Journal of studies on alcohol and drugs最新文献

Objective: Hypertension is highly prevalent in primary care. Unhealthy alcohol use can impact its management and associated cardiovascular disease risks. Alcohol screening and brief intervention (ASBI) in primary care is effective for early intervention for unhealthy use, yet its effectiveness in heterogeneous populations in real-world settings remains unclear. Using electronic health records, we emulated a pragmatic clinical trial to evaluate the effects of receiving ASBI on drinking and blood pressure (BP) outcomes among primary care patients with hypertension and unhealthy alcohol use.

Method: This observational study identified 72,979 patients with hypertension who screened positive for unhealthy drinking between January 1, 2014, and December 31, 2017. We used a target trial framework to compare the effects of receiving ASBI (intervention) to not receiving brief intervention (comparison) on drinking (change in heavy drinking days and drinks/week) and BP outcomes (changes in diastolic and systolic BP) from baseline to 2- and 5-year follow-ups. Treatment effect estimates were obtained using inverse probability-weighted models.

Results: At 2 years, the intervention condition had about 0.2 fewer heavy drinking days and about 0.1 fewer drinks/week than the comparison condition. The intervention condition had an additional 0.5 mmHg and 0.7 mmHg decline in diastolic and systolic BP, and 8% and 6% higher odds of having a ≥3 mmHg reduction in diastolic and systolic BP, respectively, than the comparison condition. Between-group differences in both outcomes diminished at 5 years.

Conclusions: The modest changes in drinking and BP we found contribute to the emerging evidence that brief intervention may benefit broader health outcomes at the population level.

Objective: Women who have experienced sexual assault report higher rates of alcohol use. Sexual objectification experiences, such as sexualized body gazes, gestures, commentary, and physical contact, have been linked with greater alcohol use and may represent a particular stressor for women who have experienced sexual assault, potentially leading to craving and alcohol use to cope. This study used a 3-week ecological momentary assessment design to test whether experiencing sexual objectification indirectly predicted the likelihood of later alcohol use through heightened craving. Further, because sexual minority women may be disproportionately targeted by objectification and are more likely to report alcohol misuse, we explored whether sexual minority women experienced more objectification than heterosexual women and, in turn, greater craving and alcohol use.

Method: Participants were 82 women who had experienced sexual assault and reported probable alcohol misuse and posttraumatic stress symptoms. Women were predominantly heterosexual and bisexual. Participants reported on daily objectification experiences and momentary craving each evening, as well as past-day alcohol use each morning. A multilevel structural equation model was estimated in Mplus.

Results: As hypothesized, there was an indirect effect of experiencing objectification on a given day on later alcohol use endorsement via greater alcohol craving. There was not an indirect effect of sexual minority identity on average alcohol use frequency via objectification and craving, but sexual minority women experienced greater average craving than heterosexual women.

Conclusions: Findings support daily objectification experiences as a novel proximal risk factor for heightened craving and drinking among sexual assault survivors with diverse sexual identities.

Objective: We investigated the association between the adherence to a repetitive transcranial magnetic stimulation (rTMS)-based treatment program and resting-state (RS) functional connectivity within two large-scale networks (i.e., the frontoparietal network [FPN] and the default mode network [DMN]) in a sample of patients with cocaine use disorder (CUD; N = 33; 32 males).

Method: Before starting the treatment protocol, each participant underwent a psychopathological assessment and an RS electroencephalography (EEG) recording. EEG connectivity analysis was performed using the exact Low-Resolution Brain Electromagnetic Tomography (eLORETA) software, comparing dropout patients (i.e., treatment program abandonment within 3 months) and adherence patients.

Results: Compared with the dropout group, the adherence group showed increased pre-treatment delta connectivity within the FPN (T = 4.562, p = .010, Cohen's d = 0.819) and the DMN (T = 4.045, p = .036, Cohen's d = 0.726). Multivariable Cox proportional hazard models showed that both DMN (hazard ratio [HR] = 0.41, p = .015) and FPN connectivity data (HR = 0.54, p = .007) were significantly related to prolonged treatment adherence. Increased functional connectivity within the FPN decreased the probability of dropout during the first 12 weeks of treatment (odds ratio = 0.36, p = .019).

Conclusions: Our results may reflect enhanced goal-driven cognitive integration in adherent patients. Providing effective neurophysiological predictors of treatment outcomes, such as relapse and dropout, could allow the timely implementation of additional support measures for CUD patients.

Objective: Theoretical models suggest that internalizing symptoms predispose individuals toward solitary drinking. However, data have not explicated whether longitudinal relations occur across or within individuals over time, which would have important yet distinct clinical implications. If relations exist across individuals, targeted prevention in individuals with higher internalizing symptoms may be most clinically effective. However, if relations exist within individuals, monitoring within-person deviations in internalizing symptoms and coupling increases in internalizing with adaptive interventions may prove most effective.

Method: Emerging adults (N = 448; 43.4% female; ages 21-25) with a history of past-month binge drinking at baseline reported on depressive, anxiety, stress symptoms (i.e., "internalizing symptoms") and solitary drinking frequency every 6 months over 2 years. Autoregressive multilevel models tested whether (a) individuals with higher internalizing symptoms reported more frequent solitary drinking across the span of 2 years, and (b) within-person deviations in internalizing symptoms covaried with (and prospectively predicted) within-person deviations in solitary drinking.

Results: Internalizing symptoms predicted more frequent solitary drinking at the between-person level. Within-person deviations in internalizing symptoms were positively contemporaneously correlated with deviations in solitary drinking. However, within-person deviations in internalizing symptoms at a given time point predicted within-person decreases in solitary drinking 6 months later.

Conclusions: Individuals with higher internalizing symptoms reported more frequent solitary drinking, yet within-person deviations in internalizing symptoms prospectively predicted decreases in solitary drinking. Findings suggest a complex, level-specific relation between internalizing symptoms and solitary drinking, which may have implications for preventive interventions.

Objective: The objective of this study was to conduct a national survey of practicing dentists to assess their current knowledge, attitudes, and practice behaviors related to substance use screening among their adult patients. The secondary objective was to identify practitioner- and practice-level facilitators and barriers to substance use screening.

Method: This cross-sectional study consisted of an electronic survey disseminated to practicing dentists who were active members of the National Dental Practice-Based Research Network (n = 790; 61% male).

Results: The majority of dentists reported some level of screening for nicotine (95.7%), alcohol (87.2%), cannabis (83.9%), and illicit drug (87.7%) use among their adult patients. More than 2 in 5 dentists reported never counseling patients regarding problematic use of alcohol, cannabis, and illicit drugs. Higher screening frequency was associated with higher counseling frequency and lower endorsement of two barrier factors: beliefs regarding responsibility, relevance, and effectiveness, and lack of training and/or resources. Higher frequency of counseling was associated with higher frequency of referral behavior and lower endorsement of three barrier factors: concerns regarding patient truthfulness/discomfort; beliefs regarding responsibility, relevance, and effectiveness; and lack of training and/or resources.

Conclusions: Results indicate a high level of willingness to screen, counsel, and refer patients for substance use among a majority of dentists, although current practice behaviors lag willingness. Findings regarding barriers and facilitators can guide efforts to develop, disseminate, and implement screening, brief intervention, and referral to treatment training, initiatives, and tools that are inclusive of or specifically target dental providers.

Ecological momentary assessment (EMA) can be a powerful and flexible tool for collecting data on alcohol use, particularly to understand proximal precursors and consequences. EMA can also be leveraged to inform the development of and deploy mobile-health (mHealth) interventions. This article describes the development of an mHealth ecological momentary intervention (EMI) for young adults with high-risk alcohol use and attention-deficit/hyperactivity disorder (ADHD). This novel intervention uses EMA as an intervention component to increase self-awareness via symptom monitoring. It also incorporates additional EMI components, including personalized feedback and behavioral strategy suggestions ("tips"), which operate synergistically with EMA questions and are tailored by EMA data. The theoretical underpinnings of this intervention are described, and its distinct relevance for young adults with ADHD who engage in high-risk alcohol use is discussed. The process of developing this mHealth EMI is detailed, including examining EMA data to generate intervention content, considering participant feedback through iterative pilot testing, and applying human-centered design methods with end users and community partners. Finally, practical considerations of this intervention approach are discussed, including unique benefits, key challenges, and exciting future opportunities.

Objective: Alcohol cues vary situationally across contexts and have been recognized as a factor that contributes to craving and alcohol use. We describe a brief web-based personalized feedback intervention (PFI) that summarizes ecological momentary assessment (EMA) data collected in a pilot study. The PFI highlighted young adults' desire to drink and the presence/absence of alcohol cues, capitalizing on variability found in the natural environment across 17 days. We examined the extent to which the EMA data collected in the pilot study were optimal for use in the PFI and participants' evaluations of the PFI.

Method: Eligibility criteria included being age 18-24 years and reporting one or more heavy episodic drinking occasions in the last month. Data were collected from 51 participants (mean age = 21.69 years, SD = 1.86; 54.9% female; 56.9% non-Hispanic White). Data were from a baseline survey, 17 days of EMAs (4×/day), and an evaluation survey.

Results: High EMA survey retention was obtained (85.8% completion). The intraclass correlation coefficient for desire to drink showed that 22% of the variability was between persons and 78% was within persons. Cues of interest were adequately reported (e.g., physical cues reported on 23.2% of P.M. surveys, being around people with whom they typically drink on 31.9% of P.M. surveys). Participants rated the intervention favorably on 8 of 14 items (mean greater than 4.0 on a scale of 1-5).

Conclusions: EMA data offer rich opportunities for PFIs aimed at reducing alcohol use and consequences. The Alcohol Cue Reactivity PFI described here can inform future intervention research.

Objective: Using a national U.S. underage young adult sample, we examined the prevalence of smoking, vaping, eating, drinking, and dabbing cannabis; perceived accessibility by product type; and perceived accessibility correlates (adolescent cannabis use, state cannabis policy context, sociodemographic characteristics).

Method: Data were obtained from adults younger than age 21 years participating in the U.S. national Monitoring the Future Panel study from 2019 to 2023. Cannabis use prevalence by smoking, vaping, edibles, drinking, and dabbing was measured (n = 3,075; 52.9% female). Perceived accessibility was measured for smoking, vaping, and edibles (n = 1,227; 52.1% female). Covariate and accessibility associations were modeled using logistic regression.

Results: Multiple cannabis use modalities were reported by 23.3% of all respondents and 63.5% of those reporting past-12-month use. Among all respondents, smoking (30.7%), vaping (19.7%), and edibles (18.2%) were the most prevalent; fewer reported dabbing (10.4%) or drinking (2.8%). Perceiving easy access to smoking, vaping, and edibles was reported by 95.0%, 91.3%, and 86.7% of those reporting past-12-month use (77.5%, 71.2%, and 71.8% of those reporting no use). Among those reporting no 12-month use, state recreational use policy was associated with perceiving easier access for smoking and edibles; full-time 4-year college attendance was associated with easier perceived access across modalities (vs. part-time/2-year college or not attending).

Conclusions: Underage U.S. young adults are not legally able to purchase cannabis but reported easy access across products; those who used cannabis typically used multiple products. Among those reporting no past-12-month use, state policy and college attendance were strongly associated with perceived accessibility across products.