Journal of Addictive Diseases最新文献

Concurrent use of benzodiazepines (BZDs) and opioids in patients with opioid use disorder (OUD) is prevalent and poses significant clinical challenges, including increased risks of overdose, ER visits, and treatment discontinuation. This article synthesizes current evidence on the prevalence, risks, and management of BZD co-use in OUD, focusing on patients receiving medications for OUD (MOUD) such as buprenorphine and methadone. Data indicate that approximately 16-21% of patients on buprenorphine and up to 40-47% of those on methadone use BZDs, with nonmedical use linked to a significant increase in overdose-related emergency visits and overdose mortality (95% CI: 7.8-13.2). We propose an evidence-informed framework for managing co-use, prioritizing OUD stabilization, close monitoring and harm reduction, gradual BZD tapering, and integrated psychosocial interventions. This approach balances safety and efficacy, ensuring patient-centered care while mitigating risks.

Background: Despite the rising prevalence of methamphetamine use disorder (MUD) among adolescents and its severe consequences, data on hematological inflammatory indices in this population remain limited.

Objectives: This study aimed to evaluate systemic inflammatory markers in adolescents with MUD and their associations with addiction severity.

Methods: The retrospective case-control study included 44 adolescents with MUD and 44 age- and gender-matched healthy controls. Hematological indices were calculated from complete blood count data, including neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), Basophil-to-lymphocyte ratio (BLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Group comparisons, receiver operating characteristic (ROC) analyses, and partial correlations were performed.

Results: The MUD group included 30 females (68.2%) and 14 males (31.8%); the control group included 25 females (56.8%) and 19 males (43.2%). Adolescents with MUD showed significantly higher neutrophil and platelet counts, NLR, dNLR, PLR, MLR, SII, SIRI, and AISI, alongside reduced lymphocyte counts, compared with controls (all p < .05). ROC analyses revealed good discriminative ability for SII (AUC = 0.79), AISI (AUC = 0.73), and SIRI (AUC = 0.69). Several indices, including NLR, PLR, and SII, correlated negatively with treatment motivation, while PLR and MLR correlated positively with diagnostic severity.

Conclusions: Adolescents with MUD demonstrate marked systemic inflammatory alterations detectable through routine hematological indices. These markers may serve as low-cost, clinically accessible biomarkers for identifying high-risk individuals and monitoring disease severity, with implications for early intervention and personalized treatment.

Background and objectives: Reaching the maintenance phase and reducing illicit substance use in those with severe opioid use disorder (OUD) remains a large clinical challenge. The use of intravenous opioid agonist treatment has become a last-line treatment for severe OUD. In this case series, we describe a novel form of this treatment using both long-acting buprenorphine and injectable hydromorphone.

Methods: Retrospective chart review of cases in specialized enhanced addiction treatment centers in Alberta, Canada of patients prescribed long-acting injectable buprenorphine and intravenous hydromorphone.

Results: We describe four cases of males ranging from 39 to 64 years of age with treatment-refractory opioid use disorder and multiple concurrent mental health and social issues who have experienced various periods of stability on long-acting injectable buprenorphine and along with intravenous hydromorphone or slow release oral morphine).

Discussion and conclusions: This case series presents a novel treatment combining buprenorphine extended-release injection with hydromorphone or slow release oral morphine for individuals with OUD who have not responded to standard opioid agonist treatment. The approach showed promise in managing withdrawal and cravings, potentially improving treatment retention. Further research is needed to evaluate long-term outcomes and optimize retention strategies to reduce opioid-related mortality.

Cocaine use disorder (CUD) is a significant public health issue, and cocaine's common pairing with alcohol has been linked to adverse cardiovascular outcomes. Among adults with unhealthy alcohol use, we investigated whether co-occurring CUD was associated with excess risk of acute coronary syndrome (ACS). We retrospectively studied 413,511 adults in Northern California from June 1, 2013 to December 31, 2022, with documented unhealthy alcohol use, defined as exceeding either the daily limit and/or weekly drinking limits recommended by the U.S. National Institute of Alcohol Abuse and Alcoholism (NIAAA) guidelines. Using health system electronic health record (EHR) data, concomitant CUD was ascertained from ICD-9/10 diagnosis codes, and alcohol consumption from patient self-report on screening questionnaires. During a follow-up period of up to 9.5 years, ACS was defined as a primary hospital discharge ICD-9/10 diagnosis code for unstable angina or myocardial infarction with elevated cardiac troponin I. Logistic regression evaluated the association of concomitant CUD and alcohol consumption levels with ACS. Models were adjusted for demographic, socioeconomic, and clinical covariates, including cardiovascular risk factors. The prevalence of CUD diagnoses was 0.6%, and 12.4% of the cohort exceeded both daily and weekly drinking limits. CUD was not significantly associated with ACS (adjusted odds ratio [aOR] = 1.27 [95% CI: 0.94-1.73]). Patients who exceeded daily and weekly drinking limits had higher odds of ACS, compared to those who exceeded only daily limits (aOR = 1.20 [95% CI: 1.12-1.28, p < .001). Among adults with unhealthy alcohol use, diagnosed CUD was not significantly linked to ACS. The heaviest drinking pattern was associated with a modestly higher adjusted risk of ACS.

Methods: In this retrospective case-control study we enrolled 283 patients with AUD (261 men, 22 women) admitted between 2021 and 2024, of whom 80 had AIPD. Baseline levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroxine (T4) and triiodothyronine (T3) were measured at the time of admission. A second measurement was performed three to four weeks after detoxification. Baseline values were compared with those of 300 age- and sex-matched healthy controls. Longitudinal changes within the AUD cohort and differences between AIPD and non-AIPD subgroups were analyzed by paired t-tests and chi-square tests as appropriate.

Results: Mean serum levels of FT4, FT3, T4 and T3 were significantly lower in AUD patients than in healthy controls, while TSH had no significant change. In the same comparison, the proportion of individuals with abnormal thyroid parameters was higher in the AUD group than in controls. Among AUD patients, women, showed a higher proportion of elevated TSH, and reduced FT4, FT3 and T3 than men with AUD. The level of thyroid hormone in patients with AIPD was higher than that in patients with Non-AIPD, and after detoxification treatment, thyroid function may not necessarily return to normal, but showed a trend of thyroid hormone decreased and TSH increased, which was more pronounced in AIPD patients.

Conclusion: AUD can lead to thyroid dysfunction. Patients with AUD should closely monitor their thyroid hormone levels to prevent the worsening of psychiatric and neurological symptoms.

Background: Women in their 50s and early 60s experience significant, unique life events that may affect their alcohol use. This complex period in a woman's life has co-occurring stressors that can affect alcohol use. Little is understood with regards to what predictors influence the alcohol use of women in this age group.

Objective: The objective of the study was to conduct an exploratory quantitative analysis to determine the social, physical and psychological predictors of increased daily alcohol use of women aged between 50 and 62 years.

Methods: The research sample of women aged 50-62 years was extracted across three waves of data from The Irish Longitudinal Study on Aging (TILDA) collected from Wave 1 (2010) (n = 893), Wave 3 (2014) (n = 709) and Wave 5 (2018) (n = 579). Repeated measures analysis was conducted across Wave 1, 3 and 5 on the women's alcohol use as they age over eight years. Multiple regression analysis within the waves examined demographic and biopsychosocial predictive factors with daily alcohol use.

Results: Repeated measures analysis showed that women's alcohol use remained fixed and did not significantly change from 50 to 62 years. Multiple regression analysis on demographic and biopsychological factors found that factors of social connectedness were the most significant predictor of lower daily alcohol use.

Conclusions: Social connectedness, specifically attending religious services and club membership were the most significant predictors of lower daily alcohol use. Therefore, social connectedness is an important factor to consider when providing healthcare and support to women in their 50s and 60s.

Cannabis use disorder (CUD) is an escalating global public health issue, especially amid growing legalization. Despite its cognitive, psychological, and social harms, many individuals with CUD do not access treatment, often due to stigma, limited awareness, or service inaccessibility. Brief Motivational Interventions (BMIs), based on motivational interviewing, offer a promising, accessible, and cost-effective approach to addressing CUD in routine clinical settings. However, qualitative evidence on the practical implementation and perceived effectiveness of BMIs remains limited. This systematic review aims to synthesize qualitative evidence on the barriers and facilitators to implementing and delivering BMIs for CUD in routine practice, as perceived by healthcare providers, patients, and other stakeholders. A systematic search will be conducted across PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Scopus. The search strategy will incorporate four conceptual domains: cannabis use disorder, brief motivational interventions, implementation/perceptions, and clinical setting. Eligible studies will include qualitative or mixed-methods designs with distinct qualitative components, published in English since 2000. Methodological quality will be assessed using the Joanna Briggs Institute (JBI) checklist, and data will be synthesized using thematic synthesis. The review will identify key contextual factors influencing BMI adoption and success, offering evidence to guide policy, professional training, and implementation strategies for improving cannabis intervention practices. This review highlights that successful implementation of Brief Motivational Interventions for Cannabis Use Disorder depends on provider readiness, training adequacy, systemic support, and culturally sensitive approaches. Addressing these multilevel factors is essential for wider adoption in clinical practice.

Background: Benzodiazepines are widely prescribed, yet their long-term use among patients with substance-use disorders (SUDs) remains poorly understood. This study examined benzodiazepines in a substance use treatment program.

Objectives: This study aims to describe prescribing patterns, tapering and discontinuation characteristics, and return to use rates in SUD patients receiving benzodiazepines in a community-based outpatient substance use treatment program.

Methods: In this single-site, retrospective chart review study, electronic health records of 51 patients, prescribed benzodiazepines between FY 2014-2024, in a community-based outpatient substance use treatment program were analyzed. Demographics, psychiatric and SUD diagnoses, benzodiazepine half-life, dose, taper duration, discontinuation status, and return to use were examined descriptively.

Results: Intermediate-acting BZDs were the most commonly prescribed (68.6%), with limited attempts to switch to longer-acting agents. BZD prescriptions were discontinued in only 25.4% of cases, and 38.4% of those who discontinued returned to use. Patients who successfully tapered had longer down-titration durations compared to those who returned to use. (5.4 months vs. 2.2 months in return to use cases). Among patients with benzodiazepine use disorder, return to use occurred in 50.0% of those who discontinued. The patient population demonstrated notably high rates of psychiatric comorbidities and previous psychiatric hospitalizations.

Conclusions: In patients with SUDs, benzodiazepine discontinuation is uncommon and frequently followed by return to use. Brief tapers show little benefit. Our data support that successful BZD tapering may require prolonged, structured tapering within integrated mental-health and substance use care to minimize return to use.

Background: Substance use disorders (SUDs) are a growing public health concern with high relapse rates. Noninvasive brain stimulation techniques are emerging as potential adjunctive therapies; however, recruitment challenges persist in related clinical trials. To use systematic review and meta-analysis to determine the rate and reasons for nonparticipation in randomized controlled trials (RCTs) involving noninvasive brain stimulation for substance-related and addictive disorders.

Materials and methods: Major databases (PubMed, CENTRAL, and Google Scholar) were searched from inception to January 2025 for RCTs of noninvasive brain stimulation and SUD. Of 3589 abstracts searched, 55 RCTs met the inclusion criteria. Eligible studies were peer-reviewed, published in English and examined any form of noninvasive brain stimulation in individuals with substance-related or behavioral addictions. Studies were required to report the number of individuals screened and ultimately randomized. Non-randomized studies, those involving invasive brain stimulation, were excluded.Following PRISMA guidelines, data were extracted independently by two reviewers, with discrepancies resolved by a third. Risk of bias (RoB) was assessed using the Cochrane RoB tool. Random-effects model was used for meta-analysis.

Results: A total of 55 randomized trials were included which involved diverse SUDs and behavioral addictions. The pooled nonparticipation rate was 55.9% (95% CI: 45.9-65.8%; I² = 99.56%, p < 0.001). Majority of the studies reported craving as an outcome measure. Key reasons included failure to meet inclusion criteria (reported in over 25 studies), refusal to participate due to anxiety or lack of motivation (≥15 studies), and logistical barriers such as travel or session frequency (≥10 studies).

Conclusion: Nonparticipation in noninvasive brain stimulation trials for SUD are high, largely due to stringent eligibility criteria, procedural apprehension, and practical burdens faced by participants. Addressing these barriers through broader inclusion criteria, participant education, incentives, and flexible scheduling is essential to enhance recruitment, trial generalizability, and future clinical applicability of NIBS in addiction treatment.

Background: Behavioral addictions exhibit convergent dysregulation of meso-striatal reward, cortico-limbic stress, and executive-control circuits. Top-down interventions such as CBT demonstrate moderate, often transient effects, leaving autonomic dysregulation insufficiently targeted. Somatic and body-oriented psychotherapies (SBPs) may remediate these deficits via bottom-up interoceptive and autonomic mechanisms, but quantitative synthesis is lacking.

Methods: Nine randomized controlled trials (RCTs) (total N = 573) of yoga, mindfulness, or somatic interventions for gambling, gaming, or compulsive sexual behavior were systematically reviewed. Hedges' g was pooled using random-effects meta-analysis (DerSimonian-Laird, Hartung-Knapp intervals). Risk-of-bias was evaluated with RoB-2; sensitivity analyses included leave-one-out models.

Results: Pooled effect size indicated a large benefit (g = -2.62, 95% CI [-4.73, -0.51], p = .015), with heterogeneity substantial (I² = 95.6%). Directionality persisted under sensitivity analyses. No serious adverse events were reported.

Conclusions: This review delivers the first quantitative synthesis of SBPs in behavioral addictions, delineating robust short-term symptom reduction alongside preliminary mechanistic signals implicating interoceptive-autonomic and fronto-striatal circuits. A novel phased, biomarker-guided treatment framework is proposed, situating SBPs as adjunctive modulators within integrative addiction care. Future trials should prioritize mechanistic endpoints, longer follow-up, and dismantling designs to isolate active components.