Treatment Of Substance-related Disorders Research Articles

Digital health divide and digital technologies for treating substance-related disorders in Argentina

Abstract Argentina is a country located in the South American region with more than 45 million inhabitants. According to the National Institute of Statistics and Censuses, over 92% of the population lives in urban areas. Additionally, 47% households do not have access to computers, and 12% lack availability of the internet. The present case study demonstrates the effects of the digital divide regarding the use and access to digital technologies in patients who underwent virtual treatment for substance-related disorders in a mental health service in the city of Córdoba, Argentina. This treatment modality included virtual consultation with a psychologist and WhatsApp groups for mutual support. The data obtained is part of a larger research project aimed at evaluating access to digital healthcare treatment, quality of life and patient satisfaction with the use of digital tools for treating substance-related disorders. Participants were adults between 25 and 60 years. The majority of the patients who were surveyed presented cognitive impairment and unemployment status. Those who completed secondary school (79%), stated that virtual consultation was easy to conduct (83%) and WhatsApp group texting information for mutual support was very difficult to comprehend for participating actively (63%). On the other hand, participants who only reached primary school (21%) declared that virtual consultation was easy to do (71%) and WhatsApp group texting information for mutual support was very difficult to comprehend for participating actively (87%). Concerning access, 78% of participants answered that they have difficulties with the availability of digital devices (i.e., smartphones, computers, or tablets), internet connectivity and privacy at home or work for undergoing digital treatment.

Взаимосвязь особенностей регуляции эмоций и социальной тревоги у лиц, зависимых от психоактивных веществ

Social phobia is one of the most common anxiety disorders among patients receiving medical treatment for substance-related disorders. There is reason to believe that certain strategies of emotional regulation act as risk factors for the development of social anxiety in persons dependent on psychoactive substances (PAS), while other strategies are protective factors. Using a sample of 30 people undergoing rehabilitation at a drug abuse clinic, the authors showed the relationships between social anxiety and its components, emotional states and specific strategies of emotional regulation. Shame experience increases with an increase in social anxiety, but the self-accusation strategy is used to reduce it. Focus on problem-solving and cognitive revaluation, as well as the ability to maintain attention to daily activities and focus on current activities are inversely associated with social phobia symptoms. Taking a problem situation for granted is inversely associated with social anxiety, which may be specific to the sample of individuals undergoing rehabilitation. Awareness as a self-regulation mechanism generally showed no association with social phobia symptoms. Most likely, this is explained by its low development in general among people who use PAS. Since social anxiety is a factor that provokes substance misuse, hinders gaining positive experience in resolving difficult situations, and reduces the quality of life, it is recommended that rehabilitation programs for PAS-dependent persons include the formation of skills in adaptive emotional regulation and techniques that allow restoring the attention processes underlying complex self-regulation functions.

The Microbiome-Gut-Brain Axis, a Potential Therapeutic Target for Substance-Related Disorders.

Substance addiction is a complex worldwide public health problem. It endangers both personal life and social stability, causing great loss on economy. Substance-related disorder is considered to be a complicated chronic brain disorder. It resulted from interactions among pharmacological properties of addictive substances, individual susceptibility, and social–environmental factors. Unfortunately, there is still no ideal treatment for this disorder. Recent lines of evidence suggest that gut microbiome may play an important role in the pathogenesis of neuropsychiatric disorders, including substance-related disorders. This review summarizes the research on the relationship between gut microbiome and substance-related disorders, including different types of substance, different individual susceptibility, and the occurrence and development of substance-induced mental disorders. We also discuss the potentiation of gut microbiome in the treatment of substance-related disorders, especially in the treatment of substance-induced mental disorders and manipulation on individuals’ responsiveness to addictive substances.

Individuals With Substance-Related Disorders: Lived Experiences and Perceptions of Daily Life

Abstract Date Presented 04/19/21 Because drug and alcohol addiction remains a significant societal concern, it is important to understand the experiences and the daily lives of those affected. The results of this research add to the growing knowledge of the potential role for OT for individuals with substance-related disorders. Additionally, the results emphasize the distinct value that OT has in fostering an interdisciplinary approach to the treatment of substance-related disorders. Primary Author and Speaker: Roshni Patel Additional Authors and Speakers: Hyun Kyoon Lim Contributing Authors: Il Doh

Determination of acamprosate in human plasma by UPLC-MS/MS: Application to therapeutic drug monitoring.

Acamprosate is a medication used to treat alcohol dependence. Therapeutic drug monitoring is important in drugs for the treatment of substance-related disorders. Therefore, in this study, a new selective, very simple and rapid ultra-performance liquid chromatography-tandem mass spectrometer method was developed for the therapeutic drug monitoring of acamprosate. The developed method allows the determination of acamprosate in human plasma. The method was validated in terms of selectivity and linearity, which was in the range of 100-1,200 ng/ml for acamprosate. Intra-assay and inter-assay accuracy and precision were within the acceptable limits of the Eueopean Medicines Agency guideline. The lower limit of quantitation was 100 ng/ml for acamprosate. The developed method was successfully applied for therapeutic drug monitoring in patient plasma samples.

Anxiety sensitivity and substance-related disorders: a narrative review

Anxiety sensitivity means fear of anxiety-related sensations which is one of the important factors in the development and maintenance of substance-related disorders. Studies support the underlying, mediating, and moderating role of this construct in the etiology of substancerelated disorders. This review suggests that anxiety sensitivity can play a role in this group of disorders in different ways, such as fear of body sensations, fear of cognitive dyscontrol, and fear of socially observable anxiety symptoms. Finally, high anxiety sensitivity can interfere with the treatment of substance-related disorders as an underlying vulnerability and increase the likelihood of relapse in this group of people.

Very Low Frequency of Drug Therapy of Alcohol Dependence in Germany - Analysis of Data of A Statutory Health Insurance.

Acamprosate and naltrexone are medications of proven efficacy in the treatment of alcohol dependence. In order to investigate the prescription of these drugs in outpatient routine treatment in Germany (frequency of prescription, duration, medical specialty of prescribing physician), data of a large statutory health insurance were analyzed. Persons were included who were discharged from inpatient treatment with an alcohol-related disorder among their diagnoses during a one year observation period and with no diagnosed additional substance-related disorder (apart from nicotine- and cannabis-related disorders). Thus 12.958 patients were identified (mainly male, 77.9%; at average 51.4 years [+/-12.7] of age). 44.3% of these patients were treated in a psychiatric hospital, the remaining patients in hospitals of other specialties (e. g. 9.2% in departments of surgery). During an observation period of 6 months after discharge, acamprosate or naltrexone were prescribed at least once to 98 persons (0.76% of 12.958 patients; acamprosate n=80, 0.62%; naltrexone n=18, 0.14%). 16 (0.12%) patients were prescribed acamprosate or naltrexone for more than 3 months. Half of the prescriptions were issued by general practitioners. Possible reasons for this under-prescription are lack of knowledge about the drug treatment of alcohol dependence outside of addiction psychiatry, neglect of biological aspects (including medication) regarding etiology and treatment of substance-related disorders, and stigma of patients with substance-related disorders.

Psychoactive Substance Use and Disabled People: An Integrative Review

This study aimed to analyze the evidence available in the literature about psychoactive substance use by persons with disabilities. We used integrative review of literature in SciELO, PubMed, SCOPUS, BDENF, and PsychINFO databases, with the descriptors: pessoas com deficiência; transtornos relacionados a uso de substancias; disabled persons; and substance-related disorders. Twelve articles were included in the sample. Data were analyzed and discussed descriptively. The studies’ results, with scientific evidence, were synthesized on two main themes: substance use by people with disabilities, and access of people with disabilities to treatment for substance-related disorders. The scientific evidences identified in studies reported disability as a risk factor for substance abuse, and also reported that disabled persons did not have access to treatment and rehabilitation services for substance abuse. Finally, the studies analyzed pointed to the need for scientific research on this topic.

Reliability and Validity of the Spanish Version of the Substance Dependence Severity Scale

Purpose: The purpose of this study was to estimate the reliability and provide evidence for the validity of the Spanish version of the Substance Dependence Severity Scale (SDSS). Methods: A total of 211 substance abusers recruited at a public center that provides treatment for substance-related disorders in an outpatient setting were assessed. Reliability was estimated by Cronbach's α and test-retest. Validity evidence was studied by analyzing the relationships with the European Addiction Severity Index (EuropASI) and Health-Related Quality of Life for Drug Abusers (HRQoLDA). Results: Adequate reliability coefficients were found for the dependence scales of all addressed substances (α = 0.737 to 0.877; test-retest r = 0.796-0.952). Low internal consistency was found for the abuse scales (α = 0.329-0.694), and adequate test-retest coefficients on alcohol, cocaine and heroin (test-retest r = 0.708-0.902). The reliability of the cannabis abuse scales was inadequate. The SDSS scores showed significant relationships with the EuropASI and HRQoLDA dimensions. Conclusions: The psychometric analyses validate the use of the severity of dependence scales. The SDSS abuse scales must be used taking the limitations detected into consideration.

Therapeutic Drug Monitoring for Drugs Used in the Treatment of Substance-Related Disorders: Literature Review Using a Therapeutic Drug Monitoring Appropriateness Rating Scale

The efficacy of drugs for the treatment of substance-related disorders is moderate at best. Therapeutic drug monitoring (TDM) could be an instrument to improve outcomes. Because TDM for most of those drugs is not established, the authors reviewed the literature and built a rating scale to detect the potential added value of TDM for these pharmacologic agents. A literature search was performed for acamprosate, bupropion, buprenorphine, clomethiazole, disulfiram, methadone, naltrexone, and varenicline. The rating scale included 22 items and was divided in five categories: efficacy, toxicity, pharmacokinetics, patient characteristics, and cost-effectiveness. Three reference substances with established TDM were similarly assessed for comparison: clozapine, lithium, and nortriptyline. The three reference substances achieved scores of 15, 12, and 14 points, respectively. Drugs for treatment of substance-related disorders achieved 3 to 17 points, 17 for methadone, 11 for buprenorphine, 10 for disulfiram, also 10 for naltrexone for the indication opioid-dependence and 9 for the indication alcohol dependence as well as bupropion, 7 points for acamprosate, 6 points for clomethiazole, and 3 for varenicline. It is concluded that systematic evaluation of drug- and patient-related variables with the new rating scale can estimate the appropriateness of TDM. Because their rating revealed similar scores as the three reference drugs, it is proposed that TDM should be established for bupropion, buprenorphine, disulfiram or a metabolite, methadone, and naltrexone. An objective rating of drug- and patient-related characteristics could help laboratories focus their method development on the most likely drugs to require TDM along with a thorough drug use evaluation.

Obsessive-Compulsive Disorder, Impulse Control Disorders and Drug Addiction

The basic concepts underlying compulsive, impulsive and addictive behaviours overlap, which may help explain why laymen use these expressions interchangeably. Although there has been a large research effort to better characterize and disentangle these behaviours, clinicians and scientists are still unable to clearly differentiate them. Accordingly, obsessive-compulsive disorder (OCD), impulse control disorders (ICD) and substance-related disorders (SUD) overlap on different levels, including phenomenology, co-morbidity, neurocircuitry, neurocognition, neurochemistry and family history. In this review we summarize these issues with particular emphasis on the role of the opioid system in the pathophysiology and treatment of OCD, ICD and SUD. We postulate that with progression and chronicity of OCD, the proportion of the OCD-related behaviours (e.g. checking, washing, ordering and hoarding, among others) that are driven by impulsive 'rash' processes increase as involvement of more ventral striatal circuits becomes prominent. In contrast, as SUD and ICD progress, the proportion of the SUD- and ICD-related behaviours that are driven by compulsive 'habitual' processes increase as involvement of more dorsal striatal circuits become prominent. We are not arguing that, with time, ICD becomes OCD or vice versa. Instead, we are proposing that these disorders may acquire qualities of the other with time. In other words, while patients with ICD/SUD may develop 'compulsive impulsions', patients with OCD may exhibit 'impulsive compulsions'. There are many potential implications of our model. Theoretically, OCD patients exhibiting impulsive or addictive features could be managed with drugs that address the quality of the underlying drives and the involvement of neural systems. For example, agents for the reduction or prevention of relapse of addiction (e.g. heavy drinking), which modulate the cortico-mesolimbic dopamine system through the opioid (e.g. buprenorphine and naltrexone), glutamate (e.g. topiramate), serotonin (e.g. ondansetron) or γ-aminobutyric acid (e.g. baclofen and topiramate) systems, may prove to show some benefit in certain forms of OCD. Based on the available evidence, we suggest that the treatment of patients with these disorders must account for alterations in the underlying motivations and neurobiology of the condition. We provide an initial guide to the specific treatments that future clinical trials might consider in patients with OCD. For example, it might be wise to test naltrexone in patients with co-morbid SUD and ICD, topiramate in patients with co-morbid ICD and eating disorders, and baclofen in patients with co-morbid Tourette's syndrome. These trials could also include scales aimed at assessing underlying impulsivity (e.g. Barratt Impulsiveness Scale) to check whether this construct might predict response to drugs acting on the reward system.

P01-13 - Therapeutic drug monitoring of drugs for treatment of substance-related disorders

IntroductionThe effect of pharmacotherapy of substance-related disorders is moderate at best.ObjectivesTherapeutic drug monitoring (TDM) could be an instrument to improve the outcomes. TDM is for most of these drugs not established yet.AimsThe authors built a literature based rating scale to evaluate the necessity of TDM for these pharmacological agents.MethodsA literature research was performed for TDM related properties of acamprosate, bupropion, buprenorphine, clomethiazole, disulfiram, methadone, naltrexone, and varenicline. A rating scale was established for evaluation. It included 28 items related to five categories (efficacy, toxicity, pharmacokinetics, patient characteristics and cost effectiveness). For comparison, three reference substances with established TDM were similarly assessed: clozapine, lithium and nortriptyline.ResultsThe three reference substances, lithium, clozapine and nortriptyline, achieved scores of 15, 18, and 14 points, respectively. Rating of methadone (19 points), bupropion (14 points), buprenorphine (14 points), disulfiram (13) and naltrexone (12 points in the indication opioid-dependency and 10 points in the indication alcohol dependency) achieved more than 30% of the reachable points, whereas acamprosate (9 points), clomethiazole (9 points), and varenicline (5 points) had fewer points especially in the main characteristics in favor of TDM.ConclusionsThese results suggest this rating scale is sensitive to detect the appropriateness of TDM for drug treatment. Literature based rating and clinical experience give evidence that TDM has the potential to optimize the pharmacotherapy of substance related-disorders with different rank orders of the single substances.

The American Psychiatric Publishing textbook of psychopharmacology

Part I: Principles of Psychopharmacology. Neurotransmitters, receptors, signal transduction, and second messengers in psychiatric disorders. Basic principles of molecular biology and genomics. Chemical neuroanatomy of the primate brain. Electrophysiology. Animal models. Psychoneuroendocrinology. Principles of pharmacokinetics and pharmacodynamics. Brain-immune system interactions: relevance to the pathophysiology and treatment of neuropsychiatric disorders. Brain imaging in psychopharmacology. Statistics and clinical trial design in psychopharmacology. Pharmacoeconomics. Part II: Classes of Psychiatric Treatments: animal and human pharmacology. Antidepressants and Anxiolytics. Tricyclic and tetracyclic drugs. Fluoxetine. Sertraline. Paroxetine. Fluvoxamine. Citalopram and s-citalopram. Monoamine oxidase inhibitors. Trazodone and nefazodone. Bupropion. Mirtazapine. Venlafaxine. Duloxetine and milnacipran. Benzodiazepines. Buspirone and gepirone. Investigational treatments for mood and anxiety disorders: CRH receptor antagonists, NK-1 receptor antagonists, and glucocorticoid receptor antagonists. Antipsychotics. Classic antipsychotic medications. Clozapine. Olanzapine. Quetiapine. Aripiprazole. Risperidone. Ziprasidone. Drugs to treat extrapyramidal side effects. Drugs for Treatment of Bipolar Disorder. Lithium. Valproate. Carbamazepine and oxcarbazepine. Gabapentin. Lamotrigine. Topiramate. Other Agents. Cognitive enhancers. Sedative-hypnotics. Psychostimulants in psychiatry: amphetamine, methylphenidate, and modafinil. Electroconvulsive therapy. Part III: Clinical Psychobiology and Psychiatric Syndromes. Biology of mood disorders. Neurobiology of schizophrenia. Neurobiology of anxiety disorders. Biology of Alzheimer's disease. Neurobiology of substance abuse disorders. Biology of eating disorders. Biology of personality disorders. Part IV: Psychopharmacological Treatment. Treatment of depression. Treatment of bipolar disorder. Treatment of schizophrenia. Treatment of anxiety disorders. Management of noncognitive symptoms of dementia: behavioral and psychological symptoms of dementia. Treatment of childhood and adolescent disorders. Treatment of substance-related disorders. Treatment of eating disorders. Treatment of agitation and aggression in the elderly. Treatment of personality disorders. Psychiatric emergencies. Treatment during late life. Psychopharmacology during pregnancy and lactation. Treatment of insomnia. Index.

Topiramate in the Treatment of Substance-Related Disorders

To critically review the literature on topiramate in the treatment of substance-related disorders. A PubMed search of human studies published in English through January 2009 was conducted using the following search terms: topiramate and substance abuse, topiramate and substance dependence, topiramate and withdrawal, topiramate and alcohol, topiramate and nicotine, topiramate and cocaine, topiramate and opiates, and topiramate and benzodiazepines. 26 articles were identified and reviewed; these studies examined topiramate in disorders related to alcohol, nicotine, cocaine, methamphetamine, opioids, Ecstasy, and benzodiazepines. Study design, sample size, topiramate dose and duration, and study outcomes were reviewed. There is compelling evidence for the efficacy of topiramate in the treatment of alcohol dependence. Two trials show trends for topiramate's superiority over oral naltrexone in alcohol dependence, while 1 trial suggests topiramate is inferior to disulfiram. Despite suggestive animal models, evidence for topiramate in treating alcohol withdrawal in humans is slim. Studies of topiramate in nicotine dependence show mixed results. Human laboratory studies that used acute topiramate dosing show that topiramate actually enhances the pleasurable effects of both nicotine and methamphetamine. Evidence for topiramate in the treatment of cocaine dependence is promising, but limited by small sample size. The data on opioids, benzodiazepines, and Ecstasy are sparse. Topiramate is efficacious for the treatment of alcohol dependence, but side effects may limit widespread use. While topiramate's unique pharmacodynamic profile offers a promising theoretical rationale for use across multiple substance-related disorders, heterogeneity both across and within these disorders limits topiramate's broad applicability in treating substance-related disorders. Recommendations for future research include exploration of genetic variants for more targeted pharmacotherapies.

Vaccines & Other Large Molecules For Treatment Of Substance Related Disorders - NIDA: Vaccine and other large molecules for treatment of substance related disorders

Vaccines & Other Large Molecules For Treatment Of Substance Related Disorders - NIDA: Vaccine and other large molecules for treatment of substance related disorders

Prevalence of Hepatitis B, Hepatitis C, and HIV Infections Among Patients in a Psychiatric Hospital in Greece

Psychiatric patients are considered to be at increased risk of infection with hepatitis B virus (HBV), hepatitis C virus (HCV), or HIV. This study retrospectively assessed the seroprevalence of these infections among psychiatric patients who were referred for laboratory testing over a 24-month period in a 415-bed tertiary care psychiatric hospital in Greece. More than two-thirds of the 805 unique tested patients received care in short-term hospitalization units (patients receiving treatment for substance-related disorders were excluded from this analysis). Two percent tested positive for having the hepatitis B surface antigen, 9% for the HCV antibody, and 1% for HIV. Males were more likely than females to test positive for the HCV antibody (p=.04). Compared with rates in the general population, in this study population the rate of HCV was more than ten times as high, the rate of HIV was three times as high, and the rate of HBV was comparable.

Acupuncture for Alcohol Dependence: A Systematic Review

Acupuncture has been used in the treatment of substance-related disorders for the past 30 years. However, a systematic review to assess the effect of various types of acupuncture for alcohol dependence has not yet been performed. The present systematic review assessed the results of randomized controlled trials (RCTs). Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs of acupuncture for alcohol dependence up to June 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook. Eleven studies, which comprised a total of 1,110 individual cases, were systematically reviewed. Only 2 of 11 trials reported satisfactorily all quality criteria. Four trials comparing acupuncture treatment and sham treatments reported data for alcohol craving. Three studies reported that there were no significant differences. Among 4 trials comparing acupuncture and no acupuncture with conventional therapies, 3 reported significant reductions. No differences between acupuncture and sham treatments were found for completion rates (Risk Ratio = 1.07, 95% confidence interval, CI = 0.91 to 1.25) or acupuncture and no acupuncture (Risk Ratio = 1.15, 95% CI = 0.79 to 1.67). Only 3 RCTs reported acupuncture-related adverse events, which were mostly minimal. The results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues.

Inmunoterapias para las adicciones a las drogas

Immunotherapies in the form of vaccines (active immunization) or monoclonal antibodies (passive immunization) appear safe and a promising treatment approaches for some substance-related disorders. The mechanism of action of the antibody therapy is by preventing the rapid entry of drugs of abuse into the central nervous system. In theory, immunotherapies could have several clinical applications. Monoclonal antibodies may be useful to treat drug overdoses and prevent the neurotoxic effects of drugs by blocking the access of drugs to the brain. Vaccines may help to prevent the development of addiction, initiate drug abstinence in those already addicted to drugs, or prevent drug use relapse by reducing the pharmacological effects and rewarding properties of the drugs of abuse on the brain. Passive immunization with monoclonal antibodies has been investigated for cocaine, methamphetamine, nicotine, and phencyclidine (PCP). Active immunization with vaccines has been studied for cocaine, heroin, methamphetamine, and nicotine. These immunotherapies seem promising therapeutic tools and are at different stages in their development before they can be approved by regulatory agencies for the treatment of substance-related disorders. The purpose of this article is to review the current immunotherapy approaches with emphasis on the risks and benefits for the treatment of these disorders.

Clinical Manual of Geriatric Psychopharmacology

Back to table of contents Previous article Next article Book ReviewFull AccessClinical Manual of Geriatric PsychopharmacologyOthmane Alami M.D.Othmane Alami M.D.Search for more papers by this authorPublished Online:1 Mar 2008https://doi.org/10.1176/ps.2008.59.3.334AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Medication management in the field of geriatric psychiatry is a real and constant challenge. Elderly patients tend to be on multiple medications, have multiple comorbidities, be more sensitive to side effects, and have issues that can impair their adherence to treatment. To make matters worse, there is a lack of empirical evidence that can guide the clinician because a majority of clinical trials for psychotropic medications are done with young individuals. These elements make the decision to start psychotropic treatment of an elderly patient a real challenge because the clinician has to assess the risk-benefit ratio.In the first chapter of this book, the authors give valuable general advice on how to maximize the therapeutic effects of the medications, how to minimize the adverse side effects, and how to simplify the treatment plan in order to improve adherence. The basics of geriatric psychopharmacology are covered in the second chapter, with useful figures and tables. The chapter could have been more extensive, but the purpose of this book is, after all, to be an easy-to-use book, thorough yet practical. Each major class of psychotropic medication—antipsychotics, antidepressants, mood stabilizers, and sedative-hypnotic drugs—gets a full chapter. Each chapter has treatment algorithms, rating scales, tables covering the adverse side effects, and quick-reference summaries on selected drugs.The last chapters are dedicated to the treatment of substance-related disorders, movement disorder, dementia, and cognitive disorders. Finally, a full chapter is dedicated to analgesic medications. Some may be surprised to find a full chapter covering analgesic medications. This is quite appropriate because a large percentage of the elderly population, often in nursing homes, have an underlying pain condition. The authors could have spent some time discussing how to prescribe in the context of the constraint of Medicare Part D. Because elderly patients may end up receiving electroconvulsive therapy, covering the management of medications for a patient about to receive or undergoing electroconvulsive therapy could also be useful.If the authors were trying to come up with a reference that is easy to read yet thorough, a book that can be used by all health professionals working closely with elderly patients regardless of the setting—inpatient, outpatient, nursing home—then they did a great job.Dr. Alami is a geriatric psychiatry fellow at Columbia University, New York City. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 3 March, 2008Pages 334-335PSYCHIATRIC SERVICES March 2008 Volume 59 Number 3 Metrics PDF download History Published online 1 March 2008 Published in print 1 March 2008

Cultural Context and Treatment for Substance-Related Disorders: An Invitation

Cultural Context and Treatment for Substance-Related Disorders: An Invitation