Substance-Related Disorders has intense cravings for the drug. Social impairment system (disinhibition).
mpairment system (disinhibition). Alcohol effects closely relate to
Learning Objectives
Develop an understanding of the major features
and epidemiology of the substance-related
disorders.
Understand the major risk factors associated
with substance-related disorders, including
genetics and other biological factors as well as
cognitive and learning experiences.
Review methods of preventing substance-
related disorders.
Recognize different assessment methods
pertinent to substance-related disorders.
Understand major biological and psychological
approaches to treating substance-related
disorders as well as long-term outcomes.
Normal Substance Use and Substance-Related
Disorders: What Are They?
This section covers substance use along a continuum,
beginning with typical behaviors such as drinking a glass
of wine and progressing to more intense and frequent
substance use. When daily functions are impaired, a
person may have a substance abuse problem, which is a
substance-related disorder. Substance dependence is a
particularly severe substance-related disorder.
Substance-Related Disorders: Features and
Epidemiology
Substance Use Disorder
A substance use disorder involves repeated use
of substances to the point that recurring problems are
evident.
Impaired control means the person has difficulty
cutting down 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 from its use, and
means the person is experiencing key problems in his or
her life because of substance use. People with substance
use disorders often exhibit tolerance and/or withdrawal.
Tolerance refers to the need to ingest greater and greater
quantities of a drug to achieve the same effect. For
example, someone who regularly drinks three beers a day
will find over time that the same physiological high no
longer occurs when this amount is consumed. That
person must drink more beer or switch to another, more
powerful drug to achieve the same effect. Withdrawal
refers to maladaptive behavioral changes when a person
stops using a drug.
Substance Intoxication
Substance intoxication refers to a reversible
condition brought on by excessive use of a drug, such as
alcohol. Intoxication is not abnormal without maladaptive
behavioral changes.
Substance Withdrawal
Substance withdrawal refers to maladaptive
behavioral changes when a person stops using a drug.
Substance withdrawal may be an aspect of substance
dependence and a substance-related disorder in its own
right. A well-known feature of alcohol withdrawal is
delirium tremens (DTs), which involves severe
confusion and autonomic overactivity in the
form of sweating, heart palpitations, and trembling. Drug-
seeking behavior sometimes relates to psychological
dependence on a drug, meaning a person believes he or
she needs the drug to function effectively. Polysubstance
refers to dependence on more than one drug.
Depressants
Depressant or sedative drugs inhibit aspects of
the central nervous system. Common depressants
include alcohol, anesthetics for surgery, antiseizure
medications for epilepsy, barbiturate drugs people use to
calm themselves, and hypnotic drugs people use to go to
sleep. Alcohol is the most well-known and used
depressant drug. Alcohol inhibits a key inhibitory brain
blood alcohol level, or the concentration of alcohol in the
blood. A lethal dose (LD) is the amount of a substance
that will kill a certain percentage of test animals. This
section describes the common effects of alcohol. Mixing
different drugs causes a synergistic or multiplicative, not
additive, effect. Binge drinking involves ingesting large
amounts of alcohol in a short period and relates to many
college student deaths and problems.
Extensive alcohol use is also associated with
increased risk for suicide, homicide, unprotected sexual
activity, sexual assault, and traffic and other accidents.
People who chronically and excessively use alcohol also
commonly experience cirrhosis of the liver, when scar
tissue replaces liver tissue, leading to a loss of function
and possibly death. Korsakoffs syndrome,involves
confusion, memory loss, and coordination difficulties
because of a thiamine deficiency resulting from extended
alcohol use. Fetal alcohol syndrome, a condition in
children whose mothers ingested alcohol during
pregnancy, produces physical and cognitive problems.
Alcohol use by pregnant mothers, particularly binge
drinking, can produce more general fetal alcohol effects
as well.
Stimulants
Stimulant drugs activate or stimulate the central
nervous system. Caffeine is a legal drug found in soda,
coffee, tea, and chocolate. People generally ingest
nicotine via cigarettes and other tobacco products.
Cocaine is a powerful stimulant usually ingested
by sniffing or snorting crystals or smoking cocaine in the
form of crack. Cocaine stimulates dopamine,
norepinephrine, and serotonin systems to produce
euphoria, high energy similar to mania, and bizarre,
paranoid, and occasionally violent behavior.
Amphetamines are also powerful stimulants that primarily
increase dopamine and norepinephrine. Approximately
90% of all amphetamine abuse today is from
methamphetamines, or crank.

Opiates
Opiates (sometimes called narcotics or opioids)
are drugs, such as morphine or codeine, commonly used
to relieve pain or coughs. Morphine and codeine can be
abused substances, but a related opiate, heroin, is
abused more. Modern-day painkillers are also related
to morphine and can be highly addictive. OxyContin,
Darvon, Vicodin, Percoset, and Percodan are narcotic-
based drugs that can cause physical and psychological
dependence in only a few doses.
Hallucinogens
Hallucinogens are drugs that cause symptoms
of psychosis such as hallucinations (seeing or hearing
things not actually there), disorganized thinking, odd
perceptions, and delirium (a cognitive state of confusion
and memory problems). Hallucinogen use often involves
peyote or lysergic acid diethylamide (LSD), the latter of
which seems to spur dopamine in the brain (a
phenomenon also linked to psychoses such as
schizophrenia). Another drug, ecstasy or MDMA (3,4-
methylenedioxy-N methylamphetamine), acts as
a stimulant and a hallucinogen.
Marijuana
Marijuana comes from Cannabis sativa, or the
hemp plant, which contains an active ingredient known
as THC (delta-9-tetrahydrocannabinol). Marijuana
stimulates cannabinoid receptors throughout the brain,
especially the cortex, hippocampus, basal ganglia, and
hypothalamus. The drug creates a dream-like state and
feelings of joy, well-being, and good humor. Marijuana
may not be physically addictive for everyone because
tolerance is not always present, but heavy users may
become physically and psychologically dependent.
According to the Office of National Drug Control Policy,
49.1% of college students have tried marijuana and
33.3% have done so in the past year.
Other Drugs
Designer drugs or club drugs represent
manmade modifications of psychoactive drugs such as
amphetamines and heroin. Phencyclidine (PCP) induces
strong perceptual distortions and often highly violent and
dangerous behavior. Club drugs may also include date
rape drugs.
Inhalants, or volatile liquids in a stored container
that contain strong fumes, are inhaled to produce feelings
of euphoria and lightheadedness.
Steroids are synthetic substances to enhance
muscle growth and secondary sexual characteristics and
are sometimes abused by adolescents and athletes to
gain a competitive edge.
Epidemiology of Substance-Related Disorders
Approximately 50.3% of Americans aged 12
years or older currently use alcohol and 22.8% have
engaged in binge drinking in the past 30 days. Recent
alcohol use is more common among men (59.8%) than
women (45%) and among European Americans (56.2%)
than Hispanics (43.2%), African Americans (38.9%),
American Indians/Alaska Natives (38.1%), and Asian
Americans (34.1%). In addition, 13.5% of Americans have
recently driven a motor vehicle under the influence of
alcohol. Of Americans aged 12 years and older, 29.2%
use some tobacco product (85.2% of this is cigarette use).
This rate rises for adults aged 18 to 25 years (39.5%) and
males (27.7%), compared with females (22.3%). Recent
illicit drug use is particularly common among American
Indians/Alaska Natives (11.2) compared with African
Americans (6.9% percent), European Americans (6.8%),
Hispanics (5.9%), and Asian/Indian Americans (2.2%).
Marijuana is the most commonly used illegal drug, but
nonmedical use of therapeutic medications is also
frequent. Drugs tried for the first time commonly include
prescription medications and marijuana.
The lifetime prevalence of any substance-
related disorder is 14.6% and, for the past 12 months,
3.8%. This is particularly true for alcohol abuse and
dependence. According to the Department of Health and
Human Services, substance use disorders are more
common among males (12.7%) than females (6.2%) and
among people aged 18 to 25 years (21.2%). Substance
use disorders are higher among American Indians/Alaska
Natives (20.2%) compared with multiracial individuals
(12.2 %), Hispanics (9.8%), European Americans (9.6%),
African Americans (8.3%), and Asian Americans (4.7%).
Some (22.7%) people with a substance-related disorder
sought treatment in the past year, especially for alcohol
and drug dependence. Substance-related disorders are
often comorbid with anxiety-related, depression, and
personality disorders.
Stigma Associated with Substance Related
Disorders
People with substance-related disorders often
face social discrimination with respect to employment and
housing as well as interpersonal rejection. One survey of
people with substance-related disorders revealed that
many felt stigmatized (Luoma et al., 2007). Many in the
sample believed that, once others knew of the persons
substance problem, they treated them unfairly (60%) or
were afraid of them (46%). Many people in the sample
also believed that some family members had given up on
them (45%), some friends had rejected them (38%), and
employers paid them a lower wage (14%). Participants in
the survey reported that hearing others say unfavorable or
offensive things about people in treatment for substance
use was a common experience.
Substance-Related Disorders: Causes and
Prevention
Risk Factors for Substance-Related
Disorders
Biological Risk Factors
Genetics

Genetics influence substance-related disorders,
especially alcoholism. Heritability estimates for alcoholism
are 0.52 to 0.57. Early family studies revealed that people
whose family members overused alcohol were three to
four times more likely to overuse alcohol themselves
compared with people without such a family history.
Genetic influences may be stronger for males than
females and for severe compared with less severe cases
of alcoholism. Alcoholism is likely predisposed by many
genes working together. Genetic models for
alcoholism are modest, but variables related to
alcoholism may have a stronger genetic effect.
Genetics may affect how a person metabolizes alcohol
some people process alcohol faster than others and may
be less susceptible to alcoholism. Genetics may also
affect a persons sensitivity to alcohol. Genetics
influence low-level responses to alcohol, which
can predict alcoholism in offspring of people with
alcoholism. Heritability also plays a factor with other
substances and is strongest for dependence on cocaine
and opiates (such as heroin) or prescription painkillers
(such as OxyContin).
Brain Features
Many brain features are linked to substance-
related disorders. Brain changes in substance-related
disorders coincide with several inducements toward
compulsive drug use: priming, drug cues, cravings, and
stress. Priming refers to a situation in which 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 with drug use, such as friends,
favorite hangouts, and other things that stimulate further
drug use. Cravings refer to an obsessive drive for drug
use. Brain features related to each of these areas are
primarily part of the mesolimbic system, a major
dopamine pathway and one strongly implicated in
sensations of pleasure, reward, and desire. The
mesolimbic system generally begins in the ventral
tegmental area and ends in the nucleus accumbens.
People who excessively use alcohol or nicotine for long
periods also have a reduced brain size. Changes in brain
function also occur in children with fetal alcohol syndrome
whose 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.
Neurochemical Features
The mesolimbic dopamine pathway appears to
be the main neural base for the reinforcing effects of
many drugs, especially alcohol, stimulants, opiates, and
marijuana. These drugs increase dopamine release in the
nucleus accumbens by stimulating specialized dopamine
(D2) receptors or blocking reuptake of dopamine. Some
people with substance-related disorders have fewer D2
receptors, meaning they may not be able to obtain much
reward from everyday life events and thus resort to
excesses such as drug use to obtain sufficient rewards
(reward-deficiency syndrome). Other neurotransmitters
influence substance-related disorders as well, but even
these neural pathways affect dopamine release in the
mesolimbic system. Glutamate, gamma aminobutyric acid
(GABA), acetylcholine, serotonin, and norepinephrine
have excitatory or inhibitory connections to the
mesolimbic dopamine system. Dopamine release acts as
a powerful reward (euphoria), thus providing an incentive
to increase and maintain drug use. Dopamine release
also promotes reward-related learning, so a person often
seeks rewards such as drugs.
Environmental Risk Factors
Stress
Stress is an important trigger for many mental
disorders; this is especially true for substance-related
disorders. Excessive substance use is closely associated
with early physical and sexual maltreatment, poor
parental and social support, and chronic distress. A
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 pathway. Stress also increases
norepinephrine, which helps stimulate key components of
the mesolimbic pathway: the bed nucleus of the
stria terminalis, nucleus accumbens, and amygdala.
Stress may enhance drug relapse in other key ways as
well. Increased glutamate from stress may produce a
state of sadness from dopamine depletion that triggers
cravings for increased dopamine. Chronic stress may also
weaken a persons ability to cope effectively with difficult
situations by creating damage to the prefrontal cortex.
Cognitive Factors
Cognitive distortions refer to erroneous beliefs
about oneself and the surrounding world that can lead to
maladjustment. One common misperception among
people with substance-related disorders is increased
positive expectancies about the effects of various
substances and minimization of negative effects. Some
people believe that using certain substances will lead to
grand experiences or life changes, such as enhanced
personal or social functioning. Another misperception
among many people with substance-related disorders,
especially college students, is that other people use the
same amounts of alcohol and drugs as they do. People
with alcoholism also selectively attend to cues that
indicate alcohol is nearby, such as seeing a favorite
drinking buddy. Cognitions affect substance use, but
severe substance use may itself create cognitive changes
by altering the prefrontal cortex. Alcohol 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.
Learning
Classic and operant conditioning and modeling
can also affect substance use. If a person always uses
methamphetamines with friends at a local park, he or she
is more likely in the future to use the drug when
surrounded by these cues. Treatment for a substance use
disorder can thus be difficultpeople may get clean in a
drug rehabilitation center but then relapse quickly when
they return to old environments where cues for substance
use are strong. Drug use can also be rewarding, of
course, and it is therefore maintained by operant
conditioning. The brains reward centers are highly
stimulated by drug use, and people can become
particularly vulnerable to drug-conditioned stimuli. Positive
reinforcers of drug use include fitting in with peers, a
sense of euphoria and invulnerability, and feelings of
sexual prowess. Drug use can also serve as a powerful
negative reinforcer in that stress, pressure, depression,
and withdrawal symptoms recede. Negative reinforcers
serve as strong indicators of a craving and relapse.
Modeling or imitating the behavior of others can
also be a significant learning-based factor for substance-
related disorders because people often model the
behavior from others.
Personality Factors
A personality trait closely related to substance-
related disorders is impulsivity, or risk taking, lack of
planning, a chaotic lifestyle, desire for immediate
gratification, and explosiveness. Psychopathy also closely
relates to substance-related disorders. People with
psychopathy or a substance use disorder may react
quickly or impulsively to stressors by aggressively facing
a perceived threat and/or by using drugs to cope with a
threat. Other researchers have found excessive
substance use to be related to disinhibited, disagreeable,
depressed, and anxious personality features.
Family Factors
Family factors relate closely to the onset and
maintenance of substance-related disorders. The risk of a
substance use disorder increases with spikes in family
conflict and detachment as well as permissive parent
attitudes toward drug use. Another family factor linked
closely to adolescent drug use is parent psychopathology,
especially substance use disorders and antisocial
behaviors. Codependency refers to dysfunctional
behaviors that spouses, partners, children, and others do
to cope with the stress of having a family member with a
substance-related disorder. Adult children of parents with
alcoholism are at significant risk for excessive substance
use; antisocial behaviors such as aggression, anxiety-
related disorders, and distress; depression; low self-
esteem; and difficult family relationships.
Cultural Factors
Aside from American Indians/Alaska Natives,
rates of substance use disorders are fairly equal among
European Americans, African Americans, Hispanics, and
Asian Americans. The reasons why some American
Indians/Alaska Natives have such high rates of
substance-related disorder are not completely clear.
Substance use disorder in this population may be
associated with high rates of trauma. The rates of lifetime
drug use among European Americans, African Americans,
and Hispanics resemble rates in the general population.
Cultures in Asia (in particularly, Japan, China, and Korea)
historically have low rates of alcoholism.
Evolutionary Influences
Evolutionary theories have been proposed for
substance-related disorders. One evolutionary theory is
that the mesolimbic dopamine system is not strictly a
reward-based system but one intricately involved in
survival motivations. Another evolutionary view is that
individuals within societies generally pursue positions of
dominance and submission to maintain social order.
Causes of Substance-Related Disorders
Many researchers adopt a biopsychosocial
approach to substance-related disorders that incorporates
aspects of the diathesis-stress model. Biological factors
may predispose a person toward substance use, and
environmental factors may trigger this predisposition to
produce a substance-related disorder. Comprehensive
models of addiction often divide biological and
environmental risk factors into distal or proximal factors.
Distal factors are background factors that indirectly affect
a person and can generally contribute to a mental
disorder. Proximal 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 toward substance use disorder. Many people
with substance related disorders experience a Substance-Related Disorders: Assessment and
phenomenon they describe as rock-bottom, meaning their
brain function and behavior are almost singularly geared
toward seeking and using drugs.
Prevention of Substance-Related Disorders
This section discusses several prevention
programs for substance-related disorders. These 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.
Examples include raising the minimum drinking age,
lowering the legal limit for defining driving while impaired,
airing antidrug commercials, banning advertisements for
tobacco in some media, engaging in workplace drug
testing, and implementing heavy taxation on alcohol and
tobacco products.
A controversial approach to preventing
extended health problems in those addicted to drugs is to
reduce needle sharing by supplying new, clean needles or
syringes. Relapse prevention is also a key way of
reducing further drug use in someone with a substance-
related disorder. Relapse prevention involves reducing
exposure to alcohol and other drugs, improving
motivation to continue abstinence, self-monitoring daily
moods and tempting situations, recognizing and coping
appropriately with drug cravings, reducing anxiety 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. These programs typically focus on the following:
Reducing availability of illegal drugs.
Increasing legal consequences for drug use.
School-related media programs such as Drug
Abuse Resistance Education (DARE) to
educate youth and change drug-related
attitudes.
Programs to increase work and leisure
opportunities to deflect youths from drug-
seeking opportunities.
Peer-based programs.
Treatment
Interviews
Screening interviews are designed to assess
recent and lifetime problems with respect to substance
use. The Addiction Severity Index-6 has structured
questions about medical status, employment, social
support, alcohol and drug use, and legal, family, and
psychiatric status. The Comprehensive Drinker Profile
helps clinicians obtain information about past and
present drinking patterns, life and medical problems
related to alcohol use, and reasons for drinking.
Motivational interviewing is an assessment and treatment
strategy that involves obtaining information about peoples
substance-related problem and providing feedback to help
increase their readiness for change.
Psychological Testing
Therapists also use psychological tests to
screen and assess for drug use. The Minnesota
Multiphasic Personality Inventory (MMPI-2) has three
subscales that assess for drug use. Items on the
Addictions Acknowledgement Scale detect substance use
among people willing to admit such use. Items on the
Addiction Potential Scale are those typically endorsed by
people who use substances more so than those who do
not. Items on the MacAndrew Alcoholism Scale are
general MMPI-2 items that help discriminate people who
use substances from people who do not. The Millon
Clinical Multiaxial Inventory-III assesses personality
disorders but has two subscales for alcohol dependence
and drug dependence. The Michigan Alcohol Screening
Test is a 24-item measure of drinking habits, interpersonal
and legal problems related to drinking, and alcoholism
treatment. The CAGE is a four-item measure.
Observations from Others
Excessive drug use is often a hidden problem,
and many people do not accurately report their alcohol or
other drug use. Therapists may thus conduct observations
and solicit reports from others. Family members, partners,
coworkers, and friends can help monitor a persons
behavior and report days missed from work, time away
from home, family arguments over drug use, and binges,
among other things.
Laboratory Testing
Laboratory tests involve analyzing urine, blood,
breath, hair, saliva, or sweat to detect recent drug use.
Potential 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. A quick method of assessing recent alcohol use
and blood alcohol level is via ones breath using a
toximeter or Breathalyzer test. Hair analysis is becoming
a preferred method of drug testing because it can detect
illicit drug use months after a person ingested a drug.
Biological Treatment of Substance-Related
Disorders
Agonists
Agonists are drugs that have a chemical
composition similar to the abused drug. Agonist drug
treatment takes advantage of cross-tolerance, or
tolerance for a drug one has never taken. Agonist drug
treatment includes methadone for people addicted to
heroin or opiates (such as morphine or oxycodone).
Another drug, a methadone derivative known as levo-
alpha-acetyl-methadol, lasts longer in the body. Nicotine
replacement therapy refers to ingesting safe amounts of
nicotine without smoking tobacco.
Antagonists
Antagonists are drugs that block the
pleasurable effects of an addictive drug and hopefully
reduce cravings for the addictive drug. A good example is
naltrexone (Revia), which blocks opiate receptors in the
brain, specifically the nucleus accumbens, to decrease
craving for alcohol and reduce its pleasurable effects. A
combination of naltrexone with acamprosate, a drug that
may also have some antagonist properties, seems
effective for preventing relapse in people with alcoholism.
A related antagonist, naloxone (Narcan), treats opiate
overdose in emergency rooms.
Partial Agonists
Partial agonists are drugs that may act as an
agonist or antagonist depending on how much of a
neurotransmitter is produced. Dopamine has a close
association with substance-related disorders, so a partial
agonist will increase dopamine levels when this
neurotransmitter is not highly produced in the brain and
decrease dopamine levels when this neurotransmitter is
highly produced in the brain. A common partial agonist for
substance-related disorders is buprenorphine (Subutex),
which acts as an agonist at certain opiate receptors but
an antagonist at other opiate receptors.
Aversives
Aversive drugs are those that make ingestion of
an addictive drug uncomfortable. A good example is
disulfiram (Antabuse), which creates no ill effects until a
person drinks alcohol. A related drug, calcium carbimide
(Temposil), has similar but milder effects. Another
aversive drug is silver nitrate, a substance placed in gum,
lozenges, or mouthwash to deter smoking.
Other Medications
Other medications treat substance-related
disorders as well, especially antianxiety and
antidepressant drugs. Research continues as well on
medications to speed drug metabolism to cleanse the
body quickly and vaccines for substance-related
disorders.
Psychological Treatment of Substance-Related
Disorders
Inpatient and Residential Treatment
People who are intoxicated or dependent on a
particular substance often must first undergo inpatient or
residential treatment where the major focus is
detoxification and rehabilitation. Detoxification involves
withdrawing from a drug under medical supervision, which
may include the medications mentioned previously.
Rehabilitation from drug use is then next phase of
inpatient or residential treatment. Many rehabilitation
treatment programs rely on the Minnesota model that
emphasizes complete abstinence, education about the
substance-related disorder and its consequences, the
effects of addiction on family members, and cognitive-
behavioral techniques to prevent relapse. Most
rehabilitation programs last about four weeks but could
last longer in some cases. More than half the people who
enter rehabilitation programs for alcohol remain abstinent
a year after discharge, but only about one-fourth remain
abstinent four years after discharge.
Brief Interventions
Brief interventions for substance-related
disorders include short-term strategies to change
behavior as much as possible in a limited time. Brief
interventions include motivational interviewing, which
includes providing feedback about ones substance use
and negotiating and setting a goal for change. Brief
interventions also focus on identifying high-risk situations
for excessive substance use, especially when a person is
stressed, lonely, bored, or depressed.
Cognitive-Behavioral Therapy
Cognitive 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 which a
person constantly records the amount of drugs taken or
various situations and emotions that lead to urges for drug
use. Therapists may combine skills training with cue
exposure therapy, in which a person is exposed to cues
such as the sight and smell of alcohol and then uses skills
such as relaxation or discussion to successfully decline
drug use. Behavior therapy refers to changing learning
patterns and other maladaptive behaviors associated with
a given disorder. A key aspect of behavior therapy for
substance-related disorders is contingency management,
or rewarding positive behaviors via praise and other
reinforcers from family members, friends, and close
associates. A community reinforcement approach to
substance-related disorders is similar to contingency
management. A person with a substance use disorder is
not only rewarded by others for abstinence but also
encouraged to change conditions in his environment
such as work, home, and recreationto make them more
rewarding than substance use.
Family and Marital Therapy
Family and marital therapy are also commonly
used for substance-related disorders. Multidimensional
family therapy consists of a 12-week program that
focuses on developing a strong adolescent-parent bond, ways of coping with stress and other triggers, and seek
enhancing good negotiation and family problem-solving professional treatment if necessary.
skills, improving the supervision of adolescents, and
correcting learning and school-based problems. Long-Term Outcome for People with Substance-
Related Disorders
Group Therapy
Regarding adolescents, treatment effectiveness
Group therapy has always been a popular form is approximately 38% at six months after treatment and
of treatment for people with substance-related disorders. 32% at 12 months after treatment. Adolescents who do
Groups meet together with a therapist with the goal of better in treatment are those who complete a treatment
helping to reduce alcohol and other drug use. Group program, who had less severe substance use, and who
therapy approaches can differ widely based on the have peers and parents that provide positive social
therapists orientation, but common practices include support and do not condone substance use. Some adults
providing education about the consequences of excessive (31%) with substance-related disorders achieve
drug use, encouraging commitment to change, enhancing abstinence at posttreatment compared with 13% of
social support, recognizing cues that lead to excessive people in control groups. Long-term
substance use, restructuring destructive lifestyles and dependence on alcohol is closely related to intense
relationships, and identifying alternative ways of coping craving for alcohol, a family history of alcoholism, greater
with stress. alcohol intake, a history of other drug use, and the
presence of legal and other problems related to drinking.
Self-Help Groups The degree of stability for use of other drugs ranges
widely. Almost all (96%) people who smoke cigarettes
Self-help groups are similar to group therapy in reportedly continue over a five-year period. Contrast this
that several people with a substance-related disorder with follow-up rates for alcohol (82%), cocaine (74%),
meet to support one another and encourage abstinence. marijuana (66%), stimulants other than cocaine
Most self-help groups are led not by a professional (60%), opiates (55%), and sedatives (33%).
therapist but by other people with the same substance
use problem. Approximately two-thirds (67.4%) of people
with alcoholism seek help through Alcoholics Anonymous.
Related 12-step groups include Narcotics Anonymous or
Cocaine Anonymous for mind-altering substances as well
as groups for family members of people with alcoholism
or other substance-related disorders, including Al-
Anon/Alateen and Nar-Anon. Many groups, such as
Double Trouble in Recovery, address people with
substance-related disorders and another mental disorder
such as depression. Alcoholics Anonymous and related
groups are moderately effective.
What if I or Someone I Know Has a Substance-
Related Disorder?
Students are provided with screening questions
regarding substance-related problems. They are
encouraged to work with family members to monitor
substance use, consult self-help guides, discover other
Handout
The Young Adult Alcohol Consequences
Questionnaire is a scale that measures alcohol-related
consequences in college-aged students. Consider the
following sample items and discuss whether you have
experienced these consequences and what you did to
address them (from Read, Kahler, Strong, & Colder,
2006):
While drinking, I have said or done
embarrassing things.
My drinking has created problems between
myself and significant others.
I have said things while drinking that I later
regretted.
I have tried to quit drinking because I thought I
was drinking too much.
I have felt badly about myself because of
drinking.
I have been less physically active because of
my drinking.
I havent been as sharp mentally because of my
drinking.
I have driven a car when I knew I had too much
to drink to drive.
I have taken foolish risks when I have been
drinking.
I have damaged property or done something
disruptive after drinking.
When drinking, I have done impulsive things
that I regretted later.
My drinking has gotten me into sexual situations
I later regretted.
I have injured someone else while drinking or
intoxicated.
The quality of my work or school work has
suffered because of my drinking.
I have neglected obligations to family, work, or
school because of my drinking.
I have found that I need larger amounts of
alcohol to feel any effect or that I could no longer get
high/drunk on the amount that used to get me high/drunk.
I have had a hangover (headache or sick
stomach) the morning after drinking.