Drug and alcohol dependence最新文献_第5页

Population perinatal substance use and an environmental scan of health services in British Columbia, Canada 加拿大不列颠哥伦比亚省围产期药物使用人群和医疗服务环境扫描。

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-27 DOI: 10.1016/j.drugalcdep.2024.112457

Micah Piske , Shannon Joyce , Youwei Yan , Noah Katsuno , Fahmida Homayra , Michelle J. Zanette , Brittany Barker , Louise Meilleur , Bronwyn McBride , Pamela Joshi , Eva Sullivan , Bohdan Nosyk

Background

Substance use during pregnancy is underreported globally and there is limited data on its prevalence and the availability of supportive services. This study determined population perinatal substance use in British Columbia (BC) by region and examined the availability of clinical and community-based programs.

Methods

Using linked provincial health administrative data, we conducted a population-based retrospective cohort study including all BC residents accessing care for substance use (alcohol, opioids, stimulants, sedatives, and cannabis) within 12 months of first perinatal care record to delivery during 2016–2021. We also conducted an environmental scan to identify all programs offering perinatal care and substance use treatment/support in BC as of December 2022 and described program components by region.

Results

The population included 12,439 people with perinatal substance use with 13,814 linked livebirths during the study period. The incidence rate of perinatal substance use was nearly eight times higher in rural/remote Northern BC compared to the metropolitan Vancouver Coastal region (1044.2 vs. 131.3 per 100,000 population, respectively). We identified 29 related services (19 wrap-around programs, 8 supportive housing, and only 2 acute care programs). Residents outside of Metro Vancouver accounted for 60 % (N=1745) of people with perinatal substance use; however, these regions represented only 35 % of BC’s specialized acute care and supportive housing beds (N=140).

Conclusions

Expanding supports for perinatal substance use - particularly acute care and supportive housing within more rural/remote regions in BC - will be critical to address geographic inequities in access to perinatal care and improve health outcomes for pregnant people who use substances and their infants.

背景：在全球范围内，对孕期使用药物的报告不足，有关其流行率和支持性服务可用性的数据也很有限。本研究按地区确定了不列颠哥伦比亚省（BC）围产期药物使用人群，并考察了临床和社区项目的可用性：利用链接的省级卫生行政数据，我们开展了一项基于人群的回顾性队列研究，研究对象包括在 2016-2021 年间因使用药物（酒精、阿片类药物、兴奋剂、镇静剂和大麻）而在首次围产期护理记录至分娩的 12 个月内接受护理的所有不列颠哥伦比亚省居民。我们还进行了环境扫描，以确定不列颠哥伦比亚省截至 2022 年 12 月提供围产期护理和药物使用治疗/支持的所有计划，并按地区描述了计划的组成部分：研究对象包括 12,439 名围产期药物使用患者和 13,814 名相关活产婴儿。与大都市温哥华沿海地区相比，不列颠哥伦比亚省北部农村/偏远地区的围产期药物使用发病率高出近八倍（分别为每 10 万人口中 1044.2 例与 131.3 例）。我们确定了 29 项相关服务（19 项环绕计划、8 项支持性住房和仅 2 项急症护理计划）。大温哥华地区以外的居民占围产期药物使用患者的60%（N=1745）；然而，这些地区仅占不列颠哥伦比亚省专业急症护理和支持性住房床位的35%（N=140）：结论：扩大对围产期药物使用的支持--特别是在不列颠哥伦比亚省更多的农村/偏远地区提供急症护理和支持性住房--对于解决围产期护理机会方面的地域不平等以及改善药物使用孕妇及其婴儿的健康状况至关重要。

{"title":"Population perinatal substance use and an environmental scan of health services in British Columbia, Canada","authors":"Micah Piske , Shannon Joyce , Youwei Yan , Noah Katsuno , Fahmida Homayra , Michelle J. Zanette , Brittany Barker , Louise Meilleur , Bronwyn McBride , Pamela Joshi , Eva Sullivan , Bohdan Nosyk","doi":"10.1016/j.drugalcdep.2024.112457","DOIUrl":"10.1016/j.drugalcdep.2024.112457","url":null,"abstract":"<div><h3>Background</h3><div>Substance use during pregnancy is underreported globally and there is limited data on its prevalence and the availability of supportive services. This study determined population perinatal substance use in British Columbia (BC) by region and examined the availability of clinical and community-based programs.</div></div><div><h3>Methods</h3><div>Using linked provincial health administrative data, we conducted a population-based retrospective cohort study including all BC residents accessing care for substance use (alcohol, opioids, stimulants, sedatives, and cannabis) within 12 months of first perinatal care record to delivery during 2016–2021. We also conducted an environmental scan to identify all programs offering perinatal care and substance use treatment/support in BC as of December 2022 and described program components by region.</div></div><div><h3>Results</h3><div>The population included 12,439 people with perinatal substance use with 13,814 linked livebirths during the study period. The incidence rate of perinatal substance use was nearly eight times higher in rural/remote Northern BC compared to the metropolitan Vancouver Coastal region (1044.2 vs. 131.3 per 100,000 population, respectively). We identified 29 related services (19 wrap-around programs, 8 supportive housing, and only 2 acute care programs). Residents outside of Metro Vancouver accounted for 60 % (N=1745) of people with perinatal substance use; however, these regions represented only 35 % of BC’s specialized acute care and supportive housing beds (N=140).</div></div><div><h3>Conclusions</h3><div>Expanding supports for perinatal substance use - particularly acute care and supportive housing within more rural/remote regions in BC - will be critical to address geographic inequities in access to perinatal care and improve health outcomes for pregnant people who use substances and their infants.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112457"},"PeriodicalIF":3.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Buprenorphine use among non-hospital residential programs 非医院住院计划中丁丙诺啡的使用情况。

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-26 DOI: 10.1016/j.drugalcdep.2024.112456

Cynthia Nichols , Daniel Baslock , Margaret Lloyd Sieger

Background

The purpose of this study is to investigate the use of buprenorphine within non-hospital residential programs. We hypothesize that programs offering long-term treatment will be less likely to accept or prescribe buprenorphine, but those that accept public insurance will demonstrate relative increased likelihood of buprenorphine availability.

Method

This study analyzed data from the 2021 National Substance Use and Mental Health Services Survey. The analytic sample (n=3654) included a subset of facilities that reported providing only substance use treatment, including three non-mutually exclusive service types: detox, short-term, and long-term. A logistic regression examined the association between buprenorphine availability and residential service type, holding constant characteristics associated with the outcome of interest. We then tested an interaction between public insurance and long-term service type on the outcome of interest.

Results

While long-term service type was associated with reduced odds of buprenorphine availability (OR=.288, p <.05), programs that both offered long-term residential programs and accepted public health insurance had 3.5 higher odds of accepting or prescribing buprenorphine (OR=4.586, p<.01) compared to long-term programs without public insurance.

Implications

Patients who require treatment of longer duration may face barriers to buprenorphine availability; however, public insurance acceptance may increase odds of availability of buprenorphine among long-term programs.

研究背景本研究旨在调查丁丙诺啡在非医院住院治疗项目中的使用情况。我们假设，提供长期治疗的项目不太可能接受或处方丁丙诺啡，但那些接受公共保险的项目则会相对增加丁丙诺啡的可用性：本研究分析了 2021 年全国药物使用和心理健康服务调查的数据。分析样本（n=3654）包括报告仅提供药物使用治疗的机构子集，其中包括三种非相互排斥的服务类型：戒毒、短期和长期。在与相关结果相关的特征保持不变的情况下，逻辑回归检验了丁丙诺啡可用性与住院服务类型之间的关联。然后，我们测试了公共保险和长期服务类型对相关结果的交互作用：尽管长期服务类型与丁丙诺啡可用性的几率降低有关（OR=.288，P需要长期治疗的患者可能会面临丁丙诺啡供应的障碍；然而，公共保险的接受度可能会增加长期项目中丁丙诺啡的供应几率。

{"title":"Buprenorphine use among non-hospital residential programs","authors":"Cynthia Nichols , Daniel Baslock , Margaret Lloyd Sieger","doi":"10.1016/j.drugalcdep.2024.112456","DOIUrl":"10.1016/j.drugalcdep.2024.112456","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to investigate the use of buprenorphine within non-hospital residential programs. We hypothesize that programs offering long-term treatment will be less likely to accept or prescribe buprenorphine, but those that accept public insurance will demonstrate relative increased likelihood of buprenorphine availability.</div></div><div><h3>Method</h3><div>This study analyzed data from the 2021 National Substance Use and Mental Health Services Survey. The analytic sample (n=3654) included a subset of facilities that reported providing only substance use treatment, including three non-mutually exclusive service types: detox, short-term, and long-term. A logistic regression examined the association between buprenorphine availability and residential service type, holding constant characteristics associated with the outcome of interest. We then tested an interaction between public insurance and long-term service type on the outcome of interest.</div></div><div><h3>Results</h3><div>While long-term service type was associated with reduced odds of buprenorphine availability (OR=.288, p <.05), programs that both offered long-term residential programs <em>and</em> accepted public health insurance had 3.5 higher odds of accepting or prescribing buprenorphine (OR=4.586, p<.01) compared to long-term programs without public insurance.</div></div><div><h3>Implications</h3><div>Patients who require treatment of longer duration may face barriers to buprenorphine availability; however, public insurance acceptance may increase odds of availability of buprenorphine among long-term programs.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112456"},"PeriodicalIF":3.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383039","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

Effects of in vivo NRT sampling on smoking abstinence and NRT adherence: A randomized clinical trial 体内 NRT 采样对戒烟和 NRT 依从性的影响：随机临床试验。

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-26 DOI: 10.1016/j.drugalcdep.2024.112458

Karen L. Cropsey , William P. Wagner , Andrew Bontemps , Elizabeth Hawes , Bailey Pridgen , Adrienne C. Lahti , Peter S. Hendricks , Andres Azuero , Matthew J. Carpenter

Background

Nicotine replacement therapy (NRT) is an effective treatment but is associated with poor adherence during smoking cessation attempts. This study aimed to determine if In Vivo Sampling, an experiential intervention that includes sampling of NRT in-session, increases NRT adherence and smoking abstinence compared to standard smoking cessation behavioral counseling.

Methods

Eligible participants were under community corrections supervision and smoked five or more cigarettes per day for the past year. Participants were randomly assigned to receive either In Vivo Sampling or standard smoking cessation behavioral counseling. Both interventions involved four 30-minute sessions and received 12 weeks of combination NRT. Self-reported NRT adherence, quit attempts, and carbon monoxide (CO)-verified smoking cessation were measured at one, three-, and six-months post-intervention.

Results

From 2017–2022, 515 participants were enrolled and randomized. The In Vivo Sampling group had significantly greater mean adherence to patch and lozenge NRT regimens (71 % vs. 60 %, OR: 1.63, 95 % CI: 1.36–1.96, p<.001). The In Vivo group had a significantly higher likelihood of quit attempts across time (61 % vs. 53 %, OR: 1.4, 95 % CI: 1.05–1.87, p=.021). Groups did not significantly differ on the percent of participants who had quit smoking at 6 months post-intervention (17 % In Vivo Sampling vs. 13 % standard counseling, OR: 1.43, p=.24).

Conclusion

In Vivo Sampling demonstrated better NRT adherence and quit attempts but similar cessation rates to standard behavioral counseling. The In Vivo Sampling intervention represents a novel approach that increased behaviors typically associated with successful cessation over standard behavioral counseling.

背景：尼古丁替代疗法（NRT）是一种有效的治疗方法，但在戒烟尝试中的依从性较差。本研究旨在确定，与标准的戒烟行为咨询相比，体内采样这种包括在治疗过程中采样尼古丁替代疗法的体验式干预是否能提高尼古丁替代疗法的依从性和戒烟率：符合条件的参与者均在社区矫正监管之下，且在过去一年中每天吸烟五支或五支以上。参与者被随机分配接受体内采样或标准戒烟行为咨询。两种干预都包括四次 30 分钟的课程，并接受为期 12 周的联合 NRT 治疗。在干预后的一个月、三个月和六个月测量自我报告的NRT依从性、戒烟尝试和一氧化碳（CO）验证的戒烟情况：从 2017 年到 2022 年，共有 515 名参与者被纳入并进行了随机干预。In Vivo 采样组对贴片和锭剂 NRT 方案的平均依从性明显更高（71 % vs. 60 %，OR：1.63，95 % CI：1.36-1.96，pConclusion）：体内采样法显示出更好的 NRT 依从性和戒烟尝试，但戒烟率与标准行为咨询相似。体内取样干预是一种新方法，与标准行为咨询相比，它能增加通常与成功戒烟相关的行为。

{"title":"Effects of in vivo NRT sampling on smoking abstinence and NRT adherence: A randomized clinical trial","authors":"Karen L. Cropsey , William P. Wagner , Andrew Bontemps , Elizabeth Hawes , Bailey Pridgen , Adrienne C. Lahti , Peter S. Hendricks , Andres Azuero , Matthew J. Carpenter","doi":"10.1016/j.drugalcdep.2024.112458","DOIUrl":"10.1016/j.drugalcdep.2024.112458","url":null,"abstract":"<div><h3>Background</h3><div>Nicotine replacement therapy (NRT) is an effective treatment but is associated with poor adherence during smoking cessation attempts. This study aimed to determine if In Vivo Sampling, an experiential intervention that includes sampling of NRT in-session, increases NRT adherence and smoking abstinence compared to standard smoking cessation behavioral counseling.</div></div><div><h3>Methods</h3><div>Eligible participants were under community corrections supervision and smoked five or more cigarettes per day for the past year. Participants were randomly assigned to receive either In Vivo Sampling or standard smoking cessation behavioral counseling. Both interventions involved four 30-minute sessions and received 12 weeks of combination NRT. Self-reported NRT adherence, quit attempts, and carbon monoxide (CO)-verified smoking cessation were measured at one, three-, and six-months post-intervention.</div></div><div><h3>Results</h3><div>From 2017–2022, 515 participants were enrolled and randomized. The In Vivo Sampling group had significantly greater mean adherence to patch and lozenge NRT regimens (71 % vs. 60 %, OR: 1.63, 95 % CI: 1.36–1.96, p<.001). The In Vivo group had a significantly higher likelihood of quit attempts across time (61 % vs. 53 %, OR: 1.4, 95 % CI: 1.05–1.87, p=.021). Groups did not significantly differ on the percent of participants who had quit smoking at 6 months post-intervention (17 % In Vivo Sampling vs. 13 % standard counseling, OR: 1.43, p=.24).</div></div><div><h3>Conclusion</h3><div>In Vivo Sampling demonstrated better NRT adherence and quit attempts but similar cessation rates to standard behavioral counseling. The In Vivo Sampling intervention represents a novel approach that increased behaviors typically associated with successful cessation over standard behavioral counseling.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112458"},"PeriodicalIF":3.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142368006","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

Trends in injectable buprenorphine prescribing in Canada: A descriptive analysis in five Canadian Provinces 加拿大注射用丁丙诺啡处方的趋势：加拿大五个省的描述性分析

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-24 DOI: 10.1016/j.drugalcdep.2024.112451

Philippe Boilard , Tianru Wang , Anita Iacono , S Monty Ghosh , Tara Gomes

Background

Injectable extended-release buprenorphine (BUP-ER) (Sublocade®) is a newer form of opioid agonist therapy (OAT) administered monthly. It was listed on formularies across Canada in February 2020, expanding the options for OAT across the country. This study describes rates of injectable BUP-ER uptake in five provinces to compare access to this novel medication across Canada.

Methods

We conducted a retrospective time-series analysis among individuals who received injectable BUP-ER in British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario from February 1, 2020, to March 31, 2022. The primary outcome was the population-adjusted rate of injectable BUP-ER in each province, with secondary analyses exploring rates by urban/rural location, and the number of prescribers of injectable BUP-ER per 100,000 population.

Results

In total, 6528 individuals were treated with injectable BUP-ER, with the majority in British Columbia (29.0 %) and Ontario (47.0 %). By March 2022, the rate of BUP-ER use was highest in British Columbia (16.6 per 100,000), and lowest in Ontario (9.1 per 100,000). The rate of BUP-ER use was higher in rural areas (15.5 per 100,000) compared to urban centres (10.6 per 100,000), and British Columbia had the highest rate of prescribers per 100,000 population (5.9) compared to Ontario (2.2), Alberta (2.3), Saskatchewan (3.4) and Manitoba (3.5) by the end of Q1–2022.

Conclusion

Uptake of BUP-ER varied geographically since being approved by Health Canada. More rapid uptake in rural areas is reassuring and suggests that this form of OAT may be supporting treatment access to those with barriers to more traditional treatment formulations.

背景注射用缓释丁丙诺啡（BUP-ER）（Sublocade®）是一种较新的阿片激动剂疗法（OAT），每月给药一次。它于 2020 年 2 月被列入加拿大全国的处方集，从而扩大了全国范围内 OAT 的选择范围。本研究描述了五个省份的注射用 BUP-ER 使用率，以比较加拿大各地获得这种新型药物的情况。方法我们对 2020 年 2 月 1 日至 2022 年 3 月 31 日期间不列颠哥伦比亚省、艾伯塔省、萨斯喀彻温省、马尼托巴省和安大略省接受注射用 BUP-ER 的个人进行了回顾性时间序列分析。主要结果是各省经人口调整后的注射用 BUP-ER 使用率，次要分析包括城市/农村地区的使用率，以及每 10 万人口中注射用 BUP-ER 的处方者数量。截至 2022 年 3 月，不列颠哥伦比亚省的 BUP-ER 使用率最高（每 10 万人中有 16.6 人使用），安大略省最低（每 10 万人中有 9.1 人使用）。到 2022 年第一季度末，BUP-ER 在农村地区的使用率（每 100,000 人中有 15.5 人）高于城市中心（每 100,000 人中有 10.6 人），不列颠哥伦比亚省每 100,000 人中的处方者比例最高（5.9 人），而安大略省（2.2 人）、艾伯塔省（2.3 人）、萨斯喀彻温省（3.4 人）和马尼托巴省（3.5 人）的处方者比例最低。令人欣慰的是，农村地区的吸收速度更快，这表明这种形式的 OAT 可能有助于那些在接受更传统的治疗配方方面存在障碍的人获得治疗。

{"title":"Trends in injectable buprenorphine prescribing in Canada: A descriptive analysis in five Canadian Provinces","authors":"Philippe Boilard , Tianru Wang , Anita Iacono , S Monty Ghosh , Tara Gomes","doi":"10.1016/j.drugalcdep.2024.112451","DOIUrl":"10.1016/j.drugalcdep.2024.112451","url":null,"abstract":"<div><h3>Background</h3><div>Injectable extended-release buprenorphine (BUP-ER) (Sublocade®) is a newer form of opioid agonist therapy (OAT) administered monthly. It was listed on formularies across Canada in February 2020, expanding the options for OAT across the country. This study describes rates of injectable BUP-ER uptake in five provinces to compare access to this novel medication across Canada.</div></div><div><h3>Methods</h3><div>We conducted a retrospective time-series analysis among individuals who received injectable BUP-ER in British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario from February 1, 2020, to March 31, 2022. The primary outcome was the population-adjusted rate of injectable BUP-ER in each province, with secondary analyses exploring rates by urban/rural location, and the number of prescribers of injectable BUP-ER per 100,000 population.</div></div><div><h3>Results</h3><div>In total, 6528 individuals were treated with injectable BUP-ER, with the majority in British Columbia (29.0 %) and Ontario (47.0 %). By March 2022, the rate of BUP-ER use was highest in British Columbia (16.6 per 100,000), and lowest in Ontario (9.1 per 100,000). The rate of BUP-ER use was higher in rural areas (15.5 per 100,000) compared to urban centres (10.6 per 100,000), and British Columbia had the highest rate of prescribers per 100,000 population (5.9) compared to Ontario (2.2), Alberta (2.3), Saskatchewan (3.4) and Manitoba (3.5) by the end of Q1–2022.</div></div><div><h3>Conclusion</h3><div>Uptake of BUP-ER varied geographically since being approved by Health Canada. More rapid uptake in rural areas is reassuring and suggests that this form of OAT may be supporting treatment access to those with barriers to more traditional treatment formulations.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112451"},"PeriodicalIF":3.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding the motivational mechanisms for smoking and vaping among dual users and exclusive smokers 了解双重吸烟者和专门吸烟者吸烟和吸食电子烟的动机机制

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-19 DOI: 10.1016/j.drugalcdep.2024.112436

Jennifer M. Betts , Jessica W. Cook , Kate H. Kobinsky , Timothy B. Baker , Douglas E. Jorenby , Megan E. Piper

Background

Understanding the motivational processes that influence e-cigarette use in a laboratory setting may help elucidate mechanisms that support long-term ecigarette use, which could have significant clinical and public health consequences.

Methods

Secondary analyses were conducted on data from exclusive smokers (N=47) and dual users (N=88) who underwent a laboratory ad lib use session. Participants were given 10 minutes to smoke (exclusive smokers) or vape (dual users) as much as they wanted. Withdrawal was assessed pre- and post-use. Smoking and vaping behavior was coded from session videos. Person-level predictors included cigarette/ecigarette craving-relief expectancies, demographics, and cigarette/e-cigarette use and dependence. Smoking and vaping status was assessed at Year 1 using self-reported 30-day point prevalence. Data were analyzed using general linear models and logistic regressions.

Results

Both groups reported reductions in withdrawal after product use, including cigarette craving. Baseline e-cigarette craving-relief expectancies, pre-session ecigarette craving, heaviness of e-cigarette use, and relative e-cigarette dependence were significant univariate predictors of continued vaping in dual users at Year 1 (ORs>1.04, ps<.05). Dual users and exclusive smokers did not differ on use behavior (i.e., average number of puffs, ps>.16).

Conclusions

E-cigarette use alleviated withdrawal, including cigarette and e-cigarette craving, in dual users. Laboratory use behavior did not differ between dual users using e-cigarettes and exclusive smokers using cigarettes. Greater e-cigarette craving-relief expectancies, e-cigarette craving, heaviness of e-cigarette use, and morning product use pattern (‘relative dependence’) may reflect mechanisms that sustain e-cigarette use.

背景了解在实验室环境中影响电子烟使用的动机过程可能有助于阐明支持长期使用电子烟的机制，这可能会对临床和公共健康产生重大影响。方法对接受实验室自由使用环节的专属吸烟者（N=47）和双重使用者（N=88）的数据进行了二次分析。参与者有10分钟的时间随意吸烟（完全吸烟者）或吸食毒品（双重使用者）。对使用前和使用后的戒断情况进行了评估。吸烟和吸食电子烟的行为是通过会话视频进行编码的。个人层面的预测因素包括香烟/电子烟渴望-缓解期望、人口统计学、香烟/电子烟使用和依赖。在第一年，使用自我报告的 30 天点流行率评估吸烟和吸电子烟状况。使用一般线性模型和逻辑回归对数据进行了分析。基线电子烟渴求缓解预期、会前电子烟渴求、电子烟使用强度和电子烟相对依赖性是双重使用者在第一年继续吸食电子烟的重要单变量预测因素（ORs>1.04, ps<.05）。结论使用电子烟可减轻双重使用者的戒断症状，包括对香烟和电子烟的渴求。使用电子烟的双重使用者与使用香烟的纯吸烟者在实验室使用行为上没有差异。更大的电子烟渴求缓解预期、电子烟渴求、电子烟使用强度和上午产品使用模式（"相对依赖"）可能反映了维持电子烟使用的机制。

{"title":"Understanding the motivational mechanisms for smoking and vaping among dual users and exclusive smokers","authors":"Jennifer M. Betts , Jessica W. Cook , Kate H. Kobinsky , Timothy B. Baker , Douglas E. Jorenby , Megan E. Piper","doi":"10.1016/j.drugalcdep.2024.112436","DOIUrl":"10.1016/j.drugalcdep.2024.112436","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the motivational processes that influence e-cigarette use in a laboratory setting may help elucidate mechanisms that support long-term ecigarette use, which could have significant clinical and public health consequences.</div></div><div><h3>Methods</h3><div>Secondary analyses were conducted on data from exclusive smokers (<em>N</em>=47) and dual users (<em>N</em>=88) who underwent a laboratory <em>ad lib</em> use session. Participants were given 10minutes to smoke (exclusive smokers) or vape (dual users) as much as they wanted. Withdrawal was assessed pre- and post-use. Smoking and vaping behavior was coded from session videos. Person-level predictors included cigarette/ecigarette craving-relief expectancies, demographics, and cigarette/e-cigarette use and dependence. Smoking and vaping status was assessed at Year 1 using self-reported 30-day point prevalence. Data were analyzed using general linear models and logistic regressions.</div></div><div><h3>Results</h3><div>Both groups reported reductions in withdrawal after product use, including cigarette craving. Baseline e-cigarette craving-relief expectancies, pre-session ecigarette craving, heaviness of e-cigarette use, and relative e-cigarette dependence were significant univariate predictors of continued vaping in dual users at Year 1 (<em>OR</em>s>1.04, <em>p</em>s<.05). Dual users and exclusive smokers did not differ on use behavior (i.e., average number of puffs, <em>p</em>s>.16).</div></div><div><h3>Conclusions</h3><div>E-cigarette use alleviated withdrawal, including cigarette and e-cigarette craving, in dual users. Laboratory use behavior did not differ between dual users using e-cigarettes and exclusive smokers using cigarettes. Greater e-cigarette craving-relief expectancies, e-cigarette craving, heaviness of e-cigarette use, and morning product use pattern (‘relative dependence’) may reflect mechanisms that sustain e-cigarette use.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112436"},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328117","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

Criminal legal system engagement among people who use drugs in Oregon following decriminalization of drug possession 持有毒品非刑罪化后俄勒冈州吸毒者参与刑事法律系统的情况

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-19 DOI: 10.1016/j.drugalcdep.2024.112449

Hope M. Smiley-McDonald , Esther Chung , Lynn D. Wenger , Morgan Godvin , Danielle Good , Gillian Leichtling , Erica N. Browne , Barrot H. Lambdin , Alex H. Kral

Background

In February 2021, Measure 110 (M110) in Oregon decriminalized noncommercial possession of drugs. We examined criminal legal system (CLS) involvement of people who use drugs (PWUD) 2 years after decriminalization.

Methods

We conducted a quantitative survey of PWUD (N=468) in eight Oregon counties between March and November 2023. We ran multivariable models to examine predictors of CLS involvement and law enforcement stops.

Results

The majority of PWUD (74 %) reported any past year CLS involvement; 67 % had at least one law enforcement stop (mean of 11.4 and median of 3 law enforcement stops) and 33 % had at least one jail incarceration. Among PWUD whom law enforcement had found to possess drugs (n=101), 77 % had their drugs seized at least once, and 63 % (n=56) were taken into custody for charges that did not include drug use or possession at least once. Younger age, cisgender male identity, unstable housing, and nonurban county location were associated with a higher prevalence of any CLS involvement. PWUD who were unstably housed had 6.80 more law enforcement stops than housed PWUD (95 % CI: 4.03–9.57). PWUD in nonurban counties experienced 9.73 more law enforcement stops than those in urban areas (95 % CI: 4.90–14.56). No significant differences were found by race or ethnicity and CLS involvement. Only 13 % of PWUD were aware that all drugs had been decriminalized.

Conclusions

Despite drug decriminalization, the majority of PWUD in our study reported significant CLS engagement and limited M110 knowledge.

背景2021年2月，俄勒冈州110号法案（M110）将非商业性持有毒品非刑罪化。我们在 2023 年 3 月至 11 月期间对俄勒冈州 8 个县的吸毒者（468 人）进行了定量调查。结果大多数吸毒成瘾者（74%）报告说过去一年曾参与过 CLS；67% 的人至少被执法部门拦截过一次（平均 11.4 次，中位数为 3 次），33% 的人至少被监禁过一次。在被执法人员发现持有毒品的残疾人中（人数=101），77%的人至少有一次被没收毒品，63%的人至少有一次（人数=56）因不包括使用或持有毒品的指控而被拘留。年龄较小、顺性别男性身份、住房不稳定以及位于非城市县城与参与任何社区服务的流行率较高有关。与有住房的残疾人相比，住房不稳定的残疾人被执法部门拦截的次数多 6.80 次（95 % CI：4.03-9.57）。非城市县的残疾人比城市地区的残疾人多经历了 9.73 次执法拦截（95 % CI：4.90-14.56）。在种族或民族以及 CLS 参与度方面没有发现明显差异。只有 13% 的残疾人知道所有毒品都已非刑罪化。结论尽管毒品非刑罪化，但在我们的研究中，大多数残疾人都表示参与了大量的社区法律服务，对 M110 的了解有限。

{"title":"Criminal legal system engagement among people who use drugs in Oregon following decriminalization of drug possession","authors":"Hope M. Smiley-McDonald , Esther Chung , Lynn D. Wenger , Morgan Godvin , Danielle Good , Gillian Leichtling , Erica N. Browne , Barrot H. Lambdin , Alex H. Kral","doi":"10.1016/j.drugalcdep.2024.112449","DOIUrl":"10.1016/j.drugalcdep.2024.112449","url":null,"abstract":"<div><h3>Background</h3><div>In February 2021, Measure 110 (M110) in Oregon decriminalized noncommercial possession of drugs. We examined criminal legal system (CLS) involvement of people who use drugs (PWUD) 2 years after decriminalization.</div></div><div><h3>Methods</h3><div>We conducted a quantitative survey of PWUD (N=468) in eight Oregon counties between March and November 2023. We ran multivariable models to examine predictors of CLS involvement and law enforcement stops.</div></div><div><h3>Results</h3><div>The majority of PWUD (74 %) reported any past year CLS involvement; 67 % had at least one law enforcement stop (mean of 11.4 and median of 3 law enforcement stops) and 33 % had at least one jail incarceration. Among PWUD whom law enforcement had found to possess drugs (n=101), 77 % had their drugs seized at least once, and 63 % (n=56) were taken into custody for charges that did not include drug use or possession at least once. Younger age, cisgender male identity, unstable housing, and nonurban county location were associated with a higher prevalence of any CLS involvement. PWUD who were unstably housed had 6.80 more law enforcement stops than housed PWUD (95 % CI: 4.03–9.57). PWUD in nonurban counties experienced 9.73 more law enforcement stops than those in urban areas (95 % CI: 4.90–14.56). No significant differences were found by race or ethnicity and CLS involvement. Only 13 % of PWUD were aware that all drugs had been decriminalized.</div></div><div><h3>Conclusions</h3><div>Despite drug decriminalization, the majority of PWUD in our study reported significant CLS engagement and limited M110 knowledge.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112449"},"PeriodicalIF":3.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319529","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

Community-based medical education in addiction and harm reduction: Perspectives on addiction medicine training 以社区为基础的成瘾和减低伤害医学教育：成瘾医学培训视角

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-18 DOI: 10.1016/j.drugalcdep.2024.112448

Sara Beeler , Elisabeth A. Poorman , Sarah E. Messmer , Geoffrey V. Stetson , Madelyn Perez

引用次数: 0

Effects of xylazine on naloxone-precipitated fentanyl withdrawal in male and female rats 羟嗪对纳洛酮沉淀诱发的雌雄大鼠芬太尼戒断的影响

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-16 DOI: 10.1016/j.drugalcdep.2024.112450

Hannah N. Carlson , Anthony G. Spera , Mark A. Smith

Purpose

The combination of fentanyl and xylazine (i.e., “tranq-dope”) was recently declared an emerging national health threat in the United States. Given the recency of this development, very little is known regarding the behavioral pharmacology of fentanyl-xylazine combinations. The purpose of this study was to characterize the somatic and affective withdrawal symptoms of this drug combination.

Methods

Male and female Long Evans rats were given twice daily (08:00 and 20:00) subcutaneous injections of fentanyl, xylazine, or combined fentanyl-xylazine for five days. On the sixth (testing) day, rats were given a final injection at 08:00. Four hours later, rats were injected intraperitoneally with either saline or a naloxone challenge before behavioral observation. Somatic withdrawal was examined using the Gellert-Holtzman scale and anxiety-like behavior was examined using the elevated plus maze.

Results

Naloxone administration did not induce somatic or affective symptoms in rats treated with fentanyl alone, a low dose of xylazine alone, or a high dose of xylazine alone. Naloxone induced somatic but not affective withdrawal symptoms in rats treated with both fentanyl and xylazine.

Conclusion

Chronic co-exposure to fentanyl and xylazine produces an opioid-like somatic withdrawal syndrome at doses that are not apparent with either drug alone. These results corroborate clinical reports that xylazine worsens fentanyl withdrawal and suggest that novel interventions may be required to treat withdrawal from fentanyl-xylazine combinations in humans.

目的最近，美国宣布芬太尼和恶嗪（即 "氨甲喋呤"）的复方制剂已成为一种新的国家健康威胁。由于这种药物的出现时间不长，人们对芬太尼和恶嗪复方制剂的行为药理学知之甚少。本研究的目的是描述这种药物组合的躯体和情感戒断症状。方法每天两次（08:00 和 20:00）给雄性和雌性 Long Evans 大鼠皮下注射芬太尼、恶嗪或芬太尼-恶嗪组合，连续注射五天。第六天（测试），大鼠在 08:00 时接受最后一次注射。四小时后，大鼠腹腔注射生理盐水或纳洛酮，然后进行行为观察。结果纳洛酮不会诱发单独使用芬太尼、单独使用低剂量异丙嗪或单独使用高剂量异丙嗪的大鼠出现躯体或情感症状。结论长期同时接触芬太尼和恶嗪会产生类似阿片类药物的躯体戒断综合征，而单独使用其中任何一种药物都不会产生这种症状。这些结果证实了关于恶嗪会加重芬太尼戒断的临床报告，并表明可能需要采取新的干预措施来治疗芬太尼-恶嗪联合用药导致的人体戒断。

{"title":"Effects of xylazine on naloxone-precipitated fentanyl withdrawal in male and female rats","authors":"Hannah N. Carlson , Anthony G. Spera , Mark A. Smith","doi":"10.1016/j.drugalcdep.2024.112450","DOIUrl":"10.1016/j.drugalcdep.2024.112450","url":null,"abstract":"<div><h3>Purpose</h3><p>The combination of fentanyl and xylazine (i.e., “tranq-dope”) was recently declared an emerging national health threat in the United States. Given the recency of this development, very little is known regarding the behavioral pharmacology of fentanyl-xylazine combinations. The purpose of this study was to characterize the somatic and affective withdrawal symptoms of this drug combination.</p></div><div><h3>Methods</h3><p>Male and female Long Evans rats were given twice daily (08:00 and 20:00) subcutaneous injections of fentanyl, xylazine, or combined fentanyl-xylazine for five days. On the sixth (testing) day, rats were given a final injection at 08:00. Four hours later, rats were injected intraperitoneally with either saline or a naloxone challenge before behavioral observation. Somatic withdrawal was examined using the Gellert-Holtzman scale and anxiety-like behavior was examined using the elevated plus maze.</p></div><div><h3>Results</h3><p>Naloxone administration did not induce somatic or affective symptoms in rats treated with fentanyl alone, a low dose of xylazine alone, or a high dose of xylazine alone. Naloxone induced somatic but not affective withdrawal symptoms in rats treated with both fentanyl and xylazine.</p></div><div><h3>Conclusion</h3><p>Chronic co-exposure to fentanyl and xylazine produces an opioid-like somatic withdrawal syndrome at doses that are not apparent with either drug alone<strong>.</strong> These results corroborate clinical reports that xylazine worsens fentanyl withdrawal and suggest that novel interventions may be required to treat withdrawal from fentanyl-xylazine combinations in humans.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112450"},"PeriodicalIF":3.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238902","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

Estimating the societal cost of heroin dependence in an Australian population engaged in treatment or harm reduction services 估算接受治疗或减低危害服务的澳大利亚人对海洛因依赖的社会成本

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-13 DOI: 10.1016/j.drugalcdep.2024.112447

Natasha Hall , Long Le , Julie Abimanyi-Ochom , Christina Marel , Katherine Mills , Maree Teesson , Cathrine Mihalopoulos

Introduction

Heroin dependence is a public health concern in Australia. High mortality rates, increased risk of physical/mental health comorbidities and increased risk of social issues contribute to a high personal and societal cost. The aim of this paper is to understand the societal cost of heroin dependence in an Australian population.

Methods

A longitudinal cohort study of 600 people with heroin dependence were interviewed at five timepoints. Resource use was determined from interviews and was multiplied by unit costs to estimate the annual healthcare, productivity, crime and other costs (homelessness, heroin drug and prison costs). The monetary value of premature mortality was calculated using the value of a statistical life year method.

Results

The annual mean societal cost of heroin dependence in Australia was A$120,599/person. This included healthcare costs (A$10,055), lost productivity costs (A$63,158), crime costs (A$7204) and other costs (A$40,182). Healthcare costs, lost productivity costs, crime costs and other costs trended downwards over the five waves. Lost productivity was the highest cost contributor (52 %), followed by heroin drug (25 %). The estimated number of life years lost due to heroin over the 11-year study period was 2703 years, which approximates to a monetary value of premature death of $213 million.

Discussion and conclusions

The significant societal cost emphasises the importance of providing resources to heroin dependence. The cost of lost productivity, crime and heroin contributed to over 80 % of the total costs, which highlights the illicit nature and reduced capacity to work contributes to the high costs to society.

导言海洛因依赖是澳大利亚的一个公共卫生问题。高死亡率、更高的身体/精神健康并发症风险和更高的社会问题风险导致了高昂的个人和社会成本。本文旨在了解澳大利亚海洛因依赖人群的社会成本。方法：对 600 名海洛因依赖者进行纵向队列研究，在五个时间点进行访谈。通过访谈确定资源使用情况，然后乘以单位成本，估算出每年的医疗保健、生产力、犯罪和其他成本（无家可归、海洛因毒品和监狱成本）。过早死亡的货币价值采用统计寿命年值法进行计算。结果澳大利亚海洛因依赖的年平均社会成本为 120,599 澳元/人。其中包括医疗成本（10055 澳元）、生产力损失成本（63158 澳元）、犯罪成本（7204 澳元）和其他成本（40182 澳元）。在五个波次中，医疗费用、生产力损失费用、犯罪费用和其他费用呈下降趋势。生产力损失的成本最高（52%），其次是海洛因毒品（25%）。在 11 年的研究期间，因海洛因而损失的生命年数估计为 2703 年，这近似于 2.13 亿美元的过早死亡货币价值。生产力损失、犯罪和海洛因造成的成本占总成本的 80% 以上，这凸显了海洛因的非法性和工作能力的降低导致了高昂的社会成本。

{"title":"Estimating the societal cost of heroin dependence in an Australian population engaged in treatment or harm reduction services","authors":"Natasha Hall , Long Le , Julie Abimanyi-Ochom , Christina Marel , Katherine Mills , Maree Teesson , Cathrine Mihalopoulos","doi":"10.1016/j.drugalcdep.2024.112447","DOIUrl":"10.1016/j.drugalcdep.2024.112447","url":null,"abstract":"<div><h3>Introduction</h3><div>Heroin dependence is a public health concern in Australia. High mortality rates, increased risk of physical/mental health comorbidities and increased risk of social issues contribute to a high personal and societal cost. The aim of this paper is to understand the societal cost of heroin dependence in an Australian population.</div></div><div><h3>Methods</h3><div>A longitudinal cohort study of 600 people with heroin dependence were interviewed at five timepoints. Resource use was determined from interviews and was multiplied by unit costs to estimate the annual healthcare, productivity, crime and other costs (homelessness, heroin drug and prison costs). The monetary value of premature mortality was calculated using the value of a statistical life year method.</div></div><div><h3>Results</h3><div>The annual mean societal cost of heroin dependence in Australia was A$120,599/person. This included healthcare costs (A$10,055), lost productivity costs (A$63,158), crime costs (A$7204) and other costs (A$40,182). Healthcare costs, lost productivity costs, crime costs and other costs trended downwards over the five waves. Lost productivity was the highest cost contributor (52 %), followed by heroin drug (25 %). The estimated number of life years lost due to heroin over the 11-year study period was 2703 years, which approximates to a monetary value of premature death of $213 million.</div></div><div><h3>Discussion and conclusions</h3><div>The significant societal cost emphasises the importance of providing resources to heroin dependence. The cost of lost productivity, crime and heroin contributed to over 80 % of the total costs, which highlights the illicit nature and reduced capacity to work contributes to the high costs to society.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112447"},"PeriodicalIF":3.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0376871624013723/pdfft?md5=b817daea5f3121e835c69936bb1d138d&pid=1-s2.0-S0376871624013723-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142313024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is severe alcohol use disorder really associated with increased utilitarian moral judgment? Exploration using the CNI model 严重酒精使用障碍真的与功利性道德判断力增强有关吗？使用 CNI 模型进行探索

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence

Pub Date : 2024-09-12 DOI: 10.1016/j.drugalcdep.2024.112435

Mado Gautier , Jessica Mange , Xavier De Longueville , Pierre Maurage

Objectives

The psychology of moral decision-making classically contrasts utilitarianism (based on consequences) and deontology (based on moral norms). Previous studies capitalizing on this dichotomy have suggested the presence of a utilitarian bias among patients with severe alcohol use disorder (SAUD). We aimed to further disentangle the processes involved in such bias through a more validated approach, the CNI model of moral decision-making. This model allows to go further than the classical approach by distinguishing sensitivity to consequences (C), to moral norms (N), and general preference for inaction over action (I) in response to moral dilemmas.

Methods

Thirty-four recently detoxified patients with SAUD and 34 matched control participants completed a battery of 48 dilemmas derived from the CNI model, as well as social cognition tasks.

Results

In contrast with the utilitarian bias suggested in previous studies based on the classical approach, patients with SAUD did not show an increased sensitivity to consequences in comparison with control participants. However, they showed a reduced sensitivity to moral norms, as well as a greater action tendency. These biases were not related to social cognition deficits.

Conclusions

Patients with SAUD are not more utilitarian than healthy controls, this previously reported bias being artificially generated by the methodological limits of the classical approach. Instead, they present a reduced sensitivity to moral norms and an action bias, which might impact their interpersonal relations and contribute to the social isolation frequently reported in this population, thus identifying moral decision-making as a new therapeutic lever in SAUD.

目的道德决策心理学将功利主义（基于后果）和道义论（基于道德规范）进行了经典对比。以往利用这种二分法进行的研究表明，在严重酒精使用障碍（SAUD）患者中存在功利主义偏差。我们的目标是通过一种更有效的方法，即道德决策 CNI 模型，进一步厘清这种偏差所涉及的过程。该模型通过区分对后果的敏感性（C）、对道德规范的敏感性（N）以及在道德两难情况下对不作为而非作为的普遍偏好（I），比经典方法更进一步。结果与以往基于经典方法的研究中提出的功利主义偏差不同，SAUD 患者与对照组参与者相比，对后果的敏感性并没有增加。但是，他们对道德规范的敏感度降低，行动倾向增强。这些偏差与社会认知缺陷无关。结论SAUD 患者的功利性并不比健康对照组高，之前报道的这种偏差是由于经典方法的方法限制而人为造成的。相反，他们对道德规范的敏感性降低，出现了行动偏差，这可能会影响他们的人际关系，并导致这一人群中经常出现的社会隔离现象，因此，道德决策是治疗 SAUD 的新手段。

{"title":"Is severe alcohol use disorder really associated with increased utilitarian moral judgment? Exploration using the CNI model","authors":"Mado Gautier , Jessica Mange , Xavier De Longueville , Pierre Maurage","doi":"10.1016/j.drugalcdep.2024.112435","DOIUrl":"10.1016/j.drugalcdep.2024.112435","url":null,"abstract":"<div><h3>Objectives</h3><p>The psychology of moral decision-making classically contrasts utilitarianism (based on consequences) and deontology (based on moral norms). Previous studies capitalizing on this dichotomy have suggested the presence of a utilitarian bias among patients with severe alcohol use disorder (SAUD). We aimed to further disentangle the processes involved in such bias through a more validated approach, the CNI model of moral decision-making. This model allows to go further than the classical approach by distinguishing sensitivity to consequences (C), to moral norms (N), and general preference for inaction over action (I) in response to moral dilemmas.</p></div><div><h3>Methods</h3><p>Thirty-four recently detoxified patients with SAUD and 34 matched control participants completed a battery of 48 dilemmas derived from the CNI model, as well as social cognition tasks.</p></div><div><h3>Results</h3><p>In contrast with the utilitarian bias suggested in previous studies based on the classical approach, patients with SAUD did not show an increased sensitivity to consequences in comparison with control participants. However, they showed a reduced sensitivity to moral norms, as well as a greater action tendency. These biases were not related to social cognition deficits.</p></div><div><h3>Conclusions</h3><p>Patients with SAUD are not more utilitarian than healthy controls, this previously reported bias being artificially generated by the methodological limits of the classical approach. Instead, they present a reduced sensitivity to moral norms and an action bias, which might impact their interpersonal relations and contribute to the social isolation frequently reported in this population, thus identifying moral decision-making as a new therapeutic lever in SAUD.</p></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"264 ","pages":"Article 112435"},"PeriodicalIF":3.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238901","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