Addiction最新文献_第8页

Predictors of substance use during treatment for addiction: A network analysis of ecological momentary assessment data. 成瘾治疗期间使用药物的预测因素：生态瞬间评估数据的网络分析。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-30 DOI: 10.1111/add.16658

Fuschia Serre, Christophe Gauld, Laura Lambert, Emmanuelle Baillet, Virginie Beltran, Jean-Pierre Daulouede, Jean-Arthur Micoulaud-Franchi, Marc Auriacombe

Background and aims: Ecological momentary assessment (EMA) studies have previously demonstrated a prospective influence of craving on substance use in the following hours. Conceptualizing substance use as a dynamic system of causal elements could provide valuable insights into the interaction of craving with other symptoms in the process of relapse. The aim of this study was to improve the understanding of these daily life dynamic inter-relationships by applying dynamic networks analyses to EMA data sets.

Design, setting and participants: Secondary analyses were conducted on time-series data from two 2-week EMA studies. Data were collected in French outpatient addiction treatment centres. A total of 211 outpatients beginning treatment for alcohol, tobacco, cannabis, stimulants and opiate addiction took part.

Measurements: Using mobile technologies, participants were questioned four times per day relative to substance use, craving, exposure to cues, mood, self-efficacy and pharmacological addiction treatment use. Multi-level vector auto-regression models were used to explore contemporaneous, temporal and between-subjects networks.

Findings: Among the 8260 daily evaluations, the temporal network model, which depicts the lagged associations of symptoms within participants, demonstrated a unidirectional association between craving intensity at one time (T0) and primary substance use at the next assessment (T1, r = 0.1), after controlling for the effect of all other variables. A greater self-efficacy at T0 was associated with fewer cues (r = -0.04), less craving (r = -0.1) and less substance use at T1 (r = -0.07), and craving presented a negative feedback loop with self-efficacy (r = -0.09).

Conclusions: Dynamic network analyses showed that, among outpatients beginning treatment for addiction, high craving, together with low self-efficacy, appear to predict substance use more strongly than low mood or high exposure to cues.

背景和目的：生态瞬间评估（EMA）研究曾证明，渴求对随后几小时的药物使用具有前瞻性影响。将药物使用概念化为一个由因果要素组成的动态系统，可以为了解复吸过程中渴求与其他症状的相互作用提供有价值的见解。本研究旨在通过对 EMA 数据集进行动态网络分析，加深对这些日常生活动态相互关系的理解：对两项为期两周的 EMA 研究的时间序列数据进行了二次分析。数据在法国的门诊成瘾治疗中心收集。共有 211 名开始接受酒精、烟草、大麻、兴奋剂和阿片类药物成瘾治疗的门诊患者参与了这项研究：利用移动技术，每天对参与者进行四次询问，内容涉及药物使用、渴求、接触线索、情绪、自我效能和药物成瘾治疗的使用。使用多层次向量自动回归模型来探索同时、时间和受试者之间的网络：在 8260 次日常评估中，时间网络模型描述了参与者体内症状的滞后关联，在控制了所有其他变量的影响后，该模型显示了某一次（T0）渴求强度与下一次评估（T1，r = 0.1）主要药物使用之间的单向关联。T0时更高的自我效能感与更少的线索（r = -0.04）、更低的渴求（r = -0.1）和T1时更少的药物使用（r = -0.07）相关，渴求与自我效能感之间呈现负反馈循环（r = -0.09）：动态网络分析显示，在开始接受成瘾治疗的门诊患者中，高渴求感和低自我效能感似乎比低情绪或高线索暴露更能预测药物使用。

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引用次数: 0

Harm to children from others' drinking: A survey of caregivers in Australia 他人饮酒对儿童的伤害：澳大利亚照料者调查。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-27 DOI: 10.1111/add.16637

Cassandra Hopkins, Sandra Kuntsche, Robyn Dwyer, Dan Anderson-Luxford, Anne-Marie Laslett

Aims

This study aimed to identify the prevalence and types of harm to children from others' drinking in Australia, as indicated by caregivers, and examine socio-demographic characteristics of caregivers who indicated a child was affected by others' drinking.

Design, setting, participants and measurements

A subsample of 854 adult respondents, who were caregivers of children under 18 years from the 2021 Australian Alcohol's Harm to Others study, were asked questions about whether children in their care had been negatively affected by others' drinking in the past year. Weighted prevalence estimates of overall and specific harms to children are presented. Logistic regressions were conducted to determine characteristics associated with indicating harms to children from others' drinking.

Findings

Over 17% of caregivers (95% confidence interval [CI] = 13.0–19.0) indicated that one or more children in their care had been affected by others' drinking in the past 12 months. Verbal abuse (6.2%; 95% CI = 4.3–8.3) was the most common harm indicated, followed by financial harm (4.3%; 95% CI = 2.7–6.2). One percent of caregivers (95% CI = 0.4–2.3) indicated a child was physically hurt and less than 1% (95% CI = 0.2–1.4) indicated a child was the subject of a child protection call due to someone's drinking. Women and caregivers over 65 years were more likely to indicate a child had been affected compared with men and caregivers under 65 years. Caregivers who drank five or more drinks at least three times per week were four times more likely to indicate a child was affected compared with abstainers. Living in a household with someone who drinks heavily and who had negatively affected the child's caregiver was associated with an increased likelihood of child harm.

Conclusions

In 2021, a weighted survey estimate for caregivers in Australia indicated that almost one in six children had been affected by others' drinking. Heavier drinking of caregivers and other household members was the most substantial predictor for indicating a child had been negatively affected by others' drinking.

研究目的：本研究旨在确定澳大利亚儿童因他人酗酒而受到伤害的普遍程度和类型，并研究表示儿童受到他人酗酒影响的儿童照料者的社会人口特征：在 2021 年澳大利亚酒精对他人的危害研究中，854 名成年受访者是 18 岁以下儿童的看护人，他们被问及在过去一年中，他们看护的儿童是否受到他人饮酒的负面影响。结果显示了儿童总体和特定危害的加权流行率估计值。研究还进行了逻辑回归，以确定表明他人饮酒对儿童造成伤害的相关特征：超过 17% 的照料者（95% 置信区间 [CI] = 13.0-19.0）表示，在过去 12 个月中，他们照料的一名或多名儿童受到了他人饮酒的影响。辱骂（6.2%；95% CI = 4.3-8.3）是最常见的伤害，其次是经济伤害（4.3%；95% CI = 2.7-6.2）。1%的照顾者（95% CI = 0.4-2.3）表示孩子受到了身体伤害，不到1%的照顾者（95% CI = 0.2-1.4）表示孩子因他人酗酒而成为儿童保护电话的对象。与男性和 65 岁以下的照料者相比，女性和 65 岁以上的照料者更有可能表示儿童受到了影响。与戒酒者相比，每周至少三次饮酒五杯或五杯以上的照顾者表示儿童受到影响的可能性要高出四倍。与酗酒并对儿童造成负面影响的照顾者生活在一起，儿童受到伤害的可能性也会增加：2021 年，对澳大利亚照顾者的加权调查估计表明，几乎每六个儿童中就有一个受到他人饮酒的影响。照顾者和其他家庭成员酗酒程度较高是儿童受到他人酗酒负面影响的最主要预测因素。

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引用次数: 0

Commentary on Conde et al.: Addressing evidence gaps on the impact of vaping among young people 对 Conde 等人的评论：解决青少年吸食影响方面的证据差距。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-26 DOI: 10.1111/add.16656

Katherine East

In their recent article, Conde et al. [1] introduce the concept of interactive evidence and gap maps (EGMs) to assess vaping (e-cigarettes). In health research, repetition of poor-quality studies is, unfortunately, common, and Conde et al. demonstrate the utility of stepping back to identify gaps and what is needed to fill them.Conde et al. map the evidence exploring the relationship between vaping and subsequent smoking among young people (aged < 30 years). They found that the evidence to date clusters around vaping and subsequent initiation of smoking or current smoking (i.e. ‘gateway hypothesis’), with little attention given to the harm reduction potential of vaping among young people, particularly those from disadvantaged groups. They also found that most studies were from a few high-income countries.Of the 134 studies mapped, 106 assessed vaping as an exposure and current, or initiation of, smoking as an outcome. Reviews previously published in Addiction [2] and elsewhere [3, 4] have discussed the limitations of such ‘gateway’ studies, including inadequate adjustment for confounders, reliance upon self-report measures of infrequent use (e.g. ever use) without biochemical verification and high attrition. These limitations mean it is difficult to establish meaningful associations or causality. Evidence also suggests that the association between starting vaping and starting smoking works both ways [5] and that both behaviours share genetic aetiology [6], which is more consistent with a common liability rather than a causal association. Rather than more studies in this area, researchers could focus their attention elsewhere.Vaping poses only a fraction of the health harms of smoking, and there is now a substantial evidence base for vaping for tobacco harm reduction among adults [7]. Vaping nicotine can help adults to quit or reduce their smoking [8], and this effect is greater among adults with no initial plans to quit smoking [9]. Qualitative work also suggests some ‘accidental quitting’ or ‘sliding’ into tobacco abstinence among adults who try vaping [10]. Young adults have historically underutilized evidence-based cessation treatments for smoking [11], and quit rates are low among this age group [12]. However, at the population level, since disposable vapes have come onto the market in Great Britain smoking declines have been most pronounced among young adults, a group with the largest increases in vaping [13]. Vaping could therefore be a ‘gateway out’ of smoking although, as Conde et al. show, there are few studies specifically assessing vaping for smoking cessation, reduction or prevention among young adults. Addressing this gap is crucial, because the earlier someone stops smoking the better their health outcomes [14</s

在年轻人（尤其是弱势群体）中开展的高质量研究，对吸食电子烟预防吸烟和戒烟进行评估，可能会更新这个年龄段的人对吸食电子烟的看法，并对整个生命周期的公平产生影响。K.E.是成瘾研究学会（SSA）奖学金的获得者。没有其他利益冲突需要声明。

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引用次数: 0

Evidence and policy is certainly more complex than it seems 证据和政策肯定比看上去要复杂得多。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-26 DOI: 10.1111/add.16660

Virginia Berridge, Wayne Hall, Kylie Morphett, Amy Fairchild, Ron Bayer, Coral Gartner

We thank the commentators for providing a sense of how the conclusions we drew [1] from research in Australia, the United Kingdom and the United States do or do not apply to the development of tobacco and e-cigarette policies in Japan [2], New Zealand [3] and the Nordic countries [4].The commentaries support our conclusion that pre-history is important. Sweden has a long history of the use of snus to replace cigarette smoking, but oral tobacco products have been banned in England and Australia, and they are not widely used in the United States. Despite the Swedish history with snus, policymakers in neighbouring Nordic countries are hostile to its use for harm reduction. The European Union (EU) seems to have played a positive role, with special exemption for Sweden, but a negative role in Denmark and Finland. This is an interesting contrast with the EU’s later role in relation to e-cigarettes with its impact on England. Therefore, timing and history emerge as significant, together with the role of regional government.Japan is an interesting case, because the major concern there is with the high uptake of heated tobacco products (HTPs) by young people. One suspects that Japan Tobacco has played a key role in this outcome by ensuring that HTPs have been legally promoted and widely adopted by those who smoke cigarettes, while the sale of e-cigarettes has been banned.Waa’s commentary highlights another central issue: who policy is intended to benefit. We pointed to the stark contrast between English e-cigarette policy that focused upon reducing harms among people who smoke and the long-standing Australian and US concerns with protecting youth. Waa highlights the importance of policy attending to the high rates of e-cigarette and tobacco use by Māori youth and adults in New Zealand. The colonial legacy, much discussed in current work by historians, is clearly important here.Deguchi & Tabuchi note that policy towards tobacco harm reduction products is dynamic and evolving. This has been clearly seen with the recent move in Australia away from a prescription-only model for e-cigarettes towards allowing their sale in pharmacies without a medical prescription. As these authors point out, the recent concern in the United Kingdom regarding unregulated youth vaping has been reflected in the UK Tobacco and Vapes Bill. That Bill has been revived by the incoming Labour government. However, it does not mark a major change in the use of e-cigarettes as a harm reduction strategy for people who smoke, as demonstrated by the provision of e-cigarettes in the ‘Swap to Stop’ scheme through the National Health Service (NHS). Some aspects of policy in the three countries may be converging around youth use, but some still remain distinct.We are pleased that our paper has served its intended purpose in encouraging analyses of other countries’ e-cigarette policies, deepening our und

我们感谢评论者让我们了解到我们从澳大利亚、英国和美国的研究中得出的结论[1]如何适用于或不适用于日本[2]、新西兰[3]和北欧国家[4]的烟草和电子烟政策的制定。瑞典使用鼻烟代替香烟的历史悠久，但口服烟草产品在英国和澳大利亚已被禁止，在美国也没有广泛使用。尽管瑞典有使用鼻烟的历史，但邻近的北欧国家的政策制定者却对使用鼻烟来减少危害持敌视态度。欧盟（EU）似乎发挥了积极作用，对瑞典给予了特别豁免，但在丹麦和芬兰却发挥了消极作用。这与欧盟后来在电子烟方面的作用及其对英格兰的影响形成了有趣的对比。因此，时间和历史以及地区政府的作用显得尤为重要。日本是一个有趣的案例，因为那里的主要问题是年轻人对加热烟草制品（HTPs）的大量使用。人们怀疑日本烟草公司在这一结果中起到了关键作用，因为它确保了加热烟草制品得到合法推广，并被吸烟者广泛采用，同时禁止销售电子烟。我们指出，英国电子烟政策的重点是减少吸烟者的危害，而澳大利亚和美国长期以来关注的是保护青少年，两者之间形成了鲜明对比。Waa强调了政策关注新西兰毛利青年和成年人使用电子烟和烟草的高比率的重要性。Deguchi & Tabuchi指出，针对烟草减害产品的政策是动态的、不断变化的。澳大利亚最近从电子烟只需处方的模式转向允许在药店销售电子烟而无需医生处方，就清楚地表明了这一点。正如这些作者所指出的，英国最近对无管制的青少年吸食电子烟的关注已经反映在英国的《烟草和电子烟法案》中。即将上台的工党政府恢复了该法案。然而，这并不标志着将电子烟作为吸烟者减低危害策略的重大改变，国民健康服务（NHS）的 "交换戒烟 "计划中提供的电子烟就证明了这一点。我们很高兴我们的论文达到了预期目的，鼓励了对其他国家电子烟政策的分析，加深了我们对这一争议领域政策演变的理解。与证据之间的关系比表面看起来要复杂得多：这些评论表明，我们强调的前史、随时间推移的变化、管理结构和政策对象等问题都具有现实意义：概念化；形式分析；方法论；项目管理。韦恩-霍尔概念化；数据整理；正式分析；资金获取；调查；方法论；项目管理；写作-审阅和编辑。凯莉-莫菲特（Kylie Morphett）：概念化；数据整理；形式分析；资金获取；调查；方法论；项目管理；写作-原稿；写作-审阅和编辑。艾米-费尔柴尔德概念化；数据整理；正式分析；资金获取；调查；方法论；项目管理；写作-原稿；写作-审阅和编辑。罗恩-拜尔概念化；数据整理；正式分析；资金获取；调查；方法论；项目管理；撰写-原稿；撰写-审阅和编辑。Coral Gartner：概念化；数据整理；正式分析；资金获取；调查；方法；项目管理；撰写-原稿；撰写-审阅和编辑。

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引用次数: 0

Better data access can lead to better collaborative conclusions: Results of a discussion with Heirene 更好的数据访问可以带来更好的合作结论：与 Heirene 讨论的结果。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-23 DOI: 10.1111/add.16657

David Zendle, Philip Newall

Heirene [1] raises a series of valid points. We agree that our inferences provide stronger evidence for a general relationship between gambling spend and risk; but importantly, weaker evidence for proposed specific monthly financial risk checks.Based on discussion with Heirene, we agreed that a better way of evaluating risk checks would be to determine how many times each person in each risk group would have reached the now £150 net-deposit threshold with a single operator in a given month. We performed these analyses, finding that the typical ‘unharmed’ [Problem Gambling Severity Index (PGSI) = 0; n = 229] gambler would be flagged 0.28 times [95% confidence interval (CI) = 0.14, 0.54] during the calendar year, whereas the average ‘at-risk’ gambler (PGSI > 0; n = 195) would be flagged 1.94 times (95% CI = 1.42, 2.66). Code and analysis output are available on-line [2]. We hope that this analysis addresses Heirene’s [1] concerns and supports the target article in suggesting the potential utility of financial risk checks at the now £150 monthly net-deposit threshold [3].Regulation in technology-focused domains such as gambling must be fast-moving if it is to be effective. When we began writing [3], public language centred around ‘affordability checks’; now stakeholder discussions have moved forward to ‘financial risk checks’ [4]. When we published [3], checks were proposed for £125 monthly net loss [5]; now proposed thresholds are at £150 in net deposits [6]. To provide timely guidance in dynamic environments, researchers need rapid access to naturalistic data. Without this, agile academic responses become intractable and the ability of the research community to inform policy becomes limited. We hope that this constructive and collaborative debate with Heirene provides a test case in the ability for better data access to unlock better, data-driven ways of making policy.Crucially, this open exchange of views is facilitated by our reliance upon data infrastructure, rather than data sharing. There are typically significant barriers to the repeated sharing of naturalistic datasets with the research community by third parties [7]. This point is demonstrated by two impactful projects using naturalistic data [8, 9]. These projects have been transformative in terms of obtaining insights, but have faced barriers in terms of translating ongoing data access to the wider community. An understated strength of Zendle & Newall [3] is that the implementation of novel data infrastructure allowed us to crowd-source naturalistic data directly from gamblers via a process of data donation [10]. This means that such data remain accessible for iterative and incremental research: this is the process by which science becomes self-correcting.All evidence in

Heirene [1] 提出了一系列有道理的观点。我们同意，我们的推论为赌博支出与风险之间的一般关系提供了更有力的证据；但重要的是，为提议的具体每月财务风险检查提供了较弱的证据。根据与 Heirene 的讨论，我们同意，评估风险检查的更好方法是确定每个风险组别中的每个人在给定月份在单个经营者处达到现在的 150 英镑净存款门槛的次数。我们进行了这些分析，发现典型的 "未受伤害"[问题赌博严重程度指数（PGSI）= 0；n = 229]赌徒在日历年内会被标记 0.28 次[95% 置信区间（CI）= 0.14，0.54]，而平均 "高风险 "赌徒（PGSI > 0；n = 195）会被标记 1.94 次（95% CI = 1.42，2.66）。代码和分析结果可在线查阅[2]。我们希望这一分析能解决 Heirene [1] 所关注的问题，并支持目标文章中提出的金融风险检查在目前每月净存款 150 英镑的阈值下的潜在效用[3]。当我们开始撰写[3]时，公众语言的中心是 "负担能力检查"；现在，利益相关者的讨论已转向 "金融风险检查"[4]。当我们发布[3]时，建议每月净损失为 125 英镑[5]；现在建议的阈值为净存款 150 英镑[6]。为了在动态环境中提供及时指导，研究人员需要快速获取自然数据。如果不能做到这一点，灵活的学术对策就会变得难以实施，研究界为政策提供信息的能力也会受到限制。我们希望这次与 Heirene 的建设性合作辩论能够提供一个测试案例，证明更好的数据访问能够开启更好的、数据驱动的政策制定方式。第三方与研究界反复共享自然数据集通常会遇到巨大障碍[7]。使用自然数据的两个具有影响力的项目[8, 9]就证明了这一点。这些项目在获得洞察力方面具有变革性，但在向更广泛的社区提供持续的数据访问方面却面临着障碍。Zendle & Newall[3]的一个被低估的优势是，新数据基础设施的实施使我们能够通过数据捐赠过程[10]直接从赌徒那里获得自然数据。这意味着这些数据仍可用于迭代和增量研究：这就是科学自我修正的过程。赌博政策领域的所有证据都有其固有的局限性，需要通过公开辩论和批评来逐步消除这些局限性。然而，在任何时候都无法避免的局限性不应妨碍政策利益相关者采取行动[11, 12]。政策利益相关者还可以采取行动，支持研究界获取自然数据，将这些数据与其他相关数据集结合起来，开展自然实地研究[13]。对此类基础设施的利用应尽可能公平和包容，既要考虑到变革的速度，又要消除对潜在利益冲突的担忧[14]。总体而言，本文介绍的新成果为英国在拟议阈值下进行金融风险检查提供了更明确的证据。D.Z. 是 "加强博彩安全咨询委员会"（Advisory Board for Safer Gambling）的成员，该委员会是一个法定机构，其职责是向英国博彩委员会提供独立建议。D.Z.获得了赌博研究学术论坛（Academic Forum for the Study of Gambling Major Exploratory Grant）的资助，该资助来自英国赌博委员会（UK Gambling Commission）的 "用于社会责任目的的监管结算"，由安大略省赌博研究交流中心（GREO）管理。D.Z. 曾作为有偿顾问，帮助政府了解电子游戏和赌博的影响。他曾在与电子游戏产业有关的案件中担任专家证人，但从未在法律上代表过游戏产业，也从未以任何方式正式隶属于任何游戏产业机构。D.Z. 曾参与促成与电子游戏行业利益相关者的数据共享协议。他承认此类数据共享协议构成了与经济奖励同等重要的利益冲突，并希望强调，他利用此类数据中介服务的方式可能会给他带来间接的经济利益。P.N. 是英国赌博委员会的一个咨询小组--"加强赌博安全咨询委员会"（Advisory Board for Safer Gambling）的成员。在过去 3 年中，P.N.

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引用次数: 0

Commentary on Yang et al.: The need for a renewed focus on identifying and responding to chronic pain among people with substance use disorders 对 Yang 等人的评论：需要重新关注识别和应对药物使用障碍患者的慢性疼痛。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-23 DOI: 10.1111/add.16654

Gabrielle Campbell, Briony Larance

Chronic non-cancer pain (hereafter referred to as chronic pain) is defined as non-malignant pain persisting for 3 months or longer. It is a common problem world-wide, affecting approximately one in five people globally [1]. Yang et al.’s [2] review is the first to provide pooled estimates of the prevalence of current pain and chronic pain among the specific group of people seeking or receiving opioid agonist treatment (OAT), finding a prevalence twice that of the general population (44%). Importantly, although chronic pain is more prevalent in people seeking or receiving OAT, emerging research suggests that it is also common among people with other substance use disorders [3]. We recently estimated the prevalence of chronic pain to be 37.5% among 9413 clients enrolled in a large not-for-profit alcohol and other drug (AOD) service in Australia [4]. However, evidence on the causes, consequences and appropriate treatment responses remain relatively underdeveloped.We know that in the general population, chronic pain is associated with being older, higher levels of socio-economic disadvantage via reduced working ability [5], poorer physical and mental health [5], functional decline and loss of independent living [6] and increased risk of suicide [7]. Many of these characteristics are more pronounced among AOD treatment populations, particularly those with opioid use disorder. Yang et al. [2] report that among people seeking treatment or receiving OAT, chronic pain was associated with a greater risk of unemployment and more severe mental health symptoms compared to people without chronic pain. We found similar associations among people with chronic pain entering general AOD treatment [4]. Additionally, we found that chronic pain was associated with a two times increased risk for suicide-related behaviours, homelessness and eviction [4]. Chronic pain is also associated with poorer AOD treatment outcomes, including poorer rates of abstinence [8].Access and affordability of appropriate pain management services remain an issue in the general population [9, 10]. These barriers are probably greater among people entering treatment for substance use disorders due to financial disadvantage and poorer private health insurance coverage [11]. Integrated behavioural pain management treatments incorporated into AOD treatments show promise [12]; however, there is a need to invest in further research to improve outcomes for people with chronic pain and substance use disorders.Chronic pain should be incorporated into AOD work-force education and development and more effectively integrated into our treatment responses. Furthermore, to date, only a small percentage of substance use treatment facilities report having programmes to treat patien

慢性非癌症疼痛（以下简称 "慢性疼痛"）是指持续 3 个月或更长时间的非恶性疼痛。它是一个世界性的常见问题，影响着全球大约五分之一的人[1]。Yang等人[2]的综述首次对寻求或接受阿片类受体激动剂治疗（OAT）的特定人群中当前疼痛和慢性疼痛的患病率进行了汇总估算，发现其患病率是普通人群（44%）的两倍。重要的是，虽然慢性疼痛在寻求或接受阿片类激动剂治疗的人群中更为普遍，但新的研究表明，慢性疼痛在患有其他药物使用障碍的人群中也很常见[3]。我们最近估计，在澳大利亚一家大型非营利性酒精和其他药物（AOD）服务机构登记的 9413 名客户中，慢性疼痛的患病率为 37.5%[4]。我们知道，在一般人群中，慢性疼痛与年龄较大、因工作能力下降而处于较高的社会经济不利地位[5]、身心健康较差[5]、功能衰退和丧失独立生活能力[6]以及自杀风险增加[7]有关。其中许多特征在接受 AOD 治疗的人群中更为明显，尤其是阿片类药物使用障碍患者。Yang等人[2]报告说，在寻求治疗或接受OAT的人群中，与没有慢性疼痛的人相比，慢性疼痛与更大的失业风险和更严重的精神健康症状有关。我们在接受一般 AOD 治疗的慢性疼痛患者中也发现了类似的关联[4]。此外，我们还发现，慢性疼痛与自杀相关行为、无家可归和被驱逐的风险增加了两倍[4]。慢性疼痛还与较差的 AOD 治疗效果有关，包括较差的戒断率[8]。在接受药物使用障碍治疗的人群中，由于经济状况不佳和私人医疗保险覆盖率较低，这些障碍可能更大[11]。将疼痛管理综合行为疗法纳入 AOD 治疗显示了前景[12]；然而，有必要投资于进一步的研究，以改善慢性疼痛和药物使用障碍患者的治疗效果。此外，迄今为止，只有一小部分药物使用治疗机构报告有治疗合并慢性疼痛和药物使用障碍患者的计划[13]，2.6%的住院治疗机构报告有慢性疼痛计划[14]。有必要改进对慢性疼痛的筛查和评估，并加强治疗对策，尤其是在预防自杀方面。G.C.的研究得到了澳大利亚政府卫生部授予国家青少年药物使用研究中心（NCYSUR）和国家健康与医学研究委员会（NHMRC）药物使用治疗有意义成果卓越研究中心的支持。B.L.没有需要声明的竞争利益。

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引用次数: 0

Mapping consumptions and market size of cocaine, amphetamine and MDMA through wastewater analysis: A Dutch case study. 通过废水分析了解可卡因、苯丙胺和摇头丸的消费情况和市场规模：荷兰案例研究。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-21 DOI: 10.1111/add.16649

Thomas L Ter Laak, Erik Emke, Nicole Dolot, Emiel E van Loon, Margo M E van der Kooi, Arian C van Asten, Pim de Voogt

Background and aims: Illicit drug consumption is associated with public health effects and criminal activities. This study aimed to estimate Illicit drug consumption and annual market in the Netherlands from wastewater analysis of drug residues.

Methods: Residues of cocaine, amphetamine and 3,4-methylene dioxymethamphetamine (MDMA) were measured between 2015 and 2022 in 30 Dutch wastewater treatment plants serving both rural and urban populations. These wastewater treatment plants covered 20% of the total Dutch population. The Dutch annual retail market was estimated by extrapolating consumption to the total Dutch population, back-calculating consumption volume, correcting for drug purity and street price collected in voluntary checking services, and accounting for the correlation of consumption and urbanity.

Results: The per capita MDMA and cocaine consumption correlated positively with the urbanity of the wastewater treatment plant catchments with r² of 31% and 64%, respectively. Amphetamine did not show a significant correlation with urbanity. The three studied drugs were conservatively estimated to cover an average annual market value of 903 (95% prediction interval 829 to 987) million Euro for the studied period. Market estimations from prevalence figures and interceptions of international trade were similar.

Conclusions: Illicit drug consumption in the Netherlands appears to correlate positively with urban (in contrast to rural) areas. Wastewater analysis can be used to estimate the volume and monetary value of illicit drug markets as a proof of concept.

背景和目的：非法药物消费与公共健康影响和犯罪活动有关。本研究旨在通过对废水中的毒品残留物进行分析，估算荷兰的非法毒品消费量和年度市场：方法：在 2015 年至 2022 年期间，对服务于农村和城市人口的 30 家荷兰污水处理厂的可卡因、苯丙胺和 3,4-亚甲基二氧甲基苯丙胺（MDMA）残留量进行了测量。这些污水处理厂覆盖了荷兰总人口的 20%。荷兰每年的零售市场是通过将消费量推算到荷兰总人口、反向计算消费量、校正自愿检查服务中收集的毒品纯度和街头价格以及考虑消费量与城市化的相关性估算得出的：结果：摇头丸和可卡因的人均消费量与污水处理厂集水区的城市化程度呈正相关，r2 分别为 31% 和 64%。苯丙胺与城市化程度的相关性不明显。据保守估计，在研究期间，三种研究药物的年均市场价值为 9.03 亿欧元（95% 预测区间为 8.29 至 9.87 亿欧元）。根据流行率数字和国际贸易截获量得出的市场估算值相差无几：荷兰的非法药物消费似乎与城市（而非农村）地区呈正相关。废水分析可用于估算非法药物市场的数量和货币价值，作为概念验证。

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引用次数: 0

Mega-analysis of the brain-age gap in substance use disorder: An ENIGMA Addiction working group study 药物使用障碍中脑龄差距的大型分析：ENIGMA成瘾问题工作组的一项研究。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-21 DOI: 10.1111/add.16621

Freda Scheffler, Jonathan Ipser, Devarshi Pancholi, Alistair Murphy, Zhipeng Cao, Jonatan Ottino-González, ENIGMA Addiction Working Group, Paul M. Thompson, Steve Shoptaw, Patricia Conrod, Scott Mackey, Hugh Garavan, Dan J. Stein

Background and Aims

The brain age gap (BAG), calculated as the difference between a machine learning model-based predicted brain age and chronological age, has been increasingly investigated in psychiatric disorders. Tobacco and alcohol use are associated with increased BAG; however, no studies have compared global and regional BAG across substances other than alcohol and tobacco. This study aimed to compare global and regional estimates of brain age in individuals with substance use disorders and healthy controls.

Design

This was a cross-sectional study.

Setting

This is an Enhancing Neuro Imaging through Meta-Analysis Consortium (ENIGMA) Addiction Working Group study including data from 38 global sites.

Participants

This study included 2606 participants, of whom 1725 were cases with a substance use disorder and 881 healthy controls.

Measurements

This study used the Kaufmann brain age prediction algorithms to generate global and regional brain age estimates using T1 weighted magnetic resonance imaging (MRI) scans. We used linear mixed effects models to compare global and regional (FreeSurfer lobestrict output) BAG (i.e. predicted minus chronological age) between individuals with one of five primary substance use disorders as well as healthy controls.

Findings

Alcohol use disorder (β = −5.49, t = −5.51, p < 0.001) was associated with higher global BAG, whereas amphetamine-type stimulant use disorder (β = 3.44, t = 2.42, p = 0.02) was associated with lower global BAG in the separate substance-specific models.

Conclusions

People with alcohol use disorder appear to have a higher brain-age gap than people without alcohol use disorder, which is consistent with other evidence of the negative impact of alcohol on the brain.

背景和目的：脑年龄差距（BAG）是指基于机器学习模型预测的脑年龄与实际年龄之间的差值。烟草和酒精的使用与脑年龄差距的增加有关；然而，除烟草和酒精外，还没有研究比较过其他物质的全球和区域脑年龄差距。本研究旨在比较药物使用障碍患者和健康对照组的全球和区域脑年龄估计值：设计：这是一项横断面研究：这是一项 "通过元分析增强神经成像联合会（ENIGMA）成瘾工作组 "的研究，包括来自全球 38 个地点的数据：这项研究包括 2606 名参与者，其中 1725 人为药物使用障碍病例，881 人为健康对照组：本研究使用考夫曼脑年龄预测算法，利用 T1 加权磁共振成像（MRI）扫描生成全球和区域脑年龄估计值。我们使用线性混合效应模型比较了患有五种主要药物使用障碍之一的患者和健康对照组的整体和区域（FreeSurfer lobestrict 输出）BAG（即预测年龄减去实际年龄）：酗酒障碍（β = -5.49，t = -5.51，p 结论：酗酒障碍患者的 BAG（即预测年龄减去实际年龄）与健康对照组的 BAG（即预测年龄减去实际年龄）之间存在差异：与没有酒精使用障碍的人相比，有酒精使用障碍的人的脑年龄差距似乎更大，这与酒精对大脑的负面影响的其他证据是一致的。

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引用次数: 0

How psychedelics legalization debates could differ from cannabis. 迷幻药合法化辩论与大麻有何不同？

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-13 DOI: 10.1111/add.16644

Beau Kilmer

引用次数: 0

Commentary on Conde et al.: Evidence and gap map offer an important opportunity for dialogue and refinement of the gateway hypothesis controversy 对 Conde 等人的评论证据和差距图为对话和完善网关假说之争提供了重要机会。

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction

Pub Date : 2024-08-12 DOI: 10.1111/add.16645

Arielle Selya, Joe G. Gitchell

The question of whether e-cigarette use promotes subsequent cigarette smoking among youth (commonly known as the ‘gateway hypothesis’) is critical for understanding e-cigarettes' net impact on population health. Unfortunately, it is also a highly polarized topic. Not only is there no clear resolution (yet) embraced by both sides [1, 2], but the many studies published on the topic do not seem to have changed anyone's mind. This seems to be a real-life example of the epistemological network model described by O'Connor and Weatherall [3] (see the figures, particularly the polarization one) whereby levels of social trust and conformity are such that more research does not lead to a convergence on truth.

We hope that researchers willing to devote the effort and take the risks to work with ‘adversaries’ will draw motivation from peers in other fields taking the same risks and efforts.

Arielle Selya: Conceptualization; project administration; writing—original draft; writing—review and editing. Joe G. Gitchell: Conceptualization; writing—review and editing.

Through Pinney Associates, A.S. and J.G.G. provide consulting services on tobacco harm reduction to Juul Labs (JLI). A.S. also individually provides consulting services on behavioural science to the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) through ECLAT Srl, which received funding from the Foundation for a Smoke-Free World (FSFW; now the Global Action to End Smoking [GA]). Neither JLI, CoEHAR, nor FSFW/GA had any role in, or oversight of, this commentary.

使用电子烟是否会促进青少年随后吸烟（俗称 "网关假说"）的问题对于了解电子烟对人群健康的净影响至关重要。遗憾的是，这也是一个两极分化严重的话题。不仅双方都没有明确的解决方案（尚未）[1, 2]，而且就该主题发表的许多研究似乎也没有改变任何人的想法。这似乎是奥康纳和韦瑟拉尔（O'Connor and Weatherall）[3]所描述的认识论网络模型（见图，尤其是两极分化模型）在现实生活中的一个例子，在这个模型中，社会信任度和一致性的水平决定了更多的研究并不会导致真理的趋同：构思；项目管理；写作-原稿；写作-审阅和编辑。乔-G-吉切尔通过 Pinney Associates 公司，A.S. 和 J.G.G. 为 Juul 实验室（JLI）提供减少烟草危害方面的咨询服务。A.S. 还通过 ECLAT Srl 单独为加速减害卓越中心（CoEHAR）提供行为科学方面的咨询服务，该中心得到了无烟世界基金会（FSFW；现为全球终止吸烟行动[GA]）的资助。JLI、CoEHAR 和 FSFW/GA 均未参与或监督本评论。

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引用次数: 0