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Tata V, Majd Z, Talwar A, Bapat S, Cruz ADL, Essien JE, Thornton JD. Differences in Perceived Threat and Efficacy in Managing Opioid Use Disorder versus Alcohol Use Disorder. Subst Use Misuse 2023; 58:1187-1195. [PMID: 37271735 DOI: 10.1080/10826084.2023.2212075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background: Efforts to increase the availability of Medication Assisted Treatment for alcohol use disorder (AUD) and opioid use disorder (OUD) may be futile if patients lack motivation for recovery and are unwilling to seek treatment. Objectives: In this cross-sectional, online survey, we used the Extended Parallel Process Model (EPPM) to assess how participants at risk of AUD or OUD react to their perceived threat and assess their response to pharmacotherapy as a potential treatment. EPPM constructs were assessed using the Risk Based Diagnosis Scale. Descriptive statistics measure the proportion of treated vs untreated participants. Untreated participants were sorted into one of three groups categorizing perceived threat - low threat appraisal, and danger or fear control. Results: Of 411 total responses, most (n = 293[71.29%]) sorted into the AUD cohort and 118(28.71%) into the OUD cohort. Overall, 104(25.30%) had received treatment and 307(74.70%) didn't. Within the OUD cohort, there were 67 untreated participants - 16(23.88%) exhibited low threat appraisal, 13(19.40%) were likely to undergo fear control, and 38(56.72%) were likely to undergo danger control. Within the AUD cohort, there were 240 untreated participants - 75(31.25%) exhibited low threat appraisal, 100(41.67%) were likely to experience fear control, and 65(27.08%) were likely to experience danger control. Participants in the OUD cohort were more likely to undergo danger control than those in the AUD cohort (χ2 = 19.26, p < 0.05). Conclusions: This study identified perceived threat and efficacy when an individual was at risk of a SUD, but more insight into potential early interventions is needed - particularly in those individuals with polysubstance use disorder.
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Affiliation(s)
- Vaishnavi Tata
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Zahra Majd
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
| | - Ashna Talwar
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
| | - Shweta Bapat
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Austin De La Cruz
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
| | - James E Essien
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
| | - J Douglas Thornton
- College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, Texas, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, Texas, USA
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Adzrago D, Evans GS, Dias EM, Kwentua V, White GE, Wilkerson JM. Association of receiving opioid medication-assisted treatment with sexual identity and mental health/substance use disorder symptoms in a nationally representative sample of adults. RESEARCH SQUARE 2023:rs.3.rs-2837899. [PMID: 37162987 PMCID: PMC10168441 DOI: 10.21203/rs.3.rs-2837899/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Although the literature suggests that medication-assisted treatment (MAT) is an effective treatment for opioid use disorder, limited studies have assessed the prevalence or the association between MAT use and sexual identity, mental health, or substance use disorder among a nationally representative sample. We assessed the prevalence and association of opioid MAT use between sexual identity, depressive disorder symptoms, alcohol use dependence, and marijuana use dependence in the United States. Methods We used the 2019 National Survey on Drug Use and Health public-use data on adults aged 18-64 years (N = 38,841) to conduct a weighted multivariable logistic regression analysis. Results A total of 4.80% and 2.32% of the population identified as bisexual and lesbian/gay, respectively. About 0.31% (612,750 people) of the population reported receiving opioid MAT, 3.73% had alcohol use dependence, 1.42% had marijuana use dependence, and 9.13% had major depressive episode (MDE) symptoms. Of those who had received opioid MAT, 0.57% were bisexuals and 1.07% were lesbians/gays, 0.65% were people with alcohol use dependence, 2.32% with marijuana use dependence, and 1.59% with MDE symptoms. Lesbian/gay individuals were more likely to receive opioid MAT (AOR = 3.43, 95% CI = 1.42, 8.25) compared to heterosexual individuals. The odds were higher for people with marijuana use dependence (AOR = 3.44, 95% CI = 1.47, 8.06) and MDE symptoms (AOR = 5.22, 95% CI = 3.46, 7.89) than their counterparts. Conclusions In this study, sexual minorities, people with MDE symptoms, and those dependent on marijuana use were more likely to receive opioid MAT, suggesting the need to investigate further opioid use disorder symptoms and their risk factors among these populations.
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Affiliation(s)
- David Adzrago
- The University of Texas Health Science Center at Houston (UTHealth)
| | | | - Emanuelle M Dias
- The University of Texas Health Science Center at Houston (UTHealth)
| | - Victoria Kwentua
- The University of Texas Health Science Center at Houston (UTHealth)
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Roache JD, Pavlicova M, Campbell A, Choo TH, Peavy M, Kermack AS, Nunes EV, Rotrosen J. Is extended release naltrexone superior to buprenorphine-naloxone to reduce drinking among outpatients receiving treatment for opioid use disorder? A secondary analysis of the CTN X:BOT trial. Alcohol Clin Exp Res 2021; 45:2569-2578. [PMID: 34698397 PMCID: PMC8722377 DOI: 10.1111/acer.14729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT) trial showed that following induction, treatment with the sublingual agonist (buprenorphine-naloxone, BUP-NX) or injected antagonist (extended release naltrexone, XR-NTX) produced similar reductions in opioid relapse in injection users with opioid use disorder (OUD). Because XR-NTX reduces drinking in alcohol use disorder (AUD), we conducted a secondary analysis of the X:BOT sample of patients successfully inducted onto treatment to determine whether XR-NTX (n = 204) was superior to BUP-NX (n = 270) in reducing drinking or heavy drinking in patients with OUD. METHODS Standard drink units consumed were measured using the Timeline Follow-back method. Mixed-models regression was used to examine the monthly frequency of any drinking and heavy drinking over 6 months of treatment. We used a proportional hazard survival analysis to examine the time to first drink. RESULTS Both treatment groups reduced drinking from baseline to posttreatment (small to medium effect), but no differences between groups were detected. However, only 29% (n = 136) of the sample had AUD and 19% (n = 26/136) of those were abstinent before treatment. Analysis of a subsample enriched for possible drinking included 136 individuals with an AUD diagnosis plus 43 who did not have AUD, but reported at least one day of heavy drinking prior to the study. However, this subsample reported only 32% of days of any drinking with a median of only 13% of days designated as "heavy." Within this subsample, at baseline, the BUP-NX group reported more mean drinks per drinking day than the XR-NTX group (p = 0.03); however, there were no other significant group differences on drinking observed before, during, or at the end of treatment. CONCLUSIONS There was an overall reduction in drinking during treatment of OUD using both agonist and antagonist medications, so that the hypothesis that XR-NTX would be superior to BUP-NX was not supported. The study is limited by low levels of comorbid AUD or heavy drinking observed in X:BOT trial participants seeking treatment for OUD.
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Affiliation(s)
- John D. Roache
- Division of Alcohol & Drug Addiction, Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Martina Pavlicova
- Biostatistics Department, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Aimee Campbell
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York City, New York, USA
| | - Tse-Hwei Choo
- Mental Health Data Science, Department of Psychiatry, Columbia University, New York City, New York, USA
| | | | - Andrea S. Kermack
- Division of Substance Abuse, Departments of Internal Medicine and Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert, Einstein College of Medicine, New York City, New York, USA
| | - Edward V. Nunes
- Columbia University Irving Medical Center and New York State Psychiatric Institute, New York City, New York, USA
| | - John Rotrosen
- New York University Grossman School of Medicine, New York City, New York, USA
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Mintz CM, Presnall NJ, Xu KY, Hartz SM, Sahrmann JM, Bierut LJ, Grucza RA. An examination between treatment type and treatment retention in persons with opioid and co-occurring alcohol use disorders. Drug Alcohol Depend 2021; 226:108886. [PMID: 34245997 PMCID: PMC8370094 DOI: 10.1016/j.drugalcdep.2021.108886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Persons with opioid use disorder (OUD) and co-occurring alcohol use disorder (AUD) are understudied. We identified whether co-occurring AUD was associated with OUD treatment type, compared associations between treatment type and six-month treatment retention and determined whether co-occurring AUD moderated these relationships. METHODS We used an observational cohort study design to analyze insurance claims data from 2011 to 2016 from persons aged 12-64 with an opioid abuse or opioid dependence diagnosis and OUD treatment claim. Our unit of analysis was the treatment episode; we used logistic regression for analyses. RESULTS Of 211,047 treatment episodes analyzed, 14 % had co-occurring alcohol abuse or dependence diagnoses. Among persons with opioid dependence, persons with co-occurring alcohol dependence were 25 % less likely to receive medication treatment relative to those without AUD. Further, alcohol dependence was associated with decreased likelihood of treatment with buprenorphine (AOR 0.47, 95 % CI 0.44-0.49) or methadone (AOR 0.31, 95 % CI 0.28-0.35) and increased likelihood of treatment with extended-release (AOR 1.36, 95 % CI 1.21-1.54) or oral (AOR 1.73, 95 % CI 1.57-1.90) naltrexone relative to psychosocial treatment. Buprenorphine and methadone were associated with highest retention prevalence regardless of OUD or AUD severity. Co-occurring alcohol abuse or dependence did not meaningfully change retention prevalence associated with buprenorphine or methadone. Co-occurring AUD was not associated with improved retention among persons receiving either formulation of naltrexone. CONCLUSIONS Buprenorphine and methadone are associated with relatively high likelihood of treatment retention among persons opioid and alcohol dependence, but are disproportionately under-prescribed.
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Affiliation(s)
- Carrie M Mintz
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8134, St. Louis, MO, 63110, United States.
| | - Ned J Presnall
- Department of Social Work, Washington University, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, United States
| | - Kevin Y Xu
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8134, St. Louis, MO, 63110, United States
| | - Sarah M Hartz
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8134, St. Louis, MO, 63110, United States
| | - John M Sahrmann
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, 4990 Children's Place, St. Louis, MO, 63110, United States
| | - Laura J Bierut
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8134, St. Louis, MO, 63110, United States
| | - Richard A Grucza
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, 1008 South Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, United States
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Perez-Macia V, Martinez- Cortes M, Mesones J, Segura-Trepichio M, Garcia-Fernandez L. Monitoring and Improving Naltrexone Adherence in Patients with Substance Use Disorder. Patient Prefer Adherence 2021; 15:999-1015. [PMID: 34040354 PMCID: PMC8140930 DOI: 10.2147/ppa.s277861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/09/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Naltrexone is an opioid antagonist used for the treatment of patients with opioid use disorder and alcohol use disorder. This population often presents problems of follow-up and therapeutic efficacy related to adherence to treatment. The purpose of our study is to provide an exhaustive summary of the current evidence regarding naltrexone adherence in people with substance use disorders and to identify possible variables that may influence adherence to naltrexone. METHODS Two searches were performed in bibliographic databases (PubMed, Embase), and studies included in the systematic review were those published from January 1, 2011 to September 2020, with participants over 18 years of age, evaluating treatment with naltrexone in alcohol use disorder and opioid use disorder. From the total of 133 articles initially selected, 36 were included and analyzed in the systematic review. RESULTS Naltrexone has not demonstrated superiority over other available treatments in terms of adherence and abstinence, although reinforcement systems have obtained favorable results as an additional strategy to improve adherence. CONCLUSION It is necessary to study other psychosocial variables involved in improving adherence, in addition to taking patient preferences into account in order to improve the external validity of the results.
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Affiliation(s)
- Virginia Perez-Macia
- Vinalopó University Hospital, Elche, Spain
- Psychology and Psychiatry Department, Catholic University of Murcia, Murcia, Spain
- Correspondence: Virginia Perez-Macia 36 Vicente Fuentes Sansano Road, Elche (Alicante), 03205, SpainTel +34 675550722 Email
| | | | - Jesus Mesones
- Vinalopó University Hospital, Elche, Spain
- Psychology and Psychiatry Department, Catholic University of Murcia, Murcia, Spain
| | | | - Lorena Garcia-Fernandez
- University Hospital of San Juan, Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, Alicante, Spain
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Peters ZJ, Kincaid MW, Greenberg JG, Quah RF, Curry JC. Rates of prescription orders for United States active duty service members diagnosed with alcohol use disorder. Subst Abus 2020; 42:638-645. [PMID: 32870103 DOI: 10.1080/08897077.2020.1809604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alcohol-use disorders (AUD) pose a significant challenge for the United States (US) military. The US Department of Defense has strongly recommended several medications for use in the treatment of patients with diagnosed AUD. This study assessed the prescription of medications for active duty service members (ADSMs) diagnosed with AUD in the US Military Health System (MHS). Methods: Rates of prescription orders were retrospectively examined from 2010 to 2017 among ADSMs with an incident diagnosis of moderate-to-severe AUD. The rate of prescription orders was defined as the proportion of ADSMs with an ICD-9 or ICD-10 diagnosis code of alcohol dependence who received an order for acamprosate, disulfiram, naltrexone, and/or topiramate at a military treatment facility in the year following their incident diagnosis. Results: ADSMs receiving an order for at least one medication in the year following their incident AUD diagnosis increased from 8.8% in 2010 to 16.2% in 2017 (RR = 1.84, 95% CI, 1.76, 1.93). Oral naltrexone was ordered most frequently among this patient population, while injectable naltrexone, a medication option meant to ease and improve adherence, was ordered for a smaller proportion of patients. Conclusions: Most ADSMs who might benefit from prescriptions for AUD are not receiving them as part of their treatment despite strong clinical evidence and Department of Defense policy support for their use among this cohort.
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Affiliation(s)
- Zachary J Peters
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Melissa W Kincaid
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Jennifer G Greenberg
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Ruth F Quah
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Justin C Curry
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
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Bi-directional Acceleration of Alcohol Use and Opioid Use Disorder. JOURNAL OF DRUG AND ALCOHOL RESEARCH 2019; 2019:236084. [PMID: 32440365 PMCID: PMC7241514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol is the most widely used addictive substance. Severe alcohol abuse is diagnosed as "alcohol use disorder" (AUD). A common and harmful drinking pattern is binge drinking that elevates a person's blood alcohol concentration to ≥ 0.08%. Such drinking may be an early indicator of AUD. Opioid misuse and dependence have become worldwide crises. Patterned consumption of various opioids can develop into opioid use disorder (OUD). An intertwined epidemic exists between opioid abuse, alcohol addiction, and binge drinking. Currently, studies on the interaction of AUD and OUD are limited and the underlying mechanisms linking these disorders remains unclear. We reviewed studies on AUD and OUD and utilized Ingenuity Pathway Analysis (IPA) to identify mechanisms of AUD and OUD interaction and potential gene targets for therapeutic agents. According to IPA Canonical Pathways Analysis, Gamma-aminobutyric Acid (GABA) Receptor Signaling, Neuroinflammation Signaling Pathway, Opioid Signaling Pathway and Dopamine-DARPP32 Feedback in cAMP Signaling are potential contributors to the interaction of AUD and OUD.
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8
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Weitzman ER, Ong MS. Rising Prevalence of Comorbid Alcohol and Opioid Use Disorders in Adolescents and Young Adults in the United States. J Gen Intern Med 2019; 34:1987-1989. [PMID: 31152359 PMCID: PMC6816705 DOI: 10.1007/s11606-019-05068-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA.
| | - Mei-Sing Ong
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Healthcare Institute, Boston, MA, USA
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Votaw VR, McHugh RK, Witkiewitz K. Alcohol use disorder and motives for prescription opioid misuse: A latent class analysis. Subst Use Misuse 2019; 54:1558-1568. [PMID: 31062626 PMCID: PMC6785983 DOI: 10.1080/10826084.2019.1594904] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Among those who misuse prescription opioids, alcohol use disorder (AUD) is associated with progression to opioid use disorder, risk of overdose, and poor treatment outcomes. However, little is known about co-occurring AUD and prescription opioid misuse. Motives, or reasons, for substance use are important factors in substance use initiation and maintenance; characterizing common motives can help inform treatment targets. The aims of the present study were to (1) identify patterns of motives for prescription opioid misuse, and (2) examine the association between AUD and motives. Methods: Data were extracted from the 2015 National Survey on Drug Use and Health. Analyses included adult respondents with past-year prescription opioid misuse (N = 2,627), of which 24.2% had a co-occurring AUD. Latent class analysis was utilized to identify patterns of motives for prescription opioid misuse. AUD was included as a predictor of class membership. Results: We identified three classes: (1) pain relief (56.1% of the sample), (2) recreational (e.g., to get high; 29.3%), and (3) mixed motives (e.g., coping, pain relief, recreational; 14.6%). AUD was associated with greater odds of membership in the recreational (OR = 2.05, 95% CI = 1.36, 3.10, p = .001) and mixed motives (OR = 2.11, 95% CI = 1.21, 3.67, p = .008) classes, as compared to the pain relief class. Results: Pain relief was the most commonly endorsed motive for opioid misuse among those with and without AUD. These results underscore the need to improve pain management among those who misuse prescription opioids. Those with co-occurring AUD might also benefit from interventions targeting negative affect and/or positive outcome expectancies.
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Affiliation(s)
- Victoria R Votaw
- a Department of Psychology , University of New Mexico , Albuquerque , New Mexico , USA.,b Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico , Albuquerque , New Mexico , USA
| | - R Kathryn McHugh
- c Division of Alcohol and Drug Abuse , McLean Hospital , Belmont , Massachusetts , USA.,d Department of Psychiatry , Harvard Medical School , Boston , Massachusetts , USA
| | - Katie Witkiewitz
- a Department of Psychology , University of New Mexico , Albuquerque , New Mexico , USA.,b Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico , Albuquerque , New Mexico , USA
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Saxon AJ. The Unmet Challenges of Co-Occurring Alcohol and Opioid Use. Alcohol Clin Exp Res 2018; 42:1406-1407. [PMID: 29846946 DOI: 10.1111/acer.13797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
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