Substance Abuse Research Articles

Mid-term outcomes of sartorius flap reconstruction in groin infection following vascular procedures or intravenous drug injections.

In this study, the early and mid-term outcomes of sartorius flap reconstruction after the development of a prior groin infection were investigated. From January 2017 until June 2023, 44 patients from 2 centers in Italy underwent sartorius flap reconstruction after the development of a prior groin infection. Thirty-day outcome measures including major morbidity, amputation-free survival, and mortality were assessed. At 2-year follow-up, estimated outcomes of freedom from hemorrhagic complications, freedom from recurrent infection, freedom from reintervention, and amputation-free survival were analyzed using Kaplan-Meier curves. In 35 cases (79.5%) a previous vascular procedure was performed, whilst in the remaining 9 cases (20.5%) the patient was an intravenous drug abuser. Thirty-day mortality and major amputation rates were 4.5%, and 2.3%, respectively. Overall 30-day wound healing rate was 56.8% (25 cases). The overall median duration of follow-up was 12 months (IQR 4-24). Complete wound healing was obtained in 36 cases (81.8%) after a median period of 1 month (IQR 1-3). The 2-year Kaplan-Meier estimates of freedom from hemorrhagic complications, freedom from recurrent infection, freedom from reintervention, and amputation-free survival were 82.1%, 70%, 71.9%, and 97.7%, respectively. Multivariate analysis confirmed the association of female sex with recurrent infection (HR 3.4, P=.05). Sartorius flap reconstruction after the development of a prior groin infection following vascular procedures or intravenous drug injections yielded acceptable mid-term outcomes in terms of freedom from hemorrhagic complications, and freedom from recurrent infection. Female sex seemed to affect the rate of recurrent infection.

Evaluation of the Generic Drug User Fee Act (GDUFA) Program for Fiscal Years 2013-2022.

The effectiveness of the regulatory initiatives, strategies, and incentives put forth in the first two authorizations of the Generic Drug User Fees Act (GDUFA) were evaluated using factors including the number of Abbreviated New Drug Application (ANDA) withdrawals and first-cycle approvals. GDUFA was originally authorized in 2012 for FY 2013-2017 (GDUFA I) and reauthorized for FY 2018-2022 (GDUFA II). ANDA approvals were analyzed from the Drugs @ FDA database covering 2013-2022. From the applications, the approval time, dosage form and route of administration (ROA), product indication, market status of the product, first generic status, company and company size filing the ANDA were noted. Despite the COVID pandemic, there was more than a 40% increase in ANDA approvals during GDUFA II relative to GDUFA I. Oral and parenteral drugs were the two leading categories of approved generics during both iterations of GDUFA. There was more than a 120% increase in withdrawn applications during GDUFA II, which reflects the partial refund that is now offered to incentivize companies to withdraw inadequate applications prior to review. This also appears to have contributed to an increase in the number of first-cycle approvals, which increased by 100% between GDUFA I and II. Due to the COVID-19 public health emergency, there was a decrease in activity within the generic drug program and market. Therefore, it is important to consider this impact when observing actual trends from this study.

Capture and analysis of MDMB-4en-PINACA and ADB-4en-PINACA in exhaled breath using functionalized cotton fiber: A novel approach to noninvasive drug abuse detection

Breath analysis has emerged as a promising noninvasive method for detecting drug abuse, offering potential advantages over traditional blood or urine samples. However, the capture and analysis of trace analytes in exhaled breath (EB) remains a challenge for practical applications. In this study, we explore the utilization of poly (methacrylic anhydride-co-ethylene glycol dimethacrylate)-functionalized cotton fiber (poly (MAA-co-EGDMA)-functionalized cotton fiber) for the capture of MDMB-4en-PINACA and ADB-4en-PINACA, two popular synthetic cannabinoids, from exhaled breath. Capture efficiencies of 92 % and 88 % for MDMB-4en-PINACA and ADB-4en-PINACA were achieved demonstrating robust performance across batches and excellent stability. Animal experiments were conducted and exhaled breath samples were collected and analyzed. Shorter half-lives were shown for MDMB-4en-PINACA and ADB-4en-PINACA in EB than in plasma. The detection window for MDMB-4en-PINACA was 210 min, while 150 min for ADB-4en-PINACA. This pilot study presents a novel approach for the capture of MDMB-4en-PINACA and ADB-4en-PINACA in exhaled breath using functionalized cotton fiber. The demonstrated efficacy in capturing MDMB-4en-PINACA and ADB-4en-PINACA highlights the potential of this low-cost and stable platform for noninvasive drug abuse detection. By offering a viable alternative to invasive methods, our findings demonstrate a new noninvasive method of drug abuse detection using exhaled breath holds great promise for enhancing public health efforts to combat drug abuse.

Firearm ownership and suicide: Has the time come to discuss uniformity of health and social assessments in aid of regulation? Reflection from a retrospective study on a forensic case series.

Firearm-related deaths are an issue of ongoing public interest, from a health and economic perspective. Worldwide, firearm prevalence in suicides varies widely, depending on multiple factors including the availability of weapons in each country. Although several studies have shown that national laws about gun ownership, reducing legal access to guns, decrease the risk of suicide by firearm, the current situation clashes with widely differing legislations. Retrospective study on a forensic case series. Autopsy reports assessed at the Section of Legal Medicine of Milan (Italy) from January 2014 to December 2023 were retrospectively documented. Only firearm suicides were considered. For each case, a close analysis of the criminal offence reports has been performed to obtain information about the gender and age of the victim, as well as the legal possession of firearms, psychiatric disorders, alcohol, and illicit drug abuse. Among all the 1,164 suicides assessed at the Section of Legal Medicine of Milan over a 10-year-period, 101 cases (8.7%) were firearm-related. The male to female ratio was therefore about 13:1. No seasonal trends were observed. Most of the individuals owned the firearm license. Of the entire dataset, 35.6% suffered from psychiatric disorders, 4% of alcohol abuse and 2% of drug addiction. Among the owners of a firearm license, 42.3% had psychiatric disorders. Knowledge about firearm suicide and its relation to firearm legal possession is limited and current preventive laws should be reconsidered. Present administrative and clinical examinations required to obtain a firearm license in Italy and in some European territories are dealt with. The evaluation of the firearm-related risk of abuse is an essential but complex procedure, which requires not only clinic-anamnestic data but also in-deep psychiatric information. There is a need to develop and reinvigorate a debate that currently presents very heterogeneous solutions, but which would probably benefit from a common vision of the prevention strategies that can be implemented and enacted for the benefit of the entire community.

Sociological Analysis of Restorative Justice in Rehabilitative Law Enforcement for Drug Abuse Cases

Sociological Analysis of Restorative Justice in Rehabilitative Law Enforcement for Drug Abuse Cases

CHANTER syndrome in the context of pain medication: a case report

BackgroundCHANTER (Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion) is a recently described syndrome occurring in the context of drug abuse. While clinical findings are rather unspecific (disorientation, unresponsiveness), MR imaging (MRI) discloses a characteristic pattern (restricted diffusion in the basal ganglia and hippocampi, cerebellar oedema and haemorrhage), allowing for timely diagnosis before complications such as cerebellar swelling and herniation do occur. Here we report a case of CHANTER primarily based on imaging findings, as there was no evidence of drug abuse on admission.Case presentationA 62-year-old Patient was admitted to our hospital after being unresponsive at home. Prehospital intubation was performed, which limited neurological assessment. Under these circumstances no obvious symptoms could be determined, i.e. pupils were isocoric and responsive, and there were no signs of seizures. While the initial CT scan was unremarkable, the subsequent MRI scan showed a distinct imaging pattern: moderately enhancing areas in the basal ganglia and hippocampi with diffusion restriction, accompanied by cerebellar haemorrhage and oedema (Figs. 1 and 2). A comprehensive clinical and laboratory work-up was performed, including drug screening, spinal tap, Holter ECG, echocardiography and EEG. The only conspicuous anamnestic finding was a chronic pain syndrome whose medication had been supplemented with opioids two months previously. The opioid medication was discontinued, which led to a rapid improvement in the patient’s clinical condition without any further measures. The patient was able to leave the intensive care unit and was discharged 10 days after admission without persistent neurological deficits.ConclusionFamiliarity with typical MRI patterns of toxic encephalopathy in patients from high-risk groups, such as drug abusers, is crucial in emergency neuroradiology. In the presence of typical MRI findings, CHANTER syndrome should be included in the differential diagnosis, even if there is no history of drug abuse, to avoid delay in diagnosis and treatment.

PENGARUH EDUKASI KESEHATAN REPRODUKSI TERHADAP PENGETAHUAN DAN SIKAP REMAJA TERHADAP PERILAKU SEKSUAL PRANIKAH DI SMKN 11 KABUPATEN TANGERANG

Actions that can be risky for adolescent reproductive health are engaging in premarital sexual behavior, drug abuse, violence, dating, smoking, drinking alcohol, and others. Premarital sexual behavior often results in unwanted pregnancies, contracting sexually transmitted diseases (STDs), abortion, and maternal death. One form of preventive action to maintain adolescent reproductive health today is to provide education or counseling with media that is interesting and liked by students such as animated videos. The purpose of the study was to determine the effect of providing reproductive health education with animated video media on adolescent knowledge and attitudes related to premarital sexual behavior at SMKN 11 Tangerang Regency. This research method used a quasi-experimental design with a one group pretest-posttest design. The population of this study was 125 class X students of SMKN 11 Tangerang Regency. Sampling used a random sampling technique so that the number of samples was 25 people who were adjusted to the research inclusion criteria. The research instrument used a questionnaire. Data processing was carried out using paired ¬t-tests at α = 5%. The results of the study showed an increase in knowledge from good as many as 5 people (20%) to 24 people (96%), sufficient as many as 15 people (60%) to 1 person (4%), lacking as many as 5 people (20%) to 0% after providing reproductive health education. The results of the T-test showed that there was an effect of providing health education on the knowledge and attitudes of adolescents regarding premarital sexual behavior at SMKN 11 Tangerang Regency (p-value = 0.0001 ≤ α = 0.05). In conclusion, providing reproductive health education has an effect on the knowledge and attitudes of adolescents towards premarital sexual behavior at SMKN 11 Tangerang Regency.

Analysis of Substance Abuse Control Model in Nigeria

Analysis of Substance Abuse Control Model in Nigeria

Identification of Substance Abuse Using Urinary Kits: A Prospective Observational Study at a Tertiary Care Hospital

Identification of Substance Abuse Using Urinary Kits: A Prospective Observational Study at a Tertiary Care Hospital

Weight of Evidence: Is an Animal Study Warranted? Assessments for Carcinogenicity, Drug Abuse Liability, and Pediatric Safety.

Nonclinical safety studies are typically conducted to establish a toxicity profile of a new pharmaceutical in clinical development. Such a profile may encompass multiple differing types of animal studies, or not! Some types of animal studies may not be warranted for a specific program or may only require a limited evaluation if scientifically justified. The goal of this course was to provide a practical perspective on regulatory writing of a dossier(s) using the weight of evidence (WOE) approach for carcinogenicity, drug abuse liability and pediatric safety assessments. These assessments are typically done after some clinical data are available and are highly bespoke to the pharmaceutical being developed. This manuscript will discuss key data elements to consider and strategy options with some case studies and examples. Additionally, US FDA experience with dossier(s) including WOE arguments is discussed.

Infective endocarditis in HIV-infected patients. Analysis of a national cohort

Background There is limited recent evidence about infective endocarditis (IE) in HIV-infected patients. Our aim was to compare IE according to HIV infection presence. Methods Consecutive inclusion of IE patients at 46 Spanish hospitals between 2008 and 2021. Results From 5667 patients, 99 were HIV-infected (1·7%; 50 intravenous drugs users). Compared to patients without HIV, HIV-infected patients were more frequently male (84% vs. 67%), had younger median age (46 vs. 69 years), and less comorbidities, except liver disease (52% vs. 9%) and intravenous drug use (51% vs. 1%). They had more common tricuspid location (36% vs. 5%) and community-acquired IE (82% vs. 63%), vascular (29% vs. 17%) and cutaneous (22% vs. 7%) foci of infection, and Staphylococcus aureus aetiology (46% vs. 22%). Vegetations (84% vs. 72%), vascular phenomena (17% vs. 9%), splenomegaly (30% vs. 11%), and embolisation (41% vs 21%) were also more common. Surgical indication and surgery were less frequent in HIV-infected patients (54% vs 67%, 28% vs 47%, respectively). Median CD4 count in HIV-infected patients was 318 cells/mm3. In-hospital mortality (23% vs. 26%) and one-year mortality (25% vs. 32%) were similar in both groups. HIV infection was not independently associated with in-hospital (odds ratio 1·1, 95% CI 0·6–1·9) nor one-year mortality (hazard ratio 0·8, 95% CI 0·4–1·3). Conclusions In the combined antiretroviral therapy era, less than 2% of IE patients have HIV infection. HIV-infected patients have a different clinical profile than those without HIV, but the presence of HIV does not seem to impact on IE prognosis.

What Effect does Ideological Extremism have on Mass Shootings? An Assessment of Motivational Inconsistencies, Risk Profiles, and Attack Behaviors

ABSTRACT Much like other violent extremists, some mass shooters embrace inconsistent, mixed, or customized beliefs and attack for a combination of personal and ideological reasons. This makes it difficult to understand what effects ideology has on their behavior. To obtain empirical answers, we studied (1) the frequency of extreme ideological interests and motives among public mass shooters, (2) differences between perpetrators with and without extreme ideological interests, and (3) the degree of consistency between their ideologies and attack outcomes. Findings suggest that from 1966–2023, approximately one-quarter of public mass shooters in the United States had extreme ideological interests and roughly 70 percent of them were partially motivated by those extreme beliefs. Mass shooters with and without extremist interests showed similar rates of childhood trauma, mental health problems, suicidality, crisis, substance abuse, and criminal records, but ideological shooters were more likely to create legacy tokens, use semi-automatic or automatic rifles, kill strangers and non-white victims, and be copycats or role models. It appears extremism was sometimes a correlate and sometimes a cause of their behavior, with a clear effect on shaping some attacks. Nevertheless, inconsistencies were common, and many attackers did not target locations or victims that fit their ideological enemies.

Exploring the Psychological Impact of Childhood-Onset Psoriasis: A Systematic Review.

Childhood-onset psoriasis (COP) is often associated with various psychological challenges. While numerous studies have delved into the connection between adult-onset psoriasis and its potential to heighten a patient's susceptibility to various psychological challenges, less has been written about the influence of childhood psoriasis on psychological disorders, particularly anxiety and depression, eating disorders, and substance abuse. In this study, we delve into studies that shed light on these associated risks. A systematic literature review was conducted using PubMed, focusing on the psychological impacts of childhood-onset psoriasis. From an initial pool of 313 articles, we utilized Covidence for screening and selection, adhering to strict exclusion criteria such as psoriasis in adulthood and incorrect study designs. This process refined our focus to 12 relevant articles, which were critically analyzed to understand the psychological comorbidities associated with childhood-onset psoriasis. Our review reveals a significant link between childhood-onset psoriasis and increased instances of depression and anxiety. Notably, children with psoriasis demonstrate higher frequencies of suicidal thoughts and behaviors, as well as a marked propensity for substance abuse and addiction. The study also uncovers a strong connection between psoriasis in children and the development of eating disorders like anorexia nervosa and bulimia nervosa. COP significantly affects the psychological wellbeing of children, with heightened risks for depression, anxiety, suicidality, substance abuse, and eating disorders. These findings underscore the need for comprehensive management strategies that encompass not only the physical symptoms but also the mental health and psychological support for children with psoriasis. Early intervention and regular screenings are crucial in mitigating these risks and improving the quality of life for pediatric patients with psoriasis.

The psychedelic mind: Current user perceptions of psychedelic drugs and their use

Purpose Psychedelic drugs can induce altered states of consciousness characterised by changes in visual perception, tactile sensation, cognition, and emotion. Although there is a history of misinformation surrounding these drugs, recent investigation has reinvigorated interest. However, little research has assessed the attitudes of psychedelic consumers regarding these substances. The current study aims to explore the attitudes and perceptions of people with experience with psychedelic drugs, specifically surrounding psychedelic drugs themselves and their use within Aotearoa New Zealand. Design/methodology/approach Nineteen individuals with experience of psychedelic use were recruited to participate across eight groups in semi-structured, exploratory interviews, where a range of topics associated with psychedelics were discussed. Reflexive thematic analysis of the data focussed on participants’ current perceptions and attitudes. Findings Four themes were produced: (1) a negative historical influence on current perceptions of psychedelics; (2) knowledge is key but not everyone has it; (3) prohibition is not working, policy needs to change; (4) psychedelics have therapeutic potential. These themes emphasise key features of people with experience of psychedelic drugs’ current views and highlight potential areas for future investigation and intervention. Social implications Findings indicate a need for greater public knowledge and awareness of psychedelics in Aotearoa society. Findings also inform information, education and policy, which in turn will reduce the stigma and associated harm that those who have used or use psychedelic drugs may experience. Originality/value To the best of the authors’ knowledge, qualitative research aiming to understand attitudes and perspectives surrounding psychedelic drugs and their use from a drug users’ perspective have not yet been assessed.

Comparative pharmacology and abuse potential of oral dexamphetamine and lisdexamfetamine-A literature review.

To compare the pharmacology and abuse potential of oral dexamphetamine and lisdexamfetamine (LDX). A search of Medline and Embase was conducted to identify relevant articles for this literature review. Dexamphetamine and LDX, a prodrug of dexamphetamine, are indicated for the treatment of attention-deficit/hyperactivity disorder. It has been suggested that LDX may have a reduced potential for oral abuse compared to immediate-release dexamphetamine. As a prodrug, LDX has the same pharmacodynamic properties as dexamphetamine. A study in healthy adults showed that the pharmacokinetic profile of dexamphetamine following oral administration of LDX is essentially identical to that of an equimolar dose of dexamphetamine administered 1h later. In addition, dexamphetamine produced subjective drug liking effects comparable to those produced by LDX. LDX showed linear dose proportional pharmacokinetics up to a dose of 250mg, indicating a lack of overdose protection at supratherapeutic doses. Furthermore, the exposure to dexamphetamine released from LDX may be prolonged by the consumption of alkalizing agents. The available evidence from pharmacodynamic, pharmacokinetic and abuse liability studies suggests a comparable potential for oral abuse of dexamphetamine and LDX.

Collaboration between Islamic Religious Education Teachers and Islamic Religious Extension Workers in Drug Abuse Prevention in Labuhan Batu

Collaboration between Islamic Religious Education Teachers and Islamic Religious Extension Workers in Drug Abuse Prevention in Labuhan Batu

Modelling the nicotine pharmacokinetic profile for e-cigarettes using real time monitoring of consumers’ physiological measurements and mouth level exposure

Pharmacokinetic (PK) studies can provide essential information on abuse liability of nicotine and tobacco products but are intrusive and must be conducted in a clinical environment. The objective of the study was to explore whether changes in plasma nicotine levels following use of an e-cigarette can be predicted from real time monitoring of physiological parameters and mouth level exposure (MLE) to nicotine before, during, and after e-cigarette vaping, using wearable devices. Such an approach would allow an -effective pre-screening process, reducing the number of clinical studies, reducing the number of products to be tested and the number of blood draws required in a clinical PK study Establishing such a prediction model might facilitate the longitudinal collection of data on product use and nicotine expression among consumers using nicotine products in their normal environments, thereby reducing the need for intrusive clinical studies while generating PK data related to product use in the real world.An exploratory machine learning model was developed to predict changes in plasma nicotine levels following the use of an e-cigarette; from real time monitoring of physiological parameters and MLE to nicotine before, during, and after e-cigarette vaping. This preliminary study identified key parameters, such as heart rate (HR), heart rate variability (HRV), and physiological stress (PS) that may act as predictors for an individual’s plasma nicotine response (PK curve). Relative to baseline measurements (per participant), HR showed a significant increase for nicotine containing e-liquids and was consistent across sessions (intra-participant). Imputing missing values and training the model on all data resulted in 57% improvement from the original’learning’ data and achieved a median validation R2 of 0.70.The study is in its exploratory phase, with limitations including a small and non-diverse sample size and reliance on data from a single e-cigarette product. These findings necessitate further research for validation and to enhance the model's generalisability and applicability in real-world settings. This study serves as a foundational step towards developing non-intrusive PK models for nicotine product use.

Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research.

Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons.

Effects of Drug and Substance Abuse on Academic Performance among Secondary School Students, Kauma Subcounty, Kilifii County, Kenya

Purpose: The study aims at investigating effects of substance abuse in Kauma Sub County of Kilifi County of the Coast Province. The Purpose is of the study is to uncover the effects of substance abuse and its relation to academic performance in Secondary schools in Kauma, with the purpose of recommending how to address the Situation. Methodology: The study involves Random selection of Schools and random filling of questioners by learners and Teachers. It was pegged on Uri Bronfenbrenner’s’ Ecological Contextual Theory (1979). Which denotes that behavior is controlled by ecological environmental systems that affects positively or negatively the personality of man culminating to the totality of one’s character. Findings: The research found that the cultural norms of Disco Matanga has greatly contributed to Palm wine (Mnazi), Muguka/ Ghat and Marijuana abuse. Efforts by the Presidency to address the issue and stop the vice has met stiff resistance from locals and politicians for their own motives which were not captured in this research. The research also found that 70% of Secondary school students scored D plus and below in National Examinations. Unique Contribution to Theory, Policy and Practice: The research recommends collaborative efforts on addressing drug abuse in secondary school students and the use of Faith based organizations , academic institutions, Intercountry – National and NGO approaches in Guidance and Counselling with emphasis to co-curricular and art therapies to first educate and inform the population on the effects of drug Abuse, the economic strain on both county and national government on rehabilitation and apply the multi sectorial approach to scaffold the emotional, mental, physiological effects on health and academics with subsequent methods to address the issue including further research studies..

Which pediatric practices use substance use consultation services?

Substance use disorders (SUD) are common in adolescents and young adults, though few youth with SUD receive treatment, and rates of medication for substance use disorder treatment are much lower in youth compared to adults. Pediatric primary care could present an opportunity for youth with SUD to access medication, though pediatric providers may need support. Massachusetts has provided a substance use consultation line for pediatric providers since 2018. One large network of independent primary care practices within the state has been further supported by access to resources provided through a grant from the Substance Abuse and Mental Health Services Administration. In this paper, we describe the services provided in Massachusetts and examine whether additional resources are associated with increased use of the consultation line as a marker of provider engagement in SUD treatment.