Skip to main content
SpringerLink
Log in

Cognitive Behavior Therapy for Co-occurring of Eating and Substance Use Disorders

  • Chapter
  • First Online:
Eating Disorders, Addictions and Substance Use Disorders

Abstract

Cognitive behavior therapy has received empirical support for the treatment of eating disorders, alcohol use disorders, and substance use disorders; however, there is no empirical research on the use of cognitive behavior therapy specifically for comorbid eating disorders and substance use disorders. Common cognitive behavioral treatments of alcohol use disorder and substance use disorders include (1) cue exposure interventions, (2) contingency management interventions, and (3) coping skill interventions. Treatment for eating disorders initially focuses on establishing regular eating, changing disturbed beliefs about dieting, and the importance of shape/weight and transitions into modular-based treatment that targets a number of hypothesized maintaining factors. We present a model for combining these existing approaches into a single treatment that builds on core overlapping interventions targeting behavioral change (e.g., self-monitoring, functional analysis, etc.) and allows for use of modular-based integration of comorbidity-specific interventions targeting aspects of comorbidity (e.g., PTSD) and personality (e.g., impulsivity). Special considerations for treating the comorbid population are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Agras, W. S., Walsh, B. T., Fairburn, C. G., Wilson, G. T., & Kraemer, H. C. (2000). A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57, 459–466.

    Article  CAS  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Google Scholar 

  • Ball, J., & Mitchell, P. (2004). A randomized controlled study of cognitive behavior therapy and behavioral family therapy for anorexia nervosa patients. Eating Disorders, 12, 303–314.

    Article  PubMed  Google Scholar 

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Review, 84, 191–215.

    Article  CAS  PubMed  Google Scholar 

  • Becker, C. B., Zayfert, C., & Pratt, E. M. (2009). Resolving treatment complications associated with comorbid eating disorders. In M. Otto & S. Hofmann (Eds.), Avoiding treatment failures in the anxiety disorders (pp. 291–316). New York, NY: Springer Publishing Company.

    Google Scholar 

  • Birmingham, C. L., & Beumont, P. J. (2004). Medical management of eating disorders: A practical handbook for health care professionals. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Brewerton, T. D. (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders, 15, 285–304.

    Article  PubMed  Google Scholar 

  • Brownley, K. A., Berkman, N. D., Sedway, J. A., Lohr, K. N., & Bulik, C. M. (2007). Binge eating disorder treatment: A systematic review of randomized controlled trials. International Journal of Eating Disorders, 40, 337–348.

    Article  PubMed  Google Scholar 

  • Bulik, C. M., Sullivan, P. F., Joyce, P. R., Carter, F. A., & McIntosh, V. V. (1998). Predictors of 1-year treatment outcome in bulimia nervosa. Comprehensive Psychiatry, 39, 206–214.

    Article  CAS  PubMed  Google Scholar 

  • Carroll, K. M. (1999). Behavioral and cognitive behavioral treatments. In B. S. McCrady & E. E. Epstein (Eds.), Addictions: A comprehensive guidebook (pp. 250–286). New York, NY: Oxford University Press.

    Google Scholar 

  • Carroll, K. M., & Onken, L. S. (2005). Behavioral therapies for drug abuse. American Journal of Psychiatry, 162, 1452–1460.

    Article  PubMed Central  PubMed  Google Scholar 

  • Carter, F. A., Jordan, J., McIntosh, V. V., Luty, S. E., McKenzie, J. M., Frampton, C., … Joyce, P. R. (2011). The long-term efficacy of three psychotherapies for anorexia nervosa: A randomized, controlled trial. International Journal of eating disorders, 44, 647–654.

    Google Scholar 

  • Carter, J. C., McFarlane, T. L., Bewell, C., Olmsted, M. P., Woodside, D. B., Kaplan, A. S., Crosby, R. D. (2009). Maintenance treatment for anorexia nervosa: A comparison of cognitive behavior therapy and treatment as usual. International Journal of Eating Disorders, 42, 202–207.

    Google Scholar 

  • Channon, S., De Silva, P., Helmsley, D., & Perkins, R. (1989). A controlled trial of cognitive behavioural and behavioural treatment of anorexia nervosa. Behaviour Research and Therapy, 27, 529–535.

    Article  CAS  PubMed  Google Scholar 

  • Cuffel, B. J. (1996). Comorbid substance use disorder: Prevalence, patterns of use, and course. New Directions for Mental Health Services, 1996, 93–105.

    Article  Google Scholar 

  • Devlin, M. J., Goldfein, J. A., Petkova, E., Jiang, H., Raizman, P. S., Wolk, S. … Walsh, B. T. (2005). Cognitive behavioral therapy and fluoxetine as adjuncts to group behavioral therapy for binge eating disorder. Obesity Research, 13, 1077–1088.

    Google Scholar 

  • Dore, G., Mills, K., Murray, R., Teesson, M., & Farrugia, P. (2012). Post-traumatic stress disorder, depression and suicidality in inpatients with substance use disorders. Drug and Alcohol Review, 31, 294–302.

    Article  PubMed  Google Scholar 

  • Dunn, E. C., Geller, J., Neighbors, C., Brown, K. E., Williams, K. D., & Jones, M. I. (2007, November). Women with severe eating disorders and concurrent substance use disorders: Prevalence and barriers to treatment. Poster presented at the 41st annual conference of the Association for Behavioral and Cognitive Therapies, Philadelphia, PA.

    Google Scholar 

  • Fairburn, C. G. (1995). Overcoming binge eating. New York, NY: Guilford Press.

    Google Scholar 

  • Fairburn, C. G. (1997). Eating disorders. In D. M. Clark & C. G. Fairburn (Eds.), The science and practice of cognitive behaviour therapy (pp. 209–242). Oxford: Oxford University Press.

    Google Scholar 

  • Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press.

    Google Scholar 

  • Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., … R. L. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. The American Journal of Psychiatry, 166, 311–319.

    Google Scholar 

  • Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Palmer, R. L., & Dalle, G. R. (2013). Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK-Italy study. Behaviour Research and Therapy, 51, R2–8.

    Article  PubMed Central  PubMed  Google Scholar 

  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.

    Article  PubMed  Google Scholar 

  • Fairburn, C. G., Cooper, Z., Shafran, R., Bohn, K., Hawker, D. M., Murphy, R., & Straebler, S. (2008). Enhanced cognitive behavior therapy for eating disorders: The core protocol. In C. G. Fairburn (Ed.), Cognitive behavior therapy and eating disorders (pp. 47–193). New York, NY: Guilford Press.

    Google Scholar 

  • Fairburn, C. G., Jones, R., Peveler, R. C., Carr, S. J., Solomon, R. A., O’Connor, M. E.,… Hope, R. A. (1991). Three psychological treatments for bulimia nervosa. Archives of General Psychiatry, 48, 463–469.

    Google Scholar 

  • Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 361–404). New York, NY: Guilford Press.

    Google Scholar 

  • Finney, J. W., Noyes, C. A., Coutts, A. I., & Moos, R. H. (1998). Evaluating substance abuse treatment process models: I. Changes on proximal outcome variables during 12-step and cognitive-behavioral treatment. Journal of Studies on Alcohol, 59, 371–380.

    CAS  PubMed  Google Scholar 

  • Foa, E. B., Yusko, D. A., McLean, C. P., Suvak, M. K., Bux, D. A., Oslin, D., … Volpicelli, J. (2013). Concurrent naltrexone and prolonged exposure therapy for patients with comorbid alcohol dependence and PTSD: A randomized clinical trial therapy for alcohol dependence and PTSD therapy for alcohol dependence and PTSD. Journal of the American Medical Association, 310, 488–495.

    Google Scholar 

  • Freeman, C. P. L., Barry, F., Dunkeld-Turnbull, J., & Henderson, A. (1988). Controlled trial of psychotherapy for bulimia nervosa. British Medical Journal, 296, 521–525.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Garner, D. M., & Bemis, K. M. (1982). A cognitive-behavioral approach to anorexia nervosa. Cognitive Therapy and Research, 6, 123–150.

    Article  Google Scholar 

  • Garner, D. M., & Bemis, K. M. (1985). Cognitive therapy for anorexia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of psychotherapy for anorexia nervosa and bulimia (pp. 107–146). New York, NY: Guilford Press.

    Google Scholar 

  • Garner, D. M., Vitousek, K., & Pike, K. M. (1997). Cognitive behavioral therapy for anorexia. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of treatment for eating disorders (2nd ed., pp. 91–144). New York, NY: Guilford Press.

    Google Scholar 

  • Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W., … Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61(8), 80.

    Google Scholar 

  • Griffith, J. D., Rowan-Szal, G. A., Roark, R. R., & Simpson, D. D. (2000). Contingency management in outpatient methadone treatment: A meta-analysis. Drug and Alcohol Dependence, 58(1), 55–66.

    Article  CAS  PubMed  Google Scholar 

  • Grilo, C. M., Masheb, R. M., & Salant, S. L. (2005). Cognitive behavioral therapy guided self-help and orlistat for the treatment of binge eating disorder: A randomized, double-blind, placebo-controlled trial. Biological Psychiatry, 57, 1193–1201.

    Article  CAS  PubMed  Google Scholar 

  • Grilo, C. M., Masheb, R., Brownell, K. D., & White, M. A. (2007, July). Randomized comparison of cognitive behavioral therapy and behavioral weight loss treatments for obese patients with binge eating disorder: 12-month outcomes. Paper presented at the World Congress of Behavioural and Cognitive Therapy, Barcelona, Spain.

    Google Scholar 

  • Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press.

    Google Scholar 

  • Higgins, S. T., Budney, A. J., Bickel, W. K., Foerg, F. E., Donham, R., & Badger, G. J. (1994). Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry, 51, 568–576.

    Article  CAS  PubMed  Google Scholar 

  • Higgins, S. T., Budney, A. J., Bickel, W. K., Hughes, J. R., Foerg, F., & Badger, G. J. (1993). Achieving cocaine abstinence with a behavioral approach. American Journal of Psychiatry, 150, 763–769.

    CAS  PubMed  Google Scholar 

  • Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61, 348–358.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kleber, H. D., Weiss, R. D., Anton, R. F., Jr., George, T. P., Greenfield, S. F., Kosten, T. R., … Regier, D. (2007). Work Group on Substance Use Disorders; American Psychiatric Association; Steering Committee on Practice Guidelines. Treatment of patients with substance use disorders. American Journal of Psychiatry, 164(4 Suppl), 5–123.

    Google Scholar 

  • Loeber, S., Croissant, B., Heinz, A., Mann, K., & Flor, H. (2006). Cue exposure in the treatment of alcohol dependence: Effects on drinking outcome, craving, and self-efficacy. British Journal of Clinical Psychology, 45, 515–529.

    Article  PubMed  Google Scholar 

  • Longabaugh, R., & Morgenstern, J. (1999). Cognitive-behavioral coping-skills therapy for alcohol dependence: Current status and future directions. Alcohol Research & Health, 32, 78–85.

    Google Scholar 

  • Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York, NY: Guilford Press.

    Google Scholar 

  • McCrady, B. S., & Epstein, E. E. (2008). Overcoming alcohol problems: A couples-focused program. New York, NY: Oxford University Press.

    Google Scholar 

  • McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive-behavioral therapy for substance use disorders. The Psychiatric Clinics of North America, 33, 511–525.

    Article  PubMed Central  PubMed  Google Scholar 

  • McIntosh, V. V. W., Jordan, J., Carter, F. A., Luty, S. E., McKenzie, J. M., Bulik, C. M., … Joyce, P. (2005). Three psychotherapies for anorexia nervosa: A randomized, controlled trial. American Journal of Psychiatry, 162, 741–747.

    Google Scholar 

  • Mills, K. L., Teesson, M., Back, S. E., Brady, K. T., Baker, A. L., Hopwood, S. … Ewer, P. L. (2012). Integrated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence: A randomized controlled trial. The Journal of the American Medical Association. 308, 690–699.

    Google Scholar 

  • Minkoff, K. (2001). Best practices: Developing standards of care for individuals with co-occurring psychiatric and substance use disorders. Psychiatric services, 52, 597–599.

    Article  CAS  PubMed  Google Scholar 

  • Monti, P. M., Kadden, R. M., Rohsenow, D. J., Conney, N. L., & Abrams, D. B. (2002). Treating alcohol dependence: A coping skills training guide (2nd ed.). New York, NY: Guilford Press.

    Google Scholar 

  • Munsch. S., Biedert, E., Meyer, A., Michael, T., Schlup, B., Tuch, A., & Margraf, J. (2007). A randomized comparison of cognitive behavioral therapy and behavioral weight loss treatment for overweight individuals with binge eating disorder. International Journal of Eating Disorders, 40, 102–113.

    Google Scholar 

  • National Institute for Clinical Excellence. (2004). Eating disorders—Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. NICE Clinical Guideline No. 9. London: NICE. http://www.nice.org.uk

  • O’Malley, S. S., Sinha, R., Grilo, C. M., Capone, C., Farren, C. K., McKee, S. A., … Wu, R. (2007). Naltrexone and cognitive behavioral coping skills therapy for the treatment of alcohol drinking and eating disorder features in alcohol-dependent women: A randomized controlled trial. Alcoholism, Clinical and Experimental Research, 31, 625–634.

    Google Scholar 

  • Persons, J. B. (2005). Empiricism, mechanism, and the practice of cognitive-behavior therapy. Behavior Therapy, 36, 107–118.

    Article  Google Scholar 

  • Persons, J. B., & Tompkins, M. A. (2007). Cognitive-behavioral case formulation. In T. T. Eells (Ed.), Handbook of psychotherapy case formulation. New York, NY: Guilford Press.

    Google Scholar 

  • Petrakis, I. L., Gonzalez, G., Rosenheck, R., & Krystal, J. H. (2002). Comorbidity of alcoholism and psychiatric disorders: An overview. Alcohol Research and Health, 26, 81–89.

    Google Scholar 

  • Petry, N. M., Alessi, S. M., Marx, J., Austin, M., & Tardif, M. (2005). Vouchers versus prizes: Contingency management treatment of substance abusers in community settings. Journal of Consulting and Clinical Psychology, 73, 1005–1014.

    Article  PubMed  Google Scholar 

  • Petry, N. M., & Martin, B. (2002). Low-cost contingency management for treating cocaine- and opioid abusing methadone patients. Journal of Consulting and Clinical Psychology, 70, 398–405.

    Article  PubMed  Google Scholar 

  • Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). Give them prizes, and they will come: Contingency management for treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68, 250–257.

    Article  CAS  PubMed  Google Scholar 

  • Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T., & Bauer, J. (2003). Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. American Journal of Psychiatry, 160, 2046–2049.

    Article  PubMed  Google Scholar 

  • Prendergast, M., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Contingency management for treatment of substance use disorders: A meta-analysis. Addiction, 101, 1546–1560.

    Article  PubMed  Google Scholar 

  • Rawson, R. A., Huber, A. McCann, M. Shoptaw, S. Farabee, D. Reiber, C. Ling, W. (2002). A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Archives of General Psychiatry, 59, 817–824.

    Google Scholar 

  • Ries, R., Galanter, M., Tonigan, J. S., & Ziegler, P. (2011). Twelve-step facilitation for co-occurring addiction and mental health disorders. In M. Galanter & H. Kleber (Eds.), Psychotherapy for the treatment of substance abuse (pp. 299–328). Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • Rohsenow, D. J., Monti, P. M., Rubonis, A. V., Gulliver, S. B., Colby, S. M., Binkoff, J. A. & Abrams, D. B. (2001). Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes. Addiction, 96, 1161–1174.

    Google Scholar 

  • Sinha, R., & O’Malley, S. S. (2000). Alcohol and eating disorders: Implications for alcohol treatment and health services research. Alcoholism, Clinical and Experimental Research, 24, 1312–1319.

    Article  CAS  PubMed  Google Scholar 

  • Sysko, R., & Hildebrandt, T. (2009). Cognitive-behavioural therapy for individuals with bulimia nervosa and a co-occurring substance use disorder. European Eating Disorders Review, 17, 89–100.

    Article  PubMed Central  PubMed  Google Scholar 

  • Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the bulimia test: The BULIT-R. Psychological Assessment, 3, 119–124.

    Article  Google Scholar 

  • Vitousek, K. M., Watson, S., & Wilson, G. T. (1998). Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review, 18, 391–420.

    Article  CAS  PubMed  Google Scholar 

  • Wilson, G. T. (1996). Manual-based treatments: The clinical application of research findings. Behaviour Research and Therapy, 34, 295–314.

    Article  CAS  PubMed  Google Scholar 

  • Wilson, G. T. (2010). Eating disorders, obesity and addiction. European Eating Disorders Review, 18, 341–351.

    Article  PubMed  Google Scholar 

  • Wilson, G. T., Becker, C. B., & Heffernan, K. (2003). Eating disorders. In E. J. Mash & R. A. Barkely (Eds.), Child psychopathology (2nd ed., pp. 687–715). New York, NY: The Guilford Press.

    Google Scholar 

  • Wilson, G. T., Fairburn, C. G., & Agras, W. S. (1997). Cognitive-behavioral therapy for bulimia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of treatment for eating disorders (2nd ed., pp. 67–93). New York, NY: Guilford Press.

    Google Scholar 

  • Wilson, G. T., Grilo, C. M., & Vitousek, K. M. (2007). Psychological treatment of eating disorders. American Psychologist, 62, 199–216.

    Article  PubMed  Google Scholar 

  • Wilson, G. T., & Schlam, T. R. (2004). The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clinical Psychology Review, 24, 361–378.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Psychology, Fairleigh Dickinson University, 1000 River Road, T-WH1-01, Teaneck, NJ, 07666, USA

    Lisa Hail & Tom Hildebrandt

  2. Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Lisa Hail & Tom Hildebrandt

  3. Department of Psychology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA

    Lisa Hail & Tom Hildebrandt

  4. Division of Clinical Therapeutics, Columbia Center for Eating Disorders, New York State Psychiatric Institute, New York, NY, USA

    Robyn Sysko

  5. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA

    Robyn Sysko

  6. Department of Psychology, Trinity University, San Antonio, TX, USA

    Carolyn Black Becker

Authors
  1. Lisa Hail
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robyn Sysko
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tom Hildebrandt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carolyn Black Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa Hail .

Editor information

Editors and Affiliations

  1. Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA

    Timothy D. Brewerton

  2. Psychiatry and Behavioral Neurosciences, University of South Florida, Bloomfield Hills, Michigan, USA

    Amy Baker Dennis

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Hail, L., Sysko, R., Hildebrandt, T., Becker, C.B. (2014). Cognitive Behavior Therapy for Co-occurring of Eating and Substance Use Disorders. In: Brewerton, T., Baker Dennis, A. (eds) Eating Disorders, Addictions and Substance Use Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45378-6_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-45378-6_24

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-45377-9

  • Online ISBN: 978-3-642-45378-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation