All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.

"Implementing Evidence-Based Practices for Treatment of Alcohol and Drug Disorders" provides managers and clinicians with results from Practice Improvement Collaboratives (PIC) that demonstrate how substance abuse treatment can be improved by increasing the exchange of knowledge between community-based service providers and the research community. The book examines improvement collaboratives and mentoring strategies for adopting and using evidence-based practices. Contributors address how to determine the best treatment processes to serve clients, how to deal with the hurdles faced in preparing and training counsellors, and how to affect the needed changes in agency activities. This unique professional resource responds to an Institute of Medicine report that found a substantial disconnect between research and practice in treatment for drug and alcohol dependence. Focusing on how to make the changes necessary to support the adoption and use of evidence-based practices, the book documents the activities of four sites to illustrate how investigators and treatment practitioners worked together to implement evidence-based practices. Contributors examine the development and early implementation of Practice Improvement Collaboratives, the investigator-provider-policymaker model, Motivational Enhancement Therapy, the use of Opinion Leaders in training, and targeted strategies that take into account the differences in clinician demographics and training. "Implementing Evidence-Based Practices for Treatment of Alcohol and Drug Disorders" is an essential tool for alcohol and drug counsellors, directors of alcohol and drug treatment clinics, and instructors in counsellor training and academic programs.

Integrating Psychological and Pharmacological Treatments for Addictive Disorders distills the complex literature on addiction, offering a curated toolbox of integrated pharmacological and psychotherapeutic treatments in chapters authored by leading experts. Introductory chapters on the epidemiology, etiology, and fundamentals of addiction treatment provide a concise overview of the state of the field. Subsequent chapters then focus on the treatment of specific substance use disorders and on gambling disorder. Finally, a chapter on the treatment of addiction in primary care addresses the opportunities for clinical care in non-specialist outpatient settings. Physicians, psychologists, social workers, and other mental health professionals will come away from the book with an essential understanding of evidence-based practice in treating addiction and the scientific foundations of those approaches. .

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

Alcohol use disorder (AUD) is a major public health problem in the United States. The estimated 12-month and lifetime prevalence values for AUD are 13.9% and 29.1%, respectively, with approximately half of individuals with lifetime AUD having a severe disorder. AUD and its sequelae also account for significant excess mortality and cost the United States more than $200 billion annually. Despite its high prevalence and numerous negative consequences, AUD remains undertreated. In fact, fewer than 1 in 10 individuals in the United States with a 12-month diagnosis of AUD receive any treatment. Nevertheless, effective and evidence-based interventions are available, and treatment is associated with reductions in the risk of relapse and AUD-associated mortality. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder seeks to reduce these substantial psychosocial and public health consequences of AUD for millions of affected individuals. The guideline focuses specifically on evidence-based pharmacological treatments for AUD in outpatient settings and includes additional information on assessment and treatment planning, which are an integral part of using pharmacotherapy to treat AUD. In addition to reviewing the available evidence on the use of AUD pharmacotherapy, the guideline offers clear, concise, and actionable recommendation statements, each of which is given a rating that reflects the level of confidence that potential benefits of an intervention outweigh potential harms. The guideline provides guidance on implementing these recommendations into clinical practice, with the goal of improving quality of care and treatment outcomes of AUD.

Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade-in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD). To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM's task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.