Addiction最新文献

Background and aims: Affordability of alcohol is a key driver of consumption. The cost-of-living crisis in Great Britain has been putting pressure on household budgets since late 2021. In addition, the UK Government implemented substantial reforms to the alcohol duty system and increased alcohol taxes in 2023. This study aimed to estimate changes in the monthly prevalence of cost-motivated alcohol reduction attempts among risky drinkers over this period.

Design: Data were drawn from the Alcohol Toolkit Study, a nationally representative monthly cross-sectional household survey.

Setting: Great Britain.

Participants: 26 212 risky drinkers [alcohol use disorders identification test - consumption (AUDIT-C) score ≥5] aged ≥18y surveyed between January 2021 and December 2024 [mean (SD) age = 45.9 (17.1); 61.4% men].

Measurements: The primary outcome was having tried to reduce alcohol consumption in the past year due to a decision that drinking was too expensive ('cost-motivated alcohol reduction attempt'). This included participants who also reported other motives (e.g. health concerns) for trying to reduce their consumption.

Findings: Overall, 1355 participants reported making a cost-motivated alcohol reduction attempt. The monthly weighted prevalence of cost-motivated alcohol reduction attempts among risky drinkers increased from 4.6% in January 2021 to 7.0% in December 2024 [prevalence ratio (PR) = 1.54, 95% confidence interval (CI) = 1.34-1.74]; equating to ~1.1 million people attempting to reduce their drinking among risky drinkers in 2024. This was primarily driven by a rise in the proportion of all alcohol reduction attempts that were motivated by cost, from 12.4% to 19.7% (PR = 1.58, 95% CI = 1.39-1.77), rather than an overall increase in the prevalence of alcohol reduction attempts (which remained relatively stable across the period at an average of 36.0%). The pattern of results was similar when the outcome was restricted to alcohol reduction attempts only motivated by cost [17.3% (95% CI = 15.0-19.7%) of all cost-motivated alcohol reduction attempts].

Conclusions: During a period of increasing financial pressures in Great Britain, alcohol reduction attempts were increasingly motivated by cost but the overall prevalence of reduction attempts did not increase.

Background and aims: Heated tobacco products (HTPs) are increasingly used by individuals attempting to quit smoking, particularly in Japan where HTP use is prevalent; however, the effectiveness of HTPs in achieving complete tobacco abstinence remains unclear. This study aimed to estimate the likelihood of complete tobacco abstinence and combustible cigarette abstinence among exclusive HTP users and dual users compared with exclusive combustible cigarette users.

Design: A prospective cohort design using sequential annual follow-ups (2019-2023) from the Japan 'Society and New Tobacco' Internet Survey (JASTIS). Inverse probability-weighted Poisson generalized estimating equation models were used to estimate rate ratios for abstinence outcomes.

Setting: Nationwide internet-based survey conducted in Japan.

Participants: A total of 8969 Japanese adults aged 20 years and older who were current tobacco users at baseline were included. Participants were categorized as exclusive combustible cigarette users (55.6%), exclusive HTP users (16.3%) or dual users (28.0%). Exclusive HTP users were further categorized as established (daily use, ≥100 HTPs used, or >12 months of lifetime use) or non-established users.

Measurements: Primary outcomes were (1) complete tobacco abstinence-defined as no current use of any tobacco products used at baseline-and (2) combustible cigarette abstinence after one year. Abstinence required selecting "used regularly in the past but quit" for each relevant product.

Findings: Compared with exclusive combustible cigarette users (as classified at baseline), the rate ratio (RR) for complete tobacco abstinence was 0.85 [95% confidence interval (CI) = 0.71-1.02] among exclusive HTP users and 0.49 (95% CI = 0.42-0.58) among dual users. When stratified, established HTP users had a statistically significantly lower likelihood of complete tobacco abstinence (RR = 0.57, 95% CI = 0.47-0.70), while non-established users showed a higher likelihood (RR = 2.41, 95% CI = 1.83-3.17). Compared with exclusive combustible cigarette users, the RR for combustible cigarette abstinence after one year was 0.93 (95% CI = 0.83-1.04) among dual users.

Conclusions: In this one-year follow-up, dual use of cigarettes and heated tobacco products (HTP) and established exclusive HTP use were associated with lower rates of complete tobacco abstinence compared with exclusive cigarette use, while non-established exclusive HTP use showed higher abstinence rates. Overall, HTP use was not associated with higher tobacco abstinence rates.

Background and aims: Korsakoff's syndrome is an alcohol-related neurocognitive disorder characterized by episodic memory impairments, apathy, confabulations and poor illness-insight. This meta-analysis aimed to estimate mean effect sizes of performance in social cognition in people with Korsakoff's syndrome (KS) compared with controls.

Method: A systematic literature search was conducted in May 2024 to identify research articles that examined social cognition in patients with KS and control groups. Weighted effect sizes (Hedges' g) were calculated for the three levels of social cognition: emotion perception, social interpretation and socio-cognitive integration. There was no restriction on setting. Instruments examining emotion perception (facial emotion recognition and prosody), interpretation (mentalizing, self-awareness and empathy) and socio-cognitive integration (moral reasoning and social knowledge) were used in the included studies.

Results: Thirteen studies (n = 622; 292 KS, 330 controls) showed that individuals with KS performed statistically significantly worse across all domains of social cognition compared with controls. Large effect sizes were found in emotion perception [g = -1.14, 95% confidence interval (CI) = -1.46 to -0.81), P < 0.001, I² = 58.5%, 8 studies, n = 372], with comparable effect sizes for facial emotion recognition and prosody. In social interpretation (g = -0.77, 95% CI = -1.34 to -0.21, P = 0.007, I² = 96.6%, 4 studies, n = 188), a large effect was found for mentalizing (g = -1.05, 95% CI = -1.61 to -0.50, P < 0.001, I² = 74.1%; 3 studies, n = 120). In socio-cognitive integration (g = -0.74, 95% CI = -1.11 to -0.37, P < 0.001, I² = 0%, 3 studies, n = 184), social knowledge showed a large effect size (g = -0.81, 95% CI = -1.24 to -0.38, P < 0.001, 1 study, n = 104). Results for empathy (g = -0.43, 95% CI = -1.05 to 0.20, P = 0.18, 1 study, n = 40), self-awareness (g = -0.21, 95% CI = -0.47 to 0.05, P = 0.12, 1 study, n = 68) and moral reasoning (k = 2, g = -0.54, 95% CI = -1.28 to 0.19, P = 0.15, I² = 0%; 2 studies, n = 80) were uncertain, with possible important differences in both directions.

Conclusions: This meta-analysis shows that people with Korsakoff's syndrome perform statistically significantly worse than controls on socio-cognitive measures, with the largest effect sizes in the perception and interpretation of social information.

Background and aims: In recent years, the potency of natural cannabis products (herb and resin) has increased with a higher delta- 9-tetrahydrocannabinol (Δ9-THC) content, but there are limited data on trends on clinical presentation and severity of toxicity in cannabis users consulting the emergency department (ED) for acute intoxication. This study aimed to analyse the evolution over time of clinical findings and severity of presentations in a large series of patients presenting to European EDs with acute toxicity after lone cannabis use.

Design: Secondary analysis of data included in the Euro-DEN Registry from 1 October 2013 to 31 December 2022.

Setting: 40 EDs in 25 European countries.

Participants/cases: ED presentations reporting lone cannabis use. Presentations reporting concomitant use of, or having positive toxicological tests for, ethanol or other drugs were excluded. 3839 ED presentations reporting lone cannabis use were analysed (median age 25 years, interquartile range= 20-33; 71% male).

Measurements: Temporal trends of 14 pre-defined clinical signs/symptoms and 4 markers of severity, which included the need for ambulance transfer to the ED, hospitalisation, intensive care unit admission (ICU) and death.

Findings: The most frequent clinical features were anxiety (35%), agitation (22%), decreased alertness (drowsiness or coma, 21%) and vomiting (20%), while seizures, arrythmias and hyperthermia were observed in <3% of cases. Statistically significant changes over time were only found in the frequency of hypotension [adjusted odds ratio (OR) = 1.239 per every subsequent year, 95% confidence interval (CI) = 1.107-1.386], hypertensive crisis (OR = 1.168, 95% CI = 1.070-1.274) and palpitations (OR = 0.922, 95% CI = 0.883-0.962). Nonlinear analyses detected statistically significant mid-period increases for anxiety, agitation and arrhythmias that subsided by the end of the study, and showed increases in chest pain and decreases in seizures that became statistically significant in the latter half of the period. Regarding episode severity, 76% of cases were brought to the ED by ambulance, 13% required hospitalisation, 1% were admitted to the ICU and 0.1% died. No statistically significant changes were observed over time in either the linear or the nonlinear models.

Conclusion: Very few changes in the clinical features of patients presenting to European emergency departments with lone acute cannabis toxicity were identified over 2013 to 2022, suggesting that despite the increase in potency of cannabis in Europe over this period, the severity of acute intoxication has remained unchanged.

BACKGROUND AND  AIMS: Oral nicotine pouches (ONPs) have seen a dramatic rise in sales since their introduction to the US market in 2016. We aimed to define the relationship between ONP prices and sales (e.g. price elasticity of demand) and determine how taxes on cigarettes and e-cigarettes (ECs) impact ONP sales.

Methods: Using Nielsen ScanTrack data, we employed the Ordinary Least Squares technique and several statistical specifications to examine the relationship between ONP prices and sales, as well as the impacts of other tobacco taxes on ONP sales in the US.

Results: A 10% increase in ONP prices was associated with 2.3% (P < 0.05) lower sales in convenience stores, which account for 92% of total ONP sales. Higher cigarette (but not EC) taxes increased ONP sales, indicating that ONPs likely serve as economic substitutes for cigarettes but not for ECs.

Conclusion: Higher prices are associated with lower sales of oral nicotine pouches (ONPs), which suggests that taxes on ONPs may be effective in reducing ONP use. Moreover, increasing cigarette taxes (but not e-cigarette taxes) may shift consumption from cigarettes to ONPs.

Background and aims: Smoking is the leading preventable cause of premature death in China, yet less than 10% of smokers seeking to quit receive treatment. This study aimed to test the efficacy of a cognitive behavioral therapy (CBT)-based smoking cessation intervention ('Smokefree Life') via a smartphone app in China.

Design: A digital, parallel, single-blind, two-arm (1:1) randomized controlled trial.

Setting: This trial was conducted via 'Smokefree Life' app in the whole of mainland of China between 13 December 2021 and 15 April 2023.

Participants: Chinese-speaking adult smokers (925 males, 102 females, mean age 35.0 ± 6.7) willing to quit within one month were recruited via WeChat, survey sampling and referral from doctors, friends and family and randomized in a 1:1 ratio.

Intervention: The intervention group (n = 523) received a 13-14 week CBT-based smoking cessation intervention via smartphone app and the control group (n = 504) received only control messages. All participants were followed for 26 weeks post-quit date.

Measurements: The primary outcome was biochemically validated continuous abstinence at 26 weeks. Secondary outcomes were self-reported 7-day abstinence and continuous abstinence at 26 weeks.

Findings: By intention-to-treat analysis, the biochemically verified 26-week continuous abstinence rate was statistically significantly higher in the intervention group (6.50%) compared with the control group (2.58%) (odds ratio = 2.63, 95% confidence interval = 1.40-5.22, P = 0.0037). Self-reported 7-day and continuous abstinence rates were also consistently higher in the intervention group across follow-ups (all P < 0.05).

Conclusions: The 'Smokefree Life' app-based smoking cessation intervention statistically significantly improved 6-month biochemically confirmed quit rates among adult smokers in China.

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.

Aims: To assess whether combining nicotine replacement therapy (NRT) with varenicline improves long-term smoking cessation rates compared with varenicline or NRT alone.

Method: Systematic review and meta-analysis of randomized controlled trials (RCTs) or quasi-RCTs, conducted according to PRISMA guidelines. A comprehensive literature search of PubMed, MEDLINE, EMBASE, Web of Science and the Cochrane Central Register of Controlled Trials was conducted through June 2025. The primary outcome was smoking abstinence at the longest follow-up (≥6 months). Secondary outcomes included adverse events (AEs) and serious adverse events (SAEs). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects meta-analyses. The certainty of evidence was assessed using the GRADE approach. Risk of bias was assessed using the Cochrane RoB 2.0 tool. The protocol was pre-registered in the PROSPERO (registration number CRD42024600510).

Results: Seven trials including 2631 participants met inclusion criteria. Compared with varenicline alone, combination therapy was associated with statistically significantly higher abstinence rates at the longest follow-up (RR = 1.33, 95% CI = 1.04-1.69; 5 studies; I² = 51%). A sensitivity analysis including trials with ≥3 months of follow-up yielded similar results (RR = 1.31, 95% CI = 1.06-1.62; 6 studies). However, when excluding the trial at high risk of bias, the result was not statistically significant (RR = 1.26, 95% CI = 0.94-1.68). Compared with NRT alone, only one RCT was included, and the effect of combination therapy on abstinence was not statistically significant (RR = 0.94, 95% CI = 0.51-1.72). AEs were more common with combination therapy compared with varenicline alone (RR = 1.11, 95% CI = 1.02-1.20). Specifically, skin reactions were significantly increased with NRT patch plus varenicline (RR = 1.67; 95% CI = 1.29-2.16). Compared with NRT alone, combination therapy was associated with increased AEs (RR = 1.23; 95% CI = 1.07-1.41). SAEs were infrequent and generally unrelated to treatment.

Conclusions: Low-certainty evidence indicates that combining varenicline with nicotine replacement therapy may improve long-term smoking cessation rates compared with varenicline alone and is generally well tolerated.