APA Handbook of Trauma Psychology: Foundations in Knowledge

http://dx.doi.org/10.1037/0000019-012 APA Handbook of Trauma Psychology: Vol. 1. Foundations in Knowledge, S. N. Gold (Editor-in-Chief) Copyright © 2017 by the American Psychological Association. All rights reserved. Substance use disorder (SUD) is characterized by an intense, enduring, and often irresistible desire for subjective effects of substances (cravings); impaired insight; poor judgment and risky decisionmaking about substance-seeking behavior; markedly reduced desire for naturally rewarding social relationships and activities; reduced sensitivity to euphoric effects of substances over time (tolerance); uncomfortable and sometimes life-threatening withdrawal symptoms that develop when stopping substance use; negative emotions when unable to obtain access to substances (e.g., dysphoria, anxiety, irritability); compulsive substance seeking that persists despite repeated damaging consequences to self, family, and society; and multiple relapses (American Psychiatric Association, 2013; Crean, Crane, & Mason, 2011; Goldstein et al., 2009; Kalivas & O’Brien, 2008; Koob & Volkow, 2010; National Institute on Drug Abuse [NIDA], 2011; Schoenbaum, Roesch, & Stalnaker, 2006; Tiffany & Wray, 2012; Volkow & Li, 2004). The structural brain abnormalities and associated cognitive and behavioral disruptions seen in individuals with SUD are so striking that many experts have come to refer to the disorder as a disease of the brain (Volkow & Li, 2004). Different patterns of disease expression can be seen for the various substances of abuse depending on factors, such as dosing, duration of use, route of administration (e.g., intravenous versus inhalation), and even gender and culture (Back & Hyman, 2014; Koob, 2008). Although there is currently debate as to whether certain substances, such as marijuana, are of less concern than others, there is no doubt that, overall, SUD is a tremendous public health concern that contributes to numerous preventable social and health problems and financial costs to society (Child Welfare Information Gateway, 2014; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2005; NIDA, 2005, 2007, 2011). SUD is one of the most common psychiatric disorders in the United States with a 14.8% lifetime rate in the community (Kessler et al., 2005), and new substances of abuse are emerging all the time based on novel chemical formulations.