Journal of Psychosomatic Research 61 (2006) 305 – 310
Review article
Substance use disorders: recent advances in treatment and models of care
Mohammed T. Abou-Saleh4
Division of Mental Health, St. George’s, University of London, Cranmer Terrace, SW17 0RE London, UK
Received 20 June 2006
Abstract
Drug and alcohol misuse is a global health problem with
great health economic costs to substance misusers, their families,
and their communities. It is associated with high physical
and psychiatric morbidity, and with high mortality. There are
serious obstacles to its treatment, including the stigma associated
with it. Major advances in assessment and treatment have enabled
health professionals to tackle drug and alcohol problems in
a variety of settings, including primary care setting. This overview
focuses on recent advances in the treatment of substance
Keywords: Addiction; Alcohol; Drugs; Models of care; Treatment; Substance misuse
Introduction
Substance use disorders are among the most common
mental and behavioral disorders that affect mankind. These
disorders include those caused by alcohol, opiates, cannabis,
cocaine, sedatives, and volatile solvents. Common presen-
tations are states of intoxication, harmful use (abuse),
dependence, and comorbid psychiatric disorders. Harmful
use is diagnosed when damage has been caused to physical
or mental health, while substance dependence is diagnosed
when substance use becomes compulsive, uncontrollable,
and associated with physiological withdrawal symptoms,
with the sole pursuit of substance use despite the occurrence
of serious harm to self or others. Alcohol use disorders are
the commonest, with a global point prevalence of 1.7,
according to the Global Burden of Disease and Injury
Series, and with variation ranging from very low prevalence
rates in Middle Eastern countries to over 5% in North
4 Tel: +44 2087250368; fax: +44 2087252914.
E-mail address: mabousal@sgul.ac.uk.
0022-3999/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.jpsychores.2006.06.013
use disorders and on optimal models of care and services, with
reference to studies conducted in the United Arab Emirates.
Community surveys in Dubai and Al-Ain have shown a
high prevalence of these disorders. It is proposed that
these problems be dealt with in primary care settings, and it has
been found that primary health care workers have a key role to
play and are often in an ideal position to coordinate the com-
munity’s response.
D 2006 Elsevier Inc. All rights reserved.
America and Eastern Europe [1]. The Global Burden of
Disease and Injury Series estimated alcohol to be respon-
sible for 1.5% of all deaths and for 3.5% of total disability
adjusted life years [2]. To a lesser extent, drug use disorders
account for 1.8% of lives with disability in 15- to 44-year-
olds, compared to alcohol use disorders (5.5%) [2]. The
point prevalence of drug abuse and dependence ranges from
0.4% to 4%, which includes heroin use and cocaine use
disorders (0.25%). Injecting drug use is associated with a
high risk for contracting blood-borne infections, including
hepatitis B, hepatitis C, and HIV (20–80%).
There remains some controversy over the notion that
substance use disorders are not medical disorders but are
expressions of lifestyle or, at worst, of criminal behaviors by
people who self-inflict these problems upon themselves.
However, the development of harmful use and dependence
renders these disorders as serious psychiatric disorders
consistent with other disease states. Substance use disorders
are complex disorders and result from an interplay of genetic
and environmental factors, with a significant contribution
from genetic disposition, abnormal development, and
psychosocial disadvantage. Recent advances in neuro-
306 M.T. Abou-Saleh / Journal of Psychosomatic Research 61 (2006) 305–310
science and experimental psychology, and the applications
of their techniques have demonstrated biological and
psychosocial mechanisms that contribute to the development
of substance use disorders [3].
This overview focuses on recent advances in the treat-
ment of substance use disorders and on optimal models of
care and services, with reference to studies conducted in the
United Arab Emirates (UAE).
Assessment
The core value or guiding principle for the management
of substance misuse and dependence is that people with
substance use disorders have the same entitlement to health
and social care as other patients. It is the responsibility of all
health professionals involved in their care to provide for their
general health and social needs, as well as for their drug-
related problems, through evidence-based interventions,
including harm-reduction approaches [4].
A good assessment should be thorough and compre-
hensive, with the purposes of identifying the nature and
severity of any drug-related problem, understanding its
causes, and assessing its consequences to establish the
strengths and weaknesses of patients and their conditions.
A good assessment will enable the formulation of the
diagnosis, which comprises medical and psychiatric diag-
nosis, and appropriate investigations, including psycholog-
ical and social assessments. A good formulation will result
in a comprehensive treatment and care plan, addressing
immediate needs, risk factors, and short-term and long-term
management, including social rehabilitation for optimal
integration into normal community living.
The aims of assessment are to: (a) treat any emergency or
acute problem; (b) confirm that the patient is taking drugs
(history, examination, and urine analysis); (c) assess degree of
dependence; (d) identify complications of drug misuse and
assess risk behavior; (e) identify other medical, social, and
mental health problems; (f) give advice on harm minimization,
including, if appropriate, access to sterile needles and syringes,
testing for hepatitis and HIV, and immunization against
hepatitis B; (g) determine a patient’s expectations regarding
treatment and the degree of motivation to change; (h) assess the
most appropriate level of expertise required to manage the
patient (this may alter over time); and (i) refer/liaise
appropriately (i.e., shared care, specialist or specialized
generalist care, or other forms of psychological care, where
appropriate); (j) determine the need for substitute medica-
tion—in the case of the general practitioner, this should be
with advice from a specialist, ideally through shared care
arrangements and (k) in private practice, establish that the pa-
tient is able to pay for treatment through legitimate means [4].
Treatment
A comprehensive assessment will produce a compre-
hensive treatment and care plan. Ultimately, the aim is to
enable patients to change their lifestyle so that they can
lead life without the use of substances and they can be free
from all constraints and disabilities. The assessment of a
patient’s readiness for change is a core intervention. The
assessment of this readiness to change is based on the cycle
of change of Prochaska and DiClemente, wherein the
substance user goes through the following: (a) precontem-
plation stage—no change is being considered; (b) con-
templation stage—the user becomes ambivalent towards
drug use; (c) determination—the user decides to take steps;
and (d) action—change is started; (e) maintenance—the
user consolidates the change achieved. Drug users, how-
ever, often experience relapses into substance use and
the cycle restarts again. Based on the assessment of
readiness to change, the counselor attending to the drug
user and using motivational interviewing will provide
interventions to enhance the user’s motivation by providing
information during the precontemplation phase, increasing
ambivalence during contemplation, exploring options dur-
ing determination, working out practical strategies during
action, working out relapse prevention during maintenance,
and, finally, avoiding demoralization during relapse into
substance misuse.
The aims of the treatment are as follows: to assist patients
to remain healthy until they receive appropriate care/support
so that they can achieve a drug-free life; reduce the use of
illicit or unprescribed drugs; deal with problems relating to
drug misuse; reduce the dangers associated with drug
misuse, particularly the risk of HIV, hepatitis B/C, and
other blood-borne infections; reduce the duration of
episodes of drug misuse; reduce the chance of future relapse
into drug misuse; reduce the need for criminal activity to
finance drug misuse; reduce the risk of prescribed drugs
being diverted to the illegal drug market; stabilize the
patient, where appropriate, on a substitute medication to
alleviate withdrawal symptoms; and improve overall per-
sonal, social, and family functions [4].
Treatment is subdivided into psychological and pharma-
cological treatments, and the optimal treatment plan
provides tailor-made combined psychosocial and pharma-
cological treatments matching the substance user’s physical,
psychiatric, psychological, and social needs.
Treatment of severe addictions
There is a wide range of psychological treatments that
have been developed in recent decades and are based on
psychological theories of addictive behavior, including
conditioning and cognitive theories.
The goals of treatment are best conceived as a hierarchy
of goals, including the following: reduction of psycholog-
ical, social, and other problems directly related to drug use;
reduction of psychological, social, and other problems not
directly attributable to drug use; reduction of harmful or
risky behaviors associated with drug use (e.g., sharing
injecting equipment); attainment of less chaotic, non-
 M.T. Abou-Saleh / Journal of Psychosomatic Research 61 (2006) 305–310 307

Table 1
A summary of the main psychological therapies used in treating substance misuse
Behavioral therapy
Cue exposure treatment
Community reinforcement approach
Contingency management
Cognitive therapy
Cognitive–behavioral therapy (CBT)
Relapse prevention
Motivational interviewing
Motivational enhancement therapy
Twelve-step approaches
Other approaches
Reprinted with permission from Curran and Drummand [8]. Reproduced under the terms of the Click-Use License.
A structured therapy focusing on changing behaviors and on environmental factors that trigger
maladaptive behavior
A structured treatment involving exposure to drug-related cues that have been associated with past drug use
without consumption of the drug; this is intended to lead to a reduction (or habituation) of reactivity to drug
cues and, thus, to a reduced likelihood of relapse
A behavioral approach that focuses on what clients find rewarding in their social, occupational, and recreational
life; it aims to help them change their lifestyle and social environment to support long-term changes in behavior
whereby substances use is less rewarding that nonuse
Also known as voucher-based therapy, this aims to encourage adaptive behavior by rewarding the client for
attaining goals (e.g., no use of illicit drugs as checked by urine screens) and by not rewarding them when these
goals are unmet (e.g., illicit drug use); vouchers can usually be exchanged for consumer goods
A structured therapy using cognitive techniques (e.g., challenging a person’s negative thoughts) and behavioral
techniques (e.g., behavioral experiments and activity planning) to change maladaptive thoughts and beliefs
A combination of both cognitive and behavioral therapies
Uses several CBT strategies to enhance clients’ self-control and to prevent relapse; highlights problems that
clients may face and develops strategies that they can use to deal with high-risk situations
A focused approach aiming to enhance motivation for stopping substance use by exploring and resolving
individuals’ ambivalence about change
A brief intervention based on motivational interviewing, which also incorporates bcheck-upQ
assessment and feedback
Interventions used by self-help organizations such as Alcoholics Anonymous; these are based on a philosophy
that adopts an illness model and sees substance use as stemming from an innate vulnerability; individuals must
acknowledge their addiction and the harm it has caused to themselves and others; they must also accept their
lack of control over use and, thus, the only acceptable goal is abstinence
The involvement of partners and family through marital and family therapies builds on the known social context
of substance use; there are also various forms of counseling, group therapy, and milieu therapy

dependent, or nonproblematic drug use; abstinence from
main problem drugs; and abstinence from all drugs.
In the UK, treatments have been critically reviewed by
the government’s Task Force to Review Services for Drug
Misusers, which identified four effective treatments for drug
misuse: methadone detoxification, oral methadone main-
tenance programs, residential rehabilitation programs, and
specialist inpatient drug dependence units [5]. The task
force commissioned the National Treatment Outcome
Research Study (NTORS), which reported its findings at
1 year [6]. There were substantial and important improve-
ments in drug use, with reductions in the use of heroin,
unprescribed methadone, and benzodiazepine; in injecting;
and in the sharing of injecting equipment. Reductions were
evident at 1 year, with outcomes remaining at about the
1-year level or demonstrating further reductions. However,
crack cocaine and alcohol outcomes at 4–5 years were not
significantly different from those on intake. There were also
significant improvements in both physical and psycholog-
ical health, and a marked reduction in criminal activity, with
the important finding that, for every extra o1 (sterling) spent
on drug misuse treatment, there is a return of more than o3
in terms of cost savings associated with victim costs of
crime and reduced demands on the criminal justice system.
The authors concluded: b despite differences between the
United Kingdom and the United States in patient popula-
tions and in treatment programs, there are many similarities
between the two countries in outcomes from large-scale,
multisite studies.Q Indeed, the Drug Abuse Treatment
Outcome Study, which conducted an outpatient methadone
treatment evaluation examining the long-term effects of
methadone maintenance treatment, showed results similar to
those of NTORS [7].
Psychosocial treatments
The primacy of the psychosocial treatment of addictions
is related to their established effectiveness and, importantly,
to the provision of a context for comprehensive treatment,
including pharmacotherapy. Moreover, psychosocial treat-
ment is the treatment of choice for stimulant and cannabis
misuse, and nondependent alcohol and drug use, since there
are no effective pharmacological treatments for these
disorders. They are also useful for the treatment of comorbid
psychiatric disorders such as anxiety and depressive
disorders, and related social problems.
Elements of psychosocial treatment include the follow-
ing: provision of information, structure for care, family
involvement, facilitation of engagement and retention in
treatment, self-help groups, and a counseling style that is
nonjudgmental, empowering, and enhancing of self-esteem
and self-efficacy.
A recent review of evidence for effectiveness has been
conducted by the Foresight Brain Science, Addiction and
Drugs Project (Psychological Treatment of Substance
Misuse and Dependence) [8], as summarized in Table 1.
Psychopharmacological treatments
There has been relatively fewer new psychopharmaceut-
icals introduced for addictive disorders than for other
308 M.T. Abou-Saleh / Journal of Psychosomatic Research 61 (2006) 305–310

Table 2
Evidence-based drug treatments for substance use disorders, based on the BAP’s guidelines
Target drug Therapeutic agent(s) and mechanism
Alcohol Benzodiazepines (e.g., chlordiazepoxide and diazepam)—act
as direct g-aminobutyric acid (GABA) agonists
Antiepileptic agents (e.g., carbemazepine)—act as
GABA promoters, with other less well-characterized mechanisms
Acamprosate—affects glutamate receptors, which reduce
withdrawal-related neuronal excitation and neurotoxicity
Naltrexone—acts as opioid antagonist
Disulfiram (aldehyde dehydrogenase inhibitor)—allows the
buildup of the toxic breakdown product, acetaldehyde
Selective serotonin reuptake inhibitors
Thiamine—acts as a vitamin supplement
Benzodiazepines Carbemazepine—modulates sodium channels and
affects neurotransmission
Nicotine Nicotine agonists—are used in nicotine replacement therapy
Bupropion—acts as a monoamine (especially dopamine)
reuptake inhibitor
Opiates Methadone—acts as opioid agonist
Buprenorphine—acts as opioid A-receptor partial agonist
and n antagonist
Clonidine and lofexidine—act as a2-adrenoreceptor agonists
Naltrexone
Reprinted with permission from Iverson, Morris, and Nutt [10]. Reproduced under the terms of the Click-Use License.
Indications
(1) Withdrawal symptoms
(2) Seizure prevention and treatment
(3) Delirium prevention and treatment
(1) Withdrawal symptoms
(2) Seizure prevention
Maintenance of abstinence and relapse prevention
Maintenance of abstinence and relapse prevention
(although not licensed for this use in the UK)
Supervised use for maintenance of abstinence and
relapse prevention
(1) Maintenance of abstinence and relapse prevention in
late-onset alcoholics
(2) Treatment of comorbid depression in selected patients
(1) Prevention of neurological complications
(2) Treatment of Wernicke’s encephalopathy
Prevention and treatment of withdrawal in selected patients
Smoking cessation—maintenance therapy
Smoking cessation
(1) Withdrawal symptoms
(2) Maintenance therapy
Withdrawal symptoms
Withdrawal symptoms
Relapse prevention in selected patients

psychiatric disorders. Moreover, people with addictive Models of care

disorders comprise probably the most socially excluded
group and, importantly, they are often excluded from
participation in clinical trials of new psychopharmaceuticals
in a variety of psychiatric disorders.
The pharmacotherapy of addictions has been the
mainstay of treatment since the introduction of methadone
for opiate addiction. This established the British model
comprising methadone detoxification and maintenance,
with the latter indication becoming more established when
a harm-reduction approach was widely adopted to combat
the spread of HIV, which was later extended to reduce other
harms, including social harm and drug-related crimes. The
other well-established—albeit more recently introduced—
drug is buprenorphine, which is used for both opiate
detoxification and maintenance, and is a safe and effective
treatment for opiate addiction delivered in specialist and
general practice settings. Other new treatments include
lofexidine (for opiate detoxification). For alcohol use
disorder, one new treatment is acamprosate, an anticraving
medication, which is used particularly in combination with
naltrexone, which has also been shown to be an effective
anticraving medicine on its own. The British Association
for Psychopharmacology (BAP) [9] has recently introduced
guidelines for the treatment of addictions and comorbid
psychiatric disorders. The BAP review findings were
summarized in a the science review, Pharmacology and
Treatment [10] (Foresight Brain Science, Addiction and
Drugs Project) (Table 2).
The National Treatment Agency of Substance Misuse in
England guidance on models of care provides a treatment
framework and a process intended to support the move
towards a consensus on the essential components of
specialist substance misuse services and the importance of
links with other health, social care, and criminal justice
agencies [11]. The guidance structures substance misuse
services into four broad tiers: from Tier 1 (nonspecialist
services, including general psychiatric services) to Tier 4a
(residential care specifically for substance misusers) and
Tier 4b (highly specialized services unrelated to substance
misuse, such as forensic psychiatric services and specialist
personality disorder services). The guidance also stipulates
the development of integrated care pathways as the
preferred method of applying packages of care in a
coordinated and integrated way. Integrated care pathways
provide a means of merging local referral and treatment
protocols to define where and when a particular service user
needs to be referred.
Specialist drug services
In the UK, specialist drug clinics were established in the
late 1960s and have since evolved in their dealings with
drug users [12]. These clinics provide a comprehensive
service for drug users with complex needs, including
patients with dual diagnosis (comorbid mental illness),
 M.T. Abou-Saleh / Journal of Psychosomatic Research 61 (2006) 305–310
pregnant patients, chaotic and polydrug users, and those
with a history of failed treatment attempts, violence, and
legal problems. The drive for providing community-based
services for drug users in the 1980s led to the development
of community drug teams (CDTs) in the previous decade.
The key characteristics of CDTs include the following:
narrowly defined geographical focus, community emphasis,
multidisciplinary composition, and promotion of generic
contribution through bconsultancy.Q Collaboration between
general practitioners (GPs) and primary care teams was poor
but has slowly improved. This improvement may be related
to the abandonment of the original consultancy role for the
CDT, which has become more actively involved in the
delivery of care either directly or indirectly (on bshared-
careQ basis).
Drug services in primary health care
There is a good scope for the extension of services for
drug misusers in primary care [12]. Firstly, there are benefits
such as easy access, less stigma, and early intervention.
Secondly, the development of community-based specialized
services has provided opportunities for effective liaison and
bshared care,Q and effective models have emerged (e.g., the
Edinburgh and Glasgow schemes). Thirdly, more GPs,
particularly those more recently qualified, are willing
to provide care for drug misusers with the support of
specialist services.
A successful liaison between primary care and specialist
services depends on real communication, jointly agreed
protocols (including care planning), patient contracts with
appropriate sanctions, and regular formal reviews against
treatment goals. With appropriate training and remuneration,
methadone maintenance does have a role in general practice
settings, particularly for limited periods of time, in the
achievement of nondrug goals. Finally, since GPs accept
medical and legal responsibility for anything they prescribe,
they must have the final say, and this must be accepted by
specialist services.
Substance misuse in developing countries
The epidemic of addictions has been increasingly
recognized in the developing world. However, there have
been few epidemiological studies on their prevalence and
risk factors. Goldberg and Lecrubier [1], in a multicountry
survey, showed variation in the prevalence of alcohol use
disorders, with lower prevalence rates in non-European
countries such as India. The World Health Organization
(WHO)’s world mental health survey showed lower
12-month prevalence rates for psychiatric disorders and
less treatment in developing countries than in developed
countries, including substance misuse treatment (Lebanon,
1.3%; Nigeria, 0.8%) [13]. Moreover, disorder severity
309
correlated with the probability of treatment in almost all
countries: 35.5–50.3% of serious cases in developed
countries and 76.3–85.4% of serious cases in less devel-
oped countries received no treatment in the 12 months
before the interview. Some mild cases, especially those at
risk, progress to more serious disorders.
In the UAE, a community-based survey has shown a very
low rate of substance misuse (1%). However, when female
participants in the survey were asked about substance
misuse in first-degree male relatives, the prevalence rate
increased to 9% [14]. This indicated an underreporting of
substance misuse by men, which may be related to the
stigma of addiction (criminality of illicit drug use and
religious prohibition of alcohol use in Muslim commun-
ities). The prevalence of substance misuse in adolescents in
primary care was also studied in the UAE by Eapen and
Abou-Salehl (unpublished data), who showed that 5% of
adolescents attending primary care in the city of Al-Ain
reported substance misuse. Importantly, the use of alcohol
and drugs in adults was shown to be a strong correlate/risk
factor for psychiatric disorders in first degree relative adults
[15] and in their children [16].
Addiction services in developing countries
The development of services for substance misusers in
developing countries has been slow or nonexistent.
National mental health programs promoted by the WHO
have often referred to the growth of substance misuse in
developing countries and the need for developing addiction
services. Few countries that have developed addiction
services have targeted the needs of those with severe
addictions. In Saudi Arabia, the Al-Amal group of
addiction treatment hospitals has been established to
provide detoxification treatment and social rehabilitation.
Alcohol services are often provided by mainstream mental
health services. Drug treatment has been confined to
detoxification for people with opiate addiction, but not
maintenance treatment. There has been widespread resist-
ance to introducing methodone maintenance treatment for
people with opiate addiction, including those with injecting
drug use. This has been related to the rather puritanical
attitude that maintenance treatment with addictive thera-
peutic drugs replaces one addiction with another and that
abstinence should be the sole aim of treatment. The WHO
has promoted flexible and comprehensive approaches to the
treatment of addictions in developing countries, including
the provision of care and services in primary care.
Conclusions
Substance use disorders are common psychiatric prob-
lems in all communities and are associated with great
burdens on substance misusers, their families, and their
310 M.T. Abou-Saleh / Journal of Psychosomatic Research 61 (2006) 305–310
communities. They are associated with high rates of medical
and psychiatric comorbidity, and with high mortality.
Evidence-based assessments and treatments have been
universally established. Recent advances in psychological
and pharmacological treatments have enabled the provi-
sion of effective treatments, optimal care, and appropriate
service models. The spectrum of substance misuse
disorders requires a spectrum of comprehensive services
to match the variable severity and complexity of the needs
of substance misusers. While substance misuse services
have been well established in western communities, there
has been a large gap in the provision of these services in
the developing world. It is crucial that governments and
policy makers attend to the needs of people with
substance misuse in these countries by developing com-
prehensive community-based services, including primary-
care-based services, and by providing the training require-
ments of the workforce.
Community surveys in Dubai and Al-Ain have shown a
high prevalence of these disorders. It is proposed that these
problems be dealt with in primary care settings, and it has
been found that primary health care workers have a key role
to play and are often in an ideal position to coordinate the
community’s response.
References
[1] Goldberg DP, Lecrubier Y. From frequency of mental disorders across
centres. In: Ustin TB, Sartorius N, editors. Mental illness in general
health care: an international study. Chichester, UK: John Wiley and
Sons, 1997. pp. 323–34.
[2] Murray CJ, Lopez AD, 1996. Global burden of disease and injury
series, vol. II. Cambridge (MA)7 Global Health Statistics, Harvard
School of Public Health, on behalf of the WHO and the World
Bank, 1996.
[3] Volkow ND, Fowler JS, Wang GJ. The addicted human brain viewed
in the light of imaging studies: brain circuits and treatment strategies.
Neuropharmacology 2004;47:3 – 13.
[4] Department of Health, The Scottish Office Department of Health,
Welsh Office, Department of Health and Social Security in Northern
Ireland. Drug misuse and dependence—guidelines on clinical
management. London: The Stationary Office, 1999.
[5] Task Force to Review Services for Drug Misusers. Report of an
independent review of drug treatment services in England. London:
Department of Health, 1996.
[6] Gossop M, Marsden J, Stewart D, Kidd T. The National Treatment
Outcome Research Study (NTORS): 4–5 year follow-up results.
Addiction 2003;98:291 – 303.
[7] Hubbard RL, Craddock SG, Flynn PM, Anderson J, Etheridge RM.
Overview of 1-year follow-up outcomes in Drug Abuse Treat-
ment Outcome Study (DATOS). Psychol Addict Behav 1997;11:261 – 78.
[8] Curran V, Drummond C. Psychological treatment of substance
misuse and dependence. Office of Science and Technology, Depart-
ment of Trade and Industry, UK. Foresight Brain Science, Addiction
and Drugs Project, 2005. Available at: http://www.foresight.gov.uk/
Brain_Science_Addiction_and_Drugs/Reports_and_Publications/
ScienceReviews/Psychological%20Treatments.pdf. Accessed Febru-
ary 6, 2006.
[9] Lingford-Hughes AR, Welch S, Nutt DJ, British Association
for Psychopharmacology. Evidence-based guidelines for the phar-
macological management of substance misuse, addiction and
comorbidity: recommendations from the British Association for Psy-
chopharmacology. Br J Psychopharmacol 2004;18:293 – 335.
[10] Iverson L, Morris K, Nutt D. Pharmacology and treatment. Office of
Science and Technology, Department of Trade and Industry, UK.
Foresight Brain Science, Addiction and Drugs Project, 2005.
Available at: http://www.foresight.gov.uk/Brain_Science_Addiction_
and_Drugs/Reports_and_Publications/ScienceReviews/Pharmacology%
20and%20Treatments.pdf. Accessed February 6, 2006.
[11] Models of care for the treatment of adult drug misusers. London:
National Treatment Agency for Substance Misuse, 2002. Available at:
http://www.nta.nhs.uk. Accessed August 8, 2006.
[12] Abou-Saleh MT, Miller J. The management of drug misuse in primary
care. Prim Care Psychiatry 1999;5:49 – 56.
[13] WHO World Mental Health Survey Consortium. Prevalence,
severity, and unmet need for treatment of mental disorders in the
World Health Organization World Mental Health Surveys. JAMA
2004;291:2581 – 90.
[14] Abou-Saleh MT, Ghubash R, Daradkeh T. Al-Ain community
psychiatric survey: I Prevalence and socio-demographic correlates.
Soc Psychiatry Psychiatr Epidemiol 2001;36:20 – 8.
[15] Ghubash R, Abou-Saleh MT. Postpartum psychiatric illness in Arab
culture: prevalence and psychosocial correlates. Br J Psychiatry
1997;171:65 – 8.
[16] Eapen V, Swadi H, Sabri S, Abou-Saleh M. Childhood behavioural
disturbance in a community sample in Al-Ain, United Arab Emirates.
East Mediterr Health J 2001;7:428 – 34.