Sally Olderbak, Justin Möckl, Jakob Manthey, Sara Lee, Jürgen Rehm, Eva Hoch, Ludwig Kraus
Aims
To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.
Design
Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.
Setting
Germany.
Participants/cases
German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative.
Measurements
Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.
Findings
The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.
Conclusions
Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).
{"title":"Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021","authors":"Sally Olderbak, Justin Möckl, Jakob Manthey, Sara Lee, Jürgen Rehm, Eva Hoch, Ludwig Kraus","doi":"10.1111/add.16356","DOIUrl":"10.1111/add.16356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Germany.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants/cases</h3>\u0000 \u0000 <p>German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (<i>n</i> = 78 678). With the application of a weighting scheme, the data are nationally representative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"311-321"},"PeriodicalIF":6.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Greta A. Bushnell, Moira A. Rynn, Tobias Gerhard, Katherine M. Keyes, Deborah S. Hasin, Magdalena Cerdá, Abner Nyandege, Mark Olfson
Background and Aims
Benzodiazepines (BZDs) carry a risk for drug overdose and are prescribed alone or simultaneously with selective-serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety and depression in young adults. We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiation, compared with SSRI treatment alone in young adults with depression or anxiety.
Design, Setting, Participants
The cohort study used administrative databases covering privately (MarketScan, 1/1/2009–12/31/2018) and publicly (Medicaid, 1/1/2015–12/31/2016) insured young adults (18–29 years) in the United States. Those with depression or anxiety diagnoses newly initiating BZD or SSRI treatment (without BZD or SSRI prescriptions in prior year) were included. Simultaneous “BZD + SSRI” initiation was defined as starting BZD and SSRI treatment on the same day. The cohorts included 604 664 privately insured young adults (BZD = 22%, BZD + SSRI = 10%, SSRI = 68%) and 110 493 publicly insured young adults (BZD = 23%, BZD + SSRI = 5%, SSRI = 72%).
Measurements
Incident medically treated drug overdose events were identified from emergency department and inpatient encounters (ICD poisoning codes) within 6 months of treatment initiation. Crude and propensity-score adjusted cumulative incidence and hazard ratios (HR) were estimated. Sub-analyses evaluated drug overdose intent.
Findings
Adjusted HRs of drug overdose for BZD vs. SSRI treatment was 1.36 (95% confidence interval [CI]:1.23–1.51) in privately and 1.59 (95%CI:1.37–1.83) in publicly insured young adults. The adjusted HRs of drug overdose for BZD + SSRI treatment vs. SSRI treatment were 1.99 (95%CI:1.77–2.25) in privately and 1.98 (95%CI:1.47–2.68) in publicly insured young adults.
Conclusions
Among young adults in the United States, initiating benzodiazepine treatment for anxiety and depression, alone or simultaneously with selective-serotonin reuptake inhibitors (SSRI), appears to have an increased risk of medically treated drug overdose compared with SSRI treatment alone. These associations were observed in publicly and privately insured individuals.
{"title":"Drug overdose risk with benzodiazepine treatment in young adults: Comparative analysis in privately and publicly insured individuals","authors":"Greta A. Bushnell, Moira A. Rynn, Tobias Gerhard, Katherine M. Keyes, Deborah S. Hasin, Magdalena Cerdá, Abner Nyandege, Mark Olfson","doi":"10.1111/add.16359","DOIUrl":"10.1111/add.16359","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Benzodiazepines (BZDs) carry a risk for drug overdose and are prescribed alone or simultaneously with selective-serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety and depression in young adults. We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiation, compared with SSRI treatment alone in young adults with depression or anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting, Participants</h3>\u0000 \u0000 <p>The cohort study used administrative databases covering privately (MarketScan, 1/1/2009–12/31/2018) and publicly (Medicaid, 1/1/2015–12/31/2016) insured young adults (18–29 years) in the United States. Those with depression or anxiety diagnoses newly initiating BZD or SSRI treatment (without BZD or SSRI prescriptions in prior year) were included. Simultaneous “BZD + SSRI” initiation was defined as starting BZD and SSRI treatment on the same day. The cohorts included 604 664 privately insured young adults (BZD = 22%, BZD + SSRI = 10%, SSRI = 68%) and 110 493 publicly insured young adults (BZD = 23%, BZD + SSRI = 5%, SSRI = 72%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Incident medically treated drug overdose events were identified from emergency department and inpatient encounters (ICD poisoning codes) within 6 months of treatment initiation. Crude and propensity-score adjusted cumulative incidence and hazard ratios (HR) were estimated. Sub-analyses evaluated drug overdose intent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Adjusted HRs of drug overdose for BZD vs. SSRI treatment was 1.36 (95% confidence interval [CI]:1.23–1.51) in privately and 1.59 (95%CI:1.37–1.83) in publicly insured young adults. The adjusted HRs of drug overdose for BZD + SSRI treatment vs. SSRI treatment were 1.99 (95%CI:1.77–2.25) in privately and 1.98 (95%CI:1.47–2.68) in publicly insured young adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among young adults in the United States, initiating benzodiazepine treatment for anxiety and depression, alone or simultaneously with selective-serotonin reuptake inhibitors (SSRI), appears to have an increased risk of medically treated drug overdose compared with SSRI treatment alone. These associations were observed in publicly and privately insured individuals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"356-368"},"PeriodicalIF":6.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41186287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oliver Grundmann, Albert Garcia-Romeu, Christopher R. McCurdy, Abhisheak Sharma, Kirsten E. Smith, Marc T. Swogger, Stephanie T. Weiss
<p>The Southeast Asian plant kratom (<i>Mitragyna speciosa</i> Korth.) has garnered growing popularity among North American consumers as a herbal product used for recreational, performance enhancement and self-treatment purposes. Scientifically, there has also been substantial interest in studying kratom and its constituents as a possible therapy for several conditions, including pain, mood, fatigue and substance use disorders (SUDs) [<span>1</span>]. Pre-clinical animal studies, human surveys and clinical case reports indicate that kratom has potential therapeutic effects as well as possible abuse and dependence potential, consistent with its complex opioidergic, adrenergic and serotonergic pharmacology [<span>2</span>].</p><p>Kratom is not federally recognized as a dietary supplement, and is therefore largely unregulated. Native kratom leaf material contains up to 2% of the major indole alkaloid mitragynine by weight. In addition, more than 50 other indole and oxindole alkaloids, some with known pharmacological effects, are present in lesser, but potentially significant, amounts [<span>3</span>].</p><p>Recently, there is a growing and concerning commercial trend in Western countries towards the production and marketing of kratom extract products created via extraction of kratom leaves using organic solvents. This enrichment process can increase the mitragynine concentration to 40% or higher in such products. Of great concern from a public health perspective, commercial kratom extract products lack data regarding their safety, efficacy and abuse potential. In addition, the formulation of concentrated kratom extracts as capsules, tablets, liquid shots or gummies circumvents kratom’s natural self-limiting qualities (e.g. unpleasant taste) and reduces the volume of product needed to achieve an effect, thereby raising the risk of users ingesting larger amounts of alkaloids with potentially toxic effects.</p><p>History has shown us that developing enriched natural-product elixirs or purified active agents, as with cocaine from the coca shrub and morphine from the opium poppy, can be both a blessing and a curse: a blessing in that some of these concentrates can be medically useful to improve quality of life for patients suffering from a variety of disorders and a curse of increased risk. Concentrated kratom extracts are analogous to these previous historical examples. They may provide benefit to some, but they may result in unpredictable adverse effects and other potential harms resulting from dependence and drug–drug interactions.</p><p>As researchers studying the therapeutic potential of kratom, while also desiring to reduce possible associated harms, we strongly recommend that kratom in its native form as the unadulterated fresh or dried leaf material remains available to consumers with proper oversight and regulation, including clear labeling describing the amount of mitragynine per dose, recommended maximum daily doses, potential for drug interac
{"title":"Not all kratom is equal: The important distinction between native leaf and extract products","authors":"Oliver Grundmann, Albert Garcia-Romeu, Christopher R. McCurdy, Abhisheak Sharma, Kirsten E. Smith, Marc T. Swogger, Stephanie T. Weiss","doi":"10.1111/add.16366","DOIUrl":"10.1111/add.16366","url":null,"abstract":"<p>The Southeast Asian plant kratom (<i>Mitragyna speciosa</i> Korth.) has garnered growing popularity among North American consumers as a herbal product used for recreational, performance enhancement and self-treatment purposes. Scientifically, there has also been substantial interest in studying kratom and its constituents as a possible therapy for several conditions, including pain, mood, fatigue and substance use disorders (SUDs) [<span>1</span>]. Pre-clinical animal studies, human surveys and clinical case reports indicate that kratom has potential therapeutic effects as well as possible abuse and dependence potential, consistent with its complex opioidergic, adrenergic and serotonergic pharmacology [<span>2</span>].</p><p>Kratom is not federally recognized as a dietary supplement, and is therefore largely unregulated. Native kratom leaf material contains up to 2% of the major indole alkaloid mitragynine by weight. In addition, more than 50 other indole and oxindole alkaloids, some with known pharmacological effects, are present in lesser, but potentially significant, amounts [<span>3</span>].</p><p>Recently, there is a growing and concerning commercial trend in Western countries towards the production and marketing of kratom extract products created via extraction of kratom leaves using organic solvents. This enrichment process can increase the mitragynine concentration to 40% or higher in such products. Of great concern from a public health perspective, commercial kratom extract products lack data regarding their safety, efficacy and abuse potential. In addition, the formulation of concentrated kratom extracts as capsules, tablets, liquid shots or gummies circumvents kratom’s natural self-limiting qualities (e.g. unpleasant taste) and reduces the volume of product needed to achieve an effect, thereby raising the risk of users ingesting larger amounts of alkaloids with potentially toxic effects.</p><p>History has shown us that developing enriched natural-product elixirs or purified active agents, as with cocaine from the coca shrub and morphine from the opium poppy, can be both a blessing and a curse: a blessing in that some of these concentrates can be medically useful to improve quality of life for patients suffering from a variety of disorders and a curse of increased risk. Concentrated kratom extracts are analogous to these previous historical examples. They may provide benefit to some, but they may result in unpredictable adverse effects and other potential harms resulting from dependence and drug–drug interactions.</p><p>As researchers studying the therapeutic potential of kratom, while also desiring to reduce possible associated harms, we strongly recommend that kratom in its native form as the unadulterated fresh or dried leaf material remains available to consumers with proper oversight and regulation, including clear labeling describing the amount of mitragynine per dose, recommended maximum daily doses, potential for drug interac","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 1","pages":"202-203"},"PeriodicalIF":6.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16366","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41181437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background and Aims</h3> <p>Fathers' parental leave has been associated with decreased risks of alcohol-related hospitalizations and mortality. Whether this is attributable to the health protections of parental leave itself (through stress reduction or behavioral changes) or to selection into leave uptake remains unclear, given that fathers are more likely to use leave if they are in better health. Using the quasi-experimental variation of a reform incentivizing fathers' leave uptake (the 1995 <i>Father's quota</i> reform), this study aimed to assess whether fathers' parental leave influences alcohol-related morbidity and mortality.</p> </section> <section> <h3> Design</h3> <p>Quasi-experimental interrupted time series and instrumental variable analyses.</p> </section> <section> <h3> Setting</h3> <p>Sweden.</p> </section> <section> <h3> Participants</h3> <p>Fathers of singleton children born from January 1992 to December 1997 (<i>n</i> = 220 412).</p> </section> <section> <h3> Measurements</h3> <p>Exposure was indicated by the child's birthdate before or after the reform and used to instrument fathers' 2- and 8-year parental leave uptake. Outcomes included fathers' hospitalization rates for acute alcohol-related (intoxication; mental and behavioral disorders) and chronic alcohol-related diagnoses (cardiovascular, stomach and other diseases; liver diseases), as well as alcohol-related mortality, up to 2, 8 and 18 years after the first child's birthdate.</p> </section> <section> <h3> Findings</h3> <p>In interrupted time series analyses, fathers of children born after the reform exhibited immediate decreases in alcohol-related hospitalization rates up to 2 (incidence rate ratio [IRR] = 0.66, 95% confidence interval [CI] = 0.51–0.87), 8 (IRR = 0.74, 95% CI = 0.57–0.96) and 18 years after birth (IRR = 0.72, 95% CI = 0.54–0.96), particularly in acute alcohol-related hospitalization rates, compared with those with children born before. No changes were found for alcohol-related mortality. Instrumental variable results suggest that alcohol-related hospitalization decreases were driven by fathers' parental leave uptake (e.g. 2-year hospitalizations: IRR = 0.16, 95% CI = 0.03–0.84).</p> </section> <section> <h3> Conclusions</h3> <p>In Swe
{"title":"Alcohol-related morbidity and mortality by fathers' parental leave: A quasi-experimental study in Sweden","authors":"Helena Honkaniemi, Sol Pía Juárez","doi":"10.1111/add.16354","DOIUrl":"10.1111/add.16354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Fathers' parental leave has been associated with decreased risks of alcohol-related hospitalizations and mortality. Whether this is attributable to the health protections of parental leave itself (through stress reduction or behavioral changes) or to selection into leave uptake remains unclear, given that fathers are more likely to use leave if they are in better health. Using the quasi-experimental variation of a reform incentivizing fathers' leave uptake (the 1995 <i>Father's quota</i> reform), this study aimed to assess whether fathers' parental leave influences alcohol-related morbidity and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Quasi-experimental interrupted time series and instrumental variable analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Fathers of singleton children born from January 1992 to December 1997 (<i>n</i> = 220 412).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Exposure was indicated by the child's birthdate before or after the reform and used to instrument fathers' 2- and 8-year parental leave uptake. Outcomes included fathers' hospitalization rates for acute alcohol-related (intoxication; mental and behavioral disorders) and chronic alcohol-related diagnoses (cardiovascular, stomach and other diseases; liver diseases), as well as alcohol-related mortality, up to 2, 8 and 18 years after the first child's birthdate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>In interrupted time series analyses, fathers of children born after the reform exhibited immediate decreases in alcohol-related hospitalization rates up to 2 (incidence rate ratio [IRR] = 0.66, 95% confidence interval [CI] = 0.51–0.87), 8 (IRR = 0.74, 95% CI = 0.57–0.96) and 18 years after birth (IRR = 0.72, 95% CI = 0.54–0.96), particularly in acute alcohol-related hospitalization rates, compared with those with children born before. No changes were found for alcohol-related mortality. Instrumental variable results suggest that alcohol-related hospitalization decreases were driven by fathers' parental leave uptake (e.g. 2-year hospitalizations: IRR = 0.16, 95% CI = 0.03–0.84).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In Swe","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"301-310"},"PeriodicalIF":6.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41093032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Shield <i>et al</i>. [<span>1</span>] draw upon the recent redevelopment of the Canadian Low Risk Drinking Guidelines to formulate some key principles that, they argue, should underpin future guidelines work internationally. This is an admirable attempt to further earlier work by Holmes <i>et al</i>. [<span>2</span>] arguing for increasing rigour and transparency in the guidelines setting process and offers much food for thought.</p><p>Fundamentally, the setting of guidelines is concerned with risk, with (i) accurately estimating via sophisticated epidemiology and modelling the risks of various outcomes (often mortality) associated with drinking, (ii) determining some level of population risk considered acceptable and (iii) communicating these risks to the population. Much of the energy in the various guidelines committees in recent decades has been focused upon (i), which has led to substantial improvements in our understanding of the population impacts of alcohol e.g. [<span>3, 4</span>], although there remains ongoing debate and uncertainty in key areas [<span>5</span>].</p><p>Strikingly little research has been conducted on either (ii) or (iii). It is remarkable that guidelines committees have, from at least the 2009 Australian guidelines [<span>6</span>], relied upon a 1969 analysis of risk acceptability by Starr [<span>7</span>], which has since been critiqued and expanded upon in a large body of work examining risk perception and acceptability [<span>8, 9</span>]. Research has demonstrated clearly that risk perceptions and acceptability vary markedly among different risks, depending upon factors including familiarity, immediacy, personal experience and perceived benefits (among many others) [<span>10</span>]. Further, there are clear and predictable variations in risk acceptability between subpopulations, based on gender, age, living situation and more [<span>11-13</span>]. Surprisingly little work has followed to situate alcohol epidemiology within these broader literatures on risk. Thus, our reliance upon relatively simplistic risk thresholds (1/100 in the recent Australian and UK guidelines) seems arbitrary.</p><p>This supports the argument put forward by Shield <i>et al</i>. that providing a continuum of risk is a more appropriate approach to guideline development, letting individuals make their own, informed decisions about risk acceptability by providing a range of risk thresholds or a continuous risk function. This is, however, obviously contingent upon (iii), the communication and understanding of risk by the general public. The Canadian guidelines provide a good example of the challenges here, with the relatively sophisticated risk continuum simplified throughout hundreds of media articles into a single guideline of two drinks per week [<span>14, 15</span>]. Our understanding of how best to communicate the risks that underpin drinking guidelines remains poor, despite potential lessons from a substantial broader research field [
{"title":"Improving the epidemiology of low-risk drinking guidelines is not enough","authors":"Michael Livingston","doi":"10.1111/add.16358","DOIUrl":"10.1111/add.16358","url":null,"abstract":"<p>Shield <i>et al</i>. [<span>1</span>] draw upon the recent redevelopment of the Canadian Low Risk Drinking Guidelines to formulate some key principles that, they argue, should underpin future guidelines work internationally. This is an admirable attempt to further earlier work by Holmes <i>et al</i>. [<span>2</span>] arguing for increasing rigour and transparency in the guidelines setting process and offers much food for thought.</p><p>Fundamentally, the setting of guidelines is concerned with risk, with (i) accurately estimating via sophisticated epidemiology and modelling the risks of various outcomes (often mortality) associated with drinking, (ii) determining some level of population risk considered acceptable and (iii) communicating these risks to the population. Much of the energy in the various guidelines committees in recent decades has been focused upon (i), which has led to substantial improvements in our understanding of the population impacts of alcohol e.g. [<span>3, 4</span>], although there remains ongoing debate and uncertainty in key areas [<span>5</span>].</p><p>Strikingly little research has been conducted on either (ii) or (iii). It is remarkable that guidelines committees have, from at least the 2009 Australian guidelines [<span>6</span>], relied upon a 1969 analysis of risk acceptability by Starr [<span>7</span>], which has since been critiqued and expanded upon in a large body of work examining risk perception and acceptability [<span>8, 9</span>]. Research has demonstrated clearly that risk perceptions and acceptability vary markedly among different risks, depending upon factors including familiarity, immediacy, personal experience and perceived benefits (among many others) [<span>10</span>]. Further, there are clear and predictable variations in risk acceptability between subpopulations, based on gender, age, living situation and more [<span>11-13</span>]. Surprisingly little work has followed to situate alcohol epidemiology within these broader literatures on risk. Thus, our reliance upon relatively simplistic risk thresholds (1/100 in the recent Australian and UK guidelines) seems arbitrary.</p><p>This supports the argument put forward by Shield <i>et al</i>. that providing a continuum of risk is a more appropriate approach to guideline development, letting individuals make their own, informed decisions about risk acceptability by providing a range of risk thresholds or a continuous risk function. This is, however, obviously contingent upon (iii), the communication and understanding of risk by the general public. The Canadian guidelines provide a good example of the challenges here, with the relatively sophisticated risk continuum simplified throughout hundreds of media articles into a single guideline of two drinks per week [<span>14, 15</span>]. Our understanding of how best to communicate the risks that underpin drinking guidelines remains poor, despite potential lessons from a substantial broader research field [","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 1","pages":"20-21"},"PeriodicalIF":6.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41090439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Craving has a very long history in the addiction field. In the early days, many authors questioned the relevance of the craving concept for addictive behaviours [<span>1, 2</span>]. After decades of research into craving, however, studies have increasingly demonstrated the relevance of this concept for addictive behaviour. It is, for example, currently part of the DSM criteria [<span>3, 4</span>], and many studies have shown that craving is an important predictor of relapse [<span>5, 6</span>]. However, there are still many issues that are not fully understood or addressed. One such issue is whether craving for substances is similar in nature to craving associated with behavioural addictions. Miele and colleagues [<span>7</span>] ask an important but scarcely addressed question: what about behavioural cravings such as sexual cravings?</p><p>Although, as Miele <i>et al</i>. show, there are many similarities between substance craving and sexual craving, there are also differences. Unlike alcohol and drug addiction, sexual addiction has different characteristics because sexual desire is also, at least for most people, a normal and healthy behaviour. The authors aptly introduce the term ‘egodystonic’ to address this issue. I assume they are referring to desires that conflict with an individual’s ideal self-concept. I would argue that future research should explore possible ways of further quantifying this construct. Is there really a difference between egodystonic or problematic cravings and egosyntonic or non-conflicting cravings? Are there mere quantitative differences in terms of frequency and intensity or are there also qualitative differences? I predict that it will be difficult to differentiate between egodystonic and egosyntonic sexual craving, especially in the field of sexual violence, where it is likely that craving will be presented as egodystonic. As sexual craving is still taboo and there are possible legal consequences, it will be unlikely that self-reports alone could reveal meaningful insights into this particular topic. For example, a sexual offender is likely to explain the offence by pointing towards an egodystonic (‘I was not myself’) rather than an egosyntonic mechanism.</p><p>Psychophysiological measures, such as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), could be employed to gain a richer understanding of the nature of behavioural cravings, including sexual craving. Although it is tempting to look for similarities, there is work showing remarkable differences between the psychophysiology associated with sexual craving and that associated with alcohol and drug craving. One notable difference was found in a study by Prause and colleagues [<span>8</span>], who found opposite results to the addiction models. That is, participants with problematic and ‘excessive’ viewing of visual sexual stimuli, who were reported to have higher sexual desire, had lower EGG responses to sexual images compared t
{"title":"Is sexual craving a sign of sex addiction?","authors":"Ingmar H. A. Franken","doi":"10.1111/add.16362","DOIUrl":"10.1111/add.16362","url":null,"abstract":"<p>Craving has a very long history in the addiction field. In the early days, many authors questioned the relevance of the craving concept for addictive behaviours [<span>1, 2</span>]. After decades of research into craving, however, studies have increasingly demonstrated the relevance of this concept for addictive behaviour. It is, for example, currently part of the DSM criteria [<span>3, 4</span>], and many studies have shown that craving is an important predictor of relapse [<span>5, 6</span>]. However, there are still many issues that are not fully understood or addressed. One such issue is whether craving for substances is similar in nature to craving associated with behavioural addictions. Miele and colleagues [<span>7</span>] ask an important but scarcely addressed question: what about behavioural cravings such as sexual cravings?</p><p>Although, as Miele <i>et al</i>. show, there are many similarities between substance craving and sexual craving, there are also differences. Unlike alcohol and drug addiction, sexual addiction has different characteristics because sexual desire is also, at least for most people, a normal and healthy behaviour. The authors aptly introduce the term ‘egodystonic’ to address this issue. I assume they are referring to desires that conflict with an individual’s ideal self-concept. I would argue that future research should explore possible ways of further quantifying this construct. Is there really a difference between egodystonic or problematic cravings and egosyntonic or non-conflicting cravings? Are there mere quantitative differences in terms of frequency and intensity or are there also qualitative differences? I predict that it will be difficult to differentiate between egodystonic and egosyntonic sexual craving, especially in the field of sexual violence, where it is likely that craving will be presented as egodystonic. As sexual craving is still taboo and there are possible legal consequences, it will be unlikely that self-reports alone could reveal meaningful insights into this particular topic. For example, a sexual offender is likely to explain the offence by pointing towards an egodystonic (‘I was not myself’) rather than an egosyntonic mechanism.</p><p>Psychophysiological measures, such as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI), could be employed to gain a richer understanding of the nature of behavioural cravings, including sexual craving. Although it is tempting to look for similarities, there is work showing remarkable differences between the psychophysiology associated with sexual craving and that associated with alcohol and drug craving. One notable difference was found in a study by Prause and colleagues [<span>8</span>], who found opposite results to the addiction models. That is, participants with problematic and ‘excessive’ viewing of visual sexual stimuli, who were reported to have higher sexual desire, had lower EGG responses to sexual images compared t","PeriodicalId":109,"journal":{"name":"Addiction","volume":"118 12","pages":"2315-2316"},"PeriodicalIF":6.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41099004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background and Aims</h3> <p>Heavy alcohol use and depression commonly co-occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co-occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice.</p> </section> <section> <h3> Design</h3> <p>Semi-structured qualitative interviews underpinned by the methodology of interpretive description.</p> </section> <section> <h3> Setting</h3> <p>North East and North Cumbria, UK.</p> </section> <section> <h3> Participants</h3> <p>Thirty-nine people (21 men and 18 women) with current or recent experience of co-occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8]) and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score).</p> </section> <section> <h3> Measurements</h3> <p>Semi-structured interview guide supported in-depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression.</p> </section> <section> <h3> Findings</h3> <p>Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) ‘lack of recognition’ of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having ‘nowhere to go’ to access relevant treatment and care and (3) ‘supporting relational autonomy’ as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals’ differential capacity for agency may contribute to delays in help-seeking, increased distress and suicidal ideation.</p> </section> <section> <h3> Conclusions</h3> <p>Among people with co-occurring heavy alcohol use and depression, lack of recognition of a relationship
{"title":"Understanding people's experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: A qualitative study","authors":"Katherine Jackson, Eileen Kaner, Barbara Hanratty, Eilish Gilvarry, Lucy Yardley, Amy O'Donnell","doi":"10.1111/add.16350","DOIUrl":"10.1111/add.16350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Heavy alcohol use and depression commonly co-occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co-occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Semi-structured qualitative interviews underpinned by the methodology of interpretive description.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>North East and North Cumbria, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Thirty-nine people (21 men and 18 women) with current or recent experience of co-occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8]) and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Semi-structured interview guide supported in-depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) ‘lack of recognition’ of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having ‘nowhere to go’ to access relevant treatment and care and (3) ‘supporting relational autonomy’ as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals’ differential capacity for agency may contribute to delays in help-seeking, increased distress and suicidal ideation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among people with co-occurring heavy alcohol use and depression, lack of recognition of a relationship","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"268-280"},"PeriodicalIF":6.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41090295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aurora Quaye, Charlotte Crist, Simba Matoi, Yi Zhang
<p>For over two decades, the United States has grappled with our current opioid use disorder (OUD) epidemic [<span>1</span>]. In response, there has been a significant increase in the utilization of buprenorphine for OUD treatment, in part because of its distinctive pharmacologic properties [<span>2, 3</span>]. Compared to other opioids, buprenorphine has a long half-life, high binding affinity and slow dissociation from opioid receptors. Therefore, it resists displacement from these receptors when other opioids are used in conjunction [<span>4</span>]. The therapeutic doses of buprenorphine used for chronic pain treatment are significantly lower than those required for OUD treatment; therefore, opioid receptors are available when additional opioids are used concomitantly to enhance analgesia [<span>5</span>]. Conversely, when buprenorphine is used for OUD treatment, the diminished availability of opioid receptors resulting from the higher buprenorphine doses required can pose challenges for analgesic management [<span>6</span>]. Although routine practice involves continuing chronic pain buprenorphine formulations when acute pain is anticipated, the prevailing practice until recently has been withholding OUD dosed buprenorphine [<span>4, 7</span>]. Emerging evidence challenges these notions and supports opioid based analgesia can be achieved in parallel with OUD buprenorphine continuation [<span>5, 8, 9</span>].</p><p>In our previous retrospective study of surgical patients with OUD comparing patients where buprenorphine was continued or discontinued, we identified significantly higher outpatient opioid dispensing with buprenorphine discontinuation [<span>5</span>]. Similar findings were reported by Li <i>et al</i>., [<span>8</span>] where patients who continued buprenorphine perioperatively at various tapered doses received significantly fewer opioid prescriptions compared to those where buprenorphine was discontinued.</p><p>Despite these studies, our recent national survey revealed significant variation in perioperative buprenorphine management practices [<span>10</span>]. Among surveyed anesthesiologists, only 36% of institutions had a protocol for buprenorphine management, and over a third endorsed either discontinuing buprenorphine in situations where moderate to severe pain was anticipated or adopting inconsistent management practices because of the lack of an institutional protocol. Premature discontinuation of buprenorphine is associated with an increased risk of opioid-induced relapse, making such practices concerning [<span>11, 12</span>].</p><p>The lack of clear guidance for buprenorphine management also extends to the critical care community. The 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption in Adult Patients in the Intensive Care Unit did not provide recommendations for managing buprenorphine in patients maintained on this medication [<span>1
{"title":"Commentary on the current state of perioperative and critical care buprenorphine management","authors":"Aurora Quaye, Charlotte Crist, Simba Matoi, Yi Zhang","doi":"10.1111/add.16346","DOIUrl":"10.1111/add.16346","url":null,"abstract":"<p>For over two decades, the United States has grappled with our current opioid use disorder (OUD) epidemic [<span>1</span>]. In response, there has been a significant increase in the utilization of buprenorphine for OUD treatment, in part because of its distinctive pharmacologic properties [<span>2, 3</span>]. Compared to other opioids, buprenorphine has a long half-life, high binding affinity and slow dissociation from opioid receptors. Therefore, it resists displacement from these receptors when other opioids are used in conjunction [<span>4</span>]. The therapeutic doses of buprenorphine used for chronic pain treatment are significantly lower than those required for OUD treatment; therefore, opioid receptors are available when additional opioids are used concomitantly to enhance analgesia [<span>5</span>]. Conversely, when buprenorphine is used for OUD treatment, the diminished availability of opioid receptors resulting from the higher buprenorphine doses required can pose challenges for analgesic management [<span>6</span>]. Although routine practice involves continuing chronic pain buprenorphine formulations when acute pain is anticipated, the prevailing practice until recently has been withholding OUD dosed buprenorphine [<span>4, 7</span>]. Emerging evidence challenges these notions and supports opioid based analgesia can be achieved in parallel with OUD buprenorphine continuation [<span>5, 8, 9</span>].</p><p>In our previous retrospective study of surgical patients with OUD comparing patients where buprenorphine was continued or discontinued, we identified significantly higher outpatient opioid dispensing with buprenorphine discontinuation [<span>5</span>]. Similar findings were reported by Li <i>et al</i>., [<span>8</span>] where patients who continued buprenorphine perioperatively at various tapered doses received significantly fewer opioid prescriptions compared to those where buprenorphine was discontinued.</p><p>Despite these studies, our recent national survey revealed significant variation in perioperative buprenorphine management practices [<span>10</span>]. Among surveyed anesthesiologists, only 36% of institutions had a protocol for buprenorphine management, and over a third endorsed either discontinuing buprenorphine in situations where moderate to severe pain was anticipated or adopting inconsistent management practices because of the lack of an institutional protocol. Premature discontinuation of buprenorphine is associated with an increased risk of opioid-induced relapse, making such practices concerning [<span>11, 12</span>].</p><p>The lack of clear guidance for buprenorphine management also extends to the critical care community. The 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption in Adult Patients in the Intensive Care Unit did not provide recommendations for managing buprenorphine in patients maintained on this medication [<span>1","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 1","pages":"200-201"},"PeriodicalIF":6.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41091576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ronny Bruffaerts, William G. Axinn, Dirgha J. Ghimire, Corina Benjet, Stephanie Chardoul, Kate M. Scott, Ronald C. Kessler, Paul Schulz, Jordan W. Smoller
<div> <section> <h3> Aims</h3> <p>To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000–2006 conflict.</p> </section> <section> <h3> Design</h3> <p>A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence.</p> </section> <section> <h3> Setting</h3> <p>Chitwan, Nepal.</p> </section> <section> <h3> Participants</h3> <p>Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15–59 were eligible (response rate 93%).</p> </section> <section> <h3> Measurements</h3> <p>Measures of beatings in the community during the conflict (2000–2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016–2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021–2022.</p> </section> <section> <h3> Findings</h3> <p>Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992–2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02–2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings.</p> </section> <section> <h3> Conclusions</h3> <p>Among male children living in Chitwan, Nepal during the 2000–2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.
{"title":"Community exposure to armed conflict and subsequent onset of alcohol use disorder","authors":"Ronny Bruffaerts, William G. Axinn, Dirgha J. Ghimire, Corina Benjet, Stephanie Chardoul, Kate M. Scott, Ronald C. Kessler, Paul Schulz, Jordan W. Smoller","doi":"10.1111/add.16343","DOIUrl":"10.1111/add.16343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000–2006 conflict.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Chitwan, Nepal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15–59 were eligible (response rate 93%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Measures of beatings in the community during the conflict (2000–2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016–2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021–2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992–2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02–2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among male children living in Chitwan, Nepal during the 2000–2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.","PeriodicalId":109,"journal":{"name":"Addiction","volume":"119 2","pages":"248-258"},"PeriodicalIF":6.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41090273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号