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Aghaei AM, Gholami J, Sangchooli A, Rostam-Abadi Y, Olamazadeh S, Ardeshir M, Baheshmat S, Shadloo B, Taj M, Saeed K, Rahimi-Movaghar A. Prevalence of injecting drug use and HIV, hepatitis B, and hepatitis C in people who inject drugs in the Eastern Mediterranean region: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e1225-e1237. [PMID: 37474230 DOI: 10.1016/s2214-109x(23)00267-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Considerable disease burden is attributed to injecting drug use (IDU). This regional systematic review and meta-analysis aimed to assess the prevalence of IDU and the characteristics of people who inject drugs in the 22 countries of the WHO Eastern Mediterranean region. METHODS We conducted a systematic review and meta-analysis on the prevalence of IDU, estimation of the population size of people who inject drugs, the characteristics of people who inject drugs, commonly injected drugs, the prevalence of HIV, hepatitis C virus, and hepatitis B virus in people who inject drugs, and opioid agonist treatment and needle and syringe programme services. We searched PubMed, Web of Science, Scopus, Embase, and the Index Medicus for the Eastern Mediterranean Region for documents published between Jan 1, 2010, and April 17, 2022, with no language restrictions. We also searched government reports, civil society information, and UN websites and databases for grey literature published between Jan 1, 2010, and April 17, 2022. Documents were eligible if they reported or estimated an indicator of interest, or reported enough data to permit calculation of the indicator. We extracted data from the eligible documents and calculated national and regional estimates. FINDINGS We identified 38 283 documents and included 201 documents in the systematic review. A total of 115 documents were included for the four outcomes for which meta-analyses were performed. The number of people who inject drugs was estimated as 864 597 (95% CI 641 909-1 205 255), amounting to a prevalence of 20·0 per 10 000 adults (95% CI 14·9-27·9) in the region. Among people who inject drugs, the prevalence of HIV was estimated as 19·22% (95% CI 12·86-26·36), hepatitis C virus as 44·82% (29·32-61·16), and hepatitis B virus as 2·66% (0·84-7·26). Countries varied greatly regarding the variables of interest and the availability of relevant data. Nine countries provided needle and syringe programme services and seven countries provided opioid agonist treatment services, mostly with very low, low, or unclear coverage. INTERPRETATION The prevalence of IDU in the Eastern Mediterranean region is lower than the global mean, particularly among women. The HIV infection rate is higher than the global mean, and the hepatitis C virus infection rate is lower than the global mean. Harm-reduction services are underdeveloped. Data collection on IDU and provision of services need improvement in the region. FUNDING World Health Organization. TRANSLATIONS For the Arabic, Farsi and French translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ardavan Mohammad Aghaei
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Arshiya Sangchooli
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasna Rostam-Abadi
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Olamazadeh
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ardeshir
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Baheshmat
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrang Shadloo
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Taj
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Khalid Saeed
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addictions Studies, Tehran University of Medical Sciences, Tehran, Iran.
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Rostam-Abadi Y, Gholami J, Jobehdar MM, Ardeshir M, Aghaei AM, Olamazadeh S, Taj M, Saeed K, Mojtabai R, Rahimi-Movaghar A. Drug use, drug use disorders, and treatment services in the Eastern Mediterranean region: a systematic review. Lancet Psychiatry 2023; 10:282-295. [PMID: 36848914 DOI: 10.1016/s2215-0366(22)00435-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 02/26/2023]
Abstract
Drug use is an increasing global public health concern. We reviewed the prevalence and patterns of drug use, drug use disorders, and the extent of treatment services in 21 countries and one territory in the Eastern Mediterranean region from 2010 to 2022. Online databases were systematically searched on April 17, 2022, along with other sources for grey literature. The extracted data were analysed and used for synthesis at the country, subregional, and regional levels. The prevalence of drug use is higher in the Eastern Mediterranean region than global estimates, with cannabis, opium, khat, and tramadol among the main drugs used in the region. Data on the prevalence of drug use disorders were scarce and heterogeneous. Treatment facilities for drug use disorders are available in most countries, but opioid agonist treatment exists in only seven countries. There is a need to expand evidence-based and cost-effective care. Limited data exist, especially regarding drug use disorders, treatment coverage, and drug use among women and young people.
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Affiliation(s)
- Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS) WHO Collaborating Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS) WHO Collaborating Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maral Mardaneh Jobehdar
- Iranian National Center for Addiction Studies (INCAS) WHO Collaborating Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ardeshir
- Iranian National Center for Addiction Studies (INCAS) WHO Collaborating Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardavan Mohammad Aghaei
- Iranian National Center for Addiction Studies (INCAS) WHO Collaborating Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Olamazadeh
- Iranian National Center for Addiction Studies (INCAS) WHO Collaborating Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Taj
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Khalid Saeed
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS) WHO Collaborating Center, Tehran University of Medical Sciences, Tehran, Iran.
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Alawa J, Muhammad M, Kazemitabar M, Bromberg DJ, Garcia D, Khoshnood K, Ghandour L. Medication for opioid use disorder in the Arab World: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103617. [PMID: 35182841 PMCID: PMC9851143 DOI: 10.1016/j.drugpo.2022.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) is a global public health concern. The standard of care for OUD involves treatment using medications such as buprenorphine, methadone, or naltrexone. No known review exists to assess the contextual factors associated with medication for opioid use disorder (MOUD) in the Arab World. This systematic review serves as an implementation science study to address this research gap and improve the uptake of MOUD in the Arab World. METHODS Systematic searches of Medline, PsycINFO, and EMBASE, and a citation analysis, were used to identify peer-reviewed articles with original data on MOUD in the Arab World. Quality assessment was conducted using the CASP appraisal tools, and main findings were extracted and coded according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS 652 research articles were identified, and 10 met inclusion criteria for final review. Four studies considered health-systems aspects of MOUD administration, such as cost-effectiveness, the motivations for and impact of national MOUD policies, the types of social, political, and scientific advocacy that led to the adoption of MOUD in Arab countries, and the challenges limiting its wide-scale adoption in the Arab World. Six papers considered MOUD at individual and group patient levels by evaluating patient quality of life, addiction severity, patient satisfaction, and patient perspectives on opioid agonist therapy. CONCLUSION Despite financial and geographic barriers that limit access to MOUD in the Arab World, this review found MOUD to be cost-effective and associated with positive health outcomes for OUD patients in the Arab World. MOUD can be successfully established and scaled to the national level in the Arab context, and strong coalitions of health practitioners can lobby to establish MOUD programs in Arab countries. Still, the relative novelty of MOUD in this context precludes an abundance of research to address its long-term delivery in the Arab World.
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Affiliation(s)
- Jude Alawa
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, United States
| | - Muzzammil Muhammad
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| | - Maryam Kazemitabar
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Daniel J Bromberg
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Danilo Garcia
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Box 100, 405 30 Gothenburg, Gothenburg, Sweden; Department of Behavioral Sciences and Learning, Linköping University, SE 581 83, Linköping, Sweden
| | - Kaveh Khoshnood
- Yale University School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Van Dyck Building, PO Box 11-0236, Riad El-Solh Beirut, 1107 2020, Lebanon.
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Roles and Perceptions of Nurses During Implementation of a Medication Treatment for Opioid Use Disorder National Initiative. J Addict Nurs 2022; 33:70-79. [PMID: 35640210 DOI: 10.1097/jan.0000000000000455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND In the United States, a national priority exists to improve access to medication treatment for opioid use disorder (MOUD). Nurses can be an essential component of that care. We examined the perceptions and evolving roles of nurses in a national Veterans Health Administration (VHA) initiative designed to improve MOUD access within general medical settings. METHODS From April 15, 2021, to June 16, 2021, we recruited nurses participating in VHA's Stepped Care for Opioid Use Disorder Train the Trainer Initiative-a national program intending to implement MOUD in general medical settings-to participate in an interview about their roles, perceptions, and experiences. The respondents answered our inquiries through an interview or responded to an email solicitation with written responses, which were then recorded, transcribed, and independently coded to identify themes. RESULTS Nurses from 10 VHA facilities participated in an interview (n = 7) or completed the questionnaire (n = 4). Inadequate staffing, high patient-to-provider ratios, and time constraints were identified as barriers to MOUD care. Mentorship activities, existing VHA informational resources, and patients' willingness to accept treatment were identified as facilitators of MOUD care. The Stepped Care for Opioid Use Disorder Train the Trainer Initiative processes were acknowledged to promote role confidence, which in turn increased job satisfaction and empowered nurses to become content experts. Respondents often identified nurses as local lead facilitators in MOUD care. CONCLUSIONS In a national initiative to implement MOUD within general medical settings, nurses identified several barriers and facilitators to MOUD implementation. Nurses play vital collaborative care roles in enhancing access to MOUD.
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Sud A, Salamanca-Buentello F, Buchman DZ, Sabioni P, Majid U. Beyond harm-producing versus harm-reducing: A qualitative meta-synthesis of people who use drugs' perspectives of and experiences with the extramedical use and diversion of buprenorphine. J Subst Abuse Treat 2021; 135:108651. [PMID: 34728134 DOI: 10.1016/j.jsat.2021.108651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/27/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This review synthesizes the literature on the perspectives and experiences of people who use drugs to better understand motivations and behaviors related to the extramedical use and diversion of buprenorphine. Given the particular social construction of buprenorphine against methadone, and the centrality of concerns around extramedical use in delivering opioid agonist therapies, a focus on extramedical buprenorphine use can provide an important lens through which to analyze treatment for opioid use disorder. This review is framed within persistent tensions between potential harm-producing versus harm-reducing effects of extramedical use that have long been described for opioid agonist therapies. METHODS The research team conducted a qualitative meta-synthesis based on a systematic search of eight databases as well as hand searching. The review includes all primary qualitative and mixed-methods studies related to the perspectives and experiences of people who use drugs on extramedical buprenorphine use. The study team carried out three rounds of qualitative coding using NVivo 12, and constructivist grounded theory and the constant comparative method informed the synthesis. RESULTS The review includes twenty-one studies. Findings are organized into the following three themes: 1) the experiences of people who use drugs (PWUD) with extramedical use of buprenorphine and their motivations to engage in it (including the desire to self-medicate and achieve "stability", to manage ongoing use of other opioids, and to "get high"); 2) the relationship between extramedical use and formal medical opioid agonist therapy programs; and 3) the established drug economy of extramedical buprenorphine. CONCLUSIONS The review identified varied and often divergent perspectives and experiences with extramedical buprenorphine use. An examination of the reported "normalizing" effects of extramedical buprenorphine suggests this practice as extending medicalized discipline beyond the clinical environment. Taken together, these findings identify a need to move beyond the tension of harm-reducing versus harm-producing effects toward forms of health care and promotion that focus on the needs, perspectives, and priorities of people who use drugs.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario M6J 1H1, Canada; Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, Ontario M5T 3M6, Canada; University of Toronto Joint Centre for Bioethics, Health Sciences Building, 155 College Street, Suite 754, Toronto, ON M5T 3M6, Canada
| | - Pamela Sabioni
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Umair Majid
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
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Mayer S, Fowler A, Brohman I, Fairbairn N, Boyd J, Kerr T, McNeil R. Motivations to initiate injectable hydromorphone and diacetylmorphine treatment: A qualitative study of patient experiences in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102930. [PMID: 32949832 PMCID: PMC7901590 DOI: 10.1016/j.drugpo.2020.102930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/31/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Within the context of the ongoing overdose crisis and limitations of conventional opioid treatments, the scale-up of injectable hydromorphone (HDM) and diacetylmorphine (DAM) as evidenced-based treatments is currently underway in some settings in Canada. Past research has underscored the importance of treatment initiation in shaping onward treatment trajectories, however structural factors that influence participants' motivations to access injectable HDM or DAM have not been fully characterized. This study examines peoples' motivations for accessing HDM/DAM treatment and situates these within the social and structural context that shapes treatment delivery by employing the concept of structural vulnerability. METHODS Fifty-two individuals enrolled in injectable HDM/DAM programs were recruited from four community-based clinical programs in Vancouver, Canada to participate in qualitative semi-structured interviews. Approximately 50 h of ethnographic fieldwork was also completed in one clinical setting, and one-on-one with participants public spaces. Interview transcripts and ethnographic fieldnotes were analyzed through a structural vulnerability lens with a focus on treatment initiation. RESULTS Participants' previous experiences and perceptions of other drug treatments (e.g. methadone) foregrounded their initiation of injectable HDM/DAM. Social and structural factors (e.g. fentanyl-adulterated drug supply, poverty, drug criminalization) influenced participants' motivations to address immediate physical risks and their initial perception of this treatment's ability to align with their opioid use experiences. Similar social and structural factors that drive immediate physical risks, were also evidenced in participants' motivations to make changes in their daily lives and to address broader opioid use goals. CONCLUSION Participants descriptions of their motivations to initiate HDM/DAM highlight how structural vulnerabilities shaped participants' experiences initiating injectable HDM/DAM.
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Affiliation(s)
- Samara Mayer
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC V6T 1Z4 Canada
| | - Al Fowler
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Isabella Brohman
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Internal Medicine, Yale School of Medicine. New Haven, CT, 06510 United States; Yale Program in Addiction Medicine, Yale School of Medicine. New Haven, Connecticut, 06510 United States.
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Jalali R, Moradi A, Dehghan F, Merzai S, Alikhani M. The exploration of factors related to treatment retention in Narcotics Anonymous members: a qualitative study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:14. [PMID: 30971274 PMCID: PMC6458757 DOI: 10.1186/s13011-019-0205-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/01/2019] [Indexed: 11/18/2022]
Abstract
Background Elimination of psychological dependence to substance is more difficult than elimination of physical dependence, and needs to time, going through several stages, and internal care. The aim of this study was to exploring the factors related to treatment retention in Narcotics Anonymous members. Methods In a qualitative study and by individual interview, 12 recovered participants were interviewed. The participants were substance user, whom recovered for more than two years. The data were gathered by purposeful sampling and through recording and transcribing interviews. Data analysis were done by qualitative content analysis through three steps: conceptualization, interview and data analysis. Results After analyzing data, two main categories had emerged: “personal-psychological” and “social” factors. Personal-psychological" factors includes: self-knowledge, change of attitude, self-confidence, consistency in treatment, living in the moment and “social” factors include interaction with others, group of sympathizers, reformation of social and familial relationships, reclaiming the social position, supports received from others, and supports received from the generalized network. Conclusion Recovered individuals are in need to emotional supports and reclaiming their positions in the family and society play an important role in their treatment retention. Keeping the Substance users away from drugs is not the basic step of substance use treatment, but the necessary supports and special cares should be given to the Substance users after elimination of physical attachment, so that the psychological dependence can be eliminated as well.
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Affiliation(s)
- Rostam Jalali
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Asie Moradi
- Department of Psychology, Faculty of Social Sciences, Razi University, Kermanshah, Iran
| | - Fateme Dehghan
- Substance use Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Samira Merzai
- Substance use Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Substance use Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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