International Journal of Mental Health and Addiction最新文献

The availability of cannabis has increased due to expanding legalization of cannabis across the USA. Controlled use of cannabis - rules by cannabis users that limit use - is a significant but understudied area in the present policy environment, particularly among young adults. A prospective Los Angeles-based cohort aged 18-26 who used cannabis in the past 90 days was assessed during eight survey waves across 9 years. Four discrete waves were analyzed: wave 1 (2014-2015/medical only policy, n = 366), wave 4 (2017-2018/transition to adult use policy, n = 275), wave 5 (2019-2020/adult use policy, n = 241), and wave 8 (2022-2023/adult use policy, n = 193). Five rules of controlled cannabis use were used as indicators in a latent class analysis. Two discrete latent classes - Controlled and Uncontrolled - emerged and became more distinct over time. The Uncontrolled class was a majority across all waves. Probabilities for two rules of controlled use - "no school/work" or "no driving" under the influence - increased overtime, and one rule - "stopping cannabis use" - decreased during the transition to legalized adult use. The Controlled class, which consistently practiced more rules, used less cannabis across all waves and had lower problematic cannabis use in waves 1, 4, and 5 compared to the Uncontrolled class.

Untreated co-occurring mental health disorders (MHD) and substance use disorders (SUD) are associated with negative treatment outcomes. This study explored the experiences and perspectives of patients with opioid use disorder (OUD) who were using methamphetamine while undergoing methadone maintenance treatment (MMT) regarding barriers and facilitators to accessing MHD services. We conducted 30 in-depth interviews with MMT participants with varying levels of MHD severity, assessed using the 21-item Depression, Anxiety, Stress Scale (DASS-21). Barriers to seeking MHD services included lack of awareness, fear of additional stigma and extra burden to families, unaddressed poly-substance use, and lack of specialized professionals. Benefits of integrating MHD services into MMT clinics included improved diagnosis, streamlined referrals, and reduced logistical challenges. Key facilitators identified included supportive family members, healthcare professionals, and digital platforms. Integrating MHD care into MMT, emphasizing family involvement, staff training, and digital platforms, holds promise to improve MHD diagnosis, referral, and treatment.

Emerging evidence suggests gender-based heterogeneity in suicide risk associated with cannabis use, while the role of cannabis in gender-dependent suicide risk is elusive. The objective of the present study is to determine whether cannabis use contributes differently to the pathway from depression or pain conditions to non-fatal suicidal behaviors (e.g., suicidal ideation, plans, or attempts) in men versus women. We analyzed the data that was extracted from the National Survey of Drug Use and Health (NSDUH) from 2020 to 2022 during the COVID-19 pandemic. Mediation analysis was conducted using a causal framework to assess the mediating role of cannabis in the association between depression, pain conditions, and suicide ideation/plan/attempt in two gender groups. A sample of 93,743 individuals aged 18-50 years participated in the NSDUH survey. Mediation analysis revealed that cannabis use mediated a greater proportion of the effect of depression on suicidal ideation (2.3%) and attempts (1.7%) in women compared to men (1.2% and 1.0%, respectively). Similarly, cannabis appears to mediate 12.5% (95% CI 0.081-0.272) of the effect of pain conditions on suicidal ideation in women versus 5.9% (95% CI 0.038-0.128) in men. These findings suggest that cannabis has a greater mediating impact in non-fatal suicidal behaviors for women than men, particularly in the context of depression and pain conditions. Tailored interventions addressing cannabis use as a self-medication strategy, especially for women, are critical for suicide prevention.

Purpose: In a sample of women living with HIV, we examined whether individual traits fear of negative evaluation and resilience moderate the internalization of poverty stigma that these women experience from others. We also examined the downstream effects of these processes on depression symptoms using moderated serial mediation analyses.

Methods: Data were collected annually for 4 years (2016-2020; T1, T2, T3, and T4) from 369 women living with HIV at 4 US cities using validated measures. Moderation effects were evaluated examining simple slopes at one standard deviation above and below the mean of the moderator. In all mediation analyses utilizing bootstrapping, we used the independent variable measured at T1, the mediators measured at subsequent visits (T2 and T3), and the outcome at the last visit (T4) to preserve the temporal sequence among the independent variable, mediators, and outcome variable. We also adjusted for T1 values of all mediators and outcome variables in analyses.

Results: Women with stronger fears of negative evaluation by others or lower dispositional resilience had stronger associations between experienced poverty stigma and internalized poverty stigma. Internalized poverty stigma (T2) mediated the association between experienced poverty stigma (T1) and depression symptoms (T4); this mediated association was moderated by fear of negative evaluation and resilience (T1). Finally, internalized poverty stigma (T2) and avoidance coping (T3) were serial mediators in the association between experienced poverty stigma (T1) and depression symptoms (T4), moderated by fear of negative evaluation and resilience.

Conclusions: Understanding factors that minimize internalization of stigma and buffer its negative effects on mental health can inform interventions to improve health outcomes of individuals with stigmatized conditions.

Objective: Alcohol and cannabis use are each associated with suicidal thoughts and behaviors and nonsuicidal self-injury (NSSI) in military veterans, but less is known with regard to concurrent use. The present study compared U.S. veterans (N = 1098; 78% male, 67% White) who in the past year engaged in hazardous drinking (HD only), cannabis use (CU only), or concurrent use (HD + CU), or used neither substance (comparison group), on past-year suicidal ideation, elevated risk for suicidal behavior, and past-year NSSI.

Method: Veterans completed questionnaires on sociodemographics, psychiatric and substance use history, and self-directed violence via a mailed self-report survey.

Results: Independent of covariates, HD + CU related to greater odds of past-year suicidal ideation relative to the CU only and comparison group, and greater odds of elevated risk for suicidal behavior relative to all groups. The HD only group related to greater odds of past-year suicidal ideation relative to the comparison group. Contrary to expectations, CU only did not relate to greater odds of any suicide-related outcomes. As for NSSI, both CU only and HD + CU related to greater odds of past-year NSSI relative to the HD only and comparison group.

Conclusions: Concurrent use may increase odds of suicide-related outcomes in veterans relative to single use alone, whereas cannabis use may confer risk for NSSI regardless of if used concurrently with alcohol. These differential associations may suggest distinct mechanisms of risk for self-directed violence in veterans based on substance type (e.g., alcohol vs. cannabis) and use practice (single vs. concurrent use).

Substance use among street-involved children and youth (SICY) in low- and middle-income countries is common. Using data abstracted from program intake forms (2016-2022) for an intervention to reintegrate SICY with their communities, we assess which individual, family, and geographic characteristics are predictive of substance use, and specifically inhalant use and non-inhalant use among a sample of 227 SICY in Meru County, Kenya. Assessed determinants include age, geographic location of home community, years on street, family deprivation prior to street-migrating, motivation for street migrating, abuse experiences on the street, and activities on the street. Number of years lived on the street, experiencing abuse on the street, and citing peer-self relations as the reason for street migration were all associated with significantly higher odds of reporting substance use, and inhalant use specifically. Inhalant use was also significantly associated with peer socialization and specific street activities. Further research should explore the role of peer-self dynamics in substance use among SICY and how it can inform approaches to reintegrating children from street situations and sustaining their development in non-street environments.

The current evidence regarding effective management of methamphetamine and amphetamine (MA/A) use disorders is inconclusive. Therefore, we assessed the comparative benefits and tolerability of pharmacological, psychosocial, and harm reduction interventions for management of MA/A use disorders. We searched six electronic databases for randomized controlled trials of any pharmacological, psychosocial, or harm reduction interventions in adults with MA/A use disorders. We performed a random-effects frequentist network meta-analysis and used the GRADE approach to assess the certainty of evidence. We included 72 randomized trials (6836 participants). Low certainty evidence suggests quetiapine may extend abstinence compared to placebo [risk ratio (RR) 3.17 (95% confidence intervals (CI), 1.24 to 8.07)] and weekly average proportion of patients with negative urine samples [mean difference (MD) 32.17 (95% CI, 14.08 to 50.26)]. Low certainty evidence also suggested that riluzole may be associated with a higher weekly average proportion of patients with negative urine samples [MD 24.10 (95% CI, 5.54 to 42.66)]. Very low certainty evidence suggests methylphenidate alone [compared to placebo MD 10.24 (95% CI, 3.49 to 16.99)] or in combination with matrix model [MD 23.55 (95% CI, 7.64 to 39.46)] may be associated with an increased weekly average proportion of patients with negative urine samples. Compared to placebo, contingency management alone [MD 21.20 (95% CI, 11.39 to 31.00), very low certainty] or in combination with cognitive behavioural therapy [MD 34.85 (95% CI, 19.63 to 50.08), very low certainty] may be associated with longer duration of abstinence. Compared to placebo, venlafaxine [RR 0.27 (95% CI 0.08 to 0.90), low certainty] and citicoline [RR 0.69 (95% CI 0.49 to 0.99), lowcertainty] may be among the most tolerable interventions. Very few interventions may be associated with slight improvement in certain outcomes, but no intervention showed moderate- to high-certainty evidence for important changes across any patient-important outcomes.

Supplementary information: The online version contains supplementary material available at 10.1007/s11469-024-01379-w.

Objective: To synthesize randomized controlled trial evidence on technology-based interventions' (TBIs) effectiveness for substance use among emerging adults (EA)/college students (CS).

Methods: Nine electronic databases were searched. Two reviewers independently screened studies, extracted data, and assessed evidence quality. We used robust variance estimation in meta-regression for effect size synthesis and moderator analysis.

Results: Based on 130 studies, the overall between-group effect size was 0.23 (95% CI= 0.18, 0.28). The effect sizes for comparing TBIs with no treatment, standard care, and non-technology interventions were 0.25 (CI=0.19, 0.31), 0.23 (CI=0.15, 0.32), and 0.12 (CI= -0.02, 0.25), respectively. Older participants showed significantly larger effect sizes, and interventions using multiple technologies had larger effects than smartphone-based ones.

Conclusion: TBIs are effective in reducing substance use in EA/CS, with outcomes comparable to non-technology interventions and advantages over no treatment and standard care. Future research should address drug-related outcomes, multi-technology approaches, age-appropriate designs, and cultural diversity.

This study examined differences in quit attempts, 1-month quit success, and vaping status at follow-up among a cohort of 3709 daily smokers with and without depression, anxiety, and regular alcohol use who participated in both the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Surveys. At baseline, a survey with validated screening tools was used to classify respondents as having no, or one or more of the following: 1) depression, 2) anxiety, and 3) regular alcohol use. Multivariable adjusted regression analyses were used to examine whether baseline (2018) self-report conditions were associated with quit attempts; quit success; and vaping status by follow-up (2020). Results showed that respondents who reported depressive symptoms were more likely than those without to have made a quit attempt (aOR=1.32, 95% CI:1.03-1.70, p=0.03), but were less likely to have quit (aOR=0.55, 95% CI:0.34-0.89, p=0.01). There were no differences in quit attempts or quit success between those with and without self-reported anxiety diagnoses or regular alcohol use. Among successful quitters, respondents with baseline depressive symptoms and self-reported anxiety diagnoses were more likely than those without to report vaping at follow-up (aOR=2.58, 95% CI:1.16-5.74, p=0.02, and aOR=3.35 95% CI:1.14-9.87, p=0.03). In summary, it appears that smokers with depression are motivated to quit smoking but were less likely to manage to stay quit, and more likely to be vaping if successfully quit. As smoking rates are higher among people with mental health conditions, it is crucial for healthcare professionals to identify these vulnerable groups and offer tailored smoking cessation support and continued support during their quit attempt.

Objective: Efforts to prevent opioid overdose mortality have rapidly expanded, including community-based distribution of naloxone to laypeople. In turn, responding to the opioid overdose crisis has increasingly fallen on the shoulders of community laypeople. Yet, little attention has been given to studying the mental health consequences of responding to an opioid overdose for community laypeople. This study examined emotion dysregulation as a risk factor for posttraumatic stress disorder (PTSD) stemming from opioid overdose responding among community laypeople.

Methods: Participants were 80 community laypeople who had responded to an opioid overdose (M _age = 39.10, 59.5% women, 86.3% white).

Results: Elevated emotion dysregulation was found in community laypeople with versus without PTSD stemming from opioid overdose responding. Limited access to effective emotion regulation strategies was uniquely associated with PTSD stemming from opioid overdose responding.

Conclusions: Opioid overdose trainings may benefit from the addition of trauma first aid to bolster emotion regulation skills.