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Important barriers to making a quit attempt during pain treatment included making changes in opioid dose while quitting and perceived difficulty managing multiple treatment-related stressors [152]

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Alcohol is contraindicated during sertraline treatment because it worsens the depression sertraline treats, competes for the CYP2C19 enzyme that metabolizes sertraline, amplifies sertralines CNS sedation, and downregulates SERT expression with chronic use, directly antagonizing sertralines mechanism

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