By William R. Miller and Sandra A. Brown, American Psychologist

Because of the prevalence of substance abuse in general clinical populations, it is important for psychologists to have knowledge and skill in this area.

Psychologists also have special expertise to offer in the assessment and treatment of alcohol/drug problems.

Current evidence indicates that (a) alcohol/drug problems generally obey ordinary behavioral principles and processes, (b) substance abuse frequently occurs within a broader cluster of psychological problems, (c) the treatment approaches most strongly supported by outcome research are fundamentally psychological in nature, (d) cognitive-behav­ioral principles are of demonstrable value in motivating change in alcohol/drug use, and (e) clinical skills and styles (e.g., empathy) commonly included in the training of psychologists are important determinants of favorable treatment outcomes with substance use disorders.

These factors in the context of changing health care indicate that psychologists should play an increasing role in as­ sessing and treating addictive behaviors. 

It is no coincidence that the American Psychological Association's (APA's) College of Professional Psy­chology selected treatment of substance use disorders as the first proficiency area for specialist certification ( S. A. Brown , 1996).

There are persuasive reasons why all practicing psychologists should be proficient in assessing and treating alcohol/drug problems and why psycholo­gists should be contributing to treatment systems, policy, and research in this area.   

Prevalence and Impact of Alcohol and Drug Problems

Surveys since the 1960s have consistently found that about 1 in 10 American adults in the general population has significant problems related to his or her own use of alcohol ( Cahalan, 1970; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1993 ).

Approximately one quarter of U.S. adults are regular users of tobacco, and about 7% currently use illicit drugs ( U.S. Department of Health and Human Services, 1996).

Together, sub­stance use disorders represent the most frequently oc­curring mental health problem ( Regier et al., 1990).

Fur­thermore, the prevalence of problematic alcohol/drug use is reliably higher in health care delivery settings than in the general population ( Helzer & Pryzbeck, 1988).

Depending on specialization and setting, between one quarter and one half of clients being treated by health care professionals for other medical and psychological problems evidence problems related to alcohol or other drug involvement ( Kiesler, Simpkins, & Morton, 1991).
Substance use disorders, in fact, are the most frequently occurring comorbid disorders among those with mental health problems (e.g., Brady, Castro, Lydiard, Malcomb , & Arana, 1991; Regier et al., 1990 ) and adversely affect the clinical course and prognosis for other mental health problems (e.g., Hesselbrock, Meyer, & Keener, 1985; Rounsaville, Dolinsky, Babor, & Meyer, 1987).

Add to this the fact that problem drinking and drug use also adversely affect the lives of others (e.g., Billings & Moos, 1983; Newcomb & Bentler, 1988; Sher, 1991 ), and it is likely that substance abuse affects a significant propor­tion of the caseload of any mental health professional. 

At the very least, alcohol and other drug problems represent one of the most serious threats to clients' lives and health ( Anderson, Cremona, Paton, Turner, & Wallace , 1993).

Alcohol and tobacco constitute two of the three leading contributors to preventable death in the United States ( McGinnis & Foege, 1993). Tobacco use alone is the largest preventable cause of illness, disability, and premature death in our society.

Alcohol is involved in nearly half of traffic fatalities and a substantial propor­tion of violent deaths, suicides, drownings, falls, and other fatal accidents, constituting (after AIDS) the leading contributor to death among young people ( Stinson, Dufour , Steffens, & DeBakey, 1993).

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Editor's note. Bernadette Gray-Little served as action editor for this article. 

Author's note. William R. Miller, Department of Psychology and Cen­ter on Alcoholism, Substance Abuse, and Addictions, University of New Mexico; Sandra A. Brown, Psychology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, and Departments of Psychia­try and Psychology, University of California, San Diego.

Preparation of this article was supported by Grants K05-AA00133 and R01-AA07033 from the National Institute on Alcohol Abuse and Alcoholism.

Excerpt from American Psychologist, Vol. 52, 1997, via questia.com