Drug and alcohol review最新文献_第4页

Drug-Induced Deaths and Non-Fatal Poisonings in Youth—Associations With Household Adversities and Out-Of-Home Care 青少年药物引起的死亡和非致命中毒——与家庭逆境和家庭外护理的关系。

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-12-04 DOI: 10.1111/dar.70083

Karoliina Karjalainen, Kirsimarja Raitasalo, Sanna Rönkä

Introduction

Drug-induced deaths have increased in many countries, representing one of the most common causes of death among young people, including in Finland. More information is needed to understand the factors leading to these preventable incidents. We examined whether household adversities (parental substance use disorder (SUD), parental psychiatric disorder and long-term financial difficulties) and out-of-home care (OHC) were associated with drug-induced deaths or non-fatal poisonings.

Methods

Population-level data from Finnish national health care and social welfare registers was used. Two cohorts born in 1991 (n = 65,103) and 1997 (n = 58,998) were followed up from birth until the end of 2019. The outcome was drug-induced death/non-fatal drug poisoning. Mortality hazards were estimated using a competing events regression model.

Results

Youths experiencing household adversities (HR 1.60 for long-term income support) or OHC (HR 9.91) encountered a drug-induced death/non-fatal drug poisoning more often than others. Household adversities increased the hazard of drug-induced death/non-fatal poisoning, especially among those who had never been placed in OHC (HR 1.70 for parental SUD; 2.45 for long-term income support), whereas no statistically significant association was found among those who had experienced household adversities but had been placed in OHC.

Discussion and Conclusions

Household and other childhood adversities as well as substance use often form a complex and intertwined set of problems resulting in poor outcomes in young people's lives. Early, accessible and effective interventions are needed for families facing such challenges. Sufficient resources and needs-based services should be guaranteed to secure safe and healthy development for children with adverse childhood experiences.

导言：毒品导致的死亡在许多国家都有所增加，这是青年人死亡的最常见原因之一，包括在芬兰。需要更多的信息来了解导致这些可预防事件的因素。我们研究了家庭逆境（父母物质使用障碍（SUD）、父母精神障碍和长期经济困难）和家庭外护理（OHC）是否与药物引起的死亡或非致命性中毒有关。方法：采用芬兰国家卫生保健和社会福利登记处的人口水平数据。1991年（n = 65,103）和1997年（n = 58,998）出生的两个队列从出生到2019年底进行了随访。结果是药物性死亡/非致命性药物中毒。使用竞争事件回归模型估计死亡率风险。结果：经历家庭逆境（长期收入支持的HR为1.60）或OHC （HR为9.91）的青少年比其他人更常遇到药物引起的死亡/非致命性药物中毒。家庭逆境增加了药物引起的死亡/非致命性中毒的危险，特别是在那些从未被安置在OHC的人中（父母SUD的HR为1.70；长期收入支持的HR为2.45），而在经历过家庭逆境但被安置在OHC的人中没有发现统计学上显著的关联。讨论和结论：家庭和其他童年逆境以及药物使用往往形成一系列复杂和相互交织的问题，导致年轻人的生活结果不佳。面临这些挑战的家庭需要采取早期、可获得和有效的干预措施。应保证提供充足的资源和基于需求的服务，以确保有不良童年经历的儿童安全和健康地发展。

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引用次数: 0

Factors Associated With Preferences for Opioid Agonist Therapies Among People Dependent on Opioids 阿片类药物依赖者对阿片类药物激动剂治疗偏好的相关因素。

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-12-04 DOI: 10.1111/dar.70079

M. J. Stowe, Anna Conway, Frederick L. Altice, Samantha College-Frisby, Phillip Read, Mark Montebello, Gilbert Whitton, Jeremy Hayllar, Mark Daglish, Victoria Cock, Michael Christmass, Sione Crawford, Charles Henderson, Gregory J. Dore, Chris Gough, Michael Farrell, Louisa Degenhardt, Jason Grebely

Introduction

Opioid agonist therapies (OAT) reduce adverse outcomes of illicit opioid use, with individual preferences potentially improving treatment outcomes. We explored preferences for OAT and associated factors in a national sample of people with opioid dependence.

Methods

This cross-sectional study recruited 400 participants (October 2020–April 2021) across Australia (excluding Tasmania) through snowball sampling. Participants completed an interviewer-administered questionnaire on sociodemographic and drug use characteristics. Multivariable logistic regression assessed factors associated with methadone preference (vs. buprenorphine).

Results

Among all participants (median age 45, 41% female, 87% ever received OAT), 92% (n = 366) indicated a preference for receiving OAT (vs. not receiving OAT) and 96% of those (n = 352) preferred a particular type of OAT. Among 366 with a stated preference, 61% (n = 216) preferred methadone and 39% (n = 136) preferred buprenorphine. Among those preferring buprenorphine (n = 136), 50% (n = 68) preferred buprenorphine ± naloxone and 50% (n = 68) preferred long-acting injectable buprenorphine. Independent correlates of preferring methadone included past month heroin use (aOR 1.78, 95% CI 1.06–3.00) and non-prescribed pharmaceutical opioid use (aOR 2.23, 95% CI 1.07, 4.95), and any prior receipt of methadone treatment (aOR 6.54, 95% CI 2.66, 17.91). Among those receiving OAT, a higher proportion of people currently receiving buprenorphine preferred their medication (61/66, 92%) compared to methadone recipients (180/235, 77%).

Discussion and Conclusions

Nearly all participants preferred OAT, mostly reflecting prior experiences, underscoring the need for expanded access to OAT in Australia. Given the multiple stated preferences, OAT options should include a variety of treatment options aligned with patient preferences, including expanded take-home options.

阿片类药物激动剂治疗（OAT）减少非法阿片类药物使用的不良后果，个人偏好可能改善治疗结果。我们在阿片类药物依赖人群的全国样本中探讨了对OAT的偏好及其相关因素。方法：本横断面研究通过滚雪球抽样在澳大利亚（不包括塔斯马尼亚州）招募了400名参与者（2020年10月至2021年4月）。参与者完成了一份由访谈者管理的关于社会人口学和药物使用特征的问卷。多变量logistic回归评估了与美沙酮偏好相关的因素（与丁丙诺啡相比）。结果：在所有参与者中（中位年龄45岁，41%女性，87%曾经接受过OAT）， 92% （n = 366）表示倾向于接受OAT（相对于不接受OAT），其中96% （n = 352）倾向于特定类型的OAT。在366名有明确偏好的患者中，61% （n = 216）选择美沙酮，39% （n = 136）选择丁丙诺啡。选择丁丙诺啡（n = 136）的患者中，50% （n = 68）的患者选择丁丙诺啡±纳洛酮，50% （n = 68）的患者选择长效注射丁丙诺啡。偏好美沙酮的独立相关因素包括过去一个月的海洛因使用（aOR 1.78, 95% CI 1.06-3.00）和非处方阿片类药物使用（aOR 2.23, 95% CI 1.07, 4.95），以及之前接受过美沙酮治疗（aOR 6.54, 95% CI 2.66, 17.91）。在接受OAT治疗的患者中，目前接受丁丙诺啡治疗的患者（61/ 66,92%）比接受美沙酮治疗的患者（180/ 235,77%）更喜欢他们的药物。讨论和结论：几乎所有的参与者都倾向于OAT，主要反映了以前的经验，强调了在澳大利亚扩大OAT的必要性。鉴于多种陈述的偏好，OAT方案应包括与患者偏好一致的各种治疗方案，包括扩展的带回家方案。

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引用次数: 0

Understanding Gender Differences in Injecting-Related Harms Among an Australian Sample of People Who Inject Drugs 了解澳大利亚注射吸毒者样本中注射相关危害的性别差异。

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-12-04 DOI: 10.1111/dar.70067

Daisy Gibbs, Rachel Sutherland, Sarah Larney, Lucy Thi Tran, Amanda Roxburgh, Raimondo Bruno, Samantha Colledge-Frisby

Introduction

People who inject drugs may experience several non-viral injecting-related injuries and diseases (IRID), including skin and soft tissue infection (SSTI) and venous disease, often resulting from bacteria introduced via unsafe injecting practices or environments. Women are overrepresented among those reporting multiple and recent IRID. However, limited evidence exists about how gender interacts with known IRID risk factors.

Methods

Surveys were conducted 2009–2023 with approximately 900 Australians who inject drugs per year (N = 7538 total). Participants self-reported past-month drug use behaviours and IRID experience. We conducted multivariable binary logistic regression to determine the relationship between gender and SSTI and venous disease. To examine whether gender uniquely affected specific injecting risk behaviours with respect to SSTI and venous disease, two interaction terms were separately added: (i) gender and injecting frequency; (ii) gender and reuse of one's needles.

Results

Surveys were completed by 5038 men and 2500 women. Past-month SSTI was reported by 8% of the sample (95% confidence interval 7%–9%), with a higher proportion among women (10%) than men (7%). Overall, 4% reported past-month venous disease (95% confidence interval 3%–4%), a higher proportion among women (5%) than men (3%). Examining both outcomes, no statistically significant interactions between gender and needle reuse or injecting frequency were found.

Discussion and Conclusions

Despite no statistically significant interaction between gender and reuse or injecting frequency, our study demonstrates a gender difference in exposure to risk factors associated with SSTIs and venous disease. Interventions to reduce SSTI and venous disease, particularly those deemed safe and appropriate by women, are needed.

注射吸毒者可能会经历几种非病毒性注射相关损伤和疾病（IRID），包括皮肤和软组织感染（SSTI）和静脉疾病，通常是由不安全注射操作或环境引入的细菌引起的。在报告多次和最近的rid的人中，妇女的比例过高。然而，关于性别如何与已知的IRID风险因素相互作用的证据有限。方法：2009-2023年对每年约900名注射毒品的澳大利亚人（N = 7538）进行调查。参与者自我报告过去一个月的药物使用行为和IRID经历。我们采用多变量二元logistic回归来确定性别与SSTI和静脉疾病之间的关系。为了研究性别是否对性传播感染和静脉疾病的特定注射风险行为有独特影响，分别添加了两个相互作用项：(i)性别和注射频率；（ii）针头的性别和重复使用。结果：共有5038名男性和2500名女性完成了调查。8%的样本报告了过去一个月的SSTI(95%置信区间为7%-9%)，其中女性的比例（10%）高于男性（7%）。总体而言，4%报告了过去一个月的静脉疾病（95%可信区间为3%-4%），女性（5%）的比例高于男性（3%）。检查这两个结果，没有发现性别与针头重复使用或注射频率之间有统计学意义的相互作用。讨论和结论：尽管性别与重复使用或注射频率之间没有统计学上显著的相互作用，但我们的研究表明，暴露于与性传播感染和静脉疾病相关的危险因素方面存在性别差异。需要采取干预措施，减少性传播感染和静脉疾病，特别是妇女认为安全和适当的干预措施。

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引用次数: 0

Recovery Capital in Chinese Drug Rehabilitation: Exploring Person-Centred and Community-Based Perspectives 中国戒毒所之康复资本：以人为本与以社区为基础之探讨。

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-12-03 DOI: 10.1111/dar.70088

Apei Song, George Christopher Dertadian, Jiaojiao He

Introduction

Chinese drug policy has begun to introduce recovery frameworks and rehabilitation models. These developments follow the recovery movement and align with several principles of recovery capital. However, this approach has tended to focus on what state systems understand recovery to be, often at the expense of how people experiencing drug dependence understand recovery. This study examines the different processes and purposes of recovery capital among those in drug rehabilitation programs in China, to highlight the importance of person-centred and community-based recovery.

Methods

From May to September 2024, the first author conducted semi-structured interviews with 24 people who had completed compulsory isolation rehabilitation in urban locations in China. Of these, 16 were undergoing community-based rehabilitation and eight had recently completed it. Thematic analysis was conducted to code for themes.

Results

Our study found that the legal and social stigma consequences of drug use impact how people access recovery resources in China. Data indicate that people's needs around employment, childcare and chronic illness management were often overlooked and that class differences played a significant role in access to recovery-related resources. Finally, participants provide a range of recommendations around making these resources more available and accessible, as well as practical strategies for navigating structural issues and barriers.

Discussion and Conclusions

Our findings confirm a significant mismatch between Chinese national rehabilitation policy frameworks and individual people's visions of recovery. Our study presents evidence for the benefit of reorienting recovery capital as an idea, and recovery policy in practice, around person-centred and community-based concerns.

导言：中国的毒品政策已经开始引入康复框架和康复模式。这些发展遵循复苏运动，并与复苏资本的若干原则相一致。然而，这种方法往往侧重于国家系统对康复的理解，往往以牺牲经历药物依赖的人对康复的理解为代价。本研究考察了中国戒毒项目中康复资本的不同过程和目的，以强调以人为本和以社区为基础的康复的重要性。方法：第一作者于2024年5月至9月对24名在中国城市地区完成强制隔离康复的人员进行半结构化访谈。其中16人正在接受社区康复，8人最近完成康复。进行主题分析，为主题编码。结果：我们的研究发现，中国吸毒的法律和社会耻辱后果影响了人们如何获得康复资源。数据表明，人们在就业、儿童保育和慢性病管理方面的需求往往被忽视，阶层差异在获得与康复有关的资源方面发挥了重要作用。最后，与会者就如何使这些资源更容易获得提出了一系列建议，并就解决结构性问题和障碍提出了切实可行的策略。讨论与结论：我们的研究结果证实了中国国家康复政策框架与个人康复愿景之间的显著不匹配。我们的研究提供了证据，证明将恢复资本重新定位为一种理念，并在实践中围绕以人为本和以社区为基础的问题重新定位恢复政策是有益的。

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引用次数: 0

Application of a Minimum Prenatal Alcohol Exposure Threshold for Diagnosis of Fetal Alcohol Spectrum Disorder: A Retrospective Chart Review 应用最低产前酒精暴露阈值诊断胎儿酒精谱系障碍：回顾性图表回顾

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-11-27 DOI: 10.1111/dar.70082

Eleanor Robinson, Karen Liddle, Khari Garavelis, Chelsea Vanderpeet, Jennifer McAuliffe, Natasha Reid

Introduction

International guidelines for diagnosing fetal alcohol spectrum disorder (FASD) differ regarding the required level of prenatal alcohol exposure (PAE). The Australian Guidelines for Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder (2025) introduce a minimum PAE threshold, unlike the 2016 Guide to FASD Diagnosis, which allowed for diagnosis at any exposure level. This retrospective case review evaluates whether applying the minimum PAE threshold would alter diagnostic outcomes for individuals previously assessed for FASD at a specialist neurodevelopmental clinic in Queensland.

Methods

Records of 81 individuals assessed between February 2019 and May 2024 were reviewed. PAE information was re-categorised according to the 2025 guideline thresholds. Diagnostic outcomes were then compared to original assessments.

Results

All individuals previously diagnosed with FASD without three sentinel facial features had PAE in at least the moderate–high range, thereby meeting the minimum PAE threshold. Those identified as ‘at risk of FASD’ were also found to have at least moderate–high PAE.

Discussion and Conclusions

Concerns have been raised that introducing a minimum PAE threshold could reduce FASD diagnoses. However, this study shows that applying the 2025 criteria retrospectively did not alter diagnostic outcomes for this specific cohort. These findings suggest the updated guidelines may not significantly impact diagnosis rates in similar specialist clinical settings. Further research is needed to assess the broader implications across other service delivery contexts.

诊断胎儿酒精谱系障碍（FASD）的国际指南在产前酒精暴露（PAE）的要求水平上有所不同。与2016年《胎儿酒精谱系障碍诊断指南》不同，《澳大利亚胎儿酒精谱系障碍评估和诊断指南》（2025年）引入了最低PAE阈值，后者允许在任何暴露水平下进行诊断。本回顾性病例综述评估应用最低PAE阈值是否会改变先前在昆士兰州一家专业神经发育诊所评估的FASD个体的诊断结果。方法对2019年2月- 2024年5月81例个体进行回顾性分析。根据2025年指南阈值对PAE信息进行重新分类。然后将诊断结果与原始评估进行比较。结果所有先前诊断为FASD且无三个前哨面部特征的个体，其PAE至少在中高范围内，从而满足最低PAE阈值。那些被确定为“有FASD风险”的人也被发现至少有中高的PAE。讨论和结论提出了引入最低PAE阈值可以减少FASD诊断的担忧。然而，本研究表明，回顾性应用2025标准并没有改变这一特定队列的诊断结果。这些发现表明，在类似的专科临床环境中，更新的指南可能不会显著影响诊断率。需要进一步的研究来评估跨其他服务交付环境的更广泛的影响。

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引用次数: 0

Behavioural Economic Demand for Medicinal and Recreational Cannabis Among People Who Use Over-The-Counter CBD Products, THC Only and CBD + THC 使用非处方CBD产品、仅使用四氢大麻酚和CBD +四氢大麻酚的人群对药用和娱乐大麻的行为经济需求

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-11-27 DOI: 10.1111/dar.70073

Alba González-Roz, Ángel García-Pérez, Ignacio Cuesta-López, Layla Alemán-Moussa, Roberto Secades-Villa

Introduction

Changes in regulatory policies regarding cannabis have led to a rapid expansion of the cannabis market and a substantial increase in cannabis sales. This study examined medicinal and recreational cannabis demand in a hypothetical legalisation scenario in Spain among people who use over-the-counter CBD, THC only and CBD + THC.

Methods

A cross-sectional study comprising 1492 participants aged 16–30. The assessment included measures of alcohol-related problems, nicotine dependence and cannabis use disorder risk. Two Marijuana Purchase Tasks including nine items were used to estimate demand (g/week) for medicinal and recreational cannabis. Bivariate analyses and split-plot ANOVAs were conducted.

Results

Demand for medicinal cannabis was higher than for recreational cannabis in the sample as a whole, indicated by statistically significant main effects of all demand indices, except elasticity. In the event of legalisation, 65.2% reported that they would be willing to try medicinal cannabis if it were legal, compared to 62.1% who reported the intention to try recreational cannabis. People who use CBD + THC showed higher medicinal and recreational cannabis demand than people using THC and CBD only (all p values < 0.001). Men reported higher medicinal and recreational cannabis demand than women (all p values < 0.023).

Discussion and Conclusions

Given that the majority of participants reported intentions to try cannabis if legalised, legalisation efforts should be accompanied by sustainable prevention programs that educate people about the risks associated with cannabis use. People who use over-the-counter CBD products may be particularly susceptible to trying cannabis if it is legalised, either for medicinal or recreational purposes.

大麻管制政策的变化导致大麻市场迅速扩大，大麻销售大幅增加。这项研究在西班牙假设大麻合法化的情况下，调查了使用非处方CBD、四氢大麻酚和CBD +四氢大麻酚的人群对药用和娱乐大麻的需求。方法采用横断面研究，包括1492名16-30岁的参与者。评估包括测量与酒精有关的问题、尼古丁依赖和大麻使用障碍风险。使用包括9个项目的两个大麻购买任务来估计药用和娱乐大麻的需求（g/周）。进行了双变量分析和分裂图方差分析。结果药用大麻需求总体高于休闲大麻需求，除弹性外，各需求指标主效应均有统计学意义。在大麻合法化的情况下，65.2%的人报告说，如果大麻合法，他们愿意尝试药用大麻，相比之下，62.1%的人报告说他们打算尝试休闲大麻。使用CBD + THC的人比只使用THC和CBD的人对医用和休闲大麻的需求更高（p值均为0.001）。男性报告的药用和娱乐大麻需求高于女性（p值均为0.023）。讨论和结论鉴于大多数参与者表示，如果大麻合法化，他们有尝试大麻的意图，合法化的努力应伴随着可持续的预防方案，教育人们使用大麻的风险。使用非处方CBD产品的人可能特别容易尝试大麻，如果大麻被合法化，无论是用于医疗还是娱乐目的。

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引用次数: 0

Toward a Coordinated Global Response to Anabolic-Androgenic Steroid Consumption: Lessons From the World's Current Steroid Checking Initiatives 对合成代谢-雄激素类固醇消费的全球协调反应：来自世界当前类固醇检查倡议的教训

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-11-27 DOI: 10.1111/dar.70075

Timothy Piatkowski, Raphael Magnolini

Anabolic-androgenic steroid (AAS) use presents a growing global public health issue. Despite evidence of significant physical, psychological and social harms, responses to non-medical AAS use remain fragmented, under-resourced and lacking in coordinated clinical and policy frameworks. This commentary synthesises emerging evidence and outlines priorities for developing a comprehensive harm reduction approach. Recent innovations in Australia and Switzerland have introduced steroid checking programs, where people who use AAS can anonymously submit products for chemical analysis. Findings from both countries indicate widespread product misrepresentation and consumer engagement with results. Peer involvement was critical to the success of these programs, suggesting that trusted, community-led harm reduction models are both feasible and effective. To address AAS-related harms, we outline four priorities: expanding AAS inclusion in drug checking programs; embedding peer-led education in service design; developing clinical pathways that reflect the complexities of AAS use; and building international consensus on harm reduction and treatment. These steps are essential to creating a coordinated global response that prioritises equity, evidence and lived-living experience.

合成代谢雄激素类固醇（AAS）的使用是一个日益严重的全球公共卫生问题。尽管有证据表明存在严重的身体、心理和社会危害，但对非医疗用途的AAS的应对措施仍然是零散的、资源不足的，并且缺乏协调的临床和政策框架。本评论综合了新出现的证据，概述了制定全面减少伤害方法的优先事项。澳大利亚和瑞士最近推出了类固醇检测项目，使用原子吸收法的人可以匿名提交产品进行化学分析。两国的调查结果都表明，普遍存在的产品虚假陈述和消费者对结果的参与。同伴参与对这些项目的成功至关重要，这表明可信的、社区主导的减少伤害模式既可行又有效。为了解决与AAS相关的危害，我们概述了四个优先事项：扩大AAS纳入药物检查项目；在服务设计中融入以同伴为主导的教育；制定反映AAS使用复杂性的临床途径；在减少危害和治疗方面建立国际共识。这些步骤对于建立协调一致的全球应对措施至关重要，该应对措施优先考虑公平、证据和实际生活经验。

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引用次数: 0

Effectiveness of Training Non-Specialist Health Workers for the Management of Substance Use Disorders: A Systematic Review and Meta-Analysis 培训非专业卫生工作者管理物质使用障碍的有效性：系统回顾和荟萃分析

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-11-27 DOI: 10.1111/dar.70078

Abhishek Ghosh, Pragyapti Malav, Blessy B. George, Manya Shukla, Nagma Imam, Renjith R. Pillai, Y. P. S. Balhara, Neha Dahiya, Ashoo Grover, Debasish Basu

Issues

Substance use disorders (SUD) pose a global health challenge, especially in resource-limited settings. Training non-specialist health workers (NSHW) is a promising task-sharing strategy. This systematic review assessed the effectiveness of such training in improving NSHWs' knowledge, attitudes, self-efficacy and practice.

Approach

We searched PubMed, SCOPUS and EMBASE and included randomised controlled trials (RCT), quasi-experimental and pre-post studies published between 1 January 2008 and 30 October 2024. Data were synthesised using effect sizes reported as standardised mean differences (SMD). Risk of bias assessments included Cochrane Risk of Bias 2.0 (RoB2) for RCTs and the Newcastle-Ottawa Scale for observational studies.

Key Findings

Of 21,892 records, 29 studies were included: RCTs (n = 7), quasi-experimental (n = 4) and pre-post studies (n = 18). Training formats ranged from 30-min sessions to two-year programs, using hybrid approaches with didactics, role-plays and simulations. Content included SBIRT (n = 8), motivational interviewing (n = 5), and management of alcohol, opioid and tobacco use. The pooled analyses of RCTs showed significant short-term changes to NSHW's knowledge [SMD 0.59 (95% CI 0.40, 0.79)], self-efficacy [SMD 0.45 (95% CI 0.26, 0.64)] and practice [SMD 0.24 (95% CI 0.03, 0.46)]. Pooled analysis from RCTs for changing attitude showed a non-significant result. Quality was mixed: most (4/7) RCTs raised some concerns, and observational studies were mostly moderate (6/13), with frequent reliance on self-report, limited confounding control and short follow-up.

Implications and Conclusion

Training NSHWs has modest effects on knowledge and self-efficacy and small effects on the practice of SUD management.

物质使用障碍（SUD）构成了全球健康挑战，特别是在资源有限的环境中。培训非专业卫生工作者（NSHW）是一项很有前途的任务分担战略。本系统综述评估了此类培训在改善非卫生保健服务人员的知识、态度、自我效能和实践方面的有效性。我们检索了PubMed、SCOPUS和EMBASE，并纳入了2008年1月1日至2024年10月30日期间发表的随机对照试验（RCT）、准实验和前后研究。使用标准平均差异（SMD）报告的效应量来合成数据。偏倚风险评估包括随机对照试验的Cochrane偏倚风险2.0 （RoB2）和观察性研究的Newcastle-Ottawa量表。在21892份记录中，纳入29项研究：rct （n = 7）、准实验研究（n = 4）和前后研究（n = 18）。培训形式从30分钟的课程到两年的课程不等，采用教学、角色扮演和模拟的混合方法。内容包括SBIRT （n = 8）、动机性访谈（n = 5）以及酒精、阿片类药物和烟草使用的管理。随机对照试验的汇总分析显示，NSHW的知识[SMD 0.59 (95% CI 0.40, 0.79)]、自我效能[SMD 0.45 (95% CI 0.26, 0.64)]和实践[SMD 0.24 (95% CI 0.03, 0.46)]在短期内发生了显著变化。对改变态度的随机对照试验进行汇总分析，结果不显著。质量参差不齐：大多数（4/7）随机对照试验提出了一些担忧，观察性研究大多是中度的（6/13），经常依赖自我报告，混淆控制有限，随访时间短。启示与结论培训非住院医师对知识和自我效能感的影响不大，对SUD管理实践的影响较小。

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引用次数: 0

Feelings of Guilt and Remorse After Alcohol Consumption Among People Who Drink at Increasing and Higher-Risk Levels: A Population Study in England 英国的一项人口研究表明，饮酒风险越来越高的人在饮酒后会感到内疚和自责

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-11-27 DOI: 10.1111/dar.70076

Sharon Cox, Melissa Oldham, Harry Tattan-Birch, Sally Marlow, Deborah Robson, Claire Garnett, Sarah Jackson

Introduction

Feelings of guilt and remorse after drinking alcohol may act as barriers to seeking support. This study aimed to estimate the prevalence and frequency of such feelings among adults in England who drink at increasing and higher-risk levels, and differences by socio-demographic and drinking subgroups.

Methods

We analysed data from 40,708 adults (≥ 18 years) who drink at increasing and higher-risk levels (AUDIT-C score ≥ 5) from a monthly cross-sectional survey in England from 2014 to 2022. Feelings of guilt and remorse after drinking in the past 6 months were assessed using the AUDIT. Logistic regression models were used to examine associations with socio-demographic characteristics, alcohol consumption and harm to oneself or others as a result of drinking.

Results

Overall, 13.3% (95% CI 12.9%–13.6%) reported experiencing feelings of guilt or remorse after drinking in the past 6 months. Among those who reported such feelings, 95.3% (95% CI 91.4%–94.9%) experienced them less than once a month. The prevalence of guilt and remorse increased non-linearly with higher AUDIT-C scores from 9.3% (95% CI 8.8%–9.9%) among those drinking at the lightest levels within the increasing/higher-risk range [AUDIT-C = 5] to 20.9% (95% CI 17.2%–24.8%) among the heaviest [AUDIT-C = 12]. After adjusting for alcohol consumption and alcohol-related injury, these feelings were more common among women (aOR 1.38; 95% CI 1.31–1.46) and people from more advantaged social grades (aOR 1.27; 95% CI 1.20–1.36), and much less common among older than younger adults (e.g., ≥ 65 vs. 16–24 years: aOR 0.23; 95% CI 0.20–0.26).

Discussion and Conclusions

In England, around one in eight adults who drink at increasing and higher-risk levels report experiencing guilt or remorse after drinking. These feelings are more common in women, younger adults and those of a more advantaged social grade.

饮酒后的内疚和自责感可能成为寻求帮助的障碍。这项研究的目的是估计这种感觉在英国饮酒风险越来越高的成年人中的流行程度和频率，以及社会人口统计学和饮酒亚组之间的差异。方法：我们分析了2014年至2022年英国每月横断面调查中40,708名饮酒风险较高（AUDIT-C评分≥5）的成年人（≥18岁）的数据。在过去的6个月里，使用审计评估了饮酒后的内疚和自责感。使用逻辑回归模型来检查社会人口统计学特征、酒精消费以及饮酒对自己或他人的伤害之间的关系。总体而言，13.3% （95% CI 12.9%-13.6%）的人报告在过去6个月内饮酒后感到内疚或自责。在报告有这种感觉的人中，95.3% （95% CI 91.4%-94.9%）的经历少于一个月一次。随着AUDIT-C评分的升高，内疚和懊悔的患病率呈非线性增长，从在增加/高风险范围内（AUDIT-C = 5）轻度饮酒者的9.3% （95% CI 8.8%-9.9%）到最重度饮酒者的20.9% (95% CI 17.2%-24.8%) [AUDIT-C = 12]。在对饮酒和酒精相关损伤进行调整后，这些感觉在女性（aOR 1.38; 95% CI 1.31-1.46）和社会地位较高的人群（aOR 1.27; 95% CI 1.20-1.36）中更为常见，而在老年人中比在年轻人中更少见（例如，≥65岁vs. 16-24岁：aOR 0.23; 95% CI 0.20-0.26）。在英国，大约八分之一的饮酒风险较高的成年人在饮酒后感到内疚或悔恨。这种感觉在女性、年轻人和社会地位较高的人身上更为常见。

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引用次数: 0

Barriers to Accessing Opioid Treatment in Rural Queensland: Perspectives From Consumers and Clinicians 在昆士兰农村获得阿片类药物治疗的障碍：来自消费者和临床医生的观点。

IF 2.6 3区医学 Q2 SUBSTANCE ABUSE

Drug and alcohol review

Pub Date : 2025-11-08 DOI: 10.1111/dar.70074

Grace Y. Wang, Daniel Spencer, Chelsea Thompson, Thilakshi Fernando, Maxine O'Brien, Allan Pascoe

Introduction

Opioid treatment (OT) is highly effective for managing opioid use disorder (OUD) but remains underutilised worldwide, including in Australia. This issue is especially pronounced in regional and rural areas; however, there has been limited research focused on the unique barriers to OT access outside of metropolitan centres. In Queensland (QLD), Australia, OT is largely community-based, with dosing, prescription and supply all occurring outside hospital settings. The state's vast size and regional spread create unique access challenges, especially given jurisdictional differences in prescriber regulations across Australia. The present study aimed to identify barriers to OT access in rural QLD.

Methods

This study employed semi-structured interviews with 12 participants, including five clinicians working in the OT and seven consumers residing in rural QLD who were currently receiving OT for OUD. Transcripts were analysed thematically.

Results

Four themes were identified that articulate the primary barriers to OT: (i) restrictive dosing practices; (ii) stigma and social perceptions; (iii) overstretched access; and (iv) gaps in continuity and personalisation of care.

Discussion and Conclusions

Rurality shapes treatment access not only through geographic isolation and limited infrastructure, but also through regulatory inconsistencies across regions, restricted service flexibility and the heightened visibility of individuals within small communities. These insights underscore the need for more localised, equity-focused policy responses and further research into new alternative interventions, such as telehealth and strategies to enhance the acceptance and uptake of long-acting injectable buprenorphine.

阿片类药物治疗（OT）对于管理阿片类药物使用障碍（OUD）非常有效，但在世界范围内仍未得到充分利用，包括在澳大利亚。这一问题在区域和农村地区尤为突出；然而，对在大都市中心以外的地方进行OT的独特障碍的研究有限。在澳大利亚昆士兰州（QLD）， OT主要以社区为基础，剂量、处方和供应都在医院之外进行。该州幅员辽阔，地域分布广泛，这带来了独特的获取挑战，特别是考虑到澳大利亚各地处方法规的司法管辖区差异。本研究旨在确定昆士兰州农村地区OT获取的障碍。方法：本研究采用半结构化访谈法，对12名参与者进行访谈，其中包括5名从事门诊工作的临床医生和7名居住在昆士兰州农村地区、目前因OUD接受门诊治疗的消费者。转录本按主题进行分析。结果：确定了四个主题，阐明了OT的主要障碍：(i)限制性给药做法；污名和社会观念；（iii）通道过长；（四）护理的连续性和个性化方面的差距。讨论和结论：乡村性不仅通过地理上的隔离和有限的基础设施，而且还通过各区域之间的监管不一致、服务灵活性受限以及个人在小社区内的可见度提高来影响治疗的获得。这些见解强调需要采取更加地方化、注重公平的政策对策，并进一步研究新的替代干预措施，如远程保健和加强接受和吸收长效注射丁丙诺啡的战略。

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引用次数: 0