American Journal of Drug and Alcohol Abuse最新文献

Background: Adolescent binge drinking increases the risk of alcohol use disorder, and individual differences in initial ethanol sensitivity may predict susceptibility to anxiety-like behaviors following ethanol withdrawal in adolescent males. It is still unclear whether these anxiety-like alterations are driven by specific subpopulations.Objectives: This study examined the impact of initial responsiveness to the socially facilitating/inhibiting effects of ethanol in adolescent males on anxiety-like behavior during ethanol withdrawal.Methods: Male rats (n = 72) were divided into socially facilitated, non-responding, and socially inhibited phenotypes using a tertile split based on changes in social behavior after an acute ethanol challenge. Ethanol or water exposure occurred from P28-53. Social anxiety-like behavior was assessed during acute withdrawal from single and repeated binge episodes and during protracted abstinence. Nonsocial anxiety-like changes were also evaluated during protracted abstinence.Results: Males initially facilitated by ethanol displayed transient social anxiety-like behavior during acute withdrawal from chronic exposure (F_2,41 = 4.418, p < .05), but not during protracted abstinence. Males inhibited by ethanol showed anxiety-like behavior during acute withdrawal from chronic exposure (F_2,42 = 4.345, p < .05), but unlike facilitated males, these effects persisted into protracted abstinence (p < .01). Only non-responsive males displayed social anxiety-like behavior during all withdrawal timepoints (F_1,22 = 30.87, p < .0001). Additionally, ethanol-exposed males displayed increased nonsocial anxiety-like behavior regardless of phenotype (F_1,66 = 12.04, p < .001).Conclusions: These results suggest that, in this rodent model, adolescent individual differences in initial ethanol sensitivity may predict ethanol withdrawal vulnerability. These findings inform research aimed at identifying adolescent boys in clinical settings who are vulnerable to developing alcohol use disorder.

Background: Timely initiation and continuation of medications for opioid use disorder (MOUD) following a new opioid use disorder (OUD) diagnosis reduces overdose risk.Objectives: To examine patient- and community-level factors associated with timely MOUD receipt and the association of these factors and MOUD modality (buprenorphine, methadone, naltrexone) with subsequent overdose.Methods: This cohort study included Medicaid enrollees in 44 states aged 18-64 with a new OUD diagnosis between April 2016 and December 2019. Multivariable Cox Proportional Hazards models assessed time (in days) to MOUD receipt and medically-treated nonfatal overdose stratified by involvement of heroin/synthetic vs. other (primarily prescription) opioids only. Models adjusted for patient, county, and state-level covariates, and models examining overdose additionally adjusted for time-varying (daily) MOUD receipt.Results: Of 1,172,200 Medicaid enrollees with a new OUD diagnosis, 51.8% were female, 55.8% White, and 42.2% aged 30-44. Most (69.2%) did not receive MOUD within 180 days. MOUD receipt was lower among Black (Hazard Ratio [HR] = 0.68, 95% Confidence Interval [CI] 0.67-0.69) and Hispanic (HR = 0.91, 95%CI = 0.90-0.92) compared to White enrollees. During follow-up, 3.2% of enrollees experienced heroin/synthetic opioid overdose, with reduced risk more strongly associated with methadone (HR = 0.14, 95%CI = 0.12-0.15) and buprenorphine (HR = 0.23, 95%CI = 0.22-0.25) than naltrexone (HR = 0.70, 95%CI 0.64-0.77).Conclusion: Use of methadone and buprenorphine, and to a lesser extent naltrexone, are associated with lower overdose risk among Medicaid beneficiaries newly diagnosed with OUD. State and local policies aimed at increasing timely, equitable, and sustained treatment receipt are needed to address the opioid epidemic and reduce disparities.

Background: Despite the availability of efficacious opioid use disorder (OUD) medications (MOUD), there are racial and ethnic disparities in their use in the general population. Here, we examine the use of MOUD in a racially and ethnically diverse veteran sample.Objectives: To examine racial and ethnic differences in veterans' 1) likelihood of receiving MOUD and 2) treatment retention, dosage, and abstinence outcomes among veterans receiving buprenorphine treatment.Methods: Among 29,502 veterans with OUD, we examined the effects of race and ethnicity on 1) whether methadone or buprenorphine was prescribed as MOUD, and 2) among those prescribed buprenorphine, using multivariable logistic regression to adjust for potential confounders, the likelihood of receiving ≥180 days of treatment and achieving opioid abstinence.Results: Thirty percent of veterans with OUD received MOUD, with race being a significant predictor (p < .01): White veterans were most likely to receive buprenorphine (12%) or both medications (11%), while Black veterans were most likely to receive only methadone (16%). Among 5,768 veterans prescribed buprenorphine, retention was highest among American Indian/Alaska Native (59%), White (59%), and Other race (62%) veterans and lowest among multiracial (47%) and Black veterans (49%). In an adjusted analysis (n = 3,273, 92% male, 8% female), Black veterans had significantly lower odds of opioid abstinence than White veterans (aOR = 0.53, 95% CI = 0.43, 0.67).Conclusion: There are racial disparities in MOUD prescribing and rates of retention, particularly in the rate of abstinence among buprenorphine-treated veterans. Standardized criteria for MOUD selection may help guide clinical decisions and reduce racial disparities in treatment outcomes.

Background: Females remain underrepresented in opioid use disorder (OUD) research, particularly regarding dorsal striatal neuroadaptations. Chaperonins seem to play a role in opioid-induced neural plasticity, yet their contribution to OUD-related changes in the dorsal striatum (DS) remains poorly understood. Given known sex differences in opioid sensitivity, it is important to determine how chaperonin expression contributes to OUD-related adaptations in females.Objective: To investigate how stressor controllability during adolescence influences heroin self-administration (SA) and responses to drug-paired cues in adult female rats, focusing on differential gene expression of chaperonins in the DS.Methods: Female rats were exposed to stress avoidance training during adolescence. These rats underwent, in adulthood, heroin SA followed by cue-induced seeking tests after early and prolonged abstinence.Results: Heroin intake during SA was similar between stress-avoiding and stress-naïve females (n = 8/group, p = .89). However, stress-avoiding females exhibited reduced drug-seeking behavior in response to drug cues at 14 days of abstinence compared to controls (p < .05; d = 0.99), suggesting a protective effect of stressor controllability. qPCR showed that the gene expression of Hspa5, a heat shock protein, was elevated in the dorsolateral striatum (DLS) of stress-avoiding females (p < .05; Cohen d > 1.0). Hspb1 gene expression was upregulated in the dorsomedial striatum (DMS) of stress-avoiding females (p < .05; d > 1.0).Conclusion: These findings suggest that chaperonin dysregulation links opioid exposure and stress avoidance conditions. Increased Hspa5 in the DLS and Hspb1 in the DMS may contribute to the observed behavioral differences supporting further preclinical investigation with clinical implications for stress and OUD.

Background: Kratom is a plant with alkaloids acting at opioid, serotonergic, adrenergic, and other receptors. Consumers report numerous use motivations.Objectives: To distinguish subgroups of kratom consumers by kratom-use motivations using latent-class analysis.Methods: From July to November 2022, we utilized convenience sampling and surveyed regular kratom consumers (n = 395, 38.1 years (SD 11.2), 54.9% male, 81.3% White) regarding demographics, lifetime and past-year substance use and preferences, substance use disorder history, healthcare barriers, kratom-use motivations, and general health. We used latent-class analysis to identify subgroups by use motivation and calculated conditional probabilities (P_c) for variables in each class.Results: A four-class model best fit our data. The largest class (32.4%) was characterized by the use of kratom for self-treatment of chronic pain (P_c = .91). The smallest class (19.2%) also reported using kratom for self-treatment, but usually as a long-term replacement for other substances (P_c = .75). The other two classes (24.8% and 23.5%) reported using kratom for management of anxiety (P_c = .87-.95) and depressive symptoms (P_c = .61-.89) and for recreation (P_c = .56- .86). These were distinguished from one another by probability of at least moderate kratom use disorder (P_c = .17 vs. .53), with greater probability observed in the class with greater anxiety (P_c = .13 vs. .50) and depressive (P_c = .34 vs. .82) symptom severity and more likely recreational use motivation (P_c = .56 vs. .86).Conclusion: Kratom consumers can be classified by their use motivations. As with other psychoactive substances, the range of motivations is consistent with the range of likely effects. It is not yet clear whether some motivations might indicate the risk of problems.

Background: The endocannabinoid (eCB) system is a key modulator of stress and reward and is impacted by alcohol and drug use. Recently, the eCB system has been highlighted as a potential novel target in the treatment of substance use disorders (SUDs).Objectives: Understanding how chronic substance use impacts the function of the eCB system can provide a mechanistic rationale for targeting this system in the treatment of SUDs.Methods: A comprehensive review of studies assessing concentrations of eCB ligands N-arachidonoyl ethanolamine (anandamide; AEA) and 2-arachidonoylglycerol (2-AG) in individuals with a SUD diagnosis was performed using all EBSCO databases, PubMed, and Google Scholar. Methods and results related to eCB concentrations, diagnosis, and other factors (e.g. treatment status) were extracted from papers written in English and published in peer-reviewed journals before May 22, 2024.Results: Fifteen studies were reviewed; three in alcohol use disorder (AUD), three in cannabis use disorder (CUD), four in cocaine use disorder, one in opioid use disorder (OUD) and four across SUDs. Generally, AEA concentrations were usually, but not always, increased in AUD, CUD, OUD, and cocaine use disorder. 2-AG concentrations were measured less often but were increased in CUD and decreased in cocaine use disorder.Conclusions: Studies generally support the hypothesis that chronic substance use can impact eCB levels, most often with increased AEA and decreased (or not quantified) 2-AG concentrations, though results were often conflicting. Variability in methodology and study design may limit generalizability across studies.

Background: Peer recovery support services (PRSS) have been widely adopted across a variety of settings, but little is known about their economic impact.Objectives: To conduct a cost-effectiveness analysis of long-term, PRSS delivered after specialty substance use disorder (SUD) treatment (post-treatment), and to describe the development of a free, web-based cost-effectiveness calculator based on this analysis.Methods: Using publicly available data from a variety of sources, post-treatment PRSS were compared to specialty SUD treatment from the societal (broad perspective including costs like participant time) and health systems perspectives (only costs borne by health system), and in terms of quality-adjusted life years (QALYs) added and people in recovery. Whenever possible, 2019 data were used to avoid the impacts of COVID-19. Standard willingness-to-pay thresholds and additional treatment episode cost ($17,203.74) were used. One-way and probabilistic sensitivity analyses were conducted. Two recovery community organizations (RCOs) were involved in model refinement and calculator development in 2022.Results: Post-treatment PRSS were cost-effective to all thresholds and perspectives: $5,898.60 per QALY and $10,562.08 per person in recovery from the health system perspective, and $3,421.58 per QALY and $6,126.72 per person in recovery from the societal perspective, and post-treatment PRSS remained cost-effective across a variety of conditions in the sensitivity analyses. A cost-effectiveness calculator was developed from the analysis and is available at https://go.uth.edu/cea.Conclusions: In light of finding PRSS cost-effective, the expansion of PRSS across the US should continue, and may be aided by using the cost-effectiveness calculator to estimate tailored results for a specific program.

Background: Understanding cannabis initiation is essential for effective prevention but remains understudied, especially for biracial youth who are disproportionately affected by substance use.Objectives: This study examined age patterns and predictors of cannabis initiation across eight monoracial and biracial groups and explored whether predictor effects varied by age, racialized group, and sex.Methods: Add Health data (n = 12,941, 50% male, baseline mean age = 15.5) were analyzed using discrete-time survival analyses to estimate cannabis initiation probabilities from ages 10-24 by age, racialized group, and other predictors.Results: Cannabis initiation probability followed a quadratic age pattern, increasing from age 10-16 and declining thereafter, with differences by racialized group (p < .05). The highest probabilities of new initiations (at age 16) ranged from lowest to highest as follows: Asian (0.08), Black (0.10), Hispanic (White) (0.12), White (0.15), Biracial White-Indigenous (0.16), Indigenous (0.18), Biracial White-Black (0.19), and Biracial White-Asian (0.25). Age- and race-varying effects were found for peer substance use and parental control (joint Wald test, p < .05). Specifically, peer substance use was positively associated with cannabis initiation during adolescence, peaking in mid-adolescence, with stronger effects for Biracial White-Black and Biracial White-Asian youth than their monoracial peers. The effects of parental control showed complex, group-specific patterns. Family support and religiosity slightly lowered cannabis initiation across racialized groups.Conclusion: These findings highlight distinct cannabis initiation patterns across racialized groups, along with variations in the effects of peer substance use and parental control by age and racialized group.

Background: Wearable devices have been increasingly adopted to collect physiological data such as heart rate that may infer momentary risk of substance use. Yet, innovative methods capable for handling these complex time series data as presented in the statistics or data science literature may not be accessible to substance use researchers.Objectives: This study introduces a series of statistical methods to analyze heart rate data and identify features that are associated with nicotine vaping.Methods: Nontechnical description of the methods coupled with the information about open-source software packages that implemented these methods was provided. The analytical procedure included 5 steps: (1) de-noising by the singular spectrum analysis (SSA); (2) sleep region identification by the Sum of Single Effects (SuSiE) model; (3) repeated heart rate pattern identification by the matrix profile; (4) dimension reduction by the linear regression; and (5) comparing repeated heart rate patterns across non-vaping and vaping regions by the linear mixed model. Secondary analysis was conducted on heart rate and ecological momentary assessment (EMA) data collected from 35 young adult e-cigarette users (66% female) for 7 days.Results: Effectiveness of the methods was demonstrated by graphical presentations showing that the extracted features characterize sleep patterns and heart rate changes before and after vaping events quite well. Secondary analysis found that heart rate was higher and changed faster before vaping.Conclusion: Statistical methods can effectively extract useful features from heart rate data that may inform momentary vaping risk and optimal timings for delivering messages in mobile-phone based interventions.