Drug and alcohol dependence最新文献_第2页

Rising and disparate trends in the private/for-profit acquisition of nonprofit substance use treatment facilities, US, 2019–2024 私人/营利性收购非营利性物质使用治疗设施的上升和不同趋势，美国，2019-2024

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-13 DOI: 10.1016/j.drugalcdep.2026.113045

George Pro , Jonathan Cantor , Mofan Gu , Kari Weber , Brooke Montgomery

Background

Private acquisition of public and nonprofit healthcare facilities is increasing throughout the United States (US). While privatization can be beneficial, growing evidence has demonstrated higher costs, larger patient volumes, and worsening outcomes. These trends are also apparent in substance use disorder (SUD) treatment facilities at a time when overdose and treatment demand are at an all time high. This study was designed to measure whether increases in private acquisitions of nonprofit substance use treatment facilities are happening faster in underrepresented and underresourced communities.

Methods

We used the Mental health and Addiction Treatment Tracking Repository (MATTR) to identify SUD treatment facilities that were nonprofit/public owned in 2019 (N = 2826 facilities). Our outcome was whether a facility became privatized and owned by a for-profit company by 2024. We linked MATTR to demographic census data and modeled privatization using a generalized estimating equation with a modified Poisson distribution, log link function, and robust standard errors.

Results

Twenty percent (n = 572) of public/nonprofit SUD treatment facilities were privatized between 2019 and 2024. Privatization of nonprofit/public facilities was more common in communities with lower household incomes (p < 0.01).

Conclusion

Private acquisition of nonprofit/public SUD treatment facilities increased between 2019 and 2024. Acquisitions were disproportionately located in communities with higher rates of low-income households. Private acquisition can be beneficial for some facilities, but a growing evidence base is demonstrating how privatization is generally followed by worsening health outcomes in the process of restructuring and reselling at a profit. Treatment systems must not be extractive. Oversight and community involvement may help ensure mutual beneficence.

背景：在美国，私人收购公共和非营利医疗机构的情况正在增加。虽然私有化可能是有益的，但越来越多的证据表明，成本更高，患者人数更多，结果更差。这些趋势在药物使用障碍（SUD）治疗设施中也很明显，因为过量和治疗需求处于历史高位。本研究旨在衡量在代表性不足和资源不足的社区，私人收购非营利性药物使用治疗设施的增长是否更快。方法使用心理健康和成瘾治疗跟踪库（matr）识别2019年非营利性/公营的SUD治疗机构（N = 2826家机构）。我们的结果是，到2024年，一个设施是否会私有化，并由一家营利性公司拥有。我们将matr与人口普查数据联系起来，并使用带有修正泊松分布、日志链接函数和鲁棒标准误差的广义估计方程来建模私有化。结果2019 - 2024年，20% （n = 572）的公立/非营利SUD治疗机构实现了私有化。非营利性/公共设施私有化在家庭收入较低的社区更为常见（p < 0.01）。结论2019 - 2024年间，非营利性/公立SUD治疗设施的私人收购有所增加。收购不成比例地位于低收入家庭比例较高的社区。私人收购对某些设施可能是有益的，但越来越多的证据表明，私有化之后，在重组和转售过程中，健康结果通常会恶化。处理系统不能是萃取性的。监督和社区参与可能有助于确保互惠互利。

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引用次数: 0

Impact of a brief fentanyl educational intervention on demand for cocaine mixed with fentanyl 短暂芬太尼教育干预对混合芬太尼可卡因需求的影响。

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-13 DOI: 10.1016/j.drugalcdep.2026.113042

Cecilia Nunez , Benedicta Anighoro , Jin H. Yoon , Margaret C. Wardle

Background

People who use cocaine are at increased risk of overdose related to fentanyl in the cocaine supply, yet few interventions address fentanyl risks among this population. Demand tasks use hypothetical decisions about drug purchases to quantify likely real-world behavior. Our cocaine demand task, the Adulterated Cocaine Purchasing Task, contrasts planned purchases of cocaine when there is 0 % probability (no chance) the cocaine is mixed with fentanyl vs. 10 % probability (in 10 chance) the cocaine is mixed with fentanyl.

Methods

Using a between-subjects design, participants who reported purchasing cocaine in the past year (N = 58) were randomly assigned to complete test measures either following (intervention group; n = 30) or before receiving (control group; n = 28) fentanyl education. Test measures consisted of the Adulterated Cocaine Purchasing Task, self-reported fentanyl knowledge, and harm reduction strategies. Demographics and substance use history were also assessed.

Results

Findings suggested providing brief fentanyl education significantly increased fentanyl knowledge. Results also indicated higher probability (1 in 10 chance) of fentanyl admixture was consistently related to decreased cocaine demand across multiple demand indices (e.g., reducing their consumption when cocaine is free). However, providing brief education did not lead to reduced demand for cocaine mixed with fentanyl relative to those in the control group. Results also showed fentanyl education did not affect endorsement of harm reduction behaviors.

Conclusion

Our findings further suggest the urgent need to prioritize strategies aside from education to address overdose risk among people who use cocaine.

背景：使用可卡因的人在可卡因供应中与芬太尼相关的过量风险增加，但很少有干预措施解决芬太尼在这一人群中的风险。需求任务使用关于药品购买的假设决策来量化可能的现实行为。我们的可卡因需求任务，掺假可卡因购买任务，将可卡因与芬太尼混合的概率为0%（没有机会）与可卡因与芬太尼混合的概率为10%（有10个机会）的可卡因计划购买进行对比。方法：采用受试者间设计，在过去一年中报告购买可卡因的参与者（N = 58）被随机分配在芬太尼教育之后（干预组，N = 30）或接受芬太尼教育之前（对照组，N = 28）完成测试措施。测试措施包括掺假可卡因购买任务、自我报告的芬太尼知识和减少危害策略。人口统计和药物使用史也进行了评估。结果：研究结果表明，提供简短的芬太尼教育可显著提高芬太尼知识。结果还表明，在多个需求指数中，芬太尼混合物的较高概率（十分之一的机会）与可卡因需求的减少一致相关（例如，当可卡因免费时，减少其消费量）。然而，与对照组相比，提供简短的教育并没有导致可卡因与芬太尼混合的需求减少。结果还显示芬太尼教育并不影响对减少危害行为的认可。结论：我们的研究结果进一步表明，除了教育之外，迫切需要优先考虑策略来解决可卡因使用者的过量风险。

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引用次数: 0

Sociodemographic, behavioral, and geospatial factors associated with syringe services program use in San Francisco, California 社会人口、行为和地理空间因素与注射器服务计划在旧金山，加利福尼亚的使用。

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-13 DOI: 10.1016/j.drugalcdep.2026.113046

Esther O. Chung , Bradley Ray , Jamie L. Humphrey , Megan Lindstrom , Cariné E. Megerian , Barrot H. Lambdin , Alex H. Kral

Background

Syringe services programs (SSPs) are a cornerstone of preventing infectious disease and overdose for people who use drugs. Given efforts to achieve universal access, we examined factors associated with SSP use, including proximity.

Methods

We used cross-sectional data from 713 people who use drugs across San Francisco, California (September 2023-September 2024). We assessed proximity to an SSP by calculating the walking time between where participants slept the night before and nearest SSP location. We conducted multivariable negative binomial models to explore factors associated with SSP use and assess whether the association between proximity and SSP use was modified by race-ethnicity.

Results

Almost 80 % of participants used an SSP at least once in the past 3 months. Age, race-ethnicity, mode of use, and proximity to SSP were negatively associated with SSP use. Participants who only smoked used SSPs less often than those who used in other ways (adjusted rate ratio [aRR]=0.77, 95 % CI: 0.61–0.97), as well as those more than a 20-minute walk to an SSP (aRR=0.54, 95 % CI: 0.36–0.83). The effect size between walking time to SSP and SSP use was substantially larger for Black participants than non-Black (Black: aRR=0.38, 95 % CI: 0.15–0.60 vs. non-Black: aRR=0.72, 95 % CI: 0.40–1.31).

Conclusions

Geographic distance was a barrier to SSP use, especially for Black participants. SSPs may not reach people who only smoke drugs. SSPs should be added to areas with limited geographic access and include safer smoking supply distribution.

背景：注射器服务计划（ssp）是预防传染病和吸毒过量的人的基石。鉴于实现普遍可及的努力，我们研究了与SSP使用相关的因素，包括邻近性。方法：我们使用了2023年9月至2024年9月在加利福尼亚州旧金山使用药物的713人的横断面数据。我们通过计算参与者前一天晚上睡觉的地方和最近的SSP地点之间的步行时间来评估与SSP的接近程度。我们使用多变量负二项模型来探索与SSP使用相关的因素，并评估邻近性与SSP使用之间的关系是否受到种族的影响。结果：近80%的参与者在过去3个月内至少使用过一次SSP。年龄、种族、使用方式和接近SSP与SSP使用呈负相关。仅吸烟的参与者使用SSP的频率低于以其他方式吸烟的参与者（调整率比[aRR]=0.77, 95% CI: 0.61-0.97），以及步行超过20分钟到SSP的参与者（aRR=0.54, 95% CI: 0.36-0.83）。黑人受试者到SSP的步行时间和使用SSP之间的效应量明显大于非黑人受试者（黑人：aRR=0.38, 95% CI: 0.15-0.60 vs.非黑人：aRR=0.72, 95% CI: 0.40-1.31）。结论：地理距离是使用SSP的障碍，尤其是对黑人参与者。ssp可能无法触及只吸食毒品的人。ssp应增加到地理通道有限的地区，并包括更安全的吸烟供应分配。

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引用次数: 0

Alcohol quantity mediates the association between daily alcohol and cannabis co-use and alcohol consequences 酒精量介导每日酒精和大麻共同使用与酒精后果之间的关联

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-12 DOI: 10.1016/j.drugalcdep.2026.113043

Rachel L. Gunn , Alexander W. Sokolovsky , Lindy K. Howe , Nancy P. Barnett , Kristina M. Jackson , Sharon Lipperman-Kreda , Robert Miranda Jr. , Timothy Trull , Jane Metrik

Background

Alcohol and cannabis are commonly used substances for young adults, and person-level co-use (i.e., concurrent or simultaneous use of both) is associated with increased likelihood of experiencing positive and negative alcohol-related consequences. However, findings regarding within-person effects (i.e.,day-level) co-use on consequences are mixed, possibly due to inconsistency in including alcohol quantity (i.e., total number of standard drinks consumed) when examining the association between co-use and consequences. In the present study, we examined whether the number of drinks mediates the association between co-use and positive or negative alcohol consequences at the day level.

Methods

Data from morning reports in a 28-day field-based study of young adults reporting frequent past 60-day alcohol and cannabis use (N = 115) were used to test multilevel mediation models.

Results

We found significant mediation for both positive and negative alcohol consequences; consuming more alcoholic drinks on co-use days, relative to alcohol-only days, was associated with a higher likelihood of experiencing negative consequences and a lower likelihood of positive consequences. These results suggest that daily number of drinks is a significant driver of the relationship between co-use and alcohol-related consequences at the day-level.

Conclusions

In the context of increased cannabis use among young adults, this finding provides critical information for prevention and intervention efforts aimed at reducing the alcohol-related consequences associated with co-use days. Overall, reducing total alcohol consumption remains a prominent harm-reduction strategy among this population.

酒精和大麻是年轻人常用的物质，个人层面的共同使用（即同时或同时使用两者）与经历与酒精有关的积极和消极后果的可能性增加有关。然而，关于共同使用对后果的个人影响（即日水平）的发现是混合的，可能是由于在检查共同使用与后果之间的关系时，包括酒精量（即消耗的标准饮料总数）不一致。在目前的研究中，我们研究了饮酒的数量是否介导了共同使用和积极或消极酒精后果之间的联系。方法对过去60天频繁使用酒精和大麻的年轻人（N = 115）进行了一项为期28天的实地研究，研究数据来自晨间报告，用于检验多层次中介模型。结果我们发现酒精对积极和消极后果都有显著的中介作用；与只喝酒的日子相比，在一起喝酒的日子里喝更多的酒，经历负面后果的可能性更高，而产生积极后果的可能性更低。这些结果表明，每天的饮酒量是共同使用和酒精相关后果之间关系的重要驱动因素。结论：在年轻人大麻使用增加的背景下，这一发现为预防和干预工作提供了重要信息，旨在减少与共同使用天数相关的酒精相关后果。总的来说，减少酒精消费总量仍然是这一人群减少危害的主要策略。

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引用次数: 0

Identification of hazardous alcohol use in outpatient psychiatric care: A comparison of biomarker phosphatidylethanol (PEth) and self-report 鉴定精神科门诊危险酒精使用：生物标志物磷脂酰乙醇（PEth）和自我报告的比较

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-12 DOI: 10.1016/j.drugalcdep.2026.113047

Lena Lundholm , Johan Skånberg , Sara Wallhed-Finn , Fabian Lenhard

Background

Phosphatidylethanol (PEth) is a reliable biomarker of recent hazardous alcohol use but is resource-intensive and not always feasible in routine mental health care. The Alcohol Use Disorders Identification Test (AUDIT-10) and its short form, AUDIT-C, are widely used self-report tools that may offer practical alternatives. This study examined whether AUDIT scores can serve as proxies for PEth and whether machine learning models enhance prediction.

Methods

Data were collected from 4063 psychiatric outpatients who completed both PEth testing and AUDIT assessments. Regression models evaluated associations between AUDIT scores and PEth concentrations. Receiver Operating Characteristic (ROC) analyses determined cut-offs for hazardous alcohol use (PEth ≥ 0.3 µmol/L). Logistic regression, random forest, and XGBoost models were trained using AUDIT-10/AUDIT-C scores, age, and gender.

Results

AUDIT-10 and AUDIT-C correlated strongly with PEth (pseudo-R² = 30–47 %). ROC analyses showed good discrimination for hazardous use: AUDIT-10 AUC = 0.80 (optimal cut-off ≥5) and AUDIT-C AUC = 0.83 (optimal cut-off ≥4). XGBoost models improved classification modestly, yielding AUCs of 0.90 (AUDIT-10) and 0.88 (AUDIT-C), with balanced accuracies of 79–83 %, outperforming logistic regression and random forest.

Conclusions

AUDIT-10 and AUDIT-C are effective, accessible tools for identifying hazardous alcohol use in psychiatric populations, supporting their role as practical alternatives when PEth testing is unavailable. Machine learning methods offer incremental gains, but simple cut-off scores remain clinically useful. Findings highlight the value of integrating brief alcohol screening into psychiatric care to guide timely interventions, while considering PEth’s biological variability.

磷脂酰乙醇（PEth）是近期危险酒精使用的可靠生物标志物，但它是资源密集型的，在常规精神卫生保健中并不总是可行的。酒精使用障碍鉴定测试（AUDIT-10）及其简短形式AUDIT-C是广泛使用的自我报告工具，可能提供实际的替代方案。本研究考察了审计分数是否可以作为PEth的代理，以及机器学习模型是否可以增强预测。方法收集4063例完成PEth检测和AUDIT评估的精神科门诊患者的数据。回归模型评估了审计分数和PEth浓度之间的关系。受试者工作特征（ROC）分析确定了有害酒精使用的截止值（PEth≥0.3µmol/L）。使用AUDIT-10/AUDIT-C分数、年龄和性别训练逻辑回归、随机森林和XGBoost模型。结果audit -10和AUDIT-C与PEth相关性较强（拟r²= 30 ~ 47%）。ROC分析显示对危险用途有很好的辨别能力：AUDIT-10 AUC = 0.80（最佳临界值≥5），AUDIT-C AUC = 0.83（最佳临界值≥4）。XGBoost模型适度改善了分类，产生的auc为0.90 （AUDIT-10）和0.88 (AUDIT-C)，平衡精度为79 - 83%，优于逻辑回归和随机森林。结论：audit -10和AUDIT-C是识别精神科人群有害酒精使用的有效、可获得的工具，在无法进行PEth检测时支持它们作为实际替代方案的作用。机器学习方法提供增量收益，但简单的截止分数在临床上仍然有用。研究结果强调了将简短的酒精筛查纳入精神科护理以指导及时干预的价值，同时考虑到PEth的生物学变异性。

{"title":"Identification of hazardous alcohol use in outpatient psychiatric care: A comparison of biomarker phosphatidylethanol (PEth) and self-report","authors":"Lena Lundholm , Johan Skånberg , Sara Wallhed-Finn , Fabian Lenhard","doi":"10.1016/j.drugalcdep.2026.113047","DOIUrl":"10.1016/j.drugalcdep.2026.113047","url":null,"abstract":"<div><h3>Background</h3><div>Phosphatidylethanol (PEth) is a reliable biomarker of recent hazardous alcohol use but is resource-intensive and not always feasible in routine mental health care. The Alcohol Use Disorders Identification Test (AUDIT-10) and its short form, AUDIT-C, are widely used self-report tools that may offer practical alternatives. This study examined whether AUDIT scores can serve as proxies for PEth and whether machine learning models enhance prediction.</div></div><div><h3>Methods</h3><div>Data were collected from 4063 psychiatric outpatients who completed both PEth testing and AUDIT assessments. Regression models evaluated associations between AUDIT scores and PEth concentrations. Receiver Operating Characteristic (ROC) analyses determined cut-offs for hazardous alcohol use (PEth ≥ 0.3 µmol/L). Logistic regression, random forest, and XGBoost models were trained using AUDIT-10/AUDIT-C scores, age, and gender.</div></div><div><h3>Results</h3><div>AUDIT-10 and AUDIT-C correlated strongly with PEth (pseudo-R² = 30–47 %). ROC analyses showed good discrimination for hazardous use: AUDIT-10 AUC = 0.80 (optimal cut-off ≥5) and AUDIT-C AUC = 0.83 (optimal cut-off ≥4). XGBoost models improved classification modestly, yielding AUCs of 0.90 (AUDIT-10) and 0.88 (AUDIT-C), with balanced accuracies of 79–83 %, outperforming logistic regression and random forest.</div></div><div><h3>Conclusions</h3><div>AUDIT-10 and AUDIT-C are effective, accessible tools for identifying hazardous alcohol use in psychiatric populations, supporting their role as practical alternatives when PEth testing is unavailable. Machine learning methods offer incremental gains, but simple cut-off scores remain clinically useful. Findings highlight the value of integrating brief alcohol screening into psychiatric care to guide timely interventions, while considering PEth’s biological variability.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113047"},"PeriodicalIF":3.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness and clinical predictors of a virtual based combined cognitive behavioral and motivational enhancement group therapy for adults with cannabis use disorder 基于虚拟的认知行为和动机增强组合治疗成人大麻使用障碍的有效性和临床预测因素

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-12 DOI: 10.1016/j.drugalcdep.2026.113048

Dhvani D. Mehta , Rachel Goud , Marcos Sanches , Leslie Buckley , Matthew E. Sloan , Julianne Vandervoort , Bernard Le Foll , Narges Beyraghi , Pamela Kaduri , Laurie Zawertailo , Peter Selby , Victor M. Tang

Background

Cannabis use has increased in recent years, while perceptions of harm have declined. Cognitive behavioural therapy (CBT), motivational enhancement therapy (MET), and their combinations (CBT-MET) are evidence-based interventions for CUD, though their effectiveness when delivered virtually is underexplored. This study evaluated the clinical efficacy of a virtual 12-week group-based CBT-MET program in individuals with CUD and examined baseline predictors of treatment response.

Methods

A retrospective analysis was conducted on 116 adults enrolled in a virtual group-based CBT-MET program between 2020 and 2023. Participants completed weekly self-report assessments of cannabis use and biweekly assessments of depression (PHQ-9) and anxiety (GAD-7). Cannabis craving (MCQ) and a measure of problematic cannabis use (CUDIT) were assessed at baseline and post-treatment. Wilcoxon signed-rank tests evaluated changes among completers (≥ 75 % attendance), and linear mixed models identified baseline predictors of change over time.

Results

Of the 116 participants, 79 (68 %) completed the program, indicating high retention. Among completers, significant reductions were observed in cannabis use frequency (p < 0.01), quantity (p < 0.01), craving (p < 0.01), depression (p < 0.01), and anxiety (p = 0.02). Higher baseline cannabis use predicted greater reductions in cannabis frequency and quantity, while higher self-efficacy predicted lower cannabis use frequency across treatment. Individuals with co-occurring substance use disorders other than tobacco demonstrated smaller reductions in cannabis quantity.

Conclusion

Virtual CBT-MET was feasible and led to significant reductions in cannabis use and psychiatric symptoms among individuals with CUD. Baseline cannabis use patterns and self-efficacy were key predictors of reduction in cannabis use, highlighting the need for personalized approaches in future interventions.

近年来，大麻的使用有所增加，而对其危害的认识却有所下降。认知行为疗法（CBT）、动机增强疗法（MET）及其组合疗法（CBT-MET）是基于证据的CUD干预措施，尽管它们的有效性尚未得到充分探索。本研究评估了一个虚拟的12周基于小组的CBT-MET项目在CUD患者中的临床疗效，并检查了治疗反应的基线预测因素。方法对2020年至2023年间参加虚拟分组CBT-MET项目的116名成年人进行回顾性分析。参与者完成了每周一次的大麻使用自我报告评估，以及两周一次的抑郁（PHQ-9）和焦虑（GAD-7）评估。在基线和治疗后评估大麻渴望（MCQ）和问题大麻使用（CUDIT）的测量。Wilcoxon符号秩检验评估了完成者（≥75%出勤率）的变化，线性混合模型确定了随时间变化的基线预测因子。结果在116名参与者中，有79人（68%）完成了课程，表明保留率很高。在完成者中，大麻使用频率（p < 0.01）、数量（p < 0.01）、渴望（p < 0.01）、抑郁（p < 0.01）和焦虑（p = 0.02）显著降低。较高的基线大麻使用量预示着大麻使用频率和数量的更大减少，而较高的自我效能预示着整个治疗过程中大麻使用频率的降低。同时患有除烟草以外其他物质使用障碍的个人大麻数量减少幅度较小。结论虚拟CBT-MET是可行的，可以显著减少CUD患者的大麻使用和精神症状。基线大麻使用模式和自我效能是减少大麻使用的关键预测因素，突出表明在今后的干预措施中需要采取个性化的方法。

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引用次数: 0

β-Nicotyrine and e-cigarette abuse liability II: Behavioral economic demand and intracranial self-stimulation in rats β-尼古丁与电子烟滥用倾向II：大鼠的行为经济需求和颅内自我刺激。

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-07 DOI: 10.1016/j.drugalcdep.2026.113025

J.R. Smethells , S. Wilde , P. Muelken , A.C. Harris , M.G. LeSage

Background

Given the prominence of electronic nicotine delivery systems (ENDS), understanding the product characteristics that underlie ENDS abuse liabilty is a public health research priority. β-Nicotyrine (β-Nic) is a uniquely prevalent constituent (up to 25 % of nicotine [Nic] levels) in ENDS aerosols that may contribute to ENDS abuse liability. Previously, we found clinically relevant concentration of β-Nic doubled the elimination half-life and prolong the interoceptive (discriminative stimulus) properties of Nic in rats, but that it had little or no psychoactive effects itself. The present study used i.v. self-administration (23 hrs/day) and intracranial self-stimulation (ICSS) paradigms to further evaluate if β-Nic alone has abuse liability or if it enhances the abuse liability of Nic.

Methods

We examined if β-Nic (> 25 % of Nic levels) substitutes for Nic (0.03 mg/kg/inf) during drug self-administration, and whether combinations of Nic and β-Nic alter the acquisition and behavioral economic demand of i.v. Nic. Reinforcement-enhancing and aversive effects of β-Nic alone or in combination with Nic were also evaluated using ICSS.

Results

Moderately high β-Nic doses (0.03 & 0.10 mg/kg/inf) increased demand for Nic (0.03 mg/kg/inf). β-Nic alone did not maintain self-administration, affect ICSS, or influence the effects of Nic on ICSS.

Conclusion

β-Nic itself does not have abuse potential in either i.v. self-administration or ICSS models, but it does increase the reinforcing efficacy of self-administered Nic. As such, β-Nic may play a role in the abuse liability of ENDS, which has important treatment and regulatory implications.

背景：鉴于电子尼古丁传递系统（ENDS）的重要性，了解ENDS滥用责任背后的产品特性是公共卫生研究的优先事项。β-烟碱（β-Nic）是ENDS气溶胶中一种独特的普遍成分（高达尼古丁[Nic]含量的25%），可能导致ENDS滥用。在此之前，我们发现临床相关浓度的β-Nic在大鼠体内的消除半衰期加倍，并延长Nic的内感受性（区别刺激）特性，但其本身几乎没有或没有精神活性作用。本研究采用自我静脉给药（23小时/天）和颅内自我刺激（ICSS）模式进一步评估β-Nic是否单独存在滥用倾向或是否增加了Nic的滥用倾向。方法：观察β-Nic （β-Nic占Nic水平的25%）在给药过程中是否能替代Nic (0.03mg/kg/inf)，以及β-Nic与β-Nic联用是否会改变静脉注射Nic的获取和行为经济需求。用ICSS评价β-Nic单独或与Nic联合的增强效应和厌恶效应。结果：中等高β-Nic剂量（0.03和0.10mg/kg/inf）增加了对Nic的需求（0.03mg/kg/inf）。单独β-Nic不能维持自我给药、影响ICSS或影响Nic对ICSS的作用。结论：β-Nic本身在静脉给药和ICSS模型中均不存在滥用的可能，但β-Nic能提高自我给药的补强作用。因此，β-Nic可能在ENDS的滥用责任中发挥作用，这具有重要的治疗和监管意义。

{"title":"β-Nicotyrine and e-cigarette abuse liability II: Behavioral economic demand and intracranial self-stimulation in rats","authors":"J.R. Smethells , S. Wilde , P. Muelken , A.C. Harris , M.G. LeSage","doi":"10.1016/j.drugalcdep.2026.113025","DOIUrl":"10.1016/j.drugalcdep.2026.113025","url":null,"abstract":"<div><h3>Background</h3><div>Given the prominence of electronic nicotine delivery systems (ENDS), understanding the product characteristics that underlie ENDS abuse liabilty is a public health research priority. β-Nicotyrine (β-Nic) is a uniquely prevalent constituent (up to 25 % of nicotine [Nic] levels) in ENDS aerosols that may contribute to ENDS abuse liability. Previously, we found clinically relevant concentration of β-Nic doubled the elimination half-life and prolong the interoceptive (discriminative stimulus) properties of Nic in rats, but that it had little or no psychoactive effects itself. The present study used i.v. self-administration (23 hrs/day) and intracranial self-stimulation (ICSS) paradigms to further evaluate if β-Nic alone has abuse liability or if it enhances the abuse liability of Nic.</div></div><div><h3>Methods</h3><div>We examined if β-Nic (> 25 % of Nic levels) substitutes for Nic (0.03mg/kg/inf) during drug self-administration, and whether combinations of Nic and β-Nic alter the acquisition and behavioral economic demand of <em>i.v.</em> Nic. Reinforcement-enhancing and aversive effects of β-Nic alone or in combination with Nic were also evaluated using ICSS.</div></div><div><h3>Results</h3><div>Moderately high β-Nic doses (0.03 & 0.10mg/kg/inf) increased demand for Nic (0.03mg/kg/inf). β-Nic alone did not maintain self-administration, affect ICSS, or influence the effects of Nic on ICSS.</div></div><div><h3>Conclusion</h3><div>β-Nic itself does not have abuse potential in either i.v. self-administration or ICSS models, but it does increase the reinforcing efficacy of self-administered Nic. As such, β-Nic may play a role in the abuse liability of ENDS, which has important treatment and regulatory implications.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113025"},"PeriodicalIF":3.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gabapentin utilization and nontherapeutic use relative to select comparator drugs, United States 2013–2022 美国2013-2022年加巴喷丁的使用和非治疗性使用相对于选择比较药物

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-07 DOI: 10.1016/j.drugalcdep.2026.113026

Sara Karami , Jae Wook Yoo, Corinne Woods, Saranrat Wittayanukorn Conrad, Jana McAninch, Tamra Meyer, Celeste Mallama

Background

Gabapentin prescribing has increased over the past decade, including as part of efforts to reduce opioid analgesic use. Data on trends and scope of harms from gabapentin nontherapeutic use (NTU) are needed.

Methods

For gabapentin and selected contextual comparator drugs (pregabalin, diazepam, oxycodone), we describe utilization using a dispensed prescriptions all-payer claims database (2013–2023) and adverse events for NTU exposure cases using Poison Center data (2013–2022). We then calculated utilization-adjusted NTU exposure case rates, based on prescription units dispensed, for each drug.

Results

From 2013–2023, the number of units (e.g., tablets) dispensed increased for gabapentin (4.4–7.7 billion [B]) and pregabalin (0.68–1.0B) and decreased for diazepam (0.7–0.3B) and oxycodone (4.2–2.5B). From 2013–2022, gabapentin NTU exposure cases (N = 8729) exceeded pregabalin (N = 1257) and diazepam (N = 2452) but not oxycodone (N = 17,808) NTU exposure cases. Gabapentin NTU exposure cases and utilization-adjusted NTU exposure case rates increased from 2013-2017, then decreased through 2022; trends were similar for pregabalin, decreased throughout for diazepam, and fluctuated for oxycodone. From 2013–2022, gabapentin annual utilization-adjusted NTU exposure case rates most closely resembled those of pregabalin (range: 0.09–0.16 versus 0.08–0.22 exposure cases per million units dispensed), while diazepam and oxycodone exhibited higher rates (range: 0.33–0.55 and 0.39–0.85 exposure cases per million units dispensed, respectively). Most gabapentin (68 %) and comparator (55–80 %) NTU exposure cases involved multiple substances, particularly opioids, resulting in more severe clinical outcomes than single-substance exposures.

Conclusions

Our study highlights the harms from gabapentin NTU, particularly in combination with opioids.

背景加巴喷丁的处方在过去十年中有所增加，包括作为减少阿片类镇痛药使用的努力的一部分。需要关于加巴喷丁非治疗性使用（NTU）的趋势和危害范围的数据。方法对于加巴喷丁和选定的对照药物（普瑞巴林、地西泮、羟考酮），我们使用处方全付款人索赔数据库（2013-2023年）描述其使用情况，并使用毒物中心数据（2013-2022年）描述NTU暴露病例的不良事件。然后，我们根据分配的处方单位计算每种药物的利用率调整后的NTU暴露病例率。结果2013-2023年，加巴喷丁（44 - 77亿[B]）和普瑞巴林（0.68-1.0B）的用药单位（如片）增加，地西泮（0.7-0.3B）和羟考酮（4.2-2.5B）的用药单位（如片）减少。2013-2022年，加巴喷丁NTU暴露病例（N = 8729）超过普瑞巴林（N = 1257）和地西泮（N = 2452），但不超过羟考酮（N = 17808） NTU暴露病例。加巴喷丁NTU暴露病例和利用调整后的NTU暴露病例率从2013-2017年上升，然后到2022年下降；普瑞巴林的趋势相似，地西泮的趋势下降，羟考酮的趋势波动。2013-2022年，加巴喷丁年度利用调整后的NTU暴露病例率与普瑞巴林最接近（范围：0.09-0.16和0.08-0.22），而地西泮和羟考酮的暴露病例率更高（范围：0.33-0.55和0.39-0.85）。大多数加巴喷丁（68%）和比较剂（55 - 80%）NTU暴露病例涉及多种物质，特别是阿片类药物，导致比单一物质暴露更严重的临床结果。结论我们的研究强调了加巴喷丁NTU的危害，特别是与阿片类药物合用。

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引用次数: 0

Use of gabapentin with or without a prescription in substance use treatment settings: A national analysis of urine drug testing data, 2016–2023 加巴喷丁在药物使用治疗环境中的使用：2016-2023年全国尿检数据分析

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-03 DOI: 10.1016/j.drugalcdep.2026.113020

Matthew S. Ellis , Penn Whitley , Steven D. Passik

Background

Gabapentin prescriptions have increased due to off-label use, including managing withdrawal/comorbidities in substance use disorder (SUD) treatment, despite gaps in evidence bases and corresponding increases in nonmedical use. This study sought to identify trends in gabapentin use with and without a prescription in SUD treatment settings.

Methods

This retrospective, serial cross-sectional study analyzed urine drug tests (UDT) (n = 206,161) ordered from 2053 SUD settings in all 50 U.S. states, from 2016 to 2023. Specimens were analyzed by liquid chromatography–tandem mass spectrometry to assess positivity for gabapentin and other prescription and illicit drugs, with prescribed medications documented in requisitions. Multivariable regression assessed characteristics/diagnoses associated with gabapentin use with and without a prescription.

Results

Gabapentin was prescribed to 5.9 % of the sample, increasing from 3.9 % in 2016–7.6 % in 2023. Use of gabapentin without a prescription was identified in 11.3 % of the sample, decreasing from 15.2 % to 9.9 %. Gabapentin prescribing was associated with anxiety/mood disorders, insomnia, pain, and sedative, alcohol, or stimulant SUDs. Use without a prescription was associated with anxiety/mood disorders, and sedative or opioid SUDs. Detection was higher across all illicit substances among those engaged in gabapentin use without a prescription.

Conclusions

Gabapentin prescribing significantly increased in SUD treatment settings despite a lack of strong evidence bases for its utility. While rates of gabapentin use outside a prescription were nearly double than for prescribed use, this appears to be decreasing over time. Polysubstance use and potential gaps in multimorbidity care may contribute to the use of gabapentin without a prescription.

背景：加巴喷丁的处方由于标签外使用而增加，包括治疗物质使用障碍（SUD）治疗中的戒断/合并症，尽管证据基础存在差距，非医疗使用也相应增加。本研究旨在确定加巴喷丁在SUD治疗中有处方和无处方使用的趋势。方法：这项回顾性、连续横断面研究分析了美国50个地区2053个SUD设置的尿药检（UDT）（n = 206161）各州，从2016年到2023年。采用液相色谱-串联质谱法对标本进行分析，以评估加巴喷丁和其他处方药和非法药物的阳性反应，并在申请单中记录处方药。多变量回归评估了加巴喷丁在有和没有处方的情况下使用的相关特征/诊断。结果：加巴喷丁的处方率为5.9%，较2016年的3.9%（2023年为7.6%）有所上升。在11.3%的样本中发现未经处方使用加巴喷丁，从15.2%下降到9.9%。加巴喷丁处方与焦虑/情绪障碍、失眠、疼痛、镇静、酒精或兴奋剂sud有关。无处方使用与焦虑/情绪障碍、镇静或阿片类药物相关。在无处方使用加巴喷丁的人群中，所有非法物质的检出率更高。结论：加巴喷丁的处方在SUD治疗环境中显著增加，尽管缺乏其效用的有力证据基础。虽然加巴喷丁非处方用药的比例几乎是处方用药的两倍，但随着时间的推移，这一比例似乎正在下降。多物质使用和多病护理的潜在差距可能导致加巴喷丁无处方使用。

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引用次数: 0

Explainable machine learning for predicting opioid-related aberrant behavior: A multimodal approach using clinical text and structured data 预测阿片类药物相关异常行为的可解释机器学习：使用临床文本和结构化数据的多模式方法。

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-01-03 DOI: 10.1016/j.drugalcdep.2026.113021

Mubashir Farooq , Asif Ali Banka

Purpose

The rising misuse of opioids, overdose deaths, and opioid use disorder (OUD) associated with chronic pain treatment present a significant public health challenge, continuing to fuel the opioid epidemic. Since opioid-related aberrant behaviours (ORABs) are early indicators of potential misuse, it is crucial to develop advanced predictive models for safe opioid management.

Methods

This study introduces an explainable machine learning framework to predict confirmed aberrant behaviours by integrating clinical text with structured data from the Opioid-Related Aberrant Behavior Detection Dataset (ODD). A multimodal, clinically applicable, and explainable predictive model is developed in this study. The study used GloVe (Global Vectors for Word Representation) embeddings and ClinicalBERT contextual embeddings for EHR text, applied Synthetic Minority Oversampling Technique (SMOTE) for data balancing, and trained various machine learning algorithms.

Results

The performance of models was assessed using multiple evaluation metrics. Additionally, SHAP (Shapley Additive exPlanations) was employed to address explainability concerns and to assess feature importance via an ablation study. Results demonstrated that Opioid Risk Ensemble achieved an AUROC of 96.0 % and an accuracy of 98.8 %, indicating that opioids, benzodiazepine prescriptions, and factors related to the central nervous system are significant predictors, as confirmed by SHAP analysis. Furthermore, the Opioid Risk Neural Network, applied with ClinicalBERT embeddings, achieved an AUROC of 98.75 % and an accuracy of 98.47 % on the held-out test set, with SHAP interpretation providing insights into the most influential clinical note terms.

Conclusion

The multimodal, explainable AI approach will be valuable for modern healthcare decision-making, supporting risk prediction for ORABs.

目的：与慢性疼痛治疗相关的阿片类药物滥用、过量死亡和阿片类药物使用障碍（OUD）的增加是一项重大的公共卫生挑战，继续助长阿片类药物的流行。由于阿片类药物相关异常行为（ORABs）是潜在滥用的早期指标，因此开发先进的阿片类药物安全管理预测模型至关重要。方法：本研究引入了一个可解释的机器学习框架，通过整合临床文本和阿片类药物相关异常行为检测数据集（ODD）的结构化数据来预测已确认的异常行为。本研究建立了一个多模态、临床适用且可解释的预测模型。该研究使用GloVe （Global Vectors for Word Representation）嵌入和ClinicalBERT上下文嵌入用于EHR文本，应用合成少数派过采样技术（SMOTE）进行数据平衡，并训练了各种机器学习算法。结果：采用多种评价指标对模型的性能进行评价。此外，采用Shapley加性解释（Shapley Additive explanation）来解决可解释性问题，并通过消融研究评估特征的重要性。结果表明，阿片类药物风险集合的AUROC为96.0%，准确率为98.8%，表明阿片类药物、苯二氮卓类药物处方和与中枢神经系统相关的因素是重要的预测因子，SHAP分析证实了这一点。此外，应用ClinicalBERT嵌入的阿片类风险神经网络在hold out测试集中实现了98.75%的AUROC和98.47%的准确率，SHAP解释提供了对最具影响力的临床笔记术语的见解。结论：多模式、可解释的人工智能方法将为现代医疗保健决策提供价值，支持orab的风险预测。

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引用次数: 0