Addiction最新文献

Aims: The present systematic review and meta-analysis synthesized the literature of positive psychological interventions (PPIs) for substance use and addiction recovery from 2010 to 2023, specifically examining intervention characteristics, outcome measurement, study rigor, feasibility/acceptability and efficacy (Prospero ID CRD42023392299).

Methods: We searched PubMed, PsycInfo and Web of Science for peer-reviewed papers in English, published between 2010 and 2023, that applied a PPI to people who used substances or were in addiction recovery. We also manually searched Google Scholar, ResearchGate and reference lists of publications. The Mixed Methods Appraisal Tool was used to assess study quality and risk of bias. We conducted meta-analyses of the effects of PPIs from eight full-scale randomized clinical trials (RCTs) (i.e. RCTs with treatment groups larger than 50 participants) that measured positive psychological outcomes (n = 5 RCTs; 12 interventions) and substance use outcomes (n = 6 RCTs; 9 interventions); all other outcomes were presented descriptively.

Results: The systematic search yielded 30 eligible publications across 6 countries (14/30 from United States), that evaluated 36 individual PPIs. Nineteen articles reported randomized studies comparing a PPI with one or more control condition (eight full-scale RCTs, or trials assigning 50 or more participants to the intervention condition) and the remaining 11 were single-arm studies. PPIs varied regarding duration, mode of delivery and content. Feasibility and acceptability ratings of PPIs were positive across studies. Meta-analyses revealed a small, nonsignificant effect of PPIs on positive psychological outcomes [d = 0.23, 95% confidence interval (CI) = -0.06 to 0.52, P = 0.12] and a very small, nonsignificant effect on substance use outcomes (d = 0.11; 95% CI = -0.05 to 0.27, P = 0.19). Ten out of 30 (30%) studies received a strong quality rating.

Conclusions: Positive psychological interventions appear to be feasible and engaging, with mixed efficacy, for people who use substances or are in recovery.

Background and aims: Exploring the relationship between vaping and smoking in young people is a key area of research that can inform e-cigarette policy. Rigorous evidence mapping and synthesis have highlighted gaps and methodological concerns in the evidence base. This study provides recommendations for the conduct and reporting of future quantitative primary research exploring e-cigarette use and later cigarette smoking in young people (≤29 years).

Methods: We developed a draft version of recommendations based on the critical appraisal of studies, findings of a systematic review and an evidence and gap map. We used an anonymized on-line survey to run a consultation exercise with stakeholders, including researchers, non-profit/charity workers and clinicians. Respondents rated the perceived importance of each draft recommendation on a 5-point Likert scale and provided open-ended comments, where relevant. We developed a final set of recommendations based on this stakeholder input.

Results: We initially came up with a list of 22 recommendations, which 36 stakeholders rated in the on-line survey. Most were researchers (n = 26) and from the USA (n = 18). Following feedback, this resulted in a final set of 23 recommendations, including recommendations for planning, data collection, data analysis and reporting. Examining causes of differences in vaping-smoking associations, including equity factors (e.g. socioeconomic status) and contextual factors (e.g. jurisdiction levels), and generating representative longitudinal data from countries other than the USA, Canada and UK, particularly low- and middle-income countries, were strongly endorsed recommendations. A new recommendation to report characteristics of e-cigarettes (e.g. flavours) was added.

Conclusions: This study provides 23 recommendations for conducting and reporting future quantitative research exploring e-cigarette use/availability and later combustible cigarette smoking in young people. Most of the recommendations are specific to studies using repeat cross-sectional data tracking population trends and to longitudinal cohort studies tracking behaviours in individuals.

Background and aims: Adolescent alcohol consumption decreased in high-income countries during the 2000s and 2010s. While evidence for declining consumption is clear, there has been less research tracking trends in alcohol-related harms. This article reviewed trends in adolescent alcohol-related harms in high-income countries where a decline in consumption had occurred and investigated sex-based differences in trends.

Methods: The databases Medline, CINAHL, Scopus and PubMed were systematically searched, with grey literature searches also conducted. Studies were included if they reported on harm rates between 2005 and 2019 for adolescents (10-19 years) from countries where a reduction in adolescent drinking occurred. Health-system based measures of alcohol-related harm were used (e.g. hospital admissions or mortality data). Search terms included alcohol, adolescents, alcohol-related harms, trends or synonyms. Risk of bias was assessed, primary screening was conducted by one author with checks by another, and data extraction was completed by three authors with accuracy checks conducted. The results are presented via narrative synthesis.

Results: Systematic searches resulted in 1311 results. A total of 18 systematic search and 23 grey literature sources were included. For many countries, alcohol-related harms have decreased since 2005, following trends in declining consumption. This evidence was strongest in Anglosphere countries, where eight of thirteen records (62%) indicated declines, followed by North America, where declines were present in four of eleven records (36%). Trends from mainland Europe were contradictory, with only four of thirteen (31%) indicating decreases in harms. Increases in harms for some female and student populations were reported in some jurisdictions.

Conclusions: Alcohol-related harms for young people have generally declined in countries where youth drinking has fallen, although the declines in harm have been smaller than the declines in drinking. Declines in alcohol-related harm were strongest in the United Kingdom, Australia, New Zealand and Ireland, followed by North America.

Background and aims: Network analysis is being used increasingly to study disorders such as alcohol use disorder (AUD) at the level of interacting symptoms. However, it remains unclear what insights AUD symptom networks have brought so far. Therefore, this pre-registered systematic review, following PRISMA reporting guidelines, aimed to collate and critically assess the literature on published AUD symptom networks.

Methods: 1608 unique articles were collected from PsycINFO, Medline, Embase and Web of Science between January 2010 and May 2023. A total of six articles were included in the review, comprising seven unique cross-sectional networks. The general characteristics of the symptom networks are summarized (i.e. edge inclusion, whether the connection between nodes is present or absent; and node centrality, the importance of a node within an estimated network) and compared between population versus clinical samples.

Results: The networks included many edges, with densities ranging from 60% to 100% (mean and mode of 80%, standard deviation of 28%). The edge connecting Tolerance and Time Spent consuming alcohol was most consistently present across samples, while edges connecting to Physical/Psychological Problems were consistently connected only in population samples. Consuming Larger/Longer than intended, and Physical/Psychological Problems had highest strength centrality, while failure to Cut Down and Hazardous Use were consistently lowest.

Conclusions: Alcohol use disorder symptom networks tend to be densely interconnected and characterized by a high proportion of included edges (dependencies between variables). Some edges are more consistently found in population samples than in clinical samples and vice versa.

Background and aims: Child maltreatment (CM) is associated with several negative mental health outcomes in later life, including alcohol and substance use (AU and SU). Internalising (e.g. anxiety and depression) and externalising (e.g. delinquency and anti-social behaviour) behaviours have also been associated with CM, and with AU and SU. This study measured whether externalising or internalising behaviours in adolescence mediate the relationship between agency-reported CM and hospital admissions for AU or SU.

Design, setting and participants: Observational study linking administrative health data from Queensland, Australia, to prospective birth cohort data comprising agency-reported CM up to 14 years (exposure).

Measurements: Externalising and internalising behaviours at 14 years measured using the Youth Self-Report (mediator) and administratively linked inpatient hospital admissions for AU and SU from ages 25-39 (outcome).

Findings: Adjusted causal mediation analyses (n = 5092) found that externalising behaviours statistically significantly mediated 31% (P = 0.007) of the CM AU relationship, and 22% of the CM SU relationship (P = 0.016). Internalising behaviours did not statistically significantly mediate between CM and either AU or SU.

Conclusions: In Queensland, Australia, externalising behaviours appear to partially mediate the relationship between agency-reported child maltreatment and hospital admissions for alcohol and substance use, while internalising behaviours do not.

Background and aims: Adolescent substance use is a growing public health concern in Africa, yet little is known about the contextual factors of substance use among young African populations. This systematic review identified factors associated with substance use among adolescents (aged 10-19 years) in Africa.

Methods: This review was conducted in line with PRISMA guidelines. We searched six databases (from January 2000 to December 2020): PubMed, Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and World Health Organization (WHO) African Index Medicus. We included population-based observational studies reporting on factors associated with adolescent substance use across Africa. Study screening was conducted by at least four independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analysed in a narrative synthesis. Studies providing sufficient statistics, i.e. three or more reporting the same outcome and exposure/predictor, were included in meta-analyses.

Results: Sixty-three peer reviewed studies that were full text accessible were included. The majority were cross-sectional surveys. Factors associated with adolescent substance use identified were linked to individual, family, socioenvironmental and non-familial social networks determinants. Results from both the narrative synthesis and meta-analysis revealed that being male and an older adolescent were significantly associated with adolescent substance use. Combined odds ratio (OR) of males who currently smoke compared with females was 1.81 [95% confidence interval (CI) = 1.37-2.39; 6 studies, 13 443 participants, I² = 59.67%]. Additional meta-analysis outcomes found that having a friend who smokes was associated with tobacco smoking. Combined OR of 'ever-smokers' with a friend who smoked was 4.83 (CI = 2.56-9.10; 3 studies, 18 858 participants, I² = 79.21%). Having a family member who smokes was associated with smoking initiation (OR = 2.99; CI = 2.67-3.35; 3 studies, 18 858 participants, I² = 0%) and current smoking (OR = 2.33; CI = 2.23-2.45; 4 studies, 13 282 participants, I² = 0%).

Conclusion: Multiple factors that operate on individual, family and societal levels influence adolescent substance use in Africa. Key factors of adolescent substance use in Africa appear to include being male, being an older adolescent and being exposed to peer substance use.

Background and aims: US regulatory changes allowed for additional methadone take-home doses following COVID-19 onset. How dispensing practices changed and which factors drove variation remains unexplored. We determined daily methadone dispensing trajectories over six months before and after regulatory changes due to COVID-19 using state sequence analysis and explored correlates.

Design: Retrospective chart review of electronic health records.

Settings: Nine opioid treatment programs (OTPs) across nine US states.

Participants: Adults initiating treatment in 2019 (n = 328) vs. initiating 1 month after the COVID-19 regulatory changes of March 2020 (n = 376).

Measurements: Type of daily methadone medication encounter (in-clinic, weekend/holiday take-home, take-home, missed dose, discontinued) based on OTP clinic; cohort (pre vs. post-COVID-19); and patient substance use, clinical and sociodemographic characteristics.

Findings: Following COVID-19 regulatory changes, allotted methadone take-home doses increased from 3.5% to 13.8% of total person-days in treatment within the first 6 months in care. Clinic site accounted for the greatest variation in methadone dispensing (6.2% and 9.5% of the variation of discrepancy between sequences pre- and post-COVID-19, respectively). People who co-use methamphetamine had a greater increase in take-homes than people who did not use methamphetamine (from 3.7% pre-pandemic to 21.2% post-pandemic vs. 3.5% to 12.5%) and higher discontinuation (average 3.6 vs. 4.7 months among people who did not use methamphetamine pre-COVID-19; average 3.3 vs. 4.6 months post-COVID-19). In the post-COVID-19 cohort, females had a higher proportion of missed doses (17.2% vs. 11.9%) than males. People experiencing houselessness had a higher proportion of missed doses (19% vs. 12.3%) and shorter stays (average 3.5 vs. 4.5 months) when compared with those with stable housing.

Conclusion: Daily methadone dispensing trajectories in the US both before and following COVID-19 regulatory changes appeared to depend more on the opioid treatment programs' practices than individual patient characteristics or response to treatment.

Aims: This study aimed to quantify the population-level impact of a large-scale opioid agonist treatment (OAT) program on suicide-related mortality among people with opioid use disorder (OUD) in New South Wales (NSW), Australia.

Design: This is the first study to use dynamic mathematical modeling to explore the population-level impact of OAT on suicide mortality. The study used a two-part approach. First, we analyzed cohort data (2001-2017) to calculate incidence rate ratios (IRRs) and other model parameters related to OAT and suicide risk. Second, findings were applied to model outputs to estimate suicides averted by the NSW OAT program (2001-2020).

Setting and participants: A cohort of 46 845 individuals who received OAT between 2001 and 2017 in community and prison settings in New South Wales, Australia.

Measurements: IRRs for suicide and other model parameters were calculated for individuals on versus off OAT in community and prison settings (2001-2017). These estimates, along with model outputs, were used to determine the number and proportion of suicides averted by the OAT program (2001-2020).

Findings: Receiving OAT was associated with an IRR for suicide of 0.32 [95% confidence interval (CI) = 0.25-0.40] in the community and 0.34 (95% CI = 0.10-1.10) in prison for cohort data analyses (2001-2017). Between 2001 and 2020, the OAT program in NSW averted an estimated 338 suicides [95% credible interval (CrI) = 213-492), with 325 (95% CrI = 202-476) averted in the community and 13 (95% CrI = 0-46) in prison, corresponding to a 35% (95% CrI = 27%-43%) reduction in suicides among those accessing OAT.

Conclusions: The opioid agonist treatment program in New South Wales, Australia, was associated with a 35% reduction in suicide mortality among individuals with opioid use disorder receiving treatment between 2001 and 2020, providing novel evidence of its population-level impact on suicide prevention.