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Measuring craving: A systematic review and mapping of assessment instruments. What about sexual craving? 衡量渴望:对评估工具进行系统审查和绘制。性渴望呢?
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-26 DOI: 10.1111/add.16287
Cécile Miele, Julien Cabé, Nicolas Cabé, Ingrid Bertsch, Georges Brousse, Bruno Pereira, Valérie Moulin, Servane Barrault

Background and aims

Craving is central in the definition of addictive disorders because of its diagnostic and prognostic value. Its measurement is essential in clinical practice. Previous reviews provided a better overview of existing instruments; however, they do not consider emerging substances and behaviors such as sexual addictions. Our objectives were threefold: (1) to provide a systematic review of craving assessment instruments and their psychometric characteristics within a transdiagnostic approach, (2) to highlight and map their conceptual relationships and (3) to identify potential sexual craving assessment instruments.

Methods

The review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The PubMed, Embase, PsychInfo and Cochrane/Central databases were searched for publications that met the following inclusion criterion: validation studies of craving assessment instruments, regardless of target substance or behavior. The original search identified 4561 references and included 147 articles. Each selected study was a peer-reviewed publication.

Results

This review provides a synthesis of the psychometric properties of 36 original instruments and identified 93 variations of these instruments (e.g. translations). We were able to highlight five transdiagnostic families of instruments, each corresponding to a conceptual model. Only one instrument for assessing craving in the domain of compulsive sexual behavior, focused on pornography use, has been identified: the Pornography Craving Questionnaire.

Conclusion

This review mapped all craving assessment instruments from a transdiagnostic perspective, finding 36 original instruments and 93 variations. The evolution of instruments to measure craving mirrors the evolution of the concept of craving which has progressively integrated cognitive, conditioning and sensory dimensions, and attests to the importance of the context of assessment. Development of an instrument to measure ‘sexual craving’ is needed and could be based on the data from our review.

背景和目的:渴求是成瘾性疾病定义的核心,因为它具有诊断和预后价值。其测量在临床实践中至关重要。以往的审查更好地概述了现有文书;然而,他们不考虑新出现的物质和行为,如性成瘾。我们的目标有三个:(1)在跨诊断方法中对渴望评估工具及其心理测量特征进行系统回顾,(2)强调和绘制它们的概念关系,(3)确定潜在的性渴望评估工具。方法:使用系统评价和荟萃分析的首选报告项目(PRISMA)方法进行审查。在PubMed、Embase、PsychInfo和Cochrane/Central数据库中搜索符合以下纳入标准的出版物:渴望评估工具的验证研究,无论目标物质或行为如何。最初的搜索确定了4561篇参考文献,包括147篇文章。每一项选定的研究都是经过同行评审的出版物。结果:这篇综述综合了36种原始工具的心理测量特性,并确定了这些工具的93种变体(如翻译)。我们能够强调五个跨诊断仪器家族,每个家族都对应一个概念模型。在强迫性行为领域,只有一种评估渴望的工具,专注于色情使用,被确定:色情渴望问卷。结论:这篇综述从跨诊断的角度绘制了所有渴望评估工具,发现了36种原始工具和93种变体。衡量渴望的工具的演变反映了渴望概念的演变,渴望概念逐渐整合了认知、条件反射和感官维度,并证明了评估背景的重要性。需要开发一种测量“性渴望”的工具,并且可以基于我们的审查数据。
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引用次数: 0
The impact of cannabis legalization and decriminalization on acute poisoning: A systematic review 大麻合法化和非刑事化对急性中毒的影响:系统综述。
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-26 DOI: 10.1111/add.16280
Sara Allaf, Jessy S. Lim, Nicholas A. Buckley, Rose Cairns

Background and Aims

Many countries have recently legalized medicinal and recreational cannabis. With increasing use and access come the potential for harms. We aimed to examine the effect of cannabis legalization/decriminalization on acute poisoning.

Methods

A systematic review and meta-analysis registered with PROSPERO (CRD42022323437). We searched Embase, Medline, Scopus and Cochrane Central Register of Controlled Trials from inception to March 2022. No restrictions on language, age or geography were applied. Abstracts from three main clinical toxicology conferences were hand-searched. Included studies had to report on poisonings before and after changes in cannabis legislation, including legalization and decriminalization of medicinal and recreational cannabis. Where possible, relative risk (RR) of poisoning after legalization (versus before) was calculated and pooled. Risk of bias was assessed with ROBINS-I.

Results

Of the 1065 articles retrieved, 30 met inclusion criteria (including 10 conference abstracts). Studies used data from the United States, Canada and Thailand. Studies examined legalization of medicinal cannabis (n = 14) and decriminalization or legalization of recreational cannabis (n = 21). Common data sources included poisons centre records (n = 18) and hospital presentations/admissions (n = 15, individual studies could report multiple intervention types and multiple data sources). Most studies (n = 19) investigated paediatric poisoning. Most (n = 24) reported an increase in poisonings; however, the magnitude varied greatly. Twenty studies were included in quantitative analysis, with RRs ranging from 0.81 to 29.00. Our pooled estimate indicated an increase in poisoning after legalization [RR = 3.56, 95% confidence interval (CI) = 2.43–5.20], which was greater in studies that focused on paediatric patients (RR = 4.31, 95% CI = 2.30–8.07).

Conclusions

Most studies on the effect of medicinal or recreational cannabis legalization/decriminalization on acute poisoning reported a rise in cannabis poisoning after legalization/decriminalization. Most evidence is from US legalization, despite legalization and decriminalization in many countries.

背景和目的:许多国家最近已将药用和娱乐用大麻合法化。随着使用和获取的增加,潜在的危害也随之而来。我们旨在研究大麻合法化/非刑事化对急性中毒的影响。方法:在PROSPERO(CRD42022323437)注册的系统综述和荟萃分析。从开始到2022年3月,我们搜索了Embase、Medline、Scopus和Cochrane对照试验中央登记册。对语言、年龄或地理位置没有任何限制。对三个主要临床毒理学会议的摘要进行了手工检索。纳入的研究必须报告大麻立法变化前后的中毒情况,包括药用和娱乐大麻的合法化和非刑事化。在可能的情况下,计算并汇总合法化后(与之前相比)中毒的相对风险(RR)。结果:在检索到的1065篇文章中,30篇符合纳入标准(包括10篇会议摘要)。研究使用了来自美国、加拿大和泰国的数据。关于药用大麻合法化的研究(n = 14) 以及娱乐性大麻的非刑事化或合法化(n = 21)。常见数据来源包括毒药中心的纪录(n = 18) 以及医院介绍/入院(n = 15,个体研究可以报告多种干预类型和多种数据来源)。大多数研究(n = 19) 调查了儿童中毒。大多数(n = 24)报告了中毒事件的增加;然而,幅度变化很大。20项研究被纳入定量分析,RR在0.81至29.00之间。我们的汇总估计表明合法化后中毒增加[RR = 3.56,95%置信区间(CI) = 2.43-5.20],这在专注于儿科患者的研究中更大(RR = 4.31195%CI = 2.30-8.07)。结论:大多数关于药用或娱乐性大麻合法化/非刑事化对急性中毒影响的研究报告称,合法化/非刑罪化后大麻中毒增加。大多数证据来自美国合法化,尽管在许多国家合法化和非刑事化。
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引用次数: 2
Joint effects of substance use disorders and recent substance use on HIV viral non-suppression among people engaged in HIV care in an urban clinic, 2014–2019 2014-2019年,在一家城市诊所从事HIV护理的人群中,药物使用障碍和最近药物使用对HIV病毒不抑制的联合影响
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-25 DOI: 10.1111/add.16301
Catherine R. Lesko, Oluwaseun O. Falade-Nwulia, Jarratt D. Pytell, Heidi E. Hutton, Anthony T. Fojo, Jeanne C. Keruly, Richard D. Moore, Geetanjali Chander

Aims

To estimate the joint effects of substance use disorder (SUD) and recent substance use on human immunodeficiency virus (HIV) non-suppression.

Design

Retrospective clinical cohort study with repeated observations within individuals.

Setting

Baltimore, Maryland, United States.

Participants

1881 patients contributed 10 794 observations.

Measurements

The primary independent variable was the combination of history of SUD and recent substance use. History of SUD was defined as any prior International Classification of Diseases 9/10 code for cocaine or opioid disorder. Recent substance use was defined as the self-report of cocaine or non-prescribed opioid use on the National Institute of Drug Abuse-modified Alcohol, Smoking and Substance Involvement Screening Test or clinician-documented cocaine or opioid use abstracted from the medical record. The outcome was viral non-suppression, defined as HIV RNA >200 copies/mL on the first viral load measurement within 1 year subsequent to each observation of substance use. We adjusted for birth sex, Black race, age, HIV acquisition risk factors, years in care and CD4 cell count. In secondary analyses, we also adjusted for depressive, anxiety and panic symptoms, cannabis use and cannabis use disorder.

Findings

On their first observation, 31% of patients had a history of an SUD and 18% had recent substance use. Relative to no history of SUD and no recent substance use, the 1-year fully adjusted risk difference (RD) for viral non-suppression associated with cocaine and opioid use disorder and recent substance use was 7.7% (95% CI = 5.3%–10.0%), the RD was 5.5% (95% CI = 1.2%–9.7%) for history of cocaine use disorder without recent substance use, and the RD was 4.6% (95% CI = 2.7%–6.5%) for recent substance use without a SUD.

Conclusions

Substance use and substance use disorders appear to be highly prevalent among, and independently associated with, viral non-suppression among people with HIV.

目的评估药物使用障碍(SUD)和近期药物使用对人类免疫缺陷病毒(HIV)非抑制的联合影响。设计在个体内重复观察的回顾性临床队列研究。背景美国马里兰州巴尔的摩。参与者1881名患者贡献了10 794次观察。测量主要自变量是SUD病史和近期药物使用的组合。SUD病史被定义为可卡因或阿片类药物障碍的任何先前的国际疾病分类9/10代码。最近的药物使用被定义为在国家药物滥用研究所修改的酒精、吸烟和药物参与筛查测试中自我报告可卡因或非处方阿片类药物的使用,或从医疗记录中提取临床医生记录的可卡因或阿片类药的使用。结果是病毒非抑制,定义为HIV RNA>;200 每次观察物质使用后1年内首次病毒载量测量的拷贝数/mL。我们对出生性别、黑人种族、年龄、HIV感染风险因素、护理年限和CD4细胞计数进行了调整。在二次分析中,我们还调整了抑郁、焦虑和恐慌症状、大麻使用和大麻使用障碍。结果在他们的第一次观察中,31%的患者有SUD病史,18%的患者最近使用过药物。相对于无SUD史和近期无药物使用史,与可卡因和阿片类药物使用障碍相关的病毒未抑制和近期药物使用的1年完全调整风险差(RD)为7.7%(95%CI=5.3%-10.0%),可卡因使用障碍史和近期未使用药物的RD为5.5%(95%CI=1.2%-9.7%),最近未使用SUD的药物的RD为4.6%(95%CI=2.7%-6.5%)。结论药物使用和药物使用障碍在HIV感染者中高度流行,并与病毒不抑制独立相关。
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引用次数: 1
How Addiction handles disagreements over potentially harmful terminology 成瘾是如何处理潜在有害术语的分歧的
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-24 DOI: 10.1111/add.16302
Keith Humphreys, Rob Calder, John Marsden, Ed Day
<p>A peer reviewer of a submitted paper on methadone maintenance states that she avoids the author’s term ‘opioid agonist therapy’ because new patients associate it with agony and become less willing to try the medication. She recommends ‘opioid substitution therapy’ instead. When the author uses this term in a revised submission, a different reviewer says that this term implicitly supports the canard that ‘methadone just substitutes one addiction for another’. Trying to moderate the dispute, an assistant editor proposes ‘medication-assisted treatment’, to which everyone agrees. When the paper is published, a reader writes in, angrily declaring that the author is putting lives at risks by ignoring the evidence that the main benefit of methadone comes from medication rather than it merely being an assist to the ‘real treatment’.</p><p>What are authors, editors and reviewers to do when people who are sincerely and laudably interested in avoiding language that harms vulnerable people do not agree on what is harmful and what is not? One approach is for journals to create an extensive listing of terms that will and will not be allowed to appear in papers, monographs and website content. Our journal does enforce a few language rules; for example, referring to urinalysis results indicating drug use as ‘positive’ rather than ‘dirty’ [<span>1</span>] and avoiding the term substance ‘abuse’. We would also, of course, not allow racially or ethnically derogatory language were it ever included in submitted papers, but in living memory it has not been.</p><p>However, after internal discussion the editorial team has decided not to attempt to generate a more lengthy list of forbidden terms because <i>Addiction</i> is a global, interdisciplinary journal whose readers and authors have diverse, competing opinions on what language is harmful and what is not. We instead follow four principles.</p><p>Some of the earliest activists who use drugs in the Netherlands labelled themselves the ‘junkie-bond’ [<span>2</span>]. Members of 12-Step groups often refer to themselves as ‘addicts’ or ‘alcoholics’ [<span>3</span>]. Some are horrified that people would choose to refer to themselves by terms they regard as stigmatizing, but in articles where someone is speaking about themselves in the first person we leave that decision up to the person concerned. Otherwise, we are in the position of putatively advocating for someone while simultaneously trying to deprive them of their right to speak and to define themselves.</p><p>Calling people what they want to be called is a sign of respect and a good practice to avoid harm. At the same time, the diversity within vulnerable populations on preferred labels should not be underestimated. For example, in the mental health field, some individuals want to be called ‘service users’, others endorse ‘patients’, others prefer ‘people who use services’ and still others plump for ‘consumer/survivors’ [<span>4</span>].</p><p>Similarly, that a te
一篇关于美沙酮维持的论文的同行审稿人表示,她避免使用作者的术语“阿片类药物激动剂治疗”,因为新患者将其与痛苦联系在一起,不太愿意尝试这种药物。她建议采用“阿片类药物替代疗法”。当作者在修改后的提交中使用这个术语时,另一位审稿人说,这个术语隐含地支持了“美沙酮只是用一种成瘾代替另一种成瘾”的谣言。为了缓和争议,一位助理编辑提出了“药物辅助治疗”的建议,大家都同意了。当这篇论文发表后,一位读者来信,愤怒地宣称作者忽视了美沙酮的主要益处来自药物治疗的证据,而不仅仅是对“真正治疗”的辅助,这是在把生命置于危险之中。当那些真诚地、值得称赞地对避免伤害弱势群体的语言感兴趣的人在什么是有害的、什么是无害的问题上意见相左时,作者、编辑和审稿人该怎么办?一种方法是让期刊创建一个广泛的术语清单,这些术语将被允许和不被允许出现在论文、专著和网站内容中。我们的杂志确实执行了一些语言规则;例如,使用“阳性”而不是“肮脏”的尿检结果来指代药物使用[1],避免使用“滥用”一词。当然,我们也不允许在提交的论文中出现种族或民族上的贬损语言,但在人们的记忆中,这种情况从未发生过。然而,在经过内部讨论后,编辑团队决定不再试图列出一份更长的禁用词汇清单,因为《成瘾》是一本全球性的跨学科期刊,其读者和作者对哪些语言有害、哪些无害有着不同的、相互矛盾的观点。相反,我们遵循四个原则。在荷兰,一些最早使用毒品的激进分子称自己为“瘾君子”[2]。12步治疗小组的成员通常称自己为“瘾君子”或“酗酒者”[3]。有些人对人们会选择用他们认为是耻辱的术语来称呼自己感到震惊,但在文章中,当有人用第一人称谈论自己时,我们把决定权留给有关的人。否则,我们就处于假定地为某人辩护的位置,同时又试图剥夺他们说话和定义自己的权利。别人想叫什么就叫什么,这是一种尊重的表现,也是避免伤害的好习惯。与此同时,不应低估弱势群体在首选标签上的多样性。例如,在心理健康领域,一些人希望被称为“服务使用者”,另一些人支持“患者”,另一些人喜欢“使用服务的人”,还有一些人喜欢“消费者/幸存者”[4]。同样,一个用来描述一个群体的术语被学术界所接受,并不一定意味着这个术语也被这样描述的群体所接受。例如,在美国,许多教授认为“拉丁裔”一词是拉丁裔/西班牙裔一词的尊重和性别敏感的替代品。但调查数据显示,美国只有四分之一的拉美裔人知道这个词,其中八分之七的人不使用它[5]。某些特定术语对弱势群体有害的说法有经验基础[6],但对于许多其他关于某些术语有害的断言,目前的证据很少或根本没有。我们尊重每个人用适当的语言表达意见的权利,但将没有证据的意见视为如此。当经验证明某一特定术语可以减少伤害时,最佳做法就是准确地使用它。例如,有证据表明,与“物质使用障碍患者”相比,“成瘾者”一词会引发更多的敌意反射反应[7]。这为“以人为本”语言的好处提供了一些经验支持,但我们不能假设它可以扩展到所有应用程序。例如,即使“使用药物的艾滋病患者”一词减少了耻辱感,PWAWUD是否产生同样的好处仍然是一个经验问题。同样,由于术语的效价会随着时间的推移而改变,过去一个术语有害或无害的证据不应被认为适用于所有时间(例如,“复发”一词在几十年前被引入,作为“重新使用”的一个不那么贬义的术语,现在有时被批评为更具贬义)。最后,我们要指出,伤害的程度和类型是不同的,同一术语可以以不同的方式影响不同的群体,这意味着证据应该为判断和讨论提供信息,但不能完全取代它们。长期以来,《成瘾》一直致力于阐明该领域的历史,其出版的历史研究和经典书籍评论就是最好的例证。 今天被视为有害的术语可能出现在历史学家分析的旧法律文本、学术研究、诊断手册、报纸、日记、信件和其他材料中。在这种情况下,我们希望历史术语被准确地呈现,而不是宽恕它,而是满足学术完整性的标准。在这种情况下,作者应该在引用以前的历史术语和提交作者使用的术语之间做出清晰的描述。在全球范围内,在不同的学科和不同的生活经历中,与术语相关的偏好是非常多样化的,因此简单地宣布可接受和不可接受的语言可能会适得其反。因此,Addiction在语言规则上采取了最低限度的方法,并赞同上述原则,以指导文明的、相互教育的讨论。在这样做的过程中,我们假设杂志家族中最好的成员;也就是说,广泛的共同愿望是不伤害他人,也不轻易冒犯他人。维持这样的社区伦理需要大家都保持谦逊。比起“在我的特定国家和特定工作场所,受过特定学科训练的人更喜欢这个术语”,说“X术语是唯一在道德上可接受的术语”可能在情感上更令人满意,但后者为前者提供了对话的机会。多年来,依靠善意和对复杂问题的深思熟虑的讨论一直是该杂志的一个标志,我们在潜在有害语言领域的政策旨在延续这一传统。基思·汉弗莱斯(Keith Humphreys):原稿(主笔);写作-审查和编辑(主导)。罗伯·考尔德(Rob Calder):原稿(配角);写作-审查和编辑(支持)。约翰·马斯登:写作原稿(支持);写作-审查和编辑(支持)。艾德·戴:写作原稿(配角);写作-审查和编辑(支持)。无。
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引用次数: 0
Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial 简短的认知行为干预促进严重酒精使用障碍成年人寻求治疗:一项随机对照试验。
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-24 DOI: 10.1111/add.16300
Kenneth R. Conner, Stephen A. Maisto, Beau Abar, Sarah Szafranski, Andrew Chiang, Morica Hutchison, Aileen Aldalur, Tracy Stecker
<div> <section> <h3> Background and Aims</h3> <p>There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use.</p> </section> <section> <h3> Design</h3> <p>Parallel group, non-pharmacologic RCT with intervention (<i>n</i> = 197) and active control (<i>n</i> = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months.</p> </section> <section> <h3> Setting</h3> <p>Online recruitment in a 17-county region of upstate New York, USA.</p> </section> <section> <h3> Participants</h3> <p>Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. <i>n</i> = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years.</p> </section> <section> <h3> Intervention and comparator</h3> <p>One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control).</p> </section> <section> <h3> Measurements</h3> <p>Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes).</p> </section> <section> <h3> Findings</h3> <p>Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ<sup>2</sup> [1] = 0.16, <i>P</i> = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (β = −1.197, <i>P</i> = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (<i>P</i> = 0.071), and it was not effective in women (17% vs 24%).</p> </section> <section> <h3> Conclusions</h3> <p>A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe a
背景和目的:很少有随机对照试验证据表明,短期干预可以改善严重酒精使用障碍(AUD)患者的治疗寻求,或治疗寻求可以减少酒精使用。目的是测试一种简短干预措施的疗效,以增加对患有严重AUD的天真成年人的治疗寻求,并测量其对饮酒的影响。设计:平行组,非药物随机对照试验加干预(n = 197)和主动控制(n = 203)条件,盲法评估员在1、3和6个月时进行随访。设置:在美国纽约州北部17个县的地区进行在线招募。参与者:纳入标准包括年龄≥18岁 年,酒精使用障碍识别测试得分≥16,超过酒精使用建议限值,且无AUD治疗史。n = 400;50%为女性;79%为白色;平均年龄40.7岁;平均受教育年限14.6年。干预和比较:一次电话干预:寻求治疗的认知行为疗法(CBT-TS;干预),国家酗酒和酗酒研究所关于AUD治疗(对照)的小册子综述。测量:3个月以上任何AUD治疗使用的自我报告(主要结果)和6个月以上饮酒的两项标准测量(次要结果)。结果:使用意向治疗分析。评估随访率≥93%。38名(19%)干预参与者和36名(18%)对照参与者在3个月的随访中获得了任何与酒精相关的治疗使用情况,差异无统计学意义,χ2[1] = 0.16,P = 0.689。二次分析显示,性别和干预分配之间存在显著的交互作用项(β = -1.197,P = 0.027)。相互作用表明CBT-TS对男性有效(22%对13%),尽管证据有些薄弱(P = 0.071),对女性无效(17%对24%)。
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引用次数: 0
Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia, Canada 使用级联护理框架来确定加拿大不列颠哥伦比亚省在获得酒精使用障碍药物方面的差距
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-24 DOI: 10.1111/add.16273
Maria Eugenia Socias, Frank Xavier Scheuermeyer, Zizhan Cui, Wing Yin Mok, Alexis Crabtree, Nadia Fairbairn, Seonaid Nolan, Amanda Slaunwhite, Lianping Ti

Background and aims

Despite the significant burden of alcohol use disorder (AUD) and availability of safe and effective medications for AUD (MAUD), population-level estimates of access and engagement in AUD-related care are limited. The aims of this study were to generate a cascade of care for AUD in British Columbia (BC), Canada, and to estimate the impacts of MAUD on health outcomes.

Design

This was a retrospective population-based cohort study using linked administrative health data.

Setting

British Columbia, Canada, 2015–2019.

Participants

Using a 20% random sample of BC residents, we identified 7231 people with moderate-to-severe alcohol use disorder (PWAUD; overall prevalence = 0.7%).

Measurements

We developed a six-stage AUD cascade (from diagnosis to ≥6 months retention in MAUD) among PWAUD. We evaluated trends over time and estimated the impacts of access to MAUD on AUD-related hospitalizations, emergency department visits and death.

Findings

Between 2015 and 2019, linkage to AUD-related care decreased (from 80.4% to 46.5%). However, rates of MAUD initiation (11.4% to 24.1%) and retention for ≥1 (7.0% to 18.2%), ≥3 (1.2% to 4.3%) or ≥6 months (0.2% to 1.6%) increased significantly. In adjusted analyses, access to MAUD was associated with reduced odds of experiencing any AUD-related adverse outcomes, with longer retention in MAUD showing a trend to greater odds reduction: adjusted odds ratio (95% CI) ranging from 0.59 (0.48–0.71) for MAUD retention <1 month to 0.37 (0.21–0.67) for ≥6 months retention.

Conclusions

Access to medications for alcohol use disorder among people with moderate-to-severe alcohol use disorder in British Colombia, Canada increased between 2015 and 2019; however, initiation and retention remained low. There was a trend between longer retention in medications for alcohol use disorder and greater reductions in the odds of experiencing alcohol use disorder-related adverse outcomes.

背景和目的尽管酒精使用障碍(AUD)的负担很重,而且可以获得安全有效的治疗AUD的药物,但在人群水平上对获得和参与AUD相关护理的估计是有限的。本研究的目的是在加拿大不列颠哥伦比亚省(BC)为AUD提供一系列护理,并估计MAUD对健康结果的影响。设计这是一项基于人群的回顾性队列研究,使用相关的管理健康数据。设定加拿大不列颠哥伦比亚省,2015-2019年。参与者使用不列颠哥伦比亚省居民的20%随机样本,我们确定了7231名患有中度至重度酒精使用障碍(PWAUD;总体患病率=0.7%)的人。测量我们在PWAUD中建立了六阶段AUD级联(从诊断到MAUD滞留≥6个月)。我们评估了一段时间以来的趋势,并估计了MAUD对AUD相关住院、急诊就诊和死亡的影响。研究结果2015年至2019年间,与AUD相关护理的相关性降低(从80.4%降至46.5%)。然而,MAUD开始率(11.4%至24.1%)和≥1个月(7.0%至18.2%)、≥3个月(1.2%至4.3%)或≥6个月(0.2%至1.6%)的保留率显著增加。在调整后的分析中,使用MAUD与经历任何AUD相关不良结果的几率降低有关,MAUD的保留时间越长,几率降低的趋势越大:MAUD保留时间的调整后比值比(95%CI)范围为0.59(0.48-0.71)<;1个月至0.37(0.21–0.67),保留期≥6个月。结论2015年至2019年间,加拿大不列颠哥伦比亚省中度至重度酒精使用障碍患者获得治疗酒精使用障碍药物的机会增加;然而,引发和保留率仍然很低。有一种趋势是,酒精使用障碍药物的保留时间更长,与酒精使用障碍相关的不良后果的几率更大。
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引用次数: 1
Addiction: A treatise from 1561 成瘾:1561年的一篇论文
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-22 DOI: 10.1111/add.16298
Louise Nadeau, Marc Valleur

Background and aims

In 1561, physician and philosopher Pascasius Justus Turq published a monograph on the description and treatment of pathological gambling. When the monograph came to the attention of the authors in 2006, there existed no known translation of it in any modern language. In 2014, it was translated and published in French. This paper analyses the monograph’s key content elements and its place in the history of the concept of addiction.

Methods

A contextual analysis of the late Italian Renaissance, followed by key excerpts from the text and commentaries on the meaning and significance of the monograph.

Findings and conclusions

Pascasius Justus Turq’s 1561 monograph on pathological gambling outlines a disease view of gambling, identifies cognitive processes and biological vulnerabilities as aetiological factors, avoids religious or moral judgements and recommends cognitive treatment to change the beliefs and expectancies of gamblers. This study shows that a ‘disease formulation’ of addiction was enunciated as early as the 16th century, and its contemporary resonance suggests that current clinical features of addictive disorders have existed for centuries.

背景和目的1561年,医生兼哲学家Pascasius Justus Turq出版了一本关于病理性赌博的描述和治疗的专著。当这本专著在2006年引起作者的注意时,还没有任何现代语言的已知翻译。2014年,它被翻译成法语出版。本文分析了该专著的主要内容要素及其在成瘾概念史上的地位。方法对意大利文艺复兴后期进行语境分析,然后对文本进行关键摘录,并对专著的意义和意义进行评述。发现和结论Pascasius Justus Turq 1561年关于病理性赌博的专著概述了赌博的疾病观,将认知过程和生物脆弱性确定为病因因素,避免宗教或道德判断,并建议进行认知治疗以改变赌徒的信仰和期望。这项研究表明,成瘾的“疾病配方”早在16世纪就已被阐明,其当代共鸣表明,成瘾性疾病的当前临床特征已经存在了几个世纪。
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引用次数: 0
Call for papers on disposable e-cigarettes 呼吁发表关于一次性电子烟的论文
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-22 DOI: 10.1111/add.16307

E-cigarettes have loomed large in tobacco control, regulatory science, addiction research and policy debates over the last decade. Early e-cigarettes were disposable devices that closely resembled cigarettes (widely described as cigalikes) and were relatively poor at delivering nicotine [1, 2]. Subsequent generations of e-cigarettes were developed that were rechargeable and included refillable tanks or replaceable cartridges or (later) pods [3], and typically delivered nicotine increasingly more effectively than earlier devices [4, 5]. Research established that nicotine e-cigarettes are more effective for smoking cessation than nicotine replacement therapy [6], less harmful than cigarettes [7] and principally attracted people who had previously smoked cigarettes regularly, or were likely to have done so in the future [8].

Since around 2021, a new form of disposable e-cigarettes has become popular in many countries. These disposable devices typically deliver nicotine more effectively by using a similar technology to pod devices and including a relatively high-strength nicotine salt e-liquid (20 mg/ml), are sold cheaply (for as little as £2.99 in the UK), and under a variety of brand names (e.g., ‘Crystal Bar’, ‘Elf Bar’, ‘Lost Mary’). From 2021 to 2022, use of disposable e-cigarettes rose sharply in Great Britain as these new products rapidly became popular among younger people (<25 year-olds) [9, 10]. Similar trends have been observed elsewhere, including among US, Australian and New Zealand youth [11-16]. The speed and extent of the increase in use of disposable e-cigarettes suggests a sizeable proportion of the youth population who were likely to have never smoked may now have been attracted to use these products.

From a public health point of view, the aim is to maximise the opportunity e-cigarettes present to help people to quit smoking, while minimising the risks of e-cigarettes being used by large numbers of young people who have never smoked. There is an urgent need for new research to estimate their likely public health impact of disposable e-cigarettes and to inform appropriate regulation.

Guest Editors:

Jamie Brown, University College London Tobacco and Alcohol Research Group, UK – [email protected]

Suzanne Colby, Brown University School of Public Health, USA – [email protected]

Natalie Walker, University of Auckland National Institute for Health Innovation, New Zealand – [email protected]

Please direct any general enquiries to Molly Jarvis, Editorial Manager and Commissioning Editor – [email protected]

Deadline for submissions: 31 December 2023.

在过去十年中,电子烟在烟草控制、监管科学、成瘾研究和政策辩论中占据了重要地位。早期的电子烟是一次性设备,与香烟(通常被称为cigalikes)非常相似,并且尼古丁的输送能力相对较差[1,2]。随后的几代电子烟被开发为可充电的,包括可重新填充的罐或可更换的烟筒或(后来的)烟筒[3],并且通常比早期的设备更有效地输送尼古丁[4,5]。研究表明,尼古丁电子烟比尼古丁替代疗法更有效戒烟[6],比香烟危害小[7],主要吸引以前经常吸烟或将来可能吸烟的人群[8]。从2021年左右开始,一种新型的一次性电子烟在许多国家流行起来。这些一次性电子烟通常使用与电子烟类似的技术,并含有相对高强度的尼古丁盐电子液体(20毫克/毫升),更有效地输送尼古丁,售价便宜(在英国低至2.99英镑),并且有各种各样的品牌名称(例如“水晶棒”、“精灵棒”、“迷失玛丽”)。从2021年到2022年,英国一次性电子烟的使用量急剧上升,因为这些新产品在年轻人(<25岁)中迅速流行[9,10]。在其他地方也观察到类似的趋势,包括美国、澳大利亚和新西兰的青年[11-16]。一次性电子烟使用增加的速度和程度表明,相当大一部分可能从未吸过烟的年轻人现在可能被吸引使用这些产品。从公共卫生的角度来看,目标是最大限度地利用电子烟帮助人们戒烟的机会,同时最大限度地降低大量从未吸烟的年轻人使用电子烟的风险。迫切需要进行新的研究,以估计一次性电子烟可能对公共卫生产生的影响,并为适当的监管提供信息。特邀编辑:Jamie Brown,英国伦敦大学学院烟草和酒精研究小组- [email protected]Suzanne Colby,美国布朗大学公共卫生学院- [email protected]Natalie Walker,新西兰奥克兰大学国家健康创新研究所- [email protected]请直接向Molly Jarvis咨询,编辑经理和委托编辑- [email protected]投稿截止日期:2023年12月31日。
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引用次数: 0
Association between job satisfaction and current smoking and change in smoking behavior: a 16-year longitudinal study in South Korea 工作满意度与当前吸烟和吸烟行为变化之间的关系:一项在韩国进行的16年纵向研究
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-19 DOI: 10.1111/add.16293
Seong-Uk Baek, Won-Tae Lee, Min-Seok Kim, Myeong-Hun Lim, Jin-Ha Yoon, Jong-Uk Won

Background and Aims

Previous studies have found that job satisfaction is closely associated with various health outcomes of workers. Our study measured the association between job satisfaction and current smoking and change in smoking behavior.

Design

Data from the longitudinal Korea Labor and Income Panel Study (KLIPS) that consist of nationally representative samples were used. The repeated measures analysis was conducted.

Setting

South Korea, 2005–2021.

Participants

In total, 21 154 workers in Korea followed from 2005 to 2021 (145 120 observations) were included as study participants.

Measurements

The main predictor variable, job satisfaction, was assessed using a five-item general job satisfaction questionnaire. Job satisfaction was classified into ‘dissatisfied’, ‘neutral’ and ‘satisfied’, according to the tertiles of the sum of scores. The outcomes of interest were current smoking and initiation and cessation of smoking in the subsequent year.

Findings

Compared with those with a neutral level of job satisfaction, those who reported dissatisfaction with their job had an increased risk of smoking initiation [odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.01–1.22)]. Workers satisfied with their jobs were associated with a decreased likelihood of current smoking (OR = 0.96, 95% CI = 0.94–0.98) and smoking initiation (OR = 0.90, 95% CI = 0.81–0.99). There was a positive relationship between cumulative years of job dissatisfaction and smoking risk: > 4 years of experiencing job dissatisfaction was positively related to current smoking (OR = 1.14, 95% CI = 1.06–1.24) and smoking initiation (OR = 1.22, 95% CI = 1.00–1.49) and negatively related to smoking cessation (OR = 0.84, 95% CI = 0.72–0.99).

Conclusions

In Korea, job dissatisfaction appears to be associated with an increased risk of smoking initiation.

背景和目的先前的研究发现,工作满意度与工人的各种健康结果密切相关。我们的研究测量了工作满意度与当前吸烟和吸烟行为变化之间的关系。使用了来自韩国劳工和收入小组纵向研究(KLIPS)的设计数据,该研究由全国代表性样本组成。进行重复测量分析。设定韩国,2005-2021。参与者2005年至2021年,共有21154名韩国工人(145120次观察)被纳入研究参与者。测量主要的预测变量,工作满意度,使用五项通用工作满意度问卷进行评估。根据得分总和的三分位数,工作满意度分为“不满意”、“中性”和“满意”。感兴趣的结果是当前吸烟以及随后一年的开始和戒烟。调查结果与工作满意度中等的人相比,那些对工作不满意的人开始吸烟的风险增加[比值比(OR) = 1.11,95%置信区间(CI) = 1.01-1.22)]。工人对自己的工作感到满意与当前吸烟的可能性降低有关(OR = 0.96,95%CI = 0.94–0.98)和吸烟(OR = 0.90,95%CI = 0.81–0.99)。累积工作不满年数与吸烟风险呈正相关:>; 4年的工作不满与当前吸烟呈正相关(OR = 1.14,95%CI = 1.06–1.24)和吸烟(OR = 1.22,95%CI = 1.00–1.49),并且与戒烟呈负相关(OR = 0.84,95%CI = 0.72–0.99)。结论在韩国,工作不满似乎与吸烟风险增加有关。
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引用次数: 1
Healthcare costs and use before and after opioid overdose in Veterans Health Administration patients with opioid use disorder 退伍军人健康管理局阿片类药物使用障碍患者阿片类物质过量前后的医疗费用和使用
IF 6 1区 医学 Q1 PSYCHIATRY Pub Date : 2023-07-19 DOI: 10.1111/add.16289
Vilija R. Joyce, Elizabeth M. Oliva, Carla C. Garcia, Jodie Trafton, Steven M. Asch, Todd H. Wagner, Keith Humphreys, Douglas K. Owens, Mark Bounthavong
<div> <section> <h3> Aims</h3> <p>To compare healthcare costs and use between United States (US) Veterans Health Administration (VHA) patients with opioid use disorder (OUD) who experienced an opioid overdose (OD cohort) and patients with OUD who did not experience an opioid overdose (non-OD cohort).</p> </section> <section> <h3> Design</h3> <p>This is a retrospective cohort study of administrative and clinical data.</p> </section> <section> <h3> Setting</h3> <p>The largest integrated national health-care system is the US Veterans Health Administration's healthcare systems.</p> </section> <section> <h3> Participants</h3> <p>We included VHA patients diagnosed with OUD from October 1, 2017 through September 30, 2018. We identified the index date of overdose for patients who had an overdose. Our control group, which included patients with OUD who did not have an overdose, was randomly assigned an index date. A total of 66 513 patients with OUD were included for analysis (OD cohort: <i>n</i> = 1413; non-OD cohort: <i>n</i> = 65 100).</p> </section> <section> <h3> Measurements</h3> <p>Monthly adjusted healthcare-related costs and use in the year before and after the index date. We used generalized estimating equation models to compare patients with an opioid overdose and controls in a difference-in-differences framework.</p> </section> <section> <h3> Findings</h3> <p>Compared with the non-OD cohort, an opioid overdose was associated with an increase of $16 890 [95% confidence interval (CI) = $15 611–18 169; <i>P</i> < 0.001] in healthcare costs for an estimated $23.9 million in direct costs to VHA (95% CI = $22.1 million, $25.7 million) within the 30 days following overdose after adjusting for baseline characteristics. Inpatient costs ($13 515; 95% CI = $12 378–14 652; <i>P</i> < 0.001) reflected most of this increase. Inpatient days (+6.15 days; 95% CI, = 5.33–6.97; <i>P</i> < 0.001), inpatient admissions (+1.01 admissions; 95% CI = 0.93–1.10; <i>P</i> < 0.001) and outpatient visits (+1.59 visits; 95% CI = 1.34–1.84; <i>P</i> < 0.001) also increased in the month after opioid overdose. Within the overdose cohort, healthcare costs and use remained higher in the year after overdose compared with pre-overdose trends.</p> </section> <section> <h3> Conclusions</h3>
目的比较经历过阿片类药物过量的美国退伍军人健康管理局(VHA)阿片类使用障碍(OUD)患者(OD队列)和没有经历过阿阿片类物质过量的OUD患者(非OD队列)的医疗费用和使用情况。设计这是一项对管理和临床数据的回顾性队列研究。设置最大的综合性国家医疗保健系统是美国退伍军人健康管理局的医疗保健系统。参与者我们纳入了2017年10月1日至2018年9月30日诊断为OUD的VHA患者。我们确定了服药过量患者的服药过量指标日期。我们的对照组,包括没有服药过量的OUD患者,被随机分配了一个指标日期。共纳入66513名OUD患者进行分析(OD队列:n=1413;非OD队列:n=65100)。测量指数日期前后一年内每月调整的医疗保健相关成本和使用情况。我们使用广义估计方程模型,在差异分析框架中比较阿片类药物过量患者和对照组。研究结果与非OD队列相比,阿片类药物过量与16美元的增加有关 890[95%置信区间(CI) = $15 611–18 169;P <; 0.001]的医疗保健成本,而VHA的直接成本估计为2390万美元(95%置信区间 = $2210万,2570万美元) 调整基线特征后用药过量后的天数。住院费用(13美元 515;95%CI = $12 378-14 652;P <; 0.001)反映了这一增长的大部分。住院天数(+6.15 天;95%CI, = 5.33–6.97;P <; 0.001),住院人数(+1.01人;95%置信区间 = 0.93–1.10;P <; 0.001)和门诊就诊(+1.59次就诊;95%CI = 1.34–1.84;P <; 0.001)也在阿片类药物过量后的一个月内增加。在过量用药队列中,与过量用药前的趋势相比,过量用药后一年的医疗费用和使用率仍然较高。结论美国退伍军人健康管理局的阿片类药物使用障碍(OUD)患者经历了阿片类物质过量,其医疗费用和使用量在过量后的一个月内一直显著高于未经历过量的OUD患者。
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Addiction
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