Cognitive and Behavioral Approaches for Treating Substance Use Disorders Among Behavioral Medicine Patients

Allison K. Labbe, Julie Yeterian, Julianne G. Wilner, and John F. Kelly

Introduction

Substance use and substance use disorders (SUD), including alcohol, are a serious public health concern. For example, from 2010 to 2012 the rate of heroin overdose doubled [1], and from 1999 to 2010 the overdose rate from prescription opioid medications has quadrupled [1]. In fact, in 2012 drug overdose was the leading cause of injury death among people aged 18-64 years, and overdose caused more deaths than motor vehicle accidents [1]. And, in 2011 drug misuse was related to

2.5 million emergency department visits [2]. Especially among individuals with a co-occurring medical condition, substance use can negatively affect treatment adherence (e.g., [3-16]) as well as disease progression and outcome (e.g., [1721]), and it is significantly related to increased mortality, particularly among medically ill people (e.g., [5, 9, 10, 22]).

A.K. Labbe, Ph.D. (*) • J.G. Wilner, M.A.

Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital,

Harvard Medical School, Boston, MA, USA

e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ; This email address is being protected from spam bots, you need Javascript enabled to view it

J. Yeterian, M.A.

Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital,

Boston , MA , USA

e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

J. F. Kelly, Ph.D.

Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital,

60 Staniford Street , Boston , MA 02114 , USA

Department of Psychiatry, Center for Addiction Medicine, Massachusetts General Hospital,

Boston , MA , USA

e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it © Springer Science+Business Media New York 2017

A.-M. Vranceanu et al. (eds.), The Massachusetts General Hospital

Handbook of Behavioral Medicine, Current Clinical Psychiatry,

DOI 10.1007/978-3-319-29294-6_4

Substance use disorders are caused by the interaction of multiple variables. These include genetic, biological, and environmental factors, as well as exposure to the specific drug. Addiction has a strong genetic component, accounting for approximately 50 % of the risk [23, 24]. When this predisposition is combined with stress- inducing environmental factors, such as developmental trauma, poverty, unemployment, and psychiatric illness, along with exposure to substances (especially during teenage years), risk for developing SUD increases [25]. Drug-specific pharmacological effects, as well as the potency, concentration, and speed at which the drug reaches the brain following administration, also independently influence perceived reward and SUD risk. The fastest routes to the brain are via the lungs (smoking), followed by injection (intravenous), nasal (snorting), and oral (drinking/ eating).

SUD presentation in clinical practice is highly heterogeneous and will differ within and across settings. In fact, the DSM-5 [26] diagnosis of SUD encompasses a broad range of severity. Individuals are diagnosed with mild (2-3 symptoms), moderate (4-5 symptoms), or severe (6 or more symptoms) SUD, depending on how many of the 11 symptoms they endorse. Individuals who use substances, but do not endorse at least two symptoms of SUD would not be classified as having the disorder.

The rates of alcohol and other substance use disorders in the United States are high. In 2013, 21.6 million people were classified with DSM-IV dependence or abuse [25]. Among this group, 14.7 million people were classified with alcohol abuse or dependence, 4.2 million met criteria for marijuana abuse or dependence, and 1.9 million met for prescription opioid abuse or dependence [25]. What is noteworthy is that 20.2 million people in the United States ages 12 and older who were classified as needing treatment for a substance use disorder did not receive specialty treatment, and that only 4.5 % of these people classified as needing treatment believed they actually needed treatment [25]. Overall, the data indicate that people with a substance use disorder are especially undertreated.

 
Source
< Prev   CONTENTS   Source   Next >