Running Commentary

As you will see in this special issue of the Monitor, psychologists are becoming increasingly involved in the substance abuse field, an area that offers tremendous opportunities for research and treatment. Psychologists have much to contribute to understanding, diagnosing, treating and preventing one of society's most pressing problems.

For the past few decades, national surveys have consistently shown that about 10 percent of American adults have significant problems related to their own use of alcohol. In addition, about 25 percent of adults have reported that they use tobacco on a regular basis and about 7 percent use illegal drugs.

Taken collectively, substance abuse problems are the most frequently occurring health and mental health problems. Yet they are also underdiagnosed and undertreated. And as alarming as these statistics may be, they do not even take into account the toll of substance abuse on families, workplaces and communities.

While substance abuse problems are highly prevalent in the general population, they are even more common in people being treated by psychologists and health-care professionals for other problems. Substance abuse often co-exists with depression, anxiety, marital difficulties and personality disorders.

Barriers facing psychologists

Even so, psychologists have sometimes been reticent to get involved in the assessment and treatment of substance abusers. Instead of treating these problems themselves, they have often referred clients to specialized programs or self-help groups.

Why? Psychologists confront several barriers. One is that many U.S. graduate psychology programs provide little training in substance abuse treatment. Patients are often referred elsewhere because unlike other people suffering from major behavioral disorders, people with addictions are often referred to addiction recovery programs run by people who are themselves recovering from substance abuse on the assumption that this qualifies them better than professional training.

Other patients are referred to self-help programs like Alcoholics Anonymous and Narcotics Anonymous, which can provide valuable support, but are not a substitute for the broader care needed by many people who have co-existing problems.

Another barrier is that addictions have often been viewed through the lens of a medical model that says that abuse problems are genetically based and best treated in inpatient medical facilities or residential treatment programs, especially in the initial phases of treatment.

In recent years, there has been a growing trend to treat substance abusers within the community in which they live, where they must learn to retain new habits in the midst of the pressures of their daily lives. Often, they must also learn to develop and maintain new lifestyles that support the change in behavior. Psychologists, by their general training, are highly qualified to treat these kinds of behavioral problems.

Psychological treatment has been shown to be very effective in treating addiction problems. In addition, psychologists can work with clients to reduce the risk of relapse and to develop and maintain motivation. Because people who have substance abuse problems often have complex, interwoven problems, it makes sense for them to be treated by a psychologist who can treat their substance abuse within the context of their other problems and their day-to-day lives.

Training and opportunities

Of course, if psychologists are to work effectively in substance abuse, they must have the necessary knowledge and skills. Recognizing this need, the APA Practice Organization's College of Professional Psychology selected treatment of substance abuse disorders as the first proficiency area of certification. Six state agencies now cite the APA Practice Organization College of Professional Psychology Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Use Disorders among their eligibility criteria for professionals to be involved with certain treatment programs. Today, more people are getting APA certification in substance abuse than ever before.

As you'll see in this issue, research opportunities in substance abuse are also promising. Psychologists and other scientists are studying exciting, newly emerging areas in brain research to develop a better understanding of marijuana dependence. Brain imaging studies are highlighting the role of the frontal lobe function in addiction, both before and after drug abuse. And there are exciting developments in smoking-cessation research. Psychologists are making many important contributions to understanding and treating substance abuse problems--and the future for their work in this realm looks promising.