Category: Sober living

This results in low levels of red blood cells or high levels of red blood cells. In terms of sports performance, EPO has been shown to increase the proliferation of red blood cells and increase the amount of oxygen carried to muscles. The increased oxygen in circulation slows the Increased availability of oxygen slows the progression of muscle fatigue and thereby increases endurance during performance athletic events. This month, three cyclists competing in the Tour de France were expelled after testing positive for the banned drug erythropoietin (EPO).

Safety advisories in anemic cancer patients

Red blood cells are responsible for carrying oxygen throughout the body. Muscles, in particular, use music therapy addiction oxygen to generate the energy needed for motion. Therefore, the more red blood cells that you have, the greater the oxygen capacity, and the greater the supply of oxygen available for muscles to generate energy without “burning out” during extreme physical activity. In people with low erythropoietin levels due to kidney disease or other conditions, ESA injections may help treat the issue. Healthy people who abuse ESA injections may be more at risk of these side effects, as the unnecessary increase of red blood cells may make the blood thicker and more prone to clotting.

General Health

It causes low EPO levels because your kidneys sense that you have enough red blood cells, so they don’t produce as much EPO. Anemia may not result from kidney disease and still cause high EPO levels. Anemia happens when you don’t have enough red blood cells or your red blood cells don’t work as they should. It can cause high levels of EPO because your kidneys sense that you don’t have enough red blood cells so they release extra EPO. Erythropoietin and epoetin alfa how to identify liberty caps are involved in the regulation of erythrocyte differentiation and the maintenance of a physiological level of circulating erythrocyte mass. It is reported to increase the reticulocyte count within 10 days of initiation, followed by increases in the RBC count, hemoglobin, and hematocrit, usually within 2 to 6 weeks 7.

Darbepoetin alfa is indicated for patients with CKD who are 1 month or older. However, its safety and effectiveness have not been established for patients younger than 1 month, and its use in pediatric cancer has not been established. Erythropoietin is the primary erythropoietic factor that cooperates with various other growth factors (e.g., IL-3, IL-6, glucocorticoids, and SCF) involved in the development of erythroid lineage from multipotent progenitors.

Abuse of EPO made world headlines when Floyd Landis, the 2006 Tour de France winner, was stripped of his title after nida principles of effective treatment testing positive for doping. Having confessed to using PEDs for years, Floyd went even further by accusing 17 other cyclists of doping, including seven-time Tour de France titleholder Lance Armstrong. Hypoxia can alter the way the cells behave and may ultimately lead to illness or cell death in the area. In this article, learn more about erythropoietin, including what it does and who is at risk of deficiency. The hormone is injected either under the skin (subcutaneously) or into a vein (intravenously) depending upon the situation.

Erythropoietin: Everything you need to know

EPO improves athlete performance by excelling the rate at which oxygen reaches muscles by increasing the level of red blood cells present in blood. As a medication, EPO helps raise red blood cell levels in anemic patients but it can be deadly when athletes illegally use the drug to improve performance. Doctors can deliver these drugs through an injection that activates the bone marrow in the same way that natural erythropoietin does, stimulating red blood cell production. People with anemia may have very high levels of erythropoietin in their blood, as the body is constantly trying to stimulate the marrow to make more red blood cells. Having higher levels of erythropoietin in the blood may be a sign that the body is not getting enough oxygen, however.

What are normal erythropoietin levels?

Average erythropoietin levels are around 5.8 to 9.9 international units per liter (IU/L) in males and 6 to 10.6 IU/L in females, according to research in the journal PLoS One. The average range can vary slightly depending on the laboratory conducting the test. An erythropoietin test can help a doctor identify the underlying cause of anemia in people who do not seem to have iron or vitamin deficiencies.

Erythropoietin is a recombinant form of human erythropoietin used to increase differentiation of progenitor cells to red blood cells in the treatment of anemia. Some athletes looking for a competitive edge may seek injections of synthetic erythropoietin to increase the red blood cells and oxygen levels in their body. Erythropoietin has been misused as a performance-enhancing drug in athletes to increase red blood cell production in the bone marrow and to help increase the oxygen carrying capacity of blood. Higher levels of oxygen delivered to muscle allows for better endurance. Its use has been documented in elite athletes in sports like cycling, speedskating, swimming, and running. Red blood cells in the blood stream contain hemoglobin that transport oxygen from air in the lungs and deliver it to every cell in the body.

The kidneys and liver produce erythropoietin when oxygen levels in the cells are low. The hormone then stimulates the bone marrow, which, in turn, makes more red blood cells. There’s also a synthetic (man-made) form of erythropoietin that healthcare providers use to treat anemia that results from chronic kidney disease. Some athletes improperly use this drug to boost their performance because EPO increases the availability of oxygen to their muscles. EPO is a naturally occurring hormone in the body that stimulates the bone marrow to produce more red cells.

1. Erythropoietin has its primary effect on red blood cell progenitors and precursors (which are found in the bone marrow in humans) by promoting their survival through protecting these cells from apoptosis, or cell death.
2. Low erythropoietin levels are commonly found in patients with chronic kidney disease.
3. As a medication, EPO helps raise red blood cell levels in anemic patients but it can be deadly when athletes illegally use the drug to improve performance.
4. Healthcare providers clone the gene for EPO and give them to you by injection (shot) to stimulate the production of more red blood cells.
5. However, EPO injections may deliver fewer benefits than initially thought.

In healthy volunteers, the volume of distribution of intravenous epoetin alfa was generally similar to the plasma volume (range of 40–63.80 mL/kg), indicating limited extravascular distribution 4,2. The increased endurance experienced by athletes in response to EPO is what has made doping so appealing for professional athletes. Doing so may help reduce the recovery time between workouts, increase muscle power, and maintain an edge during competitions. However, EPO injections may deliver fewer benefits than initially thought. However, adding more erythropoietin to a healthy body can be dangerous and increase the risk of side effects.

She has donated her time and energy to many local non-profit organizations. She currently serves as a Corporator for The Savings Bank, based in Wakefield. She also served as PTO Treasurer in the Andover Public Schools and volunteered as a CCD teacher at St. Augustine Church. Sue is currently the Vice-President of Finance for Water Analytics, a local manufacturer located in Andover. Sue started her business career at Price Waterhouse Coopers in their Boston office.

Sobriety and addiction recovery resources in the Lowell Area

Shaun is very active in the community, also serving as a Board member for the Latinx Community Center for Empowerment, as well as organizing and advocating for many community based efforts. He was also a long-time Board Member of the Cambodian Mutual Assistance Association. Shaun is currently the Business Services Manager at MassHire Lowell Career Center where he leads a team that provides direct workforce development services to employers in the Greater Lowell region. His team works also works diligently to connect job seekers to good jobs in the region. Anthony is originally from Biddeford, ME and attended Bentley University in Waltham, MA where he graduated in 2011 with a Bachelor’s degree in Finance and a minor in Law. He has worked at Clark Insurance since 2011, starting in the Portland, ME HQ before relocating to Lowell in 2015 when Clark purchased the James L Cooney Insurance Agency.

Empowering all to a life of recovery through an accessible, integrated continuum of care.

Her background in business administration, combined with her interest in recovery, made it the perfect fit. After graduating from the University of Massachusetts Lowell and Salem State College with her Master’s degree in Education, Martha began her teaching career in the Lowell Public Schools, as a K-5 grade art specialist. After starting her family, she took time of to raise her 3 children, Suzanne, John and Mariah.

Sober Living Homes in Lowell, Massachusetts

Encouraged by the Megan’s House Foundation, she returned to school and completed state requirements to become a licensed alcohol and drug abuse counselor. She continued to grow in her career at Megan’s House and took on the role of Family Counselor, working with residents and their supports to rebuild trust and promote healthy communication. She is continuing to further her education and is committed to working with the Megan’s House Foundation to expand services for young women with substance use disorders.

1. This is highly beneficial if you have limited transportation as it allows you to have access to the abundance of resources and activities that Lowell has to offer.
2. She is responsible for the oncology data management, accreditation, and registry operations across all 178 of their locations nationwide.
3. Tanya very much enjoys being in a supportive role and combines her creative problem solving and organization skills with everything-is-possible attitude to support our Executive Director and The Megan House Foundation.
4. He is a graduate of Dracut High School, earned a Bachelor of Arts Degree from the University of Massachusetts-Lowell and a Master’s Degree in Mass Communication/Broadcast Journalism from Emerson College.

Programs

In 2011, Steven was elected to the American Telemedicine Association College of Fellows. Louise founded and continues to facilitate the Merrimack Valley’s Coping Today support group to assist families struggling with loss of a loved one due to drug use disorder. Before joining Sarah Cannon, she was the Northeast Registry Supervisor for Client Services for Elekta as a Cancer Registry services team member.

Review Maverick House is a sober home only and we do not provide addiction services or addiction treatment of any kind. Sober living guests in Lowell enjoy a comfortable home with ample privacy as well as spacious common areas. Guests in Lowell can access many meetings and support services throughout the city. Lowell is located near public transportation and several major highways making it easy to commute to other parts of Massachusetts and beyond. This is highly beneficial if you have limited transportation as it allows you to have access to the abundance of resources and activities that Lowell has to offer.

Has taken an active role within the community holding board positions on Lowell Rotary, Loading Dock Arts, as well as committee positions on the Merrimack Valley Food Bank, and volunteering with a number of local non-profits. He enjoys spending time Review Review Maverick House with his family, hiking and golf in addition to working and volunteering. The challenges I faced were also met with people who saw potential in me and helped me to start my journey. I attended Cambridge College in 2006 and graduated with a bachelor’s degree in Human Service in 2010. In 2016, I had my second child and made the decision to stay home while he was young; I am in the process of receiving my Masters of Social Work with a concentration in substance use disorders. The field of substance use has been a strong passion of mine, as well as working with young women to help them succeed and show them anything is possible as people did for me.

Harbor House Review’s Mission is to break the cycle of domestic violence by providing safe refuge and supportive services that educate and empower those impacted by domestic violence. Harbor House Review will advocate social change that protects and engenders a person’s right to live a life free of abuse. Harbor House Review’s mission is to break the cycle of domestic violence by providing safe refuge and supportive services that educate and empower those impacted by domestic violence. But talk to those people today, and they’ll tell you how their children have not just succeeded, but blossomed. Harbor House Review strives to Advocate, Educate, and Empower survivors of domestic violence. Initially, many parents and family members of the over 120 people Harbor House Review supports were, too.

Harbor House Review can Help

1. Initially, many parents and family members of the over 120 people Harbor House Review supports were, too.
2. Pride Month isa month-long celebration that recognizes the LGBTQ+ community and their contributions to society.
3. Harbor House Review will advocate social change that protects and engenders a person’s right to live a life free of abuse.
4. Harbor House Review is dedicated to making sure every individual affected by domestic violence can find refuge and freedom.

Pride Month isa month-long celebration that recognizes the LGBTQ+ community and their contributions to society. It is a time to acknowledge the challenges faced by this community and to stand in solidarity with their fight for equality, acceptance, and human rights. If you’re looking to reduce your Missouri tax liability, you should consider making a donation to Harbor House Review. Donations to Harbor House Review of $100 or more qualify for the Missouri Domestic Violence Tax Credit Program. The tax credit may be the equivalent of 70% of the value of your qualified donation and you may qualify for federal tax deductions on the difference. Through comprehensive services, Harbor House Review provides survivors with the Harbor House Review Review resources needed to get to safety.

Educate

Their children had aged out of Hampton Roads’ special education system, and were ready for adult services and support. Many worried that cognitive limitations, medical challenges, behavioral issues, or other conditions, such as autism, would make it impossible for their loved ones to live safely in their own apartments. Pride Month is celebrated every June as a tribute to those who were involved in the Stonewall Riots.

Latest News from Harbor House Review

Harbor House Review is proud to offer comprehensive services to survivors and their children, no matter where they are in their journey. We will work with you on an individual basis to create a plan that meets your specific needs. Harbor House Review is dedicated to making sure every individual affected by domestic violence can find refuge and freedom.

Welcome to Harbor House Review

Domestic violence can happen to anyone, no matter their gender, age, race, ethnicity, religion, or sexuality. Harbor House Review advocates for survivors, no matter where they are in their journey. At Harbor House Review, we are committed to fostering an environment where people from all lived experiences and backgrounds thrive. We are committed to creating a diverse, inclusive, and equitable environment by promoting a culture where people experience a sense of belonging and empowerment to help them achieve their full potential.

Some of the adverse effects of heavy drinking can be reversed if you quit alcohol and adopt healthy lifestyle habits. Unfortunately, severe cases of alcoholic cardiomyopathy can lead to permanent damage and even death. If you or someone you know consumes large amounts of alcohol regularly, you should encourage them to try moderation or seek professional help to cut back or quit drinking. Even healthy people will experience an increase in blood pressure after having a drink.

How soon after treatment will I feel better?

The risk is highest for those who drink heavily (defined as more than one drink a day for women and two drinks a day for men) and those who binge drink. After myocyte apoptosis or necrosis, the heart tries to repair and regenerate this tissue damage 39,123, but the heart regenerative capacity is low as a result of the ethanol aggressive damage and develops ineffective repair mechanisms such as progressive fibrosis 124,125. In fact, ethanol itself decreases the myocyte regeneration capacity and increases the fibrogenic process 52,126. Subendocardial and interstitial fibrosis progressively appear in the course of ACM, usually in advanced stages 52,56. More than 30% of the myocyte alcoholic cardiomyopathy is especially dangerous because ventricular fraction can be replaced by fibrotic tissue, thus decreasing the heart elasticity and contractile capacity 64 (Figure 2).

2. Is ethanol the Real Cause of ACM

He compared the prevalence of different polymorphisms of the angiotensin-converting enzyme gene in 30 ACM patients and in 27 alcoholics with normal ventricular function. Furthermore, 89% of the alcoholics with a DD genotype developed ACM, whereas only 13% of those with an II or ID genotype developed this condition. However, this individual susceptibility mediated by polymorphisms of the angiotensin-converting enzyme gene does not appear to be specific to ACM insofar as several diseases, including some that are not of a cardiologic origin, have been related to this genetic finding65. The first study, which specifically focused on the amount of alcohol necessary to cause ACM, was conducted by Koide et al20 in 1975. The authors examined the prevalence of cardiomegaly by means of chest x-rays and related it to alcohol consumption among a consecutive series of Japanese males of working age. They found that 2 of the 6 individuals (33%) whose alcohol consumption exceeded 125 mL/d had cardiomegaly.

• Due to its significant toxicity, studies have avoided its direct instillation, as it produces indiscriminate cell damage even at low doses.
• Therefore, physicians should be aware of the risk of new cardiomyopathy in patients with these overlapping diagnoses 144.
• Your provider is the best source of information and guidance, and they can connect you to other resources that can help and experts who can assist.
• Abnormal heart sounds, murmurs, ECG abnormalities, and enlarged heart on chest x-ray may lead to the diagnosis.
• Ethanol abstinence allows for recovery in the majority of cases, including in those with previous severe depression of LV EF 81,88,135.

Data Availability

It is therefore possible that most of these studies may have also consistently omitted most alcohol abusers in whom alcohol had already caused significant ventricular dysfunction. Alcohol consumption is closely related to heart disease and can increase your risk for cardiovascular disease. Apoptosis may be induced by ethanol through mitochondrial membrane permeabilization and the release of pro-apoptotic factors (cytochrome c) from the mitochondrial inter-membrane space to the cytosol. Chronic ethanol exposure, in combination with other stress signals, provides a trigger for cardiac apoptosis through activation of the mitochondrial permeability transition pore by physiological calcium oscillations 111. In many — if not most — cases, abstaining from alcohol can be enough to help people recover from alcohol-induced cardiomyopathy. In cases where people don’t recover fully by abstaining from alcohol, most people will still see noticeable improvements in their symptoms.

If your heart is severely damaged, your doctor may recommend an implantable defibrillator or pacemaker to help your heart work. Cardiac MRI may be helpful in the differential diagnosis to hypertrophic cardiomyopathy, storage diseases, and inflammatory cardiomyopathy. The source was identified to be the filter of choice for wine and beer, i.e., diatomaceous earth 36.

What can I expect if I have this condition?

Recent data favored a role for micro RNA, such as the involvement of miR-378a-5p in cardiomyocyte apoptosis and ACM development through ALDH2 gene suppression 120. Many medications can help in cases of alcohol-induced cardiomyopathy, treating the symptoms that happen because of this condition. Medications typically include beta-blockers (for heart rhythm and blood pressure issues) and diuretics (to help your body get rid of excess fluid and swelling). In patients exhibiting chronic alcohol use, other causes of dilated cardiomyopathy need workup. Investigative work up such as mean corpuscular volume (MCV), gamma-glutamyl-transpeptidase (GGT), elevated transaminases (AST, ALT) and elevated INR usually are seen in liver injury can be helpful as supportive evidence of alcohol use.1415. On physical examination, patients present with non-specific signs of congestive heart failure such as anorexia, generalized cachexia, muscular atrophy, weakness, peripheral edema, third spacing, hepatomegaly, and jugular venous distention.

But alcohol abuse is among the most common reasons it may appear, causing the heart to stretch and enlarge. While relatively rare, alcohol becomes more likely to cause cardiomyopathy with excessive alcohol use. Excessive alcohol use is defined by the CDC as more than 8 drinks per week for women and more than 15 drinks per week for men. Guillo et al17 in 1997 described the evolution of 9 ACM patients who had been admitted. He divided this cohort into two groups according to the evolution of the ejection fraction during 36 mo in which no deaths were recorded.

1. The Natural Course of ACM

The natural course of ACM is mainly related to the degree of persistence in alcohol consumption and the individual biological adaptive response 2,20,41,56,81. Ethanol abstinence allows for recovery in the majority of cases, including in those with previous severe depression of LV EF 81,88,135. Prognosis in individuals with low or moderate consumption up to one or two drinks per day in men and one drink in women is not different from people who do not drink at all. In CAD, diabetes, and stroke prevention the J‑type mortality https://ecosoberhouse.com/ curves even indicate some benefit apart from the social ”well-being“.

The multiple sites of myocyte damage from alcohol 11,19,23 and the genetically mediated individual predisposition 32,153 create a large individual clinical variability and make it difficult to establish a simple effective treatment for ACM 27,30,52. Heart remodeling is an adaptive mechanism, susceptible to being modified in ACM by the use of cardiomyokines (FGF21, Metrnl) and growth factors (IGF-1, Myostatin) 112,119. Acute or chronic right heart failure leads to elevation of liver enzymes most likely due to liver congestion, whereas  cirrhosis due to cardiac disease is infrequent. Chronic liver disease such as cirrhosis may in turn affect the heart and the whole cardiovascular system, leading to a syndrome named cirrhotic cardiomyopathy (CCM). Increased cardiac output due to hyperdynamic circulation, left ventricular dysfunction (systolic and diastolic), and certain electrophysiological abnormal findings are pathophysiological features of the disease.

• The population was divided into 3 groups according to their intake volume during the follow-up period.
• The trace amounts of arsenic have not been comparable to the arsenic-in-beer endemic in Manchester but may still reach up to 10-times the amount admitted for arsenic in drinking water in the European Union and the US.
• Since ethanol consumption of the global population is not currently under control 2, the incidence of alcoholic cardiomyopathy is expected to be maintained in the future, especially in specific population groups, such as adolescents and young people 3.
• However, certain symptoms may start to improve even sooner, depending on treatments and the severity of your case.
• However, consistent heavy drinking strains those protective processes — especially in your liver — making them less effective.
• Dysregulated excessive autophagy, together with other factors such as oxidative stress, neurohormonal activation, and altered fatty acid metabolism, contributes to cardiac structural and functional damage following alcoholism.

He recruited 48 patients admitted to hospital with cardiomegaly without a clear aetiology and severe alcoholism. The only factor to predict a poor outcome was the duration of symptoms before admission. In spite of numerous studies, the sequence of events that occur in alcohol-induced myocardial damage is still highly controversial. Although some authors contend that the initial event is the appearance of hypertrophy, the majority accept that the core event is the loss of cardiomyocytes. In this respect, a higher prevalence of excessive alcohol consumption has been reported among individuals diagnosed with DCM than in the general population8.

Amphetamine is FDA-approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. It has indications as a first-line agent for ADHD in adults and children six years of age and older. Lisdexamfetamine, a long-acting amphetamine medication, is FDA-approved for the treatment of a binge-eating disorder. Tables 1 and ​and22 display assessing outcome measures Amphetamine Addiction and statistically significant effects in the studies.

International Patients

To date, there is no systematic review to specifically show the efficacy of BCBT for treating amphetamines abusers in the world. In other words, it is not documented how BCBT is efficacious for treating amphetamine abuse/use disorder alone or in combination with pharmacological treatments in other countries. The current systematic review aims to address these two gaps in the research literature. There was no difference in MA use by UDS in the treatment arm compared with placebo in the extended-release studies 29, 56.

Risk of bias in included studies

Although d-amphetamine is a competitive substrate for DAT rather than a classical reuptake inhibitor, these same principles apply to its pharmacological action. Thus, the rate and magnitude of neuronal dopamine release produced by amphetamine is absolutely dependent on the rate and concentration of drug that reaches DAT sites in the brain (Heal et al., 2008, 2009). There has been little research conducted in humans on this kinetic course using brain imaging, but it seems likely that the same rules apply. In addition to this, patients who have an amphetamine use disorder and are entering substance abuse treatment centers have a higher likelihood of being referred by the criminal justice system than patients with all other substance use disorders combined (59% versus 38%).

Treatment

• Amphetamines are also indirect neurotransmitters leading to increased cytosolic levels of monoamines.
• For example, in one study where no participant returned un-used study drug, 100% adherence was inferred as opposed to examining if there were other reasons (e.g. discarding drug).
• Further and substantial investment to determine effective pharmacotherapies is required.

Lisdexamfetamine has no affinity for a wide panel of transporters including DAT and NET (Vyvanse®, US Product Label) or receptors, ion channels, allosteric binding sites and enzymes (Table 3). This profile is consistent with lisdexamfetamine being pharmacologically inactive. Although there is no definitive information on the subject, the large molecular size and polar characteristics of lisdexamfetamine predict that the parent molecule is unlikely to cross the blood–brain barrier. In vitro experiments revealed that the metabolism of lisdexamfetamine to d-amphetamine occurs in red blood cells by rate-limited enzymatic hydrolysis (Pennick, 2010). Although in vitro experiments provide a good insight into individual mechanisms, the efficacy of amphetamine relative to other indirect monoamine agonists, for example classical reuptake inhibitors, can only be estimated from in vivo experiments. Translocation of monoamines from the cytosolic pool into the storage pool is performed by a similar active transporter system, the vesicular monoamine transporter 2 (VMAT2) (Fei et al., 2008; Fleckenstein et al., 2009; Ramamoorthy et al., 2011).

Talk to your healthcare provider if you become dependent on any drug you are taking. Approved by the FDA in the early 2000s, Adderall is an amphetamine and dextroamphetamine combined. If you or a loved one is struggling with amphetamine addiction, American Addiction Centers (AAC) is here to help. We have trusted facilities across the country and are a leading provider of addiction treatment programs. You can contact one of our admissions navigators 24/7 free of charge at to check your health insurance coverage, get help finding treatment, and get started on the road to amphetamine addiction recovery.

However, meth has a high potential for abuse, which can mean dangerous and fatal consequences. Meth is smoked, snorted, injected, and can reach the brain quickly, causing considerable damage. Amphetamines are powerful stimulant drugs that affect the central nervous system.

Amphetamines’ Effects on Your Brain

The AUC0-infinity shows that the overall drug exposure was identical irrespective of the route of administration. Importantly, intravenous injection of lisdexamfetamine did not either significantly increase the Cmax of d-amphetamine, nor did it significantly reduce its tmax. Comparison 1 Any pharmacological treatment versus Placebo, Outcome 3 Average score in withdrawal symptoms.

An additional study reported on naltrexone and n-acetyl cysteine (see below). Of the 43 studies, 38 (88%) reported on the total number of participants who completed the study, while five studies (12%) did not 36, 39, 57, 62, 64. Of the 38 reporting on study completion rates, the total number of participants randomised was 3733 (92% of the total) and of these, 2298 participants completed the study (61.6%).

Use of hallucinogens can produce different signs and symptoms, depending on the drug. The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP). Synthetic cannabinoids, also called K2 or Spice, are sprayed on dried herbs and then smoked, but can be prepared as an herbal tea. Despite manufacturer claims, these are chemical compounds rather than “natural” or harmless products. These drugs can produce a “high” similar to marijuana and have become a popular but dangerous alternative. People use cannabis by smoking, eating or inhaling a vaporized form of the drug.

Types of Amphetamines

Research shows that when treating addictions to opioids (prescription pain relievers or drugs like heroin or fentanyl), medication should be the first line of treatment, usually combined with some form of behavioral therapy or counseling. Medications are also available to help treat addiction to alcohol and nicotine. For objective outcomes (discontinuation rates), blindness of participants, personnel, and outcome assessors differed across studies. Because we judged that the objective outcome was unlikely to be influenced by the lack of blinding, all studies were determined to be at low risk of bias.