Drug and alcohol review最新文献

Introduction: Child-to-parent violence (CPV) is associated with youth substance problems; however, CPV which is substance-involved (SU-CPV) is specifically excluded from the consensus definition of CPV and few studies have explored the familial context surrounding SU-CPV. This study utilised the I³ model to explore associations between parental monitoring, parental intrusiveness, affective reactivity, concurrent reactive CPV and SU-CPV in an Australian community sample of caregivers.

Methods: A total of 119 caregivers experiencing abusive CPV (frequent and severe) completed an online survey reporting on incidence of CPV from 12 to 24-year-olds under their care, parenting behaviours, traits of the young person and their experience of SU-CPV.

Results: Poor parental monitoring was positively associated with SU-CPV, and this relationship was stronger at higher levels of affective reactivity in the young person. There were no significant three-way interactions.

Discussion and conclusions: SU-CPV may be most likely to occur where opportunity for child substance use is high, and risk of escalation is also high. These findings should be used to inform current CPV intervention, which may otherwise neglect youth substance use.

Issues: Dentists can play a key role in screening for psychoactive substances use. This systematic review aimed to identify the knowledge, attitudes and practices of dentists related to screening for use of psychoactive substances and the facilitating factors and barriers.

Approach: According to Preferred Reporting Items for Systematic reviews and Meta-Analyses, four databases were searched until July 2024 to identify reports relating to screening for substance use by dentists. Search terms used key words relating to knowledge, attitudes or practices concerning the screening of tobacco, alcohol or any other substance use.

Key findings: Twenty reports met the inclusion criteria for this review. In practice, dentists were more likely to identify tobacco use than alcohol or other substance use. Although the screening for tobacco was widely performed by dentists, the proposal of interventions was less frequent. Despite the opinion of many dentists that screening is part of their professional role, particularly tobacco, their knowledge of how to identify and intervene seemed low. Lack of knowledge or training were identified as barriers.

Implications: Identification of these factors should encourage greater diffusion of recommended tools for screening and development of initial and continuing training for dentists. These factors should convince decision-makers to help dentists to identify referral solutions, in particular coordinated care pathways, and to consider the acceptability and feasibility of the screening tools available to dentists.

Conclusion: Tobacco use was more frequently identified than was other substances, screening was always more frequent than interventions, and lack of training proved to be the main barriers to screening. Education and training in the screening of psychoactive substance use is a key factor in encouraging improved practices, particularly on intervention following detection and on substances other than tobacco.

Introduction: Some gay and bisexual men who have sex with men (GBMSM) who use drugs to enhance sex (chemsex/party and play) may experience harms and seek talk therapies. GBMSM who practice chemsex may not access drug services because of anticipated stigma and the perception that these services lack chemsex expertise. Barriers to services are documented, however, little is known about the service experiences of chemsex engaged GBMSM.

Methods: Semi-structured interviews were conducted with 24 participants reporting current practice of sexualised use of methamphetamine and/or gamma hydroxybutyrate. Interviews explored experiences of counselling and psychology services, participant's treatment goals and challenges. Data were transcribed verbatim and analysed in NVIVO14 with a qualitative description methodology.

Results: Most in our study sought to reduce the frequency of methamphetamine use and used methamphetamine only in sexual contexts. When engaging with counsellors and psychologists in alcohol and other drug or mental health services for the general adult population, most censored the sexual drivers and types of sexual behaviours incumbent in their methamphetamine use. Participants' reliance on drugs for sex was spoken about as a major barrier to reducing methamphetamine. Sexual self-censorship within services inhibited participants' abilities to access meaningful support and achieve treatment goals.

Discussion and conclusions: Counsellor and psychologists working with GBMSM around drug use, must ask about context of drug use and sex. Training and supervision around sexual therapies for those working alongside GBMSM who practice chemsex may be beneficial. Research on treatment approaches to support the sexual wellbeing of people who practice chemsex is required.

Introduction: Alcohol use disorders (AUD) are under-treated, particularly among older adults. Using data from national treatment registers can expand knowledge on the AUD treatment rate among older adults and on potential biases in treatment receipt. The aim of this paper was to determine the AUD treatment prevalence rate and to investigate sociodemographic, health-related and substance use-related correlates of AUD treatment receipt among older adults with different degrees of problematic alcohol use.

Methods: The study sample (n = 13,403; inclusion criteria: age 55-80 years, positive CAGE-C) is a subsample from the representative cross-sectional 2017 Danish National Health Survey. It was enriched with data from Danish National Registers, including the National Alcohol Treatment Database. Weighted 12-month AUD treatment prevalence rates were determined. Logistic regression analysis was applied to identify correlates of treatment receipt. All analyses were conducted among: (i) the study sample; (ii) the 28.9% with a positive original CAGE (n = 3725); and (iii) the 6.1% endorsing the CAGE's E-criterion (n = 692).

Results: The 12-month AUD treatment prevalence was 0.5% in the study sample, 1.6% in the CAGE-, and 3.8% in the E-criterion subsample. Not being married or partnered, loneliness and contacts with health care providers were positively associated with AUD treatment receipt in all three samples.

Discussion and conclusions: Even in the subsample with putative alcohol withdrawal, the AUD treatment rate did not reach 5%. This finding suggests that putative AUD is significantly undertreated in older adults. Contacts with other health care providers may facilitate AUD treatment entry in this age group.

Introduction: Many countries, including Aotearoa New Zealand, have socioeconomic and ethnic inequities in alcohol outlet density, yet the potential contribution of alcohol licensing systems is almost unexplored. After licensing reforms in Aotearoa in 2012, community groups and Māori (the Indigenous people) continued to struggle to influence decisions, prompting calls for reform and authority for Māori reflecting Te Tiriti o Waitangi obligations. This study explored factors in the failure of public objections in under-resourced neighbourhoods.

Methods: In a descriptive, multimethod qualitative study, we analysed eight decisions to grant off-licence approvals in socioeconomically deprived areas. Each licence was opposed. Hearing participants and local residents were interviewed. Data were thematically analysed to identify factors affecting objector influence, alignment with Indigenous rights and residents' awareness of alcohol issues and licensing processes.

Results: Residents identified relevant local harms but were largely unaware of opportunities to object. Objectors faced structural barriers to accessing and influencing hearings that were exacerbated by resource challenges, including travel costs, lost income, competing social issues and limited legal representation. Evidence of area deprivation supported objectors' arguments regarding risk, but a lack of official data on harms undermined them. Māori input was excluded by legal barriers and failures to recognise relevant rights and elements of culture.

Discussion and conclusions: Structural barriers, including racism, restricted the influence of under-resourced communities and Māori in licensing decisions and weakened risk assessment, which may hinder community efforts to reduce their disproportionate exposure to alcohol outlets. Licensing systems should be reviewed from equity and Indigenous perspectives.

Introduction: Nitazenes are a group of potent synthetic opioids that have had increasing prominence as novel psychoactive drugs in the last 5 years. We describe emergency department nitazene-related presentations.

Methods: This is a prospective series of patients with analytically confirmed nitazene presentations identified by the Emerging Drugs Network of Australia and Emerging Drugs Network of Australia Victoria. Both studies' databases were searched between July 2020 and February 2024 with clinical data and blood nitazene concentrations abstracted.

Results: There were 32 presentations, 23 (72%) males, with a median age of 31 years (range 18-63 years). Only five (16%) intentionally ingested a nitazene, with most (12, 38%) believing they had taken alternative opioids. Co-exposures occurred in 31 (97%), mostly metamfetamine. Naloxone was administered in 23 (72%) presentations, with a median total dose of intravenous naloxone within 1 h post hospital presentation of 400 μg (interquartile range [IQR] 160-450 μg). Four (13%) received a naloxone infusion. Thirteen (41%) were admitted to the intensive care unit. The median length of stay was 17 h (IQR 7-39 h). Protonitazene was the commonest nitazene detected in 23 (72%) presentations with a median concentration of 2.0 mg/L (range 0.7-15 mg/L). The lowest concentration of protonitazene in a patient that received naloxone was 0.7 mg/L.

Discussion and conclusions: Most patients were unaware they were using nitazenes. Given their potency, this has important implications for harm, particularly in those not intentionally using opioids. Nitazene exposure was mostly unintentional. Naloxone use was common and standard dosing regimens appeared effective in most cases.

Issues: Alcohol consumption can cause physical, psychological and social problems that can result in hospitalisations. Screening in hospitals helps to determine which patients should be given interventions. In this review, we aimed to summarise the diagnostic test accuracy (DTA) of screening instruments for problematic alcohol use among adults in hospitals.

Approach: We searched three databases for studies that assessed validated screening instruments for problematic alcohol use among hospitalised adults. We used the Quality Assessment of Diagnostic Accuracy Studies 2 tool to evaluate the risk of bias.

Key findings: We included 20 studies in the review. In 11 studies performed in the emergency departments, 5 instruments had a high DTA: the AUDIT, the AUDIT-C, the RAPS4-QF, the 2-question screener and HOLD 5. In the eight studies with inpatients, three instruments had a high DTA: the AUDIT, CAGE-C and CAGE +10 items. Finally, only one of the included studies evaluated outpatients; the authors reported a high DTA for the AUDIT-C.

Implication and conclusions: The results indicate that the AUDIT is an appropriate screening instrument for both inpatients and patients in the emergency department. Moreover, for patients in the emergency department, the AUDIT-C and the RAPS4-QF can be used. More research is needed on outpatients, and several screening instruments have only been validated with one study (i.e., the 2-question screener, DSM-IV-2, HOLD 5, CAGE-C and CAGE +10 questions).

Introduction: In January 2020, the government of the Australian Capital Territory (ACT) decriminalised the possession and cultivation of cannabis for personal use. This study explored the driving-related attitudes, beliefs and behaviours of ACT residents who are legally cultivating and consuming cannabis.

Methods: A two-part cross-sectional study was conducted. Part-1: Cannabis users residing in the ACT were invited to complete an online survey. Part-2: Survey respondents who reported 'currently growing' cannabis were invited to submit a sample of their home-grown cannabis for phytocannabinoid analysis. Data from Parts 1 and 2 were used to estimate participants' usual Δ⁹-tetrahydrocannabinol (THC) intakes.

Results: N = 385 cannabis users completed all or part of the online survey and N = 52 submitted cannabis samples for phytocannabinoid analysis. Most participants (N = 224/330; 67.9%) reported waiting ≥7 h following cannabis use before driving. However, 21.5% (N = 71/330) reported waiting ≤3 h. These individuals had the highest cannabis and THC intakes of the sample (where known). Further analyses revealed that individuals who expressed less concern about roadside drug testing and the effects of non-medicinal and medicinal cannabis on driving, and who used cannabis more frequently, in larger amounts, and exclusively for non-medicinal purposes were more likely to report shorter 'wait times'.

Discussion and conclusion: A small proportion of cannabis users in the ACT appear to be driving shortly (i.e., ≤3 h) after consuming considerable quantities of cannabis and THC. This behaviour puts them at risk of driving while impaired and incurring legal sanctions. Interventions alerting these individuals to these possible risks are, therefore, warranted.

Introduction: On 1 January 2020, Vietnam introduced a new law with harsher fines and penalties for driving under the influence of alcohol. Reports of empty beer restaurants following this implementation suggested the new law has the potential to reduce population-level alcohol consumption. This pilot study aims to quantify short-term changes in alcohol consumption levels after the implementation of the new law and assess whether it could lead to a reduction in total alcohol consumption in the population.

Methods: Wastewater samples were collected from two sites along a sewage canal in Hanoi during two periods: Period 1 (15 December 2018 to 14 January 2019) and Period 2 (15 December 2019 to 14 January 2020). Ethyl sulfate, a specific metabolite of alcohol, was quantified to monitor the trend of alcohol consumption. Both interrupted time series and controlled interrupted time series approaches were utilised, with Period 1 and Period 2 serving as the control and intervention periods, respectively.

Results: Our analysis indicated that the implementation of the new law did not result in an immediate and significant reduction in alcohol consumption at the population level. Meanwhile, there was no significant difference in alcohol consumption between weekdays and weekends both before and after the implementation of the new law.

Discussion and conclusions: Long-term monitoring is needed to assess the impact of stricter DUI policy on alcohol consumption in the urban areas of Vietnam.

Introduction: Reducing alcohol availability and restricting alcohol advertising are effective ways to reduce harm from alcohol. Implementation of public health policies involves collaboration between different stakeholders, and is influenced by public opinion. This paper explores public and professional stakeholders' perceptions of alcohol advertising and availability policies. It is the first to capture consensus and divergence in narratives of these stakeholders.

Methods: We conducted semi-structured interviews with 14 stakeholders from third sector organisations, government, public health and alcohol licensing in Scotland. We conducted 11 online focus groups with 45 participants, living in neighbourhoods in Scotland characterised by varying levels of urbanity, deprivation and retail density change. We gave participants a list of policies and discussed their views on acceptability, feasibility and likely success.

Results: Despite general consensus that regulation of alcohol advertising is an important priority, public stakeholders were concerned about the feasibility of advertising interventions and potential unintended consequences. While professional stakeholders were in favour of regulating alcohol availability, public stakeholders had misgivings about feasibility and effectiveness. When prompted to discuss specific interventions, similar views about protecting children and achieving cultural change emerged.

Discussion and conclusions: This study highlights the importance of policy makers and other stakeholders to consider public stakeholders' opinions on alcohol policy and understanding that their views may be influenced by competing framings of alcohol problems. Attempts to increase support for alcohol control policies need to consider people's concerns about the effectiveness and potential unintended consequences of these policies, and the wider social context of alcohol consumption.