Journal of studies on alcohol and drugs最新文献

Objective: Individuals with unhealthy alcohol use and comorbid depression or anxiety may be vulnerable to alcohol use escalation in times of stress such as the COVID-19 pandemic. Among a cohort of individuals with pre-pandemic unhealthy drinking, we compared changes in alcohol use by whether people had a depression or anxiety diagnosis and examined whether mental health treatment was related to these changes.

Method: Using electronic health record data from Kaiser Permanente Northern California, we analyzed drinking changes during the pandemic (3/1/2020-6/30/2022) among adults identified in primary care with unhealthy alcohol use (exceeding daily/weekly recommended limits) pre-pandemic (1/1/2019-2/29/2020). Outcomes were mean changes in number of heavy drinking days (prior 3 months), drinks/week, drinks/day, and drinking days/week. Multivariable linear regression models were fit to (a) compare outcomes of patients with depression or anxiety diagnoses to those without, and (b) among patients with depression or anxiety, estimate associations between mental health treatment and outcomes.

Results: The sample included 62,924 adults with unhealthy alcohol use, of whom 12,281 (19.5%) had depression or anxiety. On average, alcohol use significantly decreased across all measures during the pandemic; however, patients with depression or anxiety had greater decreases in drinks/week (adjusted mean difference [aMD] [CI] = -0.34 [-0.55, -0.12]) and drinking days/week (-0.15 [-0.20, -0.10]). No associations were found between mental health treatment and changes in drinking.

Conclusions: Contrary to expectations, patients with unhealthy alcohol use and depression or anxiety decreased alcohol use more than those without depression or anxiety during COVID-19, regardless of whether they accessed mental health services.

Objective: Black individuals are disproportionately affected by tobacco-related illnesses. Although tobacco use is often initiated in adolescence and risk factors thereof originate from multiple domains of influence, investigations of tobacco use among Black adolescents seldom consider these domains simultaneously. These examinations are needed to identify the impact of co-occurring risk factors on tobacco use and inform comprehensive tobacco prevention and treatment programs. Our study sought to identify the combined influence of factors across multiple domains on tobacco use among Black adolescents.

Method: Participants were non-Hispanic Black (N = 1,801) adolescent (ages 12 to 17 years) respondents from Wave 1 of the Population Assessment of Tobacco and Health Study. Latent class analysis identified unique response patterns to items assessing the risk of tobacco use across sociocultural, environmental, psychological, and behavioral (e.g., alcohol use) domains. Subsequent logistic regressions compared the odds of ever and current tobacco use between the classes.

Results: Four latent classes were identified. According to item response probabilities, they were named low risk (LR; 36.5%), low psychological (LP; 19.0%), high psychological (HP; 30.4%), and high social, psychological, and behavioral (HSPB; 14.1%) risk. The odds of ever and current tobacco use were highest among adolescents in the HSPB latent class compared with the other latent classes (odds ratio = 6.5 to 42.1).

Conclusions: Adolescents with the highest odds of tobacco use endorse multiple risks including feeling distress, perceiving tobacco as beneficial for handling stress, and using substances, and may prioritize the management of negative emotions over perceived health consequences from tobacco use. Multilevel interventions that incorporate the development of coping strategies for effectively handling negative affect may prove highly effective in preventing tobacco use among Black adolescents.

Objective: With same-day online alcohol sales increasing, there is a need to study their regulation. Test purchasing of alcohol home delivery was conducted to measure compliance with regulations for identification checks and unattended deliveries in two Australian jurisdictions (Perth, Western Australia, and Geelong, Victoria), which have differing regulations.

Method: Alcohol orders for same-day or rapid (<2 hours) delivery on Friday and Saturday nights were made by research assistants ages 18-24 years in Perth (n = 34) and Geelong (n = 29). An observation checklist was used to record the delivery interaction, with a specific focus on checking photo identification at the time of delivery and whether deliveries were left unattended.

Results: The average time from order to delivery for rapid deliveries was less than 1 hour in both sites (Perth = 50 minutes; Geelong = 36 minutes). More than 20% of deliveries were made without an identification check in both sites (Perth = 24%; Geelong = 21%).

Conclusions: This pilot study showed that alcohol can be delivered to the home within 1 hour, and not all deliveries include an identification check at the point of delivery. These findings indicate a need for policies that empower regulators and police to undertake "mystery shopper" monitoring to reduce potential harms and improve compliance with alcohol delivery policy.

Objective: This article documents the methods used to assess the implementation costs of the APPRAISE (A two-arm parallel group individually randomized Prison Pilot study of a male Remand Alcohol Intervention for Self-efficacy Enhancement) alcohol brief intervention (ABI) delivered to male remand prisoners across two study sites in Scotland and North East England.

Method: We first developed a comprehensive taxonomy of the activities constituting the APPRAISE ABI. Next, data about the study staff and the subject time spent were collected for each activity, in addition to the other resources used and unit costs.

Results: From the pilot data collection, it was possible to construct a narrative, for both study sites, how the intervention was delivered and the time required for each activity. The ABI was delivered by Change Grow Live and Humankind intervention staff. Staff salaries were obtained from both organizations to calculate the staff delivery costs for each site. Other costs, such as the printing of materials, were estimated based on APPRAISE study records. Because of the ongoing COVID-19 restrictions and limited access to prison resources and staff, there were significant deviations from the initial study protocols. As a result, we document the costs of implementing the ABI as delivered rather than as planned.

Conclusions: This article provides the first estimates of the implementation costs of an ABI delivered in a criminal justice setting in the United Kingdom. Although these costs are from a pilot implementation that was heavily impacted by the COVID-19 pandemic, this article nonetheless provides useful, policy-relevant information on the potential costs of providing ABI to remand prisoners. It also serves as a methodological template, guidance, and proof of concept for future micro-costing studies of ABIs in criminal justice settings.

Objective: The opioid overdose crisis continues within the United States, and the role of prescribed opioids and prescribing patterns in overdose deaths remains an important area of research. This study investigated patterns of prescription opioids dispensed in the 12 months before opioid-detected overdose death in Connecticut between May 8, 2016, and January 2, 2018, considering differences by demographic characteristics.

Method: The sample included decedents who had an opioid dispensed within 30 days preceding death. Using multilevel modeling, we estimated the slope of change in mean morphine equivalent (MME) daily dose over 12 months before death, considering linear and quadratic effects of time. We also estimated the main effects of age, sex, race, and ethnicity and their interactions with time on MME. A sensitivity analysis examined how excluding decedents who did not receive long-term (≥90 days) opioid therapy affected mean MME slopes. The secondary analysis explored differences according to toxicology results.

Results: Among 1,580 opioid-detected deaths, 179 decedents had prescribed opioids dispensed within 30 days preceding death. Decedents' mean age was 47.3 years (SD = 11.5), 65.5% were male, 81% were White non-Hispanic, 9.5% were Black non-Hispanic, and 9.5% were Hispanic. In the time-only model, linear (beta = 6.25, p < .01) and quadratic (beta = 0.49, p = .02) effects of time were positive, indicating exponentially increasing dose before death. Linear change in MME was significantly attenuated in men compared with women (beta = -4.87, p = .03); however, men were more likely to have nonprescription opioids in their toxicology results (p = .02). Sensitivity analysis results supported the primary findings.

Conclusions: Rapid dose increases in dispensed opioids may be associated with opioid-detected overdose deaths, especially among women.

Background: The COVID-19 pandemic had dramatic adverse impacts on people with opioid use disorder (OUD), as evidenced by significant disruptions to care and unprecedented increases in drug overdoses. In this study, we evaluated the impacts of COVID-19 on utilization of emergency and inpatient care, and fatal and non-fatal overdoses among veterans with OUD.

Methods: We used Veterans Health Administration (VHA) electronic medical record and mortality data to compare emergency department (ED) visits, inpatient hospitalizations, and fatal and non-fatal overdoses between a pandemic-exposed cohort of veterans with OUD observed both pre- and post-pandemic onset (n = 53,803; observed January 2019-March 2021) to a matched pre-pandemic control group (n = 53,803; observed October 2017-December 2019).

Results: Compared to pre-pandemic trends, there were significant decreases in the odds of ED and inpatient admissions and total number of ED and inpatient admissions during COVID-19. There was a significant decrease in the odds of having a recorded non-fatal overdose. The odds of overdose death increased during the pandemic compared to pre-pandemic trends.

Conclusion: We observed significant decreases in the utilization of ED and inpatient care services, and fewer non-fatal overdoses, post-pandemic onset. Healthcare disruptions limiting access to emergency and inpatient care could account for the lower number of recorded non-fatal overdoses, potentially reflecting an underestimate of risk. In contrast, fatal overdoses increased during the pandemic compared to pre-pandemic trends. Lower utilization of emergency and inpatient care, and higher rates of fatal overdoses during the pandemic, suggest an exacerbation of unmet treatment need post-pandemic onset.

Background: The United States has seen a rapid increase in the use of Δ-8-tetrahydrocannabinol (Δ⁸-THC), a psychoactive compound similar to Δ-9-tetrahydrocannabinol (Δ⁹-THC). This study aimed to explore themes in Δ⁸-THC related tweets from U.S. jurisdictions with varying cannabis regulations from 2020 to 2022.

Methods: Tweets mentioning Δ⁸-THC were collected using search terms: D8, Delta-8, and Delta8 THC. The tweets were date-restricted from January 21, 2020, to May 31, 2022, resulting in 139,843 tweets. The final dataset included 61,800 U.S. tweets with complete location data. A subset of 1,000 tweets (n = 250 for each legal jurisdiction) was selected for content analysis.

Results: Three main themes related to Δ⁸-THC emerged across all jurisdictions: 'Sales and Advertising', 'Policy', and 'Personal Use'. In states where cannabis was legal for adult use, sales-themed tweets were most prevalent, promoting product sales and discounts. 'Policy' tweets were more common in medical CBD-only (34.5%) and fully illegal (24.8%) jurisdictions than in those with legalized medical (20.4%) and adult use (20.2%). Tweets about personal use appeared at similar rates in fully illegal (27.7%), medical (25.0%), medical CBD-only (24.5%), and fully legal jurisdictions (22.8%). Reports of adverse effects were frequent in tweets from fully illegal (28.9%), fully legal (27.7%), and medical (27.7%) jurisdictions, with the lowest frequency in medicinal CBD-only (15.6%) jurisdictions.

Conclusion: The current study on the public discourse on Twitter indicates that discussions about the use and marketing of Δ⁸-THC are present in all U.S. jurisdictions, not just those without legal recreational cannabis markets.

Objective: Sexual minority (SM) college students have higher alcohol use and alcohol-related consequences than heterosexual students. Peers are salient determinants of young adult drinking, and examining social network characteristics is useful for understanding peer influence. This study used social network methods to understand network characteristics, alcohol use (i.e., max drinks), and alcohol consequences of SM and heterosexual college students.

Method: Sexual minority and heterosexual junior-year college students (N = 1,150) were compared on (1) social network features (eigenvector centrality, indegree, outdegree, mutuality, closeness), and (2) alcohol use and consequences. We also determined (3) whether social network characteristics were associated with alcohol use and consequences, and (4) whether these associations differed based on sexual identity or attraction.

Results: Students reporting a bisexual identity or same-gender attraction had greater eigenvector centrality (global popularity or prestige) than heterosexual or students reporting exclusively other-gender attraction, respectively. Students reporting same-gender attraction had higher outdegree (expansiveness) and more reciprocated ties (mutuality) than individuals reporting exclusively other-gender attraction, but heterosexual students and students with other-gender attraction reported higher relationship closeness; they also reported a higher number of drinks than bisexual students and students with same-gender attraction. One significant interaction showed that outdegree (expansiveness) was associated with alcohol consequences for students who reported any same-gender attraction, but not for students who reported exclusively opposite-gender attraction.

Conclusions: SM college students' greater network prominence differs from research with adolescents and might reflect students' efforts to establish more affirming social connections in a college environment.

Objective: Driving under the influence (DUI) of substances is the first cause of death among young populations. Unfortunately, there is a paucity of research looking at DUI risk factors in adolescents. This study aimed to estimate the past-year prevalence and correlates of DUI of alcohol (DUI-A), cannabis (DUI-C), and both (DUI-A+C) in adolescents who reported past-year alcohol and cannabis use.

Method: The study sample comprised 3,175 [(47.9 % females; M_age (SD) = 16.76 (.70)] Spanish adolescents from a national representative survey (ESTUDES) conducted by the Spanish Ministry of Health. Hierarchical regression models were conducted to identify correlates of DUI-A only, DUI-C only, and both behaviors, including sociodemographic, substance use and parental control variables.

Results: Past-year prevalence of DUI was 9.9 % among past-year alcohol and cannabis users. Past-year DUI of substances was more likely among males (15.4 %) relative to females (6 %) [χ² = 73.39, p = <.001, Φ = .152]. Being male, reporting higher past-month days of cannabis use and cannabis-related problems were common risk factors for DUI-C and DUI-A+C. Risk factors of DUI-A were greater money availability for going out, higher past-month frequency of heavy drinking episodes and lower past-month cannabis use days. Specific correlates of DUI-A+C were being 18, past-year simultaneous alcohol and cannabis use, and earlier age of alcohol use initiation.

Conclusions: There is a need to address DUI in substance use prevention in school settings. Screening should be particularly focused on adolescent substance users, while interventions should target attitudes and risk of substance use and driving.

Objective: Alcohol expectancy theory proposes that beliefs about drinking motivate or deter drinking. Although expectancies influence drinking, less is known about how the consequences of drinking influence expectancies. We modeled a feedback conceptualization of how the experience of specific consequences influenced people's beliefs about how likely a consequence will occur (i.e., likelihoods) and how positive the consequence will be (i.e., valences).

Method: We re-analyzed cross-sectional data from college drinkers (n = 504), using Bayesian cross-classified multilevel ordinal regressions to estimate associations between consequences, likelihoods, and valences. We performed a preregistered replication in new data (n = 362).

Results: Participants had higher likelihoods (95% CI_{Study 1} = [2.06, 2.43], 95% CI_{Study 2} = [1.75, 2.12]) and valences (95% CI_{Study 1} = [0.28, 0.52], 95% CI_{Study 2} = [0.33, 0.60]) when they had experienced consequences more often, but these associations leveled off at higher consequence frequencies. Participants also believed consequences to be more likely when they viewed them as more positive, and vice versa, and again, these associations leveled off at higher levels of the predictor. Critically, the strength of these associations varied across both people and consequences.

Conclusions: Experiencing specific consequences more often was related to people judging them to be more likely and more positive in the future, aligning with alcohol expectancy theory. This may lead to experiencing negative consequences repeatedly because people are not being demotivated from drinking in the same fashion. Given the person and consequence level variability, clinicians should consider an individualized approach when targeting drinking consequences.