European Addiction Research最新文献

Introduction: Norway's heroin-assisted treatment (HAT) project started in 2022, aimed at targeting individuals with severe opioid use disorder (OUD) who did not benefit from first-line, conventional opioid agonist treatment. The use of pharmaceutical diacetylmorphine in HAT may particularly benefit patients with comorbid psychiatric disorders due to its structured nature, which includes daily contact with outpatient clinics. However, previous findings on mental health outcomes in HAT have been inconclusive. The main aim of this study was to explore changes in patients' self-rated mental health and anxiety and depression over the first 12 months of HAT in Norway.

Methods: We used data from 2 questions about patients' self-rated mental health and anxiety and depression collected from 79 patients at the start of treatment (baseline) and at 3, 6, and 12 months into treatment. Ordinal logistic regression models were used to examine the changes in the responses over the observational period and to explore the potential effects of predictors such as gender and age, self-reported substance use, and clinic site.

Results: We found a gradual improvement in self-rated mental health from baseline over the observational period, with a statistically significant shift in response distribution at the 12-month mark (p = 0.017). The distribution of responses indicating "good" mental health increased with a 35% improvement at 12 months, with a corresponding decline of 48% in "bad" mental health. For self-rated anxiety and depression, we found no change in severity of self-rated symptoms. A decline of 48% in the proportion of responses reporting severe symptoms at 12 months was aligned with a simultaneous increase of 17% reporting moderate symptoms. Age and previous suicide attempts were significant predictors of both outcomes; gender influenced anxiety and depression only, whereas clinic site influenced only mental health ratings.

Conclusion: HAT appears to gradually improve patients' self-rated mental health over time, possibly by enhancing overall psychological well-being. Self-rated symptoms of anxiety and depression may not be affected by this treatment, indicating that psychiatric conditions can persist in HAT for those struggling with them. This highlights the importance of specific psychiatric assessments and targeted interventions for at least a subset of patients, underscoring the need for integrated treatment approaches within HAT programs that address both substance use and co-occurring psychiatric disorders.

Introduction: Cryptocurrencies are digital assets that differ from traditional currencies in their unique characteristics. An increasing number of individuals are showing interest in cryptocurrency trading and spending long hours engaged in this activity. Current studies point out that some behaviors of cryptocurrency investors may be associated with problematic mental health outcomes. The present study aims to investigate problematic cryptocurrency trading behaviors and to examine these behaviors in terms of gambling disorder and psychological risk factors.

Methods: Two hundred four volunteered participants whose ages ranged between 18 and 65 years (mean = 31.62, SD = 6.95) were recruited. For data collection, the Problematic Cryptocurrency Trading Scale, Problem Gambling Severity Index, Eysenck Personality Questionnaire Revised - Abbreviated Form, UPPS Impulsive Behavior Scale, and Positive and Negative Affect Schedule were administered.

Results: Findings demonstrated that participants exhibiting symptoms of problematic cryptocurrency trading had higher levels of problem gambling severity, negative emotions, extraversion, and urgency, along with lower levels of premeditation and perseverance. Additionally, the linear regression with backward elimination revealed that problem gambling severity and extraversion are associated with problematic cryptocurrency trading.

Conclusion: These findings suggest that greater engagement in cryptocurrency speculation may be associated with increased gambling behaviors and that both activities could be linked to underlying personality traits, impulsivity, and negative emotions.

In the article by Bretteville-Jensen and Nesse entitled "Non-Prescribed Use of Opioid Agonist Medications and Associations with Non-Fatal Overdoses: A Repeated Cross-Sectional Study across a Decade of Reduced Monitoring" [Eur Addict Res. 2025; https://doi.org/10.1159/000547909], an error was introduced during production concerning the license. The article was mistakenly published under a CCC license instead of the intended CC BY 4.0 license.The original article has been updated.

Introduction: The increasing number of refugees in the European Union has led to challenges in terms of allocation and housing. Shared accommodation, which often presents vulnerable living conditions, may exacerbate health risks including substance use (SU). This study aimed to identify individual and contextual determinants of substance use behaviours (SUBs) among refugees in shared accommodations.

Methods: Data from a cross-sectional study and baseline data from an evaluation study resulted in a sample size of 391 refugees residing in 22 shared accommodations in Stuttgart, Germany. Data were collected using self-reported measures of SU as well as physical and mental health indicators at the individual level and conditions of shared accommodations on a contextual level. Multilevel logistic regression analysis was performed to examine individual-level and contextual factors.

Results: SUBs were influenced primarily by individual factors. Male refugees were more likely to engage in SU than females, whereas being Muslim was associated with a lower likelihood of SU. Prolonged residence in shared accommodations and possession of a work permit increase the risk of SU. Poor physical health was also correlated with higher SUBs. Contextual factors, such as deteriorating conditions or isolation due to limited access to support systems, played a smaller role. However, deteriorated accommodation conditions were unexpectedly linked to a reduced likelihood of hazardous SU.

Conclusion: The findings highlight the predominance of individual-level determinants over contextual factors in shaping SUBs among refugees in shared accommodations. Interventions should prioritize addressing individual vulnerabilities, such as health and social integration challenges, while improving living conditions to mitigate risks. These insights can inform targeted European policies and support programmes for refugee populations.

Introduction: Heroin-assisted treatment (HAT) involves the supervised administration of pharmaceutical heroin (diacetylmorphine; DAM), either injectable or oral, for individuals with severe opioid use disorder who have not achieved stabilisation with conventional opioid agonist treatment. Despite its growing adoption, there is limited literature on the phenomenon of diversion in HAT. Diversion refers to the redirecting of legal prescription medications from their intended medical use to illegal or unauthorised use. This study aimed to investigate the reasons for, experiences with, and consequences of DAM diversion, as reported by both patients and treatment providers.

Methods: In this qualitative study, two separate focus groups were conducted with patients and treatment providers (nurses, psychiatrists, social workers, and psychologists), respectively. Discussions were audio-recorded, transcribed, and analysed. Mayring's qualitative content analysis was used to evaluate the findings.

Results: Five themes with fourteen categories emerged. Providers and patients both described procedures and motives of diversion, discussed the positive and negative consequences, and suggested solutions for reduced future diversion of DAM. An important motif for diversion stemmed from patients' urge for more autonomy over route, timing, and fractioning of administration, while also being used to finance concurrent cocaine use. Treatment providers and patients both noted that diversion may lead to increased overdose risk for individuals in and out of treatment. Nurses noted a substantial negative impact of diversion on the therapeutic relationship. Suggestions for reducing diversion included allowing for more take-home dosing, allowing for more flexibility in routes of administration, adapting HAT clinic opening hours, and providing effective treatment for cocaine use disorder.

Conclusion: The main drivers of diversion in HAT included a desire for more autonomy, unaddressed concurrent substance use, and significant barriers to the existing treatment options. Addressing patients' preferred opioid effect profile, accommodating their social needs, and managing concurrent cocaine use disorders may reduce diversion in the future.

Introduction: Canada legalized recreational cannabis in October 2018, but commercial retailing took time to develop. This study first explored how self-reported cannabis use prevalence, daily use, product type use, and age of initial use changed during 2019-2023. It then analyzed whether the changes were associated with rising store numbers or falling prices.

Methods: Data on store counts, retail pricing, and cannabis use came from government reports covering 10 provinces over 5 years. Panel data linear regressions analyzed 50 province-year aggregated observations.

Results: There were no significant changes in prevalence among males and people aged 16-24 or in the proportion using cannabis daily. Prevalence among females and people aged 25+ increased; those levels showed negative associations with prices but not stores. Dried cannabis use decreased, while edibles use increased; those also showed associations with prices but not stores. Mean initial age of use increased; it was negatively associated with prices and positively with stores.

Conclusion: Canada's large cannabis retail expansion was accompanied by relatively modest usage changes, most of which showed associations with falling prices but not rising store counts.

Introduction: Despite substantial health benefits, smoking cessation attempts have high relapse rates. Neuroimaging measures can sometimes predict individual differences in substance use phenotypes - including relapse - better than behavioral metrics alone. No study to date has compared the relative prediction ability of changes in psychological processes across prolonged abstinence with corresponding changes in brain activity.

Methods: Here, in a longitudinal design, measurements were made 1 day prior to smoking cessation, and at 1 and 4 weeks post-cessation (total n = 120). Next, we tested the relative role of changes in psychosocial variables versus task-based functional brain measures predicting time to nicotine relapse up to 12 months. Abstinence was bio-verified 4-5 times during the first month. Data were analyzed with a novel machine-learning approach to predict relapse.

Results: Results showed that increased electrophysiological brain activity during inhibitory control predicted longer time to relapse (c-index = 0.56). However, reward-related brain activity was not predictive (c-index = 0.45). Psychological variables, notably an increase during abstinence in psychological flexibility when experiencing negative smoking-related sensations, predicted longer time to relapse (c-index = 0.63). A model combining psychosocial and brain data was predictive (c-index = 0.68). Using a best-practice approach, we demonstrated generalizability of the combined model on a previously unseen holdout validation dataset (c-index = 0.59 vs. 0.42 for a null model).

Conclusion: These results show that changes during abstinence - increased smoking-specific psychological flexibility and increased inhibitory control brain function - are important in predicting time to relapse from smoking cessation. In the future, monitoring and augmenting changes in these variables could help improve the chances of successful nicotine smoking abstinence.

Introduction: The effectiveness of Motivational Interviewing (MI) in addiction treatment has been proven many times. Many national treatment guidelines throughout the EU recommend MI as a method in the treatment of addiction-related and comorbid disorders. However, little is known on the availability of workforce that is able to provide sufficiently quality-secured MI. The aim of this study was to investigate the level of training and the use of MI among addiction care professionals in Germany.

Methods: In a quantitative, anonymous cross-sectional survey, 262 professionals from the addiction care system were asked about their training in MI, their level of knowledge, the motivation of their clients, and the use of MI in practice. All data analyses were carried out using SPSS.

Results: Among the professionals, 54.8% (n = 143) reported having had at least 1 day of training in MI. 64.3% (n = 90) of the trained professionals felt sufficiently trained for their area of responsibility. 31.0% (n = 83) of the total sample stated that further training, quality circles, training courses, or similar had been set up at their facility. Results of an ordinal logistic regression indicated that the use of MI in practice could be predicted by MI-specific training (OR = 0.23, 95% CI = 0.13-0.38, p < 0.01) and the availability of MI support structures in the institution (OR = 0.48, 95% CI = 0.28-0.81, p < 0.01).

Conclusions: The results suggest a divergence between medical treatment recommendations for the use of MI and the level of training required for this in the German addiction treatment landscape.

Introduction: Despite extreme inter-patient differences in the benzodiazepine (BZD) metabolism rate, patients dependent on BZDs or other GABA-A receptor modulators are treated without laboratory control. The proposed detoxification method is the first to employ concentration feedback to prevent routinely unrecognized problems: overaccumulation of a long-acting BZD substitute, high concentration upon discontinuation (mimicking patients' adaptation to "abstinence"), elimination continuing long after treatment conclusion, resulting in delayed low-concentration crises and relapses of drug intake.

Methods: A new method, although evolved from a typical gradual dose reduction approach, is driven not by a dosage schedule but by an individual BZD concentration evolution. This defines four treatment stages: Substitution, anti-accumulation paradigm, elimination, and readaptation (SAER). The S stage, substitution by titration (using diazepam or clorazepate, well read by immunoassays) ends with achieving a satiation state and establishing individual clinical state and concentration baselines. During the A stage, to minimize further (unneeded) accumulation, doses are aggressively reduced daily, driven by concentration feedback, until accumulation ceases (a quasi-plateau). Further tapering opens the E stage (actual detoxification), hence slows, depending on the patient's condition and elimination rate, and concentration is tracked with lower frequency (every 3-7 days), including after drug discontinuation. Only after complete elimination (R stage), patients adapt to true abstinence.

Conclusions: The SAER approach can minimize overaccumulation-related errors. The use of serum-BZD feedback curbs the initial overaccumulation. A forced concentration plateau establishes optimized initial conditions for the elimination process. By minimizing a superfluous high-concentration treatment phase, SAER provides more time for careful escorting of the low-concentration crises, especially the one coinciding with elimination completion, weeks after drug discontinuation. Without extending the usual treatment time, the method aspires to improve both the reliability of the detoxification process and the treatment completion rate.

Introduction: There is evidence that the appetite-regulating hormone insulin plays an important role in alcohol use disorder (AUD), in the sense that there is a negative correlation between insulin and alcohol craving, meaning that an increase in insulin levels leads to a reduction in acute craving. This suggests a promising approach for the acute reduction of craving in the treatment of patients with AUD, which could be achieved via an actively induced short-term increase in insulin levels, e.g., by glucose administration, and which has not yet been investigated in the form of a randomized controlled trial. Another aspect that has not yet been investigated is the role of the insulin-responder-type of each individual, i.e., the time until the insulin peak is reached, in this relationship.

Methods: The randomized, placebo-controlled, double-blind crossover study examined a glucose intake as acute treatment to reduce craving in 80 male and female patients with AUD. Dynamics in craving and insulin levels were assessed at 8 time points on each study visit before and after alcohol cue exposure, after treatment with glucose-respective placebo solution and during the subsequent observation phase. These changes were analyzed using linear mixed models. The insulin-responder-type (fast, normal, slow) of each person was taken into account, and possible interactions with the treatment were analyzed.

Results: Linear mixed models revealed a significant interaction effect (F(2, 412.058) = 7.988, p < 0.001) between treatment and insulin-responder-type on craving, with lower craving values in the glucose compared to the placebo condition in the normal insulin-responder-type group (i.e., insulin peak after glucose intake within 30 to 60 min, difference in means = -0.805, p = 0.003, 95% CI: -1.428, -0.182). In the contrary, in the fast insulin-responder-type group craving values were higher in the glucose compared to the placebo condition (difference in means = 1.143, p = 0.011, 95% CI: 0.378, 1.907). Slow insulin-responders showed no differences in craving levels depending on the treatment condition (difference in means = -0.124, p = 0.694, 95% CI: -0.741, 0.493). No main effect was found in the linear mixed models for baseline-centered insulin levels (F(1, 395.337) = 2.328, p = 0.128).

Conclusions: Glucose intake may reduce craving in individuals with AUD who show a normal insulin response. Further research should consider the different insulin-responder-types and peak times to better understand the underlying mechanisms of craving reduction with glucose administration in the context of insulin elevation.