American Journal of Drug and Alcohol Abuse最新文献

Background: There has been a dramatic rise in alcohol consumption and alcohol use disorder (AUD) among women. Recently, the field has made substantial progress toward better understanding sex and gender differences in AUD. This research has suggested accelerated progression to AUD and associated health consequences in women, a phenomenon referred to as "telescoping."Objective: To examine evidence for the telescoping hypothesis from a biopsychosocial perspective.Methods: This narrative review examined and integrated research on biological, psychological, and socio-environmental factors that may contribute to the development and progression of AUD in women.Results: Biopsychosocial research has revealed sex- and gender-specific risk factors and pathways to AUD onset and progression. Biological sex differences render females more vulnerable to alcohol-related toxicity across various biological systems, including the brain. Notably, sex and gender differences are consistently observed in the neural circuitry underlying emotional and stress regulation, and are hypothesized to increase risk for an internalizing pathway to AUD in women. Psychological research indicates women experience greater negative emotionality and are more likely to use alcohol as a means to alleviate negative emotions compared with men. Socio-environmental factors, such as familial and peer isolation, appear to interact with biological and psychological processes in a way that increases risk for negative emotionality and associated alcohol use in women.Conclusion: There appears to be a complex interplay of biopsychosocial factors that increase risk for AUD onset and progression in women through an internalizing pathway. Developing targeted interventions for women with AUD that specifically target internalizing processes is critical.

Background: The emergence of new psychoactive substances (NPSs) poses a serious global health threat. Although various groups of psychostimulants exist, this study specifically investigated two lesser-studied substances, 4,4'-dimethylaminorex (4,4'-DMAR) and escaline.Objective: To assess liability to substance use disorder (SUD), as evidenced via preclinical models, of the two psychostimulants.Methods: 4,4'-DMAR and escaline were evaluated, in mice, for their potential to exhibit rewarding and reinforcing effects, and for causing central dopaminergic activity. The climbing behavior test investigated whether the substances acted as dopaminergic agents and to determine the dose range for further evaluation. The rewarding and reinforcing effects of these substances were evaluated via the conditioned place preference (CPP) and self-administration (SA) tests.Results: The results showed that both test substances significantly increased climbing behavior at 1 mg/kg (p < .01). Mice treated with 0.1 and 1 mg/kg 4,4'-DMAR (p < .05) and with 1 mg/kg escaline (p < .01) exhibited increased duration of time spent in the substance-paired compartment in the CPP test compared to those treated with vehicle. Further, the frequency of infusions from the 5^th to 7^th sessions was significantly increased at 1 mg/kg/infusion of 4,4'-DMAR (p < .001) and at 0.01 and 0.1 mg/kg/infusion of escaline (p < .01) compared to controls.Conclusion: The findings suggest that 4,4'-DMAR and escaline have dopaminergic activity, exert reinforcing and rewarding effects, and may cause SUD. The findings can inform relevant authorities about the need to regulate these two new compounds.

Background: It is necessary to understand drinking motives to inform tailored interventions counteracting high-risk alcohol use and alcohol use disorder. Research suggests that, during the COVID-19 pandemic, drinking to cope with the current situation (i.e. coping motive) increased. This was alarming since the coping motive is a predictor of alcohol use and alcohol-related problems.Objective: In the current study, we aimed to elucidate whether this COVID-19-induced increase in coping-motivated alcohol use outlasted the COVID-19 pandemic in the USA, Great Britain, Mexico, Spain, and Germany. We provide a 2023 post-COVID-19 update on alcohol use and drinking motives.Methods: In spring 2023, 1032 participants recruited via Prolific (48% female) across the five countries completed a cross-sectional online survey, including the Alcohol Use Disorder Identification Test (AUDIT) for alcohol use patterns and the Drinking Motives Questionnaire-Revised (DMQ-R) for drinking motives.Results: Across all five countries, 20-30% of the participants exceeded the AUDIT cutoff score for high-risk alcohol use. The ranking of all four motives for alcohol use was cross-nationally consistent: Social > Enhancement > Conformity > Coping.Conclusion: Compared to most research before the pandemic, with a Social > Enhancement > Coping > Conformity motive ranking, and research during COVID-19, with an Enhancement > Coping > Social > Conformity motive ranking, our data suggests that post-COVID drinking to socialize and to enhance one's own mood, are again the most important motives to drink alcohol. Furthermore, it seems like the increase in the coping motive found in research during the pandemic, did luckily not persist but conversely, post- compared to pre-COVID, the conformity motive seems more important than coping motive.

Background: Cocaine use disorder (CUD) is associated with executive functioning impairments linked to serotonergic function. Previous studies reported efficacy with the selective serotonin reuptake inhibitor citalopram in reducing cocaine use.Objectives: The current study explored moderation and mediation of citalopram effects on cocaine use by performance across executive function domains.Methods: We conducted a secondary analysis of a double-blind, placebo-controlled, randomized Bayesian adaptive trial investigating citalopram efficacy in CUD treatment-seeking adults. At baseline and mid-treatment, participants completed assessments of decision-making (Iowa Gambling Task; IGT), attention, response inhibition, and cognitive flexibility. Outcomes were longest duration of abstinence (LDA; count of consecutive cocaine-negative urine tests) and Treatment Effectiveness Score (TES; count of cocaine-negative urine tests from study midpoint to endpoint). Bayesian models estimated independent moderation and mediation effects of cognitive ability on the association between treatment (citalopram 40 mg vs. placebo) and LDA/TES.Results: Of the four assessments, only the IGT demonstrated concurrent moderation and mediation in the sample (N = 80; 82% males). Treatment effects on LDA (IRR = 1.02) and TES (IRR = 1.03) were strongest in participants with higher baseline IGT scores, which indicate less risky decision-making (posterior probabilities >93%). Models supported a positive indirect effect of treatment on TES (IRR = 1.12, posterior probability = 81.6%), with 52.3% of the total effect mediated by changes in IGT scores from baseline to mid-treatment.Conclusion: We found evidence for IGT as a moderator and mediator of citalopram's effects on cocaine use. Decision-making ability may play a role in predicting who responds to citalopram and how.

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: While social support benefits those in treatment for opioid use disorder, it is unclear how social support impacts patient outcomes.Objectives: This study examines how support person attitudes toward buprenorphine and their communication about substance use are associated with the well-being of patients receiving buprenorphine treatment.Methods: We analyzed cross-sectional baseline data from 219 buprenorphine patients (40% female) and their support persons (72% female). Patients were recruited from five community health centers and asked to nominate a support person. Patient outcomes included symptoms of depression, anxiety, impairment due to substance use, and perceived social support. Support persons predictors included their attitudes toward buprenorphine from four statements (e.g. "Buprenorphine is just replacing one drug for another") and communication using two items (e.g. comfort and effectiveness discussing substance use).Results: More stigmatizing attitudes, such as believing patients should quit on their own without medication, were associated with increased patient substance use-related impairment (F = 4.53, p = .01). Effective communication was associated with lower patient depression (F = 10.15, p < .001), anxiety (F = 4.73, p = .001), lower impairment (F = 6.46, p < .001), and higher perceived social support (F = 3.68, p = .007).Conclusions: This study highlights how support person attitudes and communication dynamics significantly affect the mental health and impairment of individuals receiving buprenorphine treatment. Interventions that reduce stigma and promote effective communication between patients and their loved ones could enhance treatment outcomes and overall well-being among patients with OUD.

Background: The state of Washington legalized cannabis for adult use in 2012 and retail stores began to open in 2014 with 31 stores, rising to 447 in 2020. Prior studies have evaluated impacts of legalization on state-level mortality from suicide, motor vehicle accidents and opioid poisonings with mixed findings.Objectives: To estimate relationships between county cannabis retail store density and county mortality rates from suicide, motor vehicle accidents, opioid poisoning, homicide and accidental poisonings.Methods: County mortality data for Washington state (39 counties) from individual death records for the years 2009-2020 used ICD-10 Multiple Cause of Death Files. County-level cannabis retail store counts in Washington were based on cannabis license and sales data. Fixed effect Poisson regression models predicted county-level yearly mortality rates for 2009-2020.Results: Deaths from 2009-20 in Washington were 12,933 (77% men) from suicide, 6761 (71% men) from motor vehicle accidents, 8858 (62% men) from opioid poisoning, 2408 (73% men) from homicide and 11,873 (64% men) from accidental poisonings. Store counts per 10,000 population were negatively associated with accidental poisonings (incidence rate ratio (IRR) of 0.83 (0.73-0.93)) and opioid mortality rates with (IRR of 0.83 (0.70-0.99)). No significant effects were found for motor vehicle accidents, homicide or suicide.Conclusions: County cannabis retail store density in Washington was associated with reduced accidental poisoning and opioid mortality while suicide and motor vehicle accident mortality rates did not appear to change. Results do not support any harmful effects on mortality from cannabis store expansion in Washington counties.

Background: Despite available and effective prevention and treatment strategies for substance use disorders (SUD), drug overdose deaths in the US remain high. Further, limited public knowledge of SUD pharmacotherapies may contribute to increased stigmatization toward SUD medications and a lack of willingness to help people with SUD.Objectives: This study evaluated knowledge and attitudes about SUD pharmacotherapies and willingness to help people with SUD among a sample of U.S. adults.Method: Participants recruited through Amazon's Mechanical Turk (N = 314; 62.1% male) completed online surveys evaluating knowledge, attitudes, and willingness to help by various demographic factors, history of substance use, and experience with someone with SUD.Results: Results revealed a significant difference in attitudes by race/ethnicity (F(1,307) = 11.85, p < .001). Participants with a personal history of substance use exhibited greater knowledge (F(1,312) = 31.94, p < .001) and willingness to help someone with a SUD (F(1,312) = 7.84, p = .005). Participants with experience with someone with a SUD also exhibited greater knowledge (F(1,311) = 19.42, p < .001) and willingness to help (F(1,311) = 13.63, p < .001).Conclusion: Results emphasize the importance of targeted education to bridge gaps in knowledge, enhance public attitudes, and promote willingness to help individuals with SUD. Utilizing public health strategies that promote empathy, willingness to help, and increase accessibility and acceptance of SUD treatment options, could be potential avenues that ultimately improve outcomes for individuals with SUD.

Background: Adults who smoke cigarettes (AWS) who switch to electronic nicotine delivery systems (ENDS) are likely to reduce their health risks.Objectives: To explore ENDS-users' readiness to stop smoking (RTSS) when adopting ENDS, the prospective association of RTSS and switching away from smoking (past-30-day abstinence), and the role of frequency of JUUL use in switching.Methods: Analyses used data from a naturalistic 2-year longitudinal study of 17,393 AWS (55.4% male) who had purchased a JUUL Starter Kit.Results: Only 20% were planning to stop smoking within 7 days at baseline but had the highest likelihood of switching, 70% at Month-24 (vs. in a year or more: OR = 2.33; 95%CI = 2.13-2.55). Those planning to stop smoking within 30 days (24%), 6 months (24%) or a year or more (27%) had switch rates of 53 ~ 59% at Month-24; those who planned never to quit (6%) had 51% switch rates. Daily ENDS use was prospectively associated with the highest likelihood of subsequent switching (vs. infrequent: OR = 1.68; 95%CI = 1.60-1.77); frequent users (≥20 days/month) also had higher switch rates (OR = 1.22; 95%CI = 1.15-1.28). Descriptively, participants higher on RTSS were more likely to be daily or frequent users, but frequency of use neither interacted with RTSS, nor mediated its association with switching.Conclusions: Most ENDS adopters were not ready to stop smoking, and would not be candidates for cessation treatment. However, a majority - even of those never planning to quit - were abstinent from cigarettes two years later. ENDS may facilitate smoking abstinence in populations not reached by traditional cessation interventions.