APA Handbook of Clinical Psychology: Applications and Methods

Substance abuse is a serious public health problem that warrants the attention of clinical psychologists and other health professions because of its widespread nature and deleterious impact on individuals, families, communities, and the larger society. For individuals, substance abuse contributes to a variety of negative health and behavioral outcomes, such as unintentional injuries, traffic fatalities, sexual assault, interpersonal aggression, neurocognitive deficits, and psychiatric problems (Newcomb & Locke, 2005). Because of the costs related to crime, incarceration, drug enforcement, lost productivity, and treatment, it is estimated that the societal economic impact associated with substance use and abuse, including alcohol and nicotine products, is more than half a trillion dollars in the United States alone (Volkow & Li, 2005). Treatment is an essential ingredient in efforts to combat the problem of substance abuse, but treatment can be expensive and labor intensive, and progress is often undermined by high recidivism rates. Moreover, it is estimated that fewer than 15% of individuals who develop a substance abuse problem receive treatment (Gerada, 2005). Given this reality, it is clear that an emphasis on treatment alone is not sufficient. Rather, a more comprehensive strategy is needed to effectively address the problem of substance abuse—a strategy that embraces a continuum-of-care perspective involving prevention as well as treatment and maintenance (Institute of Medicine, 1994). A variety of health and mental health professionals are needed to provide comprehensive services across the continuum of care for substance abuse. In addition to their role as psychotherapists treating substance abuse, clinical psychologists can help combat the problem of substance abuse as prevention practitioners, researchers, and teachers. Furthermore, clinical psychologists can serve an important function as opinion leaders and authoritative sources of information in their communities concerning evidence-based prevention. Early efforts to prevent substance abuse relied on providing information to educate individuals about the harmful effects of smoking, particularly in terms of increased risk for cancer, heart disease, stroke, and emphysema. Approaches to deter the use of alcohol have typically emphasized the adverse health, social, and legal consequences of use. These educational approaches have given way over the years to prevention approaches that place greater emphasis on psychosocial factors promoting substance use and abuse. Considerable research conducted over the past 3 decades has tested the effectiveness of these approaches and provided strong empirical support for a growing body of evidence-based prevention approaches. The strongest evidence of effectiveness has been shown for comprehensive skills-building preventive interventions that address an array of shared psychosocial risk and protective factors associated with onset and escalation of substance use and related risk behaviors (such as aggression, delinquency, and school dropout). Evidence suggesting that different problem behaviors stem from a set of common psychosocial