Addictive Behaviors Reports最新文献

Introduction

The popularity of cannabis vaping has increased rapidly, especially among adolescents and young adults. We posit some possible explanations and, to evaluate them, examine whether cannabis vapers differ from non-vaping cannabis users in other substance use.

Methods

Using nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study wave 5 (Dec. 2018-Nov. 2019), we assessed the association between cannabis vaping and other substance use. A total of 1,689 adolescents and 10,620 adults who reported cannabis use in the past 12 months were included in the study. We employed multivariable logistic regressions to assess the association between cannabis vaping and other substance use.

Results

Among past 12-month cannabis users, compared with those who do not vape cannabis, participants who vape cannabis had higher risks of using alcohol (adjusted relative risk [aRR] = 1.04, 95 % CI, 1.01–1.07), cigarettes (aRR = 1.09, 95 % CI, 1.02–1.15), cigars (aRR = 1.17, 95 % CI, 1.06–1.30), other tobacco products (aRR = 1.29, 95 % CI, 1.14–1.45), electronic nicotine products (aRR = 4.64, 95 % CI, 4.32–4.99), other illicit drugs (aRR = 1.53, 95 % CI, 1.29–1.80), and misuse of prescription drugs (aRR = 1.43, 95 % CI, 1.19–1.72). Compared to older cannabis vapers, younger cannabis vapers were at risk of using more other substances. Cannabis vaping was associated with all seven measures of substance use among young adults.

Conclusions

Compared to non-vaping cannabis users, cannabis vapers have higher likelihood of using other substances. Research is needed to understand why, as well as the implications of the association.

Research examining episodic future thinking (EFT; i.e., imagining oneself in future contexts) in community samples has demonstrated reduced discounting of delayed rewards when personalized event cues are included to prompt EFT related to reward latencies. While this EFT effect was recently demonstrated in individuals with substance use disorders, it is not yet known if it manifests similarly in individuals with and without a significant incarceration history—the latter being at elevated risk for negative outcomes including criminal recidivism. Individuals with cocaine use disorder (n = 35) identified personally-relevant future events and participated in a computerized delay discounting task, involving decisions between smaller immediate rewards or larger delayed rewards with and without EFT cues. Individuals with (n = 19) and without (n = 16) a significant history of incarceration were identified using the Addiction Severity Index-Lite. A significant reduction in discounting rates was observed when event cues were included to promote EFT (p = 0.02); however, there was no main effect of incarceration history on discounting behavior, or interaction between episodic future thinking condition and incarceration history. Results suggest personalized cues included to evoke EFT reduce discounting behavior in individuals with cocaine use disorder, regardless of incarceration history. EFT–based interventions may therefore have promise to reduce impulsive decision-making in individuals with cocaine use disorder with and without a significant history of incarceration, potentially supporting improved outcomes with respect to both substance use and future criminality.

Introduction

Most adult cigarette smokers have tried unsuccessfully to quit. We followed participants in the Population Assessment of Tobacco and Health (PATH) study through five waves (2013–2019), comparing smoking, quit behaviors and other characteristics between persistent smokers and those who became and stayed former smokers.

Methods

The main analysis employed treatment effects to estimate mean differences in smoking and quitting behaviors among smoker groups. Logistic models were used to estimate predicted means based on continuing smokers’ demographic characteristics to ensure that any differences in outcomes did not come from differences in demographic characteristics.

Results

Among smokers enrolled in PATH Wave 1, 68 % persisted in all subsequent waves. Compared with smokers who quit after Wave 1, persistent smokers had remarkably stable smoking behaviors, including significantly higher proportions of everyday smokers, consuming 10+ cigarettes per day, and smoking within 30 min of waking up. Persistent smokers were also less likely to try to quit completely, and experienced more negative symptoms from nicotine withdrawal. They also showed less interest in quitting and were less confident of being successful than smokers who quit by the next wave. Neither electronic nicotine delivery systems nor menthol played a role in continued smoking or quitting.

Conclusions

The characteristics and behaviors of persistent smokers in this study were stable over five waves of data collection during a six-year period, suggesting that these smokers need new cessation options.

Introduction

Loot boxes are increasingly common random-reward monetization mechanisms in digital games. They are popular among gamblers and pose various risks due to their gambling-like nature, but little is known about psychosocial vulnerabilities and financial consequences of purchasing them. This article examined psychosocial associations with self-reported increase in loot box purchasing and indebtedness among past-year gamblers during the COVID-19 pandemic.

Methods

Cross-sectional survey data were collected in April 2021 from Finnish, Swedish, and British past-year gamblers aged 18 to 75 (n = 2,022). Measures of loneliness, psychological resilience, and problem gambling were studied in relation to loot box purchasing and indebtedness. Structural equation modeling was used as an analytical technique.

Results

Loneliness was positively associated with self-reported increase in loot box purchasing. No evidence was found regarding the protective role of psychological resilience in loot box purchasing. Increased loot box purchasing was associated with problem gambling. Problem gambling mediated the relationship between loot box purchasing and indebtedness.

Conclusions

The findings bring valuable insight into the psychosocial vulnerabilities and financial consequences in loot box purchasing. Loot box purchasing can add to one’s financial strain particularly among vulnerable individuals such as problem gamblers, making it crucial to regulate such monetization practices.

Background and Aims

Medications for opioid use disorder (MOUD) are highly effective in improving treatment outcomes and reducing overdose. Concerns about interrupted access to critical MOUD services led to expansion of telemedicine services during the COVID-19 pandemic in the US. The current study tested the hypothesis that telemedicine usage and healthcare coverage would be significantly associated with access to MOUD in the early phase of the COVID-19 pandemic.

Design

A cross-sectional online survey was administered to a non-probability sample from June 18-July 19, 2020 using the Amazon Mechanical Turk platform.

Setting

Northeastern United States during the early phase of the COVID-19 pandemic. At the time of the survey, federal regulators had waived the longstanding requirement for in-office visits for MOUD prescription receipt and provided guidance on increasing third-party payer reimbursement rates for telehealth visits in order to mitigate barriers to care associated with COVID-19 safety guidelines.

Participants

Individuals 18 years or older residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to complete the survey. The analytic sample was participants who reported using opioids not as prescribed by a physician in the past seven days.

Measurements

Demographics, telemedicine usage, and healthcare coverage were assessed as explanatory variables. The primary outcome was whether participants reported ability to access MOUD in the past four weeks.

Findings

In this sample of individuals who used illicit opioids in the past week (N = 191), one in two individuals who utilized telehealth or had healthcare coverage were able to access MOUD, whereas only one in five of their respective counterparts who did not have telehealth access or healthcare coverage were able to access these medications.

Conclusions

Telemedicine and healthcare coverage were associated with greater MOUD access early in the COVID-19 pandemic, when barriers to care were high. Such findings speak to the importance of not only extending but also formalizing temporary policy changes instituted during the pandemic to allow MOUD prescribing via telemedicine.

Opioid-involved overdose deaths continue to climb, in part because of suboptimal access to and retention on medications for opioid use disorder (MOUD), including buprenorphine. Low barrier buprenorphine treatment aims to reduce or eliminate the threshold for getting and staying on medication by providing immediate and long-term access to buprenorphine without strict rules or requirements. This study examines associations between medical providers’ beliefs about treating people with opioid use disorder (OUD) and naloxone access with their self-reported low-barrier buprenorphine prescribing practices. We surveyed and analyzed responses from providers (N = 86) who completed X-waiver courses in Missouri between March 2017 and September 2019, of which 55% (n = 47) both completed the full survey and endorsed prescribing buprenorphine since the training. The survey included questions about buprenorphine prescribing behaviors as well as the Naloxone-Related Risk Compensation Beliefs (NaRCC-B) scale and the Attitudes toward Patients with OUD scale. Analyses consisted of a series of linear and logistic regressions with the NaRCC-B and OUD Attitudes scales predicting various domains of low-barrier prescribing behaviors. Findings indicate medical providers’ beliefs about treating people with OUD are associated with their practice of addiction medicine, with individuals with more favorable views being more likely to endorse low-barrier buprenorphine prescribing practices including offering telemedicine and at-home inductions, prescribing higher doses of buprenorphine, treating larger caseloads, and discussing overdose risk and protective factors with their patients. Providers’ beliefs about naloxone being enabling were less related to their buprenorphine practices but strongly related to their likelihood of providing naloxone. Future research may examine which strategies effectively change prescriber attitudes and their adoption of lower-barrier prescribing practices.

Background

Substance use patterns are diverse, and multiple substances are often involved in fatal and nonfatal overdoses. Additionally, polysubstance use is associated with greater difficulty accessing and remaining in substance use disorder (SUD) treatment. The aim of this study was to identify substance use patterns and determine their association with SUD treatment engagement among emergency department (ED) patients at risk of opioid overdose.

Methods

This was a sub-analysis of a randomized controlled trial comparing two behavioral interventions for individuals at two EDs in Rhode Island from 2018 to 2021. Past six-month substance use frequency for eight substances plus injection drug use was self-reported at trial enrollment, and SUD treatment engagement within 90 days after enrollment was obtained using administrative data linkages. Latent class analysis identified substance use patterns and multivariable log-binomial models estimated the association with SUD treatment engagement.

Results

Among 607 participants, there were four substance use patterns: 1) low reported use (n = 295), 2) frequent injection and heroin use (n = 131), 3) high frequency broad polysubstance use (n = 62), and 4) low frequency broad polysubstance use (n = 119). Compared to participants with the low reported use pattern, those with the frequent injection and heroin pattern had a greater likelihood of SUD treatment engagement (adjusted risk ratio = 1.28; 95% confidence interval = 1.02–1.61).

Conclusions

Distinct and meaningful polysubstance use patterns showed differential SUD treatment engagement after ED discharge. Nuanced relationships between substance use patterns and treatment highlight the necessity for tailored harm reduction, treatment, and recovery services.

Hallucinogen dependence and abuse are DSM-IV diagnoses that are associated with significant morbidity, yet the specific hallucinogens that are most strongly linked to dependence and abuse are understudied. We used recent data from the National Survey on Drug Use and Health (2015–2020) and multivariable logistic regression to test the relationships that lifetime use of seven individual hallucinogens (MDMA/ecstasy, PCP, ketamine, psilocybin, LSD, peyote, and mescaline) shares with hallucinogen dependence and abuse among individuals who initiated hallucinogen use within the past two years (N = 5,252). We controlled for various demographic factors (sex, age, race/ethnicity, educational attainment, self-reported engagement in risky behavior, annual household income, marital status) and lifetime use of various substances. Lifetime PCP use was associated with increased odds of hallucinogen dependence or abuse (aOR [95% CI]: 6.27 [1.51, 26.0]). Additionally, PCP increased the odds of three main hallucinogen dependence and abuse criteria measures (aOR [95% CI]: 4.45 [1.11, 17.8], 5.58 [1.42, 22.0], and 7.01 [1.87, 26.3]). LSD conferred increased odds of two criteria (aOR: 2.33 [1.37, 3.98] and 2.53 [1.48, 4.33]), while ketamine and mescaline each conferred increased odds of one criterion (aOR: 2.12 [1.03, 4.39]; 5.39 [1.05, 27.7]). Future longitudinal studies and Bayesian statistical analyses can further assess the relationships between hallucinogens and disordered hallucinogen use.

Vaping rates among Canadian youth are significantly higher compared to adults. While it is acknowledged that various personal and socio-environmental factors influence the risk of school-aged youth for vaping uptake, we don’t know which known behavior change factors are most influential, for whom, and how. The Unified Theory of Behavior (UTB) brings together theoretically-based behavior change factors that influence health risk decision making. We aimed to use this framework to study the factors that influence decision making around vaping among school-aged youth. Qualitative interviews were conducted with 25 youth aged 12 to 18 who were either vaped or didn't vape. We employed a collaborative and directed content analysis approach and the UTB constructs served as the coding framework for analysis. Gender differences were explored in the analysis. We found that multiple intersecting factors play a significant role in youth decision making to vape. Youth who vaped and those who did not vape reported similar mediating determinants that either reinforced or challenged their decision-making, such as easy access to vaping, constant exposure to vaping, and the temptation of flavors. Youth who didn't vape reported individual determinants that strengthened their intentions to not vape, including more negative behavioral beliefs (e.g., vaping is harmful) and normative beliefs (e.g., family disapproves), and strong self-efficacy (e.g. self-confidence). Youth who did vape, however, reported individual determinants that supported their intentions to vape, such as social identity, coolness, and peer endorsement. The findings revealed cohesion across multiple determinants, suggesting that consideration of multiple determinents when developing prevention messages would be beneficial for reaching youth.

Introduction

Protective factors of adolescent gambling at the school level and their buffering potential are scarcely explored in prior research. This study aims to examine the protective possibility of low student–teacher ratio on youth gambling, both directly and by moderating the effect of low school performance.

Methods

Data were derived from the 2016 Stockholm school survey, collected among 5,221 grade 11 students (∼17–18 years) in 46 schools, with information on schools’ composition and student–teacher ratio obtained through registers. Gambling and risk gambling were coded as binary variables. School performance was captured by self-reported marks in three core subjects, dichotomised into average/above average and below average, respectively. Student-teacher ratio was used both as a continuous and trichotomised variable. Two-level binary logistic regression analyses were performed.

Results

A below average school performance was associated with gambling and risk gambling but the association with gambling was only statistically significant at the 10%-level in the fully adjusted model. Student-teacher ratio was not directly associated with gambling and risk gambling but moderated the associations between school performance and both gambling and risk gambling, as these relationships were less pronounced in schools with a low student–teacher ratio.

Conclusions

In sum, a low student–teacher ratio may protect students from gambling and risk gambling by buffering against the adverse effects of other risk factors, such as poor school performance. These findings suggest that a higher teacher density in upper secondary schools can be beneficial beyond school matters by positively influencing student behaviour outside of school.