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G. S. Brindley made one of the most important contributions to the treatment of erectile dysfunction. He discovered that injecting papaverine into the penis causes an erection. He announced this discovery — in a rather unique way — in 1983 at a meeting of the Urodynamics Society. Laurence Klotz was at that talk and described Brindley’s eccentric (and to some audience members, horrifying) presentation in a paper published in 2005. Here is an extended excerpt from that paper:

In 1983, at the Urodynamics Society meeting in Las Vegas, Professor G.S. Brindley first announced to the world his experiments on self-injection with papaverine to induce a penile erection. This was the first time that an effective medical therapy for erectile dysfunction (ED) was described, and was a historic development in the management of ED. The way in which this information was first reported was completely unique and memorable, and provides an interesting context for the development of therapies for ED….
The lecture was given in a large auditorium, with a raised lectern separated by some stairs from the seats….
Professor Brindley, still in his blue track suit, was introduced as a psychiatrist with broad research interests. He began his lecture without aplomb…. His slide-based talk consisted of a large series of photographs of his penis in various states of tumescence after injection with a variety of doses of phentolamine and papaverine….
The Professor wanted to make his case in the most convincing style possible…. He had, he said, therefore injected himself with papaverine in his hotel room before coming to give the lecture, and deliberately wore loose clothes (hence the track-suit) to make it possible to exhibit the results. He stepped around the podium, and pulled his loose pants tight up around his genitalia in an attempt to demonstrate his erection….
At this point, I, and I believe everyone else in the room, was agog. I could scarcely believe what was occurring on stage. But Prof. Brindley was not satisfied. He looked down sceptically at his pants and shook his head with dismay. ‘Unfortunately, this doesn’t display the results clearly enough’. He then summarily dropped his trousers and shorts, revealing a long, thin, clearly erect penis. There was not a sound in the room. Everyone had stopped breathing…..
He then said, with gravity, ‘I’d like to give some of the audience the opportunity to confirm the degree of tumescence’. With his pants at his knees, he waddled down the stairs, approaching (to their horror) the urologists and their partners in the front row. As he approached them, erection waggling before him, four or five of the women in the front rows threw their arms up in the air, seemingly in unison, and screamed loudly….
The screams seemed to shock Professor Brindley, who rapidly pulled up his trousers, returned to the podium, and terminated the lecture.

B1

Figure 1. What Professor Brindley’s clothed erection may have looked like at his 1983 talk.

You may contact me at drjeffryricker@gmail.com

Reference

Klotz, L. (2005), How (not) to communicate new scientific information: a memoir of the famous brindley lecture. BJU International, 96, 956–957.  doi: 10.1111/j.1464-410X.2005.05797.x

Note: A pdf of the paper can be found at: http://onlinelibrary.wiley.com/store/10.1111/j.1464-410X.2005.05797.x/asset/j.1464-410X.2005.05797.x.pdf?v=1&t=hfjwg8vk&s=c47fb9dd39977745ce58b0994331feb5154737ef

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In my PSY 101 class, we recently discussed some problems with using anecdotes and testimonials as evidence for claims. In this post, I want to begin to explore this issue in more depth. In future posts, I will discuss further some of the issues touched upon here.

Anecdotes

One afternoon, Eileen Lipsker was sitting in her family room watching Jessica, her red-headed five-year-old daughter, play with her friends. Eileen later reported that she felt “spaced out” and was “thinking of nothing.” Lenore Terr (1994), a psychiatrist who spoke with her on many occasions, described what Eileen said happened next:

Jessica twisted her head to look at her mother. To ask something? Her chin pointed up in inquiry. She looked up and over her shoulder. Her eyes brightened. How odd! The young girl’s body remained stationary, while her head pivoted around and up…. And at exactly that moment Eileen Lipsker remembered something. She remembered it as a picture. She could see her redheaded friend Susan Nason looking up, twisting her head, and trying to catch her eye.

Eileen, eight years old, stood outdoors, on a spot a little above the place where her best friend was sitting. It was 1969, twenty years earlier. The sun was beaming directly into Susan’s eyes. And Eileen could see that Susan was afraid…. [Eileen] looked away from those arresting eyes and saw the silhouette of her father. Both of George Franklin’s hands were raised above his head. He was gripping a rock. He steadied himself to bring it down. His target was Susan. (pp. 2-3)

Eileen told Terr that this is how she first recovered her repressed memory of Susan Nason’s murder by her father. Eileen’s recounting of the memory recovery is an example of an anecdote: a brief story told by an individual about a personal experience. No matter how interesting or compelling an anecdote may be, it doesn’t provide good evidence for a claim because it is based on interpretations and memories of personal experiences. In other words, an anecdote is inadequate evidence for a claim because it does not control for factors that affect how a personal experience is (a) initially perceived and interpreted, and (b) eventually remembered.

Figure 1. An example of an anecdote used to support the claim that extraterrestrials visit earth

Figure 1. An example of an anecdote used to support the claim that extraterrestrials visit earth

Testimonials

Autistic Disorder is a severe mental disorder that develops in children before the age of three years. It has three main symptoms: a severe impairment in social interaction, a severe impairment in the ability to communicate, and a severely restricted range of interests, activities, and behaviors. On occasion, new treatments for autism are announced that seem to offer hope for either a cure or, at least, a dramatic reduction of symptoms. One such well-publicized treatment used injections of secretin–a hormone that assists in the digestion of food. Some have claimed that secretin improves the social and language skills of autistic individuals by affecting specific behaviors such as the amount of eye contact made, the level of awareness of one’s surroundings, the degree of sociability, and the amount of speech. One proponent of secretin therapy provided the following evidence for this claim:

The good news is that confirmatory evidence of the power of secretin keeps coming. A national newspaper told of Florida pediatrician Jeff Bradstreet’s own four-year-old son, Matthew, shocking his parents by holding his first normal conversation with them the day after his first secretin infusion. And Virginia pediatrician Lawrence Leichtman told me of his “miracle case”: a five-year-old who had previously said only two words amazed all in the office by saying, 15 minutes after his infusion, “I am hungry. I want to eat.” Most cases are much less dramatic, but the autism world is excited, and for good reason. (Rimland, 1998, p. 3)

Is this good evidence for the effectiveness of secretin in the treatment of autism? The evidence consists of two testimonials. A testimonial is an anecdote that describes the supposed merits of a product or service. Testimonials are not good evidence for a claim because they are anecdotes and, as stated above, anecdotes don’t control for factors that might distort our observations and interpretations of a personal experience, as well as how we remember it later on. For example, we may misremember exactly what happened during the event, or may have misinterpreted what we observed during the event.

Figure 2. A testimonial from a celebrity about a brand of cigarettes

Figure 2. A testimonial from a celebrity about a brand of cigarettes (circa 1951)

In testimonials about therapeutic treatments, one very important factor that causes distortions of perceptions, interpretations, and memories is people’s expectations for the treatment. These expectations may cause them to conclude that their symptoms improved or disappeared even when they haven’t. This generally happens in one of two ways:

  1. The expectations may cause observers (e,g, patients, family members, doctors) to misperceive or misinterpret the behavior of those receiving a treatment, thereby concluding that the behavior has changed when it really hasn’t.
  2. The expectations may cause observers to experience improvement that has nothing to do with the nature of the treatment itself (e.g., the placebo effect or a self-fulfilling prophecy; see later posts in this series).

Specific examples of some of the problems mentioned here will be described in future posts.

You may contact me at drjeffryricker@gmail.com

References

Pendergrast, M. (1996). Victims of memory: Sex abuse accusations and shattered lives (2nd ed.). Hinesburg, VT: Upper Access.

Rimland, B. (1998). The use of secretin in autism: Some preliminary answers. Autism Research Review International, 12(4), 3. Retrieved January 23, 2013, from http://legacy.autism.com/ari/editorials/ed_secretinfindings.htm

Terr, L. T. (1994). Unchained memories: True stories of traumatic memories, lost and found. New York: BasicBooks.

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Boing Boing‘s Cory Doctorow reported on a spurious correlation of nearly 1.0 between autism and organic-food sales discovered by Jasonp55 on Skeptic Reddit.

This inspired me to look for other extremely high (albeit spurious) correlations with autism. I discovered a correlation of 0.994 between college costs (tuition + fees) and autism rates between the years 1999 and 2007, inclusive.

In the article that I’m certain to get published in Science, my main conclusion will be this: if we want to slash autism rates, we’ll need to drastically reduce college costs by returning educational funding to the levels of previous decades.

Here’s a graph of the cumulative percentages of the two variables that shows clearly their close association.

College-Autism

You may contact me at drjeffryricker@gmail.com

Data Sources
1. Office of Special Education Programs, Data Analysis System (DANS), OMB# 1820-0043: “Children with Disabilities Receiving Special Education Under Part B of the Individuals with Disabilities Education Act”
Table 1-11. Number of children and students served under IDEA, Part B, in the U.S. and outlying areas by age group, year, and disability category: Fall 1999 through fall 2008 (Age Group 6-21)
http://archive-org.com/page/2071756/2013-05-12/https://www.ideadata.org/TABLES32ND/AR_1-11.htm
2. National Center for Education Statistics: Digest of Education Statistics 2010 Tables and Figures
Table 345. Average undergraduate tuition and fees and room and board rates charged for full-time students in degree-granting institutions, by type and control of institution: 1964-65 through 2009-10
http://nces.ed.gov/programs/digest/d10/tables/dt10_345.asp

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Yesterday, I posted a piece in which I argued that scientific researchers must be inveterate skeptics and empiricists in their day-to-day work. In this post, I propose a new mental disorder for inclusion in the 5th edition of the Diagnostic and Statistical Manual. People lacking these essential scientific attitudes (i.e., skepticism and empiricism) may be suffering from this disorder. In fact, if the following ads from long ago make you wonder if such products now may be possible given advances in science and technology, you probably will meet the criteria for Credulous Personality Disorder.

The criteria for Credulous Personality Disorder were written several years ago, so this piece may need some updating; but the message is the same.

———————————————————————————————–

301.99 Credulous Personality Disorder

(formerly Pseudoneurotic Gullibility)

Proposal Submitted By Jeffry Ricker, Ph.D.
to the DSM-V Working Group

Diagnostic Features

The essential feature of Credulous Personality Disorder is a pattern of pervasive and excessive gullibility that causes the individual to accept without question claims unsupported by any credible evidence (including but not limited to claims involving health and health-related products, unconscious motivations, advertised products and services, extraterrestrial beings, get-rich-quick schemes, psychotherapeutic interventions, and/or the supernatural). This pattern begins by early adulthood and is present in a variety of contexts.

Individuals with Credulous Personality Disorder have a marked tendency to be easily convinced by evidence of poor quality, or even by no evidence at all, as long as the knowledge claim fits easily into the individual’s irrational worldview and is made by a person of authority (e.g., a guest on an all-night radio call-in show; a self-confident telemarketer with a British accent; a celebrity interviewee on The Tonight Show or a reporter for an entertainment magazine; a “therapist” appearing on a daytime talk show; an actor playing a doctor in a television commercial; an author of a book promoted by Oprah Winfrey; a “being” who claims to be from another planet or another dimension who channels through their next-door neighbor; anyone claiming to speak with the dead, nonverbal animals, or omniscient entities from another plane of existence).

The credulity of individuals with Credulous Personality Disorder seems to be driven most commonly by their desire for personal transformation, future well-being, or continued existence after death. In fact, people with this disorder typically dismiss claims supported by evidence of high quality whenever these claims contradict their hopes or cherished beliefs. This often causes them to spend large sums of money acquiring the latest product or service that seems to offer them hope and solace. Furthermore, much of their day is consumed with learning about and/or acquiring such products and services. In severe cases, the loss of jobs and close relationships or the experiencing of serious injury and even death result from the consequences of their rejection of well-supported claims (e.g., a person with malignant melanoma avoids the established medical treatment for this disorder and subjects him- or herself to a practitioner of Reiki).

Individuals with Credulous Personality Disorder tend to be trusting, friendly, and caring unless one of their core beliefs is subjected to critical analysis, at which point they often become defensive, indignant, and angry, although they may feign extreme concern for the happiness and well-being of the person questioning the belief (e.g., they may offer to pray for the skeptic). They often can be found in the self-help sections of bookstores discussing the latest works of Deepak Chopra or Andrew Weil. They typically express a compulsive stream of optimistic statements and aphorisms (e.g., frequently stating that they “cannot afford a negative thought”) and constantly discuss the newest miracle cure, diet fad, financial scheme, etc., that they believe will bring them life-long happiness and/or eternal bliss. These individuals often accumulate large amounts of debt because of their compulsive buying of items that offer the promise of health, financial success, self-transformation, etc.

Individuals with Credulous Personality Disorder often promote “alternative ways of knowing” that involve speculation, visialization, intuition, and shamanic journeys. They are easily convinced by subjective observations consistent with their beliefs and are highly suspicious of quantifiable measurements unless the latter seem to support their beliefs, at which point the evidence will be used in debates with skeptics long after it has been shown to be unreplicable and/or fraudulently obtained. Individuals suffering from this disorder may become psychologically distressed or physically ill when hearing the name of a prominent skeptic (e.g., someone who believes that he has been abducted by alien beings and anally probed passes out whenever Carl Sagan is mentioned; or a practitioner of therapeutic touch develops catalepsy and catatonic stupor whenever someone brings up the study by Emily Rosa and colleagues).

People with Credulous Personality Disorder may become so preoccupied with their credulous belief system that they seem unable to hear or remember the arguments of those with an opposing view. In fact, they often attribute statements to the skeptic that bear no relation to what he or she actually said. It is as if their minds become temporarily inactive whenever an opposing set of beliefs is described. Even when sufferers make an attempt to listen carefully to the views of skeptic, they may dissociate at critical points in the discussion (dissociative amnesia is a common comorbid disorder, although there is some evidence that this disorder itself is the product of extreme credulousness on the part of clinicians and clients).

Associated Features and Disorders

Individuals with Credulous Personality Disorder often experience extreme dysphoria because of their desperate and constant attempts to achieve total happiness, health, and self-fulfillment — attempts that always result in eventual disappointment. The dysphoria lifts temporarily when they find a new scheme for achieving these same goals. People with Credulous Personality Disorder often are diagnosed with comorbid Anxiety Disorders, Dissociative Disorders, Somatization Disorder, Major Depression, Dysthymic Disorder, Substance-Related Disorders, Disorders of Impulse Control, as well as other Personality Disorders, especially Dependent Personality Disorder, Avoidant Personality Disorder, Histrionic Personality Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder, and several other personality disorders still under development (see future editions of this manual).

The likelihood of developing Credulous Personality Disorder is increased if the individual, during childhood, ever celebrated a major holiday in which mythical figures were said to deliver presents or candy to good girls and boys, heard an “urban myth” while sitting around a campfire on a cold and moonless night, attended a religious service, was tempted by advertisements for X-ray glasses, had close relatives who voted for Richard Nixon, watched professional wrestling, bought “sea monkeys,” attended a public school focused on raising students’ self-esteem, bought tickets to a concert performed by a “teen idol,” had a parent who subscribed to Reader’s Digest or TV Guide, thought that the “Fonz” was cool, cried for days after watching Old Yeller, bought cereal in order to obtain the prize inside, watched television more than five minutes per day, or ever ordered anything advertised in the back of a comic book.

Specific Culture, Age, and Gender Features

The prevalence of Credulous Personality Disorder does not seem to be associated with any specific cultural, age-related, or gender-related factors.

Nevertheless, the specific symptoms exhibited do seem to be influenced to some extent by these factors. With respect to culture, the symptoms of Credulous Personality Disorder reflect the beliefs common in the culture in which the person was raised (e.g., Americans are more likely to believe that they will become rich if they cash in their life savings and buy thousands of Powerball tickets). In addition, the specific symptoms change with age. For example, children are more likely to believe that, if they step on a crack, they will break their mother’s back whereas adults are more likely to believe that, if they take megadoses of Vitamin C, they will never again suffer from a cold. Lastly, there seem to be some gender differences in symptomatology, especially when the beliefs involve sexual behaviors. For example, men are more likely to believe that, if they honk their horn and hoot loudly from their car window at an attractive female, she will probably sleep with them. Women are more likely to believe that, if they sleep with a man, he probably will marry them.

Prevalence

The lifetime prevalence of Credulous Personality Disorder has been reported to be between 0.1% and 99.9% in the general population, but it is not known whether such reports can be trusted since there is evidence to suggest that a large number of these studies were performed by researchers suffering from the disorder. At present, it seems safe to say that the disorder is very common in the general population (perhaps approaching 100%). The severity of the symptoms, however, differ dramatically across individuals. It seems that the disorder is very common in both in-patient psychiatric settings and out-patient mental-health clinics, but it rarely represents the presenting disorder. Many clinicians also suffer from Credulous Personality Disorder, which makes diagnosis and treatment of the disorder very difficult. These clinicians not only tend to believe the overly credulous pronouncements of their clients, they also are much more likely to believe that untested or falsified treatment modalities actually work (such as eye-movement-desensitization-and-reprocessing therapy, or any therapy in which repressed motivations or dissociated memories induced by trauma are used as explanations of problematic behavior).

Course

In almost all cases, Credulous Personality Disorder has a chronic course. Few remissions of symptoms have been observed in people who are fully or partially conscious. In the few cases of recovery that have been reported, there is reason to suspect that the reporting clinicians were suffering from the disorder and, thus, the accuracy of their reports can be questioned. The symptoms tend to become more severe when the individual is experiencing mild to severe stressors, and even when no stressors are being experienced at all. The symptoms also tend to become more severe after the individual has had experiences designed to encourage a lack of skepticism (e.g., after watching television infomercials, after listening to an audiotape of any lecture by Anthony Robbins, or while attending a talk at a local Unitarian church, especially if that talk is related to Jungian psychotherapy). The symptoms remit completely only during coma or upon death.

Familial Pattern

There is some evidence for an increased prevalence of Credulous Personality Disorder in the first-, second-, third-, fourth-, and nth-degree relatives of probands with the disorder.

Differential Diagnosis

Credulous Personality Disorder is not easily distinguished from Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, or any other psychotic disorder in which delusional thinking is prominent. In fact, in many cases, people with Credulous Personality Disorder report hallucinatory experiences consistent with their beliefs (e.g., seeing the faces of supernatural entities in taco shells or stained toilet-seat covers). Their speech often suggests the existence of formal thought disorder, especially when trying to justify their beliefs to skeptics. At this time, there is no general consensus regarding the distinguishing characteristics of Credulous Personality Disorder with respect to Psychotic Disorders. Most clinicians agree that there is a great deal of overlap between the symptoms of Credulous Personality Disorder and Delusional Disorder. In fact, some believe that the two disorders exist on a continuum of severity, but are not certain which disorder is the more severe.

You may contact me at drjeffryricker@gmail.com

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In the case of psychoactive drugs, drug tolerance is a condition in which repeated use of a drug leads to reductions in its psychological effects, thereby requiring progressively larger doses in order for similar effects to occur. Many factors affect the development of drug tolerance, and learning is one of them. A classic study by Siegel, Hinson, Krank, and McCully (1982) was one of the first to demonstrate this. The researchers found that rats can be classically conditioned to develop tolerance to heroin.

Siegel, et al. (1982) wanted to understand why some addicts died after taking a dose of the drug that they had taken many times before. The official cause of death in these cases usually was said to be a “drug overdose” because the dose was high enough to kill most people not addicted to the drug. These addicts, however, had developed a high level of tolerance to the lethal effects of the drug, so ascribing their deaths to an overdose couldn’t be correct.

The researchers hypothesized that the addicts’ tolerance was due, in part, to classical conditioning. That is, the situation is which they typically took the drug had become a conditioned stimulus (CS) that elicited a conditioned response (CR) involving a change in biological processes that prepared their bodies to counteract the lethal effects of the drug. This explanation may be easier to understand by looking at a case study described in Siegel (2001). The study was of a man suffering from severe pain because of pancreatic cancer. In order to reduce the pain, he received four injections of morphine per day. Over time, the dosage had been increased to a high level because of the tolerance he had developed to morphine’s pain-reducing effects.

The patient stayed in his bedroom (which was dimly lit and contained apparatus necessary for his care), and received injections in this environment. For some reason, after staying in this bedroom for about a month, the patient left his bed and went to the living room (which was brightly lit and different in many ways from the bedroom/sickroom). He was in considerable pain in the living room, and, as it was time for his next scheduled morphine administration, he was administered his usual dose of the drug. The patient quickly displayed signs of opiate overdose (constricted pupils, shallow breathing), and died a few hours later. (p. 510).

The explanation given by Siegel and his colleagues involved the classical conditioning of tolerance to the lethal effects of morphine. The explanation is outlined in Figure 1:

Figure 1. Classical conditioning of tolerance to morphine

As shown in Figure 1, the stimuli in the bedroom comprise a CS that produces a CR consisting of physiological changes that counteract the effects of morphine (i.e., are opposite to the physiological changes caused by morphine). This CR is part of the change in biological processes that causes tolerance to drugs, thereby requiring people to use higher doses in order to experience the same psychological and physical effects of drugs. The CR develops because the CS is followed by the drug, which can be thought of as a UCS — in this case, the injection of morphine. The UCS causes a UCR consisting of physiological changes associated with the drug. By counteracting the physiological effects of the drug, the CR reduces its lethality (i.e., the probability that the drug will result in death).

When an addict takes a high dose of a drug in a different environment — in the case of the man taking morphine, the different environment was his living room — the CR does not occur and, therefore, the drug now has its full effect on the body, which makes it more likely that the person will die.

Siegel, et al. (1982) designed an experimental study to test the classical-conditioning theory of drug tolerance. They gave rats injections of heroin every other day for 30 days (a total of 15 injections). They increased the dose gradually over time so that the rats eventually could tolerate relatively high doses. On the days the rats didn’t get heroin,they were injected with a sugar solution (see Table 1 below).

Siegel, et al. (1982) tested two heroin-injected groups:

  1. Group 1. These rats received their heroin injections in Room 1, which was the room that housed all the rats (the “colony room”). They received their sugar injections in Room 2, which was a room that differed from Room 1 in two ways: (a) no rats were housed there;(b) a machine generated constant “white noise.”
  2. Group 2. These rats received their heroin injections in Room 2, and their sugar injections in Room 1.

The researchers also included a placebo-control group (Group 3) that received injections of the sugar solution in both Room 1 and Room 2 on the same schedule as the other rats. Table 1 shows the schedule for each group on the first four days of the 30-day experiment.

Table 1. The schedule of heroin and sugar injections over the first four days of the experiment

At the end of the 30-day period, rats in all three groups were given a very large dose of heroin (almost twice as much as those in Group 1 and Group 2 had received before). Figure 2 shows the results.

Figure 2. Mortality in heroin-tolerant and control rats after receiving a very high dose of heroin

The label Different in Figure 2 refers rats in Groups 1 and 2 that received the very large dose of heroin in the room in which they had been injected with the sugar solution during the first part of the experiment. The label Same refers to in Groups 1 and 2 that received the very large dose of heroin in the room in which they had been injected with heroin during the first part of the experiment. The label Control refers to rats that were injected only with the sugar solution during the first part of the experiment.

As can be seen in Figure 2, almost all the rats in the Control Group died after being injected with the large dose of heroin because they had no tolerance for its lethal effects. About 64% of rats in the Different condition died, whereas only 32% of the rats in the Same condition died. Siegel, et al. (1982) interpreted these results as supporting their theory: the environmental stimuli in which drug addicts usually take the drug serve as a CS that produces a CR that increases tolerance for the drug’s effects.

The researchers concluded that the sensory stimuli from the room in which the rats were injected with heroin made up a CS. The rats developed a CR to that room–a CR consisting of changes in biological changes that counteracted the effects of the drug they were about to receive. When they received the final injection in a different room, the CR didn’t occur, which increased their chances of dying from the overdose.

Another point I want to make is that, although in most experimental studies of classical conditioning, the CR and UCR are the same or very similar, the responses also may be very different. In fact, in the study by Siegel, et al. (1982), the CR and UCR were completely opposite from each other.

References

Siegel, S. (2001). Pavlovian conditioning and drug overdose: When tolerance fails. Addiction Research & Theory, 9, 503-513. doi: 10.3109/16066350109141767
Retrieved October 18, 2011, from http://people.whitman.edu/~herbrawt/classes/390/Siegel.pdf

Siegel, S., Hinson, R. E., Krank, M. D., McCully, J. (1982). Heroin “overdose” death: Contribution of drug-associated environmental cues. Science, 23, 436-437.  doi: 10.1126/science.7200260

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