therapy for Substance dependence

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The Relationship Between Alexithymia, Wellness, and Substance Dependence

The Relationship Between Alexithymia, Wellness, and Substance Dependence

Greenberg (2004) has conceptualized Emotion Focused Therapy as consisting of two phases: emotion coaching and emotion transformation. Emotional coaching refers to both awareness and the acceptance of emotion (Greenberg). Greenberg contends that clients often have maladaptive beliefs about emotional experience that are important to remediate to bring out client change for presenting problems such as substance dependence. These maladaptive beliefs can further emotional dysregulation and seem closely related to promoting the constructs of alexithymia and wellness. In EFT, Greenberg states that counselors remediate poor emotional regulation by helping clients view emotional awareness as important for growth, helping clients learn to welcome emotional experience, helping clients learn to describe their emotions to themselves and others in order to solve problems, and helping clients to focus on primary emotions, not secondary feeling states.
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Neuroscience of psychoactive substance use and dependence   WHO 2004 pdf

Neuroscience of psychoactive substance use and dependence WHO 2004 pdf

Substitution therapy is defined as the administration under medical supervision of a prescribed psychoactive substance – pharmacologically related to the one producing dependence – to people with substance dependence, for achieving defined treatment aims (usually improved health and well-being). Substitution therapy is widely used in the management of opioid dependence and is often referred to as “opioid substitution treatment,” “opioid replacement therapy”, or “opioid pharmacotherapy”. Agents suitable for substitution therapy of opioid dependence are those with some opioid properties, so that they have the capacity to prevent the emergence of withdrawal symptoms and reduce craving. At the same time they diminish the effects of heroin or other opioid drugs because they bind to opioid receptors in the brain. In general, it is desirable for opioid substitution drugs to have a longer duration of action than the drug they are replacing so as to delay the emergence of withdrawal and reduce the frequency of administration. As a result there is less disruption of normal life activities from the need to obtain and administer drugs, thereby facilitating rehabilitation efforts. Whereas non-prescribed opioids are usually injected or inhaled by drug users, these prescribed medicines are usually administered orally in the form of a solution or a tablet. Agents used in substitution therapy can also be prescribed in decreasing doses over short periods of time (usually less than one month) for detoxification purposes. Substitution maintenance treatment is associated with prescription of relatively stable doses of opioid agonists (e.g. methadone and buprenorphine) over a long period of time (usually more than 6 months). The mechanisms of action of opioid substitution maintenance therapy include prevention of disruption of molecular, cellular and physiological events and, in fact, normalization of those functions already disrupted by chronic use of usually short-acting opiates such as heroin. The context of delivery of substitution therapy has important implications for the quality of the interventions, both to maintain adequate control and to ensure responsible prescribing. Since 1970, methadone maintenance treatment has grown substantially to become the dominant form of opioid substitution treatment globally. Because the treatment was initially controversial, it has been more rigorously evaluated than any other treatment for opioid dependence. The weight of evidence for benefits is substantial.
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Achieving Effective Treatment of Patients With Chronic Psychotic Illness and Comorbid Substance Dependence

Achieving Effective Treatment of Patients With Chronic Psychotic Illness and Comorbid Substance Dependence

Although several studies of treatment for substance abuse included patients with chronic psychotic ill- nesses, only four published reports (6–8, 13) have de- scribed specific treatment outcomes for this popula- tion. The results from these studies were constrained by small sample sizes and reliance on self-reported so- briety status. The reported treatment outcomes were notable for the low treatment retention at 3 and 6 months and the low rates of sobriety for the patients who had a comorbid nonalcoholic substance disorder. Diverse approaches to the treatment of this popula- tion have been proposed. Several programs have adopted cognitive behavioral therapy oriented toward relapse prevention (6–8, 14, 15). The prevailing ratio- nale for deviations from the traditional 12-step ap- proach has been the impression that many patients with chronic psychotic illness were unable to tolerate
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Camp Approach - an Effective, Alternate Inpatient Treatment Setting For Substance Dependence: A Report from India

Camp Approach - an Effective, Alternate Inpatient Treatment Setting For Substance Dependence: A Report from India

The treating staff comprised a resident doctor and a psy- chiatric staff nurse on a regular, round-the-clock basis. A psychiatric social worker was available for a period of eight hours daily for conducting psychoeducation group sessions. The treatment consisted of both pharmacological and non- pharmacological modalities. Pharmacological therapy com- prised detoxification regime i.e. either dextropropoxyphene, clonidine, or buprenorphine for opioid dependence depending upon the type and severity of dependence and benzodiazepines (for alcohol withdrawal reactions) and vitamins (for prophylaxis of Wernicke’s encephalopathy) for alcohol dependence. Symptomatic treatment for insomnia, aches and pains, loose motions, vomiting etc. was addition- ally carried out. Non-pharmacological therapy comprised psychoeducation sessions, recreational and religious activi- ties. Psychoeducation sessions were both patient based (eight in number) and family based (four in number), of one-hour duration, didactic in nature but interactive to- wards the end addressing drug related complications, cues, coping strategies, relapse prevention and role of family. Recreational and religious activities involved yoga (a form of relaxation), indoor and outdoor games, and religious songs being played for a few hours every day. Wherever deemed necessary, disulfiram therapy (as a mode of relapse prevention) was initiated after informed consent.
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A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care

A multidimensional education program at substance dependence treatment centers improves patient knowledge and hepatitis C care

exclude that this decrease may be due to the fact that some of the patients assessed during phase I may have initiated treatment during phase II. Still, the difference in treatment initiation rates between evaluations was not statistically significant and, since there was an increase in referral rate at phase II, one may expect treatment pro- posal rate to increase or maintain in the absence of other treatment constraints. These results are aligned with the work of Brugmann et al . [7], who reported a decline in the number of patients treated for HCV in Portugal between 2011 and 2013 [7, 36]. Studies suggest that treatment costs and frequent clinical and psychological comorbidities can be important barriers to HCV treatment access [37–40]. This finding may also be attributable to the persisting resistance of physicians in treating a patient population presumably unstable and difficult to treat. In fact, many liver specialists remain hesitant to prescribe a costly and potentially intolerable therapy to active drug users, who are still considered at higher risk of non-adherence and reinfection [8, 41].
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From policy to practice: implementing frontline community health services for substance dependence-study protocol

From policy to practice: implementing frontline community health services for substance dependence-study protocol

The training program titled ‘Treating Substance Depend- ence and Mental Illness: Tools for the Front Line Practi- tioner’ was designed by addictions specialists from the Addictions Unit of the MUHC to facilitate the adoption of evidence-based practices by frontline practitioners. The intended end-users are the physicians, nurses, and other health professionals within primary healthcare clinics who are likely to encounter drug or alcohol abusers in their daily practice. This comprehensive training program for screening and brief interventions will be used as a starting point to be tailored and implemented based on the partici- pants’ reported needs. The program consists of clinical guidelines and best practices for treatment, as well as training modules that make use of case studies, videotaped interviews, role-play using actors, interactive lectures and workshops. Modules include materials related to screening, assessment, diagnostic criteria, pharmaco- therapy, brief intervention (using a validated five- session abstinence-oriented brief intervention program developed and tested at the Addictions Unit), as well as the identification and treatment of co-morbid mental illness.
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Trauma and substance cue reactivity in individuals with comorbid posttraumatic stress disorder and cocaine or alcohol dependence

Trauma and substance cue reactivity in individuals with comorbid posttraumatic stress disorder and cocaine or alcohol dependence

To elucidate the differences in CD and AD reactivity, the two groups were analyzed based on the inclusion of substance use, intoxication, or involvement within the personalized trauma script (e.g., the assailant was in- toxicated, the victim was intoxicated, trauma occurred during the acquisition of illicit drugs). The drug content within the AD participants’ trauma script did not im- pact their ratings of the imagery cues or their ratings of the in 6 i 6 o cues. In contrast, the CD participants with drug content in their personalized trauma scripts (Drug+ ) reported significantly higher craving and ap- proach in response to the imagery cues as compared to participants without drug content in their trauma scripts (Drug −). The CD Drug + participants also reported less positive emotion and higher craving and approach ratings in response to the in 6i6o cues than the CD Drug − participants. One possible explanation for the increased reactivity within the Drug+ CD group comes from the nicotine literature. Tiffany and Drobes (1990) presented imagery scripts to smokers that were designed to elicit either negative, positive, or neutral affect and that contained either drug content (i.e. a description of a smoking situation) or no drug content (i.e., a description of a nonsmoking situation). Imagery scripts that contained drug content and elicited negative affect produced the highest drug craving among all of the affect-drug content combinations. Similarly for the CD group, trauma scripts that produced negative affect and included drug content elicited higher craving and approach ratings than did trauma cues that did not contain drug references. Therefore, it may be that the patients in the CD group were not responding to the negative emotional properties of the trauma script and instead were responding to the Drug+ scripts as a pure drug cue.
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Effect of hope therapy on general self-efficacy among substance abusers

Effect of hope therapy on general self-efficacy among substance abusers

Hope therapy is treatment protocol which focused on Snyder and colleagues’ cognitive conception of hope [17]. The hope therapy is one of many generic of cognitive– behavioral group treatments [18]. This treatment offers psycho-education, skills training, and group process components. Snyder [19,20] has described hope as a process throughout that individual; set goals and foster specific strategies by which to attain those goals, and make and hold the motivation to execute those strategies. These three elements of the hope respectively are mentioned to as goals, pathway's thinking, and agency thinking. Goals include of something that individual wish to acquire, perform, to be, experience, or produce [21]. Pathway's thoughts describe a person’s perceived ability to know and extend routes to goals [19]. People involve in pathways thinking whereas they plan out ways to attain their goals. Since some plans cannot succeed, high-hope people also make many pathways in order to circumvent likely obstacles. High-hope people are belike to develop more alternatives with more important goals and higher probability of being faced with obstacles [17,22,23]. Agency thinking described as the thoughts that individuals have concerning their ability to begin and keep the action on chosen pathways toward those goals [24]. Agency thoughts stimulate people to begin and hold action along pathways into their goals [24].
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Multidimensional Family Therapy (MDFT): An Effective Treatment for Adolescent Substance Abuse

Multidimensional Family Therapy (MDFT): An Effective Treatment for Adolescent Substance Abuse

MDFT is a research supported treatment, having been developed and refined over two decades in federally funded research. MDFT studies have found this treatment approach to be an effective and flexible clinical approach. MDFT is a treatment system that has been tested in different versions, depending on the goals of the study, characteristics of the clinical sample (e.g., level of impairment, extent of co-occurring problems, level of juvenile justice involvement), and treatment setting (e.g., outpatient clinic, drug court, day treatment programme). MDFT has achieved superior clinical outcomes in comparison to several state-of-the-art, widely used treatments. The treatment engages teens and families and motivates them to complete therapy. MDFT has a lower cost than standard outpatient or residential treatment, and it has demonstrated success in treating a range of teens and families (e.g., different ethnicities, gender, ages, and severity of problems). We have developed an extensive empirically-based knowledge about how MDFT works, and have been able to successfully adapt the MDFT protocol to existing non-research treatment programmes. MDFT serves as one of the most promising interventions for adolescent drug abuse and related problem behaviours in a new generation of evidence-based, multi-component, and theory-derived treatments.
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Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America

Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America

Results: Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were “ Requesting a professional qualification to former addicts that belonged to the program ” and “ Work as part of the therapeutic program ” . Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws.
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Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study

Disparities in safe sex counseling & behavior among individuals with substance dependence: a cross-sectional study

Our findings should be interpreted within the limita- tions of our study. Although our analysis examined three racial/ethnic groups, we did not test for within group dif- ferences ( i.e., by type of Hispanic origin) or interactions by gender, because of potential sample size issues [74]. The findings that black patients and those with manic episodes had significantly higher odds of reporting being counseled could also be due to differential response bias or incomplete statistical adjustment (i.e., history of sexu- ally transmitted infections). This study is based entirely on patient self-report, which may be subject to recall or social desirability bias. However, understanding if safe sex coun- seling occurred and how it affected behavior from patient’s perspective is ideal because they can most accurately re- port if/how counseling influenced their practices. Our sample was enrolled within one metropolitan area and the majority of subjects was of low socioeconomic status and thus may not be generalizable to all other substance de- pendent populations. We were unable to determine if pa- tients received safe sex counseling from another type of clinician (other than their primary care doctor) or prac- ticed safer sex because of advice from another clinician. There may also be temporal issues, in asking about life- time safe sex counseling versus symptoms of mental illnes- ses, which may have manifested after counseling occurred (as described above).
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Substance Abuse Treatment and Family Therapy (Revised) - Part 2

Substance Abuse Treatment and Family Therapy (Revised) - Part 2

Because Asian cultures are so intensively family- centered, the responsibility of maintaining filial obligations is perhaps the dominant concern in the life of most Asians (Herrick and Brown 1998). Given the central importance of family in Asian cultures, it is critical to assess the family’s part when treating Asian Americans with substance use disorders. The psychological influence of the family, particularly the older members, is considerable even when key members are missing as a result of loss, nonmigration, or emotional estrangement (Chang 2000). Family therapy with Asian Americans is least likely to include older generations. The primary reason for this absence, younger family members say, is that they hope to spare their elders any discomfort. Working delicately and tactfully with elders is of foremost importance. When treating unresolved issues among older generations, therapists must demonstrate respect, reveal genuine empathy, and above all, avoid embar- rassing older family members. Often family members, particularly the person with the substance use problem, will try to shield older family members from shame. Family therapists must be cognizant not to rush into exploration of sensitive areas. One method is to initially join with the family at a broad experiential level—sharing their salient traumatic inci- dent—without prying for embarrassing or threatening details (Chang 2000).
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Family Behavior Therapy for Substance Abuse and Other Associated Problems

Family Behavior Therapy for Substance Abuse and Other Associated Problems

To assist in eliminating urges or strong desires to use drugs, an urge control intervention was influenced by Cautela’s (1967) covert sensitiza- tion therapy. In Cautela’s intervention, clients are instructed to imagine aversive stimuli when alcohol is about to be ingested. Through multiple trials, desire for alcohol use becomes less intense due to its pairing with aversive images. Two issues occurred in early FBT trials when piloting Cautela’s method in predominately nonmotivated adolescents who abused substances. First, many adolescents were unwilling or unable to vividly imagine the scenarios due to their lack of motivation and developmental limitations, respectively. This problem was solved by instructing youth to describe their thoughts and images to the therapist “aloud” when conduct- ing the trials. Thus, they were able to receive timely instructional prompts and feedback regarding their drug use avoidance and escape experiences. Second, FBT was developed in south Florida in the 1980s when crack cocaine use was emerging in the United States. Thus, many clients com- plained that by imagining their drug use situations immediately prior to drug use, they could not effectively lower their urges due to powerful positive images of this form of cocaine. Therefore, they were instead instructed to escape from the very first thought or image (initial antecedent or “trigger”) associated with drug use in the response chain. That is, an attempt was made to terminate the urge or craving when it was first recog- nized in the environment, and thus relatively weak.
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Assessing drama therapy as an intervention for recovering substance users: A systematic review

Assessing drama therapy as an intervention for recovering substance users: A systematic review

In the context of recovery from substance use, drama therapy appears to support the process of recovery by first helping clients develop new skills that subsequently support a process of identity transformation. New skills are learned, whereby facilitators help clients express internal issues through the process of enactment (Bruun, 2012). Clients enact a range of situations based on real life experiences and future scenarios. In one such intervention, Somov (2008) proposed that by focussing on practicing relapse prevention skills, where group members act as protagonists and the audience, lapse and relapse can be prepared for. The group is cast into a series of role plays involving potential relapse scenarios and are taught to react in real time so they can successfully resolve challenges and practice skills such as craving control; thus, people not only explore emotions, but learn new skills associated with being substance free (Megranahan & Lynskey, 2018).
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Striking a balance : improving practice as a student doing group music therapy with adults with substance abuse and dependence : a research thesis presented in partial fulfilment of the requirements for the Master of Music Therapy at the New Zealand Schoo

Striking a balance : improving practice as a student doing group music therapy with adults with substance abuse and dependence : a research thesis presented in partial fulfilment of the requirements for the Master of Music Therapy at the New Zealand School of Music, Wellington, New Zealand

supervision and support from the interdisciplinary team. At this point in my learning, I felt there was more to explore about my technique and process in this work. I felt that there was incongruence between the values I had as a student therapist and the treatment I was delivering as a student, and that the therapy I was delivering was held back by this. I found I was asking questions such as: How do I take my practice and understanding of my practice to a new level? What can I do to maximise my potential for growth in this context? How can I deliver my own level of ‘best practice’? All of these questions arose from my experiences with clients, and my desire to facilitate experiences which would be most helpful to them in their journeys to wellness. Put simply, I wanted to feel like I was doing a good job, not by others’ standards, but by my own standards. In order to answer these questions, I needed to define my values for what would be my personal concept of “best practice”. I had come to believe that the process of music making was the most powerful thing I could bring to this group. This concept lies closely to the idea my colleagues promoted of empowering clients to do their own work – or, as some counsellors say, become their own therapist. It was this process I decided to focus on, and I decided that finding ways of working which held creativity as a central ideal would be most helpful. I decided that my way forward was to find ways of keeping music at the
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An 8 Week Group Cognitive Behavioral Therapy Intervention for Mobile Dependence

An 8 Week Group Cognitive Behavioral Therapy Intervention for Mobile Dependence

First, from the descriptive statistics of the results and the interaction profiles of the time and group, the cell-dependence scores of the intervention group were shown to significantly decrease after 8 weeks, this trend remained 2 months after treatment, and there was no significant difference between the pre-test and post-test for the control group. In the C-TMD, there are questions about the phone usage such as “I used to sleep late or sleep less because I use mobile phone” “I spent more time on the phone, texting (including Wechat), or some APP than I thought”. The scores of CBT group on these questions suggested that the frequency of phone usage maintained a downtrend during and after the in- tervention, but the control group did not, which further demonstrated the possi- ble effect of an eight-week intervention for mobile phone dependence. At the same time, the results also showed that, in the absence of intervention in general, the C-TMD scores of college students generally did not automatically reduce; this suggests that the eight-week CBT designed by this study can be a good way to reduce college students’ cell-dependence scores (improve cell phone depen- dence), and remain effective for 2 months after treatment. As found in previous studies, CBT-IA improves a good effect at improving symptoms associated with Internet addiction after 12 weekly sessions, which persisted one month, three months, and six months after therapy (Young, 2013). As a result, we can hope that CBT might have a long-term effect on mobile phone dependence.
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STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D.

STATISTICS. Opiate Substitution Therapy for Opiate Dependence. Alan Shein, M.D.

Allow time to react to a dose increase (3-5 days) Avoid overly aggressive titration.. Dose/Response At steady-state in[r]

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Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs

Women with comorbid substance dependence and psychiatric disorders in Sweden: a longitudinal study of hospital care utilization and costs

Background: Substance use disorders are regarded as one of the most prevalent, deadly and costly of health problems. Research has consistently found that the prevalence of other psychiatric disorders among those with substance related disorders is substantial. Combined, these disorders lead to considerable disability and health years lost worldwide as well as extraordinary societal costs. Relatively little of the literature on substance dependence and its impact on healthcare utilization and associated costs has focused specifically on chronic drug users, adolescents or women. In addition, the research that has been conducted relies largely on self-reported data and does not provide long-term estimates of hospital care utilization. The purpose of this study is to describe the long-term (24 – 32 year) healthcare utilization and it ’ s associated costs for a nationally representative cohort of chronic substance abusing women (adults and adolescents) remanded to compulsory care between 1997 – 2000 (index episode). As such, this is the first study investigating healthcare costs for women in compulsory treatment in Sweden.
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Trait mindfulness, reasons for living and general symptom severity as predictors of suicide probability in males with substance abuse or dependence.

Trait mindfulness, reasons for living and general symptom severity as predictors of suicide probability in males with substance abuse or dependence.

Additionally, our results showed that trait mindfulness had a significant association with suicide probability. Path analysis showed that the relation between severity of general psychiatric symptoms and suicide probability could be decreased if a person obtained a high score in trait mindfulness. In other words, trait mindfulness was a protective factor that decreased both the risks of suicide and psychiatric general symptoms. These results in general were consistent with the results of other researches that showed the role of trait mindfulness as a resiliency factor against different kinds of mental disorders such as depression and social anxiety (18). Mindfulness helps individuals to use adaptive strategies for emotion regulation (37), so individuals who can use better emotion regulation strategies may be less prone to attempt suicide to cope with negative emotions. In another research on college students, it has been reported that mindfulness can decrease the effects of neuroticism as a significant mediator variables on depression, (19). Also, it has been suggested that mindfulness–based intervention such as mindfulness-based cognitive therapy and dialectical behavior therapy can decrease suicide ideation in individuals with major depressive disorder (19). This finding supported the theoretical foundation of using mindfulness in the treatment of suicidal behaviors in individuals with substance use disorders. According to cry of pain model of suicide (38), suicide is caused by feeling of entrapment and helplessness. These feelings then interrupt problem solving and increase access to negative emotions over general memories that aggravate suicidal thoughts. In contrast, mindfulness is a way of attention that enriches the capacity to solve problems and it is more related to the retrieval of specific memories (19). So, mindfulness help individuals against suicide risk by decentering from negative thoughts and changing flexibly focus of attention from distressing memories (38)
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Anger management in substance abuse based on cognitive behavioral therapy: an interventional study

Anger management in substance abuse based on cognitive behavioral therapy: an interventional study

illogical beliefs affecting patients’ affection, behaviors, and belief reconstruction [11]. The Patrick-Reilly ap- proach is a cognitive behavioral approach based on a combination of cognitive interventions, relaxation, and communication skills. During therapeutic sessions based on Patrick-Reilly’s approach, different strategies are pro- vided for controlling anger initiation and its consistency. In addition, some tasks are given to participants in order to guarantee learning. A number of these strategies include relaxation through respiration, progressive muscle relax- ation, thought blocking, and assertion skills [6]. Consider- ing the importance of anger and aggression control among patients abusing substances, researcher’s experience about the frequency of aggression and physical conflicts between patients and nurses in psychiatric wards, and families’ con- cern about management of this misbehavior after their dis- charge, the present study aims to perform anger management group education based on Patrick Reilly’s cognitive behavioral therapy approach. The aim of the intervention is to provide participants with education ac- cording to evidence-based and scientific findings in ways that help them to gradually be able to control and manage their anger through simple strategies and skills.
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