Drug abuse is a disorder that involves the use of illegal, recreational drugs or over-the-counter medications in ways other than recommended or intended.
- What Is Drug Abuse?
- Understanding Drug Abuse
- Symptoms Of Drug Abuse
- Abuse Vs Addiction
- Types Of Drug Abuse
- Causes Of Drug Abuse
- Warning Signs A Loved One Is Abusing Drugs
- Diagnosis Of Drug Abuse
- Treatment Of Drug Abuse
- Helping Someone With Drug Abuse
- Note To The Caregiver
- Prevention Is The ‘Key’
- Drug Abuse At A Glance
What Is Drug Abuse?
Also known as substance abuse, it refers to the consumption of psychoactive drugs, street drugs, medications or chemicals to experience pleasurable and mind-altering effects on the brain. “Substance 1 ” refers to psychoactive compounds that can lead to various mental & physical health issues, along with social problems, such as addiction 2 . When used regularly, substances can cause adverse mental, emotional, physical and social effects. It can develop into a dependence and addiction leading to the onset of drug use disorder. Substance abuse is typically considered as a self-destructive behavior pattern that can result in severe stress, anxiety, depression 3 and other mental health issues 4 . Identified as a drug use disorder by experts, it can be often difficult to define as different explanations are used in different contexts, such as medical, legal and public health.
According to a 2009 study 5 , “Drug addiction is considered to be a chronic, relapsing disorder characterized by compulsive drug-seeking, by continued use despite serious negative socioeconomic and health consequences, and by loss of control over drug use.” It adds that substances like opioids, cannabinoids, alcohol and even nicotine can change the levels of chemicals in our brain. Recent research 6 shows that such substances activate the reward system in the brain intensely and as a result the individual may avoid performing daily necessary activities. The researchers add that the excessive use of drugs and substances “tends to activate the brain reward system that reinforces behaviors and the production of memories.” American Psychiatric Association’s the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies the following classes of drugs that can lead to a disorder –
- Alcohol
- Caffeine
- Cannabis
- Hallucinogens
- Inhalants
- Opioids
- Sedatives
- Hypnotics
- Anxiolytics
- Stimulants
- Tobacco
- Other substances
A 2011 study 7 states that drug addiction may be influenced by genes and “there is a heritable component to drug abuse and addiction.” Currently, substance abuse and addiction has become a global trend and problem that affects both the rich and poor. Further studies 8 reveal that according to the United Nations, around 5.5% of the global population or 271 million people between the ages of 15 and 64 had “used substances in the previous year” in 2017. It is also estimated that the number of substance-using people tends to rise every year.
Understanding Drug Abuse
Many drugs of abuse are extremely addictive as they result in cravings and a continued desire to use them despite negative consequences. Drug abuse can start during adolescence and continue in adulthood. Substance use is dangerous as it can harm the brain and body, sometimes permanently. It can hurt the people around the addict, including friends, families, children, pregnant women and even infants. “Prenatal substance use is a critical public health concern that is linked with several harmful maternal and fetal consequences,” explains a 2016 study 9 .
Excessive drug abuse results in addiction. The condition generally starts out of curiosity, to escape stress, to feel good, due to peer pressure, or for a variety of other reasons. However, treatment can help but may depend on certain factors, such as the drug being abused, whether addiction is present, and whether there are coexisting health or psychological problems. Supervised withdrawal, also called detoxification (or detox), may be necessary if physical symptoms are common when the drug is stopped. Drug abuse may result in serious, life-threatening complications, such as drug overdose, alcohol poisoning, trauma, and suicidal or violent behavior.
Symptoms Of Drug Abuse
Individuals who struggle with substance use disorder share some form of similarity in terms of their experiences, however, they are also different in many ways. The symptoms are typically determined by how much and often someone uses drugs and if they consume any other addictive substances. Here are some of the most common symptoms of substance abuse –
- Detaching from family and friends who don’t use drugs
- Changing friends a lot and making new friends who get high
- Spending a lot of time alone
- Losing interest in favorite things or hobbies
- Not maintaining personal hygiene
- Feeling tired and sad or depressed
- Eating more or eating less than usual
- Talking rapidly or incoherent speech
- Mood swings
- Borrowing or stealing money from others
- Being consistently late for work/school or absenteeism
- Losing a job or doing little to find a job
- Paying less attention to basic hygiene
- Extremely private about personal belongings
- Lying about using drugs
- Missing important appointments
- Having problems in personal or family relationships
- Yearning for drugs, despite difficulties obtaining it or wanting to quit
- Withdrawal from non-drug-related activities
- High-risk sexual behavior
- Leaving responsibilities unfulfilled
- Encountering legal problems
- Engaging in higher doses to get the same effect (tolerance)
- Using a drug to avoid its withdrawal symptoms
- Taking substances in risky situations
Abuse Vs Addiction
Substance abuse occurs when one consumes legal or illegal drugs in manners that are not recommended. The person may take a higher volume or higher dosage of medications, take pills using another’s prescription or may use drugs constantly. They may consume substances to relieve stress and anxiety, to experience pleasure or to cope with reality. However, someone abusing drugs has the ability to control their usage or stop consuming substances.
Addiction occurs when the person loses all control over their substance use even when they are aware of the negative consequences. Regardless of how their addiction affects their finances, career, relationships and social reputation, they continue taking drugs. Research 10 shows that drug addiction typically involves 3 stages – preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect. This may not necessarily be the case for substance abuse. The difference between drug abuse and drugs addiction is more about how the individual reacts to the consequences rather than the type, frequency, amount or duration of use.
Read More About Addiction Here
Types Of Drug Abuse
There are multiple classes of drugs, all of which can pose an unmatched danger to those who engage in substance abuse within those classes. The continued abuse of any addictive substances can lead to problems such as unemployment, family turmoil, physical complications, and psychiatric problems. Here are some of the most common types of drug abuse.
1. Stimulant Abuse
Stimulants are substances that cause physical and psychological functions to speed up. Individuals that engage in stimulant abuse tend to experience a major boost in energy, well-being, and a powerful sense of grandiosity. The most commonly abused stimulants include:
- Cocaine
- Meth
- Amphetamines
- Concerta
- Adderall
- Vyvanse
- Dexedrine
- Ritalin
- Crack
2. Cocaine Abuse
Cocaine 11 is a street drug that is a derivative of the coca plant. It comes in white powder form and is usually snorted. While an individual abusing cocaine will experience an energetic, euphoric high for the first 20 minutes, it leads to abuse of this substance back-to-back to maintain that high which in turn, results in dependence and potential overdose.
3. Adderall Abuse
Adderall 12 is by far the most popular prescription stimulant that is used to treat attention-deficit hyperactivity disorder or ADHD. However, abusing this prescription drug excessively can lead to cardiac complications, including heart attack.
4. Meth Abuse
Known on the streets as “trash” or “garbage”, meth 13 is an extremely toxic stimulant that has a pseudoephedrine base, and abusing this substance can lead to intense euphoric highs and equally as depressing lows.
5. Opioid Abuse
Nearly 10.3 million individuals in the United States have abused opioids. Continual opioid abuse 14 can result in vital organ damage or failure, respiratory problems, and overdose.
6. Heroin Abuse
When heroin 15 , also known as diacetylmorphine, is abused, individuals obtain a pleasurable high that reduces or eliminates their physical and/or psychological distress. However, when this substance is injected, one can suffer from collapsed veins with an increased risk of contracting bloodborne diseases like HIV and hepatitis.
7. Prescription Painkillers
OxyContin, Vicodin, Percocet, and fentanyl are some of the most commonly abused prescription painkillers 16 . When taken as prescribed, each one of these painkillers can provide significant medical benefit, however, when abused, they can be deadly.
8. Sedative Abuse
Sedatives such as benzodiazepines are essentially used to treat anxiety disorders such as panic attacks, phobias, and obsessive-compulsive disorder. However, they are very popular substances of abuse due to the feelings of detachment and relaxation that they deliver.
9. Xanax, Ativan And Valium
Xanax, Ativan, and Valium are benzodiazepines that work to calm the mind and body. However, when abused, individuals are at risk of feeling excessive sleepiness, drowsiness, and respiratory depression. When an individual attempts to stop using these drugs suddenly, he or she can suffer from deadly withdrawal symptoms, including grand mal seizures 17 .
10. Hallucinogens
Hallucinogens abuse is defined by multiple physical dangers. However, the most pressing concern happens to be the behavior of an individual that is possibly dangerous or even deadly.
11. Ecstasy Abuse
When ecstasy is abused, individuals experience delusions and hallucinations that can be both visual and auditory including dehydration that can be life-threatening.
Causes Of Drug Abuse
The precise cause of drug abuse is still not clearly known. It is also not clear why some individuals can stop using drugs while others become addicted. However, social and recreational reasons are regarded as the “most commonly reported reasons for the use of most drugs,” according to research 18 . It is also assumed that biological factors, such as genes along with other psychiatric disorders may play a role. Other factors such as environmental factors (peer pressure, history of abuse, and stress) and developmental factors may also result in drug abuse. According to a 2011 study 19 , genes in combination with environmental influences, account for about half of the addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may impact the risk of drug abuse and addiction.
The study mentions that environmental factors such as peer pressure, physical and sexual abuse, stress, and quality of parenting 20 can considerably influence the occurrence of drug abuse and its development to addiction in a person’s life. Moreover, while taking drugs at any age can lead to addiction, the earlier the drug use begins, the more likely it will progress to serious abuse, posing a real challenge to adolescents. Since, their brains are still evolving in the areas that dictate decision making, judgment, and self-control, adolescents may be especially prone to risk-taking behaviors, including trying drugs of abuse.
Factors like the availability of drugs within the neighborhood, community, and school and whether the adolescent’s friends are using also influence the development of drug abuse. The family environment is equally important. Violence, physical or emotional abuse, mental illness, or drug use in the household increases the likelihood of adolescents using drugs. Moreover, personality attributes like poor impulse control or a high need for excitement, mental health conditions such as depression, anxiety, or ADHD may eventually lead to drug abuse. One 2019 study 21 revealed that a lack of knowledge regarding the harmful effects of drugs and minimal punishment for use can also be contributing factors.
Warning Signs A Loved One Is Abusing Drugs
It is essential to understand that drug abusers often try to hide their symptoms and downplay their problems. If your friend or a close one is abusing drugs, look for the following warning signs.
1. Physical Warning Signs
- Bloodshot eyes, pupils bigger or smaller than usual
- Sudden weight loss or weight gain
- Changes in hunger pattern or sleep patterns
- Poor physical appearance, personal grooming habits
- Unusual smells on breath, body, or clothing
- Shiverings, mumbled speech, or impaired coordination
2. Behavioral Warning Signs
- Poor attendance and performance at work or school
- Unexplained financial problems resulting in borrowing or stealing
- Engaging in secretive or suspicious behaviors
- Unexpected change in friends, favorite hangouts, and hobbies
- Frequently getting into trouble (fights, accidents, illegal activities)
3. Psychological Warning Signs
- Sudden change in personality or attitude
- Sudden mood swings, irritability, or rage
- Durations of unusual hyperactivity, agitation, or giddiness
- Lack of motivation, lethargic appearance, or “spaced out”
- Appears fearful, anxious, or paranoid
Diagnosis Of Drug Abuse
Diagnosing this condition requires a proper assessment of the symptoms by a healthcare professional such as a doctor, psychologist or psychiatrist. The doctor may prescribe certain lab tests and physical exams like urine or blood tests to determine the presence of any other underlying condition. However, it should be noted that there is no specific diagnostic test for substance abuse.
Mental health professionals typically use the diagnostic criteria specified in the DSM-5 to assess substance abuse disorder. These include:
- Taking the substance in larger amounts or for longer than expected
- Failed attempt to cut down or stop using the substance
- Spending a lot of time getting, using, or recovering from use of the substance
- Cravings or urges to use the substance
- Lack of responsibility at work, home, or school because of substance use.
- Continuing to use, even when it causes relationship problems
- Giving up important social, occupational, or recreational activities
- Using substances persistently, even when it puts the patient in danger
- Continuing to use, even when the patient has a physical or psychological problem that could have been caused or made worse by the abuse
- Needing more of the substance to get the required effect (tolerance)
- Development of withdrawal symptoms, which can be relieved by taking more drugs
Treatment Of Drug Abuse
The primary aim of drug abuse treatment is to not only prevent use but also manage drug-seeking behavior, facilitate rehabilitation and prevent relapse. A 2013 study 22 explains that treatment “must adapt to a chronic care model offered in an integrated care system that screens for at-risk patients and includes services needed to prevent relapses.” The treatment plan depends on the drug being abused, whether addiction is present, and whether there are coexisting health or psychological problems. The stage of treatment is generally medically assisted detoxification 23 . During this process, supportive care is provided to clear the substance from the patient’s bloodstream. Detoxification is followed by other forms of treatment to encourage long-term abstinence. These are as follows.
- Cognitive-behavioral therapy to work on thought patterns and behavior
- Family therapy to help the family understand the problem while avoiding enabling drug use
- Identification and treatment of coexisting conditions
- Medications to decrease yearnings, block withdrawal symptoms, counteract drug effects, or to cause unpleasant side effects if a drug is used
- Motivational influences to strengthen abstinence
- Motivational interviewing to utilize a person’s readiness to change behaviors
- Rehabilitation to help those with severe dependence or coexisting mental illness through the initial stages of quitting
- Support groups
According to a research paper 24 , “Treatment is provided in a variety of settings, and within each treatment setting a range of interventions may be available,” such as medications, psychosocial treatment, education etc. Combining the treatment of medications with behavioral therapy is the best way to ensure success for most patients. Treatment plans must be tailored to deal with each patient’s drug use patterns and drug-related medical, psychiatric, and social problems.
Here are some of the most recommended treatment approaches for drug abuse –
1. Medications
Different types of medications may be helpful at different stages of treatment, thereby enabling a patient to stop abusing drugs, stay in treatment, and avoid relapse. Medications help in treating withdrawal, encouraging a patient to stay in treatment while preventing relapse. According to a 2017 study 25 , commonly prescribed medications for the treatment of drug addiction include methadone, clonidine, bupropion, varenicline, topiramate, naltrexone, buprenorphine etc. Medications act slowly to stave off drug cravings by calming the mind and body, thereby enabling the patients to focus on counseling and other psychotherapies related to their drug treatment.
Withdrawal treatment through medication is aimed to stop various physical and emotional symptoms, including depression, anxiety, and other mood disorders, restlessness, or sleeplessness. “Medications can help alleviate the withdrawal manifestations among patients with severe physical dependence to help patients feel more comfortable during the early stages of treatment after stopping alcohol or drug use,” explains a 2013 study 26 .
2. Psychotherapy
Behavioral treatments that help engage people in substance use disorder treatment, modifying their attitudes and behaviors related to drug use while increasing their life skills to handle stressful circumstances. Some available therapies for the treatment of this condition include –
A. Cognitive Behavioral Therapy (CBT)
Research 27 shows that CBT is highly effective for substance abuse, whether used independently or in combination with medications. The therapy enables the patients to recognize, avoid, and cope with the situations in which they are most likely to abuse drugs. One 2017 study 28 has found that “Cognitive behavioral therapy (CBT) approaches have among the highest levels of empirical support for the treatment of drug and alcohol use disorders.”
Read More About Cognitive Behavioral Therapy Here
B. Contingency Management
The therapy uses positive support, such as providing incentives or privileges for remaining drug-free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
C. Motivational Enhancement Therapy
The therapy 29 uses tactics to elicit rapid and internally motivated behavior change to stop drug use and facilitate treatment entry. Research has found that Motivational Enhancement Therapy is highly effective for pregnant substance users.
D. Family Therapy (especially for youth)
This therapy approaches a person’s drug problems via family interactions and dynamics that may contribute to drug use and other risky behaviors.
As per another study, prevention programs involving schools, families, communities, and the media are effective for preventing or reducing drug use and addiction.
Helping Someone With Drug Abuse
Here are a few ways to help your close one with this disorder, besides helping him/her seeking professional help.
- Talk to the person openly about the dangers of both illegal and prescription drug use by providing a safe and open environment to talk
- Lay down valid rules and consequences
- Monitor the person’s activity including where he/she is going, who they are hanging out with along with checking the potential hiding places
- Keep prescription medicines in a safe place, avoid stockpiling, and dispose of any unused prescription medicines
- Encourage other interests and social activities in the person to cultivate healthy hobbies and activities
- Talk to the person about the underlying issues as drug use can be the result of other problems
Note To The Caregiver
If you are the caregiver of a person suffering from a drug abuse disorder, here are a few tips that you can follow to help yourself during such stressful times.
1. Speak Up
Talk to someone close to you about your concerns catering to your close one’s disorder and be open to accepting suggestions as it may help you to cope with such hard times. You may also join support groups and learn a few tactics from people facing similar difficulties.
2. Take Care of Yourself
Make sure to stay safe rather than putting yourself in any dangerous situations. Do not get caught up in someone else’s drug problem and end up neglecting your own needs.
3. Avoid Self-Blame
While it is true that your support and encouragement can lead the patient to take up professional help, you can’t force an addict to change. Thus, avoid blaming yourself while accepting the fact that the concerned person is responsible for his/her condition.
Prevention Is The ‘Key’
Drug abuse is a completely preventable disease. There are a number of prevention programs involving families, schools, communities, and the media which are effective in reducing drug abuse. It is essential to educate the youth and the general public about the harmful effects of drug abuse. Additionally, teachers, parents, medical and public health professionals must keep sending the message that drug addiction can be checked only if one never abuses drugs.
Drug Abuse At A Glance
- Drug abuse is a disorder that involves the use of illegal, recreational drugs or over-the-counter medications in ways other than recommended or intended.
- Many drugs of abuse are extremely addictive as they result in cravings and a continued desire to use them despite negative consequences.
- Drug abuse may result in serious, life-threatening complications, such as drug overdose, alcohol poisoning, trauma, and suicidal or violent behavior.
- Addiction occurs when the person loses all control over their substance use even when they are aware of the negative consequences.
- The primary aim of drug abuse treatment is to not only prevent use but also manage drug-seeking behavior, facilitate rehabilitation and prevent relapse.
- McLellan A. T. (2017). Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?. Transactions of the American Clinical and Climatological Association, 128, 112–130. [↩]
- Fluyau D, Charlton TE. Addiction. [Updated 2021 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549783/ [↩]
- Esmaeelzadeh, S., Moraros, J., Thorpe, L., & Bird, Y. (2018). The association between depression, anxiety and substance use among Canadian post-secondary students. Neuropsychiatric disease and treatment, 14, 3241–3251. https://doi.org/10.2147/NDT.S187419 [↩]
- Saban, A., Flisher, A. J., Grimsrud, A., Morojele, N., London, L., Williams, D. R., & Stein, D. J. (2014). The association between substance use and common mental disorders in young adults: results from the South African Stress and Health (SASH) Survey. The Pan African medical journal, 17 Suppl 1(Suppl 1), 11. https://doi.org/10.11694/pamj.supp.2014.17.1.3328 [↩]
- Justinova, Z., Panlilio, L. V., & Goldberg, S. R. (2009). Drug addiction. Current topics in behavioral neurosciences, 1, 309–346. https://doi.org/10.1007/978-3-540-88955-7_13 [↩]
- Alozai Uu, Sharma S. Drug and Alcohol Use. [Updated 2021 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513263/ [↩]
- Ali, S. F., Onaivi, E. S., Dodd, P. R., Cadet, J. L., Schenk, S., Kuhar, M. J., & Koob, G. F. (2011). Understanding the Global Problem of Drug Addiction is a Challenge for IDARS Scientists. Current neuropharmacology, 9(1), 2–7. https://doi.org/10.2174/157015911795017245 [↩]
- Lo, T. W., Yeung, J., & Tam, C. (2020). Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses. International journal of environmental research and public health, 17(7), 2610. https://doi.org/10.3390/ijerph17072610 [↩]
- Forray A. (2016). Substance use during pregnancy. F1000Research, 5, F1000 Faculty Rev-887. https://doi.org/10.12688/f1000research.7645.1 [↩]
- Herman, M. A., & Roberto, M. (2015). The addicted brain: understanding the neurophysiological mechanisms of addictive disorders. Frontiers in integrative neuroscience, 9, 18. https://doi.org/10.3389/fnint.2015.00018 [↩]
- Richards JR, Laurin EG. Cocaine. [Updated 2020 Oct 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430769/ [↩]
- Fitzgerald, K. T., & Bronstein, A. C. (2013). Adderall® (amphetamine-dextroamphetamine) toxicity. Topics in companion animal medicine, 28(1), 2–7. https://doi.org/10.1053/j.tcam.2013.03.002 [↩]
- Yasaei R, Saadabadi A. Methamphetamine. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535356/ [↩]
- Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553166/ [↩]
- Oelhaf RC, Azadfard M. Heroin Toxicity. [Updated 2021 May 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430736/ [↩]
- Gray A. (2016). Books: Painkiller Addict: From Wreckage to Redemption – My True Story: Never Enough. The British journal of general practice : the journal of the Royal College of General Practitioners, 66(651), 529. https://doi.org/10.3399/bjgp16X687397 [↩]
- Kodankandath TV, Theodore D, Samanta D. Generalized Tonic-Clonic Seizure. [Updated 2021 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554496/ [↩]
- Terry-McElrath, Y. M., O’Malley, P. M., & Johnston, L. D. (2009). Reasons for Drug Use among American Youth by Consumption Level, Gender, and Race/Ethnicity: 1976-2005. Journal of drug issues, 39(3), 677–714. https://doi.org/10.1177/002204260903900310 [↩]
- Understanding Drug Abuse and Addiction. (2011). Drugabuse.gov | National Institute on Drug Abuse (NIDA). https://www.drugabuse.gov/sites/default/files/understanding.pdf [↩]
- National Research Council (US) and Institute of Medicine (US) Committee on Drug Use in the Workplace; Normand J, Lempert RO, O’Brien CP, editors. Under the Influence? Drugs and the American Work Force. Washington (DC): National Academies Press (US); 1994. 2, Etiology of Alcohol and Other Drug Use: An Overview of Potential Causes. Available from: https://www.ncbi.nlm.nih.gov/books/NBK236261/ [↩]
- Yang, X., & Xia, G. (2019). Causes and Consequences of Drug Abuse: A Comparison Between Synthetic Drug and Heroin Users in Urban China. AIDS education and prevention : official publication of the International Society for AIDS Education, 31(1), 1–16. https://doi.org/10.1521/aeap.2019.31.1.1 [↩]
- Tai, B., & Volkow, N. D. (2013). Treatment for substance use disorder: opportunities and challenges under the affordable care act. Social work in public health, 28(3-4), 165–174. https://doi.org/10.1080/19371918.2013.758975 [↩]
- Center for Substance Abuse Treatment. (1995). Detoxification From Alcohol and Other Drugs. Substance Abuse and Mental Health Services Administration (US). [↩]
- Institute of Medicine (US) Committee on Opportunities in Drug Abuse Research. Pathways of Addiction: Opportunities in Drug Abuse Research. Washington (DC): National Academies Press (US); 1996. 8, Treatment. Available from: https://www.ncbi.nlm.nih.gov/books/NBK232966/ [↩]
- Elias, D., & Kleber, H. D. (2017). Minding the brain: the role of pharmacotherapy in substance-use disorder treatment. Dialogues in clinical neuroscience, 19(3), 289–297. https://doi.org/10.31887/DCNS.2017.19.3/hkleber [↩]
- Douaihy, A. B., Kelly, T. M., & Sullivan, C. (2013). Medications for substance use disorders. Social work in public health, 28(3-4), 264–278. https://doi.org/10.1080/19371918.2013.759031 [↩]
- McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive behavioral therapy for substance use disorders. The Psychiatric clinics of North America, 33(3), 511–525. https://doi.org/10.1016/j.psc.2010.04.012 [↩]
- Carroll, K. M., & Kiluk, B. D. (2017). Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 31(8), 847–861. https://doi.org/10.1037/adb0000311 [↩]
- Marín-Navarrete, R., Horigian, V. E., Medina-Mora, M. E., Verdeja, R. E., Alonso, E., Feaster, D. J., Fernández-Mondragón, J., Berlanga, C., Sánchez-Huesca, R., Lima-Rodríguez, C., & De la Fuente-Martín, A. (2017). Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial. International journal of clinical and health psychology : IJCHP, 17(1), 9–19. https://doi.org/10.1016/j.ijchp.2016.05.001 [↩]
