in children ith fetal alcohol syndrome hose mothers ingested alcohol during pregnancy.
Damage to the corpus callosum! basal ganglia! and cerebellum can contribute to substantial cognitive and learning problems seen in this population.
state of sadness from dopamine depletion that triggers cravings for increased dopamine. 4hronic stress may also eaken a person8s ability to cope effectively ith difficult situations by creating damage to the prefrontal corte".
(he mesolimbic dopamine pathay appears to be the main neural base for the reinforcing effects of many drugs! especially alcohol! stimulants! opiates! and marijuana. (hese drugs increase dopamine release in the nucleus accumbens by stimulating speciali#ed dopamine 2DB3 receptors or blocking reuptake of dopamine. Some people ith substance-related disorders have feer DB receptors! meaning they may not be able to obtain much reard from everyday life events and thus resort to e"cesses such as drug use to obtain sufficient reards 2reard-deficiency syndrome3. Other neurotransmitters influence substance-related disorders as ell! but even these neural pathays affect dopamine release in the mesolimbic system. Flutamate! gamma aminobutyric acid 2F'6'3! acetylcholine! serotonin! and norepinephrine have e"citatory or inhibitory connections to the mesolimbic dopamine system. Dopamine release acts as a poerful reard 2euphoria3! thus providing an incentive to increase and maintain drug use. Dopamine release also promotes reard-related learning! so a person often seeks reards such as drugs.
4ognitive distortions refer to erroneous beliefs about oneself and the surrounding orld that can lead to maladjustment. One common misperception among people ith substance-related disorders is increased positive e"pectancies about the effects of various substances and minimi#ation of negative effects. Some people believe that using certain substances ill lead to grand e"periences or life changes! such as enhanced personal or social functioning. 'nother misperception among many people ith substance-related disorders! especially college students! is that other people use the same amounts of alcohol and drugs as they do. eople ith alcoholism also selectively attend to cues that indicate alcohol is nearby! such as seeing a favorite drinking buddy. 4ognitions affect substance use! but severe substance use may itself create cognitive changes by altering the prefrontal corte". 'lcohol and other drugs can create massive changes in the brain that affect attention! perception! judgment! memory! problem-solving! decision-making! and other higher cognitive processes.
Stress is an important trigger for many mental disordersH this is especially true for substance-related disorders. ,"cessive substance use is closely associated ith early physical and se"ual maltreatment! poor parental and social support! and chronic distress. ' stress-induced relapse involves an activation of certain brain substances related to stress! such as the corticotropin-releasing hormone and cortisol! that help us cope but also increase dopamine activity in the mesolimbic pathay. Stress also increases norepinephrine! hich helps stimulate key components of the mesolimbic pathay% the bed nucleus of the stria terminalis! nucleus accumbens! and amygdala. Stress may enhance drug relapse in other key ays as ell. ncreased glutamate from stress may produce a
4lassic and operant conditioning and modeling can also affect substance use. f a person alays uses methamphetamines ith friends at a local park! he or she is more likely in the future to use the drug hen surrounded by these cues. (reatment for a substance use disorder can thus be difficultGpeople may 0get clean1 in a drug rehabilitation center but then relapse *uickly hen they return to old environments here cues for substance use are strong. Drug use can also be rearding! of course! and it is therefore maintained by operant conditioning. (he brain8s reard centers are highly stimulated by drug use! and people can become particularly vulnerable to drug-conditioned stimuli. ositive reinforcers of drug use include fitting in ith peers! a sense of euphoria and invulnerability! and feelings of se"ual proess. Drug use can also serve as a poerful
negative reinforcer in that stress! pressure! depression! and ithdraal symptoms recede. $egative reinforcers serve as strong indicators of a craving and relapse. 5odeling or imitating the behavior of others can also be a significant learning-based factor for substancerelated disorders because people often model the behavior from others.
' personality trait closely related to substancerelated disorders is impulsivity! or risk taking! lack of planning! a chaotic lifestyle! desire for immediate gratification! and e"plosiveness. sychopathy also closely relates to substance-related disorders. eople ith psychopathy or a substance use disorder may react *uickly or impulsively to stressors by aggressively facing a perceived threat and/or by using drugs to cope ith a threat. Other researchers have found e"cessive substance use to be related to disinhibited! disagreeable! depressed! and an"ious personality features.
+amily factors relate closely to the onset and maintenance of substance-related disorders. (he risk of a substance use disorder increases ith spikes in family conflict and detachment as ell as permissive parent attitudes toard drug use. 'nother family factor linked closely to adolescent drug use is parent psychopathology! especially substance use disorders and antisocial behaviors. 4odependency refers to dysfunctional behaviors that spouses! partners! children! and others do to cope ith the stress of having a family member ith a substance-related disorder. 'dult children of parents ith alcoholism are at significant risk for e"cessive substance useH antisocial behaviors such as aggression! an"ietyrelated disorders! and distressH depressionH lo selfesteemH and difficult family relationships.
'side from 'merican ndians/'laska $atives! rates of substance use disorders are fairly e*ual among ,uropean 'mericans! 'frican 'mericans! =ispanics! and 'sian 'mericans. (he reasons hy some 'merican
ndians/'laska $atives have such high rates of substance-related disorder are not completely clear. Substance use disorder in this population may be associated ith high rates of trauma. (he rates of lifetime drug use among ,uropean 'mericans! 'frican 'mericans! and =ispanics resemble rates in the general population. 4ultures in 'sia 2in particularly! Iapan! 4hina! and 7orea3 historically have lo rates of alcoholism.
,volutionary theories have been proposed for substance-related disorders. One evolutionary theory is that the mesolimbic dopamine system is not strictly a reard-based system but one intricately involved in survival motivations. 'nother evolutionary vie is that individuals ithin societies generally pursue positions of dominance and submission to maintain social order.
5any researchers adopt a biopsychosocial approach to substance-related disorders that incorporates aspects of the diathesis-stress model. 6iological factors may predispose a person toard substance use! and environmental factors may trigger this predisposition to produce a substance-related disorder. 4omprehensive models of addiction often divide biological and environmental risk factors into distal or pro"imal factors. Distal factors are background factors that indirectly affect a person and can generally contribute to a mental disorder. ro"imal factors are more immediate factors that directly affect a person and more specifically contribute to a mental disorder. Some of these factors interact to propel a person toard substance use disorder. 5any people ith substance related disorders e"perience a phenomenon they describe as rock-bottom! meaning their brain function and behavior are almost singularly geared toard seeking and using drugs.
(his section discusses several prevention programs for substance-related disorders. (hese include programs to reduce alcohol abuse in college students! reduce alcohol and other drug intake in pregnant mothers to prevent fetal alcohol effects! and universal efforts to
prevent substance abuse among the general public. ,"amples include raising the minimum drinking age! loering the legal limit for defining driving hile impaired! airing antidrug commercials! banning advertisements for tobacco in some media! engaging in orkplace drug testing! and implementing heavy ta"ation on alcohol and tobacco products. ' controversial approach to preventing e"tended health problems in those addicted to drugs is to reduce needle sharing by supplying ne! clean needles or syringes. Relapse prevention is also a key ay of reducing further drug use in someone ith a substancerelated disorder. Relapse prevention involves reducing e"posure to alcohol and other drugs! improving motivation to continue abstinence! self-monitoring daily moods and tempting situations! recogni#ing and coping appropriately ith drug cravings! reducing an"iety and depression! modifying irrational thoughts about drug use! and developing a crisis plan in the event of a relapse. Other prevention programs target children and adolescents to prevent drug use during the developmental period. (hese programs typically focus on the folloing%
Reducing availability of illegal drugs. ncreasing legal conse*uences for drug use. School-related media programs such as Drug 'buse Resistance ,ducation 2D'R,3 to educate youth and change drug-related attitudes. rograms to increase ork and leisure opportunities to deflect youths from drugseeking opportunities. eer-based programs.
ntervies Screening intervies are designed to assess recent and lifetime problems ith respect to substance u se. (he 'ddiction Severity nde" - has structured *uestions about medical status! employment! social support! alcohol and drug use! and legal! family! and psychiatric status. (he 4omprehensive Drinker .rofile helps clinicians obtain information about past and
present drinking patterns! life and medical problems related to alcohol use! and reasons for drinking. 5otivational intervieing is an assessment and treatment strategy that involves obtaining information about people8s substance-related problem and providing feedback to help increase their readiness for change.
(herapists also use psychological tests to screen and assess for drug use. (he 5innesota 5ultiphasic .ersonality nventory 255-B3 has three subscales that assess for drug use. tems on the 'ddictions 'cknoledgement Scale detect substance use among people illing to admit such use. tems on the 'ddiction .otential Scale are those typically endorsed by people ho use substances more so than those ho do not. tems on the 5ac'ndre 'lcoholism Scale are general 55-B items that help discriminate people ho use substances from people ho do not. (he 5illon 4linical 5ultia"ial nventory- assesses personality disorders but has to subscales for alcohol dependence and drug dependence. (he 5ichigan 'lcohol Screening (est is a B?-item measure of drinking habits! interpersonal and legal problems related to drinking! and alcoholism treatment. (he 4'F, is a four-item measure.
,"cessive drug use is often a hidden problem! and many people do not accurately report their alcohol or other drug use. (herapists may thus conduct observations and solicit reports from others. +amily members! partners! coorkers! and friends can help monitor a person8s behavior and report days missed from ork! time aay from home! family arguments over drug use! and binges! among other things.
Laboratory tests involve analy#ing urine! blood! breath! hair! saliva! or seat to detect recent drug use. otential employers and drug treatment facilities often use these measures to identify drug use. Urine screens are perhaps the most common laboratory measure of
recent substance use! although periods of detection differ by drug. ' *uick method of assessing recent alcohol use and blood alcohol level is via one8s breath using a to"imeter or 6reathaly#er test. =air analysis is becoming a preferred method of drug testing because it can detect illicit drug use months after a person ingested a drug.
'gonists are drugs that have a chemical composition similar to the abused drug. 'gonist drug treatment takes advantage of cross-tolerance! or tolerance for a drug one has never taken. 'gonist drug treatment includes methadone for people addicted to heroin or opiates 2such as morphine or o"ycodone3. 'nother drug! a methadone derivative knon as levoalpha-acetyl-methadol! lasts longer in the body. $icotine replacement therapy refers to ingesting safe amounts of nicotine ithout smoking tobacco.
'ntagonists are drugs that block the pleasurable effects of an addictive drug and hopefully reduce cravings for the addictive drug. ' good e"ample is naltre"one 2Revia3! hich blocks opiate receptors in the brain! specifically the nucleus accumbens! to decrease craving for alcohol and reduce its pleasurable effects. ' combination of naltre"one ith acamprosate! a drug that may also have some antagonist properties! seems effective for preventing relapse in people ith alcoholism. ' related antagonist! nalo"one 2$arcan3! treats opiate overdose in emergency rooms.
artial agonists are drugs that may act as an agonist or antagonist depending on ho much of a neurotransmitter is produced. Dopamine has a close association ith substance-related disorders! so a partial agonist ill increase dopamine levels hen this neurotransmitter is not highly produced in the brain and
decrease dopamine levels hen this neurotransmitter is highly produced in the brain. ' common partial agonist for substance-related disorders is buprenorphine 2Subute"3! hich acts as an agonist at certain opiate receptors but an antagonist at other opiate receptors.
'versive drugs are those that make ingestion of an addictive drug uncomfortable. ' good e"ample is disulfiram 2'ntabuse3! hich creates no ill effects until a person drinks alcohol. ' related drug! calcium carbimide 2(emposil3! has similar but milder effects. 'nother aversive drug is silver nitrate! a substance placed in gum! lo#enges! or mouthash to deter smoking.
Other medications treat substance-related disorders as ell! especially antian"iety and antidepressant drugs. Research continues as ell on medications to speed drug metabolism to cleanse the body *uickly and vaccines for substance-related disorders.
eople ho are into"icated or dependent on a particular substance often must first undergo inpatient or residential treatment here the major focus is deto"ification and rehabilitation. Deto"ification involves ithdraing from a drug under medical supervision! hich may include the medications mentioned previously. Rehabilitation from drug use is then ne"t phase of inpatient or residential treatment. 5any rehabilitation treatment programs rely on the 5innesota model that emphasi#es complete abstinence! education about the substance-related disorder and its conse*uences! the effects of addiction on family members! and cognitivebehavioral techni*ues to prevent relapse. 5ost rehabilitation programs last about four eeks but could last longer in some cases. 5ore than half the people ho enter rehabilitation programs for alcohol remain abstinent
a year after discharge! but only about one-fourth remain abstinent four years after discharge.
6rief interventions for substance-related disorders include short-term strategies to change behavior as much as possible in a limited time. 6rief interventions include motivational intervieing! hich includes providing feedback about one8s substance use and negotiating and setting a goal for change. 6rief interventions also focus on identifying high-risk situations for e"cessive substance use! especially hen a person is stressed! lonely! bored! or depressed.
4ognitive therapy refers to challenging and changing irrational thoughts about a given situation and is important for addressing psychological dependence. Skills training may also involve self-monitoring in hich a person constantly records the amount of drugs taken or various situations and emotions that lead to urges for drug use. (herapists may combine skills training ith cue e"posure therapy! in hich a person is e"posed to cues such as the sight and smell of a lcohol and then uses skills such as rela"ation or discussion to successfully decline drug use. 6ehavior therapy refers to changing learning patterns and other maladaptive behaviors associated ith a given disorder. ' key aspect of behavior therapy for substance-related disorders is contingency management! or rearding positive behaviors via praise and other reinforcers from family members! friends! and close associates. ' community reinforcement approach to substance-related disorders is similar to contingency management. ' person ith a substance use disorder is not only rearded by others for abstinence but also encouraged to change conditions in his environmentG such as ork! home! and recreationGto make them more rearding than substance use.
+amily and marital therapy are also commonly used for substance-related disorders. 5ultidimensional family therapy consists of a @B-eek program that
focuses on developing a strong adolescent-parent bond! enhancing good negotiation and family problem-solving skills! improving the supervision of adolescents! and correcting learning and school-based problems.
Froup therapy has alays been a popular form of treatment for people ith substance-related disorders. Froups meet together ith a therapist ith the goal of helping to reduce alcohol and other drug use. Froup therapy approaches can differ idely based on the therapist8s orientation! but common practices include providing education about the conse*uences of e"cessive drug use! encouraging commitment to change! enhancing social support! recogni#ing cues that lead to e"cessive substance use! restructuring destructive lifestyles and relationships! and identifying alternative ays of coping ith stress.
Self-help groups are similar to group therapy in that several people ith a substance-related disorder meet to support one another and encourage abstinence. 5ost self-help groups are led not by a professional therapist but by other people ith the same substance use problem. 'ppro"imately to-thirds 2E.?;3 of people ith alcoholism seek h elp through 'lcoholics 'nonymous. Related @B-step groups include $arcotics 'nonymous or 4ocaine 'nonymous for mind-altering substances as ell as groups for family members of people ith alcoholism or other substance-related disorders! includin g 'l 'non/'lateen and $ar-'non. 5any groups! such as Double (rouble in Recovery! address people ith substance-related disorders and another mental disorder such as depression. 'lcoholics 'nonymous and related groups are moderately effective.
Students are provided ith screening *uestions regarding substance-related problems. (hey are encouraged to ork ith family members to monitor substance use! consult self-help guides! discover other
ays of coping ith stress and other triggers! and seek professional treatment if necessary.
Regarding adolescents! treatment effectiveness is appro"imately >C; at si" months after treatment and >B; at @B months after treatment. 'dolescents ho do better in treatment are those ho complete a treatment program! ho had less severe substance use! and ho have peers and parents that provide positive social support and do not condone substance use. Some adults 2>@;3 ith substance-related disorders achieve abstinence at posttreatment compared ith @>; of people in control groups. Long-term dependence on alcohol is closely related to intense craving for alcohol! a family history of alcoholism! greater alcohol intake! a history of other drug use! and the presence of legal and other problems related to drinking. (he degree of stability for use of other drugs ranges idely. 'lmost all 29;3 people ho smoke cigarettes reportedly continue over a five-year period. 4ontrast this ith follo-up rates for alcohol 2CB;3! cocaine 2E?;3! marijuana 2;3! stimulants other than cocaine 2:;3! opiates 2AA;3! and sedatives 2>>;3.
(he Joung 'dult 'lcohol 4onse*uences Kuestionnaire is a scale that measures alcohol-related conse*uences in college-aged students. 4onsider the folloing sample items and discuss hether you have e"perienced these conse*uences and hat you did to address them 2from Read! 7ahler! Strong! 4older! B::3% &hile drinking! have said or done embarrassing things. 5y drinking has created problems beteen myself and significant others. have said things hile drinking that later regretted. have tried to *uit drinking because thought as drinking too much. have felt badly about myself because of drinking. have been less physically active because of my drinking. haven8t been as sharp mentally because of my drinking. have driven a car hen kne had too much to drink to drive. have taken foolish risks hen have been drinking. have damaged property or done something disruptive after drinking. &hen drinking! have done impulsive things that regretted later. 5y drinking has gotten me into se"ual situations later regretted. have injured someone else hile drinking or into"icated. (he *uality of my ork or school ork has suffered because of my drinking. have neglected obligations to family! ork! or school because of my drinking. have found that need larger amounts of alcohol to feel any effect or that could no longer get high/drunk on the amount that used to get me high/drunk. have had a hangover 2headache or sick stomach3 the morning after drinking.
