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Dear Dr Trivedi, Dr Shoptaw and Dr Ling, thank you for your work and the opportunity to discuss your paper on this platform. I was really curious to see that the combination treatment did not produce a change enough to comment in terms of reducing cravings or depression as described in Table2. How can this be explained? If the patient does not experience meaningful changes in cravings wouldn't adherence be of concern in this high risk group especially in a primary care setting? Would you still recommend this combination in PHC?