How to Reboot Your Health and Mindset After a Binge
Dr. David Wiss
September 5, 2023
Eating Disorders
What is Binge Eating Disorder?
Binge eating disorder is diagnosed based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]. It involves recurrent binge eating episodes occurring at least once a week for three months. These episodes entail consuming more food than is typically consumed in a similar timeframe, accompanied by loss of control over eating. The episode often triggers feelings of guilt and shame.
According to the DSM-5:
Binge eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after overeating
It is vital to know that even if you don't meet the clinical criteria for binge eating disorder, your experiences and struggles around binge eating are valid, and you are worthy of seeking help and finding recovery [2].
What Causes Binge Eating?
Many theories explain how binge eating is caused and sustained, including the Restraint Model, Escape Theory, and Food Addiction Theory.
Binge eating (eating a lot of food in a short time) and restriction (not eating enough) are two sides of a coin. Just like how we naturally feel really thirsty when we haven't had enough water or desperately need to breathe when we're underwater for too long, our bodies react strongly when we don't get enough of what we need.
In the same way, when we don't eat enough food, our bodies respond to the threat in powerful ways [3,4]. We might start to salivate more, and the levels of hormones that tell us we're full (leptin) and the hormone that manages our energy (insulin) go down [5]. Our body also adjusts to store more energy and reduce physical activity. Our brain changes, making us think more about food with intense and often overwhelming cravings [6,7]. This is why binge eating and restriction are closely connected, like two sides of the same coin.
Types of Restriction
Restriction comes in different forms. Physically, it involves limiting the amount of food or specific food groups or macronutrients like carbohydrates. It can also extend to sensory aspects of food, like textures and temperatures. For instance, if you're used to eating ice cream often but then start avoiding dairy, your body will register that the cold, creamy mouthfeel is no longer available; this can be one form of restriction.
Mental restriction occurs when you're eating but telling yourself not to or planning future restrictions like "starting tomorrow, I won’t have any more of this." Both physical and mental restrictions can biologically and psychologically alarm the body about the possibility of food deprivation. This can eventually trigger binge eating episodes.
Binge Eating and Escape Theory
There's another interesting idea related to binge eating called the Escape Theory. Many people tend to notice that they binge eat after experiencing negative emotional states like depression, stress, and low self-esteem. Escape Theory suggests that binge eating is a coping mechanism to avoid and escape negative feelings [8]. Some refer to this as emotional eating.
The last theory relates to food addiction and how there may be underlying mechanisms that are shared between the food addiction framework and binge eating symptoms. For example, some binge eat due to an overactivated reward system linked to chronic exposure to highly palatable foods [9-11].
Ultimately, the potential causes of binge eating are multifactorial and vary between individuals. At Wise Mind Nutrition, we value the process of individualizing care by supporting you to discern and identify which explanations resonate with your experience and will be most helpful in your recovery.
Here’s Why What You Do After a Binge Matters
In the process of recovery, relapses are to be expected. Someone doesn’t typically go from daily bingeing to suddenly completely eliminating it. An often overlooked but critical point lies in the aftermath of a binge, where you can develop patterns of thought and behavior that influence the moments leading up to and during a binge episode.
Let's take a moment to consider some questions after a binge. How do you feel right after? What thoughts are going through your mind? What do you end up doing? Imagine someone feeling awful about themselves and hopeless. They might think they have no control and just failed. In response, they might isolate themselves, try to make up for it somehow or try to forget with distracting techniques.
Now, think about what you do after bingeing. Is it actually making things better? Here's the important part: reacting with shame and feeling like everything has been undone doesn't actually stop binge eating. In fact, it keeps the cycle going. So, it's crucial to figure out a different approach to disrupt the cycle of binge eating. We'll explore more about that in the next section.
Three Effective Steps to Take After a Binge:
The steps below can help you to respond to your binges differently…
Step 1: Acknowledge what has happened
It can be incredibly difficult to acknowledge that a binge has happened. You may feel the urge to reprimand yourself, escape, or compensate. Yet, remember that beating yourself up and punishing yourself are patterns of behavior you previously engaged in and kept the binge cycle going. For example, you may think that you should skip breakfast after a binge or limit your intake, but it is vital to recall that returning to a consistent meal schedule will actually help rebalance and stabilize your appetite. Acknowledge what happened has already happened and that progress isn’t made by fighting with the past but by responding to the present moment productively.
Step 2: Respond with curiosity
Recognize that every binge holds valuable insights and something to be learned. Bingeing may feel like a sudden event, but each binge is linked to prior moments. Curiosity will let you backtrack and unravel the patterns of thought and behavior that led you to binge.
To spark curiosity, consider engaging in unrestricted writing where you can freely express whatever is on your mind. It is the thoughts you write down after a binge that will provide clues about how the binge came to be.
Some questions you can also consider:
Was there anything different about this binge?
Were you feeling differently? Thinking differently?
Were you more or less aware?
Did you feel rushed?
Were you restricted physically or mentally?
Did it happen at a certain time of day?
Step 3: Replace shame with compassion
Shame is a very ineffective tactic to stop binge eating because it directly fuels the binge-restrict cycle. It is also very difficult to be curious and learn from your experience in the shadow of shame. Instead, genuinely relate to yourself in a spirit of compassion.
You can ask yourself:
What would I say to a loved one who experienced what I have?
What do I need right now?
How can I take care of myself in this moment? Bingeing often results in a disconnection with your body. You can start to reconnect with your body by asking yourself this question and taking action.
Summary
Binge eating is a distressing experience for many, characterized by eating large amounts of food in a way that feels out of control. The potential causes of binge eating are multifactorial, and different explanatory models can help gain more awareness around your experience. Ultimately, the path to recovery is personalized and nuanced. It requires embracing curiosity and self-compassion that will allow you to tap into the insights within each binge episode, thereby disrupting the usual, shame-filled, catastrophic binge eating cycle. By taking these steps, you can progressively shift away from binge eating into food and body freedom.
The Wise Mind Nutrition app can help you build a new foundation to end binge eating and move you into a new chapter with grace! We're here for you…
Blog Contributor:
Misa Mojarrabi, Graduate Dietitian
References
1. American Psychiatric Association D. Diagnostic and statistical manual of mental disorders: DSM-5 [Internet]. [cited 2023 Aug 21]. Available from: https://www.academia.edu/download/38718268/csl6820_21.pdf
2. Striegel-Moore RH, Dohm FA, Solomon EE, Fairburn CG, Pike KM, Wilfley DE. Subthreshold binge eating disorder. Int J Eat Disord. 2000 Apr;27(3):270–8.
3. Burton AL, Abbott MJ. Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating. J Eat Disord. 2019 Jun 7;7:18.
4. Burton AL, Abbott MJ. Conceptualising Binge Eating: A Review of the Theoretical and Empirical Literature. Behav Change. 2017 Sep;34(3):168–98.
5. Maclean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol. 2011 Sep;301(3):R581–600.
6. Burger KS, Stice E. Relation of dietary restraint scores to activation of reward-related brain regions in response to food intake, anticipated intake, and food pictures. Neuroimage. 2011 Mar 1;55(1):233–9.
7. Polivy J. Psychological consequences of food restriction. J Am Diet Assoc. 1996 Jun;96(6):589–92; quiz 593–4.
8. Heatherton TF, Baumeister RF. Binge eating as escape from self-awareness. Psychol Bull. 1991 Jul;110(1):86–108.
9. Schulte EM, Grilo CM, Gearhardt AN. Shared and unique mechanisms underlying binge eating disorder and addictive disorders. Clin Psychol Rev. 2016 Mar;44:125–39.
10. Schienle A, Schäfer A, Hermann A, Vaitl D. Binge-eating disorder: reward sensitivity and brain activation to images of food. Biol Psychiatry. 2009 Apr 15;65(8):654–61.
11.Gearhardt AN, White MA, Potenza MN. Binge eating disorder and food addiction. Curr Drug Abuse Rev. 2011 Sep;4(3):201–7.
What is Binge Eating Disorder?
Binge eating disorder is diagnosed based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]. It involves recurrent binge eating episodes occurring at least once a week for three months. These episodes entail consuming more food than is typically consumed in a similar timeframe, accompanied by loss of control over eating. The episode often triggers feelings of guilt and shame.
According to the DSM-5:
Binge eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after overeating
It is vital to know that even if you don't meet the clinical criteria for binge eating disorder, your experiences and struggles around binge eating are valid, and you are worthy of seeking help and finding recovery [2].
What Causes Binge Eating?
Many theories explain how binge eating is caused and sustained, including the Restraint Model, Escape Theory, and Food Addiction Theory.
Binge eating (eating a lot of food in a short time) and restriction (not eating enough) are two sides of a coin. Just like how we naturally feel really thirsty when we haven't had enough water or desperately need to breathe when we're underwater for too long, our bodies react strongly when we don't get enough of what we need.
In the same way, when we don't eat enough food, our bodies respond to the threat in powerful ways [3,4]. We might start to salivate more, and the levels of hormones that tell us we're full (leptin) and the hormone that manages our energy (insulin) go down [5]. Our body also adjusts to store more energy and reduce physical activity. Our brain changes, making us think more about food with intense and often overwhelming cravings [6,7]. This is why binge eating and restriction are closely connected, like two sides of the same coin.
Types of Restriction
Restriction comes in different forms. Physically, it involves limiting the amount of food or specific food groups or macronutrients like carbohydrates. It can also extend to sensory aspects of food, like textures and temperatures. For instance, if you're used to eating ice cream often but then start avoiding dairy, your body will register that the cold, creamy mouthfeel is no longer available; this can be one form of restriction.
Mental restriction occurs when you're eating but telling yourself not to or planning future restrictions like "starting tomorrow, I won’t have any more of this." Both physical and mental restrictions can biologically and psychologically alarm the body about the possibility of food deprivation. This can eventually trigger binge eating episodes.
Binge Eating and Escape Theory
There's another interesting idea related to binge eating called the Escape Theory. Many people tend to notice that they binge eat after experiencing negative emotional states like depression, stress, and low self-esteem. Escape Theory suggests that binge eating is a coping mechanism to avoid and escape negative feelings [8]. Some refer to this as emotional eating.
The last theory relates to food addiction and how there may be underlying mechanisms that are shared between the food addiction framework and binge eating symptoms. For example, some binge eat due to an overactivated reward system linked to chronic exposure to highly palatable foods [9-11].
Ultimately, the potential causes of binge eating are multifactorial and vary between individuals. At Wise Mind Nutrition, we value the process of individualizing care by supporting you to discern and identify which explanations resonate with your experience and will be most helpful in your recovery.
Here’s Why What You Do After a Binge Matters
In the process of recovery, relapses are to be expected. Someone doesn’t typically go from daily bingeing to suddenly completely eliminating it. An often overlooked but critical point lies in the aftermath of a binge, where you can develop patterns of thought and behavior that influence the moments leading up to and during a binge episode.
Let's take a moment to consider some questions after a binge. How do you feel right after? What thoughts are going through your mind? What do you end up doing? Imagine someone feeling awful about themselves and hopeless. They might think they have no control and just failed. In response, they might isolate themselves, try to make up for it somehow or try to forget with distracting techniques.
Now, think about what you do after bingeing. Is it actually making things better? Here's the important part: reacting with shame and feeling like everything has been undone doesn't actually stop binge eating. In fact, it keeps the cycle going. So, it's crucial to figure out a different approach to disrupt the cycle of binge eating. We'll explore more about that in the next section.
Three Effective Steps to Take After a Binge:
The steps below can help you to respond to your binges differently…
Step 1: Acknowledge what has happened
It can be incredibly difficult to acknowledge that a binge has happened. You may feel the urge to reprimand yourself, escape, or compensate. Yet, remember that beating yourself up and punishing yourself are patterns of behavior you previously engaged in and kept the binge cycle going. For example, you may think that you should skip breakfast after a binge or limit your intake, but it is vital to recall that returning to a consistent meal schedule will actually help rebalance and stabilize your appetite. Acknowledge what happened has already happened and that progress isn’t made by fighting with the past but by responding to the present moment productively.
Step 2: Respond with curiosity
Recognize that every binge holds valuable insights and something to be learned. Bingeing may feel like a sudden event, but each binge is linked to prior moments. Curiosity will let you backtrack and unravel the patterns of thought and behavior that led you to binge.
To spark curiosity, consider engaging in unrestricted writing where you can freely express whatever is on your mind. It is the thoughts you write down after a binge that will provide clues about how the binge came to be.
Some questions you can also consider:
Was there anything different about this binge?
Were you feeling differently? Thinking differently?
Were you more or less aware?
Did you feel rushed?
Were you restricted physically or mentally?
Did it happen at a certain time of day?
Step 3: Replace shame with compassion
Shame is a very ineffective tactic to stop binge eating because it directly fuels the binge-restrict cycle. It is also very difficult to be curious and learn from your experience in the shadow of shame. Instead, genuinely relate to yourself in a spirit of compassion.
You can ask yourself:
What would I say to a loved one who experienced what I have?
What do I need right now?
How can I take care of myself in this moment? Bingeing often results in a disconnection with your body. You can start to reconnect with your body by asking yourself this question and taking action.
Summary
Binge eating is a distressing experience for many, characterized by eating large amounts of food in a way that feels out of control. The potential causes of binge eating are multifactorial, and different explanatory models can help gain more awareness around your experience. Ultimately, the path to recovery is personalized and nuanced. It requires embracing curiosity and self-compassion that will allow you to tap into the insights within each binge episode, thereby disrupting the usual, shame-filled, catastrophic binge eating cycle. By taking these steps, you can progressively shift away from binge eating into food and body freedom.
The Wise Mind Nutrition app can help you build a new foundation to end binge eating and move you into a new chapter with grace! We're here for you…
Blog Contributor:
Misa Mojarrabi, Graduate Dietitian
References
1. American Psychiatric Association D. Diagnostic and statistical manual of mental disorders: DSM-5 [Internet]. [cited 2023 Aug 21]. Available from: https://www.academia.edu/download/38718268/csl6820_21.pdf
2. Striegel-Moore RH, Dohm FA, Solomon EE, Fairburn CG, Pike KM, Wilfley DE. Subthreshold binge eating disorder. Int J Eat Disord. 2000 Apr;27(3):270–8.
3. Burton AL, Abbott MJ. Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating. J Eat Disord. 2019 Jun 7;7:18.
4. Burton AL, Abbott MJ. Conceptualising Binge Eating: A Review of the Theoretical and Empirical Literature. Behav Change. 2017 Sep;34(3):168–98.
5. Maclean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol. 2011 Sep;301(3):R581–600.
6. Burger KS, Stice E. Relation of dietary restraint scores to activation of reward-related brain regions in response to food intake, anticipated intake, and food pictures. Neuroimage. 2011 Mar 1;55(1):233–9.
7. Polivy J. Psychological consequences of food restriction. J Am Diet Assoc. 1996 Jun;96(6):589–92; quiz 593–4.
8. Heatherton TF, Baumeister RF. Binge eating as escape from self-awareness. Psychol Bull. 1991 Jul;110(1):86–108.
9. Schulte EM, Grilo CM, Gearhardt AN. Shared and unique mechanisms underlying binge eating disorder and addictive disorders. Clin Psychol Rev. 2016 Mar;44:125–39.
10. Schienle A, Schäfer A, Hermann A, Vaitl D. Binge-eating disorder: reward sensitivity and brain activation to images of food. Biol Psychiatry. 2009 Apr 15;65(8):654–61.
11.Gearhardt AN, White MA, Potenza MN. Binge eating disorder and food addiction. Curr Drug Abuse Rev. 2011 Sep;4(3):201–7.
What is Binge Eating Disorder?
Binge eating disorder is diagnosed based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]. It involves recurrent binge eating episodes occurring at least once a week for three months. These episodes entail consuming more food than is typically consumed in a similar timeframe, accompanied by loss of control over eating. The episode often triggers feelings of guilt and shame.
According to the DSM-5:
Binge eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after overeating
It is vital to know that even if you don't meet the clinical criteria for binge eating disorder, your experiences and struggles around binge eating are valid, and you are worthy of seeking help and finding recovery [2].
What Causes Binge Eating?
Many theories explain how binge eating is caused and sustained, including the Restraint Model, Escape Theory, and Food Addiction Theory.
Binge eating (eating a lot of food in a short time) and restriction (not eating enough) are two sides of a coin. Just like how we naturally feel really thirsty when we haven't had enough water or desperately need to breathe when we're underwater for too long, our bodies react strongly when we don't get enough of what we need.
In the same way, when we don't eat enough food, our bodies respond to the threat in powerful ways [3,4]. We might start to salivate more, and the levels of hormones that tell us we're full (leptin) and the hormone that manages our energy (insulin) go down [5]. Our body also adjusts to store more energy and reduce physical activity. Our brain changes, making us think more about food with intense and often overwhelming cravings [6,7]. This is why binge eating and restriction are closely connected, like two sides of the same coin.
Types of Restriction
Restriction comes in different forms. Physically, it involves limiting the amount of food or specific food groups or macronutrients like carbohydrates. It can also extend to sensory aspects of food, like textures and temperatures. For instance, if you're used to eating ice cream often but then start avoiding dairy, your body will register that the cold, creamy mouthfeel is no longer available; this can be one form of restriction.
Mental restriction occurs when you're eating but telling yourself not to or planning future restrictions like "starting tomorrow, I won’t have any more of this." Both physical and mental restrictions can biologically and psychologically alarm the body about the possibility of food deprivation. This can eventually trigger binge eating episodes.
Binge Eating and Escape Theory
There's another interesting idea related to binge eating called the Escape Theory. Many people tend to notice that they binge eat after experiencing negative emotional states like depression, stress, and low self-esteem. Escape Theory suggests that binge eating is a coping mechanism to avoid and escape negative feelings [8]. Some refer to this as emotional eating.
The last theory relates to food addiction and how there may be underlying mechanisms that are shared between the food addiction framework and binge eating symptoms. For example, some binge eat due to an overactivated reward system linked to chronic exposure to highly palatable foods [9-11].
Ultimately, the potential causes of binge eating are multifactorial and vary between individuals. At Wise Mind Nutrition, we value the process of individualizing care by supporting you to discern and identify which explanations resonate with your experience and will be most helpful in your recovery.
Here’s Why What You Do After a Binge Matters
In the process of recovery, relapses are to be expected. Someone doesn’t typically go from daily bingeing to suddenly completely eliminating it. An often overlooked but critical point lies in the aftermath of a binge, where you can develop patterns of thought and behavior that influence the moments leading up to and during a binge episode.
Let's take a moment to consider some questions after a binge. How do you feel right after? What thoughts are going through your mind? What do you end up doing? Imagine someone feeling awful about themselves and hopeless. They might think they have no control and just failed. In response, they might isolate themselves, try to make up for it somehow or try to forget with distracting techniques.
Now, think about what you do after bingeing. Is it actually making things better? Here's the important part: reacting with shame and feeling like everything has been undone doesn't actually stop binge eating. In fact, it keeps the cycle going. So, it's crucial to figure out a different approach to disrupt the cycle of binge eating. We'll explore more about that in the next section.
Three Effective Steps to Take After a Binge:
The steps below can help you to respond to your binges differently…
Step 1: Acknowledge what has happened
It can be incredibly difficult to acknowledge that a binge has happened. You may feel the urge to reprimand yourself, escape, or compensate. Yet, remember that beating yourself up and punishing yourself are patterns of behavior you previously engaged in and kept the binge cycle going. For example, you may think that you should skip breakfast after a binge or limit your intake, but it is vital to recall that returning to a consistent meal schedule will actually help rebalance and stabilize your appetite. Acknowledge what happened has already happened and that progress isn’t made by fighting with the past but by responding to the present moment productively.
Step 2: Respond with curiosity
Recognize that every binge holds valuable insights and something to be learned. Bingeing may feel like a sudden event, but each binge is linked to prior moments. Curiosity will let you backtrack and unravel the patterns of thought and behavior that led you to binge.
To spark curiosity, consider engaging in unrestricted writing where you can freely express whatever is on your mind. It is the thoughts you write down after a binge that will provide clues about how the binge came to be.
Some questions you can also consider:
Was there anything different about this binge?
Were you feeling differently? Thinking differently?
Were you more or less aware?
Did you feel rushed?
Were you restricted physically or mentally?
Did it happen at a certain time of day?
Step 3: Replace shame with compassion
Shame is a very ineffective tactic to stop binge eating because it directly fuels the binge-restrict cycle. It is also very difficult to be curious and learn from your experience in the shadow of shame. Instead, genuinely relate to yourself in a spirit of compassion.
You can ask yourself:
What would I say to a loved one who experienced what I have?
What do I need right now?
How can I take care of myself in this moment? Bingeing often results in a disconnection with your body. You can start to reconnect with your body by asking yourself this question and taking action.
Summary
Binge eating is a distressing experience for many, characterized by eating large amounts of food in a way that feels out of control. The potential causes of binge eating are multifactorial, and different explanatory models can help gain more awareness around your experience. Ultimately, the path to recovery is personalized and nuanced. It requires embracing curiosity and self-compassion that will allow you to tap into the insights within each binge episode, thereby disrupting the usual, shame-filled, catastrophic binge eating cycle. By taking these steps, you can progressively shift away from binge eating into food and body freedom.
The Wise Mind Nutrition app can help you build a new foundation to end binge eating and move you into a new chapter with grace! We're here for you…
Blog Contributor:
Misa Mojarrabi, Graduate Dietitian
References
1. American Psychiatric Association D. Diagnostic and statistical manual of mental disorders: DSM-5 [Internet]. [cited 2023 Aug 21]. Available from: https://www.academia.edu/download/38718268/csl6820_21.pdf
2. Striegel-Moore RH, Dohm FA, Solomon EE, Fairburn CG, Pike KM, Wilfley DE. Subthreshold binge eating disorder. Int J Eat Disord. 2000 Apr;27(3):270–8.
3. Burton AL, Abbott MJ. Processes and pathways to binge eating: development of an integrated cognitive and behavioural model of binge eating. J Eat Disord. 2019 Jun 7;7:18.
4. Burton AL, Abbott MJ. Conceptualising Binge Eating: A Review of the Theoretical and Empirical Literature. Behav Change. 2017 Sep;34(3):168–98.
5. Maclean PS, Bergouignan A, Cornier MA, Jackman MR. Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol. 2011 Sep;301(3):R581–600.
6. Burger KS, Stice E. Relation of dietary restraint scores to activation of reward-related brain regions in response to food intake, anticipated intake, and food pictures. Neuroimage. 2011 Mar 1;55(1):233–9.
7. Polivy J. Psychological consequences of food restriction. J Am Diet Assoc. 1996 Jun;96(6):589–92; quiz 593–4.
8. Heatherton TF, Baumeister RF. Binge eating as escape from self-awareness. Psychol Bull. 1991 Jul;110(1):86–108.
9. Schulte EM, Grilo CM, Gearhardt AN. Shared and unique mechanisms underlying binge eating disorder and addictive disorders. Clin Psychol Rev. 2016 Mar;44:125–39.
10. Schienle A, Schäfer A, Hermann A, Vaitl D. Binge-eating disorder: reward sensitivity and brain activation to images of food. Biol Psychiatry. 2009 Apr 15;65(8):654–61.
11.Gearhardt AN, White MA, Potenza MN. Binge eating disorder and food addiction. Curr Drug Abuse Rev. 2011 Sep;4(3):201–7.
