Inviting the help of colleagues worldwide, the concise Diagnostic Issues in Substance Use Disorders is part of the new series Advancing the Research Agenda for DSM-V. Its 19 chapters by an international group of experts are designed to stimulate questions that will help guide research related to the development of the next editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Classification of Diseases (ICD-11), with the goal of ensuring that the major substance use diagnoses represent the same condition in both references. They cover 10 major issues in three main sections: Overarching issues relevant for the development of international diagnostic systems -- statistical modeling techniques and whether DSM-V should use categorical and/or dimensional diagnostic approaches; methods review, emphasizing new hybrid techniques for developing and testing diagnostic concepts; the need for separate clinical and research-oriented diagnostic criteria, incorporating both categorical and dimensional attributes; neurobiological changes characterizing substance dependence; the importance of cultural attributes in developing definitions of substance use disorders; and the history of the development of diagnostic systems and how to optimize the "crosswalk" between DSM and ICD. Research questions more specific to the substance use disorders section of DSM -- comorbidity between substance use disorders and other psychiatric conditions, the relatively unique clinical course of substance-induced mental disorders and appropriate treatment approaches; the precision of the criteria and threshold for a diagnosis and how to improve them; the subtypes of substance use disorder, including how they have been derived and the extent to which they relate to neurobiological processes; the seemingly high prevalence of alcohol dependence in young people; suggested research questions to evaluate the application of diagnostic criteria to adolescents; and the specific psychoactive substances cannabis and nicotine. Whether substance use disorders should be included in a broader section termed "addictive disorders" -- impulse-control disorders (especially pathological gambling and the advantages and disadvantages of adding it to the current substance use disorders section), identifying research opportunities regarding their assessment and neurocognitive and physiological bases, discussing the specifics of the research agenda and how it might be implemented, and presenting questions generated by the research agenda developmental process. This informative compendium distills the findings of a wealth of recent research and concludes with recommendations for exploiting research opportunities that promise to inform decisions regarding DSM-V and other classification systems. As such, it will prove invaluable for clinicians and researchers everywhere.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade-in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD). To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM's task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.

Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment provides a clinically detailed, evidence-based, and exhaustive examination of a topic rarely plumbed in psychiatry texts, despite the fact that co-occurring mental illness and substance use disorders are common. The authors argue for a more holistic and integrated approach, calling for clinicians to tactfully but persistently evaluate patients for a broad range of co-occurring disorders before determining appropriate treatment. Focusing on a substance use disorder in isolation, without determining whether another psychiatric disorder is co-occurring, can doom treatment efforts, and the reverse also is true. To help clinicians keep the big picture in mind, the book is organized around 18 cases, each of which addresses a particular diagnostic skill (e.g., assessment), group of disorders commonly comorbid with substance use disorders (e.g., PTSD, eating disorders), specific treatment (e.g., pharmacological interventions), or special population (e.g., adolescents). This case-based approach makes it easy for readers to understand strategies and master transferable techniques when dealing with their own patients. Because the initial face-to-face sessions are especially important with this patient population, the book includes chapters on the diagnostic assessment and the initial interview, as well as offering interviewing tips throughout to help the clinician develop the necessary care and skill in this arena. Also included is a chapter on integrating motivational interviewing into the treatment. Each of the 18 cases stands alone, allowing the reader flexibility in using the text. For example, the 18 cases and discussions can be read sequentially, or as needed, depending on the reader's special interest or current need. The book also features chapters on how to effectively work with patients whose disorders might be affecting other members of a patient's family, since the likelihood of a successful outcome is enhanced if an integrated treatment plan is developed for their co-occurring disorders. The questions that accompany each chapter can be used as an organizational tool prior to reading or to test knowledge and comprehension afterward. The text is completely up-to date and provides DSM-5 diagnostic information essential to each case. Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment offers a straightforward approach to people with complicated presentations, offering mental health clinicians the skills they require to effectively assess, diagnose, and treat these patients and their families.

Drug abuse persists as one of the most costly and contentious problems on the nation's agenda. Pathways of Addiction meets the need for a clear and thoughtful national research agenda that will yield the greatest benefit from today's limited resources. The committee makes its recommendations within the public health framework and incorporates diverse fields of inquiry and a range of policy positions. It examines both the demand and supply aspects of drug abuse. Pathways of Addiction offers a fact-filled, highly readable examination of drug abuse issues in the United States, describing findings and outlining research needs in the areas of behavioral and neurobiological foundations of drug abuse. The book covers the epidemiology and etiology of drug abuse and discusses several of its most troubling health and social consequences, including HIV, violence, and harm to children. Pathways of Addiction looks at the efficacy of different prevention interventions and the many advances that have been made in treatment research in the past 20 years. The book also examines drug treatment in the criminal justice setting and the effectiveness of drug treatment under managed care. The committee advocates systematic study of the laws by which the nation attempts to control drug use and identifies the research questions most germane to public policy. Pathways of Addiction provides a strategic outline for wise investment of the nation's research resources in drug abuse. This comprehensive and accessible volume will have widespread relevanceâ€"to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.

Revised, updated, and expanded, this handbook is a quick, concise, practical guide for clinicians treating patients with addictive disease. Using the conversational style and clinical vignettes found in all Practical Guides in Psychiatry titles, Dr. Gitlow describes effective strategies for the step-by-step process of intervening in a lifelong illness pattern. This edition includes new material on buprenorphine, naltrexone, and other pharmacologic treatments, nicotine cessation therapies, and pharmacologic interventions for sedative dependence, plus a new chapter on substance-induced disorders, a thoroughly rewritten prevention chapter, and expanded coverage of treatment dilemmas and legal issues. Easy-to-use appendices provide quick access to numerous new screening tools and other frequently referenced information. The Practical Guides in Psychiatry series provides quick, concise information for professionals on the front lines of mental health care. Written in an easy-to-read, conversational style, these invaluable resources take you through each step of the psychiatric care process, delivering fast facts and helpful strategies that help you provide effective and compassionate care to your patients.