Advertisement

The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders

  • Courtney A. Zulauf
  • Susan E. Sprich
  • Steven A. Safren
  • Timothy E. Wilens
Child and Adolescent Disorders (T Benton, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Child and Adolescent Disorders

Abstract

Adolescents and young adults with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) are increasingly presenting in clinical practice. The overlap and role of treatment for these co-occurring disorders remains unclear. A review of the literature was conducted to highlight and update recent evidence on the overlap of ADHD and SUD, the role of ADHD medication on later SUD, and the treatment of ADHD and SUD in adolescents and young adults. Recent work continues to highlight the high risk for comorbid ADHD in patients with SUD; and conversely, the high risk for SUD developing in ADHD across the lifespan, particularly in the context of comorbid conduct disorder. Although the data remains discordant, it appears that ADHD pharmacotherapy does not increase the risk for SUD. Medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD. Structured therapies may be effective in treating adolescents and young adults with ADHD and SUD. Further controlled trials evaluating the sequence and effect of structured psychotherapies and/or ADHD pharmacotherapy on SUD relapse in these groups are warranted.

Keywords

Adolescence Substance use disorders Attention deficit/hyperactivity disorder Stimulants comorbidity Cognitive-behavioral therapy 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Courtney A. Zulauf declares that she has no conflict of interest.

Susan E. Sprich has received royalties from Oxford University Press.

Steven A. Safren has received royalties from Oxford University Press and board membership of K24MH094214.

Dr. Timothy Wilens receives or has received grant support from the following sources: NIH(NIDA) and Shire. Dr. Wilens is or has been a consultant for: Euthymics, NIH (NIDA), Shire, Tris and Theravance. Dr. Wilens has a published book with Guilford Press. Straight Talk About Psychiatric Medications for Kids. Dr. Wilens is a consultant to the US National Football League (ERM Associates), U.S. Minor/Major League Baseball and Bay Cove Human Services (Clinical Services).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.

  1. 1.•
    Merikangas KR et al. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2011;50(1):32–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Polanczyk G et al. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Merikangas KR et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Wilens TE, Spencer TJ. Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgrad Med. 2010;122(5):97–109.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Biederman J et al. Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study. Am J Psychiatry. 2010;167(4):409–17.PubMedCrossRefGoogle Scholar
  6. 6.•
    Wilens TE et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry. 2011;50(6):543–53.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Kessler RC. The epidemiology of dual diagnosis. Biol Psychiatry. 2004;56(10):730–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Brook JS et al. Longitudinally predicting late adolescent and young adult drug use: childhood and adolescent precursors. J Am Acad Child Adolesc Psychiatry. 1995;34(9):1230–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson BA et al. Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population. Am J Addict. 2000;9(1):17–27.PubMedCrossRefGoogle Scholar
  10. 10.
    Brook JS et al. Young adult drug use and delinquency: childhood antecedents and adolescent mediators. J Am Acad Child Adolesc Psychiatry. 1996;35(12):1584–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Kandel DB et al. Psychiatric comorbidity among adolescents with substance use disorders: findings from the MECA study. J Am Acad Child Adolesc Psychiatry. 1999;38(6):693–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Lewinsohn PM, Gotlib IH, Seeley JR. Adolescent psychopathology: IV. Specificity of psychosocial risk factors for depression and substance abuse in older adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34(9):1221–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Frodl T. Comorbidity of ADHD and Substance Use Disorder (SUD): a neuroimaging perspective. J Atten Disord. 2010;14(2):109–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Dennis M et al. The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. J Subst Abus Treat. 2004;27(3):197–213.CrossRefGoogle Scholar
  15. 15.•
    van Emmerik-van Oortmerssen K et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122(1-2):11–9.PubMedCrossRefGoogle Scholar
  16. 16.•
    van de Glind G et al. The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population. Int J Methods Psychiatr Res. 2013. doi: 10.1002/mpr.1397.PubMedGoogle Scholar
  17. 17.
    McAweeney M et al. Symptom prevalence of ADHD in a community residential substance abuse treatment program. J Atten Disord. 2010;13(6):601–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Barkley RA et al. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry. 2004;45(2):195–211.PubMedCrossRefGoogle Scholar
  19. 19.•
    Galera C et al. Attention problems in childhood and adult substance use. J Pediatr. 2013. doi: 10.1016/j.jpeds.2013.07.008.PubMedGoogle Scholar
  20. 20.•
    Charach A et al. Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry. 2011;50(1):9–21.PubMedCrossRefGoogle Scholar
  21. 21.•
    Chang Z, Lichtenstein P, Larsson H. The effects of childhood ADHD symptoms on early-onset substance Use: A swedish twin study. J Abnorm Child Psychol. 2012;40(3):425–35.PubMedCrossRefGoogle Scholar
  22. 22.•
    Groenman AP et al. Substance use disorders in adolescents with attention deficit hyperactivity disorder: a 4-year follow-up study. Addiction. 2013;108(8):1503–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Ercan ES et al. Childhood attention deficit/hyeractivity disorder and alcohol dependence: a 1-year follow-up. Alcohol Alcohol. 2003;38(4):352–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Biederman J et al. Is cigarette smoking a gateway drug to subsequent alcohol and illicit drug use disorders? A controlled study of youths with and without ADHD. Biol Psychiatry. 2006;59:258–64.PubMedCrossRefGoogle Scholar
  25. 25.
    Trauth JA, Seidler FJ, Slotkin TA. Persistent and delayed behavioral changes after nicotine treatment in adolescent rats. Brain Res. 2000;880(1–2):167–72.PubMedCrossRefGoogle Scholar
  26. 26.•
    Wilens TE et al. Do executive function deficits predict later substance use disorders among adolescents and young adults? J Am Acad Child Adolesc Psychiatry. 2011;50(2):141–9.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    King VL et al. Attention deficit hyperactivity disorder and treatment outcome in opioid abusers entering treatment. J Nerv Ment Dis. 1999;187(8):487–95.PubMedCrossRefGoogle Scholar
  28. 28.
    Riggs PD et al. A randomized controlled trial of pemoline for attention-deficit/hyperactivity disorder in substance-abusing adolescents. J Am Acad Child Adolesc Psychiatry. 2004;43(4):420–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Riggs PD. Clinical approach to treatment of ADHD in adolescents with substance use disorders and conduct disorder. J Am Acad Child Adolesc Psychiatry. 1998;37(3):331–2.PubMedCrossRefGoogle Scholar
  30. 30.•
    Kousha M, Shahrivar Z, Alaghband-Rad J. Substance use disorder and ADHD: is ADHD a particularly "specific" risk factor? J Atten Disord. 2012;16(4):325–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Biederman J et al. Is ADHD a risk for psychoactive substance use disorder? Findings from a four year follow-up study. J Am Acad Child Adolesc Psychiatry. 1997;36:21–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Wilens T et al. Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. Am J Addict. 2007;16 Suppl 1:14–23.PubMedCrossRefGoogle Scholar
  33. 33.
    Wilens TE, Decker MW. Neuronal nicotinic receptor agonists for the treatment of attention-deficit/hyperactivity disorder: focus on cognition. Biochem Pharmacol. 2007;74(8):1212–23.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Casey BJ, Jones RM. Neurobiology of the adolescent brain and behavior: implications for substance use disorders. J Am Acad Child Adolesc Psychiatry. 2010;49(12):1189–201. quiz 1285.PubMedCentralPubMedGoogle Scholar
  35. 35.•
    Whelan R et al. Adolescent impulsivity phenotypes characterized by distinct brain networks. Nat Neurosci. 2012. doi: 10.1038/nn.3092.PubMedGoogle Scholar
  36. 36.
    Biederman J et al. Familial risk analyses of attention deficit hyperactivity disorder and substance use disorders. Am J Psychiatry. 2008;165(1):107–15.PubMedCrossRefGoogle Scholar
  37. 37.
    Faraone SV, Biederman J. Neurobiology of attention deficit hyperactivity disorder. In: Charney DS, Nestler EJ, editors. Neurobiology of mental illness. 2nd ed. New York, NY: Oxford University Press; 2004.Google Scholar
  38. 38.•
    Yule AM et al. Does exposure to parental substance use disorders increase substance use disorder risk in offspring? A 5-year follow-up study. Am J Addict. 2013;22(5):460–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Bhatara V, Loudenberg R, Ellis R. Association of attention deficit hyperactivity disorder and gestational alcohol exposure: an exploratory study. J Atten Disord. 2006;9(3):515–22.PubMedCrossRefGoogle Scholar
  40. 40.
    Schmitz M et al. Smoking during pregnancy and attention-deficit/hyperactivity disorder, predominantly inattentive type: a case-control study. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1338–45.PubMedCrossRefGoogle Scholar
  41. 41.
    Katusic SK et al. Substance abuse among ADHD cases: a population-based birth cohort study. Seattle: Pediatric Academic Society; 2003.Google Scholar
  42. 42.
    Molina B, Pelham W. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. J Abnorm Child Psychol. 2003;112(3):497–507.CrossRefGoogle Scholar
  43. 43.
    Brook DW et al. Association between attention-deficit/hyperactivity disorder in adolescence and substance use disorders in adulthood. Arch Pediatr Adolesc Med. 2010;164(10):930–4.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Flory K, Lynam DR. The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play? Clin Child Fam Psychol Rev. 2003;6(1):1–16.PubMedCrossRefGoogle Scholar
  45. 45.•
    Lee SS et al. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev. 2011;31(3):328–41.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Elkins IJ, McGue M, Iacono WG. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007;64(10):1145–52.PubMedCrossRefGoogle Scholar
  47. 47.
    Burke JD et al. Inattention as a key predictor of tobacco use in adolescence. J Abnorm Psychol. 2007;116(2):249–59.PubMedCrossRefGoogle Scholar
  48. 48.
    Fergusson DM, Horwood LJ, Ridder EM. Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug Alcohol Depend. 2007;88 Suppl 1:S14–26.PubMedCrossRefGoogle Scholar
  49. 49.
    Szobot CM et al. Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community-based case-control study. Addiction. 2007;102(7):1122–30.PubMedCrossRefGoogle Scholar
  50. 50.
    Kollins SH. A qualitative review of issues arising in the use of psycho-stimulant medications in patients with ADHD and co-morbid substance use disorders. Curr Med Res Opin. 2008;24(5):1345–57.PubMedCrossRefGoogle Scholar
  51. 51.
    Kuczenski R, Segal DS. Stimulant actions in rodents: implications for attention-deficit/hyperactivity disorder treatment and potential substance abuse. Biol Psychiatry. 2005;57(11):1391–6.PubMedCrossRefGoogle Scholar
  52. 52.•
    Humphreys KL, Eng T, Lee SS. Stimulant medication and substance use outcomes: a meta-analysis. JAMA Psychiatr. 2013;70(7):740–9. doi: 10.1001/jamapsychiatry.2013.1273.CrossRefGoogle Scholar
  53. 53.
    Wilens T et al. Does stimulant therapy of ADHD beget later substance abuse: a metanalytic review of the literature. Pediatrics. 2003;11(1):179–85.CrossRefGoogle Scholar
  54. 54.•
    Hammerness P et al. Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. J Pediatr. 2012. doi: 10.1016/j.jpeds.2012.06.046.PubMedGoogle Scholar
  55. 55.•
    Hammerness P et al. Do Stimulants reduce the risk for alcohol and substance use in youth with ADHD? A secondary analysis of a prospective, 24-Month Open-Label Study of Osmotic-Release Methylphenidate. J Atten Disord. 2012;Google Scholar
  56. 56.•
    Lichtenstein P et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012;367(21):2006–14.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.•
    Konstenius M et al. Methylphenidate for ADHD and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial. Addiction. 2013. doi: 10.1111/add.12369.Google Scholar
  58. 58.
    Adler LD, Nierenberg AA. Review of medication adherence in children and adults with ADHD. Postgrad Med. 2010;122(1):184–91.PubMedCrossRefGoogle Scholar
  59. 59.••
    Riggs PD et al. Randomized controlled trial of osmotic-release methylphenidate with cognitive-behavioral therapy in adolescents with attention-deficit/hyperactivity disorder and substance use disorders. J Am Acad Child Adolesc Psychiatry. 2011;50(9):903–14.PubMedCentralPubMedCrossRefGoogle Scholar
  60. 60.••
    Tamm L et al. Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder. J Subst Abus Treat. 2013;44(2):224–30.CrossRefGoogle Scholar
  61. 61.•
    Wilens TE et al. Correlates of alcohol use in adults with ADHD and comorbid alcohol use disorders: exploratory analysis of a placebo-controlled trial of atomoxetine. Curr Med Res Opin. 2011. doi: 10.1185/03007995.2011.628648.PubMedCentralPubMedGoogle Scholar
  62. 62.
    National Institute on Drug Abuse, Treatment Approaches for Drug Addiction 2009: National Institute on Drug Abuse, National Institutes of Health.Google Scholar
  63. 63.•
    American Academy of Pediatrics, Recommendations: Attention-Deficit/Hyperactivity Disorder, Center for Disease Control and Prevention, Editor 2013: USA.gov.Google Scholar
  64. 64.
    National Institute on Drug Abuse, Principles of drug addiction treatment: A research-based guide 2000: National Institute on Drug Abuse, National Institutes of Health.Google Scholar
  65. 65.••
    Antshel KM, Faraone SV and Gordon M. Cognitive behavioral treatment outcomes in adolescent ADHD. J Atten Disord. 2012.Google Scholar
  66. 66.
    Bramham J et al. Evaluation of group cognitive behavioral therapy for adults with ADHD. J Atten Disord. 2009;12(5):434–41.PubMedCrossRefGoogle Scholar
  67. 67.••
    Emilsson B et al. Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. BMC Psychiatr. 2011;11:116.CrossRefGoogle Scholar
  68. 68.••
    Solanto MV et al. Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry. 2010;167(8):958–68.PubMedCentralPubMedCrossRefGoogle Scholar
  69. 69.
    Safren SA et al. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304(8):875–80.PubMedCentralPubMedCrossRefGoogle Scholar
  70. 70.
    Wilens T, Morrison NR and Prince JB. An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Expert Rev Neurother. 2011;11(10).Google Scholar
  71. 71.
    Bukstein OG. Therapeutic challenges of attention-deficit hyperactivity disorder with substance use disorders. 2006.Google Scholar
  72. 72.
    Wilens TE and Morrison NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatr. 2011;Google Scholar
  73. 73.
    Wilens TE. Attention -deficit/hyperactivity disorder and substance use disorders in adolescents. Psychiatr Times. 2006;XXV(1): 33–34.Google Scholar
  74. 74.
    Wilens TE et al. Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug Alcohol Depend. 2008;96(1–2):145–54.PubMedCrossRefGoogle Scholar
  75. 75.
    Adler L et al. Retrospective safety analysis of atomoxetine in adult ADHD patients with or without comorbid alcohol abuse and dependence. Am J Addict. 2009;18(5):393–401.PubMedCrossRefGoogle Scholar
  76. 76.
    Thurstone C et al. Randomized, controlled trial of atomoxetine for attention-deficit/hyperactivity disorder in adolescents with substance use disorder. J Am Acad Child Adolesc Psychiatry. 2010;49(6):573–82.PubMedCentralPubMedGoogle Scholar
  77. 77.
    McRae-Clark AL et al. A placebo-controlled trial of atomoxetine in marijuana-dependent individuals with attention deficit hyperactivity disorder. Am J Addict. 2010;19(6):481–9.PubMedCentralPubMedCrossRefGoogle Scholar
  78. 78.
    Levin FR et al. Treatment of methadone-maintained patients with adult ADHD: Double-blind comparison of methylphenidate, bupropion and placebo. Drug Alcohol Depend. 2006;81:137–48.PubMedCrossRefGoogle Scholar
  79. 79.
    Levin FR et al. Treatment of cocaine dependent treatment seekers with adult ADHD: double-blind comparison of methylphenidate and placebo. Drug Alcohol Depend. 2007;87(1):20–9.PubMedCrossRefGoogle Scholar
  80. 80.
    Levin FR et al. Atomoxetine Treatment for Cocaine Abuse and Adult Attention-Deficit Hyperactivity Disorder (ADHD): a preliminary open trial. j dual diagn. 2009;5(1):41–56.PubMedCentralPubMedCrossRefGoogle Scholar
  81. 81.
    Schubiner H et al. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol. 2002;10(3):286–94.PubMedCrossRefGoogle Scholar
  82. 82.•
    Winhusen TM et al. Subjective effects, misuse, and adverse effects of osmotic-release methylphenidate treatment in adolescent substance abusers with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2011;21(5):455–63.PubMedCrossRefGoogle Scholar
  83. 83.
    Safren SA et al. Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behavior Research and Therapy. 2005;43(7):831–42.CrossRefGoogle Scholar
  84. 84.
    Weiss M et al. A randomized controlled trial of CBT therapy for adults with ADHD with and without medication. BMC Psychiatry. 2012;12:30.PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    Philipsen A et al. Structured group psychotherapy in adults with attention deficit hyperactivity disorder: results of an open multicentre study. J Nerv Ment Dis. 2007;195(12):1013–9.PubMedCrossRefGoogle Scholar
  86. 86.
    Carroll KM et al. Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. Arch Gen Psychiatry. 1994;51(3):177–87.PubMedCrossRefGoogle Scholar
  87. 87.
    Kaminer Y et al. Psychotherapies for adolescent substance abusers: a pilot study. J Nerv Ment Dis. 1998;186(11):684–90.PubMedCrossRefGoogle Scholar
  88. 88.
    Austin AM, Macgowan MJ, Wagner EF. Effective family-based interventions for adolescents with substance use problems: a systematic review. Res Soc Work Pract. 2005;15(2):67–83.CrossRefGoogle Scholar
  89. 89.
    Waldron HB, Turner CW. Evidence-based psychosocial treatments for adolescent substance abuse. J Clin Child Adolesc Psychol. 2008;37(1):238–61.PubMedCrossRefGoogle Scholar
  90. 90.•
    Wilens T, Zulauf C. ADHD, cigarette smoking, and substance abuse: intoxicating combination. Contemp Pediatr. 2012;29:48–59.Google Scholar
  91. 91.
    Bates ME et al. Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change. Psychol Addict Behav. 2006;20(3):241–53.PubMedCentralPubMedCrossRefGoogle Scholar
  92. 92.
    Miller WR, Sovereign RG, Krege B. Motivational interviewing with problem drinkers: II. The drinker's check-up as a preventive intervention. Behav Psychother. 1988;16(4):251–68.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Courtney A. Zulauf
    • 1
  • Susan E. Sprich
    • 2
  • Steven A. Safren
    • 3
  • Timothy E. Wilens
    • 1
    • 4
    • 5
  1. 1.Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHDMassachusetts General HospitalBostonUSA
  2. 2.Cognitive-Behavioral Therapy ProgramMassachusetts General HospitalBostonUSA
  3. 3.Department of Behavioral MedicineMassachusetts General HospitalBostonUSA
  4. 4.Center for Addiction MedicineMassachusetts General HospitalBostonUSA
  5. 5.YAW 6A, Massachusetts General HospitalBostonUSA

Personalised recommendations