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The article describes the Paper Authoring Tool (PAT), funded by the periodical "Addiction," and designed to write-up randomized control trials. Widely available to any researcher, it generates a Word file and a machine-readable version of the paper to support automated evidence synthesis in the form of a JSON-LD file.

The principles of narrative therapy imply that autobiographical diaries written by patients in treatment will not only facilitate but also elucidate progress. The relationship between the linguistic content of diaries and progress in treatment was examined in this study. Complete sets of daily diaries of ‘significant events’ written by 16 patients receiving treatment for drug, alcohol and food addictions at a residential centre, using the 12-step approach of the Anonymous fellowships, were typed up for analysis. Three forms of socio-linguistic enquiry were employed: narrative characterization; evaluative statement coding and computer analysis of word strategies. Results indicated that success in treatment as rated by counselling and psychiatric staff was associated with the following characteristics of diary narratives. They are (a) focused on individual progress, whether adopting a ‘positive interpretative’ or ‘negative reactive’ style; (b) less critical of self over time and more positive about others external to the treatment centre; (c) both positive about the treatment programme and critical of self; (d) using words indicative of ‘insight’ and ‘negativity’ as assessed by Pennebaker's LIWC programme. It is concluded that autobiographical material can usefully be employed to assess progress in treatment, and that its intrinsic value in effecting change should be further explored. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims To understand processes placing individuals at risk for stimulant (amphetamine and cocaine) use disorder. Design Longitudinal study. Setting University of California, San Diego Department of Psychiatry, CA, USA. Participants Occasional stimulant users (OSU; n = 184) underwent a baseline clinical interview and a functional magnetic resonance imaging (fMRI) session. On the basis of a follow-up clinical interview completed 3 years later, OSU ( n = 147) were then categorized as problem stimulant users (PSU: n = 36; those who developed stimulant use disorders in the interim) or desisted stimulant users (DSU: n = 74; those who stopped using). OSU who did not meet criteria for PSU or DSU ( n = 37) were included in dimensional analyses. Measurements fMRI blood oxygen level-dependent (BOLD) contrast percentage signal change from baseline collected during a Paper-Scissors-Rock task was examined during three decision-making conditions, those resulting in: (1) wins, (2) ties and (3) losses. These data were used as dependent variables in categorical analyses comparing PSU and DSU, as well as dimensional analyses including interim drug use as predictors, controlling for baseline drug use. Findings PSU exhibited lower anterior cingulate, middle insula, superior temporal, inferior parietal, precuneus and cerebellum activation than DSU across all three conditions (significant brain clusters required > 19 neighboring voxels to exceed F(1,108) = 5.58, P < 0.01 two-tailed; all Cohen's d > 0.83). Higher interim marijuana use was linked to lower pre-central and superior temporal activation during choices resulting in wins (> 19 neighboring voxels to exceed t = 2.61, P < 0.01 two-tailed; R2 change > 0.11). Conclusions Individuals who transition from stimulant use to stimulant use disorder appear to show alterations in neural processing of stimulus valuation and outcome monitoring, patterns also evident in chronic stimulant use disorder. Attenuated anterior cingulate and insular processing may constitute a high-risk neural processing profile, which could be used to calculate risk scores for individuals experimenting with stimulants. [ABSTRACT FROM AUTHOR]

Aims Smoking prevalence is higher among people enrolled in addiction treatment compared with the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally. Methods PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation and substance use disorders using and/or Boolean connectors. For 4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies, collectively comprising 37 364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated and smoking prevalence. Results The random-effect pooled estimate of smoking across people in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%). The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates were higher in programs treating opiate use compared with alcohol use [odds ratio (OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs (OR = 1.42, CI = 1.19, 1.68). Conclusions Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder. [ABSTRACT FROM AUTHOR]

Spirituality is a topic of increasing interest to clinicians and researchers interested in addiction. To clarify the way(s) in which the concept of spirituality is understood and employed in practice by clinicians and researchers who publish papers on addiction and spirituality, and to develop a definition or description of spirituality which might receive widespread assent within the field. A descriptive study of 265 published books and papers on spirituality and addiction. The study revealed a diversity and lack of clarity of understanding of the concept of spirituality. However, it was possible to identify 13 conceptual components of spirituality which recurred within the literature. Among these conceptual components of spirituality, ‘relatedness’ and ‘transcendence’ were encountered most frequently. ‘Meaning/purpose’, ‘wholeness (non-)religiousness’ and ‘consciousness’ were encountered less frequently in the papers on addiction and spirituality than in an unsystematically ascertained sample of papers concerned with spirituality in relation to other areas of psychology and medicine. However, biases in the literature are notable. For example, the great majority of publications are from North America and the field is dominated by interest in Twelve-Step and Christian spirituality. Spirituality, as understood within the addiction field, is currently poorly defined. Thirteen conceptual components of spirituality which are employed in this field are identified provisionally and a working definition is proposed as a basis for future research. [ABSTRACT FROM AUTHOR]

Aims This study investigated the value of citation counts as an index of quality in the field of addiction and examined factors that contribute to papers being cited more or less frequently. Design The number of times papers published by the journal Addiction in 1995–98 that had been cited up to May 2000 were counted using the Science and the Social Science Citation Indexes. Articles in nine of the monthly issues from 1997 were rated by two independent expert raters for quality. Factors related to citation counts were also examined including: country of origin of the paper, substance type, solicited versus unsolicited papers and methodology used. Findings A total of 417 unsolicited research reports were included in the citation analysis, of which 79 were also subjected to quality ratings. The experts showed a moderate level of agreement in their ratings (intraclass correlation = 0.39, p < 0.001). However, there was no correlation between number of citations and expert ratings of article quality (R < 0.1). Papers from developing countries received significantly fewer citations than papers from other countries but substance type (e.g. nicotine, opiate, alcohol) and methodology (e.g. survey, treatment trial) were not related to number of citations. Conclusions This study involved just one journal but raised an important issue: the number of citations received by papers on addiction appears to reflect the geographical region of study rather than what experts would consider as 'quality'. If these findings are found to generalize they call into question the use of citation‐related indices as measures of quality in this field and perhaps in others as well. To our knowledge our methodology has not been used before and could be adapted to study the value of citations more widely. [ABSTRACT FROM AUTHOR]

Opioid use disorder (OUD) and chronic pain are commonly co‐occurring disorders which can exacerbate each other. Sex/gender differences have been shown in aspects of the clinical course and biological underpinnings of both OUD and chronic pain. The purpose of this scoping review is to summarize literature which has addressed sex/gender differences in relation to the confluence of OUD and chronic pain. This review focused on peer‐reviewed journal articles with human subjects and addressing (a) opioid misuse, chronic opioid use or opioid use disorder (OUD), (b) chronic or persistent pain and (c) sex/gender differences in relation to OUD and/or chronic pain. Of the 146 papers identified by the search strategy, 30 met the criteria for inclusion. Charting focused on a priori themes of chronic pain, opioid misuse/OUD and sex/gender in sample, predictor and outcome variables, and key study findings. The majority of research identified was cross‐sectional in nature, and sex/gender differences and treatment effects were largely included as post‐hoc analyses. Together, the results of this early work align with higher prevalence for OUD in men/males and chronic pain in women/females, while adding critical information with respect to potential sex/gender differences in the development and treatment of their co‐occurrence across a range of biological and psychosocial factors. Findings underline the importance of considering sex and gender in the intersection of the development and treatment of OUD and chronic pain. [ABSTRACT FROM AUTHOR]

Background/Aims: The COVID‐19 pandemic has significantly impacted face‐to‐face research. This has propelled ideas and plans for more remote styles of research and provided new perspectives on conducting research. This paper aimed to identify challenges specific to conducting remote forms of experimental addiction research, although some of these challenges apply to all types of addiction research. Argument The impact of the COVID‐19 pandemic has led to important lessons for future addiction research. Although remote research has been conducted for decades, little experimental research has been performed remotely. To do so require a new perspective on what research questions we can ask and could also enable preferential capture of those who may be more reluctant to engage in research based in clinical settings. There may, however, be crucial factors that will compromise this process. We illustrate our argument with three real‐world, ongoing case studies centred on gambling behaviour, opioid overdose, and cannabinoid psychopharmacology. We highlight the obstacles to overcome to enable more remote methods of study. Conclusions: The future of experimental research and, more generally, addiction research, will be shaped by the pandemic and may result in advantages, such as reaching different populations and conducting addiction research in more naturalistic settings. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: Dr Leslie E. Keeley was perhaps the world's most famous addiction cure doctor at the turn of the 20th century, but mainstream medicine dismissed him as a quack because he dispensed a secret cure. This paper aims to describe Keeley's now largely forgotten story and to draw attention to the role of contextual issues in the acceptance or rejection of any theory of addiction, particularly the neuroscientific theories of the early 21st century. Methods: This study is a qualitative assessment and contextualization of historical documents. Its main sources are archival and are, for the most part, unknown to historians. The paper also offers intellectual and historical context that is drawn from leading historical and sociological analyses. Results: Keeley's addiction cure was dismissed as quackery because it failed to meet the changing standards of late 19th‐century professional medicine. This begs us to consider contextual issues in any assertion of the viability of addiction therapeutics, in the present as well the past. Conclusions: Keeley's near erasure from the historical record was a consequence of a broader, late 19th‐century medical power struggle that took precedence over the testimony of tens of thousands of satisfied patients who claimed that Keeley's cure worked. Context matters in the assessment of the viability of theories of addiction from the past, but also from the present. Historians and social scientists are well placed to make those assessments. [ABSTRACT FROM AUTHOR]

Professional counseling literature pertaining to substance use counseling for LGBTQ+ communities is scant. One such exclusion is relapse prevention for LGBTQ+ clients. To meet this gap, this paper explored LGBTQ+‐specific factors that contribute to the development and maintenance of substance use and the risk of relapse once in recovery. We extend Witkiewitz and Marlatt's Dynamic Model of Relapse by identifying and integrating examples of LGBTQ+‐specific tonic and phasic elements that influence relapse. Based on these postulations, an LGBTQ+‐affirmative model of relapse prevention is introduced. Implications for research and pedagogy are proposed. [ABSTRACT FROM AUTHOR]

Alcohol use is a major cause of disability and death globally. These negative consequences disproportionately affect people who develop alcohol addiction, a chronic relapsing condition characterized by increased motivation to use alcohol, choice of alcohol over healthy, natural rewards, and continued use despite negative consequences. Available pharmacotherapies for alcohol addiction are few, have effect sizes in need of improvement, and remain infrequently prescribed. Research aimed at developing novel therapeutics has in large part focused on attenuating pleasurable or "rewarding" properties of alcohol, but this targets processes that primarily play a role as initiation factors. As clinical alcohol addiction develops, long‐term changes in brain function result in a shift of affective homeostasis, and rewarding alcohol effects become progressively reduced. Instead, increased stress sensitivity and negative affective states emerge in the absence of alcohol and create powerful incentives for relapse and continued use through negative reinforcement, or "relief." Based on research in animal models, several neuropeptide systems have been proposed to play an important role in this shift, suggesting that these systems could be targeted by novel medications. Two mechanisms in this category, antagonism at corticotropin‐releasing factor type 1, and neurokinin 1/substance P receptors, have been subject to initial evaluation in humans. A third, kappa‐opioid receptor antagonism, has been evaluated in nicotine addiction and could soon be tested for alcohol. This paper discusses findings with these mechanisms to date, and their prospects as future targets for novel medications. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop a comprehensive annotated public-domain bibliography of the literature on spirituality and addictions to facilitate future research and scholarship. A search was conducted of all citations listed in the MEDLINE, PsychINFO and ALTA Religion databases covering a period from 1941 to 2004 using the following search terms: substance abuse, substance dependence, addiction, religion, spirituality. A group of experts in the field then classified each citation according to empirically derived categories. A total of 1353 papers met the search parameters and were classified into 10 non-exclusive categories: (1) attitudes toward spirituality and substance use, (2) commentaries, (3) spiritual practices and development in recovery, (4) spiritual and religion variables in the epidemiology of substance abuse, (5) psychoactive substances and spiritual experiences, (6) religious and spiritual interventions, (7) literature reviews, (8) measurement of spirituality and addictions, (9) 12-Step spirituality and (10) youth and development. The literature is voluminous, but has focused primarily in a few areas. Common findings included an inverse relationship between religiosity and substance use/abuse, reduced use among those practising meditation and protective effects of 12-Step group involvement during recovery. Although sound instruments are available for measuring spirituality, studies have tended to use simplistic, often single-item measures. [Geppert C, Bogenschutz MP, Miller WR. Development of a bibliography on religion, spirituality and addictions. Drug Alcohol Rev 2007;26:389 - 395] [ABSTRACT FROM AUTHOR]

Abstract: This paper stems from the concern that, in certain situations, categorization may lead to the annihilation of the subject. It attempts to answer the question whether there is a way of framing addiction without necessarily putting the addicted persons in categories that hurt them. After showing, in the first section, how stigma is part of the process of becoming (and remaining) addicted, I will turn to the phenomenological tradition in order to re‐consider the main descriptive categories that have been used so far to capture addiction as a “pathological” or “deviant” experience. The second section addresses addiction as an experience of hetero‐transformation of the psycho‐physical unity of the individual, which presupposes a genuine sense of the power of the bodily subject, while the third focuses on the modifications of temporality in addiction, especially in the horizon of trauma. The paper concludes that understanding addiction depends on framing the experience of addiction primarily as a non‐pathological form of expression and looking at it as an attempt to restore the capabilities of a vulnerable subject. [ABSTRACT FROM AUTHOR]

Iterative categorisation (IC) is a systematic and transparent technique for analysing qualitative textual data, first presented in Addiction in 2016. IC breaks the analytical process down into stages, separating basic 'description' from more advanced 'interpretation'. This paper focuses on the interpretive analytical stage that is shown to comprise three core processes: (i) conceptualising (undertaken inductively, deductively or abductively); (ii) differentiating; and (iii) externalising. Each process is described, followed by published examples to support what has been explained. As qualitative analyses tend to be recursive rather than linear, the three processes often need to be repeated to account for all the data. Following the stages of IC will ensure that qualitative research generates improved understanding of the phenomena being studied, study findings contribute to and enhance the existing literature, the audience for any qualitative output is broad and international, and any practical implications or study recommendations are relevant to other contexts and settings. [ABSTRACT FROM AUTHOR]

In this virtual special issue, a set of 26 papers previously published in the American Journal of Community Psychology (AJCP), focused on self‐help/mutual aid groups (SH/MAGs), are being curated given their significant impact in this domain. SH/MAGs constitute an important component of the community psychology's proposal to address various psychosocial and health problems. The American Journal of Community Psychology has played an important role in exploring the characteristics of self‐help/mutual aid groups in various fields. These articles cover important areas of the study of self‐help/mutual‐aid groups. More specifically, the selected articles address issues such as the definition and key characteristics of self‐help/mutual aid groups, the main fields that are applied, such as mental health, addictions, and disabilities. The article also addresses important issues such as the place of self‐help/mutual aid groups in health systems, the experiential knowledge generated within these groups and the relationship of health professionals with these groups. The aim is this VSI to contribute to contemporary discussion on self‐help/mutual aid groups, their challenges, and their perspectives and to highlight the crucial role that community psychology has in this field. Highlights: The crucial contribution of self‐help/mutual aid groups in addressing human problems.Community psychology as a discipline enables our understanding about self‐help/mutual aid groups.Participatory action research and self‐help/mutual aid groups: a close relationship.The importance of self‐help/mutual aid groups in the field of addictions.Challenges and perspectives for self‐help/mutual aid groups in the 21st century and the role of community psychology. [ABSTRACT FROM AUTHOR]

Aims: The aim of this paper is to assess recent developments in non‐medical tramadol use, tramadol use disorder, illegal procurement and deaths. Methods: This study used repeated cross‐sectional analysis of data collected nationwide from 2013 to 2018. Analysis was conducted through multisource monitoring of the French Addictovigilance Network of: (1) validated reports of high‐risk tramadol use, (2) record systems collecting information from toxicology experts investigating analgesic‐related deaths (DTA) and deaths related to substance abuse (DRAMES), and pharmacists for forged prescriptions (OSIAP), and (3) survey of drug users, with investigation of patterns of use while visiting addiction‐specialised institutions (OPPIDUM). Results: Despite a plateauing level of tramadol exposure in the French population, the proportion of tramadol reports increased 1.7‐fold (187 cases in 2018, 3.2% (95% confidence interval [CI]: 2.74–3.63%), versus 1.9% (95% CI: 1.49–2.42% in 2013). Trends were similar in OSIAP: 11.9% of forged prescriptions in 2018 (95% CI: 10.56–13.45%); 1.7‐fold increase; in OPPIDUM: 0.76% (95% CI: 0.55–1.02); 2.2‐fold increase; and DRAMES: 3.2% of drug abuse‐related deaths in 2018 (95% CI: 1.89–5.16) versus 1.7% in 2013 (95% CI: 0.65–3.84). Tramadol was the primary opioid in analgesic‐related deaths in DTA (45% in 2018). Two profiles of high‐risk tramadol users were identified: (1) patients treated for pain or with tramadol persistence when pain disappeared (mainly women; mean age 44 years), and (2) individuals with non‐medical use for psychoactive effects (mainly men; mean age 36 years). Conclusion: The triangulation of the data obtained through addictovigilance monitoring evidenced a recent increase in high‐risk tramadol use. These findings have a practical impact on the limitation of the maximal duration of tramadol prescriptions. [ABSTRACT FROM AUTHOR]

This paper documents how substance abuse treatment (SAT) providers and services respond to increases in population‐level opioid addiction. I do this by exploiting the implementation of Medicare Part D as an exogenous increase in the availability of prescription opioids. Starting in 2006, states with higher shares of the population eligible for Medicare Part D experienced increases in residential and hospital inpatient SAT facilities, beds dedicated to SAT, and SAT facilities offering medication‐assisted treatment, relative to states with lower shares. These results suggest that the supply of SAT in the United States is capable of responding significantly to changes in demand. [ABSTRACT FROM AUTHOR]

In this paper, I postulate that the processing of concepts which are deemed controllable is rooted in neurological machinery located in the posterior parietal cortex specialised for the processing of objects which are immediately actionable because they are within reach. This is demonstrated with reference to the near‐miss effect in gambling behaviour, where it is argued that the configurative proximity of the near‐miss outcome to the win outcome creates the impression that the win outcome is 'almost within reach' or controllable. The perceived realisability of the desired outcome increases subjective reward probability and the associated expected action value, which impacts decision‐making and behaviour. When extended to substance addiction, this novel hypothesis adds fresh insight into understanding the motivational effects associated with cue exposure and opportunity for drug‐taking. Moreover, by postulating that a perception of control can be generated to minimise unpleasant affective states, it can also reconcile contrasting models of decision‐making and provide a neurological explanation for the efficacy of mindfulness‐based techniques in treating addictions. With reference to the previously hypothesised link between the self and control, these ideas can provide an explanation for the increased subjective value of self‐associated concepts in the 'endowment effect', as well as a neurological correlate for the concept of the 'narrative self'. This paper therefore provides an innovative and unifying perspective for the study and treatment of behavioural and substance addictions as well as contributing to our neurological understanding of philosophical approaches to the self. [ABSTRACT FROM AUTHOR]

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Harm reduction approaches to heroin addiction treatment are safe and effective, particularly those using medication‐assisted therapy, yet they remain underutilized in the drug treatment field. This paper posits the need for a psychoanalytic formulation of harm reduction. It draws on object relations theory, to illustrate the ways in which harm reduction, as a philosophy and as a practice, maps onto the particular developmental and attachment themes of addiction. It explores heroin addiction and harm reduction at the intersection of the psyche and the social and calls upon psychoanalysis to challenge oppressive systems in the lives of heroin users. [ABSTRACT FROM AUTHOR]

Issues: Addiction treatment providers' views about the disease model of addiction (DMA), and their contemporary views about the brain disease model of addiction (BDMA), remain an understudied area. We systematically reviewed treatment providers' attitudes about the DMA/BDMA, examined factors associated with positive or negative attitudes and assessed their views on the potential clinical impact of both models.Approach: Pubmed, EMBASE, PsycINFO, CINAHL Plus and Sociological Abstracts were systematically searched. Original papers on treatment providers' views about the DMA/BDMA and its clinical impact were included. Studies focussing on tobacco, behavioural addictions or non-Western populations were excluded.Key Findings: The 34 included studies were predominantly quantitative and conducted in the USA. Among mixed findings of treatment providers' support for the DMA, strong validity studies indicated treatment providers supported the disease concept and moral, free-will or social models simultaneously. Support for the DMA was positively associated with treatment providers' age, year of qualification, certification status, religious beliefs, being in recovery and Alcoholics Anonymous attendance. Greater education was negatively associated with DMA support. Treatment providers identified potential positive (e.g. reduced stigma) and negative (e.g. increased sense of helplessness) impacts of the DMA on client behaviour.Implications/conclusion: The review suggests treatment providers may endorse disease and other models while strategically deploying the DMA for presumed therapeutic benefits. Varying DMA support across workforces indicated service users may experience multiple and potentially contradictory explanations of addiction. Future policy development will benefit by considering how treatment providers adopt disease concepts in practice. [ABSTRACT FROM AUTHOR]

Background and Aims: A range of experimental paradigms claim to measure the cognitive processes underpinning alcohol use, suggesting that heightened attentional bias, greater approach tendencies and reduced cue‐specific inhibitory control are important drivers of consumption. This paper identifies methodological shortcomings within this broad domain of research and exemplifies them in studies focused specifically on alcohol‐related attentional bias. Argument and analysis: We highlight five main methodological issues: (i) the use of inappropriately matched control stimuli; (ii) opacity of stimulus selection and validation procedures; (iii) a credence in noisy measures; (iv) a reliance on unreliable tasks; and (v) variability in design and analysis. This is evidenced through a review of alcohol‐related attentional bias (64 empirical articles, 68 tasks), which reveals the following: only 53% of tasks use appropriately matched control stimuli; as few as 38% report their stimulus selection and 19% their validation procedures; less than 28% used indices capable of disambiguating attentional processes; 22% assess reliability; and under 2% of studies were pre‐registered. Conclusions: Well‐matched and validated experimental stimuli, the development of reliable cognitive tasks and explicit assessment of their psychometric properties, and careful consideration of behavioural indices and their analysis will improve the methodological rigour of cognitive alcohol research. Open science principles can facilitate replication and reproducibility in alcohol research. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) is a major contributor to morbidity and mortality worldwide. Although there is a heritable component, the etiology of AUD is complex and can involve environmental exposures like trauma and can be associated with many different patterns of alcohol consumption. Epigenetic modifications, which can mediate the influence of genetic variants and environmental variables on gene expression, have emerged as an important area of AUD research. Over the past decade, the number of studies investigating AUD and DNA methylation, a form of epigenetic modification, has grown rapidly. Yet we are still far from understanding how DNA methylation contributes to or reflects aspects of AUD. In this paper, we reviewed studies of DNA methylation and AUD and discussed how the field has evolved. We found that global DNA and candidate DNA methylation studies did not produce replicable results. To assess whether findings of epigenome‐wide association studies (EWAS) were replicated, we aggregated significant findings across studies and identified 184 genes and 15 gene ontological pathways that were differentially methylated in at least two studies and four genes and three gene ontological pathways that were differentially methylated in three studies. These genes and pathways repeatedly found enrichment of immune processes, which is in line with recent developments suggesting that the immune system may be altered in AUD. Finally, we assess the current limitations of studies of DNA methylation and AUD and make recommendations on how to design future studies to resolve outstanding questions. [ABSTRACT FROM AUTHOR]

The neurotensin system spans across the central nervous system, to the enteric nervous system (gut), and the periphery to govern behaviors and physiological responses that tune energy balance to maintain homeostasis. Neurotensin transmission is not only modulated by metabolic signals, neurotensin transmission itself can also impact metabolic state by exerting control over consumption, physical activity, and satiety signals. Many responses to sensory experiences and sleep processes are dictated by neurotensinergic activity via mechanisms that allow the organism to balance energy seeking and utilization to thrive in its environment. Given the broad reach neurotensin signaling has across the homeostatic landscape, understanding this system as a whole and examining new ways to target this system for therapeutic efficacy across many different conditions is necessary. [ABSTRACT FROM AUTHOR]

Aims For the first time, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduces nonsubstance addictions as psychiatric diagnoses. The aims of this paper are to (i) present the main controversies surrounding the decision to include internet gaming disorder, but not internet addiction more globally, as a non-substance addiction in the research appendix of the DSM-5, and (ii) discuss the meaning behind the DSM-5 criteria for internet gaming disorder. The paper also proposes a common method for assessing internet gaming disorder. Although the need for common diagnostic criteria is not debated, the existence of multiple instruments reflect the divergence of opinions in the field regarding how best to diagnose this condition. Methods We convened international experts from European, North and South American, Asian and Australasian countries to discuss and achieve consensus about assessing internet gaming disorder as defined within DSM-5. Results We describe the intended meaning behind each of the nine DSM-5 criteria for internet gaming disorder and present a single item that best reflects each criterion, translated into the 10 main languages of countries in which research on this condition has been conducted. Conclusions Using results from this cross-cultural collaboration, we outline important research directions for understanding and assessing internet gaming disorder. As this field moves forward, it is critical that researchers and clinicians around the world begin to apply a common methodology; this report is the first to achieve an international consensus related to the assessment of internet gaming disorder. [ABSTRACT FROM AUTHOR]

This paper presents an agent‐based model to study museum attendance, with the final aim of evaluating how the rules on free admission affect charged visits. Heterogeneous agents of a population are assumed to make their choices over a bundle of goods and activities which include museum attendance along with other consumption and leisure‐time alternatives. Simulations show that larger free‐admission rules always lead to an increase in the number of total visits. A specific focus is dedicated to show which conditions let the free admittance policies induce an increment also in charged visits. Agents are characterized in terms of income and education. Addiction to cultural consumption is modelled both with and without reference to education. Specific aspects, such as crowd effects and renovation of exhibitions, are also considered, as features of the museum attendance. [ABSTRACT FROM AUTHOR]

The Yale Food Addiction Scale (YFAS) operationalizes indicators of addictive-like eating, originally based on the Diagnostic and Statistical Manual of Mental Disorders 4th edition Text Revision (DSM-IV-TR) criteria for substance-use disorders. The YFAS has multiple adaptations, including a briefer scale (mYFAS). Recently, the YFAS 2.0 was developed to reflect changes to diagnostic criteria in the DSM-5. The current study developed a briefer version of the YFAS 2.0 (mYFAS 2.0) using the participant sample from the YFAS 2.0 validation paper ( n = 536). Then, in an independent sample recruited from Mechanical Turk, 213 participants completed the mYFAS 2.0, YFAS 2.0, and measures of eating-related constructs in order to evaluate the psychometric properties of the mYFAS 2.0, relative to the YFAS 2.0. The mYFAS 2.0 and YFAS 2.0 performed similarly on indexes of reliability, convergent validity with related constructs (e.g. weight cycling), discriminant validity with distinct measures (e.g. dietary restraint) and incremental validity evidenced by associations with frequency of binge eating beyond a measure of disinhibited eating. The mYFAS 2.0 may be an appropriate choice for studies prioritizing specificity when assessing for addictive-like eating or when a briefer measurement of food addiction is needed. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

ABSTRACT The Alcohol and Drug Abuse Research Unit (ADARU) was established at the South African Medical Research Council (MRC) at the beginning of 2001, although its origins lie in the activities of the Centre for Epidemiological Research in Southern Africa and other MRC entities. Initial challenges included attracting external funding, recruiting new staff, developing the skills of junior staff, publishing in international journals and building national and international collaborative networks. ADARU currently comprises a core staff of 33 members who work on 22 projects spanning substance use epidemiology and associated consequences, intervention studies with at-risk populations and services research. A large component of this portfolio focuses on the link between alcohol and other drug use and human immunodeficiency virus (HIV) risk behaviour, with funding from the US Centers for Disease Control and Prevention. Junior staff members are encouraged to develop independent research interests and pursue PhD studies. Research outputs, such as the 20 papers that were published in 2010 and the 35 conference presentations from that year, form an important part of the unit's research translation activities. We engage actively with policy processes at the local, provincial, national and international levels, and have given particular attention to alcohol policy in recent years. The paper includes an analysis of major challenges currently facing the unit and how we are attempting to address them. It ends with some thoughts on what the unit intends doing to enhance the quality of its research, the capacity of its staff and its international standing. [ABSTRACT FROM AUTHOR]

Aim. This paper aims to describe caring needs associated with existential aspects of living with addiction. Background. Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing. Design. Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction. Method. This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background. Results. The themes presented are: meaning – meaninglessness, connectedness – loneliness, life – death, freedom – adjustment, responsibility – guilt, control – chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability. Conclusions. When caring for patients suffering from addiction nurses should address patients’ spirituality. The caring communion is vital, as it is the foundation for meeting the patients’ needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others. Relevance to clinical practice. Understanding and being able to identify patients’ caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient’s recovery. [ABSTRACT FROM AUTHOR]

The paper describes a treatment pilot for gambling and compulsive addiction within an NHS problem gambling clinic. The pilot study used a brief relational psychodynamic treatment protocol specifically designed to meet the needs of a group of patients who had not responded to CBT and who had other addictions or co‐morbidities. Seventy‐two (n = 72) patients were offered 12 sessions of therapy by four psychodynamic counsellors. Results were assessed using scores from a pre‐ and post‐treatment patient health questionnaire, the generalised anxiety disorder—7 (GAD‐7) and the Problem Gambling Severity Index (PGSI). Weekly feedback and supervision from counsellors and patients were used to assess the treatment model. The results highlighted that the psychodynamic addiction model was associated with reduced depression (Mean = 14.9; SD: 6.7), anxiety (Mean = 11.5; SD: 5.9), and gambling severity (p < .001), suggesting that a relational psychodynamic treatment is needed for complex patients with compulsive addiction, where CBT had not been successful. These results also highlight the importance of the therapeutic relationship as a critical factor in the treatment of patients with compulsive addiction problems. [ABSTRACT FROM AUTHOR]

Introduction and Aims: A previous observational study of ayahuasca-assisted therapy demonstrated statistically significant reductions in self-reported problematic cocaine use among members of an Indigenous community in Canada. This paper aims to qualitatively explore the impact of ayahuasca-assisted therapy on addiction and other substance use-related outcomes and elucidate the lived experiences of participants.Design and Methods: Qualitative interviews were conducted with 11 adult Indigenous participants of the ayahuasca-assisted 'Working with Addiction and Stress' ceremonial retreats (June-September 2011). Semi-structured interviews assessed experiences of participants following the retreats at 6-month follow up. Thematic analysis of interview transcripts was conducted.Results: Narratives revealed that the retreats helped participants identify negative thought patterns and barriers related to their addiction in ways that differed from conventional therapies. All participants reported reductions in substance use and cravings; eight participants reported complete cessation of at least one substance at follow up. Increased connectedness with self, others and nature/spirit was described as a key element associated with reduced substance use and cravings.Discussion and Conclusions: This analysis expands upon prior quantitative results highlighting the therapeutic potential of ayahuasca-assisted therapy and provides important contextual insights into why ayahuasca-assisted therapy may have been beneficial for members of an Indigenous community seeking to address their problematic use of substances. Given limited efficacy of conventional treatments for resolving addiction issues, further research should investigate the role of ayahuasca and other psychedelic-assisted therapies in enhancing connectedness and other key factors that may improve well-being and reduce harmful substance use. [ABSTRACT FROM AUTHOR]

Time series analyses are statistical methods used to assess trends in repeated measurements taken at regular intervals and their associations with other trends or events, taking account of the temporal structure of such data. Addiction research often involves assessing associations between trends in target variables (e.g. population cigarette smoking prevalence) and predictor variables (e.g. average price of a cigarette), known as a multiple time series design, or interventions or events (e.g. introduction of an indoor smoking ban), known as an interrupted time series design. There are many analytical tools available, each with its own strengths and limitations. This paper provides addiction researchers with an overview of many of the methods available (GLM, GLMM, GLS, GAMM, ARIMA, ARIMAX, VAR, SVAR, VECM) and guidance on when and how they should be used, sample size det ermination, reporting and interpretation. The aim is to provide increased clarity for researchers proposing to undertake these analyses concerning what is likely to be acceptable for publication in journals such as Addiction. Given the large number of choices that need to be made when setting up time series models, the guidance emphasizes the importance of pre‐registering hypotheses and analysis plans before the analyses are undertaken. [ABSTRACT FROM AUTHOR]

Aims The focus of this paper is on psychometric issues related to the measurement of alcohol problems. Methods Taking a broad perspective, this paper first examines several issues around the use of instruments to provide diagnostic categories in surveys, including dimensionality, severity and alcohol consumption. Secondly, a discussion of some of the political issues surrounding measurement of alcohol problems is presented, including some of the conflicts that arise when the psychometric properties of commonly used instruments are questioned. Finally, newer statistical techniques that can be applied to scale development in the alcohol field are examined, including non-linear multivariate analyses and confirmatory/hypothesis-based methods. Results and conclusions Continued scholarly discussion needs to be encouraged around these psychometric issues so that instrument development and maintenance in the addiction sciences becomes an ongoing academic pursuit as we strive to measure alcohol problems in the best way possible. [ABSTRACT FROM AUTHOR]

Provenance This paper derives from a lecture given before the Society for the Study of Addiction in November 2004, on the author's retirement from the position of Editor-in-Chief of Addiction, one of the Society's journals. Aim To identify the live processes which have influenced the journal's evolution since its foundation in 1884. Conclusions Over the 120-year period a strong, continuing historical thread has been the fluctuating success of the journal's engagement with its ‘Invisible College’, the community which it seeks to serve. It is argued that the journal's future success will depend on its capacity to explore and nurture further this two-way relationship. Addiction is a journal with an active and clearly articulated, multiple vision of it purpose, and this vision is outlined. It dares to try to influence its future with the authority so to do rooted in its ability to reflect the aspirations and concerns of its readers. It is ‘a journal of the second kind’. [ABSTRACT FROM AUTHOR]

This paper presents a review of the recent economics literature in the area of illicit drug use. Particular attention is paid to the economics of addiction and the rational addiction model, the welfare economics framework for analysing the social costs of drug use, and the attempts that have been made by economists to evaluate recent or proposed policy interventions. A dominant theme in this review is the problem of poor data availability. This is particularly true when it comes to implementing the Rational Addiction model, but it is also apparent in the literature on estimating the costs of illicit drug use to society as a whole. One of the main conclusions of this review is that until recently public policy has not been particularly influenced by research carried out by economists. It is not clear whether this is because economists have had to grapple with inadequate data, and hence their conclusions are couched in uncertainty, or whether it is because drugs researchers have assumed a very limited role for economists in their analysis. [ABSTRACT FROM AUTHOR]

Every psychotherapist working in the challenging field of the addictions is familiar with patients who yo-yo between extended periods of abstinence from substances, or other compulsive and non-substance-based addictive behaviours, and who then lapse or relapse to compressed periods of excessive substance misuse, the so-called binge episode. In this paper we reverse the lens of theoretical focus somewhat, from its more traditional position within the clinical field of addiction. We suggest that periods of abstinence from substance misuse, or other compulsive behaviours, may also represent a type of binge-like behaviour which satisfies, for a time, core needs though which may also invariably be non-sustainable if the underlying psychodynamic processes underscoring such repetitive abstinence binges are not explored and translated, in work with the patient. Linkage will also be made between poles of experience that addicted and substance abusing patients evince, which are here termed black holes (Sweet, ) and white holes (Miller, personal communication, 2015). These proposed intra-psychic structures are, it is asserted, intimately related to the ability, or not, of the individual to bear psychological pain and distress, tolerate separation from objects at both an inter-personal and intra-psychic level and to delay gratification of instinctually grounded desires and wishes. The authors reference Hopper's () previous description of both black holes and white holes in the addictions, and Glasser's () conception of the black hole in relation to perversion and his description of the 'core complex', drawing out both similarities and differences in the viewpoints presented. Key ideas in the paper are illuminated and contextualized through the presentation of a number of illustrative clinical examples. [ABSTRACT FROM AUTHOR]

Endosymbionts are widespread in arthropods, living in host cells with effects that extend from parasitic to mutualistic. Newly acquired endosymbionts tend to be parasitic, but vertical transmission favors coevolution toward mutualism, with hosts sometimes developing dependency. Endosymbionts negatively affecting host fitness may still spread by impacting host reproductive traits, referred to as reproductive "manipulation," although costs for hosts are often assumed rather than demonstrated. For cytoplasmic incompatibility (CI) that involves endosymbiont‐mediated embryo death, theory predicts directional shifts away from "manipulation" toward reduced CI strength; moreover, CI‐causing endosymbionts need to increase host fitness to initially spread. In nature, endosymbiont–host interactions and dynamics are complex, often depending on environmental conditions and evolutionary history. We advocate for capturing this complexity through appropriate datasets, rather than relying on terms like "manipulation." Such imprecision can lead to the misclassification of endosymbionts along the parasitism–mutualism continuum. [ABSTRACT FROM AUTHOR]

For products such as tobacco and junk food, where policy interventions are often designed to decrease consumption, affected consumers gain utility from improvements in lifetime health and longevity but also lose utility associated with the activity of consuming the product. In the case of anti-smoking policies, even though published estimates of gross health and longevity benefits are up to 900 times higher than the net consumer benefits suggested by a more direct willingness-to-pay estimation approach, there is little recognition in the cost-benefit and cost-effectiveness literature that gross estimates will overstate intrapersonal welfare improvements when utility losses are not netted out. This paper presents a general framework for analyzing policies that are designed to reduce inefficiently high consumption and provides a rule of thumb for the relationship between net and gross consumer welfare effects: where there exists a plausible estimate of the tax that would allow consumers to fully internalize health costs, the ratio of the tax to the per-unit long-term cost can provide an upper bound on the ratio of net to gross benefits. Published 2014. This article is a U.S. Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

It is now well-established that Australia has a significant issue with methamphetamine. Recent dramatic changes in manufacturing have led to significant shifts in both the patterns of use and the relative purity of this illicit drug, with the crystalline form of methamphetamine commonly referred to as 'ice'. Excessive use not only impacts on those taking the drug, but also takes a heavy toll on their families. With few effective treatment options currently available, there is a strong focus on developing replacement pharmacotherapies and examining the efficacy of outpatient counselling and residential treatment options. Recent research in addiction care supports the positive impact that families of users can have on both treatment and recovery for their loved ones. Despite this recognition, there is little current research looking at the experiences of families of users of the uniquely problematic drug methamphetamine. This paper outlines the historical narrative that has led to the current worldwide phenomenon of ice use and explores contemporary directions of research into its impact and potential treatments. In doing so, it outlines the relatively unexplored impact of ice on families and highlights a current need for nursing research into their experiences living with loved ones using the drug. [ABSTRACT FROM AUTHOR]

When doing research among vulnerable populations, researchers are obliged to protect their subjects from harm. We will argue that traditional ethical guidelines are not sufficient to do this, since they mainly focus on direct harms that can occur: for example, issues around informed consent, fair recruitment and risk/harm analysis. However, research also entails indirect harms that remain largely unnoticed by research ethical committees and the research community. Indirect harms do not occur during data collection, but in the analysis of the data, and how the data is presented to the scientific and wider societal community. Highly stigmatized research subjects, like substance‐dependent parents, are especially at risk of encountering indirect harm, because the prejudice against them is so persistent. In this paper we discuss two forms of indirect harm. First, researchers have to be aware how their results will be preceived by society. Even when subjects are presented in an objective way, further, out of porportion stigmatization can occur. Researchers sometimes try to counteract this by whitewashing their results, at the risk of downplaying their respondents' problems. The second risk researchers face is that their own normative judgements influence how they question such parents, report results and interpret statements. Researchers' own normative judgements may influence the way they present their subjects. This article reviews a broad range of research that exhibits such indirect harms, discussing how and why indirect harms occur and formulating corresponding recommendations on how to prevent them. [ABSTRACT FROM AUTHOR]

The publication offers a checklist for its readers for writing research reports in the field of Addiction in order to improve the quality of initial submissions from contributors. Topics include the use of a title that precisely describes the focus of the research and does not use redundant phrases, a clear statement of the aims and research questions should be included in the introduction, and the proper format for citations and references.

The concept of recovery has been an influence on addicted individuals for many decades. But only in the past 15 years has the concept had a purchase in the world of public policy. In the USA, federal and state officials have promulgated policies intended to foster 'recovery-oriented systems of care' and have ratified recovery-supportive laws and regulations. Though of more recent vintage and therefore less developed, recovery policy initiatives are also being implemented in the UK. The present paper describes recovery-oriented policy in both countries and highlights key evaluations of the recovery-oriented interventions. [Humphreys K, Lembke A. Recovery-oriented policy and care systems in the UK and USA. Drug Alcohol Rev 2014;33:13-18] [ABSTRACT FROM AUTHOR]

We provide an introduction into a highly important research area for the improvement of preventive and therapeutic measures in the field of substance use disorders: a better understanding of core mediators and moderators of change processes, especially during critical phases like onset, progression, cessation and relapse. Based on a brief description of 12 papers on related projects we detail relevant research issues like the role of impaired cognitive control functions or the narrow “window of opportunity” for early interventions during adolescence. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this article the authors provide their insights on the paper of D. Sellman on the facts concerning addiction. They explore the two points raised by Sellman at his paper such as the explanatory model rivalries and the critical role of therapists. Furthermore, they state the absence of a well-documented process of recovery at Sellman's paper.

Objectives: Derived from classical conditioning theory and rooted in motivational mechanisms, cue reactivity paradigms (CRPs) are used in addictions research to measure participants' propensities for substance‐relevant responses (e.g., craving) during exposure to substance‐relevant cues (e.g., drug paraphernalia). CRPs are also useful in PTSD‐addiction comorbidity research, allowing the study of affective and substance‐relevant responses to trauma cues. However, studies using traditional CRPs are time‐consuming with high attrition rates due to repeat testing. Thus, we sought to test whether a single session semi‐structured trauma interview could serve as a CRP in terms of eliciting theorized cue exposure effects on craving and affect measures. Method: Fifty regular cannabis users with trauma histories provided detailed descriptions of their most traumatic lifetime experience, and a neutral experience, according to an established interview protocol. Linear mixed models examined the effect of cue type (trauma vs. neutral) on affective and craving responses. Results: As hypothesized, the trauma interview elicited significantly greater cannabis craving (and alcohol craving among the drinkers), and, greater negative affect among those with more severe PTSD symptoms, compared to the neutral interview. Conclusion: Results suggest an established semi‐structured interview may function effectively as a CRP for use in trauma and addictions research. [ABSTRACT FROM AUTHOR]

Introduction and Aims This paper explores excessive appetites, addiction and rehabilitation as described in the autobiographies, memoirs and diaries of rock artists. Design and Methods The data collection focused on autobiographical rock books written in English by internationally recognised rock artists before 2011. In total, 96 autobiographical books were published between 1974 and 2010. The mean age of the authors was 50 years and 17% of the books were by female authors. Data were encoded for: (i) addiction; (ii) the object of addiction; (iii) personal addiction; (iv) rehabilitation; (v) personal rehabilitation; and (vi) the type of recovery from the addiction. Results Of the books, 82% described addiction, 62% personal addiction, 57% rehabilitation and 40% personal participation in rehabilitation. The most common addictions were alcoholism, opiate addiction and cocaine addiction. Addicted rock stars described addictions differently from non-addicts. Of addicted rock artists, 51% recovered with the help of rehabilitation, 42% self-recovered and 7% continued the excess. There has been an increase in the prevalence of addiction in autobiographical rock books over time. In addition, it was found that gender affected the type of recovery. Discussion and Conclusions Autobiographical books by rock artists have been published in increasing numbers in the last two decades. The artists in question have described their personal experiences of addiction and rehabilitation and discussed the problems related to alcohol, drugs and excessive behaviour. The books do not glamorise addiction or excessive lifestyles. Rather, they indicate that attitudes towards drugs and alcohol are changing in the rock business. [ABSTRACT FROM AUTHOR]

If you were asked: ‘What are the most important things we know about addiction?’ what would you say? This paper brings together a body of knowledge across multiple domains and arranged as a list of 10 things known about addiction, as a response to such a question. The 10 things are: (1) addiction is fundamentally about compulsive behaviour; (2) compulsive drug seeking is initiated outside of consciousness; (3) addiction is about 50% heritable and complexity abounds; (4) most people with addictions who present for help have other psychiatric problems as well; (5) addiction is a chronic relapsing disorder in the majority of people who present for help; (6) different psychotherapies appear to produce similar treatment outcomes; (7) ‘come back when you're motivated’ is no longer an acceptable therapeutic response; (8) the more individualized and broad-based the treatment a person with addiction receives, the better the outcome; (9) epiphanies are hard to manufacture; and (10) change takes time. The paper concludes with a call for unity between warring factions in the field to use the knowledge already known more effectively for the betterment of tangata whaiora (patients) suffering from addictive disorders. [ABSTRACT FROM AUTHOR]

Becker and Murphy's theory is a well-known contribution to economists on the discussion of addiction. This class of rational choice theory is still the most important reference for economists studying addiction. In this paper, the model and the economist's rational choice theory were challenged by modern neurobiological theory. The paper suggested reconstruction work of the standard inter-temporal choice model along four lines to reduce the gap between the theory and the clinical definition of addiction: (1) a discount rate that varies; (2) revision of the concept consumption capital; (3) the possibility for genetic predisposition to addiction (even if the research up to now has not identified such a gene); and (4) social mechanisms that influence our behaviour. [ABSTRACT FROM AUTHOR]

Addictions are, to a considerable extent, born of disadvantage and deprivation. That is not the whole story; there are other factors in place, some of which are in individuals as individuals. In terms of the social determinants of ill-health, addiction and poverty are highly correlated. There is also a literature that investigates whether additionally inequality is bad for our health. The hypothesis put forward in this paper is that in a caring society being poor is not good for health but it is not so bad as being poor in an uncaring society. Societies that claim to be based on social solidarity, as do the Scandinavians, tend to be highly taxed with consequent large public sectors. In Australia, taxation is very low relative to most OECD countries. The idea of tax for redistributive purposes is not seen as politically palatable to the Australian electorate. There is a need to rethink the public health response to addictions. Epidemiology and biostatistics dominate too much. Public health needs to accept the depth and width of the challenge that a concern for and acceptance of the role of social capital offer. The paper discusses this in the context of community autonomy and public compassion and the need for societies to ‘own’ addictions and addiction policy in public discourse. More compassion will not ‘solve’ problems of inequalities and addictions. The point is rather that it is a good place to start. [Mooney GH. Addictions and social compassion. Drug Alcohol Rev 2005;24:137 – 141] [ABSTRACT FROM AUTHOR]

An important factor that has thus far limited the effectiveness of pharmacotherapies for patients with alcohol and opioid dependence is poor adherence to medication regimens. This paper presents a review of issues related to medication adherence in patients with these substance use disorders.A literature review was conducted of English language publications relating to medication adherence among patients with alcohol or opioid dependence.The paper places the topic in the context of adherence difficulties among patients with a variety of chronic medical and psychiatric illnesses. Difficulties measuring adherence are discussed, and strategies to improve medication adherence are reviewed. These include specific interventions that prescribing clinicians can implement in their individual meetings with patients; the use of external reinforcers, such as positive and negative contingencies, and involvement of family members or significant others; and specific prescribing and dosing practices that may improve adherence.As the use of pharmacotherapy for substance-dependent patients increases, rigorous and innovative approaches to encourage medication adherence should be sought. [ABSTRACT FROM AUTHOR]