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All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.
Alcohol use disorder (AUD) is a major public health problem in the United States. The estimated 12-month and lifetime prevalence values for AUD are 13.9% and 29.1%, respectively, with approximately half of individuals with lifetime AUD having a severe disorder. AUD and its sequelae also account for significant excess mortality and cost the United States more than $200 billion annually. Despite its high prevalence and numerous negative consequences, AUD remains undertreated. In fact, fewer than 1 in 10 individuals in the United States with a 12-month diagnosis of AUD receive any treatment. Nevertheless, effective and evidence-based interventions are available, and treatment is associated with reductions in the risk of relapse and AUD-associated mortality. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder seeks to reduce these substantial psychosocial and public health consequences of AUD for millions of affected individuals. The guideline focuses specifically on evidence-based pharmacological treatments for AUD in outpatient settings and includes additional information on assessment and treatment planning, which are an integral part of using pharmacotherapy to treat AUD. In addition to reviewing the available evidence on the use of AUD pharmacotherapy, the guideline offers clear, concise, and actionable recommendation statements, each of which is given a rating that reflects the level of confidence that potential benefits of an intervention outweigh potential harms. The guideline provides guidance on implementing these recommendations into clinical practice, with the goal of improving quality of care and treatment outcomes of AUD.
This eminently practical guide presents an empirically supported approach for treating people with substance abuse problems and their spouses or domestic partners. Behavioral couples therapy (BCT) explicitly focuses on both substance use and relationship issues, and is readily compatible with 12-step approaches. In a convenient large-size format, the book provides all the materials needed to introduce BCT; implement a recovery contract to support abstinence; work with clients to increase positive activities, improve communication, and reduce relapse risks; and deal with special treatment challenges. Appendices include a session-by-session treatment manual and 70 reproducible checklists, forms, and client education posters.
This volume reviews a range of empirically supported approaches to prevention and treatment of adolescent substance use problems. The focus is on motivationally based brief interventions that can be delivered in a variety of contexts, that address key developmental considerations, and that draw on cutting-edge knowledge on addictive behavior change. From expert contributors, coverage encompasses alcohol skills training; integrative behavioral and family therapy; motivational interviewing; interventions for dually diagnosed youth; Internet-based education, prevention, and treatment; and applications to HIV prevention. The volume is extensively referenced and includes numerous clinical illustrations and vignettes.
Disorders of anxiety and substance use are, for some reason, rarely treated in an integrated fashion by professionals. This timely volume addresses this glaring omission with dispatches from the frontlines of research and treatment. Thirty-four international experts offer findings, theories, and intervention strategies for this common form of dual disorder, across a range of substances and of anxiety disorders, to give the reader comprehensive knowledge in a practical format.
The first edition of this book was based upon the recommendations of the Quality Assurance in the Treatment of Drug Dependence Project, and provided a step-by-step-guide for therapists working with clients with alcohol or other drug dependency or misuse. Since publication in 1995 it has become well known for its easy-to-read style and wealth of practical resource materials. However, the evidence in the field has moved forward in the last eight years, creating a need for an updated edition. Retaining the trademark easy-to-use, up-to-date style, the Second Edition offers new chapters on pharmacotherapies, case management, young people, and dual diagnosis. Other chapters have been updated to reflect the latest research findings and current practice, and the practice sheets and client handouts are made available online for downloading and customization by therapists.
A Comprehensive, Systematic Evaluation of Treatment Effectiveness for Major Psychological Disorders With over 500 types of psychotherapy being practiced in the field today, navigating the maze of possible treatments can be daunting for clinicians and researchers, as well as for consumers who seek help in obtaining psychological services. Evidence-Based Psychotherapy: The State of Science and Practice offers a roadmap to identifying the most appropriate and efficacious interventions, and provides the most comprehensive review to date of treatments for psychological disorders most often encountered in clinical practice. Each chapter applies a rigorous assessment framework to evaluate psychotherapeutic interventions for a specific disorder. The authors include the reader in the evaluation scheme by describing both effective and potentially non-effective treatments. Assessments are based upon the extant research evidence regarding both clinical efficacy and support of underyling theory. Ultimately, the book seeks to inform treatment planning and enhance therapeutic outcomes. Evidence-Based Psychotherapy: The State of Science and Practice: Presents the available scientific research for evidence-based psychotherapies commonly practiced today Systematically evaluates theory and intervention efficacy based on the David and Montgomery nine-category evaluative framework Covers essential modes of treatment for major disorders, including bipolar disorder, generalized anxiety disorder, PTSD, eating disorders, alcohol use disorder, major depressive disorder, phobias, and more Includes insightful discussion of clinical practice written by leading experts Clarifies “evidence-based practice” versus “evidence-based science” and offers historical context for the development of the treatments under discussion Evidence-Based Psychotherapy: The State of Science and Practice is designed to inform treatment choices as well as strengthen critical evaluation. In doing so, it provides an invaluable resource for both researchers and clinicians.
Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.
This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies, treated by different therapists, that vividly illustrate this treatment approach with a wide variety of clients. Harm reduction is a framework for helping drug and alcohol users who cannot or will not stop completely—the majority of users—reduce the harmful consequences of use. Harm reduction accepts that abstinence may be the best outcome for many but relaxes the emphasis on abstinence as the only acceptable goal and criterion of success. Instead, smaller incremental changes in the direction of reduced harmfulness of drug use are accepted. This book will show how these simple changes in emphasis and expectation have dramatic implications for improving the effectiveness of psychotherapy in many ways. From the Foreword by Alan Marlatt, Ph.D.: “This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies, treated by different therapists, that vividly illustrate this treatment approach with a wide variety of clients. In his introduction, Andrew Tatarsky describes harm reduction as a new paradigm for treating drug and alcohol problems. Some would say that harm reduction embraces a paradigm shift in addiction treatment, as it has moved the field beyond the traditional abstinence-only focus typically associated with the disease model and the ideology of the twelve-step approach. Others may conclude that the move toward harm reduction represents an integration of what Dr. Tatarsky describes as the “basic principles of good clinical practice” into the treatment of addictive behaviors. “Changing addiction behavior is often a complex and complicated process for both client and therapist. What seems to work best is the development of a strong therapeutic alliance, the right fit between the client and treatment provider. The role of the harm reduction therapist is closer to that of a guide, someone who can provide support an
This book has been replaced by Treating Alcohol and Drug Problems in Psychotherapy Practice, Second Edition, ISBN 978-1-4625-5086-9.