American Journal of Drug and Alcohol Abuse最新文献

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.

Background: Drug use among men is a significant public health concern in China, with compulsory drug treatment centers being the primary approach. Police officers in these centers play a crucial role in shaping the interactions and experiences of men who use drugs (MWUD). However, little research exists on the attitudes of police officers toward MWUD in China.Objectives: This qualitative study aimed to explore the attitudes of police officers toward MWUD and drug rehabilitation approaches in China.Methods: Semi-structured individual interviews were conducted among 23 police officers recruited from two compulsory drug treatment centers in Jiangsu Province, China. Of the participants, two were females and 21 were males. Thematic analysis was employed to analyze the data.Results: Three key themes emerged: 1) Multifaceted perspectives on MWUD. Participants viewed MWUD as offenders, victims, and patients. 2) Dynamic interactions with MWUD. Relationships were characterized as either adversarial or supportive, influenced by participants' personalities, experiences, beliefs, workload, and psychological training. 3) Advocating for punitive measures in drug rehabilitation. While the participants generally favored strict penalties for MWUD, they acknowledged the value of community-based rehabilitation. Concerns about social stigma, privacy, motivation, and the costs of voluntary rehabilitation tempered their support.Conclusions: The study highlights the importance of raising awareness and challenging bias among police officers. It emphasizes the need for psychological training to enhance their capacity to provide humane care and foster positive interactions with MWUD. Additionally, ensuring access to affordable, accessible, and stigma-free voluntary rehabilitation is crucial for effective drug rehabilitation efforts.

Background: Young sexual and gender minority (SGM) men experience disproportionate risk of drug-related harms. Improving access to drug checking services (DCS), where people can receive information about the contents of their illicit drugs, is critical to facilitate safer drug use among this population. However, no research to date has explored their perspectives on DCS.Objectives: To explore perspectives on DCS among young SGM men in Metro Vancouver, Canada.Methods: Semi-structured interviews were conducted with 50 young (ages 18-30) SGM men living in Metro Vancouver in 2018. Interviews were audio-recorded, transcribed verbatim, and coded. Themes were identified using inductive-deductive approaches and interpreted by drawing on the Risk Environment Framework.Results: Two key themes emerged. First, participants generally had limited awareness and experience with DCS. Nevertheless, given concerns over the increasingly toxic drug supply, they perceived benefits to getting their drugs tested, including reducing their risk of overdose. Second, participants identified social (e.g. anti-drug stigma), policy/legal (e.g. drug criminalization), and physical (e.g. lack of services outside of downtown Vancouver) barriers in the current context of DCS. To improve access, participants encouraged the expansion of DCS in community settings (e.g. bars) and through community-based approaches (e.g. integration within community sexual health programming) tailored for young SGM men.Conclusion: Despite low levels of awareness and experience with DCS, young SGM men demonstrated a strong interest in accessing these services. Efforts to adapt and scale up DCS need to account for the social, policy/legal, and physical contexts that shape the lives of young SGM men.

Background: Adults experiencing homelessness (AEH) disproportionately suffer from substance use disorders (SUD) and under-utilize SUD treatments compared with the general population. AEH with a recent history of justice involvement (AEH+J) face additional treatment barriers related to discrimination and criminal history.Objective: To describe types of discrimination that AEH+J experience and assess whether the type of discrimination experienced impacts motivation for SUD treatment by SUD severity.Methods: We analyzed data from 164 AEH+J (85% male, 54% non-Hispanic Black) from the Link2Care cohort. ANOVA and linear regression analyses tested for associations between discrimination type, SUD treatment motivation, and SUD severity. Multivariable linear regression models examined associations between discrimination types and SUD treatment motivation by SUD severity level.Results: The majority of AEH+J experienced discrimination (90%), primarily due to homeless status (27%) and race (27%). AEH+J with severe SUD had a significantly greater motivation for SUD treatment than those with mild/moderate disorders (mean difference: 7.34, p < .0001). Discrimination type was not directly associated with SUD severity or treatment motivation. However, among participants with severe SUD, AEH+J who experienced race-related discrimination had lower treatment motivation than those who did not experience discrimination (β = -6.17, p = .03).Conclusion: Results support allocating scarce publicly available SUD treatment resources to AEH+J with the greatest need and motivation to receive treatment. Results also highlight the importance of screening for discriminatory experiences, especially to those who primarily experience race-related discrimination, to improve motivation for SUD treatment among AEH+J with severe SUD.