Addiction最新文献

Background and aims: Public perceptions of alcohol and its related harms and policies are shaped by multiple discourses and can influence behaviour and policy support. As part of a FrameWorks-informed project to test framing approaches to improve public understanding and support for evidence-based alcohol policies in the UK, this research aimed to (i) summarise relevant evidence; (ii) compare how public understanding of alcohol harms differs from those of academic and charity experts; and (iii) develop novel framing approaches.

Methods: (1) a literature review including systematic, scoping and targeted components to understand previous evidence on effective framing from behaviour change, UK alcohol policy and FrameWorks literatures; (2) comparison of public views of alcohol harms and policies from four focus groups (n = 20) with those of public health experts; (3) an iterative process involving workshops and stakeholder consultation to develop 12 novel framing approaches.

Results: We found no previous study that directly tested framing approaches for alcohol policy advocacy. Our narrative summary of 35 studies found that explaining diverse harms may be important, whereas framing that engenders empathy, emphasises dependence or invokes a sense of crisis may be less effective. In focus groups, the public linked alcohol to pleasure/socialising, whilst understandings of harm focused on severe alcohol problems and individual deficits of biology or personality, with policy proposals focused mainly on treatment/support services. Public health experts highlighted more diverse harms and solutions, emphasising environmental and commercial causes. Comparison of public and expert views yielded six tasks for novel framing approaches to deepen public understanding. The team co-developed initial framing ideas (n = 31), before finalising 12 narrative framing approaches based on values (n = 5), metaphors (n = 3) and explanation (n = 4).

Conclusions: In the United Kingdom, public and expert understandings of alcoholrelated harms, causes and solutions differ. Along with prior evidence, these differences can inform novel framing approaches designed to deepen public understanding.

Nitrous oxide (N₂O), used medically as an anaesthetic, has gained popularity as a recreational drug, with rising prevalence particularly among young adults. While its reinforcing and addictive potential remains debated, N₂O is proven to be neurotoxic, especially with prolonged, heavy use, which is often unexpected for users. The neurotoxicological mechanism underlying N₂O-induced neurotoxicity involves inactivation of vitamin B₁₂ (cobalamin), which disrupts methionine synthesis, essential for maintaining the myelin sheath. This can result in demyelinating diseases, including generalized demyelinating polyneuropathy (GDP). Clinical incidence of N₂O-induced peripheral neuropathy is largely unknown, although some research suggests it is not uncommon. Treatment includes immediate cessation of N₂O use and vitamin B₁₂ supplementation. Although this treatment often reverses damage, residual symptoms such as limb weakness may persist. Additionally, genetic and dietary factors, such as vitamin B₁₂ deficiency, may heighten individual vulnerability for N₂O's detrimental effects.

Background and aims: Patterns of daily or near-daily (DND) use of alcohol and cannabis among adults in the United States have been changing. The current study measured how these shifts have occurred across developmental periods of adulthood.

Design, setting, and participants: U.S. national data from the Monitoring the Future Panel Study include responses from approximately 20 000 adults aged 19 to 65 in 2023. In total, annual data from 1988 to 2023 include 389 649 responses.

Measurements: Self-report measures of use of cannabis and alcohol DND (i.e., 20 + occasions in the last 30 days) were available for the full age ranges of 19-30 years from 1988 to 2023, of 35-50 years from 2008 to 2023, and of 55-65 years in 2023.

Findings: As of 2023, DND cannabis use was nearly three times as prevalent (10.4%) as DND alcohol use (3.6%) among young adults ages 19 to 30. Early midlife adults have had a convergence but not yet a crossover; there were similar prevalence levels of DND use of cannabis (7.5%) and alcohol (7.8%) among those ages 35 to 50 in 2023. Among late midlife adults ages 55 to 65, DND alcohol use remained more than twice as prevalent (11.4%) as DND cannabis use (5.2%) in 2023.

Conclusions: In the United States, daily or near-daily (DND) alcohol use remains more prevalent than DND cannabis use among late midlife adults, but the opposite is true for young adults.

Background and aims: The presence of sections or chapters on spontaneous human combustion in more than half of the key texts in English on the action of alcohol on the body and mind in the first half of the nineteenth century demonstrates the seriousness with which it was considered. We aimed to chart discussions about the links between spontaneous human combustion and spirit drinking in medical texts and representations in fiction through three key chronological periods from 1804 to 1900.

Methods: A contextual analysis using eighteenth- and nineteenth-century historical, literary and medical sources to chart and reflect on public and medical discourses.

Findings and conclusions: The development of new theories about the action of alcohol on the body and mind appears to have been influenced by the now-discredited eighteenth- and nineteenth-century idea that the phenomenon of human combustion, spontaneous or not, was linked to spirit drinking. As an extreme example of the consequences of heavy drinking, spontaneous human combustion was used to underpin early theories on the clinical chemistry of alcohol.

Aims: This study tested the efficacy and safety of a 12-week course of lisdexamfetamine in reducing methamphetamine use, an outcome which is associated with improvements in health and wellbeing, in people dependent on methamphetamine.

Design, setting and participants: This study was a randomised double-blind placebo-controlled trial conducted in six specialist outpatient clinics in Adelaide, Melbourne, Newcastle and Sydney, Australia (2018-2021). Participants were164 adults with methamphetamine dependence, reporting at least 14 use days out of the previous 28 days (62% male, 38% female, < 1% other; mean age 39 years).

Interventions: Participants were randomly allocated 1:1 to a 15-week regimen of lisdexamfetamine (1-week induction to 250 mg, 12-week maintenance regimen, 2-week reduction; n = 80) or matched placebo (n = 84), followed-up to Week 19.

Measurements: The primary efficacy measure was past 28-day methamphetamine use at Week 13. Safety was assessed by adverse event rates. Secondary measures included methamphetamine use during the 12-week treatment period and treatment satisfaction.

Findings: Nine randomized participants did not start treatment (five were allocated to lisdexamfetamine and four allocated to placebo) and were excluded from the analyses. Fifty-seven per cent of participants were retained on study medication to primary end-point. There was only weak evidence of a lisdexamfetamine benefit at 13 weeks [adjusted difference in days of methamphetamine use = 2.2, 95% confidence interval (CI) = -0.5 to 5.0; P = 0.49]. However, throughout the whole 12-week treatment maintenance phase, the lisdexamfetamine group had fewer days of methamphetamine use in total (difference = 8.8, 95% CI = 2.7-15.0; P = 0.005). The lisdexamfetamine group reported greater self-reported treatment effectiveness [odds ratio (OR) = 2.89, 95% CI = 1.67-5.02; P < 0.001] and treatment satisfaction (OR = 3.80, 95% CI = 1.93-7.47; P < 0.001). Adverse events with lisdexamfetamine included nausea. Serious adverse events occurred in four (5%) of participants who received lisdexamfetamine.

Conclusions: Lisdexamfetamine appears to reduce methamphetamine use over a 12-week treatment period, although there is only weak evidence that reduced use is maintained during the last 4 weeks.

Aims: To determine patterns of e-cigarette flavour use (sweet, tobacco, menthol/mint) in interventional studies of e-cigarettes for stopping smoking, and to estimate associations between flavours and smoking/vaping outcomes.

Methods: Update of secondary data analyses, including meta-analyses subgrouped by flavour provision and narrative syntheses, incorporating data from January 2004 to February 2024. Eligible studies were identified from a Cochrane review. Studies provided adults who smoked cigarettes with nicotine-containing e-cigarettes for smoking cessation and provided data on e-cigarette e-liquid flavour use. Outcomes included participants' flavour use measured at any time, plus smoking abstinence, abstinence from all tobacco or commercial nicotine products and allocated product use at 6 months or longer, reported as risk ratios with 95% confidence intervals. We assessed risk of bias using the Cochrane Risk of Bias 1 tool.

Results: We included 25 studies (n = 16 748); 21 contributed to subgroup meta-analyses and 18 provided flavour choices. We judged 15 studies at high, seven at low and three at unclear risk of bias. In studies where participants had a choice of flavours, some switching between flavours occurred (five studies). A preference for sweet (including fruit) flavours over tobacco and menthol was indicated (in 6 of 11 studies); however, there were differences across studies. Subgroup meta-analyses showed no clear associations between e-liquid flavours provided and smoking cessation or study product use. One included study randomised participants to two different flavour conditions and found similar cessation rates and long-term e-cigarette use between arms at 12 months.

Conclusions: Some people using e-cigarettes to quit smoking switch between e-cigarette flavours during a quit attempt. Sweet flavours may be preferred overall, but this may differ depending on context. Based on intervention studies, there is no clear association between the use of e-cigarette flavours and smoking cessation or longer-term e-cigarette use, possibly due to a paucity of data.

Background and aims: Stimulant-involved overdose deaths are increasing throughout the United States. Because stimulant misuse (i.e. taking a prescribed medicine not as directed) and stimulant use disorder contribute to the surging number of stimulant-related deaths, knowing the prevalence of stimulant misuse and use disorder is important. We aimed to estimate the prevalence of stimulant misuse and/or use disorder in Massachusetts from 2014 to 2021.

Design, setting and participants: This was a cohort study using a multiple systems estimation approach (previously known as 'capture-recapture'), using multiple individually linked epidemiological data sources, located in the Commonwealth of Massachusetts, 2014-2021. People aged 18-64 years from administrative databases were linked at the individual level and included in the analysis.

Measurements: Measurements included known and estimated counts of people with stimulant misuse and/or use disorder (as defined in each individual database) as well as total count and prevalence in Massachusetts. We performed both a stratified analysis using log-linear models to estimate the unknown population with stimulant misuse/use disorder and a single model analysis in which demographics were used as covariates. Uncertainty is characterized using 95% confidence intervals (95% CI) on the total counts and prevalence estimates.

Findings: The number of known individuals increased during the study period from 31 037 in 2014 to 42 612 in 2021. Using the multiple systems estimation approach, the estimated prevalence of underlying stimulant misuse and/or use disorder population ranged from 4.1 to 7.1% during the study period in the stratified analysis and 4.2 to 6.8% in the single model. By race, the highest prevalence estimates were among the Black non-Hispanic population, which showed a prevalence of up to 14.5% (95% CI = 14.32%, 14.57%) in 2021.

Conclusions: The estimated prevalence of stimulant misuse and/or use disorder in Massachusetts from 2014 to 2021 ranged from 4% to nearly 7% of the population. People from racial minorities appear to be disproportionately affected compared with the white non-Hispanic population. The unknown population accounted for large proportions of the total estimated population.