Alcohol use disorder (AUD) is a prevalent medical condition characterized by the continuation of alcohol use despite negative consequences. AUD affects almost 15 million people over the age of 12 annually in the United States. Some of the major long-term negative health consequences of drinking alcohol include digestive problems, heart disease, stroke, liver disease, and cancer. Drinking alcohol can also result in emergency department visits for injuries or alcohol poisoning/overdose. In addition to these physical health consequences, AUD can have a negative impact on occupational performance, social relationships, and mental health. The good news is, there are guidelines to help health care providers identify who may be at risk to develop and who may be suffering from an AUD, and there are many evidence-based treatment options. In this chapter we outline the best practices for diagnosis, withdrawal management, long-term pharmacotherapy options, and resources for patients.

This chapter describes pseudoscience and questionable ideas related to substance use disorders and addiction. The chapter opens by discussing diagnostic controversies and myths that influence treatments. Dubious treatments include naturopathy, homeopathy, orthomolecular medicine, acupuncture, energy medicine, hypnosis, chiropractic care, and animal-assisted therapy. The fuzzy boundary between science-based and pseudoscientific approaches is also considered. The chapter closes by reviewing research-supported approaches.

Any role for spirituality in addressing the serious clinical and public health problems related to substance misuse and addiction might seem antiquated at best, and clinical malpractice at worst. Yet, from a phenomenological perspective, addiction often penetrates and pervades the core of conscious thought and behaviour, undermining personal values and meaning and purpose in life – factors that many people associate with a diminished sense of personal spirituality. Research on spiritual/religious identity and practices has shown that these both protect against the onset of substance misuse and help millions each year to recover from it. This chapter reviews the interplay of morality, spirituality/religion and substance misuse, suggests why addiction in particular is so prone to spiritual pathology, and describes why spirituality/religion have played such prominent roles in successful remission and stable recovery. Spiritually oriented treatment approaches to addiction are reviewed along with their implications for practice and research.

Several pathways can lead out of destructive drug use, including natural recovery with no treatment. Mental-health professionals in treatment programs or working independently offer treatment, and Alcoholics Anonymous (AA) and secular groups enable mutual support for recovery from SUD. The Minnesota Model, based on the principles of AA, heavily influences many treatment programs. Counseling and psychotherapy are primary treatments for SUD, often conducted in groups. Sharing of common SUD experiences relieves shame and isolation that impede recovery. Office-based treatment may provide individual psychotherapy. Therapists and counselors try to establish an alliance with clients to promote intrinsic motivation for secure abstinence. Therapies include cognitive-behavioral, 12-step facilitation, mindfulness, dialectical behavior change, and couples or family therapy. Brief Interventions are short counseling sessions most appropriate for early-stage substance abuse. Alcohol or other drug use often recurs after treatment, and prevention of relapse is a primary goal of SUD treatment. Participation in mutual assistance groups is associated with lower rates of relapse.

A disease-based explanation of substance use disorders is dominant in many Western countries, especially in treatment settings. Acceptance of the disease concept of SUD reduces the shame and guilt of suffering individuals, a definite benefit for treatment of the disorder. Genetic and neurological factors are basic to the disease concept of SUD. However, less severe SUD can result from factors other than a disease process, and is better explained as a behavioral disorder. Even addiction – the most extremely disordered use of drugs – is influenced by developmental, experiential, and societal factors. Basic tenets of disease theory are of limited validity, including that SUD is always a primary disorder (not caused by a psychological disorder), that progression of the disorder is inevitable, and that addictive drug use is uncontrollable. Compulsive behavior and poor impulse control are common in SUD. However, many instances of drug use by addicted individuals require deliberation and apparent full control, especially when the behavior occurs in a non-drugged state. Judgment is often impaired by addiction, but behavior is rarely actually uncontrolled.