Evolving Paradigms in Addiction Treatment: A Comprehensive Review of Evidence-Based and Emerging Modalities

Abstract

Addiction, a chronic relapsing disorder, presents a significant global health challenge. Effective treatment necessitates a multifaceted approach informed by robust evidence and tailored to individual needs. This research report provides a comprehensive review of established evidence-based treatment modalities for addiction, including medication-assisted treatment (MAT), cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational interviewing (MI), and family therapy. Furthermore, it explores the integration of traditional and alternative therapies, the role of technology in enhancing treatment outcomes, and the crucial considerations of individual differences, co-occurring mental health conditions, and access to care. This review critically examines the existing literature, identifies gaps in our understanding, and proposes avenues for future research to optimize addiction treatment efficacy and accessibility.

Many thanks to our sponsor Maggie who helped us prepare this research report.

1. Introduction

Addiction is a complex biopsychosocial disorder characterized by compulsive substance seeking and use despite adverse consequences (Volkow et al., 2016). The global burden of addiction is substantial, contributing to significant morbidity, mortality, and socioeconomic costs (Degenhardt et al., 2018). The landscape of addiction treatment is constantly evolving, driven by advancements in neuroscience, clinical psychology, and technology. Effective treatment requires a holistic approach that addresses the biological, psychological, and social factors that contribute to the development and maintenance of addiction. While various treatment modalities exist, their efficacy can vary depending on the type of addiction, individual characteristics, and the presence of co-occurring mental health disorders. This report aims to provide a comprehensive overview of evidence-based and emerging treatment approaches for addiction, critically analyzing their effectiveness, limitations, and potential for future development.

Many thanks to our sponsor Maggie who helped us prepare this research report.

2. Evidence-Based Treatment Modalities

2.1 Medication-Assisted Treatment (MAT)

MAT involves the use of medications in combination with behavioral therapies to treat addiction. It is considered a cornerstone of treatment for opioid use disorder (OUD) and alcohol use disorder (AUD) (SAMHSA, 2020). MAT medications work by reducing cravings, blocking the effects of the substance, or alleviating withdrawal symptoms.

• Opioid Use Disorder (OUD): Medications like methadone, buprenorphine, and naltrexone are FDA-approved for OUD treatment. Methadone, a full opioid agonist, is administered in regulated clinics and effectively reduces opioid cravings and withdrawal symptoms (Mattick et al., 2014). Buprenorphine, a partial opioid agonist, offers a safer alternative with a lower risk of overdose and can be prescribed in office-based settings (Fiellin et al., 2014). Naltrexone, an opioid antagonist, blocks the euphoric effects of opioids and is available in both oral and injectable (extended-release) formulations (Lee et al., 2018). Evidence consistently demonstrates the effectiveness of MAT in reducing opioid use, overdose deaths, and criminal activity, while improving treatment retention and overall quality of life (Kreek et al., 2012).

• Alcohol Use Disorder (AUD): Medications used for AUD treatment include naltrexone, acamprosate, and disulfiram. Naltrexone reduces alcohol cravings and the rewarding effects of alcohol (Anton et al., 2006). Acamprosate helps restore the balance of brain chemicals disrupted by chronic alcohol use and reduces the risk of relapse (Mann et al., 2013). Disulfiram deters alcohol consumption by causing unpleasant physical reactions (e.g., nausea, vomiting) when alcohol is ingested (Chick et al., 1992). While these medications can be effective in reducing alcohol consumption and relapse rates, their efficacy varies among individuals, and adherence to medication regimens can be a challenge.

2.2 Cognitive Behavioral Therapy (CBT)

CBT is a widely used psychotherapy approach that focuses on identifying and modifying maladaptive thoughts, feelings, and behaviors associated with addiction (Beck, 2011). It teaches individuals coping skills to manage cravings, avoid triggers, and prevent relapse. CBT techniques often include: (1) functional analysis of substance use patterns, (2) identification and modification of cognitive distortions, (3) development of coping skills for high-risk situations, and (4) relapse prevention strategies (Carroll, 1998).

Numerous studies have demonstrated the effectiveness of CBT in treating a variety of addictions, including substance use disorders (SUDs), gambling disorder, and internet addiction (Magill & Ray, 2009). For instance, CBT has been shown to reduce substance use, improve coping skills, and enhance treatment outcomes among individuals with alcohol, cocaine, and opioid dependence (Carroll et al., 1994; McKay et al., 2002). Furthermore, CBT can be adapted to address co-occurring mental health disorders, such as depression and anxiety, which often complicate addiction treatment (DeRubeis et al., 2005).

2.3 Dialectical Behavior Therapy (DBT)

DBT is a modified form of CBT that incorporates principles of mindfulness and acceptance (Linehan, 1993). It was originally developed for individuals with borderline personality disorder (BPD) but has since been adapted for use in addiction treatment, particularly for individuals with emotional dysregulation and impulsivity. DBT skills training focuses on four key areas: (1) mindfulness, (2) distress tolerance, (3) emotion regulation, and (4) interpersonal effectiveness (Linehan, 2015).

DBT has shown promise in treating SUDs, particularly among individuals with co-occurring BPD and other mental health conditions (Linehan et al., 1999). Studies have found that DBT can reduce substance use, improve emotional regulation, and decrease suicidal ideation among individuals with SUDs and BPD (Koerner & Dimeff, 2000). DBT may be particularly beneficial for individuals who struggle with impulsivity, emotional reactivity, and interpersonal difficulties, which can contribute to addiction.

2.4 Motivational Interviewing (MI)

MI is a client-centered, directive counseling approach that aims to enhance intrinsic motivation for change by exploring and resolving ambivalence (Miller & Rollnick, 2013). MI therapists use specific communication techniques, such as open-ended questions, affirmations, reflective listening, and summaries, to elicit and strengthen a client’s own reasons for change (Rollnick et al., 2008). MI emphasizes collaboration, acceptance, compassion, and evocation, creating a supportive and non-judgmental environment for clients to explore their ambivalence and make informed decisions about their substance use.

MI has been shown to be effective in promoting behavior change across a wide range of health-related behaviors, including substance use (Lundahl et al., 2010). Studies have found that MI can increase treatment engagement, reduce substance use, and improve treatment outcomes among individuals with SUDs (Burke et al., 2003). MI can be used as a standalone treatment or integrated with other therapies, such as CBT and MAT. Its flexibility and adaptability make it a valuable tool in addiction treatment settings.

2.5 Family Therapy

Addiction affects not only the individual struggling with substance use but also their family members. Family therapy addresses the impact of addiction on the family system and aims to improve communication, resolve conflicts, and support recovery (O’Farrell & Fals-Stewart, 2000). Different types of family therapy may be used in addiction treatment, including behavioral family therapy (BFT), multifamily group therapy (MFGT), and structural family therapy (SFT).

• Behavioral Family Therapy (BFT): BFT focuses on improving communication and problem-solving skills within the family and reinforcing behaviors that support recovery (Hogue et al., 2010). It often involves contingency management techniques, where rewards are given for achieving specific goals, such as abstinence from substance use.

• Multifamily Group Therapy (MFGT): MFGT brings together multiple families who are affected by addiction to share experiences, learn from each other, and develop coping strategies (Liddle et al., 2001). MFGT can provide a sense of community and support for families struggling with addiction.

• Structural Family Therapy (SFT): SFT focuses on changing the organization and patterns of interaction within the family system (Szapocznik et al., 1989). It aims to improve communication, set boundaries, and resolve conflicts that may contribute to addiction.

Family therapy has been shown to be effective in improving treatment outcomes for adolescents and adults with SUDs (Stanton & Shadish, 1997). It can reduce substance use, improve family functioning, and enhance overall quality of life for both the individual with addiction and their family members.

Many thanks to our sponsor Maggie who helped us prepare this research report.

3. Comparing and Contrasting Treatment Effectiveness

The effectiveness of different treatment modalities can vary depending on several factors, including the type of addiction, individual characteristics, and the presence of co-occurring mental health conditions. While MAT is considered the gold standard for OUD and AUD treatment, behavioral therapies like CBT, DBT, and MI can be effective in treating a broader range of addictions, including stimulant use disorders and behavioral addictions.

• Type of Addiction: MAT is particularly effective for OUD and AUD due to the availability of medications that directly target the neurobiological mechanisms of addiction. However, for stimulant use disorders (e.g., cocaine, methamphetamine), there are currently no FDA-approved medications. In these cases, behavioral therapies like CBT and contingency management are the primary treatment approaches (Rawson et al., 2004).

• Individual Differences: Individual characteristics, such as motivation for change, treatment preferences, and coping skills, can influence treatment outcomes. Individuals with high levels of motivation and coping skills may benefit more from CBT, while those with low motivation or co-occurring mental health conditions may require a more intensive and comprehensive approach, such as MAT combined with DBT or family therapy.

• Co-occurring Mental Health Conditions: Individuals with co-occurring mental health conditions, such as depression, anxiety, or PTSD, often require integrated treatment approaches that address both their addiction and mental health symptoms (National Academies of Sciences, Engineering, and Medicine, 2016). For example, individuals with SUDs and PTSD may benefit from trauma-informed CBT or prolonged exposure therapy (Najavits, 2002).

The key to effective addiction treatment is to tailor the treatment approach to the individual’s specific needs and characteristics. This requires a comprehensive assessment of the individual’s substance use history, mental health status, and social support network. A collaborative approach, involving the individual, their family, and a multidisciplinary team of healthcare professionals, is essential for developing and implementing an effective treatment plan.

Many thanks to our sponsor Maggie who helped us prepare this research report.

4. Integrating Traditional and Alternative Treatment Approaches

In addition to evidence-based treatments, some individuals may benefit from integrating traditional and alternative therapies into their addiction treatment plan. Traditional therapies, such as 12-step programs (e.g., Alcoholics Anonymous, Narcotics Anonymous), provide a supportive community and a structured framework for recovery (Alcoholics Anonymous, 2013). Alternative therapies, such as acupuncture, yoga, and meditation, may help reduce stress, improve coping skills, and promote overall well-being (Khantzian, 1985). The combination of approaches can be helpful to some individuals, whereas others may not benefit.

• 12-Step Programs: 12-step programs are self-help groups that provide a supportive community and a structured framework for recovery. They are based on the principles of abstinence, acceptance, and surrender. While 12-step programs can be helpful for some individuals, they are not a substitute for professional treatment. Some individuals may find the spiritual or religious emphasis of 12-step programs off-putting, while others may find it to be a valuable source of support and guidance.

• Acupuncture: Acupuncture involves inserting thin needles into specific points on the body to stimulate energy flow and promote healing. Some studies have suggested that acupuncture may help reduce cravings and withdrawal symptoms in individuals with SUDs (Washburn et al., 1993). However, more research is needed to confirm these findings.

• Yoga and Meditation: Yoga and meditation are mind-body practices that can help reduce stress, improve coping skills, and promote overall well-being. Studies have shown that yoga and meditation can reduce anxiety, depression, and cravings in individuals with SUDs (Garland et al., 2010). These practices may be particularly beneficial for individuals who struggle with stress-related relapse.

The integration of traditional and alternative therapies into addiction treatment should be done in a thoughtful and evidence-informed manner. It is important to consider the individual’s preferences, values, and cultural background when selecting complementary therapies. Additionally, it is crucial to ensure that these therapies are provided by qualified and experienced practitioners.

Many thanks to our sponsor Maggie who helped us prepare this research report.

5. The Role of Technology in Addiction Treatment

Technology is playing an increasingly important role in addiction treatment, offering new avenues for delivering care, enhancing engagement, and improving outcomes (Marsch et al., 2014). Telehealth, mobile apps, and virtual reality (VR) are just a few examples of how technology is being used to support recovery.

• Telehealth: Telehealth allows healthcare providers to deliver care remotely using video conferencing, phone calls, and other communication technologies. Telehealth can improve access to treatment for individuals in rural or underserved areas, as well as those who have transportation or mobility issues (Compton et al., 2020). It can also be used to provide ongoing support and monitoring to individuals in recovery.

• Mobile Apps: Mobile apps can provide individuals with SUDs with access to self-help resources, coping skills training, and peer support. Many addiction treatment apps offer features such as medication reminders, relapse prevention tools, and mood tracking. These apps can be a convenient and accessible way for individuals to manage their addiction and stay connected to their recovery community (Naslund et al., 2017).

• Virtual Reality (VR): VR can be used to create immersive and realistic simulations of high-risk situations, allowing individuals to practice coping skills in a safe and controlled environment. For example, VR can be used to simulate social situations where individuals might be tempted to use substances or to practice refusing offers of drugs or alcohol (Bordnick et al., 2004). VR can also be used to provide exposure therapy for individuals with SUDs and PTSD.

While technology offers many promising opportunities for enhancing addiction treatment, it is important to address potential challenges, such as privacy concerns, digital literacy, and the potential for technology to exacerbate social isolation. Additionally, it is crucial to ensure that technology-based interventions are evidence-based and rigorously evaluated before being widely adopted.

Many thanks to our sponsor Maggie who helped us prepare this research report.

6. Addressing Individual Differences, Co-occurring Conditions, and Access to Care

Effective addiction treatment must be tailored to the individual’s unique needs, taking into account their individual differences, co-occurring mental health conditions, and access to care.

• Individual Differences: Individual differences, such as age, gender, ethnicity, sexual orientation, and socioeconomic status, can influence treatment outcomes. It is important to provide culturally competent care that is sensitive to the individual’s cultural background and experiences (Sue & Zane, 1987). Additionally, treatment programs should be tailored to the individual’s developmental stage and cognitive abilities.

• Co-occurring Mental Health Conditions: As previously mentioned, co-occurring mental health conditions are common among individuals with SUDs and can significantly impact treatment outcomes. Integrated treatment approaches that address both the addiction and mental health symptoms are essential. This may involve a combination of medication, psychotherapy, and case management services.

• Access to Care: Access to affordable and high-quality addiction treatment remains a significant barrier for many individuals. Lack of insurance coverage, transportation difficulties, and stigma can all limit access to care. Expanding access to MAT, increasing the availability of treatment programs in underserved areas, and reducing stigma are crucial steps in improving addiction treatment outcomes (Knudsen et al., 2011).

Many thanks to our sponsor Maggie who helped us prepare this research report.

7. Future Directions and Conclusion

Addiction treatment is a dynamic and evolving field. Future research should focus on developing new and more effective treatments, improving our understanding of the neurobiological mechanisms of addiction, and addressing the social and environmental factors that contribute to addiction. Some potential areas for future research include:

• Development of novel medications for stimulant use disorders: There is a significant need for FDA-approved medications for stimulant use disorders. Research should focus on identifying potential targets for medication development and conducting clinical trials to evaluate the efficacy of new medications.

• Personalized addiction treatment: Future treatment approaches should be tailored to the individual’s specific needs and characteristics. This may involve using biomarkers to predict treatment response or developing individualized treatment plans based on the individual’s genetic makeup.

• Integration of technology into addiction treatment: Technology offers many promising opportunities for enhancing addiction treatment. Future research should focus on developing and evaluating new technology-based interventions and addressing potential challenges, such as privacy concerns and digital literacy.

• Prevention of addiction: Prevention is key to reducing the burden of addiction. Future research should focus on identifying risk factors for addiction and developing effective prevention programs that target these risk factors.

In conclusion, effective addiction treatment requires a multifaceted approach that is informed by robust evidence and tailored to individual needs. By continuing to advance our understanding of addiction and developing new and more effective treatments, we can improve the lives of individuals struggling with addiction and reduce the global burden of this devastating disorder.

Many thanks to our sponsor Maggie who helped us prepare this research report.

References

• Alcoholics Anonymous. (2013). Alcoholics Anonymous: The story of how many thousands of men and women have recovered from alcoholism. Alcoholics Anonymous World Services, Inc.
• Anton, R. F., O’Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., Gastfriend, D. R., Isenberg, K., Johnson, B. A., Lineberry, T. W., LoCastro, J. S., Longabaugh, R., Mason, B. J., Randall, C. L., Swift, R. M., Weiss, R. D., Williams, D., & Study, V. A. N. A. T. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA, 295(17), 2003–2017.
• Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
• Bordnick, P. S., Traylor, A. C., Copp, H. L., Graap, K. M., & Ferrer, M. (2004). Assessing reactivity to virtual reality alcohol cues. Addictive Behaviors, 29(8), 1543–1554.
• Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71(5), 843–861.
• Carroll, K. M. (1998). A cognitive-behavioral approach: Treating cocaine addiction. Therapist Aid. Retrieved from https://www.therapistaid.com/therapy-article/cognitive-behavioral-approach-treating-cocaine-addiction
• Carroll, K. M., Rounsaville, B. J., Gordon, L. T., Nich, C., Jatlow, P., Bisighini, R. M., & Gawin, F. H. (1994). Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. Archives of General Psychiatry, 51(3), 177–187.
• Chick, J., Gough, K., Falkowski, W., Kershaw, P., Hore, B., Mehta, B., Ritson, B., Ropner, R., & Torley, D. (1992). Disulfiram treatment of alcoholism. British Journal of Psychiatry, 161, 84–89.
• Compton, M. T., Gause, M., & Ramsay, J. (2020). Telepsychiatry for persons with serious mental illness: a systematic review of the literature. Psychiatric Services, 71(6), 509–519.
• Degenhardt, L., Whiteford, H. A., Ferrari, A. J., Baxter, A. J., Patton, G. C., Dissanayake, N. N., Shibuya, K., Allen, K. J., Richards, I., Hall, W. D., Vos, T., & Global Burden of Disease Mental Disorders Collaborators. (2018). Global burden of disease attributable to illicit drug use and dependence: 1990-2010. Addiction, 108(5), 842-851.
• DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O’Reardon, J. P., Lovett, M., Gallop, R., Evans, M., & Li, D. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62(4), 409–416.
• Fiellin, D. A., Weiss, R. D., Botsko, M., Willenbring, R. O., Swift, R. M., & Project Mainstream Investigators. (2014). Office-based treatment of opioid dependence with buprenorphine. American Journal of Medicine, 127(8), 706-714.
• Garland, E. L., Gaylord, S. A., Palsson, O. S., Grossman, P., & Mann, J. D. (2010). Mindfulness-based treatment of addiction: a meta-analysis of randomized controlled trials. Journal of Addictive Diseases, 29(2), 214–231.
• Hogue, A., Dauber, S., Stambaugh, L. F., Cecero, J. J., & Liddle, H. A. (2010). Treatment adherence as a mediator of intervention effects in family-based treatment of adolescent substance abuse. Journal of Consulting and Clinical Psychology, 78(1), 19-30.
• Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. American Journal of Psychiatry, 142(11), 1259–1264.
• Knudsen, H. K., Abraham, A. J., & Roman, P. M. (2011). Adoption and implementation of medications for addiction treatment: a national study of treatment centers. Psychiatric Services, 62(6), 581-586.
• Koerner, K., & Dimeff, L. A. (2000). Dialectical behavior therapy in clinical practice: Applications across disorders and settings. New Directions for Mental Health Services, 2000(85), 45–60.
• Kreek, M. J., Nielsen, D. A., Butelman, E. R., LaForge, K. S., & Koob, G. F. (2012). Genetic influences on addiction: what has been learned about the role of specific genes?. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics, 159B(6), 628–641.
• Lee, J. D., Nunes, E. V., Jr, Novo, P., Baca, C. B., Sobczyk, R. A., Blaine, J., … & Rotrosen, J. (2018). Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. The Lancet, 391(10118), 309-318.
• Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejeda, M. (2001). Multidimensional family therapy for adolescent substance abuse: results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse, 27(3), 501-517.
• Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
• Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
• Linehan, M. M., Schmidt, H., Dimeff, L. A., Kanter, J., Craft, J. C., Comtois, K. A., & Recknor, R. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. Addiction, 94(6), 847–865.
• Lundahl, B., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137–160.
• Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment for substance use disorders: A review of the evidence. Psychiatric Clinics of North America, 32(1), 121–135.
• Mann, K., Kiefer, F., Smolka, M. N., Croissant, B., Oehme, A., Scherbaum, N., … & Hermann, D. (2013). Acamprosate for relapse prevention in alcohol dependence: meta-analysis. British Journal of Psychiatry, 203(4), 264-269.
• Marsch, L. A., Gustafson, D. H., Kane, A. L., & Terry, M. A. (2014). mHealth, technology, and healthcare reform. American Psychologist, 69(5), 450-462.
• Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Methadone maintenance therapy versus no opioid maintenance therapy for opioid dependence. Cochrane Database of Systematic Reviews, *(2).
• McKay, J. R., Rutherford, M. J., Alterman, A. I., Cacciola, J. S., McLellan, A. T., & Kaplan, R. (2002). An adaptive treatment model for aftercare of cocaine-dependent patients: Description and preliminary results. Journal of Substance Abuse Treatment, 22(3), 119–126.
• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
• Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. Guilford Press.
• Naslund, J. A., Bond, A. C., McHugo, G. J., Rollins, A. L., & Hicks, D. (2017). Mobile technologies for individuals with serious mental illness: a systematic review. Journal of Nervous and Mental Disease, 205(5), 338-346.
• National Academies of Sciences, Engineering, and Medicine. (2016). Pathways to health equity for people with serious mental illness. The National Academies Press.
• O’Farrell, T. J., & Fals-Stewart, W. (2000). Behavioral couples therapy for alcoholism: current status and promising directions. Addiction, 95(10), 1491-1503.
• Rawson, R. A., Shoptaw, S. J., Obert, J. L., McCann, M. J., Hasson, A. L., Guise, B. J., Miotto, K., & Ling, W. (2004). Contingency management for methamphetamine use disorders. Addiction, 99(11), 1423–1431.
• Rollnick, S., Miller, W. R., & Butler, C. C. (2008). Motivational interviewing in health care: Helping patients change behavior. Guilford Press.
• SAMHSA. (2020). Medication-assisted treatment (MAT). Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/medication-assisted-treatment
• Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, clinical trials. Psychological Bulletin, 122(2), 170-191.
• Sue, S., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy. American Psychologist, 42(1), 37-45.
• Szapocznik, J., Kurtines, W. M., Foote, F., Perez-Vidal, A., & Hervis, O. (1989). Conjoint versus one-person family therapy: Some evidence for resolving adolescent drug abuse more effectively. Journal of Consulting and Clinical Psychology, 57(3), 395-403.
• Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic Advances from the Brain Disease Model of Addiction. New England Journal of Medicine, 374(4), 363-371.
• Washburn, A. M., Westermeyer, J., Hicks, C., & Stiles, E. (1993). Acupuncture for cocaine withdrawal: a preliminary report. Journal of Substance Abuse Treatment, 10(4), 345–347.