Journal of studies on alcohol and drugs最新文献

Objective: These analyses use data from a 40-year prospective study to extend information into the sixth and seventh decades of life regarding latent trajectory classes of cannabis use and predictors of those classes.

Method: Data from the San Diego Prospective Study were analyzed for 329 men of European and Hispanic ethnicity who had used cannabis at about age 23 at study entry (Time 1) and who were interviewed about every 5 years through about age 60 to 70. Latent classes of cannabis use trajectories were evaluated using latent class growth analyses, baseline predictors of class membership were determined, and significant predictors of each class were established using logistic regression analyses.

Results: Four latent classes were identified ranging from 12.5% with cannabis use at every follow-up to 25.8% with no use after Time 1. Eight of 14 Time 1 predictors differed significantly across the trajectory classes, including five (age, marital status, religious identity, intensity of cannabis use, and sensation seeking) that significantly contributed to regression analyses when all significant predictors were considered together.

Discussion: Forty-two percent of participants continued using cannabis long-term, including one in eight who used it at every follow-up. Predictors of continued use and identification of those most likely to stop required gathering information on a range of demographic, prior substance use, and personality characteristics.

Conclusions: Considering the potential enhanced dangers of cannabis use in later life, the high rate of continued use over four decades implies that clinicians should ask all older patients about recent cannabis use, especially if they had used it in their 20s.

Objective: Impaired control over alcohol is a hallmark of addiction relevant to young adults, but additional prospective findings are needed, particularly in samples reporting heavy drinking. Further, we lack understanding of how attempts and failed efforts to control drinking relate to each other in predicting outcomes. We hypothesized that attempted and failed control would prospectively predict outcomes, with endorsement of both being especially problematic.

Method: We used data from young adults reporting heavy drinking who enrolled in laboratory alcohol self-administration studies (n = 109). Mixed-effects models were used to predict drinks per drinking day, heavy drinking, and negative consequences across baseline and 6- and 12-month follow-ups. Interactions by time and between attempted and failed control were tested.

Results: Higher failed control was associated with steeper declines in consequences and heavy drinking over time compared with lower failed control. However, higher attempted or failed control was still associated with more consequences and alcohol use than lower impaired control at multiple time points. A significant interaction indicated that the combination of higher attempted and failed control was associated with the most drinks per drinking day. There was also a significant Attempted × Failed Control interaction for heavy drinking.

Conclusions: These findings provide further evidence supporting impaired control over alcohol use as a risk factor among young adults. Those reporting both higher attempted and failed control drank the most per day. Either attempted or failed control was associated with negative consequences. Those reporting both higher attempted and failed control may be in greatest need of intensive intervention.

Objective: World Health Organization (WHO) risk drinking levels (i.e., low, moderate, high, or very high risk) have been used as a drinking-reduction endpoint in clinical trials. Yet, prior work has not attempted to quantify reductions in WHO risk levels among mandated students, who may also benefit from reduced drinking. We sought to validate WHO risk drinking levels in differentiating students' alcohol-related outcomes, depressive symptoms, and academic performance. Defining risk via typical drinks per drinking day versus drinks per day was compared, and gender differences were examined.

Method: Baseline data were drawn from three intervention trials for students mandated to intervention and who were not abstinent (N = 1,436). Sex-specific WHO risk levels were generated and dummy coded, with low risk as the reference. Regression models examined associations of risk levels with positive Alcohol Use Disorders Identification Test (AUDIT) scores, peak drinking, consequences, depressive symptoms, and grade point average.

Results: Defining WHO risk via drinks per drinking day evenly dispersed students across categories, whereas drinks per day categorized most students as low risk. More women than men were classified as very high risk across definitions. Students classified as low risk differed from those classified as moderate, high, and very high risk in screening positive on the AUDIT, peak drinking, and consequences. WHO risk levels did not differentiate depressive symptoms. Differences in grade point average were inconsistent across risk definitions.

Conclusions: WHO risk drinking levels differentiated alcohol use and consequences and, therefore, hold promise for clinical use and for quantifying drinking reductions among mandated college students.

Objective: Epidemiologic surveys aim to estimate the population prevalence of cannabis use and cannabis use disorder. Prevalences estimates are important for understanding trends, such as the impact of policy change. Existing epidemiologic surveys have produced discrepant and potentially unreliable estimates. The current meta-analysis (PROSPERO CRD42022364818) aims to identify potential sources of unreliability in prevalence estimates of cannabis use and use disorder among the general population (aged 12+). There was no specific hypothesis about overall prevalence estimate, but we expected significant variability (i.e., heterogeneity) in estimates based on factors such as country, year of data collection, and specific methodological factors (e.g., diagnostic instrument).

Method: Systematic searches identified manuscripts and reports documenting nationally representative lifetime or past-year cannabis use disorder prevalence estimates. Meta-analysis was used to synthesize prevalence estimates, evaluate heterogeneity, and test moderators.

Results: There were 39 manuscripts/reports included in analyses which resulted in 259 unique prevalence estimates spanning 1980-2013 and an aggregated sample size of 973,281 individuals. Past-year and lifetime prevalence estimates for cannabis use were 12.83% (95% CI: 11.15%, 14.71%) and 38.31% (95% CI: 35.92%, 40.76%) and those for cannabis use disorder were 2.59% (95% CI:2.30%, 2.90%) and 6.77% (95% CI: 4.89%, 9.30%), respectively. There was significant heterogeneity in estimates, which was partially explained by factors such as country, year of data collection, and methodological characteristics.

Conclusions: The significant heterogeneity in prevalence estimates as a function of methodological characteristics raises concerns about the generalizability of estimates. Recommendations for enhancing validity and reliability of these estimates are offered.

Background: Five U.S. states where recreational cannabis is legal require Mandatory Warning Signs for cannabis use during pregnancy (MWS-cannabis) to be posted in cannabis dispensaries. Previous research has found adverse health consequences associated with MWS-cannabis and that people lack trust in information on signs. This qualitative study explores people's perspectives and preferences regarding MWS-cannabis.

Methods: We conducted in-depth interviews with 34 pregnant or recently pregnant individuals from multiple states with varying policy climates in the U.S. who used cannabis before and/or during pregnancy. We asked participants about their perspectives on MWS-cannabis and reactions to specific messages. We reviewed transcripts using thematic analysis.

Results: Participants reported mostly negative views on MWS-cannabis, suggesting they may have stigmatizing and negative impacts on pregnant people who use cannabis, discouraging them from seeking care. Many said that the scientific evidence is not strong enough to justify MWS-cannabis, and that they are unlikely to deter pregnant people from using cannabis. Participants asserted that vague or fear-based messages, distrust of government, and the location and timing of the signs undermine the goals of MWS-cannabis. When reacting to specific messages, participants preferred messages that are evidence-based, clear, specific, and aligned with autonomous decision-making.

Conclusions: Pregnant and recently pregnant people who use cannabis have mostly negative perceptions of MWS-cannabis and believe they have negative consequences. More work is needed to develop health information resources that meet the needs of people who use cannabis in pregnancy without increasing stigma.

Objective: Safer supply programs are a novel response to the ongoing overdose crisis in Canada - providing people at high overdose risk with a safer alternative to the highly toxic unregulated drug supply. The MySafe program provides pharmaceutical-grade opioids to participants via biometric dispensing machines. This study examines program-related goals and related outcomes across time.

Method: Longitudinal semi-structured interviews were conducted with 29 study participants at baseline and one-year follow-up. Interviews covered program functionality, experiences, outcomes, and reasons for enrollment and engagement. Baseline and follow-up interviews were compared to explore changes over time, including the effectiveness of the MySafe program in supporting individuals' achievement of their stated goals.

Results: Most participants reported similar goals at their baseline and follow-up interviews. The most common goal for initiating and staying in the program was to stop or reduce using street-purchased drugs, followed by abstinence, and wanting to stop injecting drugs. A number of participants described goals addressing issues related to structural vulnerability (e.g., improving living situations). At follow-up, some participants reported reducing street-purchased drug use, no participants reported abstinence, and all those wanting to stop injecting drugs reported achieving their goals.

Conclusion: Our findings highlight a strong desire among study participants to be separated from the unpredictable street-drug supply. Participants reported variable success attaining their stated goals. However, our results demonstrate the need for such programs to better attend to participant goals, especially those impacted by structural vulnerability, that can be supported with wrap-around social and health care supports.

Objective: Men's coercive condom use resistance (CUR) with female partners is common and is associated with greater alcohol consumption than men's noncoercive CUR engagement. Prior research indicates that emotion-related factors are relevant to alcohol-involved coercive CUR. Thus, in this alcohol administration study, we examined emotional factors as distal and proximal predictors of alcohol-involved coercive CUR among young men who have sex with women.

Method: Non-problem drinking young adult men who have sex with women (N = 282) were recruited from the local community, and as part of a larger study, completed a background survey and an in-lab alcohol administration session that included a mood induction and sexual scenario task using a 2 (sober vs. intoxicated) x 2 (positive mood vs. negative mood) experimental design.

Results: Path analysis testing a moderated mediation model revealed that for participants in the sober, positive mood, and intoxicated, negative mood conditions, there was a positive association between distal ER difficulties and motives to have sex to cope with negative emotions. Additionally, distal ER difficulties were positively associated with proximal difficulties modulating one's emotions among intoxicated participants. Among those with greater proximal difficulties modulating their emotions, state anger was positively associated with coercive CUR intentions.

Conclusions: Results demonstrate the importance of alcohol intoxication, emotions and emotion regulation, and sexual coping motives in men's coercive CUR likelihood, demonstrating potential malleable targets for prevention efforts.

Objective: This study examined whether the cumulative experience of elevated depressive symptoms from age 19 to 23 was associated with cannabis use disorder (CUD) at age 26, and whether the association varied by perceived ease of access to cannabis and perceived risk for harms from cannabis use.

Method: Data were from 4407 young adults participating in the Community Youth Development Study. Cumulative experience of elevated depressive symptoms was calculated by summing the number of times a participant scored 10+ on the 9-item Patient Health Questionnaire across three biennial survey waves (age 19 to 23). To assess CUD, the Diagnostic Interview Schedule was used. Participants also self-reported their ease of access to cannabis and the perceived harm of regular cannabis use at the age 19, 21, and 23 waves. Marginal structural modeling was used to account for multiple time-varying and time-fixed covariates through use of inverse probability weights.

Results: In final weighted models, a greater number of time points (i.e., study waves) showing elevated depressive symptoms was associated with an increased likelihood of CUD at age 26 (Prevalence Ratio = 1.46; 95% CI: 1.20, 1.77). There was no strong evidence for moderation of this association by perceived ease of access or perceived risk for harms due to regular cannabis use.

Conclusions: Persistent experience of elevated depressive symptoms may place young adults at risk for cannabis use disorder. Strategies to reduce the burden of depressive symptoms among young adults may lead to downstream effects such as reducing the prevalence of cannabis-related problems.

Objective: Ayahuasca, an entheogen from the Amazon rainforest, has garnered growing interest to treat substance dependence. To date, there is little research concerning the act of Ayahuasca-related purging (mainly vomiting), which is considered to be central to healing during Ayahuasca rituals. This study explored practitioner perspectives on purging during Ayahuasca rituals at the Takiwasi Centre in Peru.

Method: We conducted in-depth interviews with curanderos (healers), plant preparers, and psychotherapists (N=11) at the Takiwasi Centre between August-October 2021. Interviews were conducted and transcribed in Spanish. Interviews were analyzed using a thematic analysis approach.

Results: Participants described purging as a fluid concept that went beyond the act of vomiting. Participant narratives around purging were organized into three central themes or "accounts": Spiritual-oriented, which highlighted the relationship between purging and spiritual development; Amazonian-oriented, which placed emphasis on purging as a cathartic expulsion of embodied cargas (loads) that are perceived to lead to sickness; and Clinical-oriented, which stressed that purging generates a range of empirically-observable therapeutic benefits. All of these explanatory models emphasized the pivotal interconnection between purging and healing during Ayahuasca-assisted treatment for substance dependence at Takiwasi.

Conclusions: This study highlights practitioner perspectives on purging at the Takiwasi Centre, who offer three main explanatory models for this aspect of healing during Ayahuasca-assisted therapy for substance dependence. This research contributes to the limited literature on the role of purging in Ayahuasca-related healing, which may inform further investigation into differential understandings of the role of purging for therapeutic benefits.

Objective: Alcohol contributes to a large number of deaths annually, both in terms of deaths fully attributed to alcohol (e.g., alcohol poisoning) and deaths where alcohol is a contributing cause (e.g., motor-vehicle accidents). Nationally, alcohol-involved deaths are increasing. This study examines alcohol's role in substance-involved deaths and factors that are associated with alcohol-involvement in the St. Louis, Missouri region.

Method: The present study examines 7,641 substance-involved deaths that occurred in the St. Louis, Missouri region. Data were provided by city and county medical examiner offices and comprise all substance-involved deaths between 2011 and 2022. We examined the prevalence of alcohol stratified by manner of death, sex, and race. We conducted logistic regression predicting odds of alcohol involvement based demographic factors, presence of medical conditions, involvement of other substances, and year of death.

Results: Overall, 26.29% (2,009/7,671) of substance-involved deaths involved alcohol, and annual alcohol-involved deaths increased 54.33% from 2011 to 2022. Most substance-involved deaths were overdose deaths (82.54%, 6,307/7,641). Alcohol-involved overdose deaths increased 60.76% from 2011 to 2022. Prevalence of alcohol was higher for overdose deaths involving opioids and benzodiazepines (18-24%) than for other drug classes (7-16%). Odds of alcohol involvement in overdose deaths increased with age (OR=1.02, 95% CI:[ 1.01, 1.02]) and were higher for males (OR=1.67, 95% CI: [1.43-1.96]).

Conclusions: The St. Louis metropolitan area saw increases in alcohol-involved fatalities for all manner of deaths, particularly overdose deaths and deaths among Black men. To improve prevention strategies for alcohol fatalities, further research is needed to investigate the role of alcohol in polysubstance overdose deaths.