Addiction最新文献

Background and aims: Internet gaming addiction (IGA) is associated with altered reward/punishment sensitivity and risky decision-making. Nevertheless, the underlying neural mechanisms of such changes remain poorly understood. This study examined behavioral and neural predictors of IGA tendency with multiple datasets.

Design: Observational study.

Setting and participants: A total of 1142 university students [360 males and 782 females, mean (standard deviation) age of 18.75 (1.67) years] participated in the behavior-brain cross-sectional dataset (BBC). A subset of 303 BBC participants [71 males and 232 females, baseline mean age of 18.84 (1.72) years] participated in the behavior longitudinal dataset (BL).

Measurements: The Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ) assessed sensitivity to reward and punishment stimuli. The Internet Game Addiction Questionnaire assessed levels of addiction symptoms in the context of internet games. The Iowa Gambling Task (IGT) assessed risky decision-making behavior. Resting-state functional magnetic resonance imaging (MRI) data were preprocessed using standard pipelines and analyzed based on Yeo's seven-network parcellation template, with particular focus on the Limbic Network (LN) and its functional connectivity patterns. Statistical analyses included Spearman correlation, structural equation modeling and cross-lagged panel models.

Findings: Cross-sectional analyses revealed that the IGT net score (NS) was negatively associated with reward sensitivity (RS, rho = -0.181, P = 0.022), which was positively associated with punishment sensitivity (PS, rho = 0.125, P < 0.001). PS positively predicted IGA tendency (β = 0.180, P < 0.001). Additionally, LN strength exhibited a positive correlation with RS (rho = 0.077, P < 0.001) and a negative correlation with PS (rho = -0.045, P = 0.090). Moreover, the functional connectivity strength between LN and other functional networks was positively associated with RS. Longitudinal analyses demonstrated that (1) the IGT net score at the first time point (T1) negatively predicted RS at the second time point (T2, β = -0.123, P = 0.031), (2) RS at T1 positively predicted IGA tendency at T2 (β = 0.100, P = 0.019), (3) PS at T1 negatively predicted RS at T2 (β = 0.085, P = 0.056) and (4) LN strength at T1 directly predicted RS and PS at T1 (RS: β = 0.126, P = 0.027; PS: β = -0.104, P = 0.064), as well as RS at T2 (β = 0.079, P = 0.080).

Conclusion: Internet gaming activity net score appears to be negatively correlated with reward sensitivity. Punishment sensitivity appears to be positively correlated with tendency toward internet gaming activity. There appears to be a positive correlation between reward sensitivity and punishment sensitivity.

Background and aims: Recovery-focused measurement-based care of opioid use disorder (OUD) could inform clinical care by assessing patient-reported outcome measures (PROMs). We sought to identify and describe validated PROMs which assess recovery among patients with OUD, focusing on PROM characteristics, recovery domains and pragmatism for implementation in outpatient settings.

Methods: A preregistered (PROSPERO: CRD42023394770) systematic review was conducted using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. Validated PROMs that assessed at least one of 17 recovery domains and contained fewer than 50 items were identified. The review described PROM characteristics, including the number of items, subscales, response options and time to complete. Content validity was assessed from the patient perspective. Recovery domains assessed were categorized into 17 domains, including substance-related, psychological health and quality of life. The presence of clinically relevant score changes was assessed. Hierarchical clustering was performed to describe co-occurrence patterns among recovery domains.

Results: A total of 122 studies were included, identifying 90 unique PROMs. Three PROMs (3%) received a 'moderate' grade on content validity. PROMs assessed a median of 4 recovery domains [inter-quartile range (IQR) = 1-7], with substance-related outcomes being most common (51%), followed by psychological health (49%), relationships (41%) and physical health (36%). Nineteen PROMs (21%) contained fewer than 10 items, making them highly pragmatic for clinical use. Fourteen PROMs (16%) assessed 8 or more recovery domains and were categorized as comprehensive. Two (2%) comprehensive PROMs were developed with input from individuals with lived experience of substance use, providing a patient-centered perspective. Five PROMs (6%) defined clinically relevant score changes.

Conclusions: There are many patient-reported outcome measures (PROMs) which assess diverse and often broadly defined recovery domains that can be used in recovery-focused measurement-based care of opioid use disorder; however, few PROMs are brief enough to be pragmatic for clinical use, nearly all lack clinically relevant score changes that could help inform treatment decisions, and few were developed with input from people with lived experience.

Background and aims: The tension reduction hypothesis suggests that people consume alcohol to alleviate stress. While previous studies showed stress increases alcohol's absolute value, alcohol's value relative to alternatives should be more relevant for drinking decisions. We aimed to test whether acute stress causes individuals to choose alcohol over appealing non-alcoholic alternatives and to identify the cognitive mechanisms underlying this choice behavior.

Design: Laboratory-based randomized 2 × 2 experimental study.

Setting: Controlled laboratory environment including a simulated bar setting.

Participants: 160 adults [56% male; mean age = 31 years; median Alcohol Use Disorders Identification Test (AUDIT) score = 8] who regularly consume alcohol.

Interventions: Participants first rated beverages and made repeated choices between alcoholic and non-alcoholic options. They then received either alcoholic beverages [target breath alcohol concentration (BrAC) = 0.06%] or non-alcoholic beverages, followed by either a personalized stress induction using autobiographical emotional memories or a neutral control procedure.

Measurements: Primary outcomes were proportion of choices for alcoholic beverages and decision response times. Choice behavior was analyzed using drift diffusion modeling to decompose decisions into three mechanisms: decision carefulness (boundary parameter), sensitivity to prior preferences (drift rate) and bias toward alcohol regardless of preference (bias parameter).

Findings: Stress moderately increased choices for alcohol [95% highest density interval (HDI) = 0.01-0.13], but only in sober participants. Drift diffusion modeling revealed that stress primarily affected decision-making by inducing a bias toward alcohol during evidence accumulation (95% HDI = 0.19-0.76), without impacting decision carefulness or evidence sensitivity. This computational bias was stronger than observed in raw choice behavior, indicating that while stress consistently biased evaluation toward alcohol, this bias only sometimes overcame competing considerations (i.e. a person might reverse a preference from 'a little bit' to 'not really', but not from 'a little bit' to 'not at all').

Conclusions: Our results support the tension reduction hypothesis by demonstrating that stress occasionally led individuals to choose alcohol even when they preferred the non-alcoholic alternative; however, this effect only appeared in sober participants who had not yet consumed any alcohol, suggesting the hypothesis primarily explains decisions about initiating rather than continuing drinking episodes.

Background and aims: Restricting alcohol advertising may reduce alcohol consumption and related ill-health. However, advertisements for alcohol-free and low-alcohol drinks (NoLos) with brand-matched alcoholic versions are typically exempt from restrictions, which could lead to surrogate marketing (adverts for NoLo beverages also promoting brand-matched alcoholic options). This study measured the impact of advertisements for brand-matched NoLo beverages on product selections in a simulated online supermarket, in the UK.

Design, setting, participants and intervention: We conducted a randomised controlled trial with 1638 UK regular alcohol consumers (aged 18-91), assigned to one of three groups: (1) alcohol adverts (n = 469), where participants viewed an advertisement (embedded within a video) for one of four alcoholic beverages; (2) NoLo adverts (n = 472), for one of four brand-matched NoLo beverages; and (3) unrelated adverts (n = 697), for batteries. Participants then selected food and drinks for a barbecue in a simulated online supermarket.

Measurements: We collected data on products selected in the simulated online supermarket (e.g. product name, category, quantity, energy). Risk of alcohol dependence was measured using the Alcohol Use Disorder Identification Test Consumption Questions (AUDIT-C). The primary outcome was selection (yes/no) of advertised alcoholic and NoLo products. Secondary outcomes included the selection (yes/no) of any alcoholic or NoLo products. We also examined the recall of advertised brands and products through survey questions.

Findings: Viewing NoLo, but not alcohol, advertisements statistically significantly increased the odds of selecting the advertised products, compared with unrelated advertisements [alcohol group: odds ratio (OR) = 1.62, 95% confidence interval (CI) = 1.03-2.53, Benjamini-Hochberg-adjusted P = 0.11; NoLo group: OR = 2.18, 95% CI = 1.24-3.91, Benjamini-Hochberg-adjusted P = 0.022]. Although the odds of selecting the alcoholic version of the advertised product were higher in those exposed to NoLo adverts vs. control (OR = 1.48, 95% CI = 0.94-2.33, Benjamini-Hochberg-adjusted P = 0.13), this association did not reach statistical significance. Fifty-nine percent of participants in all three groups recalled the advertised brand. Among those who remembered the brand of advertisement, 96% in the alcohol group also correctly recalled the advertised product, while 44% in the NoLo group reported seeing an advert for the alcoholic version of the product (X² = 297.16, P < 0.001, df = 2).

Conclusions: Exposure to advertisements for brand-matched alcohol-free and low-alcohol drinks increases brand (over product) recall, but, while the direction of effects is consistent with these advertisements promoting the selection of alcoholic beverages, evidence of the impact on alcohol selection is inc

Background and aims: Smoking tobacco increases the risk of intra- and post-operative complications. Abstinence before surgery reduces these risks and costs to healthcare services. This study measured smoking abstinence among elective pre-operative patients who smoked following a modified clinical pathway.

Design: An observational, follow-up study of patients who received the changed pre-operative pathway, supplemented by a controlled interrupted time series analysis (ITSA) of hospital patients referred to the community Stop Smoking Service (SSS) between April 2020 and August 2024. Patients referred to the SSS by primary care clinicians acted as a negative control to assess whether any observed changes reflected general time trends rather than the intervention effect.

Setting: A district general hospital in Nottinghamshire, United Kingdom, during January 2024.

Participants: 476 pre-operative patients recorded as smokers in primary care electronic health records (52% female; mean age 52 years) awaiting elective procedures taking place in more than 6 weeks were included.

Intervention: Patients who had completed the routine pre-operative care pathway were invited via Short Message Service message (SMS) to opt out of SSS referral. Those who did not respond within 14 days were referred. The SSS provided usual care consisting of face-to-face or virtual counselling and an offer of nicotine replacement therapy. The intervention was low-cost and used existing pre-operative services.

Measurements: The primary outcome was patient-reported smoking abstinence 28 days after an agreed quit date. This is a routinely collected SSS outcome. Controlled ITSA compared weekly counts of first SSS appointments between secondary care and primary care referrals among patients who subsequently achieved abstinence, before and after the intervention was implemented.

Findings: 10.5% (50/476) of patients reported 28-day abstinence. 25.4% (121/476) booked an SSS appointment and 16% (77/476) opted out of SSS referral. 63.9% (304/476) were contactable by the SSS and 54.2% (258/476) confirmed smoking. 19.4% (50/258) of patients who were contactable and confirmed smoking stopped. ITSA indicated an immediate increase in weekly hospital patients referred who reported abstinence was not due to any general time trends (5.83, 95% confidence interval = 2.50-9.16, P < 0.001), consistent with a pulsed intervention of limited duration.

Conclusions: Inviting elective surgical patients to opt out of Stop Smoking Service referral via Short Message Service message appears to increase 28-day smoking abstinence.

The article provides an overview of key substance use and addictive behaviors in Vietnam, alongside the development of addiction science, drawing from a synthesis of literature and the authors' perspectives. Over the last two decades, the primary illicit drug of concern has shifted from heroin to methamphetamine and other psychoactive substances. Tobacco use has declined but remains widespread while alcohol consumption is high compared with other countries in the region with common binge drinking. Studies on behavioral addictions in Vietnam are limited. While the impacts of opioid addiction are well documented, reports on the societal impacts of methamphetamine use remain scarce. Public discourse has often framed substance use negatively, fueling stigmatization and supporting abstinence-oriented policies. Vietnam's drug policy reflects a tension between abstinence-focused and harm reduction approaches. The nationwide expansion of methadone treatment is a significant achievement. However, the country's responses to the new epidemic of methamphetamine and other psychoactive substances are still evolving. International cooperation has continued to play an important role in advancing research and surveillance as well as adapting evidence-based interventions. There are promising signs that Vietnam will strengthen public awareness and expand workforce training and policy innovation to address the issue of substance use in the population.

We thank our colleagues for their responses to our article [1] in which we proposed a more nuanced approach to the emergency management of opioid overdose. We are pleased that it has generated thoughtful discussion and debate.

Wong et al. [2] raise the valid concern that evidence on responding to potent synthetic opioids is lacking, concluding that ‘the risk of inadequate reversal […] often outweighs the potential harms of over-antagonism.’ We agree that there is a pressing need for improved evidence on responses to synthetic opioid overdose to inform real-world, evidence-based practice. There is an urgent need for clinical trials, observational studies and emergency medical services data analysis involving these drugs.

Coffin [3] supports our core argument for integrating tailored dosing strategies into overdose management protocols. We agree that over-reliance on naloxone risks delaying other critical interventions, such as respiratory and cardiovascular support. Coffin also highlights the importance of timing, noting that fentanyl-related mortality may reflect not only its potency, but also the rapid onset of its effects compared with heroin.

Similarly, Morgan and Walley [4] emphasize the importance of timely intervention and how dose selection is secondary to a more fundamental issue—whether a bystander is present and able to respond, particularly given that witnesses may not be present. On this basis, not consuming drugs alone should be a core in harm reduction strategies. Our research group is one of a number around the world developing real-time overdose detection interventions to enable the earliest possible response [5].

We believe that there are three practical aspects that deserve emphasis. First, naloxone training in the community must include recognizing symptoms, basic first aid including airway and rescue breathing and alerting medical services before naloxone administration. Second, we need improved naloxone products that allow dose titration in community settings. Products designed to ensure individual incremental dosing could help bridge the gap between clinical and community environments. Recent pharmacokinetic studies have demonstrated significant inter-individual variability in naloxone absorption, supporting the need for flexible dosing approaches [6, 7]. The development of naloxone formulations that permit stepwise administration could address both efficacy and safety concerns in community settings. Third, we should develop simple, teachable principles of dose titration for lay responders. Rather than complex protocols, basic training could focus on the initial assessment and then starting conservatively if the patient is not in extremis/still breathing, monitoring respiratory response, and understanding when additional doses are warranted. Evidence from emergency medical services suggests that trained responders

Background and aim: Relapse risk among people who formerly smoke is influenced by task difficulty. Cessation fatigue (CF) may be a better predictor than measures such as reported strength of urges to smoke (SUTS) and abstinence self-efficacy (ASE). It may also be affected by quit length and use of other nicotine products. The current study investigated whether post-quitting CF predicts higher relapse risk, its predictive utility relative to ASE and SUTS and whether the CF-relapse prediction was moderated by time since quitting.

Design: Data drawn from longitudinal cohort surveys conducted between 2016 and 2022 of the International Tobacco Control Four Country Smoking and Vaping Survey.

Setting: Canada, the United States, England and Australia.

Participants: People aged 18 + years who formerly smoked (n = 1914).

Measurements: Generalised estimating equations logistic regression models were used to test for associations and moderation.

Findings: In separate individual analyses, CF, ASE and SUTS were statistically significant independent relapse predictors; however, when analysed together, CF was the only statistically significant relapse predictor [moderate CF: odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.21-2.23, P = 0.002; high CF: OR = 1.81, 95% CI = 1.07-3.07, P = 0.027) on top of continuing main effects of vaping and time since quitting, but time since quitting was not a moderator.

Conclusions: Cessation fatigue appears to predict smoking relapse risk better than other measures related to task difficulty and does so independently of vaping and time since quitting, which are both protective.

Background and aims: People who use methamphetamine have a standardised mortality ratio 6.8 times greater than the general population, with several countries reporting concerning increases in methamphetamine-related mortality over the past decade. Methamphetamine use in the United Kingdom (UK) has been reported as largely confined to communities of men who have sex with men (MSM) with no previous large-scale studies describing mortality associated with methamphetamine. We aimed to determine trends and case characteristics of methamphetamine-related deaths in the UK.

Design: Retrospective cohort study.

Setting: Coronial records submitted to the National Programme on Substance Use Mortality (NPSUM) in the UK, 1997-2024.

Cases: Decedents for whom methamphetamine was determined as implicated in death following coronial investigation.

Measurements: Information was available on decedent sociodemographics, characteristics of death and drugs implicated in death.

Findings: 136 decedents had methamphetamine implicated in death. The number of deaths per year were observed to be higher over time since the first death recorded in 2006 (2005-2010, 8 deaths; 2011-2015, 24 deaths; 2016-2020, 47 deaths; 2021-2024, 57 deaths). Decedents were predominantly male (n = 124, 91%) of White ethnicity (n = 68, 50%) with a mean age of 41.5 years (standard deviation 10.4; range 18-71); 77% had a history of substance dependence, 48% of which involved injecting drug use, and 88% had a history of a mental disorder. The median blood methamphetamine concentration detected at post-mortem was 0.83 mg/l (interquartile range 0.26, 2.5). Multiple drug toxicity was implicated in the majority of cases (n = 88, 65%), the most common implicated other drugs being cocaine (n = 27, 20%), gamma-hydroxybutyrate (n = 20, 15%), opioids (n = 20, 15%), benzodiazepines (n = 18, 13%), mephedrone (n = 13, 10%) and ketamine (n = 12, 8%). Accidental poisoning was the most common direct cause of death (n = 89, 65%), with other causes including intentional poisoning, cardiovascular disease, aspiration pneumonia and ischemic bowel disease.

Conclusions: Over the past two decades there appears to have been an increase in the number of methamphetamine-related deaths in the UK. These deaths largely involve polysubstance use within an overwhelmingly male population with a high prevalence of substance dependence and mental health disorders.