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Exposure Therapy when Patients Present with Comorbid Substance Use Disorders

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Clinical Guide to Exposure Therapy

Abstract

Substance use is a common comorbidity for people experiencing anxiety-related disorders. Although exposure therapy has proven effective in both of these conditions, clinicians often report hesitations about applying these interventions when patients have substance-related comorbidities. There is now increasing evidence for treatment programs integrating substance use treatment and exposure therapy in a variety of areas, demonstrating the efficacy of applying these interventions in this population. The following chapter will describe the background knowledge and adjustments to treatment required to implement exposure interventions in this population.

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Notes

  1. 1.

    Clinical case details have been de-identified and amalgamated to ensure patients’ anonymity.

  2. 2.

    Clinical case details have been de-identified and amalgamated to ensure patients’ anonymity.

References

  • Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd ed.). The Guildford Press.

    Google Scholar 

  • Adams, J., & White, M. (2007). Are the stages of change socioeconomically distributed? A scoping review. American Journal of Health Promotion, 21(4), 237–247. https://doi.org/10.4278/0890-1171-21.4.237

    Article  PubMed  Google Scholar 

  • Australian Institute for Health and Welfare. (2016). Australian burden of disease study: Impact and causes of illness and death in aboriginal and Torres Strait islander people 2011. AIHW.

    Google Scholar 

  • Back, S. E., Killeen, T., Badour, C. L., Flanagan, J. C., Allan, N. P., Ana, E. S., … Brady, K. T. (2019). Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans. Addictive Behaviors, 90, 369–377. https://doi.org/10.1016/j.addbeh.2018.11.032

    Article  PubMed  Google Scholar 

  • Back, S. E., Waldrop, A. E., & Brady, K. T. (2009). Treatment challenges associated with comorbid substance use and posttraumatic stress disorder: Clinicians’ perspectives. American Journal on Addictions, 18(1), 15–20.

    Article  Google Scholar 

  • Bahji, A., Stephenson, C., Tyo, R., Hawken, E. R., & Seitz, D. P. (2020). Prevalence of cannabis withdrawal symptoms among people with regular or dependent use of cannabinoids: A systematic review and meta-analysis. JAMA Network Open, 3(4), e202370. https://doi.org/10.1001/jamanetworkopen.2020.2370

    Article  PubMed  PubMed Central  Google Scholar 

  • Barrett, E. L., Deady, M., Kihas, I., & Mills, K. L. (2019). Assessment of substance use disorders in individuals with PTSD. In A. A. Vujanovic & S. E. Back (Eds.), Posttraumatic stress and substance use disorders. Routledge.

    Google Scholar 

  • Becker, C. B., Zayfert, C., & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behavior Research and Therapy, 42(3), 277–292. https://doi.org/10.1016/s0005-7967(03)00138-4

    Article  Google Scholar 

  • Blakey, S. M., & Abramowitz, J. S. (2016). The effects of safety behaviors during exposure therapy for anxiety: Critical analysis from an inhibitory learning perspective. Clinical Psychology Review, 49, 1–15. https://doi.org/10.1016/j.cpr.2016.07.002

    Article  PubMed  Google Scholar 

  • Blumenthal, H., Leen-Feldner, E. W., Knapp, A. A., Badour, C. L., & Boals, A. (2015). Traumatic event exposure and alcohol use expectancies among adolescents. Journal of Child & Adolescent Substance Abuse, 24(6), 337–343. https://doi.org/10.1080/1067828X.2013.839407

    Article  Google Scholar 

  • Buckner, J. D., Bonn-Miller, M. O., Zvolensky, M. J., & Schmidt, N. B. (2007). Marijuana use motives and social anxiety among marijuana-using young adults. Addictive Behaviors, 32(10), 2238–2252. https://doi.org/10.1016/j.addbeh.2007.04.004

    Article  PubMed  PubMed Central  Google Scholar 

  • Collins, S. E. (2016). Associations between socioeconomic factors and alcohol outcomes. Alcohol Research: Current Reviews, 38(1), 83–94.

    Google Scholar 

  • Conway, K. P., Compton, W., Stinson, F. S., & Grant, B. F. (2006). Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on alcohol and related conditions. Journal of Clinical Psychiatry, 67(2), 247–257.

    Article  Google Scholar 

  • Cox, K. S., Wangelin, B. C., Keller, S. M., Lozano, B. E., Murphy, M. M., Maher, E. K., … Tuerk, P. W. (2020). Emotional processing of imaginal exposures predicts symptom improvement: Therapist ratings can assess trajectory in prolonged exposure for posttraumatic stress disorder. Journal of Traumatic Stress, 33(3), 338–344. https://doi.org/10.1002/jts.22493

    Article  PubMed  Google Scholar 

  • Degenhardt, L., Bharat, C., Glantz, M. D., Sampson, N. A., Scott, K., Lim, C. C., … Bromet, E. J. (2019). The epidemiology of drug use disorders cross-nationally: Findings from the WHO’s world mental health surveys. International Journal of Drug Policy, 71, 103–112.

    Article  Google Scholar 

  • Embersin-Kyprianou, C., Yermachenko, A., Massari, V., El-Khoury-Lesueur, F., & Melchior, M. (2020). Unintended pregnancies, sexual violence and contraception among women consuming cannabis or other illegal psychoactive substances in Île-de-France: Data from the 2016 health barometer. Revue d’Épidémiologie et de Santé Publique, 68(1), 9–15.

    Article  Google Scholar 

  • Fals-Stewart, W., & Schafer, J. (1992). The treatment of substance abusers diagnosed with obsessive compulsive disorder: An outcome study. Journal of Substance Abuse Treatment, 9, 365–370.

    Article  Google Scholar 

  • Fluyau, D., Revadigar, N., & Manobianco, B. E. (2018). Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation. Therapeutic Advances in Psychopharmacology, 8(5), 147–168. https://doi.org/10.1177/2045125317753340

    Article  PubMed  PubMed Central  Google Scholar 

  • Gielen, N., Krumeich, A., Havermans, R. C., Smeets, F., & Jansen, A. (2014). Why clinicians do not implement integrated treatment for comorbid substance use disorder and posttraumatic stress disorder: A qualitative study. European Journal of Psychotraumatology, 5(1), 22821.

    Article  Google Scholar 

  • Goetz, A. R., Davine, T. P., Siwiec, S. G., & Lee, H.-J. (2016). The functional value of preventive and restorative safety behaviors: A systematic review of the literature. Clinical Psychology Review, 44, 112–124. https://doi.org/10.1016/j.cpr.2015.12.005

    Article  PubMed  Google Scholar 

  • Goodman, A., Fleming, K., Markwick, N., Morrison, T., Lagimodiere, L., & Kerr, T. (2017). “They treated me like crap and I know it was because I was native”: The healthcare experiences of aboriginal peoples living in Vancouver’s inner city. Social Science & Medicine, 178, 87–94. https://doi.org/10.1016/j.socscimed.2017.01.053

    Article  Google Scholar 

  • Hartwell, K. J., Back, S. E., McRae-Clark, A. L., Shaftman, S. R., & Brady, K. T. (2012). Motives for using: A comparison of prescription opioid, marijuana and cocaine dependent individuals. Addictive Behaviors, 37(4), 373–378. https://doi.org/10.1016/j.addbeh.2011.11.014

    Article  PubMed  Google Scholar 

  • Henslee, A. M., & Coffey, S. F. (2010). Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility. Professional Psychology: Research and Practice, 41(1), 34–40. https://doi.org/10.1037/a0018235

    Article  Google Scholar 

  • Hien, D. A., Jiang, H., Campbell, A. N., Hu, M. C., Miele, G. M., Cohen, L. R., … Nunes, E. V. (2010). Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA’s clinical trials network. American Journal of Psychiatry, 167(1), 95–101. https://doi.org/10.1176/appi.ajp.2009.09091261

    Article  PubMed  Google Scholar 

  • Jarnecke, A. M., Allan, N. P., Badour, C. L., Flanagan, J. C., Killeen, T. K., & Back, S. E. (2019). Substance use disorders and PTSD: Examining substance use, PTSD symptoms, and dropout following imaginal exposure. Addictive Behaviors, 90, 35–39. https://doi.org/10.1016/j.addbeh.2018.10.020

    Article  PubMed  Google Scholar 

  • Jesse, S., Brathen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., … Ludolph, A. C. (2017). Alcohol withdrawal syndrome: Mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4–16. https://doi.org/10.1111/ane.12671

    Article  PubMed  Google Scholar 

  • Kayser, R. R., Raskin, M., Snorrason, I., Hezel, D. M., Haney, M., & Simpson, H. B. (2020). Cannabinoid augmentation of exposure-based psychotherapy for obsessive-compulsive disorder. Journal of Clinical Psychopharmacology, 40(2), 207–210. https://doi.org/10.1097/jcp.0000000000001179

    Article  PubMed  PubMed Central  Google Scholar 

  • Kingston, R. E. F., Marel, C., & Mills, K. L. (2017). A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug and Alcohol Review, 36, 527–539. https://doi.org/10.1111/dar.12448

    Article  PubMed  Google Scholar 

  • Kushner, M. G., Maurer, E. W., Thuras, P., Donahue, C., Frye, B., Menary, K. R., … Van Demark, J. (2013). Hybrid cognitive behavioral therapy versus relaxation training for co-occurring anxiety and alcohol disorder: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 81(3), 429–442.

    Article  Google Scholar 

  • Kushner, M. G., Sletten, S., Donahue, C., Thuras, P., Maurer, E., Schneider, A., Frye, B., & Van Demark, J. (2009). Cognitive-behavioral therapy for panic disorder in patients being treated for alcohol dependence: Moderating effects of alcohol outcome expectancies. Addictive Behaviors, 34(6–7), 554–560. https://doi.org/10.1016/j.addbeh.2009.03.011

    Article  PubMed  PubMed Central  Google Scholar 

  • Lancaster, C. L., Gros, D. F., Mullarkey, M. C., Badour, C. L., Killeen, T. K., Brady, K. T., & Back, S. E. (2020). Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders? Behavioral and Cognitive Psychotherapy, 48(1), 38–53. https://doi.org/10.1017/s1352465819000304

    Article  Google Scholar 

  • Lavalley, J., Kastor, S., Tourangeau, M., Goodman, A., & Kerr, T. (2020). You just have to have other models, our DNA is different: The experiences of indigenous people who use illicit drugs and/or alcohol accessing substance use treatment. Harm Reduction Journal, 17(1), 19. https://doi.org/10.1186/s12954-020-00366-3

    Article  PubMed  PubMed Central  Google Scholar 

  • Marel, C., Mills, K., Kingston, R., Gournay, K., Deady, M., Kay-Lambkin, F., Baker, A., & Teesson, M. (2016). Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (2nd ed.). Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales.

    Google Scholar 

  • Martin, C. E., Scialli, A., & Terplan, M. (2020). Unmet substance use disorder treatment need among reproductive age women. Drug and Alcohol Dependence, 206, 107679. https://doi.org/10.1016/j.drugalcdep.2019.107679

    Article  PubMed  Google Scholar 

  • McGregor, C., Srisurapanont, M., Jittiwutikarn, J., Laobhripatr, S., Wongtan, T., & White, J. M. (2005). The nature, time course and severity of methamphetamine withdrawal. Addiction, 100(9), 1320–1329. https://doi.org/10.1111/j.1360-0443.2005.01160.x

    Article  PubMed  Google Scholar 

  • McHugh, R. K. (2015). Treatment of co-occurring anxiety disorders and substance use disorders. Harvard Review of Psychiatry, 23(2), 99–111. https://doi.org/10.1097/HRP.0000000000000058

    Article  PubMed  PubMed Central  Google Scholar 

  • Meulders, A., Van Daele, T., Volders, S., & Vlaeyen, J. W. (2016). The use of safety-seeking behavior in exposure-based treatments for fear and anxiety: Benefit or burden? A meta-analytic review. Clinical Psychology Review, 45, 144–156. https://doi.org/10.1016/j.cpr.2016.02.002

    Article  PubMed  Google Scholar 

  • Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1999). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. National Institute on Alcohol Abuse and Alcoholism.

    Google Scholar 

  • Mills, K. L., Barrett, E. L., Merz, S., Rosenfeld, J., Ewer, P. L., Sannibale, C., … Teesson, M. (2016). Integrated exposure-based therapy for co-occurring post traumatic stress disorder (PTSD) and substance dependence: Predictors of change in PTSD symptom severity. Journal of Clinical Medicine, 5(11). https://doi.org/10.3390/jcm5110101

  • Mills, K. L., Teesson, M., Back, S. E., Brady, K. T., Baker, A. L., Hopwood, S., … Ewer, P. L. (2012). Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: A randomized controlled trial. JAMA, 308(7), 690–699. https://doi.org/10.1001/jama.2012.9071

    Article  PubMed  Google Scholar 

  • Monti, P. M., Kadden, R. M., Rohsenow, D. J., Cooney, N. L., & Abrams, D. B. (2002). Treating alcohol dependence: A coping skills training guide (2nd ed.). Guilford Press.

    Google Scholar 

  • Morissette, S. B., Spiegel, D. A., & Barlow, D. H. (2008). Combining exposure and pharmacotherapy in the treatment of social anxiety disorder: A preliminary study of state dependent learning. Journal of Psychopathology and Behavioral Assessment, 30(3), 211–219. https://doi.org/10.1007/s10862-007-9061-1

    Article  Google Scholar 

  • Morley, K. C., Baillie, A., Leung, S., Sannibale, C., Teesson, M., & Haber, P. S. (2016). Is specialized integrated treatment for comorbid anxiety, depression and alcohol dependence better than treatment as usual in a public hospital setting? Alcohol and Alcoholism, 51, 402–409.

    Article  Google Scholar 

  • NIDA. (2020a, May 28). Part 1: The connection between substance use disorders and mental illness. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness

  • NIDA. (2020b, May 28). Sex and gender differences in substance use disorder treatment. Retrieved from https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use-disorder-treatment.

  • Oluwoye, O., Kriegel, L. S., Alcover, K. C., Hirchak, K., & Amiri, S. (2020). Racial and ethnic differences in alcohol-, opioid-, and co-use-related deaths in Washington state from 2011 to 2017. Addictive Behaviors Reports, 12, 100–316. https://doi.org/10.1016/j.abrep.2020.100316

    Article  Google Scholar 

  • Pergolizzi, J. V., Jr., Raffa, R. B., & Rosenblatt, M. H. (2020). Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: Current understanding and approaches to management. Journal of Clinical Pharmacy and Therapeutics. https://doi.org/10.1111/jcpt.13114

  • Peters, J., Kalivas, P. W., & Quirk, G. J. (2009). Extinction circuits for fear and addiction overlap in prefrontal cortex. Learning & Memory, 16(5), 279–288. https://doi.org/10.1101/lm.1041309

    Article  Google Scholar 

  • Pinedo, M. (2019). A current re-examination of racial/ethnic disparities in the use of substance abuse treatment: Do disparities persist? Drug & Alcohol Dependence, 202, 162–167. https://doi.org/10.1016/j.drugalcdep.2019.05.017

    Article  Google Scholar 

  • Randall, C. L., Thomas, S., & Thevos, A. K. (2001). Concurrent alcoholism and social anxiety disorder: A first step toward developing effective treatments. Alcoholism, Clinical and Experimental Research, 25(2), 210–220.

    Article  Google Scholar 

  • Ritchie, H. (2018). Alcohol consumption. Retrieved from: https://ourworldindata.org/alcohol-consumption.

  • Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: A systematic review and meta-analysis. Clinical Psychology Review, 38, 25–38. https://doi.org/10.1016/j.cpr.2015.02.007

    Article  PubMed  Google Scholar 

  • Rosen, C. S., Greenbaum, M. A., Schnurr, P. P., Holmes, T. H., Brennan, P. L., & Friedman, M. J. (2013). Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder? Journal of Clinical Psychiatry, 74(12), 1241–1248. https://doi.org/10.4088/JCP.13m08592

    Article  PubMed  Google Scholar 

  • Rouf, K., Fennell, M., Westbrook, D., Cooper, M., & Bennett-Levy, J. (2004). Devising effective behavioural experiments. In J. Bennett-Levy, G. Butler, M. Fennell, A. Hackman, M. Mueller, & D. Westbrook (Eds.), Cognitive behaviour therapy: Science and practice series. Oxford guide to behavioural experiments in cognitive therapy (pp. 21–58). Oxford University Press. https://doi.org/10.1093/med:psych/9780198529163.003.0002

    Chapter  Google Scholar 

  • Ruglass, L. M., Lopez-Castro, T., Cheref, S., Papini, S., & Hien, D. A. (2014). At the crossroads: The intersection of substance use disorders, anxiety disorders, and posttraumatic stress disorder. Current Psychiatry Reports, 16(11), 505. https://doi.org/10.1007/s11920-014-0505-5

    Article  PubMed  Google Scholar 

  • Skinner, M. D., & Aubin, H. J. (2010). Craving’s place in addiction theory: Contributions of the major models. Neuroscience and Biobehavioral Reviews, 34(4), 606–623. https://doi.org/10.1016/j.neubiorev.2009.11.024

    Article  PubMed  Google Scholar 

  • Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: Comorbidity and treatment considerations. Alcohol Research: Current Reviews, 34(4), 414–431.

    Google Scholar 

  • Spiegel, D. A., & Bruce, T. J. (1997). Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder: Conclusions from combined treatment trials. American Journal of Psychiatry, 154(6), 773–781. https://doi.org/10.1176/ajp.154.6.773

    Article  PubMed  Google Scholar 

  • Stapinski, L. A., Rapee, R. M., Sannibale, C., Teesson, M., Haber, P. S., & Baillie, A. J. (2015). The clinical and theoretical basis for integrated cognitive behavioral treatment of comorbid social anxiety and alcohol use disorders. Cognitive and Behavioral Practice, 22(4), 504–521.

    Article  Google Scholar 

  • Stapinski, L. A., Sannibale, C., Subotic, M., Rapee, R. M., Teesson, M., Haber, P. S., & Baillie, A. J. (2020). Randomised controlled trial of integrated cognitive behavioural treatment and motivational enhancement for comorbid social anxiety and alcohol use disorders. Australian and New Zealand Journal of Psychiatry, 4867420952539. https://doi.org/10.1177/0004867420952539

  • Stewart, S. H., Grant, V. V., Mackie, C. J., & Conrod, P. J. (2016). Comorbidity of anxiety and depression with substance use disorders. In K. J. Sher (Ed.), The Oxford handbook of substance use and substance use disorders (Vol. 2, pp. 149–186). Oxford University Press.

    Google Scholar 

  • Tirado-Muñoz, J., Gilchrist, G., Fischer, G., Taylor, A., Moskalewicz, J., Giammarchi, C., … Di Furia, L. (2018). Psychiatric comorbidity and intimate partner violence among women who inject drugs in Europe: A cross-sectional study. Archives of Women’s Mental Health, 21(3), 259–269.

    Article  Google Scholar 

  • Tripp, J. C., Worley, M. J., Straus, E., Angkaw, A. C., Trim, R. S., & Norman, S. B. (2020). Bidirectional relationship of posttraumatic stress disorder (PTSD) symptom severity and alcohol use over the course of integrated treatment. Psychology of Addictive Behaviors, 34(4), 506–511. https://doi.org/10.1037/adb0000564

    Article  PubMed  PubMed Central  Google Scholar 

  • United Nations Office on Drugs and Crime. (2018). World drug report 2018. United Nations.

    Book  Google Scholar 

  • United Nations Office on Drugs and Crime (2020). World Drug Report 2020. Vienna: UnitedNations.

    Google Scholar 

  • van Boekel, L. C., Brouwers, E. P., van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug & Alcohol Dependence, 131(1–2), 23–35. https://doi.org/10.1016/j.drugalcdep.2013.02.018

    Article  Google Scholar 

  • van Dam, D., Vedel, E., Ehring, T., & Emmelkamp, P. M. G. (2012). Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: A systematic review. Clinical Psychology Review, 32, 202–214. https://doi.org/10.1016/j.cpr.2012.01.004

    Article  PubMed  Google Scholar 

  • van Minnen, A., Arntz, A., & Keijsers, G. P. J. (2002). Prolonged exposure in patients with chronic PTSD: Predictors of treatment outcome and dropout. Behavior Research and Therapy, 40(4), 439–457. https://doi.org/10.1016/S0005-7967(01)00024-9

    Article  Google Scholar 

  • van Minnen, A., Harned, M. S., Zoellner, L., & Mills, K. (2012). Examining potential contraindications for prolonged exposure therapy for PTSD. European Journal of Psychotraumatology, 3. https://doi.org/10.3402/ejpt.v3i0.18805

  • Walmsley, R. (2017). World female imprisonment list (4th ed.) Retrieved from: https://www.prisonstudies.org/sites/default/files/resources/downloads/world_female_prison_4th_edn_v4_web.pdf

    Google Scholar 

  • Watanabe, N., Churchill, R., & Furukawa, T. A. (2007). Combination of psychotherapy and benzodiazepines versus either therapy alone for panic disorder: A systematic review. BMC Psychiatry, 7, 18. https://doi.org/10.1186/1471-244X-7-18

    Article  PubMed  PubMed Central  Google Scholar 

  • White, W., & Miller, W. (2007). The use of confrontation in addiction treatment: History, science and time for change. Counselor, 8(4), 12–30.

    Google Scholar 

  • Witkiewitz, K. A., & Marlatt, G. A. (Eds.). (2007). Therapist’s guide to evidence-based relapse prevention. Elsevier Academic Press.

    Google Scholar 

  • Wixted, J. T. (2004). The psychology and neuroscience of forgetting. Annual Review of Psychology, 55, 235–269. https://doi.org/10.1146/annurev.psych.55.090902.141555

    Article  PubMed  Google Scholar 

  • Wolitzky-Taylor, K., Operskalski, J. T., Ries, R., Craske, M. G., & Roy-Byrne, P. (2011). Understanding and treating comorbid anxiety disorders in substance users: Review and future directions. Journal of Addiction Medicine, 5(4), 233–247.

    Article  Google Scholar 

  • World Health Organization. (2018). Global status report on alcohol and health 2018. World Health Organisation.

    Google Scholar 

  • Yang, L. H., Wong, L. Y., Grivel, M. M., & Hasin, D. S. (2017). Stigma and substance use disorders: An international phenomenon. Current Opinion in Psychiatry, 30(5), 378–388. https://doi.org/10.1097/YCO.0000000000000351

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. The Matilda Centre for Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia

    Logan R. Harvey, Katherine L. Mills & Lexine A. Stapinski

  2. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA

    Tanya C. Saraiya, Delisa G. Brown & Amber M. Jarnecke

  3. Medical University of South Carolina (MUSC), Charleston, SC, USA

    Sudie E. Back

  4. Ralph H. Johnson VA Medical Center, Charleston, SC, USA

    Sudie E. Back

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  1. Logan R. Harvey
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  2. Tanya C. Saraiya
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  5. Amber M. Jarnecke
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  7. Lexine A. Stapinski
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Correspondence to Logan R. Harvey .

Editor information

Editors and Affiliations

  1. Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, Austin, TX, USA

    Jasper A. J. Smits

  2. Department of Psychology, The University of Arizona, Tucson, AZ, USA

    Jolene Jacquart

  3. Department of Psychology and Neuroscience, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA

    Jonathan Abramowitz

  4. Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA

    Joanna Arch

  5. Mental Health Research & Treatment Centre, Ruhr-Universität Bochum, Bochum, Nordrhein-Westfalen, Germany

    Jürgen Margraf

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Harvey, L.R. et al. (2022). Exposure Therapy when Patients Present with Comorbid Substance Use Disorders. In: Smits, J.A.J., Jacquart, J., Abramowitz, J., Arch, J., Margraf, J. (eds) Clinical Guide to Exposure Therapy. Springer, Cham. https://doi.org/10.1007/978-3-031-04927-9_5

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