Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder.

Abstinence motivation Alcohol Use Disorder App Intervention Mixed methods Qualitative interviews Relapse prevention Telephone coaching

Journal

Addiction science & clinical practice
ISSN: 1940-0640
Titre abrégé: Addict Sci Clin Pract
Pays: England
ID NLM: 101316917

Informations de publication

Date de publication:
06 May 2024
Historique:
received: 05 02 2023
accepted: 25 03 2024
medline: 7 5 2024
pubmed: 7 5 2024
entrez: 6 5 2024
Statut: epublish

Résumé

As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation. Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data. Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior. The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether. The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).

Sections du résumé

BACKGROUND BACKGROUND
As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation.
METHODS METHODS
Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data.
RESULTS RESULTS
Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior.
CONCLUSIONS CONCLUSIONS
The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether.
TRIAL REGISTRATION BACKGROUND
The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).

Identifiants

pubmed: 38711152
doi: 10.1186/s13722-024-00457-7
pii: 10.1186/s13722-024-00457-7
doi:

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

35

Informations de copyright

© 2024. The Author(s).

Références

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders [Internet]. American Psychiatric Association. 2013 [cited 2018 Mar 31]. http://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 .
Atzendorf J, Rauschert C, Seitz N-N, Lochbühler K, Kraus L. The Use of Alcohol, Tobacco, illegal drugs and Medicines. Dtsch Arztebl Int; 2019. p. 116.
Hammer JH, Parent MC, Spiker DA, World Health Organization. Global status report on alcohol and health 2018 [Internet]. Glob status Rep alcohol; 2018. http://www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf http://www.ncbi.nlm.nih.gov/pubmed/29355346 .
Henssler J, Müller M, Carreira H, Bschor T, Heinz A, Baethge C. Controlled drinking—non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression. Addiction. 2021;116:1973–87. https://doi.org/10.1111/add.15329 .
doi: 10.1111/add.15329 pubmed: 33188563
Magill M, Ray L, Kiluk B, Hoadley A, Bernstein M, Tonigan JS, Carroll K. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: treatment efficacy by contrast condition. J Consult Clin Psychol. 2019;87(12):1093. https://doi.org/10.1037/ccp0000447 .
doi: 10.1037/ccp0000447 pubmed: 31599606 pmcid: 6856400
Ray LA, Bujarski S, Grodin E, Hartwell E, Green RJ, Venegas A et al. State-of-the-art behavioral and pharmacological treatments for alcohol use disorder. Taylor & Francis. 2019;45:124–40. https://doi.org/101080/0095299020181528265.
Ray LA, Meredith LR, Kiluk BD, Walthers J, Carroll KM, Magill M. Combined pharmacotherapy and cognitive behavioral therapy for adults with Alcohol or Substance Use disorders: a systematic review and Meta-analysis. JAMA Netw Open. 2020;3:e208279–208279. https://doi.org/10.1001/jamanetworkopen.2020.8279 .
doi: 10.1001/jamanetworkopen.2020.8279 pubmed: 32558914 pmcid: 7305524
Deutsche Gesellschaft für Psychiatrie und, Psychotherapie P. und N, (DGPPN), (DG-SUCHT) DG für S Und S e. V. overview | alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence |. Guidance | Nice; 2020.
Nora D, Volkow MD. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Preface | NIDA. Princ. drug Addict. Treat. A Res. Guid. (Vol. 12, No. 4180). DIANE Publ; 2011.
Miller WR, Walters ST, Bennett ME. How effective is alcoholism treatment in the United States? Rutgers University Piscataway, NJ; 2001;62:211–20. http://dx.doi.org/1015288/jsa200162211.
Raven MC, Carrier ER, Lee J, Billings JC, Marr M, Gourevitch MN. Substance use treatment barriers for patients with frequent hospital admissions. J Subst Abuse Treat. 2010;38:22–30. https://doi.org/10.1016/j.jsat.2009.05.009 .
doi: 10.1016/j.jsat.2009.05.009 pubmed: 19540700
Andrade LH, Alonso J, Mneimneh Z, Wells JE, Al-Hamzawi A, Borges G, et al. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med. 2014;44:1303–17. https://doi.org/10.1017/S0033291713001943 .
doi: 10.1017/S0033291713001943 pubmed: 23931656
Mojtabai R, Chen LY, Kaufmann CN, Crum RM. Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders. J Subst Abuse Treat. 2014;46:268–73. https://doi.org/10.1016/j.jsat.2013.07.012 .
doi: 10.1016/j.jsat.2013.07.012 pubmed: 23992953
Campbell EJ, Lawrence AJ, Perry CJ. New steps for treating alcohol use disorder. Psychopharmacology. 2018;235:1759–73. https://doi.org/10.1007/s00213-018-4887-7 .
doi: 10.1007/s00213-018-4887-7 pubmed: 29574507
Ebert DD, Van Daele T, Nordgreen T, Karekla M, Compare A, Zarbo C et al. Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health. European Psychologist. 2018;23:167–87. https://doi.org/101027/1016-9040/a000318.
Barak A, Grohol JM. Current and future trends in Internet-supported Mental Health interventions. J Technol Hum Serv Routledge. 2011;29:155–96. https://doi.org/10.1080/15228835.2011.616939 .
doi: 10.1080/15228835.2011.616939
Donker T, Petrie K, Proudfoot J, Clarke J, Birch M-R, Christensen H. Smartphones for smarter delivery of mental health programs: a systematic review. J Med Internet Res. 2013;15:e247. https://doi.org/10.2196/jmir.2791 .
doi: 10.2196/jmir.2791 pubmed: 24240579 pmcid: 3841358
Riper H, Hoogendoorn A, Cuijpers P, Karyotaki E, Boumparis N, Mira A, et al. Effectiveness and treatment moderators of internet interventions for adult problem drinking: an individual patient data meta-analysis of 19 randomised controlled trials. PLOS Med Public Libr Sci. 2018;15:e1002714. https://doi.org/10.1371/journal.pmed.1002714 .
doi: 10.1371/journal.pmed.1002714
Riper H, Blankers M, Hadiwijaya H, Cunningham J, Clarke S, Wiers R, et al. Effectiveness of guided and unguided low-intensity internet interventions for adult alcohol misuse: a meta-analysis. PLoS ONE. 2014;9. https://doi.org/10.1371/journal.pone.0099912 .
Kiluk BD, Ray LA, Walthers J, Bernstein M, Tonigan JS, Magill M. Technology-delivered cognitive‐behavioral interventions for alcohol use: a meta‐analysis. Alcohol Clin Exp Res. 2019;43(11):2285–95. https://doi.org/10.1111/acer.14189 .
doi: 10.1111/acer.14189 pubmed: 31566787 pmcid: 6824956
Gonzalez VM, Dulin PL. Comparison of a smartphone app for alcohol use disorders with an internet-based intervention plus bibliotherapy: a pilot study. J Consult Clin Psychol. 2015;83:335–45. https://doi.org/10.1037/a0038620 .
doi: 10.1037/a0038620 pubmed: 25622202 pmcid: 4426096
Gustafson DH, McTavish FM, Chih M-Y, Atwood AK, Johnson RA, Boyle MG, et al. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry. 2014;71:566–72. https://doi.org/10.1001/jamapsychiatry.2013.4642 .
doi: 10.1001/jamapsychiatry.2013.4642 pubmed: 24671165 pmcid: 4016167
Ryan RM, Deci EL. A self-determination theory approach to psychotherapy: the motivational basis for effective change. Can Psychol. 2008;49:186–93. https://doi.org/10.1037/a0012753 .
doi: 10.1037/a0012753
Krebs P, Norcross JC, Nicholson JM, Prochaska JO. Stages of change and psychotherapy outcomes: a review and meta-analysis. J Clin Psychol. 2018;74:1964–79. https://doi.org/10.1002/jclp.22683 .
doi: 10.1002/jclp.22683 pubmed: 30335193
Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71:843–61. https://doi.org/10.1037/0022-006X.71.5.843 .
doi: 10.1037/0022-006X.71.5.843 pubmed: 14516234
Senn S, Odenwald M, Sehrig S, Haffke P, Rockstroh B, Pereyra Kröll D et al. Therapeutic success in relapse prevention in alcohol use disorder: the role of treatment motivation and drinking-related treatment goals. Taylor & Francis. 2020;39:88–95. https://doi.org/101080/1055088720201820810.
DiClemente CC, Bellino LE, Neavins TM. Motivation for change and alcoholism treatment. Alcohol Res Health. 1999;23(2):86. PMID: 10890801; PMCID: PMC6760428.
pubmed: 10890801 pmcid: 6760428
Simpson DD. Modeling treatment process and outcomes. Addiction. 2001;96(2):207–11. https://doi.org/10.1080/09652140020020937 .
doi: 10.1080/09652140020020937 pubmed: 11182865
Kennedy K, Gregoire TK. Theories of Motivation in Addiction Treatment: Testing the Relationship of the Transtheoretical Model of Change and Self-Determination Theory. Taylor & Francis. 2009;9:163–83. http://dx.doi.org/101080/15332560902852052.
Philips B, Wennberg P. The importance of therapy motivation for patients with substance use disorders. Psychother (Chic). 2014;51:555–62.
doi: 10.1037/a0033360
Ryan RM, Plant RW, O’Malley S. Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvment, and dropout. Addict Behav. 1995;20:279–97. https://doi.org/10.1016/0306-4603(94)00072-7 .
doi: 10.1016/0306-4603(94)00072-7 pubmed: 7653312
Gaume J, Bertholet N, Daeppen JB. Readiness to Change predicts drinking: findings from 12-Month Follow-Up of Alcohol Use Disorder outpatients. Alcohol Alcohol. 2017;52:65–71. https://doi.org/10.1093/alcalc/agw047 .
doi: 10.1093/alcalc/agw047 pubmed: 27469491
Hser YI. Predicting long-term stable recovery from heroin addiction: findings from a 33-year follow-up study. J Addict Dis. 2007;26(1):51–60. https://doi.org/10.1300/J069v26n01_07 .
doi: 10.1300/J069v26n01_07 pubmed: 17439868
Burman S. The challenge of sobriety: natural recovery without treatment and self-help groups. J Subst Abuse. 1997;9:41–61. https://doi.org/10.1016/S0899-3289(97)90005-5 .
doi: 10.1016/S0899-3289(97)90005-5 pubmed: 9494938
Stanick V, Laudet A, Sands B. Role of individual, treatment, and post-treatment factors on sustained remission: examining gender differences. 69 ed. Annual Scientific Meeting of the College on Problems of Drug Dependence; 2007.
DiClemente CC, Doyle SR, Donovan D. Predicting treatment seekers’ readiness to change their drinking behavior in the COMBINE Study. Alcohol Clin Exp Res. 2009;33(5):879–92. https://doi.org/10.1111/j.1530-0277.2009.00905.x .
doi: 10.1111/j.1530-0277.2009.00905.x pubmed: 19320633 pmcid: 2954369
Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–5. https://doi.org/10.1037/0022-006X.51.3.390 .
doi: 10.1037/0022-006X.51.3.390 pubmed: 6863699
DiClemente CC. Addiction & change: how addictions develop and addicted people recover. 2nd ed. New York: Guilford Press; 2018.
Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, ... & COMBINE Study Research Group. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17):2003–2017. https://doi.org/10.1001/jama.295.17.2003 .
Laudet AB, Stanick V. Predictors of motivation for abstinence at the end of outpatient substance abuse treatment. J Subst Abuse Treat. 2010;38(4):317–27. https://doi.org/10.1016/j.jsat.2010.01.007 .
doi: 10.1016/j.jsat.2010.01.007 pubmed: 20185267 pmcid: 2859988
Guliyev C, İnce-Guliyev E, Ögel K. Predictors of relapse to Alcohol and Substance Use: are there any differences between 3 and 12 months after Inpatient Treatment? J Psychoact Drugs. 2021;54(4):358–67. https://doi.org/10.1080/02791072.2021.1976887 .
doi: 10.1080/02791072.2021.1976887
Marlatt GA, Witkiewitz K. Relapse Prevention for Alcohol and Drug problems. In: Marlatt GA, Donovan DM, editors. Relapse prevention: maintenance strategies in the treatment of addictive behaviors. The Guilford; 2005. pp. 1–44.
DiClemente CC. Motivation for change: implications for substance abuse treatment. Psychol Sci. 1999;10(3):209–13. https://doi.org/10.1111/1467-9280.00137 .
doi: 10.1111/1467-9280.00137
Bendelin N, Hesser H, Dahl J, Carlbring P, Nelson KZ, Andersson G. Experiences of guided internet-based cognitive-behavioural treatment for depression: a qualitative study. BMC Psychiatry. 2011;11:1–10. https://doi.org/10.1186/1471-244X-11-107 .
doi: 10.1186/1471-244X-11-107
Neale J, Allen D, Coombes L. Qualitative research methods within the addictions. Addiction. 2005;100(11):1584–93. https://doi.org/10.1111/j.1360-0443.2005.01230.x .
doi: 10.1111/j.1360-0443.2005.01230.x pubmed: 16277621
Malina MA, Nørreklit HS, Selto FH. Lessons learned: advantages and disadvantages of mixed method research. (2011). Qual Res Account Manag. 2011;8(1):59–71.
Doyle L, Brady AM, Byrne G. An overview of mixed methods research. J Res Nurs. 2009;14(2):175–85. https://doi.org/10.1177/1744987108093962 .
doi: 10.1177/1744987108093962
Saur S, Weisel KK, Lang C, Fuhrmann LM, Steins-Loeber S, Enewoldsen N, et al. App-based maintenance treatment for alcohol use disorder after acute inpatient treatment: study protocol for a multicentre randomized controlled trial. Internet Interv. 2022;28. https://doi.org/10.1016/j.invent.2022.100517 .
Mayring P. Qualitative Forschungsdesigns. Handbuch Qualitative Forschung in der Psychologie: Band 2: Designs und Verfahren; 2020;2:3–17.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. https://doi.org/10.1093/intqhc/mzm042 .
doi: 10.1093/intqhc/mzm042 pubmed: 17872937
Wiers RW, Eberl C, Rinck M, Becker ES, Lindenmeyer J. Retraining Automatic Action tendencies Changes alcoholic patients’ Approach Bias for Alcohol and improves treatment outcome. Psychol Sci. 2011;490–7. https://doi.org/10.1177/0956797611400615 .
Kuckartz U, Dresing T, Rädiker S, Stefer C. Qualitative Evaluation in sieben Schritten Schritt 1: Evaluationsgegenstand und Evaluationsziele. Qualitative Evaluation: Der Einstieg in die Praxis. 2007;15–57.
Schreier M. Varianten Qualitativer Inhaltsanalyse: Ein Wegweiser Im Dickicht Der Begrifflichkeiten. Forum Qual Soc Res. 2014;15:27. https://doi.org/10.17169/fqs-15.1.2043 .
doi: 10.17169/fqs-15.1.2043
Mayring P. Einführung in die qualitative Sozialforschung. Weinheim, Basel: Beltz; 2016.
Williams EC, Kivlahan DR, Saitz R, Merrill JO, Achtmeyer CE, McCormick KA, Bradley KA. Readiness to change in primary care patients who screened positive for alcohol misuse. Ann Fam Med. 2006;4(3):213–20. https://doi.org/10.1370/afm.542 .
doi: 10.1370/afm.542 pubmed: 16735522 pmcid: 1479439
Roskes M, Elliot AJ, De Dreu CK. Why is avoidance motivation problematic, and what can be done about it? Curr Dir Psychol Sci. 2014;23(2):133–8. https://doi.org/10.1177/0963721414524224 .
doi: 10.1177/0963721414524224
Wollburg E, Braukhaus C. Goal setting in psychotherapy: the relevance of approach and avoidance goals for treatment outcome. Psychother Res. 2010;20:488–94. https://doi.org/10.1080/10503301003796839 .
doi: 10.1080/10503301003796839 pubmed: 20665341
Mann RE, Webster SD, Schofield C, Marshall WL. Approach versus avoidance goals in relapse prevention with sexual offenders. Sex Abuse. 2004;16:65–75. https://doi.org/10.1023/B:SEBU.0000006285.73534.57 .
doi: 10.1023/B:SEBU.0000006285.73534.57 pubmed: 15017827
Fossey E, Harvey C, McDermott F, Davidson L. Understanding and evaluating qualitative research. Aust N Z J Psychiatry. 2002;36(6):717–32. https://doi.org/10.1046/j.1440-1614.2002.01100.x .
doi: 10.1046/j.1440-1614.2002.01100.x pubmed: 12406114
Peters S. Qualitative research methods in mental health. BMJ Ment Health. 2010;13:35–40. https://doi.org/10.1136/ebmh.13.2.35 .
doi: 10.1136/ebmh.13.2.35
Whitley R, Crawford M. Qualitative research in psychiatry. Can J Psychiatry. 2005;50:108–14. https://doi.org/10.1177/070674370505000206 .
doi: 10.1177/070674370505000206 pubmed: 15807227
Kelle U. Combining qualitative and quantitative methods in research practice: purposes and advantages. Qual Res Psychol. 2006;3(4):293–311. https://doi.org/10.1177/1478088706070839 .
doi: 10.1177/1478088706070839
McHugh RK, Votaw VR, Sugarman DE, Greenfield SF. Sex and gender differences in substance use disorders. Clin Psychol Rev. 2018;66:12–23. https://doi.org/10.1016/j.cpr.2017.10.012 .
doi: 10.1016/j.cpr.2017.10.012 pubmed: 29174306
Agabio R, Pisanu C, Luigi Gessa G, Franconi F. Sex differences in alcohol use disorder. Curr Med Chem. 2017;24(24):2661–70. https://doi.org/10.2174/0929867323666161202092908 .
doi: 10.2174/0929867323666161202092908 pubmed: 27915987

Auteurs

Catharina Lang (C)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany. catharina.lang@fau.de.

Kiona K Weisel (KK)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.

Sebastian Saur (S)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.

Lukas M Fuhrmann (LM)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.

Antonie Schoenleber (A)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.

Daniela Reichl (D)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany.

Niklas Enewoldsen (N)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany.

Sabine Steins-Loeber (S)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany.

Matthias Berking (M)

Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH