Substance use and abuse is a ubiquitous problem in American society. The magnitude of the problem is illustrated by the findings of the National Household Survey, which showed that in 2000, an estimated 14.5 million Americans were dependent on illicit drugs or alcohol. The events of September 11 also had an impact on substance use disorders. The use of illicit drugs and alcohol increased in many of the individuals who had personal exposure to this tragedy. Millions of Americans are directly affected by substance abuse, and untold millions are affected indirectly as family or friends or through the societal costs associated with substance abuse and dependence.
Data from a number of sources are converging to indicate that substance use disorders are particularly prevalent among individuals with psychiatric disorders. Recent epidemiologic survey studies indicate that substance use disorders occur in more than 50% of individuals in certain "high-risk" diagnostic categories. Moreover, substance use can have an impact on the presentation, prognosis, and treatment of other psychiatric disorders. For this reason, all psychiatrists must understand the fundamentals of the diagnosis and treatment of substance use disorders in order to best serve their patients.
Major advances have been made in the past 10 years in both psychotherapeutic and pharmacologic treatments for substance use disorders. Recent advances in neurobiology have helped identify major brain regions and neurotransmitter systems involved in addictions. With this information, pharmacotherapeutic treatments can be designed to more specifically target systems and regions involved in addictive processes. Important advances have also been made in the techniques used to specify psychotherapeutic and behavioral treatments and to study these treatments more carefully. These advances have made it possible to begin to identify key elements of effective treatments and effective treatment programs. Thus, as knowledge concerning the prevalence and serious consequences of substance use disorders has expanded, so has our ability to diagnose and effectively treat this devastating illness in our patients.
In this era of shrinking resources dedicated to health care in general and mental health care in particular, it is increasingly important for treatment delivery to be efficient and effective. Evidence-based treatment is becoming a standard. In this issue, evidence-based treatments for substance use disorders are reviewed. As the articles here show, this is a time for much optimism: although substantial challenges remain, major advances have been made in the treatment of substance use disorders.