Journal of studies on alcohol and drugs最新文献

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.

Objective: Numerous studies have reported associations between child maltreatment and drug use and abuse. We ask whether internalizing and externalizing symptoms during young adulthood mediate the relationship between childhood maltreatment and illicit drug use and use of prescribed medications later in middle adulthood.

Method: Using a prospective cohort design, a large group of court-substantiated cases of childhood maltreatment (ages 0-11) and demographically matched controls were followed into adulthood. Internalizing symptoms (depression and anxiety), externalizing symptoms (antisocial personality disorder), and drug abuse and dependence symptoms were assessed in young adulthood (M age = 29) in interviews during 1989-1995 (N = 1,196). Information about the use of illicit drugs and prescribed medications was obtained in middle adulthood in interviews during 2003-2005 (N = 807, M age = 41). Parallel mediation models were tested for depression and anxiety separately using path analysis.

Results: Childhood maltreatment predicted more internalizing and externalizing symptoms during young adulthood. Internalizing symptoms during young adulthood mediated the effect of childhood maltreatment on prescription drug use in middle adulthood. In contrast, externalizing symptoms mediated the relationship between childhood maltreatment and illicit drug use in middle adulthood, despite controls for drug abuse/dependence symptoms in young adulthood.

Conclusions: These new findings suggest that efforts should be directed at reducing internalizing symptoms of anxiety and depression and externalizing symptoms in maltreated children to reduce the risk for drug use later in life. The unique mediating effects of internalizing versus externalizing symptoms on prescription drug and illicit drug use, respectively, suggest the need for tailored interventions for different kinds of drug use.

Objective: Heavy drinking is common among men who have sex with men (MSM) and significantly increases HIV acquisition risk. MSM who report heavy drinking also report higher cannabis use, which has also been associated with sexual behaviors known to elevate HIV transmission risk. Despite evidence of associations at the between-subjects level, the effects of alcohol and cannabis use on sexual risk behavior among MSM who engage in heavy drinking are largely unknown. The current study used ecological momentary assessment to examine the between- and within-subject associations of heavy drinking, cannabis use, and sexual behavior.

Method: This is a secondary data analysis of a study on alcohol intoxication and sexual decision making that included 115 MSM who reported cannabis use and were not using pre-exposure prophylaxis (PrEP) at baseline. Participants reported daily alcohol and cannabis use and sexual activities over 6 weeks. Multilevel multinomial regression was used to evaluate how alcohol and cannabis use were associated with sexual behaviors.

Results: Higher alcohol use was associated with higher rates of intercourse at the between-persons level and a higher likelihood of all sexual behaviors at the event level. In contrast, cannabis use at the between-person level was associated with an increased rate of condomless anal intercourse relative to both anal intercourse with a condom as well as no sex. At the within-person level, cannabis was associated with an increased likelihood of anal sex with or without a condom relative to no sex.

Conclusions: Cannabis and alcohol may have independent effects on sexual risk behavior among MSM. Interventions addressing sexual health among MSM who engage in heavy drinking should also consider the additive risks of cannabis use.

Objective: We investigated risk for alcohol use disorder (AUD) and drug use disorder (DUD) in offspring of parents with major depression (MDD) or bipolar disorder (BD), including how parent and offspring sex impact familial transmission.

Method: Offspring born in Sweden 1970-1990 in intact families with parental MDD or BD (n=1,218,920) were examined using Swedish population registries. Hazard ratios (HRs) for AUD and DUD risk among offspring were calculated using Cox models.

Results: Offspring of one parent with MDD or BD had higher risks of AUD (HR=1.34; HR=1.50) and DUD (HR=1.32; HR=1.43) than offspring of unaffected parents. Maternal MDD (HR=1.38) had a stronger effect on offspring DUD than paternal MDD (HR=1.26), and maternal BD (HR=1.67) more strongly influenced offspring AUD than paternal BD (HR=1.34). Parental MDD had stronger effects on daughters than sons for AUD (HR=1.40 vs. HR=1.32) and DUD (HR=1.44 vs. HR=1.27), while no sex differences were found for parental BD. Among daughters, maternal MDD had stronger effects than paternal MDD for AUD (HR=1.48 vs. 1.32) and DUD (HR=1.56 vs. 1.33); for sons, maternal MDD had greater impact on DUD (HR=1.31 vs. 1.23). Maternal BD had greater effects in daughters, both versus sons for DUD (HR=1.92 vs. HR=1.37) and versus paternal BD for AUD (HR=1.82 vs. HR=1.30) and DUD (HR=1.92 vs. HR=1.31).

Conclusions: Findings demonstrate familial transmission of MDD and BD in parents to AUD and DUD in offspring. Affected mothers may be particularly influential. When sex-specific transmission occurred, it was consistently strongest from mother to daughter.