History Opiates have been used for thousands of years, with evidence of opium poppy (known as Hul Gil, “joy plant”) cultivation more than 5000 years ago among the Sumerians in the area of Mesopotamia, near modern day Iraq. Its use for rituals and mystical purposes is evidenced by poppy seed capsules discovered in burial sites in Neuchatel, Switzerland and the Cueva de los Murciélagos , Spain,…
Strategies for Selecting Candidate Medications for Testing Bottom–Up Approach: Modulation of Appetitive Drives Preclinical animal models of cocaine addiction, self-administration, reinstatement, and cue reactivity are commonly used to screen compounds for their potential as medications for treating cocaine dependence. These models, although helpful in selecting compounds, have very limited predictive validity. This issue is a critical one and will not be resolved fully until an effective…
Introduction Alcohol was used in Egypt since the time of the pharaohs, when wine played an important part in ceremonial life. . Egyptian texts more than 8000-years-old made reference to alcohol abuse and its consequences. The ancient Greeks were also experienced with alcohol use disorders. They first drank as part of a religious ritual to please their gods and forget their worries. but soon realized that…
Acknowledgments We are grateful to Elsevier for permission to reproduce some text from a recent review article. We also thank the National Institute on Alcohol Abuse and Alcoholism for its support through grants 5 R01 AA010522–14, 5 R01 AA012964–06, 5 R01 AA014628–04, and 5 R01 AA013964–05; the National Institutes of Health for its support through University of Virginia General Clinical Research Center Grant M01 RR00847, and…
Acknowledgments Department of Veterans Affairs Health Services Research and Development Service funds (RCS 00-001) supported preparation of the manuscript. The views expressed here are those of the author. Introduction Twelve-step mutual-help groups, often also called self-help or support groups, are an important component of the system of care for individuals with substance use disorders. Individuals make more visits to mutual-help groups for help with their own…
Introduction Since we finished this chapter in 2012, there has been a notable gap in therapeutic community outcome research. Although systematic reviews of the research in recent years on the therapeutic community conclude that therapeutic communities produce positive outcomes on substance use, employment, criminality and psychological health, both interest and financial resources in support of this model have atrophied. Chief among the likely causes of this…
Acknowledgment This paper was supported by grants from the National Institute on Drug Abuse (No. DA13814, DA016090, DA020138, and P50 DA16094). Introduction Schools are an efficient and convenient choice of setting for intervention programs targeting adolescents. Schools provide access to a large number of adolescents in a learning environment in which adolescents are more likely to be receptive toward instructions involved in an intervention. Moreover, monitoring…
Introduction Compared with other nations, the United States incarcerates the largest percentage of its citizens, with close to 7 million adults and 650,000 youth under some form of criminal justice supervision, including prison, jail, and probation or parole supervision in the community. Incarceration in the United States costs nearly $1.2 trillion each year in incarceration and societal costs, and 40%–60% of prison intakes result from failures…
Introduction The Health and Medicine Division, National Academies of Sciences, Engineering and Medicine has provided a working definition of primary care: Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. This definition emphasizes several…
Introduction The first section of this chapter traces the history of community clinic treatment for substance use disorders. Next, the chapter reviews various venues for community treatment and the effectiveness of approaches used where this is known. The definition of substance use disorders has been taken from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). There, “substance-related and addictive disorders”…
Defining Self-Help Help from without is often enfeebling in its effects, but help from within invariably invigorates. Self-help approaches to addiction encompass those strategies designed to reduce or eliminate substance use and/or associated negative consequences. As a construct, the boundaries that define self-help are potentially blurred. Virtually all successful and lasting change involves some degree of self-help and some measure of support by others. For the…
Drug Use and Problems A broad range of treatment approaches are available and necessary for the management of persons with problem drug and/or alcohol use. Individuals with problem substance use can present anywhere along a continuum, from early stage problems associated with acute, recreational, or binge use to severe dependence with major physical and psychosocial problems. This latter group commonly has multiple health problems with poor…
Introduction In the struggle to be free from addiction, for most individuals, repeated attempts are required to stop the addictive behavior. Multiple attempts to change and multiple treatment events are the norm rather than the exception in recovery from addiction. There seems to be a predictable cycle in the path to recovery. Once addicted individuals become convinced that they need to change problematic addictive behaviors (illegal…
Introduction This chapter describes the rationale behind and evidence in support of the efficacy of two reinforcement-based therapies: community reinforcement approach therapy and contingency management. The first section of the chapter reviews the evidence for the community reinforcement approach and recent studies extending the approach to adolescents with substance use disorders. The second section of this chapter details the theoretical basis and evidence of efficacy for…
Introduction With the most recent revision (Fifth Edition) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), addictions are included in a larger category of Substance-Related and Addictive Disorders. Substance use disorders (SUDs) are now subcategorized into three levels of severity (mild, moderate, and severe). The specific criteria individuals must meet has remained similar, with recurrent legal problems no longer serving as a criterion, and…
What Is Motivational Interviewing? Motivational interviewing (MI) is a therapeutic approach used to explore and resolve ambivalence about behavior change. There is a strong evidence base to suggest that it reduces substance use problems and a growing evidence base for other problems. MI is an empathic therapeutic approach that explores and resolves lingering ambivalence about change. The clinician intentionally pursues the resolution of ambivalence and initiation…
Overview Hoarding disorder (HD) is defined as the acquisition of—and inability to discard—a large number of possessions, to a degree that precludes intended use of living spaces and creates significant distress or impairment in functioning. Hoarding can interfere with an individual’s ability to work, interact with others, and perform basic activities, such as eating or sleeping. In severe cases, it may lead to dangerous, even life-threatening…
Introduction In recent decades, one area of research on media effects has shed extensive light on problematic behavior in the use of media, particularly the overuse or the maladaptive use of the Internet, which is commonly known as Internet addiction (IA). Previous research supported the notion that the excessive use of technology could be problematic. Young posited that IA could be defined as an impulse-control disorder…
Introduction Due to the magnitude of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) epidemic, and its profound impact on public health and social structures, an emphasis on the behavioral, social, and cultural factors associated with sexual risk and its relation to HIV transmission has been essential. However, an unanticipated artifact of disease-focused research is that much of the contemporary knowledge related to sexual…
Introduction Kraepelin and Bleuler first identified oniomania, or the urge to buy, in the early 1900s. Today, compulsive buying is likely a much different phenomenon from what it was when Kraepelin and Bleuler first conceptualized the disorder. In the United States, and likely in all industrialized nations, consumer spending takes place in both public places such as shopping centers, discount stores, or rummage sales and in…