Substance Use Problems

By Mitch Earleywine, PhD

Course Outline

Health professionals in a range of settings are bound to meet clients with troubles related to drugs. The literature on their diagnosis and treatment is filled with successful, empirically based approaches, but also with controversy and hearsay. Separating the myths from the facts can be difficult. This text does so, providing trainees and professionals with a handy, concise guide for helping problem drug users build enjoyable, multifaceted lives using approaches based on decades of research. Readers will be able to improve their intuitions and clinical skills by adding an overarching understanding of drug use and the development of problems that translates into appropriate techniques for encouraging clients to change behavior themselves. Each strategy and process rests on maintaining a genuine, empathic, therapeutic relationship. The highly readable text explains not only what to do, but when and how to do it. Seasoned experts and those new to the field will welcome the chance to review the latest developments in guiding self-change for this intriguing, prevalent set of problems.

About the Authors

Mitch Earleywine, PhD, is Associate Professor of Clinical Psychology at the University at Albany, State University of New York, where he teaches drugs and human behavior, substance abuse treatment and clinical research methods. He has received 10 teaching commendations, including the coveted General Education Teaching Award from the University of Southern California. His research funding has come from the National Institute on Alcohol Abuse and Alcoholism, the Alcoholic Beverage Medical Research Foundation, and the Marijuana Policy Project. He serves on the editorial boards of four psychology journals, reviews for over a dozen, and has more than 80 publications on drug use and abuse, including “Understanding Marijuana” (Oxford University Press, 2002). He serves on the advisory board for the National Organization for the Reform of Marijuana Laws, and is a member of the Research Society on Alcoholism, the Association for the Advancement of Behavior Therapy, and the Drug Policy Alliance.

Learning Objectives

After completing this course you’ll be able to:

  1. Describe the continuum of drug use according to Figure 1.
  2. Describe a users expectations when drinking alcohol.
  3. State the most effective way for mental health professionals to learn about drugs.
  4. Describe the percent of Americans who have used an illicit drug.
  5. List and define dependence symptoms (Table 3).
  6. List abuse symptoms (Table 4).
  7. State the most prevalent illicit drug across nations.
  8. State which ethnic group has a higher percentage of drug use
  9. State which groups received the diagnosis of abuse and dependence most often.
  10. State the age at which most drug use begins and why this is the best predictor of problems.
  11. Discuss the effects of comorbidities and the prognosis.
  12. Discuss drug problems among those with problem gambling, eating disorders and attention deficit disorder.
  13. Discuss the borderline personality disorder and substance abuse.
  14. Discuss suicide attempts among drug dependent individuals.
  15. Discuss substance abuse and genetics.
  16. List several factors that improve treatment.
  17. Discuss note taking when conducting an assessment.
  18. Describe the Timeline Follow-Back.
  19. Describe the contemplation ladder.
  20. Discuss the research of Jungerman, et al., 2007 regarding duration of treatment.
  21. List safer methods of drug administration when compared to intravenous administration.
  22. List several events that impact a drug user’s trajectory.
  23. Describe motivational interviewing.
  24. Define self-efficacy.
  25. Describe the decisional balance.
  26. Define challenging.
  27. Define prolapsed, relapse, and lapse.
  28. Describe the interpersonal and intrapersonal categories.
  29. Define alexthymia.
  30. Describe the 12-step facilitation therapy (TSF).
  31. Describe Vipassana meditation.
  32. List several drugs approved for treatment for drug-related and alcohol disorders.

Course Contents

  1. Description of Problem Drug Use
    1. Terminology
      1. Diagnostic Terms
      2. Common Drugs
      3. Nonproblematic, Recreational Drug Use
      4. Problematic Drug Use
    2. Definitions
      1. Dependence
      2. Abuse
      3. Codes from the Diagnostic and Statistical Manual
      4. Drug Problems
    3. Epidemiology
      1. World Statistics
      2. Demographic Correlates
      3. Recent Use
      4. Abuse and Dependence
    4. Course and Prognosis
      1. Chronicity
    5. Differential Diagnosis
      1. Deviant Arousal
      2. Thought Disorder
    6. Comorbidities
      1. Impulse control disorders
      2. Problem Gambling
      3. Eating Disorders
      4. Attention Deficit Disorders
      5. Conduct Disorder
      6. Personality Disorders
      7. Mood Disorders
      8. Anxiety Disorders
      9. Suicide
    7. Diagnostic Procedures and Documentation
  2. The Biopsychosocial Model of Drug Problems
    1. Interacting Components
    2. Initiation
    3. Regular Use
    4. Problem Use
    5. Treatment Outcomes
  3. Diagnosis, Assessment and Treatment Indications
    1. General Guidelines
      1. Assessment IS treatment
    2. A Note on Taking Notes
    3. The Timeline Follow-Back (TLFB)
      1. Encouraging Assessment
    4. The Inventory of Drug Use Consequences (InDUC)
    5. Motivation to Change
    6. Treatment History
    7. Social Support
  4. Methods of Treatment
    1. Overview
      1. Empirically supported treatments (ESTs)
      2. Harm Reduction, Drug Safety, and Abstinence
    2. Efficacy and Prognosis
    3. The Therapeutic Relationship as a Mechanism of Action
      1. Empathy
      2. Warmth
      3. Genuineness
    4. Combinations of Methods
      1. Motivational Interviewing
      2. Mutual Help and Self-Help Groups
      3. Meditation Techniques
      4. Psychopharmacological Adjuncts to Treatment
    5. Multicultural Issues
  5. Further Readings
  6. References
    • Inventury of Drug Use Consequences
    • Shortened Inventory of Problems – Alcohol and Drugs


“I really liked this book, but struggled with writing an endorsement that really captured my enthusiasm for what Mitch Earleywine has achieved. Every aspect of the book echoes the best in theory, research and practice that I have learned over my 30-year career in the addiction field. I could not recommend it more highly.” – George A. Parks, PhD, Associate Director, Addictive Behaviors Research Center, University of Washington, Seattle, WA

“Dr. Earleywine has produced a wonderful introductory volume for practitioners and others who want to learn the current state of the art in empirically validated assessment and treatment of substance use disorders. In a refreshing departure from ideologically driven views of substance use and substance users, he has followed the science to produce a readable, informative volume.” – Frederick Rotgers, PsyD, ABPP, Program Director of Clinical Psychology PhD, Walden University, Minneapolis, MN

“Mitch Earleywine’s ‘Substance Use Problems’ is the ideal volume for teaching students the issues involved in contemporary treatment of substance abuse problems. This is unsurprising – since Dr. Earleywine has been teaching this subject for the last 17 years while regularly winning awards in the process – along with accolades from his students. The qualities that produce these reactions to his teaching are everywhere evident in this volume – clear writing and explanation, strong knowledge of the important research in the field, respect for readers, students, treatment clients, and counselors, and a cutting edge familiarity with modern therapy techniques (like motivational interviewing) and emerging trends in the treatment field (like harm reduction), along with respectful attention to established treatment approaches and groups like the twelve steps and AA. In the same pithy and hard-hitting volume, Dr. Earleywine manages both to convey empathic hints and subtly nuanced techniques to counselors in training, while describing diagnostic systems and epidemiological data on who is susceptible to substance abuse and how they are likely to fare — with and without treatment. Mitch Earleywine’s volume is a beacon of light, good judgment, and balance in this rapidly changing and contentious field.” – Stanton Peele, PhD, Author, 7 Tools to Beat Addiction; Creator, Life Process Program

“Extremely comprehensive–can be a very useful tool for those clinicians dealing hands on with asthma patients on a frequent basis.” – C.W., Palo Alto, CA

“Because I have ASTHMA & also a grandchild suffers ASTHMA, I found this extremely educational, informative and helpful.” – D.K., Templeton, CA

“Very informative & helpful–were pass informative to family (son-in-law) has severe asthma & needs is encouraged to learn more.” – S.G., S. San Francisco, CA

“Very good course–content with great adherance to NIH guidelines.” – S.W., Hudsonville, MI