Substance Abuse and Rehabilitation最新文献

{"title":"Butane hash oil and dabbing: insights into use, amateur production techniques, and potential harm mitigation.","authors":"Ihsan Al-Zouabi,&nbsp;John M Stogner,&nbsp;Bryan Lee Miller,&nbsp;Elizabeth S Lane","doi":"10.2147/SAR.S135252","DOIUrl":"https://doi.org/10.2147/SAR.S135252","url":null,"abstract":"<p><p>The use of marijuana concentrates has escalated in recent years with butane extracts appearing particularly popular. The administration of butane hash oil, colloquially referred to as \"dabbing,\" is distinct from traditional flower cannabis usage due to the THC content of samples and the presence of impurities such as unpurged butane. While this may confer heightened risk to the user, additional significant concerns are tied to fires and explosions. Using butane as a solvent in amateur \"blasting\" methods may result in a flammable vapor pooling in enclosed spaces and igniting when exposed to a spark. As research on butane extract users, amateur production techniques, health risks, and legality is in its infancy, we explored existing studies on the topic to create a review of substantiated knowledge related to THC extracted using butane. The resulting assessment centers on three areas: 1) dab users including both recreational users and medical marijuana patients; 2) butane extraction techniques including illicit amateur open methods and the safer closed-loop system employed in medicinal/recreational states; and 3) risks, both related to fires and legality. We follow the presentation of this material with a summary of the (mis)information reaching the public in print and online sources so that public educational campaigns can focus on dispelling the inaccuracies and false notions of safety that may be tied to amateur production.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S135252","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36707643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of psychotropic drug-related deaths in south Osaka.","authors":"Naoto Tani,&nbsp;Tomoya Ikeda,&nbsp;Tomomi Michiue,&nbsp;Shigeki Oritani,&nbsp;Fumiya Morioka,&nbsp;Takaki Ishikawa","doi":"10.2147/SAR.S163491","DOIUrl":"https://doi.org/10.2147/SAR.S163491","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the occurrence of deaths due to psychotropic drugs in south Osaka during a 10-year period and discuss societal factors from a medical viewpoint.</p><p><strong>Methods: </strong>Psychotropic drug-related deaths were retrospectively investigated based on the forensic postmortem data of 1,746 decedents in 2005-2014, and we excluded cases in which stimulant drugs were detected. Of these, 133 cases (7.6%) were found to be psychotropic drug-related deaths and were analyzed.</p><p><strong>Results: </strong>Psychotropic drug-related deaths occurred in 78 males (59%; age range, 14-95 years) and 55 females (41%; 20-84 years). The direct cause of death was acute drug intoxication in many cases, and of these, acute combined drug intoxication due to the use of multiple drugs accounted for 76% of the deaths. Most of these victims were found to have gastrointestinal and cardiovascular diseases. Cases of psychotropic drug-related deaths had especially poor medical conditions. In addition, tests were positive for blood alcohol in 23% of the cases.</p><p><strong>Conclusion: </strong>The descriptive results revealed several factors that may be related to psychotropic drug-related deaths. To prevent drug abuse, several factors were deemed to be important, including improvements in the medical state of an individual, the avoidance of social isolation, and from a medical standpoint, the management of prescription drugs by medical personnel.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S163491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36577539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder.","authors":"Naoko A Ronquest,&nbsp;Tina M Willson,&nbsp;Leslie B Montejano,&nbsp;Vijay R Nadipelli,&nbsp;Bernd A Wollschlaeger","doi":"10.2147/SAR.S150253","DOIUrl":"https://doi.org/10.2147/SAR.S150253","url":null,"abstract":"<p><strong>Background: </strong>Treatment for opioid use disorder is important because of the negative health, societal and economic consequences of illicit opioid use, but treatment adherence can be a challenge. This study assessed the association between buprenorphine medication-assisted treatment (MAT) adherence and relapse, health care utilization and costs.</p><p><strong>Patients and methods: </strong>Patients with opioid use disorder who were newly initiating a buprenorphine MAT regimen were identified in the 2008-2014 MarketScan^® Commercial and Medicaid Databases and followed for 12 months after their earliest outpatient pharmacy claim for buprenorphine. Adherence was categorized using proportion of days covered (PDC) with buprenorphine, and patients with PDC≥0.80 were classified as adherent. Descriptive and adjusted analyses compared relapse prevalence, utilization and costs, all measured in the 12 months following buprenorphine MAT initiation, of adherent patients to patients in non-adherent PDC categories (PDC<0.20, 0.20≤PDC<0.40, 0.40≤PDC<0.60, 0.60≤PDC<0.80).</p><p><strong>Results: </strong>Adherent patients were 37.1% of the Commercial sample (N=16,085) and 41.3% of the Medicaid sample (N=5,688). In both samples, non-adherent patients were significantly more likely than adherent patients to relapse and to have hospitalizations and emergency department visits. As a result, as buprenorphine MAT adherence increased, pharmacy costs increased, but medical costs decreased. Total costs (pharmacy plus medical costs) in the 12 months following buprenorphine MAT initiation decreased with adherence in Commercial patients ($28,525 for PDC<0.20 to $17,844 for PDC≥0.80). A slight decrease in total costs in the 12 months following buprenorphine MAT initiation was also observed in Medicaid patients ($21,292 for PDC<0.20 to $18,621 for PDC≥0.80). After adjustment, total costs of adherent patients in the Commercial sample ($17,519) were significantly lower compared with those of non-adherent patients (range $20,294-$24,431). In the Medicaid sample, adjusted total costs were not significantly different between adherence groups.</p><p><strong>Conclusion: </strong>Buprenorphine MAT adherence in the 12 months following treatment was associated with reduced odds of relapse and reduced unadjusted medical costs. For Commercial patients who were adherent to treatment, the adjusted total costs were predicted to be 30% lower than those for patients with PDC<0.20.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S150253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36577538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of contingency management for the treatment of substance-use disorders: adaptation for underserved populations, use of experimental technologies, and personalized optimization strategies.","authors":"Sterling M McPherson, Ekaterina Burduli, Crystal Lederhos Smith, Jalene Herron, Oladunni Oluwoye, Katherine Hirchak, Michael F Orr, Michael G McDonell, John M Roll","doi":"10.2147/SAR.S138439","DOIUrl":"10.2147/SAR.S138439","url":null,"abstract":"<p><p>This review of contingency management (CM; the behavior-modification method of providing reinforcement in exchange for objective evidence of a desired behavior) for the treatment of substance-use disorders (SUDs) begins by describing the origins of CM and how it has come to be most commonly used during the treatment of SUDs. Our core objective is to review, describe, and discuss three ongoing critical advancements in CM. We review key emerging areas wherein CM will likely have an impact. In total, we qualitatively reviewed 31 studies in a systematic fashion after searching PubMed and Google Scholar. We then describe and highlight CM investigations across three broad themes: adapting CM for underserved populations, CM with experimental technologies, and optimizing CM for personalized interventions. Technological innovations that allow for mobile delivery of reinforcers in exchange for objective evidence of a desired behavior will likely expand the possible applications of CM throughout the SUD-treatment domain and into therapeutically related areas (eg, serious mental illness). When this mobile technology is coupled with new, easy-to-utilize biomarkers, the adaptation for individual goal setting and delivery of CM-based SUD treatment in hard-to-reach places (eg, rural locations) can have a sustained impact on communities most affected by these disorders. In conclusion, there is still much to be done, not only technologically but also in convincing policy makers to adopt this well-established, cost-effective, and evidence-based method of behavior modification.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2018-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/a4/sar-9-043.PMC6095117.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36427348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking cessation at the pharmacy: feasibility and benefits based on a French observational study with six-month follow-up.","authors":"Brigitte Bouchet-Benezech,&nbsp;Bernard Champanet,&nbsp;Pierre Rouzaud","doi":"10.2147/SAR.S152186","DOIUrl":"https://doi.org/10.2147/SAR.S152186","url":null,"abstract":"<p><strong>Background: </strong>In comparison to other European countries, the number of smokers remains high in France. Approximately five million smokers wish to quit within the year and need support that is local, easily accessible, and efficient. As public health actors, pharmacists could provide this service. The Sevrage Tabagique à l'Officine: Smoking Cessation Program at the Pharmacy (STOP) study was carried out to explore the feasibility of a smoking cessation program provided at pharmacies.</p><p><strong>Materials and methods: </strong>Pharmacists participating in the study were trained to provide a smoking cessation program to smokers recruited at the pharmacy, which included five pharmaceutical interviews in six months, along with counseling and support, in addition to nicotine replacement therapy. This observational, longitudinal, prospective study assessed the feasibility of the program by measuring the percentage of participants remaining at the six-month visit, the proportion of invited pharmacies that actually participated in the program, and the benefits to the participants.</p><p><strong>Results: </strong>Ninety pharmacies were invited to participate, 79 (88%) pharmacies entered the study, and 49 (54%) included study participants and treated 227 subjects with a mean age of 45.4 years. At six months, 23.3% of participants attended their follow-up visit, among which 75% had been abstinent since their last visit and more than half for 90 days. From the second follow-up visit, their Short Form 12 physical and mental health composite scores were improved in comparison with baseline. Participants and pharmacists all reported being highly satisfied with the program; however, the attrition rate was substantial, possibly due to some study limitations.</p><p><strong>Conclusion: </strong>The provision of support for smoking cessation by pharmacies is feasible despite some barriers such as lack of awareness and difficulty to change habits for the smokers or lack of time and training for the pharmacists. The conditions necessary for this program to be implemented on a large scale include training of pharmacists, access to a private space in the pharmacy, remuneration for the pharmaceutical interviews, collaboration with other health care professionals, and an effective communications program regarding the service, both inside and outside of pharmacies. The relatively low number of participants at the end of the study could be improved by increasing awareness of the program, involving health authorities, and enlarging the number of pharmacies engaged in the program.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S152186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36345405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint versus separate inpatient rehabilitation treatment for patients with alcohol use disorder or drug use disorder: an observational study.","authors":"Stefan Bender,&nbsp;Michael Specka,&nbsp;Angela Buchholz,&nbsp;Stefan Hölscher,&nbsp;Fred Rist,&nbsp;Thomas W Heinz,&nbsp;Fabrizio Schifano,&nbsp;Norbert Scherbaum","doi":"10.2147/SAR.S136523","DOIUrl":"https://doi.org/10.2147/SAR.S136523","url":null,"abstract":"<p><strong>Background: </strong>In many national treatment systems, patients with alcohol use disorders (AUD) and those with drug use disorders (DUD) are treated separately, while other systems provide joint treatment for both kinds of substance use disorders (SUDs). Regarding long-term rehabilitation treatment of DUD and AUD patients, there is however a lack of empirical studies on the comparison between a separate versus joint treatment modality.</p><p><strong>Methods: </strong>Data were gathered from 2 rehabilitation units located in small towns from the same German region. One unit provided treatment to a mixed group of AUD and DUD patients, while the other unit treated the 2 groups separately. Staffing, funding, and treatment programs were otherwise similar between facilities. Data were gathered from standardized routine documentation and standardized interviews. In order to understand correlates of premature treatment termination, a logistic regression analysis was performed, with treatment modality and type of SUD as main predictors, and a range of patient characteristics as covariates.</p><p><strong>Results: </strong>Patients (N=319) were diagnosed with AUD (48%), DUD (34%), or AUD plus DUD (18%). Patients in joint treatment showed a higher prevalence of lapses during treatment than those in separate treatment (26% versus 12%; <i>p</i>=0.009), but there was no significant difference in the prevalence of premature terminations (38% versus 44%, <i>p</i>=0.26). Treatment modality and interaction between modality and type of SUD was not significantly associated with premature termination. Joint treatment completers showed higher satisfaction with treatment than separate treatment completers (<i>p</i><0.001).</p><p><strong>Conclusion: </strong>We found no evidence here for a difference between treatment modalities in terms of premature termination rate. Satisfaction level was higher in those who completed joint treatment compared to separate treatment.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S136523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36281638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial magnetic stimulation for the treatment of cocaine addiction: evidence to date.","authors":"Corinna Bolloni, Paola Badas, Giorgio Corona, Marco Diana","doi":"10.2147/SAR.S161206","DOIUrl":"10.2147/SAR.S161206","url":null,"abstract":"<p><p>There is a common consensus in considering substance-use disorders (SUDs) a devastating chronic illness with social and psychological impact. Despite significant progress in understanding the neurobiology of SUDs, therapeutic advances have proceeded at a slower pace, in particular for cocaine-use disorder (CUD). Transcranial magnetic stimulation (TMS) is gaining support as a safe and cost-effective tool in the treatment of SUDs. In this review, we consider human studies that have investigated the efficacy of TMS in achieving therapeutic benefits in treating CUD. All studies conducted to date that have evaluated the therapeutic effect of TMS in CUD are included. We focus on the protocol of stimulation applied, emphasizing the neurophysiological effects of coils employed related to outcomes. Moreover, we examine the subjective and objective measurements used to assess the therapeutic effects along the timeline considered. The revision of scientific literatures underscores the therapeutic potential of TMS in treating CUD. However, the variability in stimulation protocols applied and the lack of methodological control do not allow us to draw firm conclusions, and further studies are warranted to examine the interaction between TMS patterns of stimulation relative to clinical outcomes in depth.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/bb/sar-9-011.PMC5967377.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36178155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between substance use and type of crime in prisoners with substance use problems - a focus on violence and fatal violence.","authors":"Anders Håkansson,&nbsp;Virginia Jesionowska","doi":"10.2147/SAR.S143251","DOIUrl":"https://doi.org/10.2147/SAR.S143251","url":null,"abstract":"<p><strong>Aim: </strong>The present study aimed to study the associations between substance use patterns and types of crimes in prisoners with substance use problems, and specifically whether substance use patterns were different in violent offenders.</p><p><strong>Methods: </strong>Interview data of prisoners with substance use problems (N=4,202, mean age 33.5 years, SD 9.8), derived from the Addiction Severity Index, were run against criminal register data on main types of crimes in the verdict.</p><p><strong>Results: </strong>In binary analyses, compared to those with acquisitive and drug crimes, violent offenders had lower prevalence of illicit drugs and homelessness, but higher prevalence of binge drinking, and higher prevalence of sedative use than clients sentenced with drug crimes. Clients with violent crime had lower prevalence of injecting drug use, compared to all other crimes. In logistic regression, binge drinking and sedatives were positively associated with violent crime (as opposed to non-violent crime), whereas heroin, amphetamine, cocaine, and injecting drug use were negatively associated with violent crime. Among violent offenders only, sedatives tended to be associated with fatal violence (<i>p</i>=0.06), whereas amphetamine, homelessness, age, and (marginally significant, <i>p</i>=0.05) heroin were negatively associated with fatal violence, as opposed to non-fatal violence.</p><p><strong>Conclusion: </strong>Treatment and risk assessment in violent perpetrators with substance use may need to address sedatives and alcohol specifically. Limitations of the study are due to self-reported and cross-sectional data and because a large majority of the prison sample studied here are men.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2018-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S143251","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35785331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intranasal naloxone and related strategies for opioid overdose intervention by nonmedical personnel: a review.","authors":"Christa R Lewis,&nbsp;Hoa T Vo,&nbsp;Marc Fishman","doi":"10.2147/SAR.S101700","DOIUrl":"https://doi.org/10.2147/SAR.S101700","url":null,"abstract":"<p><p>Deaths due to prescription and illicit opioid overdose have been rising at an alarming rate, particularly in the USA. Although naloxone injection is a safe and effective treatment for opioid overdose, it is frequently unavailable in a timely manner due to legal and practical restrictions on its use by laypeople. As a result, an effort spanning decades has resulted in the development of strategies to make naloxone available for layperson or \"take-home\" use. This has included the development of naloxone formulations that are easier to administer for nonmedical users, such as intranasal and autoinjector intramuscular delivery systems, efforts to distribute naloxone to potentially high-impact categories of nonmedical users, as well as efforts to reduce regulatory barriers to more widespread distribution and use. Here we review the historical and current literature on the efficacy and safety of naloxone for use by nonmedical persons, provide an evidence-based discussion of the controversies regarding the safety and efficacy of different formulations of take-home naloxone, and assess the status of current efforts to increase its public distribution. Take-home naloxone is safe and effective for the treatment of opioid overdose when administered by laypeople in a community setting, shortening the time to reversal of opioid toxicity and reducing opioid-related deaths. Complementary strategies have together shown promise for increased dissemination of take-home naloxone, including 1) provision of education and training; 2) distribution to critical populations such as persons with opioid addiction, family members, and first responders; 3) reduction of prescribing barriers to access; and 4) reduction of legal recrimination fears as barriers to use. Although there has been considerable progress in decreasing the regulatory and legal barriers to effective implementation of community naloxone programs, significant barriers still exist, and much work remains to be done to integrate these programs into efforts to provide effective treatment of opioid use disorders.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/SAR.S101700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35481001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance use disorders in military veterans: prevalence and treatment challenges.","authors":"Jenni B Teeters, Cynthia L Lancaster, Delisa G Brown, Sudie E Back","doi":"10.2147/SAR.S116720","DOIUrl":"10.2147/SAR.S116720","url":null,"abstract":"<p><p>Substance use disorders (SUDs) are a significant problem among our nation's military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed.</p>","PeriodicalId":22060,"journal":{"name":"Substance Abuse and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2017-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4e/d7/sar-8-069.PMC5587184.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35416575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}