Journal of Addictive Diseases最新文献

Background: Individuals with tobacco use disorder (TUD) may be particularly vulnerable to the challenges following long COVID.

Objective: This study assessed whether individuals with TUD and no prior neuropsychiatric conditions developed new symptoms following long COVID-19 infection.

Methods: A cohort of 104 adults with TUD completed psychological and biological assessments before the COVID-19 pandemic and were reevaluated four months post-long COVID diagnosis. Evaluations covered mood symptoms, sleep, perceived stress, quality of life, and serum cortisol.

Results: The participants exhibited marked increases in depressive symptoms, anxiety, insomnia, and perceived stress, accompanied by significant declines in sleep quality and quality of life (all p-values < 0.001). Serum cortisol levels decreased significantly, indicating altered HPA axis activity.

Conclusion: This study suggests that long COVID may disproportionately influence addictive disorders, not only by exacerbating existing vulnerabilities, but potentially contributing to the onset of new mental health challenges.

Background: Machine learning (ML) is increasingly explored for opioid overdose and opioid use disorder (OUD) detection and prevention. Regional burden is uneven: the United States currently has among the highest rates of drug-overdose deaths worldwide, underscoring the urgent need for operationalized ML tools in US clinical and public-health settings. While many models exist, few have been tested in live settings. Understanding how deployed systems perform and are governed is essential for safe, equitable use in addiction medicine.

Methods: We systematically searched PubMed, Embase, IEEE Xplore, and Scopus from January 2019 to August 2025 for studies describing real-world ML deployments for overdose or OUD. Eligible studies required live integration into clinical, public health, or consumer workflows with prospective or concurrent evaluation. Risk of bias and operational robustness were assessed using the PROBAST-R framework (a PROBAST extension for deployed ML; 'risk of bias' here denotes systematic error in reported performance due to study design, data, or reporting).

Results: Fifteen studies were included, spanning health systems, public health surveillance, emergency services, and wearable detection. Most achieved good discrimination (AUC > 0.80) or high precision, though tradeoffs between sensitivity and specificity were common. Governance structures were more consistently reported in large deployments, yet no study described automated monitoring, and only two examined subgroup performance. Fairness audits and human-factors evaluations were rare.

Conclusion: Deployed ML for opioid outcomes is feasible but uneven in maturity. Clinical implications: addiction medicine clinicians should (1) request subgroup performance results before adoption; (2) confirm post-deployment monitoring plans for drift and calibration; and (3) use human-in-the-loop safeguards (clinician or human verification before automated actions) to reduce harms from false positives/negatives.

Oxymetazoline hydrochloride 0.05% is a lipophilic sympathomimetic nasal decongestant spray available over the counter (OTC) and commonly used for allergic and chronic rhinitis. A well-known side effect of these nasal sprays is rebound congestion termed rhinitis medicamentosa (RM), but there is little literature attesting to the relationship between RM and substance use disorder. This is a case report of severe nasal spray oxymetazoline use disorder per DSM-5 criteria discovered incidentally in a 44-year-old patient receiving care at a residential addiction treatment center for long-standing polysubstance use and bipolar disorders. The patient began using oxymetazoline in 2003 for allergic rhinitis and developed rhinitis medicamentosa that progressed to an oxymetazoline use disorder. Despite medical and clinical interventions, cravings and urges prevented her from stopping the nasal spray. We discuss the pharmacological properties of oxymetazoline, the behavioral aspects of its intranasal administration, and the drug-induced rebound congestion that may contribute to its misuse. To our knowledge, this is the first reported case of oxymetazoline use disorder lasting 20 years.

Objectives: There is increasing evidence of ketamine's therapeutic potential in reducing substance use in individuals with substance use disorders. However, its effects on tobacco use disorder are unknown. We investigated the effect of a subanesthetic dose of ketamine on tobacco use.

Methods: This randomized, single-blind, placebo-controlled, pilot study administered intravenous ketamine to individuals with tobacco use disorder recruited from the local community. Participants were randomized to receive either ketamine (0.5 mg/kg) (n = 6) or saline placebo (n = 4) over 20 min. Primary outcomes included measures of drug safety and tolerability during and within an hour after the infusion. Secondary outcomes included measures of tobacco use, craving, and withdrawal before, and 24-hours after, the drug infusion study day. A follow-up visit occurred eight days after the infusion.

Results: Intravenous ketamine was well tolerated with transient side effects. No significant effects were noted on cigarette smoking, craving, or withdrawal symptoms on the post-infusion visit following overnight abstinence or on the follow-up visit (p's > 0.05).

Conclusions: Although limited by the small sample size, this pilot study extends previous research on ketamine for substance use disorders. While ketamine was well tolerated in this sample, additional research testing different ketamine doses and administration routes is necessary to determine whether ketamine has therapeutic potential for tobacco use disorder.

Background: This study investigates the effects of open and closed exercise interventions on the physical and mental health of individuals undergoing substance use disorder (SUD). We examined changes in tendency of recurrence of use, vital capacity (VC), resting heart rate (RHR), sleep quality, and choice reaction time.

Methods: Conducted over six months at the drug rehabilitation center, 95 participants were randomly assigned to closed exercise, open exercise, or control group. Outcome measures were taken at baseline, three months, and six months.

Results: Both exercise groups showed significant improvements in reduction of return-to-use risk and VC compared to baseline. Open exercise groups showed earlier significant improvements in risk of return to use at three months. No significant changes were observed in RHR. Both exercise groups showed significant improvements in sleep quality, with the open exercise group also showing significant improvements in choice reaction time. At six months, both exercise groups showed significant improvements over the control group in tendency of recurrence of use, VC, and sleep quality, with no significant differences between the exercise groups.

Conclusions: Both exercise interventions led to significant improvements in reducing the risk of return to substance use, VC, sleep quality, and choice reaction time, with the open exercise group showing the most pronounced effects in choice reaction time.

Substance use disorders (SUDs) represent a major challenge in psychiatric treatment, with significant relapse rates despite various psychotherapeutic interventions. This systematic review explores the neurobiological underpinnings of addiction and examines the efficacy of psychotherapies, such as Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), Mindfulness-Based Relapse Prevention (MBRP), and emerging therapies in treating SUDs. Additionally, the study assesses how emerging biomarkers and neuroimaging data could enhance therapeutic outcomes by guiding personalized treatments. Neurobiological markers, such as prefrontal-limbic connectivity, mesolimbic dopaminergic dysregulation, and glutamate transmission deficits, are shown to significantly influence treatment efficacy. For example, prefrontal cortex hypoactivity and amygdala hyperactivity correlate with poor impulse control and emotional regulation, making these individuals more responsive to CBT and EMDR. Similarly, dopaminergic dysfunction in the mesolimbic pathway is closely tied to reward-seeking behavior where Transcranial Magnetic Stimulation (TMS) may offer therapeutic benefits. Epigenetic modifications, primarily those affecting the glucocorticoid receptor (GR), highlight the role of stress in relapse suggesting that trauma-focused therapies can be effective for individuals with high stress vulnerability. This review finds that integrating neurobiological insights with clinically validated psychometric assessments could significantly improve treatment stratification. Future research should focus on aligning diagnostic systems, such as the DSM-5, with neurobiological markers and psychological tells to facilitate more precise and personalized interventions, potentially transforming addiction treatment outcomes.

Opioid use disorder (OUD) is associated with a reduction in brain white matter, affecting critical areas involved in decision-making, impulse control, and reward processing. The FDA has approved several drugs and natural compounds that enhance myelination, targeting oligodendrocyte progenitor cells (OPCs), directly enhancing oligodendrocyte (OL) function, or acting as cofactors for myelin production. This retrospective case study aimed to assess whether current clinical evidence supports the use of myelin-enhancing agents to promote remission in OUD. We evaluated a range of compounds with demonstrated effects on myelination, including muscarinic antagonists, cholesterol and lipid homeostatic agents, anti-aging drugs, immunomodulatory agents, anti-inflammatory medications, and others (25 medications in total), as well as 17 vitamins and supplements. Buprenorphine and methadone were used as positive controls. Sequential analyses were performed to identify individual drugs driving significant changes in remission rates (p ≤ 0.01; N ≥ 3,000) and their effects across age, sex, and Body Mass Index (BMI) categories. Three key findings emerged: (1) melatonin improved remission rates in males but showed no effect in females; (2) ibuprofen significantly increased remission rates, particularly in individuals aged 20-39 and 40-59 years; and (3) thiamin was associated with decreased remission rates in males and individuals with a BMI ranging from normal weight to obese. Additionally, buprenorphine and methadone were confirmed as effective in promoting remission. These findings highlight the importance of personalized medicine in treating OUD and suggest that further research is needed to explore individualized treatment strategies based on sex, age, and BMI.

Background: Cannabis use has increased in prevalence over the past several decades, and novel forms of cannabis (e.g., concentrates and edibles) have become readily available.

Objective: The purpose of this narrative review was to compare the prevalence of use, methods of consumption, and risk for cannabis use disorder outcomes across cannabis forms to better understand the diversifying landscape of cannabis products and practices.

Methods: The electronic database PubMed was used to find relevant articles with keyword searches related to the prevalence of use, methods of consumption, and risk for cannabis use disorder for three major forms of cannabis (flower, concentrates, and edibles).

Results: Use of all three major forms is prevalent among many cannabis users, but there are differences in user demographics and methods of consumption. Use of cannabis concentrates may be associated with a greater risk for cannabis use disorder. Given the historical predominance of cannabis flower use, many outcomes have not been compared with concentrates or edibles. Furthermore, form-specific longitudinal data is lacking.

Conclusions: Given the more recent emergence of novel cannabis products, comparisons of the long-term outcomes of use for each form are needed to advance the development of more informed harm reduction practices that are common to and specific to each form of cannabis.

Introduction: Emergency departments (EDs) are critical points of contact for individuals at high risk, as opioid use disorder (OUD) remains a major public health crisis. While Screening, Brief Intervention, and Referral to Treatment (SBIRT) andother brief intervention (BI) models have been promoted as pragmatic approaches in acute care, their efficacy for OUD is uncertain. In contrast, ED-initiated buprenorphine (BUP) has shown promise for improving outcomes, but comparative trial data require synthesis.

Methods: Following PRISMA 2020 guidelines, we reviewed randomized and nonrandomized clinical trials comparing ED-initiated BUP with BI, referral, or usual care. Primary outcomes were treatment engagement and retention; secondary outcomes included opioid use, overdose risk behaviors, and healthcare utilization. Searches were conducted in PubMed, Scopus, Google Scholar, Web of Science, and trial registries through January 29, 2025. Risk of bias was assessed using ROB-2, and data were pooled via random-effects models.

Findings: Nine trials (n = 1,172), primarily from North America, met inclusion criteria. Compared with BI (52%), BUP initiation yielded higher adherence (61%) and lower opioid use prevalence (17% vs. 28%). Multiple RCTs consistently favored BUP for short-term engagement, whereas BI showed minimal effects on treatment utilization, overdose risk, or substance use outcomes. Considerable heterogeneity (I² ≈ 99%) and potential publication bias were observed.

Conclusion: ED-initiated BUP is superior to BI for short-term treatment engagement and reducing opioid use, reinforcing its role as a frontline intervention in acute care. Nevertheless, high heterogeneity, short follow-up, and limited geographic scope constrain the evidence base, highlighting the need for broader and longer-term studies.