Journal of studies on alcohol and drugs最新文献

Objective: We investigated offspring alcohol use outcomes as a function of unremitted and remitted parental alcohol use disorder (AUD).

Method: Self-report data of participants in the Collaborative Study on the Genetics of Alcoholism (COGA) were used. Offspring (n = 2,244, mean age 16.3 years at baseline, 26.9 years at follow-up, 50.8% female) were linked to parental data. Time-varying associations of parental AUD and remission with offspring age at first drink, years from first drink to AUD onset, and years from AUD onset to first remission were tested in Cox models adjusted for polygenic risk for problematic alcohol use (PGS_PAU). Analyses were stratified by genetically inferred continental groups of European Americans (EA; 65.9%) and African Americans (AA; 34.1%) because of sociocultural factors that can contribute to differences in alcohol use and problems.

Results: In EA, maternal remission was associated with increased risk for offspring AUD; neither maternal nor paternal remission was associated with other outcomes. In AA, maternal and paternal remission were associated with an increased likelihood of early drinking; the association with maternal drinking varied as a function of whom offspring lived with during adolescence. Paternal, but not maternal, remission was associated with a heightened risk for AUD onset. Parental status had no association with offspring remission in EA or AA.

Conclusions: Evidence that parental remission can help mitigate the risk associated with parental AUD and increase the likelihood of remission in affected offspring was limited and mixed based on continental group and sex. These nuanced outcomes highlight the complex interplay of parental AUD status and offspring's alcohol-related behaviors.

Objective: This study examines the differential predictive value of baseline characteristics of clients being treated for an alcohol problem with respect to the development of an opioid use disorder (OUD) or opioid overdose (OD) within 1 year, between 1 and 4 years, and beyond 4 years after treatment.

Method: A cohort of 87,172 patients treated for an alcohol use problem within state treatment centers was examined. We extracted the first OUD/OD diagnosis event within 1 year of, between 1 and 4 years of, and more than 4 years after the patient's first admission to the Office of Addiction Services and Supports. We calculated odds ratios for all predictors and control variables with respect to OUD/OD events and compared the predictive values of these variables for the different periods.

Results: Both sociodemographic and clinical factors predicted an OUD/OD overall and in most specific follow-up periods. Sociodemographic factors were more strongly associated with OUD/OD during follow-ups beyond 4 years, perhaps because of the increasing availability of opioids over time. Mental health and alcohol use severity factors were more strongly associated with OUD in the 1-year and 1-to 4-year periods, suggesting a rapid progression to OUD/OD.

Conclusions: Both sociodemographic and clinical factors were predictive of a diagnosis of OUD/OD within a brief period; however, they were only predictive of approximately 40% of those who would develop OUD/OD within any specific period. These findings highlight the need for a more formal assessment of opioid use at treatment entry, and for the implementation of harm reduction measures throughout treatment.

Objective: Lower education is a risk factor for alcohol-related deaths, but it is unknown if the impact of education varies by race/ethnicity. We evaluated the interaction between education and race/ethnicity on the odds of alcohol use disorder (AUD) and the significance of employment and poverty as potential mediators.

Method: The 2016-2019 National Survey on Drug Use and Health was used to obtain the weighted prevalence of AUD in participants 26 years and older. Using AUD as the outcome, multivariable logistic regression analyses were performed, stratified by four levels of education, ranging from less than high school to 4-year college+; odds ratios (ORs) for each race/ethnicity were compared across models for interaction. The second model included employment and poverty as covariates; changes in ORs were calculated to assess for >|10%| change implying significant mediating or confounding effects.

Results: AUD prevalence was highest among American Indian/Alaskan Natives (AI/ANs) (8.06%) and similar among non-Hispanic Whites (5.37%) and Blacks (5.09%). When stratified by education, the odds of AUD among Blacks and AI/ANs increased with decreasing education (OR = 1.45, 95% CI [1.07, 1.96]) for Blacks versus Whites with less than high school, compared with 0.55 [0.46, 0.67] for Blacks versus Whites with 4-year college+; 2.55 [1.53, 4.24] for AI/ANs versus Whites with less than high school versus 1.01 [0.45, 2.28] for AI/ANs versus Whites with 4-year college+. Including employment and poverty resulted in <|10%| change in ORs.

Conclusions: Lower education significantly increased the odds of AUD among Blacks and AI/ANs. Employment and poverty did not significantly change the association, implying that there are likely other mechanisms accounting for racial/ethnic disparities in AUD.

Objective: Chronic heavy alcohol use increases the risk for developing alcohol use disorder (AUD), leading to adverse health outcomes. Evidence suggests that patient demographics are used to make treatment decisions, which contributes to barriers to AUD treatment experienced by Hispanic and Latino/a/x individuals. This study characterized the use of ethnicity in alcohol use assessment and treatment referral among medical trainees and dental trainees.

Method: Current medical trainees (n = 54) and dental trainees (n = 59) reviewed 32 vignettes varying systematically in sex, age, ethnicity, and alcohol concern cues. Trainees used 0-100 visual analog scales (VASs) to rate the likelihood of discussing the patient's alcohol use (VAS1), the likelihood that the patient has AUD (VAS2), comfort discussing alcohol use with the patient (VAS3), and the likelihood of referring to AUD-related treatment (VAS4). Idiographic regressions characterized individuals' decision-making policies. Group-level analysis determined the influence of trainee ethnicity and trainee type on patient ethnicity cue use.

Results: Almost all (96%-100%) trainees reliably used the alcohol concern cue when providing ratings. About 25%-56% of trainees used ethnicity as a cue. Trainee ethnicity did not significantly affect ethnicity cue use when evaluating vignettes (t < 1.37, p > .17; d < 0.56). Analyses indicated that medical trainees weighed the alcohol concern cue more heavily than dental trainees for VAS1.

Conclusions: Results suggested that a substantial proportion of trainees reliably used patient ethnicity to make alcohol treatment-related decisions, consistently to the potential detriment of Hispanic and Latino/a/x patients. Finally, the lower weighting of alcohol concern among dental trainees than medical trainees in all but one judgment suggests that dental trainees may not view alcohol screening as part of their professional role as strongly as medical trainees.

Objective: The purpose of this study was to investigate the experiences of a novel adjunctive medical cannabis (MC) intervention within a residential substance use recovery program.

Method: This qualitative study included interviews and validated self-reports with clients (N = 14) at baseline, 1 month, and 3 months after receiving adjunctive medical cannabis treatment in addition to standard of care. Interviews with program staff (N = 7) supplemented the assessment of barriers and facilitators to program delivery.

Results: Clients reported that the cannabis substitution program demonstrates promise to help reduce problematic substance use by reducing drug cravings and assisting with pain and other comorbid symptoms. The program also helped to destigmatize MC use. Staff reports highlighted the importance of MC education, clear guidelines for dispensing MC, and an accessible framework for program delivery to facilitate effective uptake of this novel intervention.

Conclusions: This study provides preliminary evidence for the feasibility of integrating MC in a supportive residential recovery program. Important factors for success include the provision of cannabis education, developing a clear organizational framework, and establishing evidence-informed policies within the context of substitution therapy and harm reduction. Further research to more formally evaluate integrating MC in residential substance use treatment is encouraged.

Objective: The purpose of this study was to investigate factors contributing to the decline in the number of passengers riding with alcohol-impaired drivers involved in fatal crashes since 1982 and to examine the impact of simulated interventions on this group through 2050.

Method: Historical data were obtained from the Fatality Analysis Reporting System. We applied linear regression to analyze changes in the average numbers of passengers per alcohol-impaired young driver involved in fatal crashes between 1982 and 2020 by age and sex. We also extended our existing system dynamics simulation model developed to examine driving-while-impaired (DWI) behaviors of U.S. male and female drivers ages 15 to 24 and explored riding-with-an-impaired-driver (RWI) behaviors and corresponding interventions. We conducted sensitivity analyses to examine the likely trajectories of alcohol-impaired drivers' passengers in fatal crashes across multiple scenarios through 2050.

Results: Our findings show that the decline in passengers of alcohol-impaired drivers in fatal crashes primarily stems from a decrease in the number of impaired drivers rather than a change in the average number of passengers per impaired driver. The simulation model replicated historical trends from 1982 to 2020, and the sensitivity analyses show that the policies reducing DWI trips also decrease RWI trips.

Conclusions: Wide adoption of a comprehensive strategy combining increased enforcement, an alcohol truth campaign, the provision of alternative transportation, and the enactment of a new DWI restrictive law could significantly reduce the number of passengers in fatal crashes involving alcohol-impaired drivers while minimizing possible unintended consequences.

Objective: This study investigated associations between social network characteristics and alcohol and cannabis use among non-reservation-living American Indian/Alaska Native (AI/AN) emerging adults (18-25 years old), with a focus on the potential protective influence of AI/AN traditional practices (e.g., dancing, storytelling, beading).

Method: The study used a multilevel, multivariable dyadic approach to analyze personal network composition and network connectivity (centrality and density) from 470 AI/AN emerging adults living in nonreservation areas across the United States. Eligible participants completed an online survey, which included questions about social networks and alcohol and cannabis use.

Results: Findings indicated that network members who were similar in age, perceived to be friends, and lived nearby were more likely to be alcohol and cannabis use partners. Network members who shared AI/AN identity but did not engage in traditional practices were more likely to be alcohol and cannabis use partners than non-AI/AN network members. Analysis of network density demonstrated that having highly connected networks was associated with lower odds of respondents engaging in alcohol and cannabis use with members of their networks. However, highly central network members had higher odds of alcohol and cannabis use with respondents than those who were less central. Findings were robust when controlling for respondent and network alcohol and cannabis use.

Conclusions: The study underscores the significance of the network context of alcohol and cannabis use for nonreservation AI/AN emerging adults. The protective role of traditional AI/AN practices highlights the importance of strength-based intervention approaches that promote healthy social connections and traditional practices. Future research should test hypotheses longitudinally to inform more effective prevention strategies.

Objective: Veterans experience high rates of co-occurring anxiety disorders, posttraumatic stress disorder (PTSD), and unhealthy alcohol use. The goal of this study was to improve the understanding of veterans' beliefs about recovery from co-occurring anxiety/PTSD and alcohol use to direct treatment adaptation and implementation for providers.

Method: Semistructured qualitative interviews were conducted with 20 veterans and analyzed with rapid qualitative analysis and inductive coding.

Results: Veterans' responses reflected themes related to improvement in functioning, including the use of coping skills and communication skills, engagement in therapy, and connection with other veterans. Veterans also described barriers and facilitators related to effective treatment for both disorders.

Conclusions: Specific elements in treatment (e.g., coping and communication skills) and broader considerations (e.g., building community among others in recovery) contribute to relationship and occupational recovery from co-occurring disorders among veterans. Ensuring that these factors are considered in behavioral treatment and treatment programs more broadly for veterans with co-occurring disorders has the potential to enhance functional recovery by aligning with veterans' perspectives and priorities.

Objective: Increasing engagement in evidence-based treatment for opioid use disorder during pregnancy is pressing. Generative artificial intelligence large language model conversational agents may support clinicians in delivering safe, accurate, and relevant information to this population. The central aim of this study was an exploratory evaluation of the steerability of GPT-4 (Generative Pre-trained Transformer) for the provision of trustworthy treatment-related information to pregnant people with opioid use disorder.

Method: The model was tuned using evidence-based guidelines and tenets of motivational interviewing. A rubric was developed to evaluate the safety, accuracy, and relevance of the tuned model's responses to user messages from the persona of a pregnant woman with an opioid use disorder. Two advanced practice registered nurses with more than 10 years of experience treating people with opioid use disorder independently evaluated the dialogs between the model and persona (n = 30) using the rubric and qualitative methodology.

Results: Responses were rated as safe, accurate, and relevant in 96.7% of cases. Qualitative analysis identified four increasing connection subthemes, including three related to client-centered communication. In 100% of cases, the model identified congruence with opioid use disorder criteria and located the person within the transtheoretical model's stages of change.

Conclusions: The tuned model generated clinically safe, accurate, and relevant responses about opioid use disorder treatment during pregnancy. Consistent with the progression of informatics study typology, before this model could be embedded in an application to allow direct public access, additional lab- and field-based testing is indicated, including with people with this use disorder.