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Ahmad Muneer Naser

The Integrated Recovery-Oriented Nursing (IRON) Care Model: A Theoretical Framework for Optimizing Addiction Treatment Outcomes

Shared by Ahmad Muneer Naser - 19 June 2025
The Integrated Recovery-Oriented Nursing (IRON) Care Model: A Theoretical Framework for Optimizing Addiction Treatment Outcomes

Submitted by Ahmad Muneer Naser - 29 May 2025
The Integrated Recovery-Oriented Nursing (IRON) Care Model: A Theoretical Framework for Optimizing Addiction Treatment Outcomes


The Integrated Recovery-Oriented Nursing (IRON) Care Model is a comprehensive theoretical framework designed to guide nursing practice in addiction treatment. It emphasizes a holistic, person-centered, and strengths-based approach, integrating evidence-based nursing interventions with the core principles of recovery. Grounded in established nursing and psychological theories, the IRON model aims to optimize treatment outcomes by fostering resilience, promoting self-efficacy, addressing co-occurring conditions, and supporting individuals through a continuum of care, ultimately leading to sustained recovery and improved quality of life. This framework positions nurses as pivotal in facilitating a hopeful and collaborative journey towards self-directed wellness.

Core Philosophy:
The IRON model is built on the belief that recovery from addiction is a deeply personal, multidimensional, and ongoing process that extends beyond mere abstinence to encompass overall well-being and a meaningful life (Anthony, 1993). It acknowledges the complex interplay of biological, psychological, social, and spiritual factors in the etiology and maintenance of addiction, as well as in the journey of recovery (Engel, 1977). The model champions hope, empowerment, respect, and collaboration, positioning nurses as key therapeutic agents and facilitators in the individual's path towards a meaningful and self-directed life, aligned with the principles of recovery-oriented systems of care (SAMHSA, 2011).

Key Tenets & Theoretical Underpinnings:
The IRON model draws upon and synthesizes several established theories and perspectives:

The Recovery Model: This model, particularly as defined by SAMHSA (2011), emphasizes that recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Core components include hope, person-driven care, many pathways, holistic approaches, peer support, relational connections, culture, addressing trauma, leveraging strengths/responsibility, and respect.
Peplau's Theory of Interpersonal Relations: This nursing theory underscores the therapeutic nurse-patient relationship as a cornerstone of healing and growth, involving distinct phases (orientation, identification, exploitation, resolution) that facilitate patient learning and self-understanding (Peplau, 1952/1991).
Strengths-Based Perspective: Originating in social work, this perspective focuses on identifying and mobilizing an individual's inherent strengths, talents, resources, and aspirations, rather than dwelling on deficits or pathology (Saleebey, 2006).
Transtheoretical Model (Stages of Change): This model (Prochaska & DiClemente, 1983) provides a framework for understanding an individual's readiness for change (precontemplation, contemplation, preparation, action, maintenance) and tailoring interventions accordingly to enhance motivation and progress.
Biopsychosocial-Spiritual Model: This model provides a holistic framework for understanding health and illness, recognizing the interconnectedness of biological, psychological, social, and spiritual dimensions of human experience (Engel, 1977; Puchalski, 2001).
Trauma-Informed Care Principles: Recognizes the pervasive impact of trauma and promotes environments of healing and recovery by emphasizing safety, trustworthiness, choice, collaboration, and empowerment (SAMHSA, 2014a; Harris & Fallot, 2001).
The IRON Acronym & Components:

The IRON model comprises four interconnected core components:

I – Integrated & Individualized Care

Holistic Assessment: Conducting comprehensive, ongoing assessments that cover physical health (including co-occurring medical conditions, chronic pain, infectious diseases), mental health (co-occurring psychiatric disorders, trauma history, cognitive function), substance use patterns and history, social determinants of health (housing stability, employment, education, financial resources, legal issues, social support networks), spiritual needs and resources, cultural background, values, and beliefs (American Psychiatric Association [APA], 2013; International Nurses Society on Addictions [IntNSA], 2016).
Person-Centered Planning & Shared Decision-Making: Collaboratively developing dynamic care plans that are explicitly tailored to the individual's unique needs, strengths, preferences, self-identified goals, cultural context, and stage of change (Prochaska & DiClemente, 1983). This involves shared decision-making where the individual is an active and respected partner in all aspects of their care (O'Connor et al., 2009; SAMHSA, 2011).
Interprofessional Collaboration & Care Coordination: Engaging in seamless teamwork and communication with physicians, therapists, social workers, peer support specialists, pharmacists, case managers, and other relevant professionals to provide comprehensive, coordinated, and non-fragmented care. Nurses often serve as crucial care coordinators, ensuring continuity and integration of services (World Health Organization [WHO], 2010).
Addressing Co-occurring Disorders (Integrated Treatment): Implementing evidence-based practices for the simultaneous and integrated treatment of substance use disorders and other mental or physical health conditions, recognizing their common co-occurrence and reciprocal influence (Drake et al., 2001; SAMHSA, 2014b).
R – Recovery-Oriented Principles & Resilience Building

Instilling Hope & Fostering Self-Efficacy: Actively communicating belief in the individual's capacity for change, growth, and recovery. Nurses help individuals identify past successes, build confidence in their ability to manage challenges, and develop a positive future orientation, which is central to self-efficacy (Bandura, 1997; SAMHSA, 2011).
Empowerment & Self-Direction: Supporting individuals in making informed choices about their treatment and life, promoting autonomy, personal responsibility, and active participation in their recovery journey. This involves respecting their right to self-determination and supporting their capacity to lead their own recovery (Rapp & Goscha, 2012).
Strengths-Based Interventions: Systematically identifying and mobilizing individual, family, and community strengths, assets, and resources to support recovery efforts. This shifts the focus from problems and pathology to capabilities and potential (Saleebey, 2006).
Trauma-Informed Care: Applying principles of trauma-informed care in all interactions and interventions, recognizing the high prevalence of trauma among individuals with addiction. This involves creating a safe, supportive, and empowering environment that avoids re-traumatization and fosters healing (Harris & Fallot, 2001; SAMHSA, 2014a).
Building Resilience & Coping Skills: Facilitating the development and enhancement of coping mechanisms, stress management techniques, emotional regulation skills, and problem-solving strategies to help individuals navigate triggers, cravings, high-risk situations, and life stressors effectively (Herrman et al., 2011).
O – Ongoing Support & Outcome-Driven Practice

Continuum of Care Navigation & Linkage: Assisting individuals in transitioning smoothly across different levels and types of care (e.g., detoxification, residential, outpatient, mutual-help groups, aftercare) and connecting them with sustainable long-term recovery supports in their communities (McKay, 2009).
Relapse Prevention & Management: Collaboratively developing personalized relapse prevention plans, including identification of warning signs and coping strategies. Educating about relapse as a potential part of the recovery process (not a failure) and providing non-judgmental support and re-engagement strategies if relapse occurs (Marlatt & Donovan, 2005).
Long-Term Engagement & Recovery Capital: Utilizing motivational interviewing (Miller & Rollnick, 2013), regular check-ins, and connection to peer support and community resources to maintain engagement in recovery-sustaining activities. Focus on building "recovery capital" – the internal and external resources necessary to initiate and sustain recovery (Cloud & Granfield, 2008).
Monitoring & Evaluating Outcomes: Systematically tracking progress towards individualized goals and broader recovery outcomes (e.g., abstinence, reduced harm, improved physical and mental health, employment, housing, quality of life) using validated instruments and patient-reported outcome measures (PROMs). Utilizing outcome data to adjust care plans, improve service delivery, and demonstrate program effectiveness (Rush et al., 2008).
Harm Reduction Strategies: When aligned with individual goals and values, incorporating harm reduction strategies (e.g., naloxone distribution, safer use education, syringe services) as part of a comprehensive approach to reduce the negative consequences of substance use, recognizing that recovery pathways are diverse and not always linear (Marlatt et al., 2011).
N – Nursing Excellence & Nurturing Therapeutic Alliance

Therapeutic Relationship & Alliance: Establishing and maintaining a trusting, empathetic, respectful, genuine, and non-judgmental relationship as the foundation for all nursing interventions. The quality of the therapeutic alliance is a significant predictor of treatment outcomes (Peplau, 1952/1991; Martin et al., 2000).
Evidence-Based Nursing Interventions: Skillfully utilizing a range of interventions supported by research, including:
Medication-Assisted Treatment (MAT) support: Education, administration, monitoring, and adherence support for FDA-approved medications (e.g., buprenorphine, naltrexone, methadone) (SAMHSA, 2021; ASAM, 2020).
Psychoeducation: Providing comprehensive education on addiction as a chronic illness, the neurobiology of addiction, recovery processes, health promotion, disease prevention, and medication management (IntNSA, 2016).
Motivational Interviewing (MI) & Brief Interventions: Employing MI techniques to enhance intrinsic motivation for change and delivering brief interventions to address substance use in various settings (Miller & Rollnick, 2013).
Symptom Management: Expertly managing withdrawal symptoms, pain, psychiatric symptoms, and side effects of medications.
Advocacy & Stigma Reduction: Championing the individual's rights and needs within the healthcare system and community. Actively working to reduce stigma associated with addiction and mental illness through education and modeling respectful, person-first language (Corrigan et al., 2009; American Nurses Association [ANA], 2015).
Ethical Practice & Cultural Humility: Adhering to high ethical standards as outlined in nursing codes of ethics (e.g., ANA Code of Ethics for Nurses), maintaining professional boundaries, and practicing cultural humility – a lifelong process of self-reflection and critique to redress power imbalances and develop mutually respectful partnerships with individuals from diverse cultural backgrounds (Tervalon & Murray-Garcia, 1998; ANA, 2015).
Continuous Professional Development: Committing to ongoing learning, skill development, and staying abreast of current research and best practices in addiction nursing, recovery-oriented care, and psychopharmacology (IntNSA, 2016).
Interplay of Components:
The IRON components are not intended to be applied in a rigid, linear fashion but are dynamic, synergistic, and iterative. For instance, an Individualized assessment (I) informs the development of a Recovery-oriented plan and resilience-building strategies (R), which requires Ongoing support and outcome monitoring (O), all delivered with Nursing excellence through a strong therapeutic alliance (N). Progress in one area often positively influences and reinforces others, creating a virtuous cycle of healing and growth.

Nursing Roles & Responsibilities within the IRON Model:
Nurses practicing within the IRON model embody multiple roles:

Therapeutic Partner & Assessor: Conducting comprehensive holistic assessments and establishing a collaborative relationship.
Care Planner & Coordinator: Developing, implementing, and evaluating individualized care plans, liaising with interprofessional teams and community resources.
Educator & Coach: Providing information, teaching skills, and using motivational approaches to support self-management and behavior change.
Advocate & Change Agent: Protecting patient rights, promoting access to equitable care, reducing stigma, and influencing systems to be more recovery-oriented.
Clinical Expert & Care Giver: Providing expert direct nursing care, including advanced assessment, medication management, symptom relief, and crisis intervention.
Expected Outcomes of the IRON Model:
Systematic implementation of the IRON model is expected to contribute to:

Increased treatment engagement, retention, and satisfaction with care.
Reduced substance use frequency and severity, and/or increased periods of abstinence.
Improved management and outcomes for co-occurring physical and mental health conditions.
Enhanced self-efficacy, coping skills, resilience, and problem-solving abilities.
Improved social functioning, community integration, and quality of life (e.g., stable housing, employment, positive relationships).
Reduced relapse rates and/or more effective management of relapse episodes.
Decreased stigma experienced by individuals seeking and receiving addiction treatment.
Enhanced safety and reduced harm associated with substance use.
Limitations and Future Directions:
While the IRON model provides a comprehensive theoretical framework, its empirical validation is a necessary next step. Future research should focus on evaluating the feasibility, fidelity, and effectiveness of implementing the IRON model across diverse addiction treatment settings and populations. This includes developing specific training curricula for nurses, creating fidelity measures, and conducting controlled trials to assess its impact on patient, provider, and system-level outcomes. Furthermore, adaptation and tailoring of the model to specific cultural contexts may be necessary.

Conclusion:
The Integrated Recovery-Oriented Nursing (IRON) Care Model offers a robust, theoretically grounded, and actionable framework to guide nurses in delivering high-quality, effective, and compassionate care in addiction treatment. By systematically integrating evidence-based nursing practices with the empowering principles of recovery, the IRON model has the potential to significantly optimize treatment outcomes, foster lasting recovery, and transform the lives of individuals, families, and communities affected by addiction. It calls for a paradigm shift where nurses are recognized and empowered as central figures in championing a hopeful, person-driven, holistic, and integrated approach to addiction care, ultimately strengthening the fabric of recovery.
Format
Наборы инструментов

The Integrated Recovery-Oriented Nursing (IRON) Care Model: A Theoretical Framework for Optimizing Addiction Treatment Outcomes


The Integrated Recovery-Oriented Nursing (IRON) Care Model is a comprehensive theoretical framework designed to guide nursing practice in addiction treatment. It emphasizes a holistic, person-centered, and strengths-based approach, integrating evidence-based nursing interventions with the core principles of recovery. Grounded in established nursing and psychological theories, the IRON model aims to optimize treatment outcomes by fostering resilience, promoting self...

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Rasha Abi Hana

Key findings from the 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD)

Shared by Rasha Abi Hana - 19 June 2025
ESPAD EUDA
Format
Брошюры
Published by / Citation
EUDA

 

This publication presents key findings from the 8th round of the European School Survey Project on Alcohol and Other Drugs (ESPAD), conducted in 2024 among 113,882 students aged 15–16 across 37 European countries.

Marking 30 years of monitoring adolescent risk behaviours, the 2024 edition introduces a new focus on mental well-being and prevention activities, highlighting their growing role in shaping youth health outcomes.

The key findings report is available in 33 languages and optimised for online access. A full report, ESPAD Report 2024, will be released in October 2025.

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James Harvey

Upcoming ICAP Exams in Indonesia – September 2025

Shared by James Harvey (ISSUP staff) - 17 June 2025
ICAP Exams.
The ICUDDR Center for Credentialing & Accreditation (CCA) has announced that all ICAP Exams will be offered in Bali, Indonesia, on 18 September 2025, during the upcoming ISSUP 2025 event.
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James Harvey

Registration open for the 2025 ISSUP Conference

Shared by James Harvey (ISSUP staff) - 17 June 2025
Registration open for the 2025 ISSUP Conference
We are excited to announce that registration is open for the 2025 ISSUP Conference taking place in Indonesia from 17-19 September 2025.
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James Harvey

ISSUP Newsletter - Issue 195 (11 June 2025)

Shared by James Harvey (ISSUP staff) - 11 June 2025
ISSUP newsletter
In the latest issue of the ISSUP Newsletter registration opens for the 2025 Regional Conference in Bali, plus news from Malaysia on strengthening advocacy for drug policy reform.
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James Harvey

Impact Survey

Shared by James Harvey (ISSUP staff) - 9 June 2025
Impact Survey
Format
Списки литературы
This survey is a collaborative effort by ICUDDR, NECPAM and ISAM. Together, we are trying to assess the impact recent reductions in funding have had to the workforce of fields dealing with substance use related issues.
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Christopher Saah Bangaou

3rd Annual Youth Policy Dialogue on Drugs Prevention in Liberia

Christopher Saah Bangaou - 6 June 2025
Date:
25 июн 2025
Country
Либерия
GASD and Partners set to Host 3rd Annual Youth Policy Dialogue on Drug Prevention in Liberia In commemoration of the 2025 International Day Against Drug Abuse and Illicit Trafficking, the Global Action for Sustainable Development (GASD), in partnership with the Youth Desk of the Liberia Council of Churches, is hosting the 3rd Annual Youth Policy Dialogue on Drug Prevention in Liberia. This landmark event serves as a vital platform to highlight the urgent need for comprehensive drug prevention strategies, grounded in evidence-based practices and tailored to Liberia’s unique social and cultural...
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Christopher Saah Bangaou

Substance Abuse Free Environment (A School-Based Intervention Program) Official Launch

Christopher Saah Bangaou - 31 May 2025
Global Action for Sustainable Development-GASD Launched First-Ever Evidence-Based Substance Used Disorders Prevention in Liberia. The Substance Abuse Free Environment (SAFE) School-Based Intervention Program is designed as a comprehensive, school-based prevention model that seeks to develop and...
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Christopher Saah Bangaou

Substance Abuse Free Environment (A School-Based Intervention Program) Official Launch

Christopher Saah Bangaou - 31 May 2025

Global Action for Sustainable Development-GASD Launched First-Ever Evidence-Based Substance Used Disorders Prevention in Liberia. 

The Substance Abuse Free Environment (SAFE) School-Based Intervention Program is designed as a comprehensive, school-based prevention model that seeks to develop and enhance students’ personal, interpersonal, and drug resistance skills. It aims to introduce, implement, and sustain evidence-based substance abuse prevention initiatives in schools across Liberia through a participatory and inclusive approach that engages students, school authorities, and community...

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PETER CHEGE KARIUKI

STRENGTHENING OUR FIGHT AGAINST DRUGS THROUGH GRASSROOTS ACTION.

PETER CHEGE KARIUKI - 28 May 2025

Strengthening Our Fight Against Drugs Through Grassroots Action.

Dear Team,

As we continue our collective efforts to prevent drug and substance abuse, it is becoming increasingly clear that real and lasting impact starts at the grassroots level. The strength of any movement lies in its foundation—and for us, that foundation is our communities.

Building a grassroots network in our areas is not just important—it is essential. By empowering local leaders, engaging families, collaborating with schools, religious institutions, youth groups, and community-based organizations, we create a strong...

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James Harvey

ISSUP Newsletter - Issue 194 (21 May 2025)

Shared by James Harvey (ISSUP staff) - 21 May 2025
ISSUP newsletter
Catch up on all the latest news from ISSUP including the launch of a new handbook on the management of drug use disorder treatment services.
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James Harvey

ISSUP Newsletter - Issue 193 (7 May 2025)

Shared by James Harvey (ISSUP staff) - 7 May 2025
ISSUP newsletter
Welcome to this edition of the ISSUP newsletter. From Paraguay to Peru, Kenya to Europe, recent milestones reflect a growing momentum in substance use prevention education and training worldwide.
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Rasha Abi Hana

An Overview of the International Drug Policy Academy

Shared by Rasha Abi Hana - 24 April 2025
Format
Вебинары ISSUP

The International Drug Policy Academy (IDPA)(внешняя ссылка), established by the Council of Europe's Pompidou Group(внешняя ссылка), is dedicated to enhancing the capabilities of professionals involved in drug policy and addiction services. With over 50 years of international cooperation and capacity building, the IDPA aims to bridge the gap between policy, research, and practice across various sectors, fostering the development of coherent and sustainable drug policies.  

 

Objectives of the IDPA

 

  • Capacity Building: Strengthening the skills of professionals for effective design, management and evaluation of drug...
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Alicia Siler-Wallace

EMDRIA: EMDR-Trained Therapist

Alicia Siler-Wallace - 20 апреля 2025 r.
EMDRIA: EMDR-Trained Therapist : Directory: "Find A Therapist"
EMDRIA: EMDR-Trained Therapist (внешняя ссылка)
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Alicia Siler-Wallace

United States: National Certified Counselor Directory

Alicia Siler-Wallace - 20 апреля 2025 r.
United States: National Certified Counselor Directory
NBCC (National Board of Certified Counselors(внешняя ссылка)
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Alicia Siler-Wallace

Psychology Today: Alicia Siler-Wallace

Alicia Siler-Wallace - 20 апреля 2025 r.
Professional Profile
Psychology Today: Alicia Siler-Wallace (внешняя ссылка)
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Rasha Abi Hana

Effectiveness of nurse-initiated smoking cessation intervention: a systematic review and meta-analysis

Shared by Rasha Abi Hana - 14 April 2025
Format
Наборы инструментов
Published by / Citation
Lee, EH., Yu, HJ. Effectiveness of nurse-initiated smoking cessation intervention: a systematic review and meta-analysis. Subst Abuse Treat Prev Policy 20, 18 (2025). https://doi.org/10.1186/s13011-025-00648-8

Background
Smoking is one of the top causes of preventable death and is linked to many serious health problems, including cancer and chronic diseases. Nurses can play a big role in helping people quit smoking by offering support through counselling, education, and mental health care. These nurse-led programs have been shown to increase quit rates. Training nurses to deliver these programs is important, and reviewing past studies helps us understand what works best.

Methods
Researchers searched eight major health databases between March 27 and August 1, 2024, to find studies on nurse-led...

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James Harvey

ISSUP Newsletter - Issue 191 (2nd April 2025)

Shared by James Harvey (ISSUP staff) - 2 April 2025
ISSUP newsletter
Welcome to this edition. We are excited to announce that there is still time to submit abstracts for the ISSUP Regional Conference 2025 taking place in September on the island of Bali, Indonesia.
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Rasha Abi Hana

Canadian Substance Use Costs and Harms Online Data Visualisation Tool

Shared by Rasha Abi Hana - 2 April 2025
Format
Книги
Published by / Citation
Canadian Substance Use Costs and Harms (CSUCH)

CSUCH’s data visualisation tool can be used to estimate substance use trends across the country. The data helps inform programs, practices, and research to protect communities, save lives, and improve the well-being of people in Canada.

 

Spotlight: Top 3 causes of death due to substance use in Canada 


More than 200 people died each day due to substance use (SU) in 2020 (the latest year for which data are available). That works out to 73,994 deaths that year. The average age of death due to SU was 45 years. Tobacco use caused 63% (46,366) of SU-related deaths, followed by alcohol at 23%...

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Rasha Abi Hana

The Psychology of Addiction and Obesity: New Treatments

Shared by Rasha Abi Hana - 24 March 2025
Format
Новости
Published by / Citation
Adi Zuloff-Shani Ph.D. Psychedelics to the Rescue

Addiction and obesity share similar neurological pathways, both linked to compulsive behaviors and the brain's reward system. Research has highlighted the potential of GLP-1 receptor agonists, originally developed for diabetes, to help manage both appetite and addictive cravings. These medications, such as semaglutide, may regulate addictive behaviors by influencing reward circuits in the brain. However, they come with potential side effects, and their long-term effects are still under investigation.

In addition, a new compound, 5-Methoxy-2-aminoindane (MEAI), is being researched for its...

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Upcoming Events

3rd Annual Youth Policy Dialogue on Drugs Prevention in Liberia

25 июн 2025
Либерия
GASD and Partners set to Host 3rd Annual Youth Policy Dialogue on Drug Prevention in Liberia In commemoration of the 2025 International Day Against Drug Abuse and Illicit Trafficking, the Global Action for Sustainable Development (GASD), in...
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ISSUP is funded by the U.S. Department of State via the Bureau of International Narcotics and Law Enforcement Affairs (INL). INL works to keep Americans safe by countering crime, illegal drugs, and instability abroad.

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