Encyclopedia of Psychology and Law

(lily) #1
See alsoDrug Courts; Substance Use Disorders; Therapeutic
Communities for Treatment of Substance Abuse

Further Readings
Blume, A. W. (2005). Treating drug problems(Treating
Addictions Series, Vol. 1, R. H. Coombs & W. A. Howatt,
Eds.). New York: Wiley.
Kadden, R., Carroll, K., Donovan, D., Cooney, N., Monti, P.,
Abrams, D., et al. (1999). Cognitive-behavioral coping
skills therapy manual(Project MATCH Monograph
Series, Vol. 3, M. E. Mattson, Ed.). Rockville, MD:
National Institute on Alcohol Abuse and Alcoholism.
Marlatt, G. A., & Donovan, D. M. (Eds.). (2005). Relapse
prevention: Maintenance strategies in the treatment of
addictive behaviors (2nd ed.). New York: Guilford Press.
Miller, W. R., & Rollnick, S. (2002). Motivational
interviewing (2nd ed.). New York: Guilford Press.
Nowinski, J., Baker, S., & Carroll, K. (1995). Twelve Step
Facilitation Therapy manual(Project MATCH
Monograph Series, Vol. 2, M. E. Mattson, Ed.). Rockville,
MD: National Institute on Alcohol Abuse and Alcoholism.

SUBSTANCEUSEDISORDERS


Substance use disorders are defined as the use of a sub-
stance that results in persistent and sometimes perva-
sive aversive consequences. Substance use disorders
have profound economic and public health impacts in
the United States. Researchers have identified impor-
tant biological, psychological, and social factors that
predict the development and resolution of substance
use disorders. Biological processes related to substance
use include physiological reactivity, changes, and adap-
tations. Psychological processes associated with sub-
stance use include conditioning, observational learning,
beliefs about substance use, and emotions that cue sub-
stance use. Social relationships and environmental
stressors also have been found to influence the course
of substance use. Diagnostic criteria have been estab-
lished to define severity and to specify the course of the
disorder. Substance use disorders are thought by some
to be chronic and progressive, but research on the nat-
ural course of these disorders disputes those beliefs.

Impact of Substance Use Disorders
The total costs of abuse of alcohol and abuse of other
drugs including tobacco to the American economy has

been estimated by the federal government to be more
than $400 billion annually. The two most common
substances of abuse are tobacco and alcohol.
Conservative estimates indicate that about 20% of the
population in the United States abuses tobacco, and
between 8% and 13% of the population abuses alco-
hol. Men are more likely to abuse substances than
women. Treatment often results in positive outcomes.
Substance abuse has been associated with the five
leading causes of death in the United States in 2004:
heart disease, cancers, strokes, chronic lower respira-
tory illnesses, and unintentional injuries. Some ethnic
minority groups may be at high risk for substance use
problems. For example, liver diseases often associated
with alcohol abuse were the sixth leading cause of
death for Hispanics and Native Americans. In con-
trast, liver diseases are not in the 10 leading causes of
death for either Whites or Blacks. However, it is also
worth noting that there is often wide variation in sub-
stance use within demographic groups. Interestingly,
Native Americans also have the highest abstention
rate from alcohol when compared with any other eth-
nic group.
In the United States, the recent trend is greater
abuse of prescription medications and methampheta-
mines. Abuse of substances not traditionally classified
as psychoactive, such as steroids and erectile dysfunc-
tion medications, has been commonly seen over the
recent years. Although these substances often are not
listed among traditional drugs of abuse, they can
become problematic for users.
Substance abuse is strongly associated with legal
consequences. In addition to violation of controlled sub-
stance statutes, substance abuse has been associated
with domestic violence and other violent crimes such as
suicide, property damage, vehicular offenses, and sexual
perpetration. In the United States, crime-related costs of
substance abuse have been projected to be around $100
billion annually, and conservative estimates have indi-
cated that at least 1 million people have substance abuse
problems. Substance abuse is also a major contributing
factor to traffic and workplace accidents. Extreme
substance-related toxicity can contribute to psychotic
symptoms, although sometimes those symptoms pre-
ceded the substance use and were masked.

Biopsychosocial Model
Researchers use a biopsychosocial model to understand
addictive processes. Biological processes that have
been identified include physiological reactivity to the

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