American Journal of Drug and Alcohol Abuse最新文献

Background: Substance use among college students has negative academic and health outcomes. Identifying substances that are more commonly used by students than non-students can reveal specific risks in the college environment.Objectives: To examine associations between college enrollment and prevalence and trends of use of a comprehensive list of substances.Methods: The sample included 2015-2019 participants in the National Survey on Drug Use and Health who were aged 18 to 22 and who were full-time enrolled or not enrolled in college. Prevalence of substance use was calculated for four subgroups: college males (n = 6,707), college females (n = 8,284), non-college males (n = 10,019), and non-college females (n = 9,266). Multivariate logistic regression was used to model the relationships between enrollment and substance use. Temporal trends in substance use prevalence were calculated for each subgroup.Results: College enrollment was associated with prescription stimulant misuse (aOR 1.50, 95% CI: 1.35-1.67), alcohol use (aOR 1.36, 95% CI: 1.27-1.47), and binge drinking (aOR 1.22, 95% CI: 1.15-1.30). From 2015 to 2019, the only substance whose use significantly increased among any subgroup was cannabis. The increase occurred among females only (+4.7% in college females and +5.6% in non-college females; both p < .01).Conclusions: College enrollment is most strongly associated with prescription stimulant misuse, suggesting that colleges should consider explicitly including stimulant misuse prevention in their health promotion strategies. The increasing use of cannabis among females warrants clinicians' attention to routine screening for use and provision of information about the mental health impacts of cannabis.

Background: The large-scale identification of people at risk of transitioning from relatively lower-risk to higher-risk alcohol use (e.g. problem drinking) remains a public health challenge despite advances in the identification of risk and protective factors.Objective: This observational study used machine learning to identify Reddit (social media platform) posting activity associated with transitioning from lower- to higher-risk forms of alcohol use.Methods: We employed bottom-up and top-down approaches to identify lower- and higher-risk alcohol-related subreddits. Using a non-parametric negative control procedure, we estimated each of 10,006 Reddit communities' risk of progression from lower- to higher-risk alcohol-related communities and applied a random forest model to predict progression among individual Reddit members. Eligible Reddit members had posted on Reddit for two or more years before their first post in a lower-risk alcohol-related community and for three or more years after that (N = 4,160).Results: Our methodology identified 42 alcohol-related communities, four of which were suggestive of problem drinking. Five communities were significantly associated with progression. Random forests model's risk scores for individual members correlated with their progression to higher-risk communities at 0.30; the model predicted progression of individual Reddit members with a 0.92 area under the curve.Conclusions: Posting in communities dedicated to other substance use, depression, and occupation in the food service industry was associated with posting activity suggestive of problem drinking 3 years later. Posting activity on Reddit may be used for early detection of people at higher risk of transitioning from lower- to higher-risk forms of alcohol use.

Background: Prior meta-analyses have evaluated digital interventions for alcohol exclusively and alcohol/tobacco combined. These meta-analyses showed positive outcomes pertaining to alcohol and alcohol/tobacco combined. Yet questions remain pertaining to the effect of digital cognitive-behavioral therapy (CBT) on reducing alcohol and drug use.Objectives: The purpose of the meta-analysis was to determine the mean effect size, relative to control groups, of digital CBT, for posttest reductions in drug and/or alcohol use.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria was used to guide this review and meta-analysis. Electronic databases (APA PsycArticles, Academic Search Complete, APA PsycInfo, CINAHL Complete, ERIC, MEDLINE, Psychology and Behavioral Sciences Collection, Social Sciences Full Text, Social Work Abstracts, SocINDEX), clinicaltrials.gov, reference lists were searched. The protocol was registered in PROSPERO (ID#: CRD42023471492). The CBT interventions included cognitive restructuring.Results: All but one of the effect sizes favored digital CBT (from -0.02 to -1.45). After the removal an outlier, a small, significant, random effects model Hedges' g summary effect of -0.23 (95% confidence interval: -0.32, -0.14, p < .0001) showed a reduction in substance use at the posttest, favoring digital CBT relative to the control group. A variety of control conditions were used; however, the effects sizes had minimal heterogeneity (k = 17, I² = 5.34, Q = 16.9, p = .39). The funnel plot and Egger regression test intercept (0.01, p = .99) lacked publication bias.Conclusion: The meta-analytic findings suggest digital CBT is an efficacious treatment for reducing alcohol and drug use overall.

Background: During the COVID-19 pandemic, caregiving responsibilities may have been associated with increased substance use.Objectives: To characterize substance use to cope with stress and willingness to seek help among (i) parents, (ii) unpaid caregivers of adults, and (iii) parent-caregivers.Methods: Data were analyzed for 10,444 non-probabilistic internet-based survey respondents of the COVID-19 Outbreak Public Evaluation (COPE) initiative (5227 females, 5217 males). Questions included new or increased substance use, substance use in the past 30 days to cope, insomnia, mental health, and willingness to seek help.Results: Nearly 20% of parents and unpaid caregivers of adults each reported new or increased use of substances to cope with stress or emotions; 65.4% of parent-caregivers endorsed this response. Compared to non-caregivers, all caregiver groups had higher odds of new or increased use of substances, with parent-caregivers showing the largest effect size (aOR: 7.19 (5.87-8.83), p < .001). Parent-caregivers had four times the adjusted odds of using drugs other than cannabis (aOR: 4.01 (3.15-5.09), p < .001) compared to non-caregivers.Conclusions: Caregivers may initiate or increase substance use as a coping strategy when under stress. The higher odds of substance use underscores the importance of efforts to screen for sleep disturbances and adverse mental health symptoms, particularly among parent-caregivers. Clinicians may consider asking patients about family situations more broadly to help identify people who may be experiencing stress related to caregiving and, if indicated, offer treatment to potentially alleviate some of the risks.

Background: Opioid-related overdoses significantly contribute to mortality in pregnancy and the postpartum period. Few studies report risk factors predisposing pregnant and postpartum patients with opioid use disorder (OUD) to overdose.Objective: This scoping review aims to describe the risk factors predisposing pregnant and postpartum patients with OUD to overdose.Method: Included studies identified pregnant and/or postpartum patients with OUD and differentiated between those who experienced overdose and those who did not. Of the 1060 articles, 8 met the criteria, examining 90,860 pregnant and postpartum patients with OUD.Results: Consistent use of medications for OUD (MOUD) during pregnancy and the postpartum period was the most frequently identified factor reducing overdose risk. Critical times of heightened overdose risk include the first trimester and the 7-12-month postpartum period. Pregnancy complications, such as stillbirth, severe maternal morbidity, preterm birth, and cesarean delivery, also increase risk. Opioid overdose is associated with being houseless, incarcerated, young, unmarried, publicly insured, not graduating high school, co-occurring substance use disorders, and inadequate prenatal care. Legislative changes, such as not classifying OUD in pregnancy as "child abuse" and increasing Medicaid reimbursement for Screening, Brief Intervention, and Referral to Treatment programs, are crucial to reducing risk. The impact of race and the influence of co-occurring psychiatric disorders was inconsistently reported.Conclusion: This scoping review identifies significant risk factors for opioid overdose in pregnant and postpartum patients. Improving access through enhanced Medicaid reimbursement, non-punitive reporting policies, and non-stigmatized care are keys to reducing overdose.

Background: Ketamine has emerged as a prominent substance of misuse. Leptin, an adipocyte-derived polypeptide hormone, has been implicated in the development of addiction. Sex-specific changes in leptin levels have been demonstrated following acute ketamine administration; the persistence of long-term ketamine use on leptin levels is uncertain.Objectives: To assess the sex-difference of leptin levels, and their persistence, in individuals with ketamine use disorder (KUD) compared to healthy controls.Methods: Plasma leptin levels were measured in 62 healthy controls (37 males, 25 females) and 68 participants with KUD (50 males, 18 females) on the first day (baseline) and after 1 and 2 weeks of abstinence. As leptin levels are affected by body mass index (BMI), BMI-adjusted leptin (leptin/BMI ratio) was also examined. Mixed model for repeated measures was used to examine changes after ketamine abstinence.Results: Compared to same-sex controls, female, but not male, participants with KUD demonstrated lower leptin levels and leptin/BMI ratio at baseline, week 1, and week 2 (leptin levels: p = .001, 0.006 and 0.032, respectively; leptin/BMI ratio: p = .004, 0.022, and 0.09, respectively). Repeated measures showed that leptin levels and the leptin/BMI ratio increased after 2 weeks of abstinence in male participants with KUD (p = .002 and 0.011, respectively), but females did not show such an increase (p > .05).Conclusions: Sex-specific differences were observed in leptin levels and the leptin/BMI ratio in individuals with KUD compared to controls. Lower leptin levels in females with KUD persisted after 2 weeks of abstinence.

Background: Amid the national opioid epidemic, it is important to assess trends in opioid prescriptions. Long-acting opioids (LAOs) are of particular interest as they are among the most intensely misused prescription opioids. Moreover, understanding geographic trends in opioid prescriptions may help identify state-level variations, illustrating state-specific disparities.Objectives: The study aims to determine geographic trends in overall and LAO prescriptions under Medicaid and Medicare Part D from 2013 to 2021.Methods: We used data from the Centers for Medicare & Medicaid Services on opioid prescriptions from 2013 to 2021. The opioid prescribing proportion was calculated as the number of opioid claims divided by the total number of overall drug claims. The LAO prescribing proportion was calculated as number of LAO claims divided by total opioid claims.Results: Despite a general decrease nationwide, Medicaid opioid prescribing proportions increased in Iowa, Montana, and Virginia. There was an increasing trend in the national-level Medicaid LAO prescribing proportion from 2017 to 2021, with a 14.1% point increase (p for the annual percent change [APC]<0.05). For Medicare Part D, the overall prescribing proportions fell by 1.7% points from 2013 to 2021, while the LAO prescribing proportion fell by 3% points from 2016 to 2021 (p for APC < .05).Conclusions: The increasing trends in national-level Medicaid LAO prescribing and Medicaid opioid prescribing in Iowa, Montana, and Virginia are concerning, and have implications for clinical opioid prescribing. The decreasing trends in Medicare Part D may reflect ongoing efforts in opioid prescription management.

Background: While medications for opioid use disorder (MOUD) are effective in reducing overdoses, widespread adoption and implementation of MOUD remains inadequate. Innovative approaches to promote MOUD use and to support people in their medication-assisted recovery (MAR) are needed. Recovery residences that serve people taking MOUD are steadily growing in number, yet little is known about how MOUD and the MAR pathway is promoted within the recovery residence setting.Objectives: The purpose of this qualitative analysis was to describe how recovery residences facilitate MOUD initiation and support residents' MAR pathway.Methods: We conducted interviews with 93 residents (59.1% male; 38.7% female) living in recovery residences located in five Texas cities that served people taking medication for opioid use disorder.Results: We found that recovery residence staff addressed linkage to care gaps in their communities by connecting people who might benefit from MOUD to appropriate providers. Recovery residence staff also strengthened participants' community of MAR-supportive peers by hosting or connecting residents to Medication-Assisted Recovery Anonymous meetings. Additionally, recovery residences helped some residents overcome common logistical barriers (e.g. transportation issues, housing instability, distance to providers) that hinder MOUD access.Conclusion: Recovery residences that serve people taking MOUD are a well-positioned recovery support service to promote MOUD initiation and the MAR pathway.

Background: Traveling to meet sexual partners and substance use are associated with increased risk of infectious disease. It is important to understand what factors may increase substances use or increased infection transmission risk (IITR) sexual behaviors among rural LGBTQ+ individuals.Objective: This study investigates substance use and sexual behaviors associated with increased infection transmission risk among rural LGBTQ+ individuals, and how these are associated with relationship type (friends or romantic partners) and travel distance.Methods: Participants (18 years+, identify as LGBTQ+, and provided a $25 gift card) were recruited from Illinois (25 counties), in 2021. Data included demographics, sexual and drug use behaviors, and assessed how these behaviors varied by relationship type and distance traveled (e.g. when meeting friends out-of-state).Results: The 398 participants were 79.1% White and 12.3% Black. By orientation, 29% heterosexual, 36% gay/lesbian, and 35% bisexual/other. By identity, 43% cisgender male, 51% cisgender female, and 6% genderqueer/other. Alcohol use while visiting out-of-state friends was more frequent among transgender (vs cisgender men; OR = 9.686, 95% confidence interval = 2.123-44.19), and individuals traveling > 1/month (all p < .050). Infection-related sexual behaviors while visiting out-of-state romantic partners was more frequent among prescription medication misuse (all p < .050) and traveling > 1/week (vs < 1/month; OR = 3.399, 95% CI = 1.037-11.144).Conclusion: This study of rural LGBTQ+ identified that alcohol use was associated with travel to visit out-of-state romantic partners, and prescription medication misuse increased infection-related sexual behavior during out-of-state travel. Health professionals can develop substance use and increased infection transmission risk sexual behavior interventions on gender minority groups in rural areas and target those who are traveling.