801). According to Green (2006), "Research on how gender influences substance use and substance-abuse-related problems has established clear differences between women and men in several important areas. Women typically consume less alcohol than men when they drink, drink alcohol less frequently, and are less likely to develop alcohol-related problems than men. Similarly, women are less likely than men to use illicit drugs and to develop drug-related problems" (p. 55).
Relationship between alcohol/substance abuse and physical/mental health issues. According to the World Health Organization's (WHO) Guide to Drug Abuse Epidemiology (2000), "Psychoactive substances cause problems that result from complex interactions between: (a) substances with diverse, toxic, psychotropic and addictive properties; (b) individuals with varied vulnerabilities and resiliency; and (c) complex sociocultural environments" (p. 117). For young adults with an alcohol or other substance abuse disorder, the likelihood of suffering from the other addictive disorder was seven times higher than in the general population; among individuals who had an alcohol disorder, 37% had a corresponding comorbid mental disorder (Regier et al., 1990). The most significant mental-addictive disorder comorbidity rate was identified among those who suffered from drug disorders besides alcohol disorders; more than half (53%) of this population has been shown to suffer from a mental disorder (Regier et al., 1990). In addition, those who have been treated for their disorders in specialty mental health and addictive disorder clinical settings have been shown to be at much higher risk of having comorbid disorders, with those being incarcerated suffering the highest levels of mental disorders (Regier et al., 1990).
CLINICAL EVALUATION BY NURSE PRACTITIONER
General considerations. The disease model that typifies most current treatment approaches to substance abuse can help address many of the common misconceptions that persist and pave the way for meaningful change. For instance, according to the National Institute on Drug Abuse (2010), "One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction -- that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower" (Understanding drug abuse and addiction, para. 1).
Identification of patterns of alcohol/substance abuse among young adults.
Young men tend to drink more and engage in other substance-abusing behaviors more than their female counterparts but there are some different patterns involved in the progression of the disease process among young women as well (Green, 2006). For instance, Green (2006) notes that, "When women do develop substance abuse problems, they tend to develop them faster than men do. For example, although women tend to be older than men, on average, when they begin a pattern of regular drunkenness, women's drinking-related problems (e.g., loss of control over drinking, negative consequences of drinking) appear to progress more quickly than those of men" (p. 56).
Interviewing techniques. Motivational interviewing (MI) is a proven approach that can be useful in counseling young adults with substance abuse disorders. In this regard, Kress and Hoffman (2008) cite the ambivalence of many young substance abusers concerning changing their behavior and report that, "Originally developed to treat substance abuse issues, MI has surged in popularity. In one review of the substance abuse literature, 73% of the studies in which MI was applied resulted in statistically significant effects, demonstrating its impact in facilitating client behavioral change" (p. 311).
Assessment tools. A number of assessment tools are available that can be used in the diagnosis and formulation of clinical interventions for young adults suffering from substance abuse disorders, including the Life History Chart, the Young Adult Behavior CheckList (YABCL; Achenbach, 1997), and structured interview questions in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (Mcconaughy et al., 2000).
Physical findings. Because substance abuse can exact a heavy toll on the body besides the mind, a comprehensive physical examination is a prerequisite to the formulation of effective clinical interventions for substance abuse (Havivi, 2005). This clinician adds that, "Besides the interview, the initial assessment may include a laboratory evaluation, with