John Andrew Mills

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/64264

#### **Abstract**

This chapter provides a broad overview of therapies for substance abuse. These therapies are understood in the context of the history of drug use in the United States and factors that influenced the expansion and regulation of substance use. This is followed by a discussion of how the complexity of these factors was associated with difficulties in understanding substance misuse and created challenges to the creation of effective treatment systems. The chapter reviews the moral and disease models of addiction before discussing the diagnosis of substance-related disorders. The chapter describes major treatment approaches and their efficacy.

**Keywords:** Substance abuse, Treatment

#### **1. Introduction**

This chapter will provide a brief overview of the history of substance abuse therapeutics and survey of approaches to the treatment of substance use disorders. To fit the history of, and approaches to, substance abuse therapeutics into a chapter of this type, great simplification is required; at the same time, the entire enterprise bears much resemblance to the well-worn parable of the group of blind men attempting to describe an elephant. The elephant parable illustrates beautifully that reasonable people may disagree vigorously about the essence of something by virtue of how they encounter it. This array of views has been likened to metaphors [1], but the significance of each metaphor has profound implications. So, while the parable of the men and the elephant *does* highlight the potential validity of differing perspectives on substance use, the parable *does not* do enough to consider the implications and consequences of substance abuse. Community and professional responses to substance use have reflected the untold conflict and enormous consequences that have still not yielded widely agreed upon responses to the

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destructive effects of substance use. The vast social issues include, but are certainly not limited to moral, legal, ethical, economic, political, sociological, and psychological considerations. So, it is virtually impossible to be exhaustive in one's review of these issues, and this chapter will focus only on the highlights of treatment of substance use conditions.

Modern data indicate that substance use and misuse continue to be widespread [2]. For 2014, nearly 140 million people over the age of 12 used alcohol, more than 60 million reported some binge drinking, and more than 16 million people reported heavy binge drinking in the United States. Estimates for the use of illicit drugs overall appear to be overshadowed by data pertaining specifically to marijuana use. More than 22 million people reported use of mari‐ juana, nearly 67 million reported use of tobacco, and more than 4 million persons reported misuse of prescription medication. Perhaps of greater concern than the reported patterns of use overall is the reported 17 million people whose self-reported use is consistent with a diagnosis of an alcohol use disorder and more than 21 million people whose self-reported use is consistent with a diagnosis of a substance use disorder. Clearly, misuse of psychoactive substances remains a significant problem.
