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Brown HD, DeFulio A. Contingency management for the treatment of methamphetamine use disorder: A systematic review. Drug Alcohol Depend 2020; 216:108307. [PMID: 33007699 DOI: 10.1016/j.drugalcdep.2020.108307] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022]
Abstract
Methamphetamine use continues to be an important public health problem. Contingency management is among the most effective interventions for reducing methamphetamine use. It has been more than ten years since the last systematic review of contingency management for methamphetamine use disorder. Since then, an additional ten randomized controlled trials and a variety of other studies have been completed. The present systematic review includes 27 studies. Several factors, most notably problem severity, appear to predict treatment outcome. However, the effectiveness of CM has been demonstrated in studies restricted to MSM, studies restricted to implementation in community programs, and in studies of the general population of methamphetamine users conducted in research treatment programs. There appear to be broad benefits of contingency management intervention, including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behavior. Twenty of the twenty-one studies that reported abstinence outcomes showed an effect of contingency management on abstinence, and seven of the nine studies that reported sexual risk behavior outcomes showed an effect of contingency management in reducing risky sexual behavior. Taken together, recent evidence suggests strongly that outpatient programs that offer treatment for methamphetamine use disorder should prioritize adoption and implementation of contingency management intervention.
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Stauffer CS, Moschetto JM, McKernan S, Meinzer N, Chiang C, Rapier R, Hsiang E, Norona J, Borsari B, Woolley JD. Oxytocin-enhanced group therapy for methamphetamine use disorder: Randomized controlled trial. J Subst Abuse Treat 2020; 116:108059. [PMID: 32741502 DOI: 10.1016/j.jsat.2020.108059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/11/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Methamphetamine (METH) use is a public health crisis that disproportionately affects men who have sex with men (MSM). There are currently no FDA-approved pharmacological interventions to treat methamphetamine use disorder (MUD). MUD is associated with social impairments and extremely high treatment attrition rates. Administration of oxytocin, a neuropeptide involved in social attachment, may be a novel approach to addressing these issues. Moreover, oxytocin administration has shown promise for reducing METH-related addictive behavior in animal models, but has not yet been investigated in clinical trials for MUD. Last, oxytocin is known to modulate stress responsivity via regulation of the autonomic nervous system, which is dysregulated in METH users. We hypothesize that oxytocin, in combination with group psychotherapy, will increase treatment engagement, reduce addiction behavior, and mitigate stress hyperreactivity. METHODS This is a randomized, double blind trial of oxytocin 40-IU (n = 24) or placebo (n = 24) administered intranasally prior to each of six weekly motivational interviewing group therapy (MIGT) sessions for MUD in MSM. PRIMARY OUTCOME (a) session attendance. SECONDARY OUTCOMES (b) group cohesion, (c) anxiety, (d) METH craving, (e) METH use, and (f) in-session cardiac physiology. RESULTS Participants receiving oxytocin had significantly higher group therapy attendance than those receiving placebo, OR 3.26, 95% CI [1.27-8.41], p = .014. There was a small effect of oxytocin on group cohension, but not anxiety or craving. METH use did not change over the six-week MIGT course in either treatment arm. Participants receiving oxytocin had lower average heart rates during MIGT sessions and higher heart rate variability. There were positive main effects of MIGT over Time regardless of study drug. CONCLUSIONS This evidence, and the lack of any serious adverse events, suggests that oxytocin may safely increase treatment attendance. One possible mechanism by which it may do so is its modulation of the autonomic nervous system. Further investigation is warranted.
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Affiliation(s)
- Christopher S Stauffer
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America; Portland Veterans Affairs Medical Center & Oregon Health and Science University, United States of America.
| | - Jenna M Moschetto
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | - Scott McKernan
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | | | - Chavy Chiang
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Rachel Rapier
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Elaine Hsiang
- University of California, San Francisco, United States of America
| | - Jerika Norona
- San Francisco Veterans Affairs Medical Center, United States of America
| | - Brian Borsari
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
| | - Joshua D Woolley
- San Francisco Veterans Affairs Medical Center, United States of America; University of California, San Francisco, United States of America
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Abstract
PURPOSE OF REVIEW This paper reports on the results of a study comparing two behavioral treatments for methamphetamine users. The outcome was the effectiveness of the interventions in reducing meth use. The interventions were contingency management (CM) and contingency management plus strengths-based case management (CM/SBCM). RECENT FINDINGS CM/SBCM was found to be associated with attending more sessions for people who reported being in a couple. Also, participants who earned more money in the first part of the study were more likely to have more clean urinalysis in the second part of the study. Latent class analysis identified a class of participants who were in a couple, without sexual abuse history, and less meth use at baseline. This class tended to have more clean urinalysis in the CM/SBCM intervention. These results indicate that incentive-based interventions with case management may be useful for helping meth users reduce their drug use.
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Petzold J, Weber B, Bassett TR, Bauer M, Bernhardt N, Groß C, Hasler H, Schützwohl M, Pilhatsch M. Effectiveness of the First German-Language Group Psychotherapy Manual to Accompany Short-Term Treatment in Methamphetamine Dependence. Front Psychiatry 2020; 11:130. [PMID: 32180742 PMCID: PMC7059436 DOI: 10.3389/fpsyt.2020.00130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Methamphetamine abuse is expanding in Europe, leading to a shortfall in medical care for related disorders in many regions. Research focusing on the effectiveness and feasibility of methamphetamine-specific treatment programs is scarce, especially in short-term settings. Methods: To this end, we treated 31 patients with methamphetamine dependence using a new group psychotherapy manual added to standard psychiatric care. Trained research assistants recorded demographic, illness and treatment variables using a standardized interview at baseline and a follow-up visit 3 months later. Outcome and process variables for this intervention encompassing 15 modules for qualified detoxification and motivation of patients with methamphetamine dependence are reported. Results: Retention and abstinence rates as well as acceptance and feasibility in daily routine were assessed positively. Patients with an unsuccessful outcome were characterized by longer regular methamphetamine use (t = -2.513, df = 29, p = 0.018) and a shorter abstinence period at baseline (U = 74.500, z = -1.808, p = 0.072). Among the demographic and clinical variables, the only predictor significantly increasing the odds of a successful outcome was a shorter period of regular methamphetamine use (OR = 1.318, CI 95% for OR = 1.021-1.700, b = 0.276, SE = 0.130, p = 0.034). Conclusions: This freely available therapy manual can help counter the shortfall in available psychotherapeutic interventions for patients with methamphetamine dependence in German-speaking countries. The routinely assessed parameters duration of regular methamphetamine use and abstinence before treatment were associated with outcome and may be used to personalize therapeutic strategies.
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Affiliation(s)
- Johannes Petzold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Benjamin Weber
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Tyler Ray Bassett
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Cornelius Groß
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Helena Hasler
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Guerin AA, Bonomo Y, Lawrence AJ, Baune BT, Nestler EJ, Rossell SL, Kim JH. Cognition and Related Neural Findings on Methamphetamine Use Disorder: Insights and Treatment Implications From Schizophrenia Research. Front Psychiatry 2019; 10:880. [PMID: 31920743 PMCID: PMC6928591 DOI: 10.3389/fpsyt.2019.00880] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
Despite the prevalence of methamphetamine (meth) use disorder, research on meth is disproportionately scarce compared to research on other illicit drugs. Existing evidence highlights cognitive deficits as an impediment against daily function and treatment of chronic meth use. Similar deficits are also observed in schizophrenia, and this review therefore draws on schizophrenia research by examining similarities and differences between the two disorders on cognition and related neural findings. While meth use disorder and schizophrenia are two distinct disorders, they are highly co-morbid and share impairments in similar cognitive domains and altered brain structure/function. This narrative review specifically identifies overlapping features such as deficits in learning and memory, social cognition, working memory and inhibitory/impulse control. We report that while working memory deficits are a core feature of schizophrenia, such deficits are inconsistently observed following chronic meth use. Similar structural and functional abnormalities are also observed in cortical and limbic regions between the two disorders, except for cingulate activity where differences are observed. There is growing evidence that targeting cognitive symptoms may improve functional outcome in schizophrenia, with evidence of normalized abnormal brain activity in regions associated with cognition. Considering the overlap between meth use disorder and schizophrenia, targeting cognitive symptoms in people with meth use disorder may also improve treatment outcome and daily function.
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Affiliation(s)
- Alexandre A. Guerin
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent’s Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Women’s Alcohol and Drug Service, Royal Women’s Hospital, Melbourne, VIC, Australia
| | - Andrew John Lawrence
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Eric J. Nestler
- Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia
| | - Jee Hyun Kim
- Mental Health Theme, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Harada T, Tsutomi H, Mori R, Wilson DB. Cognitive-behavioural treatment for amphetamine-type stimulants (ATS)-use disorders. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1026. [PMID: 37131466 PMCID: PMC8356519 DOI: 10.1002/cl2.1026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Amphetamine-type stimulants (ATS) refer to a group of synthetic stimulants including amphetamine, methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA) and related substances. ATS are highly addictive and prolonged use may result in a series of mental and physical symptoms including anxiety, confusion, insomnia, mood disturbances, cognitive impairments, paranoia, hallucinations and delusion.Currently there is no widely accepted treatment for ATS-use disorder. However, cognitive-behavioural treatment (CBT) is the first-choice treatment. The effectiveness of CBT for other substance-use disorders (e.g. alcohol-, opioid- and cocaine-use disorders) has been well documented and as such this basic treatment approach has been applied to the ATS-use disorder. Objectives To investigate the efficacy of cognitive-behavioural treatment for people with ATS-use disorder for reducing ATS use compared to other types of psychotherapy, pharmacotherapy, 12-step facilitation, no intervention or treatment as usual. Search methods We identified randomised controlled trials (RCT) and quasi-RCTs comparing CBT for ATS-use disorders with other types of psychotherapy, pharmacotherapy, 12 step facilitation or no intervention. We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Embase and five other databases up to July 2018. In addition, we examined reference lists of eligible studies and other systematic reviews. We contacted experts in the field. Selection criteria Eligibility criteria consisted of RCTs and quasi-RCTs comparing CBT versus other types of interventions with adult ATS users (aged 18 years or older) diagnosed by any explicit diagnostic system. Primary outcomes included abstinence rate and other indicators of drug-using behaviours. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results Only two studies met the eligibility criteria. Both studies were at low risk of selection bias and reporting bias. In one study, almost half of participants in the intervention group dropped out and this study was at high risk of attrition bias. The studies compared a single session of brief CBT or a web-based CBT to a waiting-list control (total sample size across studies of 129). Results were mixed across the studies. For the single-session brief CBT study, two out of five measures of drug use produced significant results, percentage of abstinent days in 90 days (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.02 to 2.11) and dependence symptoms (standardised mean difference (SMD) -0.59, 95% CI-1.16 to-0.02). Little confidence could be placed in the results from this study give the small sample size (25 participants per group) and corresponding large CIs around the observed effects. For the web-based CBT, there was no significant difference across different outcomes. Neither study reported adverse effects. The meta-analytic mean across these two trials for drug use was not significant (SMD -0.28, 95% CI-0.69 to 0.14). In summary, overall quality of evidence was low and there was insufficient evidence to conclude that CBT is effective, or ineffective, at treating ATS use. Authors' conclusions Currently, there is not enough evidence to establish the efficacy of CBT for ATS-use disorders because of a paucity of high-quality research in this area.
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Affiliation(s)
| | - Hiroshi Tsutomi
- Faculty of International RelationsUniversity of ShizuokaShizuokaJapan
| | - Rintaro Mori
- Department of Health PolicyNational Center for Child Health and DevelopmentTokyoJapan
| | - David B Wilson
- Criminology, Law and SocietyGeorge Mason UniversityFairfaxVirginiaUSA
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Knight R, Karamouzian M, Carson A, Edward J, Carrieri P, Shoveller J, Fairbairn N, Wood E, Fast D. Interventions to address substance use and sexual risk among gay, bisexual and other men who have sex with men who use methamphetamine: A systematic review. Drug Alcohol Depend 2019; 194:410-429. [PMID: 30502543 DOI: 10.1016/j.drugalcdep.2018.09.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Methamphetamine use is common among some populations of gay, bisexual and other men who have sex with men (gbMSM). This study reviewed the status of research on the efficacy of interventions that address harms among gbMSM who use methamphetamine. METHODS We searched MEDLINE, PsycINFO, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar to identify publications from inception to October 23, 2017, that assessed an intervention addressing methamphetamine use among gbMSM. RESULTS Of 1896 potential studies and 935 unique articles screened for inclusion, 28 eligible studies assessed 26 different interventions in the following categories: pharmacological (n = 5); psychosocial (n = 20); harm reduction (n = 1). Given that outcome variables were measured in highly variable ways, we were unable to conduct a meta-analysis of intervention effects. However, 22 studies reported a statistically significant effect on one or more methamphetamine-related outcomes. Among 21 studies that included measures of sexual health-related outcomes, 18 reported a significant effect on one or more sexual health-related outcomes, and 15 of those reported a concurrent effect on both drug- and sexual health-related outcomes. CONCLUSIONS This is the first review to provide compelling evidence that integrating interventions to address both drug- and sexual-related harms for gbMSM who use methamphetamine can be efficacious. Future research should focus on identifying differential effects of various intervention approaches by social positioning, as well as prioritize future evaluations of integrated harm reduction interventions (e.g., the distribution of harm reduction kits within sexual health care settings).
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Affiliation(s)
- Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada.
| | - Mohammad Karamouzian
- British Columbia Centre on Substance Use, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Anna Carson
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Joshua Edward
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Patrizia Carrieri
- Institute de la Santé et de la Recherché Médical (INSERM), Marseille, France
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, Vancouver, Canada; Department of Medicine, University of British Columbia, Canada
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8
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O'Donnell A, Addison M, Spencer L, Zurhold H, Rosenkranz M, McGovern R, Gilvarry E, Martens M, Verthein U, Kaner E. Which individual, social and environmental influences shape key phases in the amphetamine type stimulant use trajectory? A systematic narrative review and thematic synthesis of the qualitative literature. Addiction 2019; 114:24-47. [PMID: 30176077 PMCID: PMC6519251 DOI: 10.1111/add.14434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/04/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS There is limited evidence on what shapes amphetamine-type stimulant (ATS) use trajectories. This systematic narrative review and qualitative synthesis aimed to identify individual, social and environmental influences shaping key phases in the ATS use trajectory: initiation, continuation, increase/relapse and decrease/abstinence. METHODS MEDLINE, PsycINFO, EMBASE, and PROQUEST (social science premium collection) were searched from 2000 to 2018. Studies of any qualitative design were eligible for inclusion. Extracted data were analysed according to four key phases within drug pathways, and then cross-analysed for individual, social and environmental influences. RESULTS Forty-four papers based on 39 unique studies were included, reporting the views of 1879 ATS users. Participants were aged 14-58 years, from varied socio-economic and demographic groups, and located in North America, Europe, Australasia and South East Asia. Reasons for initiation included: to boost performance at work and in sexual relationships, promote a sense of social 'belonging' and help manage stress. Similar reasons motivated continued use, combined with the challenge of managing withdrawal effects in long-term users. Increased tolerance and/or experiencing a critical life event contributed to an increase in use. Reasons for decrease focused on: increased awareness of the negative health impacts of long-term use, disconnecting from social networks or relationships and financial instability. CONCLUSIONS Amphetamine-type stimulant users are a highly diverse population, and their drug use careers are shaped by a complex dynamic of individual, social and environmental factors. Tailored, joined-up interventions are needed to address users' overlapping economic, health and social care needs in order to support long-term abstinence.
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Affiliation(s)
- Amy O'Donnell
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Michelle Addison
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Liam Spencer
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Heike Zurhold
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Moritz Rosenkranz
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Ruth McGovern
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Eilish Gilvarry
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Marcus‐Sebastian Martens
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Uwe Verthein
- Centre of Interdisciplinary Addiction Research of Hamburg University, Department of PsychiatryUniversity Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Eileen Kaner
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
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Harada T, Tsutomi H, Mori R, Wilson DB. Cognitive-behavioural treatment for amphetamine-type stimulants (ATS)-use disorders. Cochrane Database Syst Rev 2018; 12:CD011315. [PMID: 30577083 PMCID: PMC6516990 DOI: 10.1002/14651858.cd011315.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Amphetamine-type stimulants (ATS) refer to a group of synthetic stimulants including amphetamine, methamphetamine, 3,4-methylenedioxy-methamphetamine (MDMA) and related substances. ATS are highly addictive and prolonged use may result in a series of mental and physical symptoms including anxiety, confusion, insomnia, mood disturbances, cognitive impairments, paranoia, hallucinations and delusion.Currently there is no widely accepted treatment for ATS-use disorder. However, cognitive-behavioural treatment (CBT) is the first-choice treatment. The effectiveness of CBT for other substance-use disorders (e.g. alcohol-, opioid- and cocaine-use disorders) has been well documented and as such this basic treatment approach has been applied to the ATS-use disorder. OBJECTIVES To investigate the efficacy of cognitive-behavioural treatment for people with ATS-use disorder for reducing ATS use compared to other types of psychotherapy, pharmacotherapy, 12-step facilitation, no intervention or treatment as usual. SEARCH METHODS We identified randomised controlled trials (RCT) and quasi-RCTs comparing CBT for ATS-use disorders with other types of psychotherapy, pharmacotherapy, 12 step facilitation or no intervention. We searched the Cochrane Drugs and Alcohol Group Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Embase and five other databases up to July 2018. In addition, we examined reference lists of eligible studies and other systematic reviews. We contacted experts in the field. SELECTION CRITERIA Eligibility criteria consisted of RCTs and quasi-RCTs comparing CBT versus other types of interventions with adult ATS users (aged 18 years or older) diagnosed by any explicit diagnostic system. Primary outcomes included abstinence rate and other indicators of drug-using behaviours. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Only two studies met the eligibility criteria. Both studies were at low risk of selection bias and reporting bias. In one study, almost half of participants in the intervention group dropped out and this study was at high risk of attrition bias. The studies compared a single session of brief CBT or a web-based CBT to a waiting-list control (total sample size across studies of 129). Results were mixed across the studies. For the single-session brief CBT study, two out of five measures of drug use produced significant results, percentage of abstinent days in 90 days (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.02 to 2.11) and dependence symptoms (standardised mean difference (SMD) -0.59, 95% CI -1.16 to -0.02). Little confidence could be placed in the results from this study give the small sample size (25 participants per group) and corresponding large CIs around the observed effects. For the web-based CBT, there was no significant difference across different outcomes. Neither study reported adverse effects. The meta-analytic mean across these two trials for drug use was not significant (SMD -0.28, 95% CI -0.69 to 0.14). In summary, overall quality of evidence was low and there was insufficient evidence to conclude that CBT is effective, or ineffective, at treating ATS use. AUTHORS' CONCLUSIONS Currently, there is not enough evidence to establish the efficacy of CBT for ATS-use disorders because of a paucity of high-quality research in this area.
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Affiliation(s)
- Takayuki Harada
- Mejiro UniversityDepartment of Psychology4‐31‐1 Naka‐Ochiai, Shinjuku‐kuTokyoJapan161‐8539
| | - Hiroshi Tsutomi
- University of ShizuokaFaculty of International Relations52‐1 Yada, Suruga‐kuShizuokaShizuokaJapan422‐8526
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 OkuraSetagaya‐kuTokyoTokyoJapan157‐0074
| | - David B Wilson
- George Mason UniversityCriminology, Law and SocietyEnterprise Hall 3394400 University Drive, MS‐4F4FairfaxVirginiaUSA22030
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Quinn B, Stoové M, Dietze P. Factors associated with professional support access among a prospective cohort of methamphetamine users. J Subst Abuse Treat 2013; 45:235-41. [DOI: 10.1016/j.jsat.2013.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/11/2013] [Accepted: 02/13/2013] [Indexed: 11/28/2022]
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Ciketic S, Hayatbakhsh MR, Doran CM, Najman JM, McKetin R. A review of psychological and pharmacological treatment options for methamphetamine dependence. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.592900] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kenny P, Harney A, Lee NK, Pennay A. Treatment utilization and barriers to treatment: results of a survey of dependent methamphetamine users. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2011; 6:3. [PMID: 21320347 PMCID: PMC3046906 DOI: 10.1186/1747-597x-6-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 02/14/2011] [Indexed: 11/10/2022]
Abstract
Background Australia has one of the highest rates of methamphetamine use in the world; however, treatment access for methamphetamine is comparatively low. This descriptive study aimed to identify patterns of treatment utilization and perceived barriers to accessing treatment among dependent methamphetamine users in the hope that such information will enable services to more appropriately respond to this group. Methods One hundred and twenty-six methamphetamine users who had a current or past history of methamphetamine dependence were interviewed about their experiences of, and perceived barriers to, treatment. Results Treatment utilization among methamphetamine users was reportedly low. One of the main reasons cited for not accessing treatment was that methamphetamine users did not perceive their drug use to be a problem (despite apparent levels of dependence). Self-detoxification with the use of other licit and illicit drugs was high among this group. Participants identified a lack of confidence in the ability of treatment services to address methamphetamine dependence and the 'opiate-centric' nature of treatment services as significant blocks to treatment entry. Suggestions for improvement by participants included operating specialist services for methamphetamine users, placing an emphasis on responsiveness and routinely involving case management services for this group. Discussion and Conclusions To improve service delivery, treatment services should reorient their services to better address the needs of methamphetamine users by making small changes such as specific opening times for methamphetamine users or using a dedicated space for methamphetamine treatment. Alternative options such as online treatments and specialist methamphetamine clinics should be considered for methamphetamine users.
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Affiliation(s)
- Pauline Kenny
- Turning Point Alcohol and Drug Centre, 54-62 Gertrude Street, Fitzroy, Victoria 3065, Australia
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PENNAY AMYE, LEE NICOLEK. Putting the call out for more research: The poor evidence base for treating methamphetamine withdrawal. Drug Alcohol Rev 2010; 30:216-22. [DOI: 10.1111/j.1465-3362.2010.00240.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wallace C, Galloway T, McKetin R, Kelly E, Leary J. Methamphetamine use, dependence and treatment access in rural and regional North Coast of New South Wales, Australia. Drug Alcohol Rev 2010; 28:592-9. [PMID: 19930011 DOI: 10.1111/j.1465-3362.2008.00016.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS To identify the sociodemographic, health, drug use patterns, treatment coverage and barriers to treatment among regular methamphetamine users in rural and regional North Coast of New South Wales. DESIGN AND METHODS A structured questionnaire was used to measure sociodemographic factors, health and well-being, drug use patterns, methamphetamine dependence, engagement in methamphetamine treatment and barriers to treatment. Participants were 140 regular methamphetamine users. Dependent and non-dependent participants were compared to identify factors associated with dependence. RESULTS Participants were predominantly in their thirties, male and had low levels of education, high levels of unemployment and polydrug use. Participants who were dependent on methamphetamine (59%) were more likely to report impaired mental health and to have been diagnosed with depression, anxiety and drug-induced psychosis. One quarter of dependent methamphetamine users had received treatment in the last year and half had ever received treatment. The main barriers to receiving treatment were a lack of perceived need or motivation to seek treatment and concerns about confidentiality. DISCUSSION AND CONCLUSIONS Methamphetamine users living on the North Coast of New South Wales require treatment options tailored to address a complex array of physical and psychological problems. The findings highlight the need for psychiatric support and improved coordination between mental health and drug and alcohol services in rural and regional areas.
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Affiliation(s)
- Cate Wallace
- Public Health Training and Development Branch, New South Wales Department of Health, North Sydney, Australia.
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Mazoni CG, Fernandes S, Pierozan PS, Moreira T, Freese L, Ferigolo M, Barros HMT. A eficácia das intervenções farmacológicas e psicossociais para o tratamento do tabagismo: revisão da literatura. ESTUDOS DE PSICOLOGIA (NATAL) 2008. [DOI: 10.1590/s1413-294x2008000200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A cessação do tabagismo traz benefícios à saúde, pois indivíduos que param de fumar evitam a maioria das doenças associadas ao tabaco. Objetiva-se revisar as características fundamentais e eficácia das intervenções farmacológicas e psicossociais para o tratamento dos tabagistas, apresentando dados de revisões tipo meta-análises e de ensaios clínico randomizados. Intervenções farmacológicas como a terapia de reposição de nicotina e a bupropiona e intervenções psicossociais como a terapia cognitivo-comportamental e a intervenção motivacional face a face e por telefone demonstram eficácia. A farmacoterapia aumenta a chance de abstinência em 2 vezes e as intervenções psicossociais face a face ou por telefone em 1,5 a 2,5 vezes em relação a tabagistas recebendo intervenções controles. Estes dados fornecem subsídios para profissionais de saúde decidirem qual o melhor tratamento para o tabagista, informando as intervenções disponíveis, sua eficácia e o benefício de sua utilização.
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Affiliation(s)
| | - Simone Fernandes
- Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas
| | | | - Taís Moreira
- Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas
| | - Luana Freese
- Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas
| | - Maristela Ferigolo
- Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas
| | - Helena M. T. Barros
- Serviço Nacional de Orientações e Informações sobre a Prevenção do Uso Indevido de Drogas
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Abstract
ISSUES Psychostimulant dependence is a chronic, relapsing condition which is highly treatment refractory. No medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Agonist strategies have attracted limited attention. APPROACH Successful examples of agonist pharmacotherapy in the treatment of heroin and nicotine dependence are first considered. Agonist pharmacological approaches to the treatment of psychostimulant dependence are then examined, based on the dopamine receptor agonist and indirect dopamine agonist strategies. Finally, the potential extension of the concept of agonist pharmacotherapy to include the novel non-amphetamine-type stimulant, modafinil, is discussed. CONCLUSIONS Agonist approaches appear to be viable with risks outweighed by benefits in carefully selected, monitored and motivated patients. On the other hand, the effectiveness of indirect agonists such as dexamphetamine and methylphenidate are not established. Further research is required to determine optimal treatment models (whether maintenance or withdrawal), effective safe dosages and duration (short or long term).
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Affiliation(s)
- James Shearer
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Baker A, Dawe S. Amphetamine use and co-occurring psychological problems: Review of the literature and implications for treatment. AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050060500094654] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A Baker
- Centre for Mental Health Studies, University of Newcastle , Newcastle, New South Wales
| | - S Dawe
- School of Applied Psychology, Griffith University , Brisbane, Queensland, Australia
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Shearer J. Psychosocial approaches to psychostimulant dependence: A systematic review. J Subst Abuse Treat 2007; 32:41-52. [PMID: 17175397 DOI: 10.1016/j.jsat.2006.06.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 06/02/2006] [Accepted: 06/16/2006] [Indexed: 11/19/2022]
Abstract
This review examines the nature and evidence for the effectiveness of psychosocial interventions for psychostimulant dependence. Psychostimulant dependence and related harms continue to increase in many parts of the world, while treatment responses are predominantly limited to psychosocial interventions. The effectiveness of psychosocial interventions is compromised by poor rates of treatment induction and retention. As with other substance use disorders, increasing the diversity of treatment options is likely to improve treatment coverage and outcomes across a broader range of users. Identifying medications that might enhance treatment induction and retention would also enhance the effectiveness of psychosocial programs. It is concluded that psychosocial interventions are moderately effective in reducing psychostimulant use and related harms among psychostimulant-dependent persons.
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Affiliation(s)
- James Shearer
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney NSW 2052, Australia.
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Feeney GFX, Connor JP, Young RM, Tucker J, McPherson A. Improvement in measures of psychological distress amongst amphetamine misusers treated with brief cognitive-behavioural therapy (CBT). Addict Behav 2006; 31:1833-43. [PMID: 16431030 DOI: 10.1016/j.addbeh.2005.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 12/07/2005] [Accepted: 12/19/2005] [Indexed: 11/28/2022]
Abstract
This trial of cognitive-behavioural therapy (CBT) based amphetamine abstinence program (n=507) focused on refusal self-efficacy, improved coping, improved problem solving and planning for relapse prevention. Measures included the Severity of Dependence Scale (SDS), the General Health Questionnaire-28 (GHQ-28) and Amphetamine Refusal Self-Efficacy. Psychiatric case identification (caseness) across the four GHQ-28 sub-scales was compared with Australian normative data. Almost 90% were amphetamine-dependent (SDS 8.15+/-3.17). Pre-treatment, all GHQ-28 sub-scale measures were below reported Australian population values. Caseness was substantially higher than Australian normative values {Somatic Symptoms (52.3%), Anxiety (68%), Social Dysfunction (46.5%) and Depression (33.7%)}. One hundred and sixty-eight subjects (33%) completed and reported program abstinence. Program completers reported improvement across all GHQ-28 sub-scales {Somatic Symptoms (p<0.001), Anxiety (p<0.001), Social Dysfunction (p<0.001) and Depression (p<0.001)}. They also reported improvement in amphetamine refusal self-efficacy (p<0.001). Improvement remained significant following intention-to-treat analyses, imputing baseline data for subjects that withdrew from the program. The GHQ-28 sub-scales, Amphetamine Refusal Self-Efficacy Questionnaire and the SDS successfully predicted treatment compliance through a discriminant analysis function (p<.001).
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Affiliation(s)
- G F X Feeney
- Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia.
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Farrell M, Gowing L, Marsden J, Ling W, Ali R. Effectiveness of drug dependence treatment in HIV prevention. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2005. [DOI: 10.1016/j.drugpo.2005.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Baker A, Lee NK, Claire M, Lewin TJ, Grant T, Pohlman S, Saunders JB, Kay-Lambkin F, Constable P, Jenner L, Carr VJ. Brief cognitive behavioural interventions for regular amphetamine users: a step in the right direction. Addiction 2005; 100:367-78. [PMID: 15733250 DOI: 10.1111/j.1360-0443.2005.01002.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The present study sought to replicate and extend a small pilot study conducted by Baker, Boggs & Lewin (2001) which demonstrated that brief interventions consisting of motivational interviewing and cognitive-behaviour therapy (CBT) were feasible and associated with better outcomes compared with a control condition. DESIGN Randomized controlled trial (RCT). SETTING Greater Brisbane Region of Queensland and Newcastle, NSW, Australia. PARTICIPANTS The study was conducted among 214 regular amphetamine users. MEASUREMENTS Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. FINDINGS The main finding of this study was that there was a significant increase in the likelihood of abstinence from amphetamines among those receiving two or more treatment sessions. In addition, the number of treatment sessions attended had a significant short-term beneficial effect on level of depression. There were no intervention effects on any other variables (HIV risk-taking, crime, social functioning and health). Overall, there was a marked reduction in amphetamine use among this sample over time and, apart from abstinence rates and short-term effects on depression level, this was not differential by treatment group. Reduction in amphetamine use was accompanied by significant improvements in stage of change, benzodiazepine use, tobacco smoking, polydrug use, injecting risk-taking behaviour, criminal activity level, and psychiatric distress and depression level. CONCLUSIONS A stepped-care approach is recommended. The first step in providing an effective intervention among many regular amphetamine users, particularly those attending non-treatment settings, may include provision of: a structured assessment of amphetamine use and related problems; self-help material; and regular monitoring of amphetamine use and related harms. Regular amphetamine users who present to treatment settings could be offered two sessions of CBT, while people with moderate to severe levels of depression may best be offered four sessions of CBT for amphetamine use from the outset, with further treatment for amphetamine use and/or depression depending on response. Pharmacotherapy and/or longer-term psychotherapy may be suitable for non-responders. An RCT of a stepped-care approach among regular amphetamine users is suggested.
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Affiliation(s)
- Amanda Baker
- Centre for Mental Health Studies, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
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Grabowski J, Shearer J, Merrill J, Negus SS. Agonist-like, replacement pharmacotherapy for stimulant abuse and dependence. Addict Behav 2004; 29:1439-64. [PMID: 15345275 DOI: 10.1016/j.addbeh.2004.06.018] [Citation(s) in RCA: 196] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Stimulant abuse and dependence are disproportionately problematic due to the combination of legal and social issues added to the serious behavioural and biological features of the disorders. These problems are compounded by adverse consequences for families and society. Illegality and stigma multiply the consequences of use and difficulties in providing treatment. Specific behavioural interventions have been demonstrated as useful in treatment of substance use disorders (SUDs). Medications also have an important role in treatment. Effective agonist and antagonist pharmacotherapies as well as symptomatic treatments exist for opioid and nicotine dependence. Neither agonists nor antagonists have been approved as uniquely effective for treatment of stimulant abuse or dependence. Still, promising results are emerging for an agonist-like or 'replacement' strategy paralleling that for nicotine and opioid dependence. Supporting data have emerged from both preclinical and clinical research environments. There are scientific, clinical, social, and legal impediments to application of an agonist-like approach to stimulant abuse and dependence. Some resemble past and current concerns about opioid replacement. Others are unique to the stimulant agents, effects, and clinical features. Here, the authors consider (1) agonist and antagonist pharmacotherapy strategies; (2) preclinical research, including methodological approaches, opioid and nicotine replacement, and agonists for stimulant dependence; (3) clinical reports with stimulant medications in cocaine dependence, and the amphetamine replacement strategy for amphetamine dependence; (4) application of agonist-like/replacement strategies, including clinical requirements and risks; and (5) directions for research.
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Affiliation(s)
- John Grabowski
- Substance Abuse Research Center, Department of Psychiatry and Behavioural Sciences, University of Texas-Health Science Center at Houston, 1300 Moursund Street, Houston, TX 77030, USA.
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