Substance abuse, including tobacco use and nicotine addiction, is associated with a wide range of serious health and social problems. Recent epidemiological evidence demonstrates that 72 conditions requiring inpatient treatment are wholly or partially attributable to substance abuse. Consequently, the estimated annual cost for health care, law enforcement, motor vehicle crashes, crime, and lost productivity due to substance abuse is nearly 1 thousand dollars for every American citizen, including children (Austin, 2005). Such disturbing situation with substance abuse can not but appeal for immediate and effective actions from the government and local authorities.
Although the problem of substance abuse is not new, the search for the most effective methods of coping with it is far from being over. Many different prevention and treatment options have been proposed up to date, but none of them can be addressed as the most universal or the most effective. Partially this is due to the fact that substance abuse is a condition with extremely complex and often controversial etiology; partially due to lack of serious scientific research exploring specific mechanisms of recovery. The increasing use of psychotherapeutic interventions in both prevention and treatment of substance abuse suggests that modern researchers and practitioners are taking efforts to finally close this gap. This paper will provide an overview of the most widely used psychotherapeutic interventions in treatment of substance abuse, and provide a detailed insight into the psychological foundations underlying one of the most popular therapies, namely the 12-step model.
The official definition of substance abuse proposed by the American Psychiatric Association (APA) identifies several distinct symptoms/patterns associated with this condition. APA defines substance abuse as a "maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household);
2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use);
3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct;
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights) (DSM-IV, 2000).
Apparently, the core characteristic of substance abuse is continued use of alcohol, tobacco, non-medically prescribed medications, drug or chemicals, which commonly leads to recurring socially negative consequences. Substance abuse is believed to be the major predictor of more severe conditions, namely substance addiction or dependence (Onken & Blaine, 1990). However, one should distinguish between them: abuse and dependence differ from addiction that involves a compulsion to continue using the substance