Stop Drug Use Research Articles

Sosialisasi Hukum Bahaya Narkoba Bagi Remaja SMK Negeri 2 Kota Tanjungbalai

Drugs are a challenge for the Indonesian people, especially the millennial generation or the generation of the nation's administrators, which can damage the mind, body and also the economy of anyone who uses them. So in this case, students care about the nation's generation. Drugs can also cause other people's bad actions, such as killing, stealing. , rape because the effects of drugs damage the mind. The purpose of this writing is to explain the dangers of drugs for teenagers because the number of drug users in Indonesia continues to increase and most of them are teenagers. Of the problems that have arisen today, many However, due to the many types of drug abuseIn the world of medicine, this is no longer used. This is a type of drug that is often abused and can cause dependence. There are various reasons why people use drugs, such as to relieve stress, have fun, or socialize with other people. The data analysis used was by analyzing various information collected from students of SMK Negeri 2 Tanjung Balai about the dangers of drugs, factors causing drug use among teenagers, and efforts to stop drug use. The results of this paper show that family factors that do not pay enough attention to children are the main cause of drug use by teenagers. To achieve this goal, this activity will use material delivery methods, discussions and question and answer sessions, as well as clinical services. The target of this activity is Tanjung Balai State Vocational School Students. The partner in this activity is TANJUNG BALAI Vocational School 2, considering that teenagers are the nation's generation and are easily influenced by drugs. After carrying out this activity, it is hoped that teenagers will be able to apply knowledge and abstain from using or abusing drugs and become a healthy generation, namely the golden Indonesian generation in 2045

Analysis of YouTube content on substance use disorder treatment and recovery.

Emerging literature suggests the role of social media in substance use disorders (SUD). This study aimed to explore the content of YouTube videos for persons on SUD treatment/recovery, describing the users' exposure and engagement metrics and understanding viewers' perspectives. We generated a set of 10 key phrases to search on YouTube. Eighty eligible videos were analyzed using a mixed-methods approach. Content analysis of all videos and thematic analysis of 30 videos were done using the three most viewed videos from each key phrase. The reliability of videos was assessed using a modified DISCERN. The total number of views, likes, dislikes, and comments were noted and created engagement metrics. The linguistic analysis of viewers' comments was done to assess their perspectives. Sixty-three (78.8%) videos were from the US, and 59 (73.8%) were intended for persons or families with substance misuse. Persons in recovery uploaded 23 (28.7%) videos. We identified five themes - reasons for using drugs, symptoms of addiction, consequences of drug use, how to stop drug use, and expressed tone in the language. The positivity and relative positivity ratios were highest for videos developed by persons in recovery. There was a negative correlation between the relative positivity ratio and content fostering internalized stigma. Words with negative emotional experiences dominated the viewers' comments. YouTube content on SUD treatment and recovery is popular and revolves around the biopsychosocial understanding of addiction. There is an urgent need for a language policy and regulation of non-scientific content.

Program Terapi Rehabilitasi Kecemasan Pecandu Narkoba dengan Metode Sujok Di Ponpes Salafiyah Sabilul Hikmah Malang

Goals of service. The Community Service Program (PKM) on Drug Addicts Anxiety Rehabilitation Therapy Program with the Sujok Method at Ponpes Salafiyah Sabilul Hikmah Malang aims to optimize the role of Islamic boarding school caregivers in an effort to socialize the movement of drug-free street children by providing counseling on tips for eliminating the anxiety of drug addicts who are addicted to drug undergoing therapy at the boarding school to stop drug use. Methods The PKM implementation team conducted counseling on how to overcome anxiety using therapeutic tools, namely massage rings, providing counseling materials, giving questionnaires about massage ring therapy, donating medicine boxes, providing digital weights, providing digital blood pressure checkers used when providing health services to patients. the caregivers of the Salafiyah Sabilul Hikmah Islamic Boarding School in Malang. Results and implications. After being given counseling about the use of ring therapy, they understand how to deal with anxiety by doing self-therapy every day for 5 minutes or 3 times or more and are able to teach other friends who feel anxious.

Patients'satisfaction and experience in treatment with opioid substitution therapy in Spain. The PREDEPO study.

The aim of this study was to compare patients' satisfaction, experience, objectives, and opinion based on their current opioid substitution therapy (OST) (buprenorphine/naloxone (B/N) or methadone). The PREDEPO study is an observational, cross-sectional, multicentric study performed in Spain. Adult patients diagnosed with opioid use disorder (OUD) receiving OST were included. They were asked to fill in a questionnaire regarding their current OST. A total of 98 patients were enrolled (B/N: 50%, methadone: 50%). Mean age was 47 ± 8 years old and 80% were male. Treatment satisfaction was similar between groups. The most frequently reported factor for being "very/quite satisfied" was "being able to distribute the dose at different times throughout the day" (44% B/N vs. 63% methadone; p = .122). A significantly lower proportion of patients in the B/N group versus the methadone group reported that having to collect the medication daily was "very/quite annoying" (19% vs. 52%, p = .032). Treatment objectives reported by the majority of patients were similar between groups ("not feeling in withdrawal anymore", "reduce/definitely stop drug use", "improve my health", and "stop thinking about using daily") except for "not having money problems anymore" (73% B/N vs. 92% methadone; p = .012). These results suggest there are several unmet expectations regarding current OST. There is a need for new treatments that reduce the burden of OUD, avoid the need for daily dosing, and are less stigmatizing which in turn could improve patient management, adherence and, quality of life.

Challenges Faced by Rehabilitation Centres in Management of Drug and Substance Abuse in Uasin Gishu, Kenya

The World Drug Report notes that globally, one in twenty adults between the ages of 15 and 64 years abused at least one type of drug. Every year in Kenya misuse of drugs costs the country lots of money and sometimes the misuse has led to deaths. Due to the impact of abuse of substances on individual’s health and the socio-economic consequences, there are several efforts towards alleviating or reducing drug abuse in Kenya. With all these challenges and strategies put in place by the government and other concerned parties, drug and substance abuse in Kenya is still on the rise. This calls for drug abuse treatment whose goal is to stop drug use. The objective of this study was to determine the challenges faced by rehabilitation centers in the management of drug and substance abuse. To achieve the purpose of this study, three specific research objectives were addressed i.e., to determine the Challenges of the rehabilitation centres in management of drug and substance abuse in Uasin Gishu as attested by the management, to determine the challenges of the rehabilitation centres in management of drug and substance abuse in Uasin Gishu as attested by the rehabilitees and to establish the ways of improving the effectiveness of the existing rehabilitation centers. The target population came from the drug rehabilitation centers in Uasin Gishu County. It comprised all the drug and substance addicts and their instructors. Purposive sampling technique was used to select the drug and substance rehabilitation centers in Uasin Gishu County while stratified random sampling was used to sample the management and staff members within the rehabilitation centers. Data was collected through questionnaires and focus group discussions. Data was analyzed using descriptive statistics . Findings as attested by the management and rehabilitees showed poor rehabilitees participation, inadequate resources, poor implementation methods, negative attitude, lack of medication, irregular follow ups, rehabilitees abandonment, high client relapse, inadequate support services being the major challenges to effective implementation. It is recommended that rehabilitation management should recruit clients in references to the infrastructures in some of the rehabilitation centers to avoid congestion and the strained resources observed in some of the rehabilitation centers during the study.

Substance Use in Pregnancy Remains a Challenge

Back to table of contents Previous article Next article Clinical & ResearchFull AccessSubstance Use in Pregnancy Remains a ChallengeTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:17 Jun 2020https://doi.org/10.1176/appi.pn.2020.6b2AbstractCigarette smoking and opioid use disorder in pregnant women illustrate the need for more screening, education, and treatment.Psychiatrists should screen all of their pregnant patients for substance use, including cigarette smoking, says Kimberly Yonkers, M.D.Yale University/Robert A LisakFour in five women who decrease or stop hazardous alcohol, tobacco, or drug use during pregnancy return to using those substances after their babies are born, but there are concrete steps psychiatrists can take to treat women both before and throughout their pregnancies. Kimberly Yonkers, M.D., director of the Division of Psychological Medicine and the Center for Wellbeing of Women and Mothers at Yale School of Medicine, discussed different substances, their impact on maternal and infant health, and the importance of tailored treatment in a presentation at the virtual APA Spring Highlights Meeting in April.Pregnant women tend to stop using alcohol earlier in their pregnancies than they stop using tobacco, cocaine, or marijuana, and they are slowest to stop smoking cigarettes, with many women smoking throughout pregnancy or resuming smoking shortly after delivery, explained Yonkers, who is also editor of the APA journal Psychiatric Research and Clinical Practice.“Cigarette smoking in general has been decreasing, but still between 10% and 15% of women [smoke], and it’s very, very difficult to discontinue smoking, even in pregnancy,” Yonkers said.She noted that pharmacological treatments have not shown a benefit in treating pregnant women who smoke. For patients who use nicotine replacement products, intermittent treatments like gum or inhalers may provide benefit with less nicotine exposure than patches. She cautioned against the use of e-cigarettes.“E-cigarettes are no panacea. The solvents can be a hazard to women,” Yonkers said.Illicit drug use, notably illicit opioid use, also takes a tremendous toll on pregnant women and their infants.“The rates of opioid use disorder have gone up in the general population, and pregnant women are not immune to this,” Yonkers said. She added that although pregnancy-associated mortality rose 34% between 2007 and 2019, pregnancy deaths related to opioids doubled during that time. “We have to be careful that we’re not just taking care of kids and offspring. We have to take care of moms.”To that end, the first step is to screen all pregnant women for substance use disorders, Yonkers said. “If you are not universally screening, you are missing people. That doesn’t mean grabbing a urine test from them. It just means asking them and, ideally, engaging them in treatment.”Yonkers discussed the benefits of medication treatment for opioid use disorder (OUD), noting that maintenance treatment increases the use of prenatal care among pregnant women and decreases craving for other illicit drugs. She added that medication treatment may increase birthweight in infants born to women who receive it, compared with birthweight in infants born to women who do not receive medication treatment.Yonkers highlighted guidance by the Council on Patient Safety in Women’s Health Care, a group of women’s health organizations, on working with pregnant women who use substances. In addition to universal screening, other key steps the Council recommends include the following:Providing education about substance use disorders, including explaining that they are chronic medical conditions and that medication treatment works for OUD, and explaining the risks of neonatal abstinence syndrome.Matching treatment with the woman’s stage of recovery.Ensuring that all patients with substance use disorders are enrolled in a treatment program, coordinating care among health professionals, and engaging child welfare in safe care protocols. ■ ISSUES NewArchived

HUBUNGAN TINGKAT PENGETAHUAN DENGAN MOTIVASI UNTUK BERHENTI MEMAKAI NAPZA PADA REMAJA DI PONPES SURYALAYA SURABAYA

The number of drug abusers has been increasing rapidly from year to year, so it can be considered to endanger the safety of the nation's next generation. The research was Purposed to analyze the relationship of knowledge and motivation to stop drug use in adolescents at boarding school students Suryalaya Korwil Inabah XIX Surabaya in East Java. The design of this research is correlational by nature analytical cross sectional approach. Population of all students at boarding school teen Suryalaya Korwil Inabah XIX Surabaya in East Java as much as 24 people until found 22 respondent. Sampling technique is simple random sampling. Instrument using a questionnaire. Processing of test data used was spearman rank through SPSS with significance level α = 0.05. Teenager in boarding school students Suryalaya Korwil Surabaya in East Java Inabah XIX obtained in the majority of students have good knowledge Inabah with half of the respondents have a high motivation. From the results of statistical tests in getting ρ <α is 0.002 <0.05 which means that Ho is rejected or no relationship between level of knowledge and motivation to stop drug use on adolescent students. Conclusion the study is the higher level of knowledge, the higher the motivation to stop drug use. The importance of nurses providing motivation to the youth about the effects of addictive drugs so they do not re use it.

Evaluation of Drug Abuse Relapse Event Rate Over Time in Frailty Model

ObjectivesDrug dependence as a chronic disorder is reversible over time and has a cost burden for individuals, families, and society. An individual who has stopped taking drugs for a long time may start taking drugs again. The variables affecting the reuse of drugs are not well known. Therefore a study of the factors that increase the length of time away from drugs is essential. MethodsThis study used data collected by the Bushehr addiction treatment centers (Tolloe and Pasargadae) from 100 men with drug addiction from March 2006 to September 2010. The shared frailty model was used to study the influence of variables on the duration of time away from drug use. The most common method for entering intra-class (personal) correlation is the survival frailty model, which uses parametric survival data for the evaluation of recurrent events. A Weibull distribution for time to event with gamma shared frailty was used. ResultsThe mean (standard deviation) age and age at onset of opium use of the sample were 33.85 (8.11) and 20.65 (6.87), respectively. About 30% of the men studied had chronic disease and 36% had a mental illness. The mean (frequency mean) of the amount of opium used were 4.73 (3.8) g and 2.54 (1.14) times per day. The desire to end drug use was 97% and 3% for the men with drug addiction and their families, respectively, at the time when the men stopped using opium. The age at onset of opium use [p = 0.046, hazards ratio (HR) = 1.30], history of chronic disease (p = 0.005, HR = 249.635), and marital status (p = 0.06, HR = 0.027) are important in the reuse of opium. ConclusionWe found that opium addiction is related to other chronic diseases and to the age at onset of opium use. A prospective study following up individuals with drug addiction who try to stop drug use in addiction treatment centers could help to determine the risk factors of resuming drug use.

Screening and brief intervention for drug use in primary care: the Assessing Screening Plus brief Intervention’s Resulting Efficacy to stop drug use (ASPIRE) randomized trial

Methods In this randomized trial (the Assessing Screening Plus brief Intervention’s Resulting Efficacy to stop drug use (ASPIRE) study) we tested the efficacy of a brief negotiated interview (BNI), and an adaptation of motivational interviewing (AMI), compared to no BI. Primary care patient participants had Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) drug specific scores of ≥4. Primary outcome at 6 months was number of days use of the drug of most concern (DOMC) in the past 30 days.

Dyadic Social Interaction as an Alternative Reward to Cocaine

Individuals suffering from substance use disorders often show severely impaired social interaction, preferring drugs of abuse to the contact with others. Their impaired social interaction is doubly harmful for them as (1) therapy itself is based and dependent on social interaction and as (2) social interaction is not available to them as an “alternative”, i.e., non-drug reward, decreasing their motivation to stop drug use. We therefore developed an animal experimental model to investigate the neurobiology of dyadic social interaction- vs. cocaine reward. We took care to avoid: (a) engaging sexual attraction-related aspects of such a social interaction and (b) hierarchical difference as confounding stimuli. The cocaine- or social interaction stimulus was offered – in a mutually exclusive setting – within the confines of a conditioned place preference (CPP) apparatus. In our paradigm, only four 15-min episodes of social interaction proved sufficient to (i) switch the rats’ preference from cocaine-associated contextual stimuli to social interaction CPP and (ii) inhibit the subsequent reacquisition/reexpression of cocaine CPP. This behavioral effect was paralleled by a reversal of brain activation (i.e., EGR1 expression) in the nucleus accumbens, the central and basolateral amygdala, and the ventral tegmental area. Of relevance for the psychotherapy of addictive disorders, the most rewarding sensory component of the composite stimulus “social interaction” was touch. To test our hypothesis that motivation is encoded in neuron ensembles dedicated to specific reward scenarios, we are currently (1) mapping the neural circuits involved in cocaine- vs. social-interaction reward and (2) adapting our paradigm for C57BL/6 mice to make use of the plethora of transgenic models available in this species.

Addiction and guilt

Both the concepts of addiction (drug-addiction) and of responsibility are not universally crystallized and accepted. Even the terms in Greek language are disputable: Toxicomania or exartisis (dependence)? Enoche (guilt) or katalogismos (imputation)? Nosology and Criminal Law disciplines do not share necessarily common definitions about. The question here is if addiction implies merely incapacity to stop drug use, or even incapacity to choose a legal way to act in general. Is this incapacity an excuse or a mitigation factor, in the field of criminal responsibility? The answer presupposes some critical differentiations (kinds of crimes seriousness of crime e.t.c). In spite of the complexity, a guideline is simple: where addiction annulates or restricts free will to choose right or wrong doing, responsibility and consequently penalty are affected in favor of the accused actor of a crime. Where this is not the case, a regular punishment is fair.

S.05.05 Preclinical and clinical aspects of vaccination for addiction

In the next decade, we should witness a number of treatment advances for opioids, stimulants, and cannabis derivatives. For opioids, this will include long acting, i.e., one month to one year, injectable or implants of the antagonist naltrexone, injectable or implants of the partial agonist buprenorphine, and innovative detoxification methods using buprenorphine. In addition, there should be much wider office based prescribing of buprenorphine for maintenance as financial, stigma, and numerical prescribing barriers are overcome.Possible new developments for cocaine dependence include vaccines that provide either active or passive immunization; agonists that could decrease craving without producing euphoria; blocking agents that do not block normal pleasures; and CRF (corticotrophin releasing factor) antagonists which could decrease both craving and relapse. In the short term, medications currently marketed for other indications that show promise for cocaine include modafinil, tiagabine, topiramate, and disulfiram.Until recently, there has been little effort toward developing medications to treat marijuana abuse/dependence. Potential medications now being considered include the agonist dronabinol, rimonabant, an antagonist and inverse agonist, and Sativex, an aerosol combining THC and cannabidiol, a non-psychoactive cannabis ingredient. Behavioral interventions will continue to be necessary, not just to increase the likelihood that patients will take effective medications but also to assist them in improving their interpersonal, educational, and vocational skills so as to develop positive rather than just negative reasons for wanting to stop drug use.

Effects of a Community-Based Drug Use Prevention Program Targeting Licensed Premises

This study evaluated the effects of a community-based drug use prevention program on the frequency with which doormen at licensed premises intervene in cases of obviously drug use-impaired patrons. Doormen were trained in recognizing signs of drug use impairment to be able to stop drug use–impaired patrons to enter the premises. The study included 28 trendy nightclubs in Stockholm, Sweden, that used doormen to screen patrons. Two male actors were instructed to act as if they were obviously drug use–impaired (cocaine/amphetamines) while attempting to enter nightclubs. Data were collected at pretest when 40 entry attempts were made (2003) and posttest (2004) when 48 attempts were made. At follow-up, the doormen intervened in 27% of the attempts, a significant improvement compared to the intervention rate of 7.5% at baseline. The results indicate that the intervention has had effect on doormen's behavior. However, in the majority of the attempted visits, the doormen still did not intervene. Limitations of the study were the lack of a control group and problems with identifying the training status for the individual doormen. Further research is necessary to explore the effectiveness of community-based drug use prevention programs targeting licensed premises.

Forces of habit ‐ why it is time to reduce the harm of drug prohibition

Continuing our look at drug policy and crime, we ask just how damaging our current drug laws are? With the ever increasing and expensive fight to stop drug use by force, are we causing more harm than good, and who is paying the price? Henry Shaftoe explains why prohibition is not only dangerous but it may also be responsible for encouraging drug use among the young.

Future advances in addiction treatment

In the next decade, we should witness a number of treatment advances for opioids, stimulants, and cannabis derivatives. For opioids, this will include long acting, i.e., one month to one year, injectable or implants of the antagonist naltrexone, injectable or implants of the partial agonist buprenorphine, and innovative detoxification methods using buprenorphine. In addition, there should be much wider office based prescribing of buprenorphine for maintenance as financial, stigma, and numerical prescribing barriers are overcome. Possible new developments for cocaine dependence include vaccines that provide either active or passive immunization; agonists that could decrease craving without producing euphoria; blocking agents that do not block normal pleasures; and CRF (corticotrophin releasing factor) antagonists which could decrease both craving and relapse. In the short term, medications currently marketed for other indications that show promise for cocaine include modafinil, tiagabine, topiramate, and disulfiram. Until recently, there has been little effort toward developing medications to treat marijuana abuse/dependence. Potential medications now being considered include the agonist dronabinol, rimonabant, an antagonist and inverse agonist, and Sativex, an aerosol combining THC and cannabidiol, a non-psychoactive cannabis ingredient. Behavioral interventions will continue to be necessary, not just to increase the likelihood that patients will take effective medications but also to assist them in improving their interpersonal, educational, and vocational skills so as to develop positive rather than just negative reasons for wanting to stop drug use.

Prefrontal Cortical Dysfunction in Abstinent Cocaine Abusers

The anterior cingulate cortex (ACC) and lateral prefrontal (LPFC) cortex are brain regions important to executive cognitive functions (ECF). We determined ACC and LPFC function in 23-day abstinent cocaine abusers using positron emission tomography (PET H215O) during performance of a modified version of the Stroop Task. Cocaine abusers showed less activation than non-drug-using comparison subjects in the left ACC and the right LPFC and greater activation in the right ACC. Average amount of cocaine used per week was negatively correlated with activity in the rostral ACC and right LPFC. Disruption of ECF in substance abusers could interfere with attempts to stop drug use and undermine treatment. Since impairment in ECF may be a common feature of various neuropsychiatric disorders, these findings have applicability beyond the neurobiology of addiction.

Prefrontal Cortical Dysfunction in Abstinent Cocaine Abusers

The anterior cingulate cortex (ACC) and lateral prefrontal (LPFC) cortex are brain regions important to executive cognitive functions (ECF). We determined ACC and LPFC function in 23-day abstinent cocaine abusers using positron emission tomography (PET H(2)(15)O) during performance of a modified version of the Stroop Task. Cocaine abusers showed less activation than non-drug-using comparison subjects in the left ACC and the right LPFC and greater activation in the right ACC. Average amount of cocaine used per week was negatively correlated with activity in the rostral ACC and right LPFC. Disruption of ECF in substance abusers could interfere with attempts to stop drug use and undermine treatment. Since impairment in ECF may be a common feature of various neuropsychiatric disorders, these findings have applicability beyond the neurobiology of addiction.

"A 28-day program ain't helping the crack smoker"--perceptions of effective drug abuse prevention interventions by north central Florida African Americans who use cocaine.

Cocaine is a major problem in the rural South, but knowledge is limited regarding the impact on African American populations. This study of 18-39-year-old black drug users assessed perceptions of contributing factors to drug use and possible interventions. The study design was qualitative-descriptive, utilizing 4 focus groups with 5 rural women and 14 small-city residents. Some respondents perceived that drug use initiation and continuation were due to themes of (1) loss, (2) peer pressure, (3) personal problems and dealing with pain, (4) desire for fun or to "feel good," and (5) drugs and drug-related messages within their environments. Common themes of effective strategies to stop drug use were (1) the necessity of wanting to quit, (2) the importance of help or support from family and friends, and (3) the need for resources, such as a job, car, and housing. Some respondents agreed on 3 human resources: (1) family, (2) ex-users, and (3) churches. Strategies to increase attendance at drug prevention programs included (1) making the program fun/enjoyable, (2) having mixed gender programs, (3) providing food/money, and (4) having the programs in their community. Recurrent themes were the lack of drug prevention intervention programs available to respondents and the failure of traditional programs of the majority culture to adequately meet their needs. Effective drug prevention programs for southern African Americans who use cocaine must be community based, personalized, and culturally relevant.

Readiness for Cessation of Drug Use Among Recent Attenders and Nonattenders of a Needle Exchange Program

Needle exchange programs (NEPs) represent a bridge to drug abuse treatment. NEP attenders tend to have more severe drug problems, however, and may be less ready to reduce their drug use than other drug users. This study investigated the relationship between NEP attendance and readiness for cessation of drug use. Since the period from 1988 through 1989, a community-based sample of injection drug users (IDUs) in Baltimore has undergone semiannual interview-administered questionnaires and HIV testing. A total of 288 IDUs completed a questionnaire on readiness for cessation of drug use. Readiness for drug use cessation was assessed from a 28-item validated scale of problem drug use and intention to quit, based on the "stages of change" model. Logistic regression was used to determine factors associated with readiness for cessation of drug use, including sociodemographics, drug use behaviors, and NEP attendance. Thirty percent of respondents attended the NEP in the past month. Stage of change in readiness for cessation of drug use did not differ between NEP attenders and nonattenders (OR = 0.9; 95% CI: 0.5-1.6). Similar proportions of persons recently attending and not attending the NEP were classified as ready to stop drug use (about 30%). In multivariate analysis, readiness for cessation of drug use was associated with speedball injection and previous enrollment in drug treatment but not with NEP attendance. NEP attenders, although exhibiting characteristics consistent with more severe drug dependence, were as motivated for cessation of drug use as were nonattenders. These findings suggest that formal collaboration between NEPs and drug treatment programs could increase the proportion of IDUs in treatment.

Psychotherapy with Substance Abusers

Integration of Psychodynamic and Cognitive-Behavioral Approaches Historically, psychotherapeutic approaches utilized with substance abusers have been a reflection of the most prominent modality being used at that particular time to treat mental disorders. Initially, the principles of psychoanalysis and psychodynamic psychotherapies were applied to substance abusers (1, 2). The concept that all symptoms arose from some underlying and often unconscious psychological conflicts was applied to the symptoms of drug abuse (3). Without resolution of the underlying conflict, symptom substitution would occur, e.g., depression or phobias. Unfortunately, using psychoanalysis or psychodynamic psychotherapy as the only treatment modality yielded disappointing outcomes. The therapist's typically neutral, passive stance that is essential to the development of transference and exploration would be ineffective in controlling the active symptoms of drug abuse. The lack of structure and limit setting allowed the ongoing drug use to undermine the treatment. The anxiety-arousing aspect of free association would elicit more drug use. Patients dropped out of treatment. Perhaps in response to the failure of psychodynamic therapies, other psychosocial treatments, geared specifically to substance abusers, were developed. These include Alcoholics Anonymous (AA) and therapeutic communities. Subsequently, the principles of cognitive, behavioral, and client-centered therapies began to be modified for application to addicted patients (4, 5). In addition, biological treatments, such as methadone maintenance for opiate dependence (6) and disulfiram for alcohol abuse (7), were introduced. The prevailing strategy that is now central to all psychotherapeutic modalities is to primarily focus on the achievement of abstinence from drug use. Once drug use becomes controlled and abstinence is attained, then the recovering addict can begin to address issues of social rehabilitation, interpersonal functioning, and even resolution of intrapsychic conflicts. There is growing evidence that individual psychotherapy can be an effective modality for substance abusers (8). The key is to match the appropriate modality to the patients' needs, depending on their stage of recovery. The sequence and timing of psychotherapeutic modalities ranging from cognitivebehavioral therapies to the integration of psychodynamic principles enhance the possibility of successful outcomes. The following is a brief description of how the various psychotherapeutic approaches can be integrated into the treatment of substance abusers. Multiple factors may influence what brings a drug abuser into treatment. But rarely is the initial motivation a desire to stop drug use altogether. Typically, the motivating factors are externally driven. These can include legal consequences of drug or alcohol use (e.g., DWI), marital or family difficulties, and school or employment jeopardy, as well as physical consequences of drug use (e.g., hepatitis, cirrhosis, HIV disease, etc.). The general motivation is that if these external consequences could be alleviated, then the substance use would not be seen as a problem. Women tend to enter treatment via the mental health or primary care system with psychological complaints of depression and anxiety and only on further questioning does it become clear that there is comorbid drug or alcohol use (9). Certain investigators have hypothesized stages in the development of drug abusers' readiness to stop drug use (10, 11). These range from precontemplation to contemplation and on to action and determination. These motivational approaches hinge on meeting patients where they are at. In order to build the resolve to stop, the ego-syntonic aspects of drug use (e.g., pleasure, social gratification, relief of painful affects) need to be counterbalanced by the ego-dystonic aspects of drug use (e.g., medical sequelae, loss of job, divorce). This motivational form of therapy uses cognitive principles to help set the goals and framework for the psychotherapy. …