Substance Abuse and Rehabilitation最新文献

Background: Substance use disorders (SUDs) are highly prevalent, chronic conditions that often go untreated. Technology-driven interventions, including digital therapeutics, web-based programs, and mobile applications, have expanded treatment access. The COVID-19 pandemic accelerated the adoption of digital approaches, and national policy calls for enhanced use of telehealth and app-based recovery support. However, user engagement with SUD apps remains a challenge.

Objective: This narrative review summarizes evidence on digital interventions for SUDs, emphasizing mobile apps. It examines what differentiates effective interventions, drawing on insights from the broader context of general mobile app use. It also proposes strategies to enhance engagement in digital therapeutics.

Methods: We reviewed the literature (2013-2025) on SUD digital interventions, including randomized trials, systematic reviews, and large observational studies of SUD-focused apps. Key findings on clinical efficacy and engagement were extracted, along with examining engagement tactics from mobile gaming and other app domains to inform potential improvements.

Results: Several apps have demonstrated efficacy in reducing substance use or supporting abstinence, particularly those that integrate evidence-based therapy content, provide personalized feedback, offer craving-management tools, and facilitate connectivity to peer or clinician support. In contrast, apps with minimal interactive content often show no added benefit. A major barrier is sustaining user engagement, as many SUD apps experience a steep drop-off in use after the initial download. Strategies such as gamification, contingency management (utilizing incentives), social networking features, and integration with ongoing care can significantly enhance engagement. Early data suggest that blending these strategies into SUD apps yields higher retention and better clinical results.

Conclusion: Mobile apps are emerging as valuable adjuncts for SUD treatment, but their real-world impact depends on users' engagement with compelling content. By incorporating tangible rewards, personalized and timely interventions, social support, and provider involvement, digital therapies for SUDs enhance engagement and, consequently, improve long-term recovery outcomes.

This narrative review highlights the growing population of older adults (OA) who use cannabis and health considerations of cannabis use especially relevant to aging. The majority of OA who endorse using cannabis also report choosing it for medical purposes, most commonly to target symptoms of pain, insomnia, anxiety, and depression. However, many OA who use cannabis also do not discuss their use with their medical providers, and additional controlled clinical trials are needed to delineate which symptoms cannabis can successfully alleviate and any conditions or circumstances for which it is contraindicated. Further, emerging research in younger populations has documented possible cardiovascular risks of heavy cannabis use, and this area has yet to be thoroughly investigated in aging adults despite risk for vascular and other forms of dementia. Preclinical models are beginning to offer insight into health effects of cannabis use with aging, including cognition and dementia risk. In particular, cannabis represents a possible treatment for cognitive decline and neurodegeneration in OA, but further research is needed to characterize effects of cannabis use in healthy aging versus dementia processes.

Background: Probable alcohol use disorder is rarely on the minds of people who use alcohol, probably due to technicality related to making that diagnosis. Men who have sex with men are more vulnerable to alcohol use, usually as a coping strategy to manage minority distress, stigma, violence and validation. This study determined the prevalence and factors associated with probable alcohol use disorder among men who have sex with men enrolled in the HIV pre-exposure prophylaxis program in Tanga, Tanzania.

Methodology: This study included 364 men who have sex with men recruited through respondent driven sampling. Structured questionnaire was used for socio-demographic and sexual characteristics data collection. Probable alcohol use disorder was assessed using the Alcohol Use Disorder Identification Test (AUDIT). A modified Poisson regression model was used to determine the factors associated with probable alcohol use disorder among men who have sex with men.

Results: Our study found that about 45% of participants had probable alcohol use disorder. The prevalence was high among participants with a history of having group sex (aPR=1.29; 95% CI: 1.00-1.65, P=0.051), who had ever paid for oral or anal sex (aPR=1.65; 95% CI: 1.21-2.25, p=0.002), who reported facing financial difficulties (aPR=1.40; 95% CI: 1.10-1.79, p=0.007), those who experienced moderate stigma (aPR=1.44;95% CI: 1.13-1.84, p=0.003) and higher stigma (aPR=1.39;95% CI: 1.02-1.91, p=0.040).

Conclusion: The prevalence of probable alcohol use disorder was found to be relatively high among men who have sex with men, especially those with a history of group sex, paying for sex, facing financial difficulties and those who reported experiencing a moderate-to-high level of stigma. This highlights the need to intensify health, reproductive and safe sex practices programs while escalating anti-stigma campaigns. We recommend the integration of substance screening and harm reduction services in HIV treatments and prevention programming.

The concomitant use of benzodiazepines (BZDs) among individuals with opioid use disorder (OUD) is highly prevalent, with a rapid annual increase in overdose-related deaths. The co-use of BZDs is a significant predictor of opioid overdose. In the absence of other drugs, BZDs are rarely the sole cause of death. Prolonged BZD use frequently results in the rapid development of tolerance and dependence. A strong association has also been established between BZD misuse and depression. Moreover, chronic BZD exposure is linked to cognitive impairments, psychomotor disturbance, delirium, and an increased risk of falls, fractures, injuries, and traffic accidents. Outpatient clinicians should routinely screen for concurrent BZD use and exercise caution in prescribing. Timely interventions-including patient education, gradual discontinuation, psychological therapies, and skills-based training-are critical to mitigating harm and improving prognosis. In addition, Traditional Chinese Medicine(TCM), including herbal prescriptions and acupuncture, may serve as promising non-addictive alternatives for the management of anxiety, insomnia, and withdrawal-related symptoms. Strengthening multifaceted efforts will be crucial for reducing the burden of BZD use and improving treatment outcomes in OUD.

Purpose: About 3 million children have lived in recent years with at least one parent who is addicted to legal and/or illegal substances in Germany. Parental substance use disorder represents a considerable social and economic burden for society. It also has severe health consequences for the parents themselves as well as for their children.The topic of parenthood and the needs of parents with substance use disorders have so far received little attention in inpatient rehabilitative treatment in Germany. Therefore, the study aims to explore the parenting-related needs of parents with substance use disorders in inpatient rehabilitation treatment from an expert perspective. We also aim to uncover structural and general challenges in relation to the topic of "parenting and substance use disorder".

Patients and methods: Semi-structured expert interviews were conducted at different intervention and non-intervention clinics. The data analysis was based on structured content analysis.

Results: The results reveal a strong need for rehabilitation measures that take the topic of parenthood into account. This would include, for example, different parenting-related offers such as organizing daily life, shaping the relationship with the children, programs about the general development of children, expressing and regulating emotions, and assistance with official/administrative matters. Further, there are various structural issues that need to be addressed.

Conclusion: Our results emphasize the concrete need for an evidence-based intervention for family-focused addiction treatment. In this way, care and the resulting health, quality of life, and functionality of the affected families can be improved in the future.

Purpose: An intersectionally-informed approach considers how personal factors such as sex, race, and ethnicity may compound to impact individuals and their health outcomes. We examined how these factors interact to influence treatment attrition in an outpatient, treatment-seeking substance use disorder population.

Patients and methods: The Treatment Episode Dataset-Discharges (2017-2021) provided de-identified data, with each outpatient treatment encounter assessed at admission and discharge, yielding a repeated cross-sectional design. The repeated admission bias was defined as the odds of total admissions relative to the odds of the first admission for each group. Discharge reasons of dropped out or terminated were coded as treatment attrition. Logistic regression assessed treatment attrition, with the interaction term assessing nonadditivity. The unadjusted model included sex, race and ethnicity, and their interaction term, and the adjusted model incorporated the state, primary substance, and age group.

Results: Of 3,934,962 admissions, 1,668,338 (42.4%) were first admissions. White males were over-represented in repeat admissions, and Latina females were 22% less likely to be readmitted. For first episode encounters, females had significantly greater treatment attrition across all groups. Sex, race, and ethnicity, and their interaction were significant in both unadjusted and adjusted models. In adjusted models, the sex difference in attrition was 1.3 percentage points for White individuals (95% CI: 1.2-1.5), but more than twice as large for Black (2.8; 95% CI: 2.5-3.2) and Latino individuals (2.8; 95% CI: 2.4-3.2).

Conclusion: Our findings show that intersecting identities of sex, race, and ethnicity shape disparities in treatment engagement. Black and Latina females face compounded barriers to retention and re-engagement. Incorporating an intersectional perspective into addiction treatment planning and policy may help reduce attrition and improve equity in care.

Purpose:  In inpatient addiction rehabilitation, the context factors of parenthood and family have long been neglected, and evidence-based inpatient, standardized programs to strengthen rehabilitants in their role as parents are not routinely implemented in Germany. Social workers are highly involved in the field of addiction and youth welfare support. Therefore, this study aimed to capture their perspectives on how to strengthen parents in the context of an inpatient addiction rehabilitation intervention.

Methods:  Semi-structured expert interviews were conducted with social workers working with parents with substance use disorder (SUD) in ambulatory settings. The interviews were transcribed verbatim and analyzed using Reflexive Thematic Analysis.

Results:  The analysis identified four main themes that are crucial for strengthening rehabilitants in their parental role. Theme one deals with the exploration of different spheres of parenthood as intervention content: the subjective perception as a parent, the parental role as a child carer, and as family manager. Theme two concerns the methods through which (theoretical knowledge transfer, reflexive and practical exercise) and social settings in which (single, one-to-one, and group settings) this intervention content shall be provided. In theme three, the importance of a sensitive and cooperative professional attitude of rehabilitation associated professional health and social care workers - towards rehabilitants and professionals alike - is included. Theme four stresses the need for a family-centered rehabilitation organization by working as a professional interinstitutional network and arranging adequate childcare.

Conclusion:  Results show that social workers see substantial potential in inpatient addiction rehabilitation for strengthening parents with SUD in their parenting role. The multifaceted parental role should be examined in depth during rehabilitation in a trusting atmosphere. After discharge, especially (social pedagogical) follow-up care is considered crucial for perpetuating insights and progressions and sustainably strengthening rehabilitants, thus, the family system as a whole.

Purpose: The rising use of electronic cigarettes alongside traditional tobacco presents a global health concern. Despite this, little is known about smokers' knowledge and attitudes toward electronic cigarettes in Qatar. This study addresses this gap by exploring the knowledge, attitude, and practice (KAP) of electronic cigarette use among smokers attending cessation clinics in Qatar.

Patients and methods: This analytical cross-sectional study involved 453 adult smokers, recruited through systematic random sampling at the Tobacco Control Center (TCC) in Qatar in 2020. Participants were interviewed via phone using a structured 42-item questionnaire after providing verbal consent. A cut-off score of 3 or higher indicated good knowledge, while a score of 1 or higher reflected a positive attitude. Bivariate analyses followed by logistic regression identified predictors of good knowledge and electronic cigarette use.

Results: Of the 453 participants, the average age was 38.9 ± 8.9 years, with most being male (95.1%, n=429), married (77.9%, n=353), and university-educated (64.7%, n=293). Participants had smoked for an average of 18.5± 9.1 years, consuming 15.3 cigarettes per day. Low nicotine dependence was found in 36% (n=163), while 5.5% (n=25) were highly dependent. About 60.2% (n=259) demonstrated good knowledge of electronic cigarettes, but 69% held negative attitudes ((n=289). Nearly half (48.3%, n=219) had tried electronic cigarettes, with 55.2% using them for cessation attempts (n=121). Age, marital status, education, and income levels were significantly associated with knowledge and practice, with high income (≥ 30,000 QR/month) predicting both good knowledge and use.

Conclusion: Although smokers are generally aware of electronic cigarettes, gaps persist in understanding their contents and health effects. Negative attitudes persist, yet half of current smokers have experimented with them. Tailored education and regulations are needed to dispel misconceptions and minimize risks for smokers in Qatar.

Introduction: Associations between substance use and unemployment are well established but complex. People dependent on opioids often want to work but encounter barriers, including requirements to attend services and/or pharmacies frequently. Long-acting injectable buprenorphine (LAIB) is a new pharmacological treatment for opioid use disorder, which reduces such attendance requirements. Studies indicate positive associations between LAIB treatment and employment, but there has been no detailed analysis of this topic.

Methods: Longitudinal qualitative interviews were conducted with 26 people (18 males; 8 females) initiating LAIB in English and Welsh drug treatment services. Participants were interviewed by telephone up to six times over a year (125 interviews in total). Interview data were used to produce narrative accounts of each participant's work-related experiences. These accounts were then combined and analysed via Iterative Categorization.

Results: Participants reported mixed education and employment histories. At first interview, three had full-time jobs, three were students, one worked occasionally, and nineteen were not working. Participants who remained on, or completed, their LAIB treatment reported ongoing work and education or new work-seeking activities, temporary/part-time work, or volunteering. Participants who discontinued LAIB did not start any new education, training or work during their time in the study. Most participants wanted to work but identified barriers to employment and little help with job-seeking. Participants confirmed that LAIB facilitated employment because they did not have to attend pharmacies so often and felt physically and psychologically more able to work. Nonetheless, they sometimes felt unwell after initiating LAIB, which interrupted work and study and made them reluctant to reduce their LAIB treatment later.

Conclusion: LAIB may help drug treatment patients who are interested in securing employment or achieving broader employment-related outcomes, such as education, training and volunteering. However, patients receiving LAIB may also need personalized employment support to assist them with wider barriers to working.