Addiction最新文献

Aims: Ultra-processed foods (UPFs; industrially produced foods typically containing unnaturally elevated levels of refined carbohydrates and/or added fats) became more widely introduced into the United States (US) food environment in the 1980s and have proliferated since. UPFs have been shown to trigger an addictive-like response. This study examines the prevalence of ultra-processed food addiction (UPFA) in older US adults and its association with various health domains.

Design: In July 2022, a cross-sectional online and telephone survey was conducted using the University of Michigan National Poll on Healthy Aging (NPHA). Gender-stratified analyses examined the association between UPFA and perceptions of physical and mental health, and social isolation. Prevalence ratios were calculated, unadjusted and adjusted for age, race/ethnicity, education, and income.

Setting: Nationally representative sample of older adults (aged 50-80 years) in the United States.

Participants: The sample included 2038 older adults (49.4% aged 50-64 years and 50.6% aged 65-80 years, 51.2% women, M age = 63.6, standard deviation = 8.1).

Measurements: The modified Yale Food Addiction Scale 2.0 (validated measure that applies the diagnostic criteria for substance use disorder to the overconsumption of UPFs) was used to assess diagnostic criteria for UPFA. Various self-reported items were used to assess health-related domains (i.e., physical and mental health, social isolation).

Findings: The overall prevalence of UPFA was 12.4%, higher among women (16.9%) than men (7.5%), with the highest rate in women aged 50-64 (21%). Men reporting being overweight were 19.14 (95% confidence interval [CI] [5.26-69.66]) times more likely to meet the criteria for UPFA. Women reporting being overweight were 11.44 (95% CI [4.56-28.71]) times more likely to meet UFPA criteria. Women and men reporting worse physical health were 1.93 (95% CI [1.26-2.98]) times and 2.99 (95% CI [1.70-5.26]) times more likely to meet the criteria for UPFA, respectively. Similarly, women reporting worse mental health were 2.78 (95% CI [1.79-4.32]) times more likely to meet the criteria for UPFA, with men 4.02 (95% CI [2.19-7.38]) times more likely. Lastly, women and men reporting feelings of social isolation were 3.40 (95% CI [2.16-5.34]) times and 3.35 (95% CI [1.83-6.14]) times more likely to meet UFPA criteria.

Conclusion: Ultra-processed food addiction appears to be prevalent among older adults in the United States, particularly among women who were in adolescence and early adulthood when the nutrient quality of the US food supply worsened. Addictive patterns of UPF intake appear to be associated with poorer physical health, mental health, and social well-being.

Formal power calculations are rarely presented in interrupted time-series (ITS) studies due to their technical complexity, creating a significant gap in methodological rigor. This paper aimed to make power and sample size determination more accessible for researchers, particularly in the field of addiction, by providing a suite of practical and user-friendly tools. A set of resources was developed using Monte Carlo simulation to allow researchers to estimate statistical power under a wide range of ITS design parameters. The approach allows for the explicit definition of the data-generating process, including specific autocorrelation error structures (ARMA), the presence of covariates and trends and different intervention effect types (step, pulse and trend change). The study produced three key resources: (1) a flexible R code base for conducting custom power simulations, (2) an intuitive, interactive R Shiny App that enables code-free power analysis through a web interface and (3) a series of pre-calculated look-up tables for quick sample size estimation during the initial stages of study design. Illustrative examples from addiction research demonstrate the tools' application. The provided tools bridge a critical gap by simplifying the process of conducting rigorous power calculations for ITS designs. Their adoption can enhance the planning, execution and interpretation of quasi-experimental studies, helping to ensure that research is adequately powered to detect meaningful policy and intervention effects.

Conventionally used for its stimulant, empathogenic and entactogenic effects, 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is one of the most commonly used psychoactive drugs, specifically among young adults and in nightlife and recreational party contexts. Often perceived as a safe drug, MDMA can display an array of toxic effects on multiple organs, with hyponatraemia (a low blood sodium concentration that can cause an altered mental state) being increasingly reported. Although hyponatraemia per se is among the most common electrolyte disorders encountered in clinical care, acute MDMA-induced hyponatraemia was first described in 1993 and constitutes a life-threatening condition if left untreated, particularly among women, who present higher incidence rates and increased odds of developing severe clinical effects. The present review outlines the main clinical manifestations and prevalence of MDMA-induced hyponatraemia, its pathophysiological mechanisms and the therapeutical approaches to correct this electrolyte imbalance.

Background and aims: Workplaces offer a practical setting for alcohol and other drug interventions, especially in industries where impairment introduces substantial risk. Screening, brief intervention and referral to treatment has demonstrated effectiveness in health care settings and shows promise in workplace settings. However, low participation and high attrition in previous workplace studies indicate a need for deeper understanding of feasibility and acceptability. This exploratory qualitative study aimed to identify likely determinants for implementing alcohol and other drug screening, brief intervention and referral to treatment in two safety-sensitive industries in Australia.

Methods: Qualitative research design based on semi-structured online interviews, focussed on the construction and manufacturing industries. Participants included 23 professionals working in health and safety roles representing 21 organisations located across six Australian jurisdictions. Interview transcripts were coded against the five domains of the updated Consolidated Framework for Implementation Research.

Findings: Sixteen determinants were identified that were expected to act as barriers (n = 10) or enablers (n = 5) or have bidirectional impacts (n = 1) on the implementation of screening, brief intervention and referral to treatment in construction and manufacturing. Enabling factors included freely available tools, flexible delivery methods and delivery by trusted, external, peer-based organisations. Pervasive barriers included workers' mistrust of management, concerns about confidentiality and fear of consequences for disclosing substance use.

Conclusions: Successful workplace implementation of screening, brief intervention and referral to treatment appears to depend on organisational cultures where workers trust management, are assured of confidentiality and are not afraid of retribution for disclosure.

Background and aims: There is significant concern about potential rising harms from gamma-hydroxybutyrate (GHB) but an absence of studies internationally synthesising data across indicators to identify changes in harms and broader patterns of use. This paper contributes to addressing this gap by measuring national trends in GHB use, harms and treatment in Australia.

Design, setting, and cases: Triangulation of indicators (2013-2024) from Australian triennial population surveys; annual interviews with cross-sectional non-representative samples of people who use illicit stimulants or who inject drugs; and administrative data on GHB-related hospitalisations, GHB-related deaths, and treatment episodes where GHB was the principal drug of concern.

Measurements: Annual trend data were analysed using Joinpoint regression. Survey data were modelled as the annual percent change in the proportion reporting lifetime, past 12-month, and past 6-month use, depending on the survey. Administrative data were modelled as the annual percent change in crude rates per 100 000 population.

Findings: Lifetime and past 12-month GHB use in the general population remained below 1.2% and 0.2% respectively, but the latter increased from 0.07% in 2013 to 0.19% in 2022-2023 (annual percent change [APC] 9.3; 95% confidence interval [CI]: 5.2, 13.2). The percentage of people who use illicit stimulants reporting past 6-month use increased from 5.7% in 2013 to 7.3% in 2017 (APC 11.6; 95%CI: 0.2, 52.9) and from 5.4% in 2019 to 11.5% in 2024 (APC 17.8; 95%CI: 5.9, 41.1). The proportion of people who inject drugs reporting use varied between 7.2% and 17.5% over the short period studied (2020-2024). There were statistically significant increases in GHB-related hospitalisations from 5.3 in 2012-13 to 19.1 per 100 000 people in 2022-23 (APC 19.0; 95%CI: 11.9, 31.1) and GHB-related deaths from 0.02 in 2013 to 0.24 per 100 000 people in 2022 (APC 36.5; 95%CI: 27.2, 58.1). Treatment episodes also increased across the period, from 0.07 in 2012-13 to 6.0 episodes per 100 000 people in 2020-21 (APC 97.3; 95%CI: 83.5, 830.9), with no subsequent statistically significant change (8.4 per 100 000 people in 2022-23).

Conclusions: Gamma-hydroxybutyrate use, harms and treatment engagement increased in Australia from 2013 to 2024. These findings highlight a need to implement acceptable, tailored prevention and harm reduction strategies for key populations, and implement stronger monitoring efforts nationally and internationally.

Aims: Industry arguments against public health policies that reduce the consumption of unhealthy commodities often include the assertion that the policy will harm the economy by reducing production and costing jobs. However, this argument does not consider that consumers may spend money previously used for unhealthy commodity consumption on other products, benefiting other sectors and potentially offsetting those negative economic consequences. In this study we aimed to estimate the macroeconomic impacts of reducing consumption of alcohol, tobacco, confectionary and gambling, accounting for reallocation of spending from these commodities to alternatives.

Method: We developed the open-source Commercial Determinants of Health Input-Output (CDOHIO) model version 1.1.0. CDOHIO models inter-sectoral linkages in the United Kingdom (UK) economy using published input-output tables to estimate the macroeconomic outcomes of changes in the total national consumer expenditure on selected unhealthy commodities and the reallocation of this expenditure to other consumption. We modelled a 10% decrease in total consumer expenditure on (1) alcohol, (2) tobacco, (3) confectionary and (4) gambling, assuming that the reduced expenditure was reallocated entirely to other products. The comparator in each case was no change in expenditure. We analysed six economic outcomes: (i) output (the total value of production in the economy), (ii) tax receipts from employees, (iii) tax receipts from employers, (iv) full-time equivalent employment, (v) total net earnings to individuals, and (vi) Gross Value Added (GVA), which is the primary outcome measure used as a proxy for national Gross Domestic Product.

Results: For tobacco, confectionary and gambling, reduced spending was estimated to yield positive effects across all six measures. The total effect of a 10% reduction in confectionary spending was an increase in GVA of £0.389 billion (0.02%), for reduced spending on tobacco, +£1.859 billion GVA (+0.09%) and for gambling +£1.250 billion GVA (+0.06%). For alcohol, a 10% reduction in spending led to a small negative effect on GVA (-£0.134 billion, -0.01%), which is the net effect of positive effects of reduced spending on off-trade alcohol (+£2.543 billion) and negative effects of reduced spending on on-trade alcohol (-£2.677 billion).

Conclusions: The potential negative macroeconomic impacts of reducing spending on tobacco, confectionary and gambling in the United Kingdom could be more than mitigated when consumers reallocate money spent on these products to other consumption. This is also the case for off-trade alcohol consumption, but not for on-trade alcohol consumption.