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Prediction markets: An emerging form of gambling? 预测市场：一种新兴的赌博形式？

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-23 DOI: 10.1111/add.70272

Benjamin Johnson, Gary Chan

We write to direct the readership to a potential new form of gambling: prediction markets. Prediction markets offer binary yes/no contracts whose prices reflect the market's estimate that a real-world event will occur. For example, a ‘Candidate X to win the election’ contract might be priced at $0.60, reflecting a market view of a 60% chance of victory [1]. Purchasing one contract pays $1 if Candidate X wins and $0 otherwise. These commonly focus on outcomes of political and sporting events.Prediction markets in the United States are overseen by the Commodity Futures Trading Commission [2], meaning they are often regulated as investments rather than as gambling products [3]. This means typical state-enforced harm-minimisation measures common in gambling regulation, such as state self-exclusion registers, advertising restrictions and in-product safer-gambling tools, generally do not apply [4].However, functionally, these products resemble gambling. Users stake money on uncertain real-world outcomes that resolve in either a full payout or nothing, depending on the outcome. Short event cycles permit repeated re-entry and loss chasing. Risk is heightened by 24/7 mobile access, push notifications, easy deposits and constant availability.The blurry line between high-risk investing and gambling has long existed in financial markets [5], especially for high-risk behaviours such as day trading or margin trading. Gambling through financial markets also has a long pedigree: individuals have used traditional stock trading [6] and, more recently, cryptocurrency trading [7] as alternative ways to gamble. These have been linked to significant harms, including economic loss [8], mental health problems [9, 10] and addiction [11]. Therefore, regardless of the legal label, these products pose a significant risk.Widely used share-trading platforms are now offering prediction markets to the broader population, most notably, the integration into the trading platform Robinhood [12], which is the most used stock trading app in the United States [13]. Robinhood has been found to host users who engage in high-frequency trading [14], implying the presence of day traders on the platform. Prior research finds that people experiencing problem gambling are more likely to engage in day trading [15] and that day traders are more likely to engage in other forms of gambling [16]. Therefore, the embedding of prediction markets into these widely used platforms may directly expose vulnerable groups to these products.With little peer-reviewed literature, action is needed now. We propose a research agenda modelled on adjacent domains such as cryptocurrency: (1) characterise how users perceive and use these products [8]; (2) quantify the prevale

我们写这篇文章是为了引导读者注意一种潜在的新赌博形式：预测市场。预测市场提供二元是/否合约，其价格反映了市场对现实世界中将发生的事件的估计。例如，“候选人X赢得选举”的合约可能定价为0.60美元，反映了市场认为候选人X获胜的可能性为60%。如果候选人X获胜，购买一份合同支付1美元，否则支付0美元。这些报道通常关注政治和体育赛事的结果。美国的预测市场由商品期货交易委员会（Commodity Futures Trading Commission）监管，这意味着它们通常被视为投资而非赌博产品。这意味着赌博监管中常见的典型的国家强制伤害最小化措施，如国家自我排除登记册，广告限制和产品内更安全的赌博工具，通常不适用[4]。然而，在功能上，这些产品类似于赌博。用户把钱押在不确定的现实世界结果上，结果取决于结果，要么全额支付，要么什么都不支付。短事件周期允许重复重新进入和损失追踪。24/7移动访问、推送通知、便捷存款和持续可用性增加了风险。高风险投资与赌博之间的模糊界限长期存在于金融市场，尤其是日内交易或保证金交易等高风险行为。通过金融市场进行赌博也有着悠久的历史：个人使用传统的股票交易[6]，以及最近的加密货币交易[7]作为赌博的替代方式。这些都与重大危害有关，包括经济损失[8]、精神健康问题[9,10]和成瘾[8]。因此，无论法律标签如何，这些产品都构成重大风险。广泛使用的股票交易平台现在为更广泛的人群提供预测市场，最值得注意的是与交易平台Robinhood[12]的整合，这是美国最常用的股票交易应用[13]。罗宾汉被发现托管从事高频交易的用户[14]，这意味着该平台上存在日内交易者。先前的研究发现，经历过问题赌博的人更有可能参与当日交易bb1，而当日交易者更有可能参与其他形式的赌博bb1。因此，在这些广泛使用的平台中嵌入预测市场可能会直接使弱势群体接触到这些产品。由于几乎没有同行评议的文献，现在需要采取行动。我们提出了一个以加密货币等邻近领域为模型的研究议程：(1)描述用户如何感知和使用这些产品[8]；(2)量化危害的普遍性和严重程度；(3)识别提升风险的产品和界面特征；（四）检验保障措施的有效性；(5)评估这些产品是如何做广告的。诸如此类的证据将允许向立法者提出有关这些产品的适当分类的确凿问题。本杰明·约翰逊：概念化；原创作品。陈可辛：写作-评论和编辑；supervision.B.J。和gc宣布他们没有利益冲突。

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引用次数: 0

Has alcohol consumption in England returned to pre-COVID-19 pandemic levels? A monthly population study, 2014 to 2024. 英国的饮酒量是否已恢复到covid -19大流行前的水平？2014年至2024年的月度人口研究。

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-23 DOI: 10.1111/add.70258

Vera Helen Buss, Melissa Oldham, Sarah E Jackson, Lion Shahab, Colin Angus, John Holmes, Jamie Brown

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

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

Setting: England, March 2014 to December 2024.

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

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

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

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

目的：确定英格兰的酒精消费量是否在2020年总体人口和亚群体的最初增长之后，到2024年12月恢复到大流行前的水平。设计：截至2020年2月，每月通过面对面访谈进行代表性调查，然后通过电话进行调查。地点：英国，2014年3月至2024年12月。研究对象：208010名18岁以上的私人住户。测量方法：平均每周饮酒量（以英国单位为单位），危险饮酒的患病率（消费酒精使用障碍识别测试[AUDIT-C]得分≥5），以及可能的依赖性（AUDIT-C≥11）。进一步的测量包括年龄、性别和社会等级。结果：所有结果在2020年4月都增加了：危险饮酒的患病率增加了30.3%(95%可信区间[CI]: 26.8, 33.8，从2020年2月的26.2%增加到2020年4月的34.0%)，可能的依赖患病率增加了90.2% (95% CI: 62.2, 122.9，从0.9%到1.7%)，平均每周饮酒量增加了34.5% （95% CI: 31.0, 38.0，从5.0单位到6.6单位）。在调整调查模式从面对面访谈到电话访谈的变化后，2020年2月至4月之间的阶跃变化仍然存在，但大幅减弱。风险饮酒流行率（差异：-1.5%/年，95% CI: -2.4, -0.6）和平均每周饮酒量（差异：-2.4%/年，95% CI: -3.3, -1.6）的大流行后趋势下降速度快于大流行前趋势，表明缓慢但不完全恢复到大流行前水平。可能依赖的流行趋势在大流行前后同样稳定（差异：-1.3%/年，95% CI: -6.2, 3.8）。在社会地位较低的人群中，酒精消费量的下降速度要慢于社会地位较高的人群。结论：英格兰的危险饮酒流行率和平均每周饮酒量似乎趋向于大流行前的水平，但英格兰的依赖性饮酒流行率似乎自大流行开始以来有所增加，与大流行前的水平相比仍然较高。与酒精有关的不平等现象可能正在恶化，因为在弱势饮酒者中，疫情爆发后，消费量下降的速度有所放缓。

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引用次数: 0

Motivational smoking cessation counselling and community-based follow-up after hospitalisation for vascular disease: A randomised controlled trial. 血管疾病住院后的动机性戒烟咨询和社区随访：一项随机对照试验

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-21 DOI: 10.1111/add.70249

Karin Pleym, Elise Sverre, Harald Weedon-Fekjær, Mohpal Singh Kahlon, Marie Stugaard, Einar Husebye, Serena Tonstad, Toril Dammen, John Munkhaugen

Background and aims: Evidence for motivational interviewing for smoking cessation is weak, with limited data on long-term abstinence rates. This trial aimed to evaluate the effect of in-hospital motivational interviewing-based smoking cessation counselling combined with proactive referral to community-based follow-up on 6- and 12-month continuous smoking abstinence in patients with atherosclerotic vascular disease.Design: Multicentre, randomised, open-label, blinded-end-point trial with 1:1 randomisation.Setting: Three secondary care hospitals in Norway, with recruitment from November 2021 to October 2023.Participants: Hospitalised patients with established atherosclerotic vascular disease who smoked ≥1 cigarette daily prior to unplanned or elective hospitalisation. A total of 221 were randomised (40% women, mean age 65.2 years), of whom 213 were included in the primary analysis due to 7 deaths and 1 withdrawal.Intervention and comparator: In the intervention group (n = 109), a trained nurse conducted a single 30-minute motivational interviewing-based counselling session, provided a leaflet explaining the local community-based cessation programme, sent discharge information to the general practitioner and arranged for a personal telephone invitation from the centre staff to the follow-up programme. In the control group (n = 111), a physician gave brief cessation advice and the nurse provided a leaflet about the cessation programme and sent discharge information to the general practitioner.Measurements: The primary outcome was self-reported continuous smoking abstinence at 6 months. Secondary outcomes included biochemically validated abstinence (measurement of exhaled carbon monoxide) at 6 months and self-reported abstinence at 12 months. Exploratory outcomes included recurrent vascular events over a median 18-month follow-up.Findings: Smoking abstinence at 6 months was 49.5% (53/107) and 24.5% (26/106) in the intervention and control groups, respectively [odds ratio (OR) = 3.08, 95% confidence interval (CI) = 1.70-5.55, P < 0.001]. The number needed to treat to achieve one additional abstinence was 4 (95% CI = 3-9). Biochemically validated abstinence was 44.9% (48/107) and 20.8% (22/106) in the intervention and control groups, respectively (OR = 3.28, 95% CI = 1.76-6.12). At 12 months, smoking abstinence was 45.7% (48/105) and 27.5% (28/102) in the intervention and control groups, respectively (OR = 2.31, 95% CI = 1.27-4.20). After a median of 18-month follow-up, a prespecified vascular event occurred in 24.8% (27/109) and 34.2% (38/111) of intervention and control participants, respectively.Conclusions: In-hospital motivational counselling combined with proactive referral to follow-up in a community-based cessation programme approximately doubled long-term smok

背景和目的：关于戒烟的动机性访谈的证据不足，关于长期戒烟率的数据有限。本试验旨在评估基于住院动机性访谈的戒烟咨询结合主动转诊到社区随访对动脉粥样硬化性血管疾病患者连续戒烟6个月和12个月的效果。设计：多中心、随机、开放标签、盲终点试验，1:1随机化。环境：挪威的三家二级护理医院，招聘时间为2021年11月至2023年10月。参与者：在非计划或选择性住院前每日吸烟≥1支的确诊动脉粥样硬化性血管疾病的住院患者。共有221人被随机分组（40%为女性，平均年龄65.2岁），其中213人因7人死亡和1人退出而被纳入初步分析。干预和比较：在干预组（n = 109）中，一名训练有素的护士进行了一次30分钟的基于动机性访谈的咨询会议，提供了一份解释当地社区戒烟方案的传单，向全科医生发送出院信息，并安排中心工作人员亲自电话邀请参加后续方案。在对照组（n = 111）中，医生提供简短的戒烟建议，护士提供戒烟计划的传单，并将出院信息发送给全科医生。测量：主要结果是自我报告的6个月持续戒烟情况。次要结果包括6个月时经生化验证的戒断（测量呼出的一氧化碳）和12个月时自我报告的戒断。探索性结果包括在中位18个月随访期间血管复发事件。结果：干预组和对照组在6个月时的戒烟率分别为49.5%（53/107）和24.5%(26/106)，[优势比(OR) = 3.08, 95%可信区间(CI) = 1.70-5.55， P]结论：在以社区为基础的戒烟计划中，住院动机咨询结合主动转诊随访，约使动脉粥样硬化性血管疾病患者的长期戒烟率翻了一番，并减少了新的血管事件的发生。

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引用次数: 0

Drug use among people in prison: A global review of epidemiology, harms and interventions. 监狱中人员吸毒：流行病学、危害和干预措施的全球审查。

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-20 DOI: 10.1111/add.70245

Louis Favril, John Strang, Seena Fazel

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

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

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

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

背景和目的：在刑事司法系统中，吸毒者的比例过高。我们的目的是对全球被监禁成年人中与药物使用和药物使用障碍有关的流行病学、危害和干预措施进行广泛的综合，并强调证据和实践方面的差距。方法：在这篇结构化综述中，我们检索了PubMed和Web of Science在2015年至2025年8月之间发表的文章。系统评价、荟萃分析和未选择样本的大型初步研究优先纳入。结果：十分之四进入监狱的成年人符合药物使用障碍的诊断标准，这是一种可治疗的精神疾病，通常是导致他们入狱的犯罪行为的基础。与一般人群相比，监狱服刑人员中药物使用障碍的发生率大约高出10倍，其中妇女的比例更高。共病性精神障碍很常见。大约三分之一的被监禁者报告在监禁期间吸毒，这对在监狱生活和工作的人构成健康和安全风险。在监狱中注射毒品有助于血液传播的病毒传播。除了与再犯密切相关外，吸毒还与出狱后过早死亡的风险显著增加有关，特别是在出狱后的头两周内因与毒品有关的原因过早死亡。尽管强有力的证据支持基于监狱的药理学（如阿片类激动剂治疗）和社会心理（如治疗社区）干预措施在减少毒品相关危害方面的有效性，但在世界各地的监狱环境中仍然存在重大的治疗差距。需要进一步研究，以评估监狱减少伤害服务，包括针头和注射器方案对健康的益处。促进与释放后服务的联系和保留的战略是确保护理连续性和实现可持续治疗成果的关键。结论：监狱中吸毒的高流行率及其多种不良后果强调了提供循证干预措施的必要性。扩大和整合基于监狱和释放后的干预措施，以解决吸毒问题，有可能带来公共卫生和刑事司法方面的惠益。

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引用次数: 0

Repeated-dose behavioral intervention to reduce opioid overdose among overdose survivors with opioid use disorder: A two-site phase III randomized controlled trial. 重复剂量行为干预减少阿片类药物使用障碍患者阿片类药物过量：一项2点III期随机对照试验

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-19 DOI: 10.1111/add.70252

Phillip O Coffin, Glenn-Milo Santos, Vanessa M McMahan, Xochitl Luna Marti, Tim Matheson, Sarah Brennan, Justine Arenander, Mackenzie Robinson, John Farley, Emily Pope, Andrew Rolles, Sarah Kosakowski, Traci C Green, Alexander Y Walley

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

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

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

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

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

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

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

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

背景和目的：芬太尼在阿片类药物街头市场的出现限制了一些管理阿片类药物过量的干预措施的益处；因此，预防阿片类药物过量的发生至关重要。我们在两个芬太尼盛行的美国城市进行了一项初步研究，测试了一种行为干预，显示可以防止海洛因过量。设计：从2019年到2023年，为期16个月的三期单盲随机对照试验，研究重复剂量动机访谈干预减少药物过量（REBOOT）与注意力控制的对比。地点：美国加利福尼亚州旧金山市和马萨诸塞州波士顿市。参与者：18-65岁，阿片类药物使用障碍（OUD），非处方阿片类药物使用活跃，3年内阿片类药物过量，之前接受过带回家的纳洛酮。共有268名参与者被随机分组（50%干预，50%对照），其中62%为男性，15%为拉丁裔，65%为白人，14%为黑人/非裔美国人；95%的患者使用芬太尼。干预措施：在第0、4、8和12个月对有用药过量经历和目击的患者进行动机性访谈，并制定个人预防计划。测量：干预前第0、4、8、12和16个月的间隔过量事件和协变量的时间线随访。主要结局是任何非致死性或致死性过量事件的发生。结果：与对照组相比，REBOOT对任何过量事件发生的主要结局[相对危险度(RR) = 0.94, 95%可信区间(CI) = 0.79-1.11, P = 0.45]或过量事件发生次数的次要结局（RR = 0.80, 95% CI = 0.6-1.06, P = 0.12）均无显著影响。在排除COVID-19大流行的前12个月收集的数据时，结果没有差异。与对照组相比，REBOOT与OUD治疗和不使用阿片类药物的天数无关（RR = 0.94, 95% CI = 0.88-1.00, P = 0.06）。在事后分析中，在基线时没有过去4个月服药过量的参与者中，REBOOT与服药过量事件较少相关（RR = 0.70, 95% CI = 0.51-0.97, P = 0.03）。结论：在芬太尼为主要街头阿片类药物的美国两个城市，重复剂量动机访谈干预减少阿片类药物过量无统计学意义。

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引用次数: 0

Examining changes in the prevalence of cost-motivated alcohol reduction attempts in the context of a cost-of-living crisis and alcohol duty reforms: A population survey of risky drinkers in Great Britain, 2021-2024. 在生活成本危机和酒精税改革的背景下，研究成本驱动的酒精减少尝试的流行程度的变化：2021-2024年英国高风险饮酒者的人口调查。

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-19 DOI: 10.1111/add.70248

Sarah E Jackson, Jamie Brown, Colin Angus, Abi Stevely, Magdalena Opazo Breton, Leonie Brose, Luke Wilson, John Holmes

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.

背景和目的：酒精的可负担性是消费的关键驱动因素。自2021年底以来，英国的生活成本危机一直在给家庭预算带来压力。此外，英国政府对酒精税制度进行了重大改革，并在2023年增加了酒精税。这项研究的目的是估计在这段时间内，有风险的饮酒者每月因成本而减少饮酒尝试的流行程度的变化。设计：数据来自酒精工具包研究，这是一项具有全国代表性的月度横断面家庭调查。背景：英国。参与者：26212名高危饮酒者[酒精使用障碍识别测试-消费（AUDIT-C）评分≥5]，年龄≥18岁，于2021年1月至2024年12月接受调查[平均（SD）年龄= 45.9 (17.1)；61.4%的男性)。测量方法：主要结果是在过去的一年中，由于决定饮酒太昂贵而试图减少酒精消费量（“成本驱动的酒精减少尝试”）。这包括还报告了试图减少消费的其他动机（例如健康问题）的参与者。研究结果：总体而言，1355名参与者报告说，他们试图减少酒精摄入。高风险饮酒者中以成本为动机的戒酒尝试的月加权患病率从2021年1月的4.6%上升到2024年12月的7.0%[患病率比(PR) = 1.54, 95%置信区间(CI) = 1.34-1.74]；相当于到2024年，有110万人在高危饮酒者中试图减少饮酒。这主要是由于成本驱动的所有酒精减少尝试的比例上升，从12.4%上升到19.7% (PR = 1.58, 95% CI = 1.39-1.77)，而不是酒精减少尝试的总体增加（在整个期间保持相对稳定，平均为36.0%）。当结果仅限于仅以成本为动机的酒精减少尝试时，结果模式相似[17.3% （95% CI = 15.0-19.7%）的所有以成本为动机的酒精减少尝试]。结论：在英国财政压力不断增加的时期，减少酒精的尝试越来越多地受到成本的驱动，但减少尝试的总体流行率并未增加。

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引用次数: 0

Heated tobacco product use and tobacco abstinence: A prospective cohort study. 加热烟草制品使用和烟草戒断：一项前瞻性队列研究。

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-19 DOI: 10.1111/add.70257

Tomohiko Ukai, Tomohiro Shinozaki, Takahiro Tabuchi

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.

背景和目的：试图戒烟的个人越来越多地使用加热烟草制品，特别是在使用加热烟草制品普遍的日本；然而，HTPs在实现完全戒烟方面的有效性仍不清楚。本研究旨在评估纯HTP使用者和双重使用者与纯可燃香烟使用者相比完全戒断烟草和可燃香烟的可能性。设计：前瞻性队列设计，采用日本“社会与新烟草”互联网调查（JASTIS）的连续年度随访（2019-2023）。使用逆概率加权泊松广义估计方程模型来估计戒断结果的比率。背景：在日本进行的全国性网络调查。参与者：总共包括8969名20岁及以上的日本成年人，他们在基线时是目前的烟草使用者。参与者分为纯可燃香烟使用者（55.6%）、纯HTP使用者（16.3%）和双重使用者（28.0%）。独家http用户进一步分为已建立用户（每日使用，使用≥100个http，或终身使用>个月）或非已建立用户。测量：主要结果是(1)完全戒烟-定义为目前没有使用任何烟草制品的基线-和(2)一年后可燃香烟戒烟。禁欲要求选择“过去经常使用，但戒了”的每一个相关产品。研究结果：与纯可燃卷烟使用者（基线分类）相比，纯HTP使用者完全戒烟的比率（RR）为0.85[95%可信区间(CI) = 0.71-1.02]，双烟使用者完全戒烟的比率（RR）为0.49 （95% CI = 0.42-0.58）。当分层时，已建立的HTP使用者完全戒烟的可能性在统计学上显著降低（RR = 0.57, 95% CI = 0.47-0.70），而未建立的HTP使用者的可能性更高（RR = 2.41, 95% CI = 1.83-3.17）。与完全使用可燃香烟的人相比，双重使用可燃香烟一年后戒烟的RR为0.93 （95% CI = 0.83-1.04）。结论：在为期一年的随访中，与专门使用香烟相比，双重使用香烟和加热烟草制品（HTP）和专门使用加热烟草制品与较低的完全烟草戒断率相关，而非专门使用加热烟草制品则显示更高的戒断率。总体而言，HTP使用与较高的戒烟率无关。

{"title":"Heated tobacco product use and tobacco abstinence: A prospective cohort study.","authors":"Tomohiko Ukai, Tomohiro Shinozaki, Takahiro Tabuchi","doi":"10.1111/add.70257","DOIUrl":"https://doi.org/10.1111/add.70257","url":null,"abstract":"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.","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555840","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}

引用次数: 0

Social cognition in Korsakoff's syndrome: A meta-analysis. Korsakoff综合征的社会认知：一项元分析。

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-18 DOI: 10.1111/add.70256

Kyra Wijnen, Willem S Eikelboom, Yvonne C M Rensen, Gwenny T L Janssen, Roy P C Kessels

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.

背景和目的：Korsakoff综合征是一种酒精相关的神经认知障碍，其特征是情景记忆障碍、冷漠、虚构和疾病洞察力差。本荟萃分析旨在估计与对照组相比，科尔萨科夫综合征（KS）患者社会认知表现的平均效应大小。方法：于2024年5月进行系统的文献检索，找出研究KS患者和对照组社会认知的研究文章。加权效应量（Hedges' g）计算了三个社会认知水平：情绪感知、社会解释和社会认知整合。设置没有限制。在纳入的研究中使用了检查情绪感知（面部情绪识别和韵律），解释（心理化，自我意识和同理心）和社会认知整合（道德推理和社会知识）的工具。结果：13项研究（n = 622； 292名KS， 330名对照）表明，与对照组相比，KS个体在所有社会认知领域的表现都有统计学意义上的显著差。在情绪感知方面发现了较大的效应量[g = -1.14, 95%可信区间(CI) = -1.46至-0.81),P 2 = 58.5%， 8项研究，n = 372]，面部情绪识别和韵律方面的效应量相当。在社会解释中（g = -0.77, 95% CI = -1.34 ~ -0.21, P = 0.007, I2 = 96.6%， 4项研究，n = 188），心理化的影响较大（g = -1.05, 95% CI = -1.61 ~ -0.50, p2 = 74.1%； 3项研究，n = 120）。在社会认知整合（g = -0.74, 95% CI = -1.11 ~ -0.37, P 2 = 0%， 3项研究，n = 184）中，社会知识表现出较大的效应量（g = -0.81, 95% CI = -1.24 ~ -0.38, P 2 = 0%； 2项研究，n = 80）不确定，在两个方向上都可能存在重要差异。结论：本荟萃分析显示，科尔萨科夫综合征患者在社会认知测量方面的表现在统计上显著低于对照组，在社会信息的感知和解释方面的效应量最大。

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引用次数: 0

Contingency management interventions for substance use and addictive behaviours: Review of the United Kingdom evidence base. 物质使用和成瘾行为的应急管理干预措施：对联合王国证据基础的审查。

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-16 DOI: 10.1111/add.70240

Carol-Ann Getty, Tricia McQuarrie, Eileen Brobbin

Background and aims: Substance use and other addictive behaviours including gambling remain major public health concerns in the UK. Despite the effectiveness of substance use treatment approaches, treatment adherence and success rates remain low. Contingency Management (CM), a behavioural intervention using positive reinforcement, is a promising approach to enhance clinical outcomes; however, its implementation in UK settings remains limited. This scoping review aimed to explore how CM has been adopted to improve outcomes for substance use and addictive behaviours in the UK, addressing the gap between international evidence and UK-specific healthcare needs.Methods: A systematic search of databases (Embase, MEDLINE, PsycArticles and PsycInfo) for UK-based CM studies published before March 2025 was undertaken. The review adhered to PRISMA-ScR guidelines, and the protocol was prospectively registered on the Open Science Framework. Eligible studies were peer-reviewed, full-text articles, reporting the exploration of CM interventions to improve outcomes for substance use and other addictive behaviours within UK settings. Screening and data extraction were independently conducted using Covidence. A narrative synthesis explored study outcomes including effectiveness, feasibility and acceptability. Using the Context and Implementation of Complex Interventions (CICI) framework, key contextual factors influencing CM implementation in the UK across setting, socio-cultural, political and ethical domains were explored.Results: A total of 208 articles were identified, with 36 full texts reviewed and 29 eligible for inclusion. Nine studies assessed effectiveness, six included economic evaluations, six assessed feasibility and 14 assessed acceptability. Clinical effectiveness was supported in most studies, particularly for promoting abstinence and medication adherence. Feasibility concerns included resource limitations, training and recruitment challenges. CM was generally well-accepted by service users and professionals, and digital approaches showed promise with high adherence and accuracy. Barriers and facilitators to CM implementation operating at micro, meso and macro levels are presented.Conclusion: This scoping review of studies implementing Contingency Management (CM) in UK addiction treatment highlights several barriers to CM adoption, including resource limitations, concerns about its impact on therapeutic relationships and ethical issues regarding manipulation and fairness. It also points to the need for adapting CM protocols to fit UK treatment philosophies, particularly aligning with harm reduction approaches. CM's success depends on multi-level support, including policy, training and integration with existing systems. Recommendations include strengthening research on CM's long-term impact, ensuring fidelity to core principles, and investing in digital tools

背景和目的：物质使用和其他成瘾行为，包括赌博，仍然是英国主要的公共卫生问题。尽管药物使用治疗方法有效，但治疗依从性和成功率仍然很低。应急管理（CM）是一种使用正强化的行为干预，是一种有希望提高临床结果的方法；然而，它在英国的实施仍然有限。本综述旨在探讨CM如何被采用来改善英国药物使用和成瘾行为的结果，解决国际证据与英国特定医疗保健需求之间的差距。方法：系统检索Embase、MEDLINE、PsycArticles和PsycInfo数据库，检索2025年3月前发表的英国CM研究。该综述遵循PRISMA-ScR指南，该方案已在开放科学框架上前瞻性注册。符合条件的研究是同行评审的全文文章，报告了CM干预措施的探索，以改善英国环境下物质使用和其他成瘾行为的结果。筛查和数据提取使用covid - ence独立进行。叙述性综合探讨了研究结果的有效性、可行性和可接受性。利用复杂干预措施的背景和实施（CICI）框架，研究了影响英国CM实施的关键背景因素，包括环境、社会文化、政治和伦理领域。结果：共鉴定出208篇文章，其中36篇全文被审查，29篇符合纳入条件。9项研究评估了有效性，6项包括经济评估，6项评估了可行性，14项评估了可接受性。临床效果在大多数研究中得到了支持，特别是在促进戒断和药物依从性方面。可行性问题包括资源限制、培训和征聘方面的挑战。CM通常被服务用户和专业人员所接受，数字方法显示出高依从性和准确性的希望。提出了在微观、中观和宏观层面上实施管理的障碍和促进因素。结论：本文对在英国成瘾治疗中实施应急管理（CM）的研究进行了范围审查，强调了采用应急管理的几个障碍，包括资源限制、对其对治疗关系的影响的担忧以及关于操纵和公平的伦理问题。它还指出需要调整CM协议以适应英国的治疗理念，特别是与减少伤害的方法保持一致。CM的成功依赖于多层次的支持，包括政策、培训和与现有系统的集成。建议包括加强对管理的长期影响的研究，确保对核心原则的忠诚，以及投资于数字工具以减少管理负担。

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引用次数: 0

Changes in clinical features and severity in patients presenting to European emergency departments with acute cannabis toxicity over the 10-year period from 2013 to 2022 2013年至2022年10年间，欧洲急诊科急性大麻毒性患者的临床特征和严重程度的变化。

IF 5.3 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2025-11-13 DOI: 10.1111/add.70233

Òscar Miró, Miguel Galicia, Paul I. Dargan, David M. Wood, Alison M. Dines, Fridtjof Heyerdahl, Knut Erik Hovda, Isabelle Giraudon, Christopher Yates, Matthias Liechti, Odd Martin Vallersnes, Florian Eyer, Guillermo Burillo-Putze

<div> <section> <h3> Background and aims</h3> 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. </section> <section> <h3> Design</h3> Secondary analysis of data included in the Euro-DEN Registry from 1 October 2013 to 31 December 2022. </section> <section> <h3> Setting</h3> 40 EDs in 25 European countries. </section> <section> <h3> Participants/cases</h3> 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). </section> <section> <h3> Measurements</h3> 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. </section> <section> <h3> Findings</h3> 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 nonline

背景和目的：近年来，天然大麻产品（药草和树脂）的效力随着δ - 9-四氢大麻酚（Δ9-THC）含量的增加而增加，但关于因急性中毒向急诊科咨询的大麻使用者的临床表现和毒性严重程度趋势的数据有限。本研究旨在分析在单独使用大麻后出现急性毒性的大量欧洲急诊科患者的临床表现和严重程度随时间的演变。设计：从2013年10月1日至2022年12月31日，对Euro-DEN登记处的数据进行二次分析。背景：欧洲25个国家的40个ed。参与者/病例：ED报告单独使用大麻。报告同时使用乙醇或其他药物或毒性试验呈阳性的报告被排除在外。分析了3839例报告单独使用大麻的ED报告（中位年龄25岁，四分位数范围= 20-33；71%为男性）。测量：14种预先定义的临床体征/症状和4种严重程度标记的时间趋势，包括需要救护车转至急诊室、住院、重症监护病房（ICU）和死亡。结果：最常见的临床特征为焦虑（35%）、躁动（22%）、警觉性下降（嗜睡或昏迷，21%）和呕吐（20%），同时观察到癫痫发作、心律失常和高热。2013年至2022年期间，在欧洲急诊室就诊的单独急性大麻中毒患者的临床特征几乎没有变化，这表明尽管在此期间欧洲大麻的效力有所增加，但急性中毒的严重程度保持不变。

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