Four Content Domains of Practice

Substance Use Disorder

Substance use disorder encompasses varying degrees of excessive use of a substance, including: alcohol; tobacco; opioids; caffeine; cannabis; hallucinogens; inhalants; sedative, hypnotics, or anxiolytics; stimulants (e.g., amphetamine, cocaine).

Addiction is a chronic disorder with biological, psychological, social and environmental factors influencing its development and maintenance. About half the risk for addiction is genetic. Genes affect the degree of reward that individuals experience when initially using a substance (e.g., drugs) or engaging in certain behaviors (e.g., gambling), as well as the way the body processes alcohol or other drugs. Heightened desire to re-experience use of the substance or behavior, potentially influenced by psychological (e.g., stress, history of trauma), social (e.g., family or friends’ use of a substance), and environmental factors (e.g., accessibility of a substance, low cost) can lead to regular use/exposure, with chronic use/exposure leading to brain changes.These brain changes include alterations in cortical (pre-frontal cortex) and sub-cortical (limbic system) regions involving the neuro-circuitry of reward, motivation, memory, impulse control and judgment. This can lead to dramatic increases in cravings for a drug or activity, as well as impairments in the ability to successfully regulate this impulse, despite the knowledge and experience of many consequences related to the addictive behavior. (Adapted from the Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School.)

Behavioral Addictions

Behavioral addictions or non-substance addictions, like gambling addiction, are a set of behaviors that a person may loose their ability to control and may become dependent upon. Studies have shown that behavioral addictions may activate similar parts of the brain like alcohol. These parts of the brain are responsible for our “reward” functions. This is what gives our bodies’ dopamine after we engage in healthy behavior, like exercise or eating a good meal.

Certain drugs are capable of activating these parts of our brain to release up to ten times the normal amount of dopamine. Over time, our brains produce less and less, and we would need more of that substance in order to get the same effect. This is understood as building tolerance.

Behavioral addictions, also known as non-substance addictions or addictive behaviors can include:

  • Food
  • Gaming
  • Plastic Surgery
  • Sex
  • Social Media
  • Gambling
  • Internet
  • Risks
  • Shopping
  • Pornograpy

Depression and Anxiety

Mental health conditions, such as depression or anxiety may “co-occur “along with substance use disorder. Mood and anxiety disorders are highly prevalent among youth and adults. They are also associated with significant interpersonal impairment both as a cause and a consequence. Evidence clearly indicates that mood and anxiety disorders both affect and are affected by romantic and family relationships. Comorbidity is often the rule rather than exception. Finally, given that mood and anxiety disorders occur in the family context, continued development and evaluation of interventions that address family and couple functioning across all ages is encouraged. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

According to the American Psychiatric Association, depression (major depressive disorder) is a common and serious medical illness that negatively affects your behaviors, thoughts and feelings. Depression, which is treatable, may cause feelings of sadness and/or a loss of interest in activities which were once enjoyed. It may also lead to a variety of problems which may impact your ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

The American Psychological Association (APA) defines anxiety as an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune. The body often mobilizes itself to meet the perceived threat: Muscles become tense, breathing is faster, and the heart beats more rapidly. Anxiety may be distinguished from fear both conceptually and physiologically, although the two terms are often used interchangeably. Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat.


The American Psychological Association (APA) describes an Anxiety Disorder as any of a group of disorders that have as their central organizing theme the emotional state of fear, worry, or excessive apprehension. This category includes, for example, panic disorder, various phobias (e.g., specific phobia, social phobia), and generalized anxiety disorder. Anxiety disorders have a chronic course, albeit waxing and waning in intensity, and are among the most common mental health problems in the United States.

They may also occur as a result of the physiological effects of a medical condition, such as endocrine disorders (e.g., hyperthyroidism), respiratory disorders (e.g., chronic obstructive pulmonary disease), cardiovascular disorders (e.g., arrhythmia), metabolic disorders (e.g., vitamin B12 deficiency), and neurological disorders (e.g., Parkinson’s disease). Obsessive-compulsive disorder and posttraumatic stress disorder were traditionally considered anxiety disorders; however, they are increasingly considered, be separate, if still related, entities.

Trauma and Attachment

According to the Substance Abuse and Mental Health Services Administration psychological trauma is defined as damage to a person’s mind as a result of one or more distressing events which caused overwhelming amounts of stress that exceeded the person’s ability to cope or integrate the emotions involved, eventually leading to serious, long-term negative consequences. Those who have experienced persistent abuse or neglect may develop specific type of attachment style impacting closeness or distance in relationship.

Adult attachment is guided by the assumption that the same motivational system that gives rise to the close emotional bond between parents and their children is responsible for the bond that develops between adults in intimate relationships, or close, emotional attachment.