Journal of Addictive Diseases最新文献

Mephentermine is a sympathomimetic amine with structural and pharmacological similarities to amphetamines. Despite its increasing misuse, particularly among athletes and bodybuilders, there is limited literature on its management. No pharmacological treatments have been approved for mephentermine misuse. We describe two cases of young adult males presenting with symptoms of mephentermine withdrawal, including insomnia, anxiety, and craving. Both had histories of prolonged intravenous mephentermine use, with one managed on an outpatient basis and the other as an inpatient. Mirtazapine was initiated in both cases and was associated with improvements in sleep, anxiety, craving and hyperarousal. Psychotic symptoms in one patient resolved with short-term risperidone. Both patients received brief motivational enhancement therapy and remained abstinent from all substances except tobacco during two months of follow-up. These cases highlight the potential utility of mirtazapine in managing mephentermine misuse, particularly for addressing withdrawal symptoms and craving. Given its noradrenergic and serotonergic profile and its demonstrated efficacy in methamphetamine use, mirtazapine may be a promising candidate for treatment. However, the findings are limited by the case series design and larger, controlled studies are needed to confirm its role in clinical management.

Background: Illicit drug use disparities persist across racial and ethnic and sexual identity groups. This study examined associations between sexual identity, race/ethnicity, and drug use patterns, focusing on types and usage within the past year.

Methods: Using data from the 2021-2023 National Survey on Drug Use and Health (n = 129,823), multinomial logistic regression was used to assess drug use patterns. Key predictors included sexual identity (heterosexual, lesbian/gay, and bisexual) and race/ethnicity (White, Black, Asian, Hispanic, and Others), controlling for socioeconomic factors.

Results: Bisexual individuals had the highest drug use rates among sexual minority groups, particularly for polysubstance use (14.29%). White individuals reported the highest overall prevalence (72.55%), while Black and Asian individuals had lower rates. Drug use was highest among young adults (32.01%) and declined with age. Among racial groups, Black individuals exhibited the highest drug misuse risk (interaction model: single-drug use RRR = 2.70, 95% CI = [2.38, 3.05]; polysubstance use RRR = 1.70, 95% CI = [1.48, 1.95]), followed by Asian individuals (single-drug use RRR = 2.21, 95% CI = [1.72, 2.85]; polysubstance use RRR = 1.78, 95% CI = [1.38, 2.30]). Among sexual identity groups, Black bisexual individuals were the most vulnerable (RRR = 1.50, 95% CI = [1.03, 2.19]), highlighting the compounded risks faced by individuals at the intersection of racial and sexual minority identities.

Conclusions: Findings emphasize the need for culturally responsive interventions targeting bisexual individuals and racial/ethnic minorities to reduce disparities and improve public health outcomes.

Background: This meta-analysis evaluated the efficacy and safety of buprenorphine-naloxone compared to methadone in the treatment of Opioid Use Disorder (OUD), with a focus on treatment retention, attrition rates, and serious adverse events. OUD remains a major public health concern, necessitating effective pharmacological interventions to improve adherence and minimize adverse outcomes.Methods: A systematic search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus identified randomized controlled trials comparing both treatments. The study adhered to PRISMA guidelines, and data were analyzed using a random-effects model with Odds Ratios (OR) and 95% Confidence Intervals (CI). Heterogeneity was assessed using the I² statistic.Results: Seven randomized controlled trials involving 3,622 patients were included. Methadone doses ranged from 5 to 397 mg/day and buprenorphine-naloxone from 2 to 32 mg/day. Methadone showed significantly higher treatment retention at six months compared to buprenorphine-naloxone (OR 0.43; 95% CI 0.27-0.67; I² = 62.2%). Attrition was higher in the buprenorphine-naloxone group (OR 2.47; 95% CI 1.42-4.30; I² = 68.4%). In contrast, serious adverse events occurred less frequently with buprenorphine-naloxone (OR 0.72; 95% CI 0.48-1.09; I² = 0.0%).Conclusion: In conclusion, methadone is associated with superior retention, while buprenorphine-naloxone presents a more favorable safety profile. These findings highlight the need for individualized treatment decisions based on clinical context and patient-specific risks. Future large-scale, high-quality studies are recommended to guide optimal pharmacological strategies for managing OUD.

Registration: PROSPERO protocol number: CRD 42025634919.

Background: Addiction is a multidimensional disorder largely influenced by biological, psychological, and social factors, presenting distinct manifestations in adolescents and adults. At different stages of brain development, neurobiological mechanisms play a central role in the development and persistence of addictive behaviors.

Objectives: This review synthesizes recent studies indexed in Scopus, focusing on biological contributions to addiction in adolescents and adults.

Materials and methods: The Scopus database was systematically searched and retrieved studies using predetermined inclusion criteria. The overall neurobiological factors that determine vulnerability to addiction among both adolescents and adults were analyzed; these include neurodevelopmental factors, neuroadaptive changes through chronic substance use, and genetic influences.

Results: The findings indicate that adolescents, with heightened dopaminergic activity and synaptic plasticity, are particularly sensitive to addictive behaviors, while adults, after prolonged substance use, experience neuroadaptations leading to tolerance and dependence. Genetic predispositions and epigenetic changes also contribute to addiction vulnerability in both groups. These insights suggest the need for targeted prevention and treatment strategies that address the unique neurobiological profiles of adolescents and adults to reduce the overall impact of addiction.

Conclusion: Understanding the biological basis of addiction in adolescents and adults is important to advise successful public health policies and clinical interventions.

Introduction: Transcranial alternating current stimulation (tACS), a noninvasive neuromodulation technique, has been demonstrated to improve cognitive function. Recent advances in neuromodulation protocols have introduced an accelerated intervention paradigm, which has shown promising therapeutic outcomes across various noninvasive brain stimulation modalities. Despite these encouraging developments in cognitive enhancement, there remains a significant gap in the literature regarding the potential therapeutic applications of accelerated tACS protocols in substance use disorders.

Case summary: We present the case of a 22-year-old man diagnosed with synthetic cannabinoid use disorder (SCUD), who underwent accelerated high-definition tACS (HD-tACS) over two days. Changes in attention bias, craving, and impulsivity were assessed by electroencephalography (EEG), standardized scale, and behavioral test. The results revealed that the patient experienced reductions in pathological attention bias, drug craving, and impulsive and risk-taking behaviors following the accelerated HD-tACS intervention, with reductions in drug craving and behavior control sustained for five weeks post-treatment.

Conclusion: This is the first case to confirm the feasibility, safety, and efficacy of accelerated HD-tACS in treating SCUD, with therapeutic effects sustained for up to five weeks, highlighting the need for further systematic investigations in substance use disorders.

Background: Binge drinking (BD) is a public health concern among young adults. Whether it is harmful even at a low frequency remains unclear.

Objectives: To test if even low-frequency (less than once a month) BD is associated with a higher likelihood of alcohol use disorder (AUD), and if some key environmental and psychological features characterize low-frequency binge drinkers.

Methods: Alcohol-related, environmental and psychological data were collected from university students aged 18-25 who drank alcohol. Students were divided into four groups according to their BD frequency: non-binge drinkers (never had six or more drinks on one occasion), and binge drinkers with low (at least once lifetime but less than once a month), medium (at least once a month but less than once a week), or high (at least once a week) frequency.

Results: Among the 3308 students included in this cross-sectional study, 473 never binged alcohol, while 1204, 1001, and 630 were low-, medium-, and high-frequency binge drinkers, respectively. Even low-frequency BD was associated with higher AUDIT scores and a larger prevalence of harmful drinking. Compared to non-binge drinkers, low-frequency binge drinkers also reported higher rates of smoking, sensation seeking, and endorsement of enhancement and social drinking motives.

Conclusions: Among 18-25-year-old students exposed to alcohol, even infrequent BD is associated with more harmful drinking. The findings highlight the importance of prevention strategies since BD less than once a month, which concerns a third of this population, is already associated with a higher likelihood of AUD.

The UK National Health Service (NHS) defines addiction as loss of control over harmful behavior. Addiction is commonly linked to drugs and alcohol with varied community-based treatment services available in England. This study presents an organizational case study of a community-based organization in the North of England commissioned by the NHS through the local authority to support people with complex health and social needs and addresses the research question: What is the experience of support workers for families in which a parent is in treatment for substance misuse? Eleven support workers whose work is guided by a Whole Family Approach took part in semi-structured interviews which were analyzed qualitatively using thematic analysis. This resulted in a model of Nested Family Support which captures how the service user is supported by their family with the help of the support worker who is, in turn, supported by their organization. This model illuminates how outer levels of nested support need to be effective for inner levels to work and the axial role of support workers in this system. The main application of the model is identifying parallels between the support employees need from their organizational to deliver effective recovery interventions and the ways in which they are trained to support their clients in terms of the need for trusting relationships and tailored support.

Background: Many United States veterans utilize prescription opioids to treat chronic pain symptoms and are subsequently at risk for opioid and alcohol misuse. As more states legalized the use of cannabis for medical use, increasing numbers of people are using cannabis pharmacotherapy for pain. The veterans Health Administration (VHA) Directive 1315, July 28, 2023 prohibits any medical staff on recommending, making referral to, and complete forms for a state approved program. Also, a veterans medical center does not provide marijuana to veterans. State laws do not change the status of CBD under federal law. CBD is illegal in the federal system.

Objectives: Our aim was to investigate the prevalence of cannabidiol product usage in Veterans and the association with changes in self-reported pain.

Methods: We conducted a cross-sectional descriptive survey offering questionnaires to patients greater than 18 years of age receiving care at the Fargo Veteran Health Administration medical center Pain Clinic (2101 Elm St N, Fargo ND, 58102).

Results: A total of 218 veterans participated of which 81.2% were male and 52.3% were in the age range of 60-80 years. Twenty-one participants reported cannabidiol usage (9.6%), with 52.4% using to treat pain symptoms. Average pain scores pre-usage of 6.37 were reduced to 4.05 post-usage indicating a statistically significant reduction in pain (p < 0.001).

Conclusion: Our study broadened the baseline knowledge of cannabidiol use in the Veteran population. Limitations include results being self-reported and the inability to verify cannabinoid constituents.

Background: Patients in methadone maintenance treatment (MMT) may develop age-related medical problems. Objective: To compare hypertension prevalence and its risk factors between two MMT clinics, having similar treatment guidelines, but different characteristics, one from Tel Aviv (TA) and one from Las Vegas (LV).

Methods: Prevalence of hypertension (systolic ≥140 and or diastolic ≥90 mmHg BP) among all current 291 MMT patients in TA and 180 patients in LV were studied, including body mass index (BMI), drugs in urine, sociodemographic, and addiction history data.

Results: Hypertension prevalence was comparable in TA (35.4%) and LV (34.4%), however TA patients were older (55.9 ± 9.5 vs. 45.5 ± 13.3, p < 0.001), with fewer females (22 vs. 42.2%, p < 0.001), fewer obese (BMI ≥30) (24 vs. 40.9%, p < 0.001), higher cocaine (21 vs. 7.8%, p < 0.001), and lower cannabis (14.1 vs. 32.4%, p < 0.001) and amphetamines (0 vs. 33.5%) users. Logistic regression found higher BMI to characterize hypertension in both clinics, but in TA also negative urine cocaine, benzodiazepine, and opioids screen, while in LV older age (≥50 y), male gender, and negative urine cannabis screen.

Conclusions: While TA was characterized with older patients, LV patients had a comparable hypertension rate, as obesity was more prevalent. No drug use was accompanied by higher BMI in TA and therefore associated with hypertension. Weight reduction, hypertension detection and treatment are recommended.