Substance Abuse and Dependence
The misuse of alcohol and other drugs (such as marijuana, cocaine, heroin, or prescribed pharmaceuticals) currently represents one of the most serious and prevalent health problems. Although substance misuse disorders are classified as psychiatric diorders, problem drinking and drug use can lead to extensive physiological, social, and legal difficulties, as well. Furthermore, people who have alcohol or other drug problems have higher prevalence rates of Depression, Anxiety, and Personality disorders, than people in the general population. As such, a person with a substance misuse disorder faces a wide spectrum of potential difficulties, ranging from relationship disruption, to brain damage, imprisonment, and, potentially, death.

To learn more about the symptoms, consequences, and treatment of alcohol abuse, see the National Institute on Alcohol Abuse and Alcoholism.

To learn more about the medical consequences of alcoholism see:

• National Institute of Health Publications - Medical Consequences of Alcohol Abuse (PDF File)
• Rutgers Center of Alcohol Studies - Medical Consequences of Alcohol: Online Facts
• National Institute on Drug Abuse - Medical Consequences of Drug Abuse

Information on Alocohol Effects on the Liver:

• Medline Plus - Alcohol Liver Disease
• Merck Manuals - Alcoholic Liver Disease
National Institute on Alcohol Abuse and Alcoholism

To learn more about various drugs that are abused please see the National Institute on Drug Abuse website.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders classifies substance misuse disorders into two major categories, these being Substance Dependence and Substance Abuse.

Substance Dependence involves a pattern of problematic substance use that leads to clinically significant impairment or distress. It is determined by the presence of three or more of the following problems, taking place at any time in the same 12 month period:

• Tolerance-which is either a need for increased amounts of a drug in order to achieve intoxication, or a clearly diminished effect with continued use of the same amount of the drug.
• Withdrawal, which involves physical and/or psychological symptoms experienced in the absence of the substance, or the repeated use of the substance or a substitute, in order to avoid such symptoms.
• Taking a substance in larger amounts or over a longer period than was intended.
• A persistent desire, or unsuccessful efforts to cut down or control substance use.
• A great deal of time spent in activities related to obtaining a substance, using the substance, or recovering from its effects.
• Abandonment or reduction of important social, occupational, or recreational activities because of substance use.
• The substance use is continued despite the knowledge of having a persistent or recurrent physcial or psychological problem that is likely to have been caused, or made worse, by the substance.

The second category of substance misuse disorder, Substance Abuse,also represents a maladaptive pattern of alcohol or drug use. However, unlike Substance Dependence, the criteria for Substance Abuse do not include tolerance, withdrawal, or compulsive use. A diagnosis of Substance Abuse is indicated by the presence of one or more of the following criteria, occurring within a twelve month period:

• Recurrent substance use resulting in the failure to fulfill major role obligations at work, school, or at home (e.g. repeated absences, poor work performance, suspensions or expulsions from school, neglect of children or household).
• Recurrent substance use in situations in which it is physically hazardous (e.g. driving while under the influence of a substance).
• Recurrent substance related legal problems.
• Continued substance use despite having persistent or recurrent social or interpersonal problems caused, or exacerbated, by the effects of a substance.

Contrary to negativistic, commonly held beliefs, addictive disorders are highly treatable. Researchers have suggested that addiction treatment may be as successful as that for conditions such as hypertension, diabetes, or asthma.

Nevertheless, people with substance misuse disorders can be difficult to assess and treat for a variety of reasons. They may be difficult to motivate to pursue treatment, particularly during active addiction. For some people with substance misuse problems, the shame and stigma associated with addictive behaviors may discourage them from seeking help. In other cases, medical and psychological problems may hide the presence of a substance misuse disorder. As the sequelae of substance misuse affect so many levels of a person's life, an effective treatment plan must take into account numerous social, psychological, interpersonal, and physical variables.

Accordingly, healthcare professionals who treat people with substance misuse disorders must be prepared to tailor a treatment approach to each individual. Involvement in self-help or 12-step recovery groups, medication compliance, and behavioral skills training are all elements which may be brought to bear in different proportions, in treating a person with a substance misuse disorder.

Cognitive Therapy of substance misuse disorders addresses these various factors as it countermands the dysfunctional thoughts, problematic behaviors, and maladaptive coping strategies, which initiate and maintain an addictive disorder. While Cognitive Therapy may be pursued as a single strategic approach in the treatment of alcohol and other drug misuse disorders, it is often used in conjunction with medication, group therapies, and 12-Step programs. Indeed, advances in the development of Cognitive Therapy (CT) of substance misuse disorders have often explicitly involved the integrating CT and other modalities, such as 12 step facilitation.

As is the case in the treatment of other disorders, Cognitive Therapy for substance misuse problems involves a unique case conceptualization for each patient. This forms the basis for a strong collaborative relationship between patient and therapist. Through such collaboration, the patient and therapist proceed to utilize specific, goal-oriented techniques. During therapy sessions, as well as in self-help homework assignments, patients pursue solution focused strategies, which address the realities of recovery from addictive disorders. Psychotherapeutic innovations in relapse prevention are often implemented over the course of Cognitive Therapy for alcohol and other drug misuse disorders. Patients are taught to address and resolve naturally arising ambivalence about treatment in order to develop their motivation and progress toward their treatment goals.

Since Cognitive Therapy has evidence based techniques as its foundation, various techniques such as cue exposure, drug refusal training, and methods for coping with craving are used to help a patient break their pattern of addiction. Furthermore, as addictive disorders often involve deficits in areas such as social skills, management of emotions, and tolerance of difficult emotions, patients often pursue progress in these areas through Cognitive Therapy.

The rationale of Cognitive Therapy holds that substance abuse is learned, and, therefore, it can be "unlearned" and stopped through the use of cognitive-behavioral techniques. Understandably, a person with a substance misuse disorder faces many challenges, and, potentially, many serious consequences. By engaging in Cognitive Therapy, such an individual can take part in an effective, flexible, and evidence based therapy. In doing so, they can avail themselves of a unique treatment plan, tailored to their needs, a respectful and collaborative therapeutic relationship, and a solution focused therapy, all of which can facilitate the overall lifestyle change and recovery from addiction which they need.

SMART Recovery is a self-help group program that addresses the dysfunctional thoughts, problematic behaviors, and maladaptive coping strategies associated with alcohol and substance abuse. SMART Recovery is a viable alternative to 12-step model groups, such as Alcoholics Anonymous and Narcotics Anonymous. To learn more, please visit www.smartrecovery.org.

Some data on this page was derived and/or influenced by the writings of Robert L. Leahy B.A., M.S., Ph.D., Director of the American Institute for Cognitive Therapy