Substance Use Problems

Substance abuse is a major public health issue worldwide. The medical and psychiatric complications of substance abuse translate to a considerable health care burden in society. Clinicians of different medical disciplines are often unprepared to handle the non-adherence and even challenging attitudes among service users presenting to the health care system for substance-related problems.

This book, from the series ‘Advances in Psychotherapy— Evidence-based Practice’, provides succinct, evidence- based practical guidance on the management of substance use problems. In this handy 88-page book, the author has successfully distilled the knowledge of substance misuse to build an evidence-based framework of assessment and intervention. The book is not meant to give readers an in- depth review of the symptomatology of various substances, neurobiology, and pharmacological and psychological treatments, but highlights the scientific backgrounds of substance misuse problems to cultivate professional attitudes among practitioners who treat clients for substance misuse.

Given the concise nature of this book, a significant proportion of it is devoted to a well-conceptualised and in-depth epidemiological overview of substance misuse problems and the co-morbidity data, setting the scene for the core chapters elaborating on the biopsychosocial model for the management of substance abuse problems. The ways that biopsychosocial factors have an effect on different stages of substance misuse, from initiation through regular use to problem use, are discussed in detail. This is an important part of the book that addresses the hurdles in establishing therapeutic relationships with substance abusers. A lack of in-depth understanding of aetiological models at different stages of a person’s substance abuse ‘career’ is often the cause of negative counter-transference among therapists. An in-depth biopsychosocial assessment at different stages of treatment thus provides a solid ground to foster appropriate empathy, on which a collaborative therapeutic relationship is firmly built.

In the third part of this book, different evidence-based psychotherapeutic techniques are introduced. For instance, fundamental principles of the therapeutic relationship, simple assessment methods such as ‘Timeline Follow- Back’ and ‘Motivation to Change Ruler’ are discussed from a practical viewpoint. This book also covers methods of empirically supported treatments, the components of harm reductions, motivational interviewing, and the techniques of cognitive behavioural therapy for motivated substance abusers. These principles and techniques are illustrated with practical examples that most readers who are practitioners might find extremely useful when treating clients at different stages of motivation for change.

This book is a good introductory text to this important public health issue. Its level of difficulty and scope are suitable for psychiatric trainees, primary care physicians, and case managers from various allied health professions. For experienced clinicians, this book provides a succinct and well-conceptualised framework for service planning and training. The most valuable take-home message of this book is: a healing relationship starts from a therapist who is directive but yet non-judgemental, and such a therapeutic relationship is not determined by a therapist’s theoretical orientation in the practice of psychotherapy for substance- related clinical problems.

Eric Yan, MBChB
Department of Psychiatry
Tai Po Hospital
Tai Po, New Territories
Hong Kong SAR, China

View My Stats