Addiction最新文献

Background and aims: Food addiction is a dysfunctional chronic psychological disease. Family environment, a modifiable factor, has demonstrated considerable contribution to food addiction. Our objective was to analyze the relationship between family environment and food addiction.

Design, setting and participants: The study included 5554 participants aged 9-19 years enrolled in the School-based Evaluation Advancing Response for Child Health (SEARCH) in China. Our study used the first three waves of data.

Measurements: The exposure was family environment, assessed by Family Environment Scale-Chinese Version (FES-CV) at baseline. The FES-CV includes seven subscales: cohesion, active-recreational orientation, achievement orientation, control, intellectual-cultural orientation, conflict and organization. The outcome was food addiction status, measured using the Chinese version of the modified Yale Food Addiction Scale 2.0 at one year follow-up. A binary logistic regression analysis was used to examine the prospective associations between exposure and outcome. Latent Class Analysis was used to identify distinct characteristics of family environment. Mediation analyses assessed the mediating effects of psychological distress.

Findings: We observed that six subscales of family environment were statistically significantly associated with food addiction in adjusted model. Control [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.22] and conflict (OR = 1.19, 95% CI = 1.11-1.28) subscales were positively associated, whereas cohesion (OR = 0.82, 95% CI = 0.77-0.88), active-recreational orientation (OR = 0.91, 95% CI = 0.85-0.97), intellectual-cultural orientation (OR = 0.91, 95% CI = 0.84-0.98) and organization (OR = 0.87, 95% CI = 0.81-0.94) subscales were inversely associated. The clustering of family environments demonstrated that compared with children and adolescents in playful families, those in conflict-ridden families had a 1.92-fold greater risk (OR = 2.92, 95% CI = 1.86-4.58) of food addiction. Further, we observed that depression and stress partially mediated this association, with the mediated proportions ranging from 18.0%-21.0%.

Conclusions: There appears to be a positive association between a conflict-ridden family environment and food addiction among children and young adults in China. Considering family environment is a modifiable factor, improvement of family environment may be an effective strategy to reduce food addiction by enhancing the psychological well-being of children and adolescents.

Background and aims: Methamphetamine use disorder (MUD) is associated with significant impairments in impulsivity control, contributing to relapse and poor treatment outcomes. Transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) may be helpful in modulating these symptoms. This study aimed at [1] investigating the differential effects of anodal and cathodal tDCS on craving, affective impulsivity, and motor impulsivity; and [2] exploring the correlations between changes in affective impulsivity & drug craving, and alterations in resting-state electroencephalography (Rs-EEG) microstate parameters following tDCS interventions.

Design: A randomized, parallel, double-blind experimental study.

Setting: Two drug rehabilitation centers in China, from June 2022 to June 2023.

Participants: One hundred male participants (ages 33.7 ± 6.26 years) during rehabilitation for MUD.

Intervention: Participants were randomly assigned to anodal (n = 33), cathodal (n = 31), or sham (n = 36) tDCS conditions. tDCS was delivered at 2 mA (anodal and cathodal) or 0 mA (sham) for 20 minutes, twice daily for ten consecutive days. The central electrode was placed on the left dorsolateral prefrontal cortex.

Measurements: Primary and secondary outcomes were assessed at four time points: baseline (before intervention), post-intervention 1 (after two sessions), post-intervention 2 (after 20 sessions, primary time-point), and one-month follow-up (post-intervention 3). Primary outcomes were affective impulsivity and motor impulsivity. Secondary outcomes included drug craving, Rs-EEG microstates, and adverse effects.

Findings: Anodal tDCS statistically significantly improved affective impulsivity control after 20 sessions (estimate = -36.23, 95% confidence interval [CI] [-59.72, -12.73], p < 0.01) but not motor impulsivity control. Both anodal and cathodal tDCS statistically significantly reduced drug craving after 20 sessions (anodal: estimate = 3.36, 95% CI [1.15, 5.57], p < 0.01; cathodal: estimate = 2.62, 95% CI [0.34, 4.9], p = 0.02). Changes in affective impulsivity were statistically significantly correlated with alterations in Rs-EEG microstate parameters, such as microstate B coverage (r = 0.29, p. < 0.01, n = 100); however, there is a lack of clear evidence for correlations between changes in craving and microstate parameters.

Conclusions: Among methamphetamine users in rehabilitation, anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex appears to improve affective impulsivity control, but not motor impulsivity control, and both anodal and cathodal tDCS reduce drug craving.

Aims: The current study measured the extent to which different neurobehavioral indices of incentive-motivational salience attribution to alcohol cues predict alcohol craving and consumption in the natural environment.

Design, setting, and participants: Laboratory study at a university in Missouri, USA, followed by a smartphone-based 21-day ecological momentary assessment (EMA) protocol. Participants were emerging adults (N = 218-268 [52-56% female], age 18-20).

Measurements: Participants completed an alcohol cue approach-avoidance task while their electroencephalogram (EEG) was recorded. Behavioral measures (response time) indexed the strength of cue-activated approach vs. avoidance tendency. Cue-locked event-related potentials provided EEG-based neural measures of motivated attention (P3 amplitude) and approach-avoidance conflict (N450 amplitude). From EMA, measures of alcohol consumption dynamics (as indexed by estimated blood alcohol concentration [eBAC], g/dL) during real-world drinking episodes were obtained, as were measures of alcohol craving (7-point visual analogue scale) dynamics during and outside these episodes.

Findings: Different approach-avoidance task-derived behavioral and neural measures rank-ordered participants differently. Participants who approached alcohol cues more rapidly in lab subsequently showed steeper increases in craving (∆B ± standard error [SE] = 1.042 ± 0.499 point/hr), and eBAC (∆B ± SE = 0.046 ± 0.017 g/dl/hr), during real-world drinking episodes. Participants who avoided alcohol cues more slowly in lab also showed steeper increases in eBAC (∆B ± SE = 0.056 ± 0.017 g/dl/hr). Participants with larger P3 during alcohol cue approach in lab subsequently showed steeper increases in eBAC (∆B ± SE = 0.048 ± 0.017 g/dl/hr), as did those with smaller P3 during alcohol cue avoidance (∆B ± SE = 0.025 ± 0.017 g/dl/hr). Participants with smaller N450 during alcohol cue approach in lab subsequently showed steeper increases in craving during drinking episodes (∆B ± SE = 1.465 ± 0.607 point/hr). Tests examining lab-based neurobehavioral measures as predictors of craving dynamics during nondrinking moments, such as following incidental cue exposure, generally were inconclusive.

Conclusions: Incentive salience toward alcohol may influence alcohol seeking (including craving) and alcohol consumption through distinct behavioral risk pathways in different people.

Aims: To test the efficacy of a participant-referred "study buddy" intervention compared with standard retention strategies in retaining rural people who use drugs (PWUD) in longitudinal research.

Design: Multi-site, two-arm, randomized controlled trial.

Setting: Rural counties in Ohio, Oregon, and Kentucky, USA.

Participants: People enrolled in the Peer-based Retention Of people who Use Drugs in Rural Research (PROUD-R²) study who were 18 years or older, resided in the study area, and used opioids or injected any drug to get high in the past 30 days between August 2020 and August 2022. Participants (n = 739) were 42% female, mostly White (89%) and non-Hispanic (96%), unstably housed (57%), and reported lifetime injection drug use (93%). The most common drugs of choice were methamphetamine (42%) and heroin (38%).

Intervention and comparator: Participants were allocated (1:1, stratified by site), to: [1] standard retention approach involving appointment reminders and contact information updates by study staff (n = 365), or [2] the intervention arm, receiving the standard retention approach and asked to recruit a "study buddy" (n = 374). Study buddies were invited to view a training video and instructed to encourage their intervention participant to attend follow-up appointments.

Measurements: Intervention, control, and study buddy participants completed interviewer-administered surveys at baseline and at 6 and 12 months. Outcomes included retention at 12 months (primary) and 6 months (secondary).

Findings: Retention was 50.3% at 6 months and 46.1% at 12 months. Only 23.5% of intervention participants recruited a study buddy. In intent-to-treat analyses, the intervention did not increase retention at 12 (adjusted odds ratio [AOR] 1.08, 95% confidence interval [CI] 0.79-1.47) or 6 (AOR 0.96, 95% CI 0.69-1.34) months.

Conclusions: Recruitment of self-identified "study buddies" did not appear to statistically significantly improve retention of rural people who use drugs in this longitudinal study at 6- and 12-month follow-up relative to standard retention approaches.

Background and aims: Female, Hispanic, and Black patients with opioid use disorder (OUD) are less likely to receive OUD medication treatment than other patients. The PROUD (PRimary care Opioid Use Disorders treatment) trial demonstrated that implementation of primary care (PC) nurse care management increases OUD medication treatment compared with usual care (UC). This study assessed whether the PROUD intervention's effect differed across sex, race and ethnicity.

Design: Secondary analyses of cluster-randomized implementation trial.

Setting: 12 PC clinics (2 per health system) in five states in the USA, randomized to UC or intervention, stratified by health system.

Participants: PC patients 16-90 years old.

Intervention: Three strategies to implement office-based addiction treatment (OBAT) by nurse care managers: (1) full-time nurse salary; (2) nurse training and technical assistance from expert nurses at Boston Medical Center; (3) ≥3 PC providers willing to prescribe buprenorphine. Nurses were trained in the Massachusetts model of OBAT which includes lowering barriers to OUD treatment, assessing and educating patients, supporting initiation of medications for OUD and providing ongoing medical management, in collaboration with PC providers.

Measurements: The primary outcome was a clinic-level measure of OUD treatment defined as patient-years of OUD treatment per 10 000 PC patients based on orders and procedures for buprenorphine or extended-release naltrexone from electronic health records and insurance claims (hereafter 'OUD treatment').

Findings: The mean numbers of patients seen by intervention and UC clinics at baseline were 18 485 and 22 557, respectively. Female patients comprised 60% of the total PC population in intervention clinics and 64% in UC clinics; Asian, Black, Hispanic or smaller racial groups comprised 61% of the PC population in intervention clinics, and 70% in UC clinics. Compared with UC, the intervention increased OUD treatment for male patients [adjusted difference: 13.7 patient-years; 95% confidence interval (CI) = 5.8-21.7], but not female patients (2.9; 95% CI = -4.3 to 10.2); effect modification test, F (1,14) = 4.77; P = 0.046. Exploratory analyses suggest that differences in the intervention's effect on receipt of any OUD treatment in female and male patients, rather than differences in the duration of OUD treatment, may account for findings. There was no significant effect modification by race or ethnic group [effect modification test F (4,44) = 1.50; P = 0.218].

Conclusions: Primary care clinics that implement office-based addiction treatment by nurses increase patient-years of opioid use disorder (OUD) treatment in male but not female patients. Exploratory findings suggest that differences in the proportion of patients treated for OUD, ra

Aim: To determine whether alcohol consumption in England had returned to pre-pandemic levels by December 2024, after the initial rise in 2020 across the total population and subgroups.

Design: Monthly representative surveys were conducted through face-to-face interviews until February 2020, and then by telephone.

Setting: England, March 2014 to December 2024.

Participants: 208 010 adults aged 18+ living in private households.

Measurements: Mean weekly alcohol consumption (in UK units), prevalence of risky drinking (Alcohol Use Disorders Identification Test for Consumption [AUDIT-C] score≥5), and possible dependence (AUDIT-C ≥ 11). Further measures included age, gender, and social grade.

Findings: All outcomes increased in April 2020: prevalence of risky drinking by 30.3% (95% confidence interval [CI]: 26.8, 33.8, from 26.2% in February 2020 to 34.0% in April 2020), prevalence of possible dependence by 90.2% (95% CI: 62.2, 122.9, from 0.9% to 1.7%) and mean weekly alcohol consumption by 34.5% (95% CI: 31.0, 38.0, from 5.0 units to 6.6 units). When adjusting for the survey mode change from face-to-face to telephone interviews, the step changes between February and April 2020 remained but were substantially attenuated. The post-pandemic trend declined more quickly than the pre-pandemic trend for the prevalence of risky drinking (difference: -1.5%/year, 95% CI: -2.4, -0.6) and mean weekly alcohol consumption (difference: -2.4%/year, 95% CI: -3.3, -1.6), indicating a slow but incomplete return to pre-pandemic levels. The trend in prevalence of possible dependence was similarly stable before and after the pandemic (difference: -1.3%/year, 95% CI: -6.2, 3.8). Alcohol consumption declined more slowly among people from less advantaged than from more advantaged social grades.

Conclusions: The prevalence of risky drinking and mean weekly alcohol consumption in England appear to be trending towards pre-pandemic levels but the prevalence of dependent drinking in England appears to have increased since the start of the pandemic and remains elevated compared with pre-pandemic levels. Alcohol-related inequalities may be worsening due to slower declines in consumption following the pandemic among less advantaged drinkers.

Background and aims: People who use drugs are overrepresented in the criminal justice system. We aimed to provide a broad synthesis of the epidemiology, harms and interventions related to drug use and drug use disorders among incarcerated adults worldwide, and highlight gaps in evidence and practice.

Methods: In this structured review, we searched PubMed and Web of Science for articles published between 2015 and August 2025. Systematic reviews, meta-analyses and large primary studies with unselected samples were given preference for inclusion.

Results: Four in ten adults who enter prison meet diagnostic criteria for a drug use disorder, a treatable psychiatric condition often underlying the offences that led to their incarceration. Drug use disorders are approximately ten times more prevalent among people in prison compared with the general population, with a higher excess in women. Comorbid mental disorders are common. Around a third of incarcerated individuals report using drugs during imprisonment, which poses a health and safety risk for people both living and working in prisons. Injecting drug use in prison contributes to blood-borne virus transmission. In addition to its strong link with recidivism, drug use is associated with a markedly increased risk of premature mortality after release from prison, particularly from drug-related causes within the first two weeks post-release. Despite robust evidence supporting the effectiveness of prison-based pharmacological (e.g. opioid agonist treatment) and psychosocial (e.g. therapeutic communities) interventions in reducing drug-related harms, there remains a significant treatment gap within prison settings worldwide. Further research is needed to assess the health benefits of harm reduction services in prisons, including needle and syringe programmes. Strategies to facilitate linkage to and retention in post-release services are key to ensure continuity of care and achieve sustainable treatment outcomes.

Conclusion: The high prevalence of drug use and its multiple adverse outcomes among people in prison underscore the need for provision of evidence-based interventions. Expanding and integrating prison-based and post-release interventions to address drug use has the potential to yield both public health and criminal justice benefits.

Background and aims: The emergence of fentanyl in the street market for opioids has limited the benefits of some interventions to manage opioid overdose; thus, preventing the occurrence of opioid overdose is essential. We tested a behavioral intervention shown to prevent heroin overdose in a pilot study, in two United States cities with prevalent fentanyl.

Design: Phase III two-site single-blinded randomized controlled trial of a repeated dose motivational interviewing intervention to reduce overdose (REBOOT) versus attention control, over 16 months from 2019 to 2023.

Setting: San Francisco, California, and Boston, Massachusetts, USA.

Participants: 18-65 years of age, with opioid use disorder (OUD), active non-prescribed opioid use, opioid overdose within 3 years and prior receipt of take-home naloxone. A total of 268 participants were randomized (50% intervention, 50% control), 62% of whom were male, 15% Latine, 65% White and 14% Black/African American; 95% had used fentanyl.

Intervention: Motivational interviewing review of experienced and witnessed overdose and development of personal prevention plan, administered at months 0, 4, 8 and 12.

Measurements: TimeLine FollowBack of interval overdose events and covariates, administered prior to the intervention at months 0, 4, 8, 12 and 16. Primary outcome was occurrence of any nonfatal or fatal overdose event.

Findings: There were no significant effects of REBOOT compared with control on the primary outcome of occurrence of any overdose [relative risk (RR) = 0.94, 95% confidence interval (CI) = 0.79-1.11, P = 0.45] or secondary outcome of the number of overdose events (RR = 0.80, 95% CI = 0.6-1.06, P = 0.12). Results did not differ when excluding data collected during the first 12 months of the COVID-19 pandemic. Compared with control, REBOOT was not associated with days in OUD treatment and not using opioids (RR = 0.94, 95% CI = 0.88-1.00, P = 0.06). In post-hoc analysis, REBOOT was associated with fewer overdose events among participants with no past 4-month overdose at baseline (RR = 0.70, 95% CI = 0.51-0.97, P = 0.03).

Conclusion: A repeated dose motivational interviewing intervention to reduce overdose had no statistically significant effect on opioid overdose in two US cities where fentanyl was the dominant street opioid.