European Addiction Research最新文献

Introduction: Studies report a high variability of cognitive impairment in people who use drugs, ranging from 20% to 80%. Most research focus on individuals who use drugs who are either admitted to treatment facilities or incarcerated and being abstinent from substances. The present study aimed to assess cognitive function among populations with ongoing, severe, habitual substance use, mimicking a real-world day-to-day situation.

Methods: Cross-sectional design with 171 participants (70.2% male) with severe substance use, recruited from two sites in Oslo, Norway. All participants were screened for cognitive function using the Montreal Cognitive Assessment (MoCA). A cutoff of < 26 points was used to classify possible cognitive impairment. Participants also provided information on their alcohol and substance use, as well as demographic data.

Results: 74.9% of the participants scored below the MoCA cutoff for possible cognitive impairment. We did not find any associations between scoring below the MoCA cutoff <26 and the substance use variables (substance use, number of substances used, history of overdoses, injection drug use, and past substance use treatment).

Conclusion: A high proportion of people with severe substance use may experience a functional cognitive impairment. This study provides novel insights into cognitive function within a population actively engaged in habitual substance use, offering a real-world perspective with high external validity. This knowledge is highly relevant for service providers who aim to deliver tailored follow-up services to this population outside of traditional treatment settings.

Introduction: This study aimed to evaluate effects of three machine learning based adjustments made to an eHealth intervention for mild alcohol use disorder, regarding (a) early dropout, (b) participation duration, and (c) success in reaching personal alcohol use goals. Additionally, we aimed to replicate earlier machine learning analyses.

Methods: We used three cohorts of observational log data from the Jellinek Digital Self-help intervention. First, a cohort before implementation of adjustments (T0; n = 320); second, a cohort after implementing two adjustments (i.e., sending daily emails in the first week and nudging participants towards a "no alcohol use" goal; T1; n = 146); third, a cohort comprising the prior adjustments complemented with eliminated time constraints to reaching further in the intervention (T2; n = 236).

Results: We found an increase in participants reaching further in the intervention, yet an increase in early dropout after implementing all adjustments. Moreover, we found that more participants aimed for a quit goal, whilst participation duration declined at T2. Intervention success increased, yet not significantly. Lastly, machine learning demonstrated reliability for outcome prediction in smaller datasets of an eHealth intervention.

Conclusion: Strong correlates as indicated by machine learning analyses were found to affect goal setting and use of an eHealth program for alcohol use problems.

Introduction: Substance misuse significantly impairs psychosocial functioning and correlates with many environmental factors, including working conditions. We investigated the influence of working conditions and other determinants on the risk of substance misuse among healthcare residents of Lyon, France.

Methods: We conducted an online survey among medicine, dentistry and pharmacy residents of Lyon from May 30, 2022, to July 15, 2022. Participants reported their age, sex, residency specialty, and living conditions and completed the French Job Content Questionnaire, the Alcohol Use Disorder Identification Test - consumption, and questions exploring their current tobacco, alcohol, and illicit drug use. We constructed directed acyclic graphs to model the effect of working conditions on substance misuse and used them to perform multivariable logistic regressions.

Results: Among the 1,936 residents of the Lyon subdivision, 904 (46.7%) completed the survey. Among these, 54.0% exhibited alcohol misuse, 23.7% reported tobacco misuse, and 34.5% reported illicit drug misuse. Working more than 48 h per week was not associated with any substance misuse. Low social support at work predicted the use of illicit drugs (aOR: 1.49, 95% CI: [1.04; 2.13]). Compared with general medicine residents, psychiatric residents had greater odds of reporting tobacco misuse (aOR: 2.28, 95% CI: [1.14; 4.58]) and illicit drug misuse (aOR: 2.51, 95% CI: [1.33; 4.74]). Pediatric and pharmacy residents had lower odds of reporting alcohol misuse (aOR: 0.42, 95% CI: [0.21; 0.84] and OR: 0.53, 95% CI: [0.28; 0.98], respectively).

Conclusions: Social support at work significantly impacts the risk of substance misuse among healthcare residents, as do other factors, such as residents' health specialty. These findings contribute to the development of appropriate institutional policies and support programs to improve the well-being of healthcare residents.

Introduction: Cannabidiol (CBD) is one of the two primary phytocannabinoids found in cannabis. Its diverse pharmacological properties suggest potential benefits for a wide range of medical conditions. The primary objective of this study was to estimate the prevalence of CBD use among patients being treated for substance use disorder. Additionally, we aimed to characterize the pattern of CBD use and describe the profiles of users.

Methods: Patients admitted to two substance use disorder departments between May 6, 2020, and July 23, 2021, were included in the study. Sociodemographic, medical and substance use data, including CBD use, were collected. A multiple correspondence analysis (MCA) was performed to identify substance uses most frequently correlated with CBD use. Multivariate analyses were also conducted to identify factors associated with CBD use.

Results: The prevalence of CBD use in the past 12 months among the 183 patients was 38.2%. However, at the time of the study, 63% had stopped using CBD, primarily due to its perceived ineffectiveness and cost. CBD was commonly consumed via inhalation, either by smoking the plant or using e-cigarette liquids. The MCA revealed that while there is no typical profile of CBD users, they were more likely to use sedative substances rather than stimulants. CBD users were younger and more likely to have psychiatric comorbidities.

Conclusion: The prevalence of CBD use was notably high. Given the significant risk of drug interactions with CBD and its wide variability in composition, it is crucial for clinicians to routinely inquire about CBD use. The potential for self-therapeutic or recreational use in these patients appears to be underestimated.

Introduction: Recovery from substance use disorder (SUD) is increasingly recognized as a personal journey, necessitating an approach that considers individual goals and priorities. Research on recovery priorities in inpatient settings is limited. Our study employs Q-methodology to explore recovery priorities among clients with multimorbid SUD, aiming to guide targeted, recovery-oriented care.

Methods: This cross-sectional study employed Q-methodology to explore recovery priorities among 129 individuals entering inpatient addiction treatment. A collaboratively developed Q-set of 42 statements covered clinical, functional, and personal recovery goals. Participants ranked statements by importance, and rotated factor analysis was used to identify clusters of recovery priorities. Qualitative interview data were then analyzed for further interpretation.

Results: We found 12 consensus statements and two distinct factors. Factor 1 (n = 60) emphasized personal growth and coping, while factor 2 (n = 51) highlighted practical aspects such as securing income and housing. Qualitative data supported these findings.

Conclusions: Despite the individual nature of recovery and the diversity within the addiction treatment population, our study identified shared goals and two distinct factors. This insight can inform tailored interventions, with factor 1 individuals potentially favoring psychological approaches and factor 2 individuals focusing on practical goals.

Introduction: A minority of addiction patients receive appropriate treatment directly from trained professionals in addiction medicine. Most countries have not recognized addiction medicine (AM) as a specialty in its own right or within psychiatry/other specialties. Therefore, the effectiveness and organization of AM training around the world need to be improved. Unfortunately, standard instruments are rarely used in most studies to assess training needs. This study aimed to determine international competencies in AM among professionals in as many countries as possible using a standard instrument such as the AM Training Needs Assessment (AM-TNA).

Method: We examined competencies in AM with the AM-TNA using an online survey. A General Competency Level in Addiction Medicine (GLOCIAM30) was calculated by dividing the total score by the number of 30 items. This GLOCIAM30 was used to measure the general level of competency in AM and to compare individual competencies.

Results: One hundred ninety-nine respondents from 45 countries completed the survey. Ninety-five of the 199 respondents (49.0%) had a GLOCIAM30 higher or equal to 4 (fairly competent). The highest skill level was found for the competency "Assessing substance use problems by taking the patient's history." Nine of the 45 countries had 8 or more respondents (n = 129). After post hoc analysis, there was no difference between these countries. Respondents could reasonably estimate whether the competency level in their country was higher or lower than the world average.

Conclusions: This study is the first international attempt to examine competencies in AM. Although a much larger study population is needed to establish an overall goal for competencies in AM, our study provided an initial direction for such a gold standard in benchmarking procedures.

Introduction: The teratogenic effect of alcohol is well known, but its prevalence is usually underestimated. This study presents the findings of a cross-sectional study conducted in Poland, which aimed to assess the prevalence and changes in alcohol consumption during pregnancy. The study utilized ethyl glucuronide (EtG) concentration in maternal hair and self-reports as measures to evaluate alcohol intake across the three trimesters of pregnancy.

Methods: The study involved postpartum women (n = 150) and their babies. Hair samples from 135 participants allowed segmental analysis (separately for the three trimesters), and hair from 15 were analysed for the entire 9 months by gas chromatography tandem mass spectrometry. Survey data included self-reports of health-related behaviours and socio-demographic characteristics; medical records - information on the course of a pregnancy and newborn's health.

Results: Standard medical interview revealed no cases of alcohol use during pregnancy. The analysis of EtG indicated 50.3% of women had been drinking alcohol at any time during pregnancy, including 10% with excessive alcohol consumption. Most participants maintained the same level of alcohol consumption throughout the pregnancy, but 8.7% of women decreased and 20.7% increased the amount of alcohol consumed between the 1st and 2nd or 2nd and 3rd trimesters. Gestational consumption of alcohol was not related to socio-demographic characteristics, course of pregnancy, and self-reported health behaviours, but babies of women who drank alcohol during pregnancy were more often small for gestation age than babies of abstainers (odds ratio [OR] = 6.008), with the highest risk observed in case of increased alcohol consumption (OR = 12.348).

Conclusions: Maternal hair analysis is useful in detecting pregnancy alcohol use and allows retrospective analysis over a longer period than other biological samples, providing a more comprehensive pattern of use throughout pregnancy. However, there is a need to improve routine methods of interviewing patients about alcohol use and to implement effective preventive strategies regarding alcohol consumption during pregnancy in Poland.

Introduction: Hexahydrocannabinol or HHC has recently appeared on the Internet and in cannabidiol (CBD) stores in various forms. Although the abuse and dependence potential of HHC consumption has not yet been established, HHC has been reported by consumers to have effects similar to delta-9-tetrahydrocannabinol (THC) and has been classified as narcotics in France since June 12, 2023.

Methods: We conducted a retrospective study of all cases of oral fluid samples collected from drivers by traffic police officers and sent to our laboratory to confirm the presence of illicit substances between June 12, 2023 and December 31, 2023. The presence of 33 psychoactive substances, including HHC, THC, and CBD, in the oral fluid samples was assessed by an ultra-high performance liquid chromatography system coupled to a triple quadrupole mass spectrometer.

Results: Of the 867 oral fluid samples analyzed, 16 were positive for HHC and involved only male drivers aged between 19 and 58. The mean and median HHC concentrations found in oral fluid were 35 ± 69 ng/mL and 10 ng/mL, respectively. In these preliminary data, HHC was always associated with THC, but the THC/HHC and CBD/HHC ratios were very broad. Although the kinetics of HHC and THC in saliva are different, the 11 cases with the highest THC/HHC ratios (>300) support that impaired alertness in drivers may be mainly due to THC. In these 11 cases, a linear correlation was found between THC and HHC concentrations in oral fluid.

Conclusion: Further large-scale studies are required to extend these preliminary data, but the emerging detection of HHC in oral fluid of drivers may illustrate its spreading use in the general population.

Introduction: Patient-reported outcome measures (PROMs) are an important source of information that allow for a patient-centered assessment. Outcome measurement of substance use disorder (SUD) treatment traditionally focuses on drug use and deficits in functioning, overlooking other aspects of the personal and dynamic process of recovery. The substance use recovery evaluator (SURE) is a PROM developed with service user input to monitor the recovery journey and assess treatment outcomes in people with SUD. The objective of this study was to examine the validity and reliability of the Dutch translation of the SURE, the SURE-NL, for measuring indicators of recovery in Dutch-speaking patients with SUD.

Methods: The original SURE questionnaire was translated from English to Dutch using forward-backward translation. A total of N = 171 participants were recruited as part of a naturalistic multicenter study in inpatient (N = 149) and outpatient (N = 22) SUD treatment centers. We examined the factorial structure, reliability, and concurrent and discriminant validity of the SURE-NL.

Results: The original 5-factor structure of the SURE showed acceptable fit for the SURE-NL, and internal consistencies of the subscales ranged from 0.61 to 0.76; internal consistency of the total score was 0.83. Concurrent validity was confirmed through positive correlations of the SURE-NL total and subscale scores with the WHOQoL-BREF subscales, but correlations varied depending on subscale and treatment setting, with higher correlations for the outpatient compared to the inpatient subgroup. Discriminant validity was confirmed through low, mostly non-significant correlations between the SURE-NL and the DASS-21.

Conclusions: Although the SURE was originally designed for outpatient settings, our findings in a predominantly inpatient sample indicate that the SURE-NL is suitable for assessing personal recovery and recovery capital in Dutch-speaking Belgian patients with SUD. However, subscales should be used and interpreted with caution. Further research is needed with larger Dutch-speaking outpatient samples and the development of a tailored SURE for inpatient settings should be considered.