Addiction最新文献

Background and aim: Accurately estimating alcohol consumption is crucial for clinical decision-making and monitoring treatment outcomes. Phosphatidylethanol in blood (B-PEth), a direct alcohol biomarker, is currently the most reliable indicator of alcohol intake, with a detection window of several weeks; however, the factors influencing the decline of B-PEth levels remain largely unknown. This study aimed to investigate the decline of B-PEth levels during abstinence in patients with alcohol use disorder (AUD) undergoing withdrawal treatment.

Method: A total of 100 patients were recruited in withdrawal treatment and followed during three to four weeks of abstinence. Blood samples were collected at baseline and weekly during abstinence to measure B-PEth levels of two homologues (16:0/18:1 and 16:0/18:2). Self-reported alcohol consumption was documented using the Timeline Followback (TLFB) method for 30 days before abstinence and throughout the study period.

Results: B-PEth elimination followed first-order kinetics. The mean half-life was 7.24 days [95% confidence interval (CI) = 6.98-7.53] for 16:0/18:1 and 4.55 days (95% CI = 4.44-4.67) for 16:0/18:2. The rate of decline varied by week, with a longer half-life observed in week three compared with week one. No statistically significant sex differences were detected. The strongest correlation between B-PEth levels and self-reported alcohol consumption was found for data from two weeks prior to abstinence.

Conclusion: Elimination of phosphatidylethanol in blood (B-Peth) follows first-order kinetics, with homologue 16:0/18:1 exhibiting a longer half-life than 16:0/18:2. The rate of decline is influenced by the week of alcohol abstinence and B-PEth levels are detectable even in the fourth week of abstinence. The strongest correlation between B-PEth and self-reported alcohol consumption is at two weeks prior to abstinence.

Background and aims: Prior studies on past year prescription stimulant diversion (PSD) have used small samples with limited representation and generated a wide range of estimates for PSD. This study aimed to estimate the prevalence and identify correlates of PSD using a large, multi-institutional sample of post-secondary students in the United States.

Design and setting: Secondary analysis of a cross-sectional survey administered to either random or census samples (i.e. a random subset or all students, respectively) across 196 post-secondary institutions in the United States during the 2023-2024 academic year.

Participants: The non-representative sample included 4771 post-secondary students who (a) were aged 18-25, (b) reported taking a prescription stimulant regularly during the past year with or without a prescription and (c) answered a question about stimulant diversion. The mean age was 20.8 years (standard error = 0.05), and most students were female (60.7%), White (71.7%) and heterosexual (50.1%).

Measurements: The weighted prevalence of past-year PSD was calculated from a self-report question. Demographic, socioeconomic, educational, substance use and service characteristics were examined for association with PSD.

Findings: Of 4771 students, 207 reported PSD (4.3%). In the multivariate regression model, PSD was associated with prescription stimulant misuse versus no misuse [adjusted odds ratio (aOR) = 4.02, 95% confidence interval (CI) = 2.32-6.99], binge drinking in the past two weeks versus no binge drinking (aOR = 1.57, 95% CI = 1.02-2.43) and use of other substances in the past 30 days versus no use (aOR = 4.94, 95% CI = 2.58-9.45, Ref = no past 30 day substance use). Receiving the prescription from a campus clinic versus any other source was also associated with PSD (aOR = 1.94, 95% CI = 1.04-3.63). Age, sex at birth, sexual orientation, race, Grade Point Average (GPA), fraternity or sorority affiliation, degree level, housing and receiving the stimulant from a psychiatrist were not associated with PSD.

Conclusions: The prevalence of prescription stimulant diversion in a multi-institutional sample of post-secondary students in the United States was 4.3%, lower than prior estimates. Certain substance use behaviors and obtaining the prescription from a campus clinic were associated with prescription stimulant diversion.

Background and aims: Global changes in cannabis legislation have raised concerns about the potential impact of cannabis advertising on cannabis use and intentions to use. This systematic review and meta-analysis evaluated the relationship between self-reported exposure to cannabis advertising across various media platforms and self-reported cannabis use and use intentions.

Design: Systematic review and meta-analysis of eligible quantitative studies using random-effects models.

Setting: All included studies were conducted in the United States or Canada.

Participants: Participants ranged in age from 11 to 65 + years across 21 included studies.

Measurements: Studies measured self-reported exposure to cannabis-related advertising and either cannabis use or intentions to use cannabis. Three types of exposure were examined: [1] general cannabis advertising (a composite measure including billboards, storefront/sidewalk, magazines, social media, and other types of advertising avenues), [2] internet/social media advertising, and [3] storefront/sidewalk advertising.

Findings: A total of 2588 records were identified through database searches (PubMed, Scopus, and PsycINFO; January 2024). After title and abstract screening, 45 underwent full text review; of these, 21 studies met inclusion criteria. Most were cross-sectional (86%, n = 18), and three were longitudinal. Ten cross-sectional studies were eligible for meta-analysis, which found a statistically significant association between cannabis advertising exposure and cannabis use (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI] [1.32, 2.30]). Statistically significant heterogeneity was found (Q [11] = 22.73, P < 0.05, I² = 42.3%) and therefore, based on methodological comparability, three additional meta-analyses were conducted by exposure type. General cannabis advertising (3 studies) exposure was statistically significantly associated with cannabis use (aOR = 1.67, 95% CI [1.27, 2.21]); internet/social media advertising (5 studies) also showed a statistically significant association (aOR = 3.38, 95% CI [1.07, 10.66]); exposure to storefront/sidewalk advertising (3 studies) was not statistically significantly associated with cannabis use (aOR = 1.25, 95% CI [0.95, 1.66]). Across studies, methodological quality was mostly good (48%) or satisfactory (43%), with 10% rated as unsatisfactory.

Conclusion: There appears to be a generally positive association between exposure to cannabis advertising and cannabis use, with a consistent positive relationship observed between advertising exposure and intentions to use.

Background and aims: The impact of exposure to cannabis dispensaries on young adult cannabis use may depend on how exposures and outcomes are defined. We estimated associations of dispensary exposure with young adult cannabis use across: (a) a government-maintained licensed dispensaries registry versus a web-scraped list of licensed and unlicensed dispensaries; and (b) varying modes of cannabis modes (i.e. smoked, edible, vaped).

Methods: This study used three waves of data (2021-2023) from a prospective cohort of n = 2277 young adults (mean baseline age = 22 years) from California, USA. Generalized linear models estimated the contemporaneous association of number of dispensaries within 1 mile of participants' homes with repeated measures of past 6-month, past 30-day frequency and past 30-day daily/near-daily (≥ 20 days/month) smoked, edible and vaped cannabis use (separate models for each product type). We compared associations for dispensary exposure derived from a government-maintained registry versus a validated web-scraped dispensary list.

Results: For each additional dispensary located within 1 mile of home, young adults had 5-6% increased risk of past 6-month use of smoked, edible and vaped cannabis use using registry data and 3-4% increased risk using web-scraped dispensary data. Dispensary exposure was positively associated with past 30-day frequency of smoked [incidence rate ratio (IRR)(registry list) = 1.08, 95% confidence interval (CI) = 1.01-1.15; IRR(web-scraped) = 1.04, 95% CI = 1.00-1.08] and edible [IRR(registry list) = 1.07, 95% CI = 0.99-1.15; IRR(web-scraped) = 1.04, 95% CI = 0.99-1.08] cannabis use, but was not consistently associated with cannabis vaping frequency or daily/near-daily use of any product. Magnitude of associations was generally smaller when using dispensary data derived through web-scraping than the government-maintained registry of dispensary licenses, though conclusions were mostly similar between the two lists and confidence intervals consistently overlapped.

Conclusions: Living near a greater number of cannabis dispensaries within 1 mile of home appears to be associated with an increased risk of cannabis use. Web-scraped dispensary sources and United States government-maintained registry lists produce similar conclusions regarding the association of living near a greater number of dispensaries with young adult cannabis use.

Background and aims: Gypsy and Traveller communities in the United Kingdom (UK) face substantial health challenges. Smoking tobacco and drinking alcohol likely contribute to health disparities, but there is little national data on the prevalence or heaviness of smoking and drinking among these communities. We aimed to estimate the prevalence and heaviness of smoking and drinking among the UK Gypsy and Traveller communities compared with people from other UK ethnic groups.

Design/setting: Observational study using data collected between 2013 and 2025 in a series of monthly cross-sectional surveys of representative samples of the adult population in England.

Participants: Adults aged 18+, between 2013 and 2025 (total n = 226 339; Gypsy or Traveller n = 213).

Measurements: Marginal means were derived from regression models and used to estimate the prevalence of current smoking and drinking (both of which includes daily and non-daily), and the heaviness of smoking (cigarettes per day) and drinking [Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score, units per week and estimated weekly alcohol consumption] by ethnicity; adjusted for age, gender and survey year.

Findings: Current smoking prevalence was markedly higher among Gypsy and Travellers [33.0%, 95% confidence interval (CI) = 26.3-39.8%, n = 81] than among the "Other White" ethnic group (18.7%, 95% CI = 18.5-18.9%; P < 0.001), and exceeded estimates observed across other ethnic groups (range: 9.4-19.9%; all P < 0.001). Among those who smoked, Gypsy and Travellers reported smoking more cigarettes per day (geometric mean = 12.5, 95% CI = 8.9-17.6) than the "Other White" group (geometric mean = 9.0, 95% CI = 8.8-9.1; P = 0.59), with other ethnic groups ranging from 6.8-9.7, although not all comparisons reached significance. The proportion reporting any current alcohol consumption was lower among Gypsy and Travellers (61.5%, 95% CI = 53.8-69.2%, n = 126) than 'Other White' ethnicities (77.1%, 95% CI = 76.8-77.3%; P < 0.001). Prevalence of high risk drinking was similar among Gypsy and Travellers (11.3%, 95% CI = 6.7-15.8%) and "Other White" ethnic groups (10.7%, 95% CI = 10.5-10.9%; P = 0.808) but exceeded estimates observed across all other ethnic groups (range: 1.3-7.1%; all P < 0.05). Prevalence of possible dependence was higher among Gypsy and Travellers (3.5%, 95% CI = 0.4-6.6%) compared with the "Other White" (1.3%, 95% CI = 1.2-1.3%; P = 0.027) and all other ethnic groups (range: 0.3-0.8%; all P < 0.05).

Conclusions: People from Gypsy and Traveller communities in the United Kingdom appear to be more likely to smoke compared with other UK ethnic groups, and those who smoke and/or drink do so at more harmful levels compared with other UK ethnic groups.

Background and aims: Health economic models can be used to assess the effectiveness and cost-effectiveness of public health policies for gambling. To develop such a model, we must understand how gambling behaviour is associated with risk of experiencing gambling-related harms. This study aimed to: (1) assess the strength of association between gambling frequency and the risk of gambling-related harm and to examine how these associations differ when lottery-only players are excluded; (2) apply the study's findings in a hypothetical policy model aimed at reducing gambling frequency.

Design: Observational study using six waves of cross-sectional data from the Health Survey for England and the Scottish Health Survey.

Setting: Survey conducted in England in 2015, 2016 and 2018 and Scotland in 2015, 2016 and 2017.

Participants: The sample included 16 648 adults (aged 18 and over) who reported gambling in the past year, generally representative of the populations of England and Scotland.

Measurements: Gambling frequency was measured using 6 categories which indicated frequency in the past 12 months: (a) 2 or more times a week; (b) once a week; (c) less than once a week, more than once a month; (d) once a month; (e) every 2-3 months; (f) once or twice a year. Risk of gambling-related harm was assessed using Problem Gambling Severity Index (PGSI) score (0-27) and its four categories: no-risk (0), low-risk (1-2), moderate-risk (3-7) and high-risk (≥8). Control variables included age, sex, deprivation, social grade, presence of mental disorder and frequency of drinking alcohol.

Findings: Using multinomial logistic regression and zero-inflated negative binomial models we found that gambling at least twice weekly was associated with a statistically significantly higher PGSI score than gambling once or twice a year (incidence rate ratio = 3.528, 95% confidence interval = 2.040-6.103, P value < 0.001). Reducing gambling to guideline levels for people gambling at least twice weekly moved 10% of the sub-sample from higher PGSI categories (low, medium and high risk) to the no-risk category and shifted the distribution of PGSI scores down.

Conclusions: There appears to be a statistically significant association between gambling frequency and risk of gambling-related harm. Data derived from this and similar analyses can be used to model gambling policies which impact gambling frequency.

Background and aims: Ketamine assisted psychotherapy is a promising new treatment for alcohol use disorder (AUD). The psychoactive effects of repeated intravenous (IV) ketamine infusions in people with AUD and their mechanistic role in treating AUD are largely unknown. This study aimed to (1) quantify the subjective, psychoactive effects of IV ketamine in people with AUD, (2) investigate how these effects change over three dosing sessions and (3) test whether these effects mediate ketamine's therapeutic benefits in reducing alcohol consumption.

Design: Secondary analysis of the randomised, parallel-arm, double-blind, placebo-controlled, phase 2 'KARE' clinical trial.

Setting: Two clinical research facilities in England.

Participants: 96 adults (35 women) aged 18-64 years with moderate-to-severe AUD.

Intervention: Three weekly infusions of either ketamine (IV 0.8 mg/kg over 40 minutes) or placebo (saline solution).

Measurements: Psychoactive drug effects experienced were self-reported pre-, during- and post-infusion, every 20 minutes (eight times/infusion) on Likert scales (1-10), for: Effects of Drug, Liking of Drug, Altered Reality, Out of Body Experiences, Visual Distortion, Sound Distortion and Altered Time Perception. For each scale, we calculated area-under-the-curve (AUC) scores for each infusion and the AUC average across three infusions. The clinical outcome was percentage of days abstinent from alcohol in the 6 months after infusions.

Findings: Ketamine produced strong psychoactive effects on every scale, relative to placebo (all P values < 0.001). Ketamine's psychoactive effects were moderated by infusion number (infusion 2 vs. infusion 1) for: Liking of Drug (P = 0.001), Altered Reality (P = 0.030) and Out of Body Experiences (P = 0.033), with small-to-moderate effect sizes. The remaining four psychoactive effects were not statistically significantly changed by repeated dosing. No psychoactive effect statistically significantly mediated the relationship between drug treatment and percentage days abstinent (all P values = 0.075-0.935).

Conclusions: People with alcohol use disorder experience alterations in consciousness from 0.8 mg/kg intravenous ketamine administration. Ketamine's effects appear to be broadly consistent across three repeated infusions. Ketamine-related reductions in alcohol consumption do not appear to be mediated by the acute psychoactive effects of ketamine.

Background and aims: There are currently no brief quantitative assessments that capture the drug patterns of people who engage in use of more than one drug on the same day or simultaneously. The current study examined the retest reliability, acceptability and feasibility of a new quantitative assessment to measure polysubstance use.

Design: A tool for assessing simultaneous and same-day polysubstance behaviors, the polysubstance assessment tool (PAT) was developed in interviewer-administered and electronic self-administered formats. Participants were allocated 1:1 to receive either version of the PAT and returned one to three days later to repeat the assessment.

Setting: New York City, New York, USA.

Participants: Adults (18 + years, n = 115) who reported use of more than one drug per day in the last 30 days.

Measurements: Test-retest reliability estimates for dichotomous items were assessed using Cohen's kappa, Gwet's Agreement Coefficient 1 (AC1) and percent agreement. Continuous items were assessed with two-way mixed effects intraclass correlations. Bivariate analyses examined acceptability using nine Likert-type survey questions. Feasibility was examined via time to completion.

Findings: Overall reliability was moderate to excellent [Gwet's AC1 range 0.70-0.96; intraclass correlation (ICC) range 0.62-0.88]. Reliability was higher for simultaneous polysubstance use (Gwet's AC1 = 0.90) as compared with same-day (Gwet's AC1 = 0.70). Acceptability was high, with no statistically significant difference between the self- and interviewer-administered versions of the tool. Median time to completion was 7 minutes, and was statistically significantly lower for the self-administered tool (median = 5 minutes) compared with the interviewer-administered version (median = 8 minutes) (P < 0.001).

Conclusions: A new polysubstance assessment tool appears to have good reliability and can be considered by researchers seeking a quantitative measure of polysubstance use behaviors given its simplicity, high acceptability and quick completion time.

Background and aims: Workplaces offer a practical setting for alcohol and other drug interventions, especially in industries where impairment introduces substantial risk. Screening, brief intervention and referral to treatment has demonstrated effectiveness in health care settings and shows promise in workplace settings. However, low participation and high attrition in previous workplace studies indicate a need for deeper understanding of feasibility and acceptability. This exploratory qualitative study aimed to identify likely determinants for implementing alcohol and other drug screening, brief intervention and referral to treatment in two safety-sensitive industries in Australia.

Methods: Qualitative research design based on semi-structured online interviews, focussed on the construction and manufacturing industries. Participants included 23 professionals working in health and safety roles representing 21 organisations located across six Australian jurisdictions. Interview transcripts were coded against the five domains of the updated Consolidated Framework for Implementation Research.

Findings: Sixteen determinants were identified that were expected to act as barriers (n = 10) or enablers (n = 5) or have bidirectional impacts (n = 1) on the implementation of screening, brief intervention and referral to treatment in construction and manufacturing. Enabling factors included freely available tools, flexible delivery methods and delivery by trusted, external, peer-based organisations. Pervasive barriers included workers' mistrust of management, concerns about confidentiality and fear of consequences for disclosing substance use.

Conclusions: Successful workplace implementation of screening, brief intervention and referral to treatment appears to depend on organisational cultures where workers trust management, are assured of confidentiality and are not afraid of retribution for disclosure.