Archival Description of the
Treatment of Alcohol and Other Psychoactive Substance Use Disorders

Two sentence general description of the proficiency

This proficiency involves the application of psychological treatment to the misuse of alcohol, tobacco, prescription medications, and illegal drugs with the aim of assisting clients to cease or reduce use of these substances.   Because the chronic misuse of these substances often causes other emotional and interpersonal problems, the proficiency also involves the application of psychological treatment to reduce problems arising from the use of these substances.

What specialized knowledge undergirds the proficiency

Alcohol and substance use disorders involve biological, psychological, and social aspects.   These disorders involve the use of one or more psychoactive substances, which have specific effects on the physical and psychological state of the individual.   If taken frequently, physical dependence may develop in which the person requires more of the substance to achieve the same effect (tolerance) or exhibits physical symptoms ranging from nausea to convulsions when the substance is not available (withdrawal).   In addition, when used frequently, each of these substances can cause or exacerbate the development of a variety of medical problems.

Substance use, abuse and dependence are also influenced, in part, by a number of different psychological factors.   Individuals with one substance use disorder (e.g. alcohol dependence) often have another psychological disorder (e.g. depression).   Psychological processes such as observational learning, substance use expectancies, self-efficacy, and coping skills are key to understanding the development of alcohol and other substance use disorders.   In addition,   basic learning processes are influential in the development of physical dependence leading cues that are associated with the use of a substance to have effects that are similar to the substance or similar to withdrawal symptoms.

Social factors are also key influences on substance use disorders.    Among adolescents, peer norms and peer influence are important contributors to the onset of substance use.    Substance use disorders can have a deleterious impact on the individual’s social functioning, by disrupting marital and parental processes, impairing role functioning, and creating, both directly and indirectly, a variety of adverse and stressful challenges to the individual and his or her family.   Attempts to repair the social disruptions created by substance use disorders (e.g., peer influence and norms, cultural beliefs and biases, etc)   have been shown to facilitate recovery from the disorder

For what populations are the services of those individuals proficient in these contents particularly useful.

The population relevant to this proficiency includes those with a wide range of addictive behavior problems including alcohol and other substance abuse and dependence.   While it is true that alcohol and substance use problems are not confined to any single, specific population, certain characteristics are associated with a particularly high risk of these problems, including age, gender, ethnicity, marital status, and socioeconomic status.    Moreover, there are differences from one population to another with respect to the specific nature and development of substance use disorders.   For example, young African-American adults are at substantially lower risk for alcohol abuse or dependence than are other ethnic groups at this age.   However, among older cohorts, these differences disappear.    Similarly, substance abuse disorders are less common among the elderly.   However, medical problems and medications that are more common in this population can interact with alcohol and other substances to create potential health risks in the absence of a diagnosable disorder.   Other populations known to be at a higher risk for substance use disorders are the offspring of parents with substance use disorders, individuals from multi-problem families, and individuals involved in the criminal justice system. Knowledge concerning the nature and development of alcohol and substance use across the life span is particularly critical to the assessment and treatment of these populations.    More specific knowledge regarding the substance use of special populations at high risk for disorders is also critical.

For what problems are the services of those individuals proficient in these contents particularly useful?

Psychologists proficient in the treatment of alcohol and other psychoactive substance use disorders are able to provide services to individuals with different types of substance use problems and different levels of severity.    Proficient practitioners have demonstrated knowledge of the biological, psychological, and social aspects that are common to many substance use disorders as well as the aspects that more specific to a particular substance.    The skills and procedures are effective for those who want to quit smoking as well as for those who are dependent on alcohol, illegal drugs, or prescribed medications.   In addition, the skills and procedures are useful for individuals with relatively mild difficulties associated with the use of substances as well as for more severe individuals who are physically dependent upon the substances.  

What are the inter-linked skills and procedures that form the essential elements of the proficiency?

The discipline of psychology has developed a number of specialized procedures for the assessment, prevention, and treatment of substance abuse disorders. Assessment procedures include measures describing the pattern of substance use, problems associated with the use of the specific substance, the motives and expected outcomes of use, measures of addiction severity and substance dependency, as well as specific biological and behavioral observation methods.  

Current prevention and treatment interventions have been designed to address the biological, psychological, and interpersonal problems of individuals with alcohol and psychoactive substance use disorders.    One of the key issues that practitioner proficient in the treatment of alcohol and substance use disorders must address is the unwillingness of those with such problems to view their behavior as a problem or to seek treatment for their substance use.   There are specific interventions designed to accomplish this.   For example, community reinforcement approaches have been used with parents and partners of substance abusers in order to facilitate treatment entry.   Motivational Enhancement Therapy has been developed to help the substance abusers evaluate the pros and cons of their substance use with the aim of increasing their motivation to change at least some aspects of their substance use.   The psychologist proficient in the treatment of alcohol and substance use disorders must also have skills for addressing the issue of relapse after treatment.   Of primary importance in these programs is the identification of relapse triggers and situations that are likely to present coping difficulties, development of a treatment plan to address and cope with these triggers, and skill or coping skills training to enhance the likelihood of appropriate actions in the face of relapse situations and to foster a sense of efficacy in these situations.   Recognizing that many of these triggers arise out of interpersonal interactions, and the post-treatment interpersonal environment may interfere with or facilitate maintenance of treatment gains, addressing the nature of the social network has been an important aspect of treatment.   This has included social network therapy and therapeutic communities, as well as marital treatment in conjunction with treatment for substance abuse.   In this context, psychologists may refer clients to support groups after treatment to maintain treatment gains.   Psychologists have also provided collaboration in the development of behavior change programs that can be used in conjunction with pharmacological interventions (e.g., counseling and behavioral programs to augment the effects of drug treatment such as disulfiram, naltrexone, methadone, and nicotine replacement therapies).   Other forms of psychotherapy (including behavior therapy and cognitive therapy) have been appropriately modified to address problems of substance abuse and dependence.

Updated 12.05.05