ALCOHOL AND SUBSTANCE ABUSE - 02/09/11
Résumé |
Substance use disorders are among the most common psychiatric disorders found in the United States today. In the United States, one in four individuals meets the criteria for a substance use disorder at some time in their lives. The consequences of substance use disorders are far-reaching and have social, economic, and medical implications.
Substance abuse involves using a substance despite persistent social, interpersonal, or other problems caused by use of the substance. Substance dependence is a more severe disorder, which entails signs of physical or psychologic tolerance or dependence. Treatment of substance use disorders generally targets the substance-dependent population. Substance abuse also can cause problems, however, that require medical attention. There has been an emphasis on early intervention and treatment in the hopes of avoiding the development of substance dependence and its consequences.32, 33
Information concerning the neurobiology of substance use disorders exploded in the 1990s. As the basic science knowledge concerning brain circuitry, reward systems, and the effects of substances of abuse has expanded, the development of pharmacologic agents for the treatment of substance use disorders has received increasing attention. This move toward pharmacologic treatment in the substance abuse area has not been trouble-free. For a long time, the substance abuse treatment community consisted primarily of nonmedical personnel. In contrast to the treatment of most psychiatric disorders, the use of pharmacologic agents in the treatment of substance use disorders is not accepted in every treatment setting. Although there is a growing trend toward increased acceptance of pharmacotherapy as one of several successful approaches that might be considered in the treatment of a patient, much work remains to be done.
Nonpharmacologic treatments have been the mainstay of substance abuse treatment since the 1940s. Several different approaches have shown reliable success, including participation in 12-step programs, cognitive behavioral treatments,71 and family therapy targeting dysfunctional family relationships that support and maintain addictive behaviors.4, 11 Contingency management coupled with community reinforcement is a new treatment that is built on the principles of behavioral psychology and uses positive reinforcement to maintain abstinence and promote healthy activities in the home environment. This therapeutic modality has shown remarkable success in decreasing substance use across a wide variety of populations.55
In the 1990s, motivational interviewing,78 which is grounded in decision-making theory and motivational psychology, gained empirical support as an intervention capable of promoting behavioral change in addictive disorders.71, 102 This relatively brief and simple intervention is designed to create a self-awareness of behavior and how a behavior may be creating problems for an individual. The style of the interview is empathic and nonjudgmental, and the intervention is designed to engage the individual in making the decision that change is necessary. Motivational interviewing is important to this article because it has been used successfully in primary care and emergency department settings to help patients begin the process of change.10
In general, psychosocial treatments can be used for many substance use disorders and are not specific to certain substances of abuse. One exception is treatment of nicotine dependence, in which many of the principles of treatment are the same, but the lack of devastating social consequences and the specific cues associated with smoking make specialized treatment programs for nicotine dependence an appropriate referral. Substance use disorders are treatable disorders,87 and there are efficacious, rigorously tested pharmacologic and psychotherapeutic treatments. Primary care and other medical providers should be aware of the treatment resources available in their community for referral. This article provides an overview of specific substances of abuse, detailing clinical presentation and medical sequelae of specific disorders and substance-specific (generally pharmacologic) treatments.
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| Address reprint requests to Aimee L. McRae, PharmD, Center for Drug and Alcohol Programs, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425. e-mail: mcraeal@musc.edu |
Vol 85 - N° 3
P. 779-801 - mai 2001 Retour au numéro
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