American Journal of Drug and Alcohol Abuse最新文献

Background: In Nepal, alcohol consumption is traditionally accepted within the religious and cultural practices of tribal communities. The Dhankuta district of Nepal, a hilly area of Eastern Nepal, is home to many indigenous and tribal communities. However, the socio-demographic and socio-contextual factors related to problematic alcohol drinking in these high-risk groups remain unexplored.Objectives: To examine how socio-demographic and socio-contextual factors contribute to predictors of problematic drinking in the Eastern Hills of Nepal.Methods: A case-control study was conducted in the Dhankuta district of Eastern Nepal in 2019. The CAGE questionnaire and AUDIT scale were used to identify problematic drinking. A sample size of 100 cases (male: female = 2.1) and 100 controls (male: female = 1.9) were purposively selected. Socio-demographic factors and socio-contextual factors were assessed. Bivariate and multiple logistic regression were used for analysis. The predictive ability of the regression model was assessed using diagnostic test characteristics.Results: In multivariable analysis, five factors remained significantly associated with problematic drinking after potential confounders were included: strongly disagreeing parental attitude toward individual's alcohol use [OR = 0.42 (0.18-0.98), p = .045], peer alcohol use [OR = 9.03 (1.21-67.38), p < .001], accepting alcohol offers made by friends (susceptibility) [OR = 33.10 (12.30-89.07), p < .001], lower socio-economic status [OR = 2.81 (1.12-7.04), p = .027] and nicotine use disorder [OR = 4.01 (1.28-12.54), p = .017]Conclusion: Predictors of problematic alcohol use in a tribal region of the Eastern Hills of Nepal resemble those observed globally, suggesting the potential applicability of cross-cultural public health strategies.

Background: There is variation in the criminalization of substance use during pregnancy across U.S. states. How the context of criminal justice system involvement impacts outpatient substance use treatment outcomes among pregnant women is understudied.Objectives: This study tested associations of criminal justice referral status with 1) treatment completion and 2) reduced substance use among individuals at discharge who were pregnant and referred to outpatient treatment from the criminal justice system.Methods: Data were obtained from the 2015-2021 Treatment Episode Dataset-Discharges (TEDS-D). The sample consisted of 7881 justice-involved outpatient discharges who were pregnant. The independent variable was the type of criminal justice referral: court or diversionary program, probation or parole, or other. Outcome variables included treatment completion and reduced substance use. Multivariable logistic regression models were used to measure associations of referral type with treatment outcomes, adjusting for covariates.Results: Referrals from court or diversionary programs had higher odds of treatment completion than referrals from probation or parole (AOR = 1.40, 95% CI = 1.23-1.60). Among individuals at discharge who reported daily use prior to admission, those referred through court or diversionary programs had higher odds of reduced substance use at discharge compared to those referred through probation or parole (AOR = 1.85, 95% CI = 1.23-2.79).Conclusions: Overall, better outcomes were observed among those referred through courts or diversionary programs compared to those referred through probation or parole. These findings demonstrate the potential utility of drug courts and diversionary programs in facilitating positive treatment outcomes while also preventing exposure to more punitive forms of criminal justice system involvement.

Background: Cocaine's psychoactive effects arise primarily from dopamine transporter (DAT) inhibition. Prior trials suggest methylphenidate, a DAT inhibitor with pharmacologic overlap with cocaine, may reduce cocaine use, but real-world data are limited.Objectives: To evaluate whether methylphenidate exposure is associated with reduced likelihood of subsequent positive cocaine screens among veterans treated within the VA healthcare system.Methods: This retrospective cohort study used the Veterans Affairs Informatics and Computing Infrastructure (VINCI) to identify 109,608 patients with a positive cocaine screen. Among these patients 109,105 (103,535 male) had no methylphenidate exposure and 503 (458 male) were prescribed methylphenidate. Patients with methylphenidate were compared to unexposed patients and to an active comparator, bupropion. Baseline covariates included age, sex, ADHD, psychiatric and substance use disorders and comorbidities. Propensity score matching balanced groups and logistic regression models with generalized estimating equations estimated adjusted odds ratios (ORs) for a positive cocaine screen during one-year follow-up.Results: After matching, methylphenidate exposure was associated with lower odds of a follow-up positive cocaine screen compared with no exposure (OR = 0.71, 95% CI 0.51-0.98) and with bupropion (OR = 0.60, 95% CI 0.41-0.87).Conclusion: In this large real-world cohort of US veterans, methylphenidate exposure was significantly associated with a lower likelihood of subsequent cocaine detection. These results suggest that methylphenidate is a viable pharmacologic candidate for addressing cocaine use disorder, demonstrating superior outcomes in this population when compared to no exposure or the use of bupropion.

Background: Statins, widely prescribed for their lipid-lowering effects, have emerged as potential neuroactive agents with anti-inflammatory and neuromodulatory properties relevant to neurobiology of substance use disorders (SUDs). However, preclinical evidence supporting their role in modulating drug use-related behaviors remains scattered and requires critical synthesis.Methods: A comprehensive narrative search was conducted in Google Scholar, Scopus, and PubMed up to May 2025 using combinations of terms related to drug dependence, SUD, relapse, withdrawal, and statins. Eligible studies included original animal or in vitro investigations assessing statins in contexts of drug exposure, tolerance, or relapse. Non-preclinical and non-brain-focused studies were excluded. The screening process followed PRISMA principles, and data were categorized by experimental model and outcome domain.Results: Of 61 initial records, 13 preclinical studies met all inclusion criteria. These studies encompassed both pain-related opioid tolerance/withdrawal models and SUDs paradigms involving morphine, nicotine, or cocaine. Across models, lipophilic statins such as simvastatin and atorvastatin consistently attenuated withdrawal symptoms, relapse behaviors, oxidative stress, and neuroinflammatory markers, while enhancing neurotrophic signaling and cognitive outcomes.Conclusion: Preclinical evidence suggests that statins, particularly lipophilic agents, may influence neural and behavioral mechanisms underlying addiction through anti-inflammatory and neuromodulatory actions. These findings highlight a promising translational avenue for adjunctive use of statins in SUDs, warranting further mechanistic and clinical studies.

Background: Alcohol withdrawal delirium (AWD) is a serious complication of alcohol use disorder associated with high morbidity and mortality. Systemic inflammation has been implicated in the pathophysiology of severe alcohol withdrawal states, but the clinical value of simple peripheral inflammatory biomarkers is unclear.Objectives: This study aimed to compare peripheral inflammatory indices among patients with AWD, patients with alcohol withdrawal without delirium, and healthy controls, and determine whether these indices differentiate AWD from alcohol withdrawal without delirium.Methods: This retrospective study included 232 adults (194 males, 38 females), of whom 81 had AWD, 91 had alcohol withdrawal without delirium (AWS), and 60 were healthy controls. Sociodemographic, clinical, and laboratory data obtained within the first 24 hours of admission were compared. Receiver operating characteristic analyses and multivariable logistic regression were performed.Results: Several inflammatory indices (particularly the monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein-to-albumin ratio (CAlb)) were significantly higher in AWD than in both comparison groups, whereas platelet counts did not differ. In the regression model, neutrophil-to-lymphocyte ratio (NLR) was independently associated with AWD (OR = 1.84, 95%CI: 1.02-3.31, p = .042) providing incremental prognostic value beyond established risk factors such as AWD history (OR = 9.09, 95%CI:2.65-31.20, p < .001) and withdrawal severity (OR = 1.18, 95%CI:1.09-1.28, p < .001). MLR best differentiated AWD from uncomplicated withdrawal (AUC = 0.760; Cutoff > 0.32; Sensitivity:71.8%, Specificity:72.5%), while NLR best distinguished AWS from controls (AUC = 0.796; Cutoff > 1.83; Sensitivity:68.1%, Specificity:85.0%).Conclusion: Simple peripheral inflammatory indices, particularly NLR and MLR, are independently associated with AWD and offer diagnostic utility to complement clinical assessment in risk stratification.

Background: Alcohol use during adolescence and early adulthood promotes the development of alcohol use disorder (AUD). Emerging evidence suggests that ethanol-induced gut microbiota alterations may contribute to AUD vulnerability; however, it remains unclear whether microbiota imbalances are a causal risk factor or a consequence of alcohol exposure.Objectives: This preclinical study assessed if fecal microbiota transplantation (FMT) from donors exposed to ethanol during adolescence/early adulthood would alter ethanol drinking and other behaviors, in unrelated naïve mice.Methods: Forty-two (31 males and 11 females) C57BL/6J mice were exposed to a repeated 2-days-on, 2-days-off ethanol access protocol from postnatal day 43 to 80. Fecal microbiota from ethanol-exposed (or control) donors was transplanted into antibiotic-pretreated naïve male (n = 26) and female (n = 16) recipients. These were assessed for ethanol intake, including compulsive-like drinking (i.e. after quinine adulteration). Anxiety and repetitive behavior were measured in the light-dark box, elevated plus maze and marble-burying tests.Results: Female, but not male, recipients of FMT from ethanol-exposed donors showed significantly increased ethanol consumption (n²p = .32) and preference (n²p = .36) compared to controls (p < .05). This included sustained intake despite quinine adulteration (p < .05), suggestive of compulsive-like drinking. Ethanol-exposed male mice showed a significant increase in marble-burying (p < .05), consistent with compulsive-like tendencies. Additionally, both male (n²p = .30) and female (n²p = .28) donor mice exhibited behavioral disinhibition (p < .05).Conclusions: These findings provide preclinical evidence that microbiota alterations after ethanol exposure at late adolescence can transmit vulnerability to alcohol intake, with sex-specific effects. The results highlight the potential of microbiota-targeted interventions in prevention and treatment strategies for AUD.

Background: Heavy episodic drinking (HED) poses significant risks during adolescence. Despite declining prevalence over years, it remains unclear whether these trends are influenced by historical changes or are independent of age and birth cohort effects.Objectives: To investigate the age-period-cohort (APC) effects on HED among adolescents in Ontario, Canada.Methods: Data drawn from the Ontario Student Drug Use and Health Survey (OSDUHS) from 1999 to 2023. OSDUHS is a repeated cross-sectional survey of students in grades 7 through 12 attending publicly funded schools in Ontario, Canada. The survey used a stratified two-stage cluster sampling method, including 103,977 adolescents (50.9% females) aged 12-18 years.Results: The observed prevalence of HED in the past 30 days declined from 27% in 1999 to 9.6% in 2023. In the pooled sample, HED increased from 2.2% at age 12-41.6% at age 18, with a notable divergence in HED rates between males and females at ages 17 and 18. APC analysis revealed that adolescents born in the early 1990s (cohort effect) were nearly twice as likely to engage in HED as those born in 2000 (RR = 1.78, 95%CI: 1.63-1.95). The strongest period effect was evident in 2000, with odds of HED higher than 2015 (RR = 1.55, 95%CI: 1.39-1.72), followed by a peak in 2018 and a decline in recent periods.Conclusions: Teen binge drinking has declined over time, with newer generations drinking less. These shifts may reflect changing social norms and lifestyle preferences. Identifying the most affected age and cohort groups can guide targeted prevention.

Background: In January 2023, British Columbia (BC) implemented a three-year pilot decriminalizing possession of up to 2.5 grams of certain illegal drugs, including opioids, cocaine, methamphetamine, and MDMA, the first policy of its kind in Canada. This initiative has faced scrutiny, culminating in a May 2024 amendment banning possession and use in public spaces.Objectives: To examine public opinion on BC's decriminalization policy by assessing perceptions of the 2024 policy amendment, potential changes in support between 2024 and 2025, and demographic factors associated with support for repealing the policy.Methods: We analyzed two waves of online, non-probability surveys of BC adults (male 48%, non-male 52%): Wave 1 (March 26-April 1, 2024; N = 1,202) and Wave 2 (February 12-18, 2025; N = 1,200). Changes in values between both waves were tested with Rao-Scott chi-square analyses, and demographic predictors of support for the policy's repeal were assessed using multinomial logistic regression.Results: Support for decriminalization weakened between 2024 and 2025, as opposition rose from 41% to 47% (p = .0427). Fewer respondents believed decriminalization reduced criminalization (50% vs. 39%; p < .0001), reduced policing costs (37% vs. 25%; p < .0001), or improved treatment access (34% vs. 27%; p = .0229). Disagreement that decriminalization reduced stigma increased from 45% to 55% (p < .0001), while perceptions of community safety declined from 28% vs. 22% (p = .0019). Overall, 61% supported the amendment, and 46% supported repeal, with support varying by age, gender, region, education, and household composition.Conclusion: Public opinion in BC reflects growing skepticism toward decriminalization, strong support for public use restrictions, and significant backing for the policy's repeal. Without visible improvements in overdose prevention, service access, and public communication, the policy's long-term viability remains uncertain. Sustained investments in harm reduction and strategic public messaging are essential.

Background: Previous work demonstrated that administration of saikosaponin A (SSA), one of the major components of the roots of Bupleurum falcatum, reduced oral alcohol self-administration, a validated measure of the reinforcing and motivational properties of alcohol, in Sardinian alcohol-preferring (sP) rats.Objectives: To evaluate whether SSA ability to reduce the reinforcing and motivational properties of alcohol extends to well-established binge-like drinking paradigms, characterized by intoxicating drinking patterns, in sP rats and C57BL/6J mice.Methods: Male sP rats (n = 48) were exposed to the 4-bottle [10%, 20%, and 30% (v/v)] alcohol vs water choice regimen, with limited and unpredictable time to access to alcohol. Male C57BL/6J mice (n = 56) were subjected to a single-bottle, 20% alcohol "drinking in the dark" protocol, initiated 3 hours into the dark phase. In both experiments, SSA (0, 1, 2, or 4 mg/kg) was administered acutely and intraperitoneally 15 min before the start of the drinking session. SSA was also tested on spontaneous locomotor activity in alcohol-naive sP rats (n = 48) and C57BL/6J mice (n = 39).Results: Alcohol binge-like drinking was prevented by administration of 2 and 4 mg/kg SSA in sP rats (p < .05; p < .005) and C57BL/6J mice (p < .005; p < .0001). However, the results of the locomotor activity experiments indicated that specificity of the reducing effect of SSA on alcohol intake was limited to sP rats and observed only at the dose of 2 mg/kg (p > .05).Conclusion: Overall, our findings support the potential of SSA as a treatment for binge alcohol drinking.

Background: Prescription opioid misuse (i.e. use without a prescription or in ways other than prescribed) is a significant health concern among individuals with chronic pain. Hazardous alcohol use (i.e. drinking that increases risk of negative consequences) is common among individuals with pain, including among those who are prescribed opioids. Everyday discrimination, which is characterized by interpersonal experiences of identity-based harassment, has been independently linked to both depressive symptoms and prescription opioid misuse. Although promising as a potentially modifiable intervention target, the mediating role of depressive symptoms in associations between everyday discrimination and prescription opioid misuse remain largely unexplored. Further, it is important to identify factors associated with prescription opioid misuse among individuals with chronic pain who engage in hazardous alcohol use, as both are positively associated with prescription opioid misuse.Objectives: To examine indirect associations between everyday discrimination and prescription opioid misuse via depressive symptoms among adults with chronic pain who engage in hazardous drinking.Methods: Participants included 150 adults with pain (35.7% Black/African American; 59.7% female; M_age = 44.27) who were prescribed opioids and drank hazardously.Results: A process model revealed that depressive symptoms acted as mediator of associationsbetween everyday discrimination and prescription opioid misuse (b  = 0.26, bootstrapped 95% CI [0.15, 0.39]). Specifically, everyday discrimination was associated with greater depressive symptoms, which in turn was associated with greater prescription opioid misuse.Conclusion: These findings suggest that providers should screen for depressive symptoms in the context of prescription opioid misuse, particularly among individuals who experience discrimination.