Substance Use Disorders: Assessment and Treatment, 2nd Edition _ ___________________________________
SPIRITUAL AND EXISTENTIAL FACTORS Researchers have noted the connection between spirituality, or its absence, and substance use (Miller, 2014), and spirituality is an important component of 12-step programs. According to Doweiko (2015), “every addiction is, at its core, a disease of the spirit” (p. 398). The abuse of alcohol and other substances is seen as leading to a narcissistic preoccupation with one’s own needs while ignoring those of others, including those of loved ones and society as a whole. Spirituality emphasizes the capacity of human beings to create meaning and purpose in life and to move away from such self-focus to a higher, or different, level of existence.
that co-occur with SUDs (CASA Columbia, 2012). Studies using daily diary methodologies have found that substance use increases on days of experiencing more negative symptoms. Furthermore, the motives for using substances to cope have been found to be associated with the actual behavior of engag- ing in substance use. Another learning and behavioral theory concerning substance use suggests that substance use is a conditioned response result- ing from the positive effects of substance use. For example, if an individual’s amphetamine use results in the desired effect of staying awake longer, he or she will be more likely to use that drug again. Behavioral theories have played a large role in explicating overdose effects, suggesting that individuals who engage in drug and alcohol use in a specific setting can be triggered to have their bodies prepare for drug use while in that setting, allowing for larger doses to be consumed in typical usage settings. However, when an individual engages in alcohol or drug use in a new setting, his or her body does not prepare for the drug, with the result that an overdose is more likely than in a typical use setting. Behavioral theories for drug and alcohol use are backed by extensive research and have yielded evidence-based treatments for SUDs. Cognitive-behavioral theorists suggest that thoughts influence mood and behavior and that it is these cognitions that can lead to substance use and abuse. Cognitive-behavioral theories are also linked to evidence-based treatments for SUDs. Personality characteristics are also associated with substance use and abuse. These characteristics can include impulsivity, sensation seeking, and anxiety sensitivity (Leonard & Blane, 1999). These personality characteristics may lead to substance use in itself, or they may lead to engagement in social settings or peer groups in which substance use is more likely. Therefore, personality characteristics may interact with environmental influences to lead to substance use. Because personality charac- teristics are thought to be stable constructs, no evidence-based treatments target personality to reduce substance use. ENVIRONMENTAL AND SOCIOCULTURAL FACTORS Environmental, cultural, and social factors are associated with substance use and SUDs. These factors include the availability of drugs and alcohol, also called exposure opportunity (NIDA, 2014; Scheier, 2015). Perceived normative behavior is also a predictor of substance use and SUDs. Perceived normative behavior describes individuals’ perceptions of what their peers are doing. For example, if an adolescent believes his or her peers are engaging in drug and alcohol use, that adolescent will be more likely to engage in drug and alcohol use either to “fit in” or because that adolescent believes that substance use is normal behavior. In adults, one spouse may initially consider the other spouse’s use too high, but with time may begin to think it typical and increase his or her own use accordingly.
SCREENING, ASSESSMENT, AND DIAGNOSIS
Screening often includes a brief set of questions that seek to identify individuals who may be engaging in problematic substance use without obvious indicators. Assessment often includes a more extensive set of questions to identify individu- als with SUDs or to identify use patterns. Comprehensive assessments often include a clinical interview, several question- naires, and medical examinations. Depending on the drug of choice, assessments can also include urinalysis. Assessments are typically an ongoing process throughout treatment and can include: • Diagnosing • Understanding the severity of the disorder and the effects on the user and his or her family • Understanding the function of substance use • Assessing a baseline and change in substance use patterns and associated consequences • Evaluating environmental influences on use • Providing feedback on prevention or treatment progress • (Straussner, 2014) There are several myths about individuals who use substances that can be detrimental to completing an assessment. It is imperative for clinicians not to stereotype substance use and to be open to the various possibilities and different reasons a person may engage in substance use. There are incredible varia- tions in individuals’ backgrounds, environments, and relation- ships, as well as the effects of substances being used. Although some common patterns present among some individuals with SUDs, it is essential to conduct a thorough assessment to understand why an individual engages in substance use, what maintains substance use for that individual, the unique conse- quences of his or her substance use, and the specific benefits to reducing substance use or becoming abstinent. Furthermore, it is important to be aware that substance abuse is a “family disease”—that although a client may not be the one who abuses alcohol or other drugs, he or she may be the spouse or child
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