____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
elements in SUDs assessment and treatment are co-occurring mental disorders; age, gender, and sexual identify of users; socioeconomic and psychological issues; family dynamics; and ethnocultural factors of users. Furthermore, SUDs treatment must be viewed within the context of governmental policies, which vary over time and in different locations. This intermediate-level course is intended for social workers, marriage and family therapists, mental health counselors, and psychologists. Substance use and treatment for substance use problems have long been topics of research and included in the curriculum for graduate students in these fields as either required or elective courses of study. Yet, in spite of recent advancements in etiological understanding and treatment, substance abuse remains a significant problem for individuals, families, and communities in the United States and worldwide. This course aims to bring clinicians in varied settings up to date with current trends in use and abuse and current treat- ment recommendations. Furthermore, the course provides information on the scope of substance-related problems in the United States; the different categories of substances that are commonly abused and their neurochemical effects on the human brain and an individual’s biopsychosocial function- ing; the major theories of addictions and different screening, assessment, and diagnostic instruments; the benefits and limitations of different intervention and evidence-based treat- ment approaches; and the unique needs of various populations affected by substance use disorders. SCOPE OF SUBSTANCE USE PROBLEMS IN THE UNITED STATES According to government data, in 2021, the percentage of people aged 12 or older with an SUD was highest among young adults aged 18 to 25 (25.6% or 8.6 million people), followed by adults aged 26 or older (16.1% or 35.5 million people), then by adolescents aged 12 to 17 (8.5% or 2.2 million people) (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021a). The National Center for Drug Abuse Statistics found that among Americans aged 12 years or older, 37.309 million were current illegal drug users (used within the last 30 days) as of 2020 (NCDAS, 2020). Of this group, 25.4% of illegal drug users have a drug disorder as defined by the DSM-5 , and 20.4% have an alcohol use disorder. Other national studies have found higher rates, with the National Epidemiological Survey on Alcohol and Related Conditions yielding a lifetime prevalence of alcohol use disorder or drug use disorder in the United States of 15.67%, or an estimated 36.8 million individuals suffering from substance use disorders annually. According to this survey, 74 million individuals meet criteria for substance use disorder at some point in their lifetimes (Goldstein et al., 2015). Substance use and substance use disorder rates vary by race, gender, and ethnicity.
INTRODUCTION Humans and drugs have a long and complicated history. For centuries, people have been using a variety of drugs for a variety of medical and/or recreational reasons, but drug use and addiction has now reached epidemic levels (Addiction Resource, 2020). Alcohol and drug abuse is a major public health concern, affecting every segment of society, and in 2017, the cost of drug abuse in the United States was nearly $272 billion, taking into account crime, healthcare needs, lost work productivity, and other impacts on society. (National Center for Drug Abuse Statistics, 2023). In 2020, the National Drug Control Budget requested $35 billion across five areas of drug control functions: operations, prevention, treatment, interdic- tion, and law enforcement (NCDAS, 2023). Every day, millions of individuals in the United States use alcohol and other psychoactive substances; however, not everyone experiences a problem from such use. It is therefore helpful to conceptualize alcohol and other drug (AOD) use as ranging on a continuum from nonproblematic experimental and social use (such as having a glass of wine with dinner) to substance misuse (such as using pain medication to get high) or abuse (excessive use of a substance that results in a negative impact on the life of the individual and those around him or her) and, finally, to AOD dependence or addiction, which may require physical detoxification, formal ongoing treatment, or both (Straussner, 2014). Although not employed professionally for diagnostic purposes, the term alcoholism is frequently used to imply a progressive deterioration of the individual’s social, physical, and mental status, combined with the inability to stop using alcohol even when wishing to do so. The inconsistent and, at times, confusing terminology in this field has been compounded by the changes in the fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; APA, 2023), which replaced the previous diagnostic classification of “substance abuse” and “substance dependence” with the more general category of “substance use disorders” (SUDs), which itself is part of the broader new DSM-5-TR category of “substance-related and addictive disorders.” Despite these changes, substance abuse is and will likely continue to be a catchall term for substance use-related problems, and it is in this context that this term is used in this course. Moreover, in line with the federal government, the term addiction may be regarded as equivalent to a severe substance use disorder as defined by the DSM-5-TR (APA, 2023; NIDA, 2021b). Research studies in the United States indicate a general trend toward the use of multiple substances and a decrease in the proportions of individuals with a single or “pure” alcohol or heroin use diagnosis (Substance Abuse and Mental Health Services Administration, 2020a). Consequently, SUDs need to be considered within the context of problematic use of a variety of chemical substances, including nicotine, as well as other behavioral addictions, such as gambling. Other important
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