Drug and alcohol dependence最新文献_第3页

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 : 2026-02-01 Epub 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

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 : 2026-02-01 Epub 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 : 2026-02-01 Epub 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

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 : 2026-02-01 Epub 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

Sustained effects of reduced nicotine cigarettes and co-use of non-combusted alternative nicotine delivery systems: A one-month follow-up to a randomized clinical trial 减少尼古丁香烟和共同使用非燃烧替代尼古丁输送系统的持续影响：一个月的随机临床试验随访。

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-02-01 Epub Date: 2026-01-16 DOI: 10.1016/j.drugalcdep.2026.113051

Elias M. Klemperer , Xianghua Luo , Qing Cao , Dana M. Carroll , F. Joseph McClernon , Neal L. Benowitz , Andrew A. Strasser , Jennifer W. Tidey , Eric C. Donny , Dorothy K. Hatsukami

Introduction

The US FDA has proposed a nicotine-reducing standard for cigarettes. A recent trial found that, with access to alternative nicotine delivery systems (ANDS; i.e., e-cigarettes, nicotine medicines), participants randomized to very low nicotine content (VLNC) vs normal nicotine content (NNC) cigarettes achieved greater smoking reduction. This secondary analysis compared effects of the VLNC+ANDS-access versus NNC+ANDS-access conditions on post-intervention cigarette smoking.

Methodology

Adults who smoke were randomized to 12 weeks of an experimental marketplace with VLNC (0.4 mg nicotine/gram tobacco) vs NNC (15.8 mg/g) cigarettes. All participants had access to non-combusted ANDS. Multivariable regressions were used to examine effects of VLNC vs NNC condition and co-use of ANDS with cigarettes on smoking and cessation-related outcomes during follow-up, when no study products were provided (weeks 12–16).

Results

Among those who completed follow-up (n = 336), VLNC vs NNC participants achieved more 7-day point-prevalence smoking abstinence (VLNC=19.6 % vs NNC=11.0 %; p = 0.031), had more smokefree days (VLNC mean=9.7 vs NNC mean=4.9; p = 0.043), and smoked fewer cigarettes/day (VLNC mean=7.3 vs NNC mean=10.7; p < 0.001). Among participants smoking at week-12 (n = 281), co-use of ANDS vs exclusive smoking was associated with more quit attempts (25.5 % vs 13.0 %; p = 0.005) and fewer cigarette/day (mean=9.3 vs mean=12.4; p < 0.001) during follow-up.

Conclusions

Switching to VLNC cigarettes with access to non-combusted ANDS produced sustained effects on smoking abstinence. Among those who continued smoking, co-use of ANDS was associated with fewer cigarettes/day and more attempts to quit. Findings provide further support for a nicotine-reducing standard for cigarettes in the context of a marketplace which includes ANDS.

导语：美国食品和药物管理局提出了一项减少香烟尼古丁的标准。最近的一项试验发现，通过使用替代尼古丁传递系统（即电子烟、尼古丁药物），参与者被随机分配到尼古丁含量极低（VLNC）和尼古丁含量正常（NNC）的香烟中，吸烟量减少得更多。这一次要分析比较了VLNC+ and - and -access条件与NNC+ and -access条件对干预后吸烟的影响。方法：吸烟的成年人被随机分为VLNC （0.4mg尼古丁/克烟草）和NNC （15.8mg/克烟草）香烟的实验市场，为期12周。所有参与者都能接触到未燃烧的手。在随访期间（第12-16周），当没有提供研究产品时，采用多变量回归来检查VLNC与NNC状况以及ANDS与香烟共同使用对吸烟和戒烟相关结果的影响。结果：在完成随访的参与者中（n = 336）， VLNC与NNC参与者实现了更多的7天点流行戒烟（VLNC= 19.6% vs NNC= 11.0%; p = 0.031），有更多的无烟天数（VLNC平均=9.7 vs NNC平均=4.9;p = 0.043），每天吸烟更少(VLNC平均=7.3 vs NNC平均=10.7；p结论：切换到可获得非燃烧源的VLNC香烟对戒烟产生了持续的影响。在那些继续吸烟的人中，共同使用ANDS与每天吸烟的减少和更多的戒烟尝试有关。研究结果进一步支持在包括ANDS在内的市场背景下制定减少香烟尼古丁的标准。

{"title":"Sustained effects of reduced nicotine cigarettes and co-use of non-combusted alternative nicotine delivery systems: A one-month follow-up to a randomized clinical trial","authors":"Elias M. Klemperer , Xianghua Luo , Qing Cao , Dana M. Carroll , F. Joseph McClernon , Neal L. Benowitz , Andrew A. Strasser , Jennifer W. Tidey , Eric C. Donny , Dorothy K. Hatsukami","doi":"10.1016/j.drugalcdep.2026.113051","DOIUrl":"10.1016/j.drugalcdep.2026.113051","url":null,"abstract":"<div><h3>Introduction</h3><div>The US FDA has proposed a nicotine-reducing standard for cigarettes. A recent trial found that, with access to alternative nicotine delivery systems (ANDS; i.e., e-cigarettes, nicotine medicines), participants randomized to very low nicotine content (VLNC) vs normal nicotine content (NNC) cigarettes achieved greater smoking reduction. This secondary analysis compared effects of the VLNC+ANDS-access versus NNC+ANDS-access conditions on post-intervention cigarette smoking.</div></div><div><h3>Methodology</h3><div>Adults who smoke were randomized to 12 weeks of an experimental marketplace with VLNC (0.4mg nicotine/gram tobacco) vs NNC (15.8mg/g) cigarettes. All participants had access to non-combusted ANDS. Multivariable regressions were used to examine effects of VLNC vs NNC condition and co-use of ANDS with cigarettes on smoking and cessation-related outcomes during follow-up, when no study products were provided (weeks 12–16).</div></div><div><h3>Results</h3><div>Among those who completed follow-up (n = 336), VLNC vs NNC participants achieved more 7-day point-prevalence smoking abstinence (VLNC=19.6 % vs NNC=11.0 %; <em>p</em> = 0.031), had more smokefree days (VLNC mean=9.7 vs NNC mean=4.9; <em>p</em> = 0.043), and smoked fewer cigarettes/day (VLNC mean=7.3 vs NNC mean=10.7; <em>p</em> < 0.001). Among participants smoking at week-12 (n = 281), co-use of ANDS vs exclusive smoking was associated with more quit attempts (25.5 % vs 13.0 %; <em>p</em> = 0.005) and fewer cigarette/day (mean=9.3 vs mean=12.4; <em>p</em> < 0.001) during follow-up.</div></div><div><h3>Conclusions</h3><div>Switching to VLNC cigarettes with access to non-combusted ANDS produced sustained effects on smoking abstinence. Among those who continued smoking, co-use of ANDS was associated with fewer cigarettes/day and more attempts to quit. Findings provide further support for a nicotine-reducing standard for cigarettes in the context of a marketplace which includes ANDS.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113051"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032097","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

Alcohol consumption in the Western Province of Sri Lanka: Prevalence, patterns, and health implications 斯里兰卡西部省的酒精消费：流行、模式和健康影响

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-02-01 Epub Date: 2026-01-15 DOI: 10.1016/j.drugalcdep.2026.113049

Prasad Katulanda , Sanduni Gamage , Tharindu Bandara , Akhila Imantha Nilaweera , Desha Rajni Fernando , Gaya Wijeweera Katulanda , Vithanage Pujitha Wickramasinghe , Eranga Wijewickrama

Introduction

Alcohol contributes to global morbidity and mortality. This study aimed to describe the prevalence and patterns of alcohol use, its correlates with health related quality of life (HRQoL) and chronic medical conditions in the Western Province of Sri Lanka.

Methods

A cross-sectional study (2018–2020) was conducted in Western Province recruited 1800 adults (>20 years) via multi-stage stratified cluster sampling. Data collection included interviewer-administered questionnaires, physiological, anthropometric, and biochemical measurements. Alcohol consumption patterns were assessed with Alcohol Use Disorders Identification Test and CAGE tools, and HRQoL with RAND-36.

Results

A total of 1333 adults participated. Alcohol consumption at any point in their life was reported by 25.5 % of participants (95 %CI:18.9–32.1), and 21.3 % (95 %CI:16.8–25.7) had consumed alcohol in the past year. The prevalence was highest among males (56.8 %;95 %CI:46.2–67.4), those aged 40–49 (27.9 %;95 %CI:20.9–34.6), residents of Gampaha district (33.2 %;95 %CI:21.4–44.9), rural dwellers (27.9 %;95 %CI:18.3–37.6), and those earning $300–400 monthly (46.5 %;95 %CI:28.4–64.6). Daily consumption was 5.2 % (95 %CI:1.9–8.3), harmful alcohol use was 28.1 % (95 %CI:19.5–36.7), and clinical alcoholism was 26.6 % (95 %CI:19.5–33.8) among alcohol consumers. Those without clinical alcoholism had higher quality of life than those with the condition. Comorbidities among consumers included dyslipidemia (81.3 %, undiagnosed:58.5 %), hypertension (61.6 %, undiagnosed:33.9 %), diabetes (41.4 %, undiagnosed:11.3 %), and prediabetes (33.8 %).

Conclusions

One-fourth of Western Province adults reported alcohol consumption, highest among middle-aged, middle-income, and residents in Gampaha district. Cardio-metabolic diseases were high among individuals who consume alcohol, many remaining undiagnosed. Non-communicable diseases programs should focus high-risk screening, alcohol control, and preventive community initiatives.

酒精导致全球发病率和死亡率。本研究旨在描述斯里兰卡西部省酒精使用的流行程度和模式，及其与健康相关生活质量（HRQoL）和慢性医疗状况的相关性。方法：采用多阶段分层整群抽样的方法，在西部省开展横断面研究（2018-2020年）。数据收集包括访谈者填写的问卷、生理、人体测量和生化测量。使用酒精使用障碍识别测试和CAGE工具评估酒精消费模式，使用RAND-36评估HRQoL。结果：共有1333名成年人参与。25.5%的参与者（95% CI:18.9-32.1）报告在他们生命中的任何时候饮酒，21.3% （95% CI:16.8-25.7）在过去一年中饮酒。患病率最高的人群为男性（56.8%,95% CI:46.2-67.4）、40-49岁人群（27.9%,95% CI:20.9-34.6）、甘帕哈区居民（33.2%,95% CI:21.4-44.9）、农村居民（27.9%,95% CI:18.3-37.6）和月收入300-400美元的人群（46.5%,95% CI:28.4-64.6）。在饮酒者中，每日饮酒量为5.2% (95% CI:1.9-8.3)，有害饮酒为28.1% (95% CI:19.5-36.7)，临床酒精中毒为26.6% （95% CI:19.5-33.8）。那些没有临床酒精中毒的人比那些有这种情况的人生活质量更高。消费者的合并症包括血脂异常（81.3%，未确诊：58.5%）、高血压（61.6%，未确诊：33.9%）、糖尿病（41.4%，未确诊：11.3%）和前驱糖尿病（33.8%）。结论：西部省份四分之一的成年人报告饮酒，在Gampaha区的中年、中等收入和居民中最高。在饮酒者中，心脏代谢疾病的发病率很高，其中许多尚未被诊断出来。非传染性疾病项目应注重高风险筛查、酒精控制和预防性社区倡议。

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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 : 2026-02-01 Epub 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。

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引用次数: 0

Successful hepatitis C elimination through decentralized treatment in Dutch addiction care: A RE-AIM based evaluation 通过分散治疗在荷兰成瘾护理中成功消除丙型肝炎：基于RE-AIM的评估

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-02-01 Epub Date: 2025-12-30 DOI: 10.1016/j.drugalcdep.2025.113014

Daan W. Von den Hoff , Floor A.C. Berden , Annemarie Noordeloos , Thomas Knuijver , Arnt F.A. Schellekens , Joost P.H. Drenth

Background

People who use drugs (PWUD) are an important population of focus for hepatitis C virus (HCV) elimination. Case-finding and treatment of these patients in outpatient specialist care is a challenge due to population specific barriers. Screening and treatment integrated in addiction care might overcome these barriers. With this study we aim to evaluate the implementation of a decentralized PWUD-HCV care model.

Methods

We conducted a multicenter prospective observational study in Dutch addiction care centers to assess a decentralized HCV care pathway for PWUD. Implementation of HCV-care within addiction care was evaluated using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework. Viral elimination, defined as the proportion of identified HCV-RNA positive PWUD achieving sustained virologic response (SVR), was the primary outcome.

Results

Reach: 870 anti-HCV tests were performed, 29 HCV-RNA positive PWUD were enrolled. Effectiveness: 23 patients initiated and completed on-site treatment, three patients were referred for treatment, two patients were lost to follow-up and one patient refused treatment. All patients tested for SVR achieved SVR, one patient was lost to follow-up before SVR test. The elimination rate was 86 % (25/29). Adoption: five out of eleven addiction care organizations (45 %) implemented decentralized HCV care within addiction care. Implementation fidelity was high.

Conclusion

This study demonstrates that successfully implemented decentralized HCV care within addiction services is feasible and highly effective, achieving an elimination rate of 86 %. However, adoption of decentralized HCV care was limited, underscoring the need for targeted strategies to enhance implementation. Our findings support expanding of decentralized HCV care models in addiction settings to meet HCV elimination targets.

药物使用者（PWUD）是消除丙型肝炎病毒（HCV）的重要人群。由于特定人群的障碍，在门诊专科护理中发现病例和治疗这些患者是一项挑战。将筛查和治疗整合到成瘾护理中可能会克服这些障碍。通过这项研究，我们旨在评估分散的PWUD-HCV护理模式的实施情况。方法：我们在荷兰成瘾护理中心进行了一项多中心前瞻性观察研究，以评估PWUD的分散HCV护理途径。使用可及性-有效性-采用-实施-维持（RE-AIM）框架评估成瘾治疗中hcv护理的实施情况。病毒消除，定义为鉴定的HCV-RNA阳性PWUD达到持续病毒学应答（SVR）的比例，是主要结局。结果：共进行抗hcv检测870例，纳入HCV-RNA阳性患者29例。效果：23例患者开始并完成现场治疗，3例患者转诊治疗，2例患者失访，1例患者拒绝治疗。所有SVR检测患者均达到SVR， 1例患者在SVR检测前失访。根除率为86%（25/29）。采用：11个成瘾治疗组织中有5个（45%）在成瘾治疗中实施了分散的丙型肝炎病毒治疗。实现保真度高。结论：本研究表明，在成瘾服务中成功实施分散的HCV护理是可行且高效的，可实现86%的消除率。然而，分散的丙型肝炎病毒治疗的采用是有限的，强调需要有针对性的战略来加强实施。我们的研究结果支持在成瘾环境中扩展分散的HCV护理模式，以满足HCV消除目标。

{"title":"Successful hepatitis C elimination through decentralized treatment in Dutch addiction care: A RE-AIM based evaluation","authors":"Daan W. Von den Hoff , Floor A.C. Berden , Annemarie Noordeloos , Thomas Knuijver , Arnt F.A. Schellekens , Joost P.H. Drenth","doi":"10.1016/j.drugalcdep.2025.113014","DOIUrl":"10.1016/j.drugalcdep.2025.113014","url":null,"abstract":"<div><h3>Background</h3><div>People who use drugs (PWUD) are an important population of focus for hepatitis C virus (HCV) elimination. Case-finding and treatment of these patients in outpatient specialist care is a challenge due to population specific barriers. Screening and treatment integrated in addiction care might overcome these barriers. With this study we aim to evaluate the implementation of a decentralized PWUD-HCV care model.</div></div><div><h3>Methods</h3><div>We conducted a multicenter prospective observational study in Dutch addiction care centers to assess a decentralized HCV care pathway for PWUD. Implementation of HCV-care within addiction care was evaluated using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework. Viral elimination, defined as the proportion of identified HCV-RNA positive PWUD achieving sustained virologic response (SVR), was the primary outcome.</div></div><div><h3>Results</h3><div>Reach: 870 anti-HCV tests were performed, 29 HCV-RNA positive PWUD were enrolled. Effectiveness: 23 patients initiated and completed on-site treatment, three patients were referred for treatment, two patients were lost to follow-up and one patient refused treatment. All patients tested for SVR achieved SVR, one patient was lost to follow-up before SVR test. The elimination rate was 86 % (25/29). Adoption: five out of eleven addiction care organizations (45 %) implemented decentralized HCV care within addiction care. Implementation fidelity was high.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that successfully implemented decentralized HCV care within addiction services is feasible and highly effective, achieving an elimination rate of 86 %. However, adoption of decentralized HCV care was limited, underscoring the need for targeted strategies to enhance implementation. Our findings support expanding of decentralized HCV care models in addiction settings to meet HCV elimination targets.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113014"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923351","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

Addiction research and national resilience: Protecting surveillance, treatment development, and integrated care 成瘾研究和国家恢复力：保护监测、治疗发展和综合护理

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-02-01 Epub Date: 2025-12-12 DOI: 10.1016/j.drugalcdep.2025.113002

Julio C. Nunes, Joao P. De Aquino

引用次数: 0

Randomized studies assessing the effect of flavor on pharmacokinetic and subjective parameters for dry and moist nicotine pouches 评估风味对干湿尼古丁袋的药代动力学和主观参数影响的随机研究

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2026-02-01 Epub Date: 2026-01-20 DOI: 10.1016/j.drugalcdep.2026.113050

Mikael Staaf, Anna E. Masser , Camilla Pramfalk , Robert Pendrill, Sara Moses, Johan Lindholm, Tryggve Ljung

Background

Nicotine pouches (NPs) have different formulations (e.g., dry or moist), and the vast majority are flavored. However, it is unclear if flavors exert any effect on nicotine pharmacology and subjective parameters.

Methods

Data from two, open-label, randomized, nine-way cross-over, single-dose administration, pharmacokinetic and subjective effects studies were analyzed, evaluating dry 6-mg and moist 9-mg NPs, respectively. The studies included unflavored and flavored varieties (flavor characteristics: traditional [tobacco], cooling, minty, fruit, beverage). All participants were adults who currently used snus and/or NPs daily (n = 38 for moist, n = 39 for dry).

Results

Maximum plasma concentrations (C_max) of nicotine were observed at NP removal at ~60 min (T_max), with overlapping geometric least squares mean (GLSM) values for the dry and moist products (12.08–15.07 ng/mL). The total nicotine exposure (calculated as area under the curve from time point 0 to infinity, AUC_inf) was 40.84–50.86 h⁎ng/mL, with overlapping GLSM values for dry and moist varieties. Equivalence testing for AUC_inf and C_max between unflavored and flavored varieties showed equivalence for all varieties except two of the moist minty NPs. For subjective parameters, the effect of flavor was more pronounced for moist NPs, with participants rating the flavored varieties higher for satisfaction, product liking, and intent to use again.

Conclusions

For dry varieties, flavor had no effect on C_max and AUC_inf, but two moist varieties were different from moist unflavored. Flavor did not affect T_max for dry or moist NPs. Considerable variation in participant preferences suggest a need for diverse varieties and product types.

尼古丁袋（NPs）有不同的配方（例如，干的或湿的），绝大多数是调味的。然而，尚不清楚香料是否对尼古丁的药理学和主观参数有任何影响。方法分析两项开放标签、随机、九向交叉、单剂量给药、药代动力学和主观效应研究的数据，分别评价干燥型6 mg和湿润型9 mg NPs。研究包括无风味和有风味的品种（风味特征：传统[烟草]，冷却，薄荷，水果，饮料）。所有参与者都是目前每天使用鼻烟和/或NPs的成年人（n = 38为潮湿，n = 39为干燥）。结果在NP去除~60 min （Tmax）时，烟碱的最大血浆浓度（Cmax）出现重叠，干湿产品的几何最小二乘平均值（GLSM）为12.08 ~ 15.07 ng/mL。总尼古丁暴露量（以从时间点0到无限长的曲线下面积计算，AUCinf）为40.84 ~ 50.86 h·ng/mL，干湿品种的GLSM值重叠。无味和有味品种间的AUCinf和Cmax等效性试验表明，除两种湿薄荷NPs外，其他品种均相等。在主观参数方面，风味的影响对潮湿的NPs更为明显，参与者在满意度、产品喜好和再次使用的意图方面对风味品种的评价更高。结论对于干型品种，风味对Cmax和aucf没有影响，但两种湿型品种与湿型无风味品种不同。风味对干性和湿性NPs的Tmax没有影响。参与者偏好的巨大差异表明需要多样化的品种和产品类型。

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引用次数: 0