American Journal of Drug and Alcohol Abuse最新文献

Background: Alcohol administration paradigms are widely used to test the effects of alcohol on human aggression. However, methods used to implement alcohol administration designs can vary considerably, with implications for impact and generalizability.Objectives: This review summarizes and critically evaluates design features of alcohol administration studies on aggression to inform protocol development and provide recommendations for reporting practices.Methods: Ninety-seven studies that employed alcohol administration to study the effects of alcohol on interpersonal aggression were coded for methodological features, including the scope of aggressive behavior and sample characteristics, alcohol administration protocols, and elicitation of alcohol-related expectancies.Results: Alcohol administration studies of aggression have used relatively homogenous samples and aggression paradigms, especially laboratory analogues of alcohol-involved physical aggression. In the alcohol condition, researchers tended to induce relatively high intoxication (mean BrAC = 0.08) using a mixed liquor drink, though drinking and absorption periods relevant for breath alcohol concentration when aggression was assessed were less consistent. Almost all studies with a placebo condition (n = 65 out of 69) included beverage features to enhance alcohol-related expectancies and bolster believability, but only a third told placebo participants they received alcohol. Recommendations for reporting are presented in a checklist.Conclusion: This review identifies several future methodological directions, including greater inclusion of underrepresented individuals and types of aggression (e.g. sexual, intimate partner), consistent reporting of alcohol administration procedures, and evaluation of placebo enhancement strategies. Maximizing the rigor and replicability of these designs is essential for efforts to understand and reduce alcohol-related aggression.

Background: Measurement-based care (MBC) is a clinical practice where patients complete standardized outcome measures throughout treatment to monitor clinical progress and inform clinical decision-making. However, MBC is rarely adopted in routine substance use disorder (SUD) treatment. We developed a digital MBC system and pilot tested it in an outpatient adult community SUD treatment setting.Objectives: The current study aims to characterize qualitative feedback from the pilot participants about their experiences using the MBC system in SUD treatment, focusing on perceived benefits, drawbacks, and suggestions for improvement.Methods: Participants (N = 30; n = 11 female 37%) completed weekly MBC questionnaires via smartphone for 6 months and completed structured interviews at 6-, 12-, and 24-weeks. Themes were identified using a combination of inductive/deductive thematic analysis.Results: Participants highlighted several benefits of using the digital MBC system, including improved self-reflection (e.g. goal clarification, noticing changes over time), treatment enhancement (e.g. improving patient-clinician communication, extending the reach of treatment beyond scheduled sessions), and ease-of-use (e.g. brief, understandable questions). Drawbacks were less frequently expressed and included limited integration with clinical care, repetitiveness of questionnaires, and some questions being difficult to answer. Suggestions included making elements more personalized and improving interactivity with the digital interface.Conclusion: Patients report several benefits of integrating digitally delivered MBC into SUD treatment, along with recommendations that may improve its usability and usefulness. Integrating MBC technology into SUD treatment may potentially aid patients by enhancing self-reflection, facilitating more efficient communication with clinicians, and extending the reach of treatment beyond scheduled treatment sessions.

Background: The synchronized disbursement of income assistance payments is associated with increased drug-related harms and substance use disorder (SUD) treatment interruptions. Desynchronizing and splitting these payments can mitigate escalations in drug use, suggesting that downstream effects on SUD treatment may be impacted as well.Objectives: To understand the effect of desynchronizing and splitting income assistance payments on treatment patterns, including adherence to medications for opioid use disorder (MOUD).Methods: Data came from The Impact of Alternative Social Assistance on Drug Related Harm (TASA) study, conducted in Vancouver, Canada. This parallel arm, multi-group, randomized controlled trial assigned participants for six payment cycles to the synchronized monthly government schedule control or one of two intervention arms receiving payments desynchronized from the government schedule: a "staggered" group receiving monthly payments or a "split & staggered" group receiving semimonthly payments. Multivariable generalized estimating equations assessed the effect on overall SUD treatment adherence, MOUD adherence, and non-MOUD SUD treatment adherence.Results: Between October 2015 and January 2019, 194 participants were randomized and followed, including 89 (45.8%) women and 83 (42.8%) who self-identified as a person of color. In both intent-to-treat (ITT) and modified per-protocol (MPP) analyses, neither intervention arm was associated with decreased adherence to SUD treatment (ITT staggered arm adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.36-1.55, split and staggered arm AOR 0.83, 95% CI 0.44-1.57; MPP staggered arm AOR 0.72, 95% CI 0.38-1.39, split and staggered arm AOR 0.89, 95% CI 0.54-1.46), including MOUD and non-MOUD.Conclusions: Alternative income assistance disbursement did not positively impact SUD treatment adherence, contrary to the hypothesis. Changing payment schedules also did not negatively impact SUD treatment adherence, suggesting that changes to payment delivery could be completed without impacting treatment.

Background: The opioid crisis, driven by fentanyl use, continues to worsen in the US and there has been a lack of focus on nonfatal overdose and how pediatric populations are being affected.Objectives: We determined the prevalence of nonfatal pediatric fentanyl exposures and associated characteristics and delineated how such characteristics are associated with major (life-threatening) outcomes.Methods: This repeated cross-sectional study examined characteristics of pediatric nonfatal fentanyl exposures (aged 0-19 years) reported to poison centers in 49 US states from 2015 through 2023.Results: 3,009 nonfatal pediatric exposures (41.5% female) were reported to poison centers-58.9% aged 13-19 and 41.1% aged 0-12. The number of exposures increased overall from 69 in 2015 to 893 in 2023 (a 1,194.2% increase, p < .001). Exposures increased by 924.3% among those aged 0-12 (p < .001) and by 1,506.3% among those aged 13-19 (p < .001). Ingestion-only use was the most prevalent route of administration by those aged 0-12 (76.9%) and 13-19 (54.1%). Prevalence of ingestion-only use increased from 44.1% of exposures in 2015 to 67.9% in 2023 (p < .001). The majority of patients aged 0-12 were exposed unintentionally (81.7%, vs. 1.0% among patients aged 13-19) while the majority of patients aged 13-19 misused or "abused" fentanyl (65.7% vs. 1.8%). The plurality of exposures (41.0%) resulted in a major (life-threatening) effect.Conclusions: Pediatric exposures to fentanyl are increasing and over one-third of cases are unintentional and/or had documented life-threatening effects. Prevention and harm reduction efforts need to include efforts for youth, particularly as counterfeit pills containing fentanyl flood the illicit market.

Background: While alcohol use disorder is a significant social problem in Romania, Alcoholics Anonymous (AA) affiliation is scarce despite proven benefits.Objectives: To identify differences between highly and low/nonaffiliated individuals and AA affiliation' associated benefits.Methods: A mixed-method research employed in Romania (n = 24,12 males,12 females; length of sobriety in days, M highly affiliated = 3406, M low/nonaffiliated = 220) comprised measures of organizational commitment, spirituality, well-being, mental health, and addiction and in-depth interviews. T-tests and thematic analysis were used.Results: Quantitative findings showed significant differences in affective organizational commitment (d = 1.1, p = .01), number of completed AA Steps (d = 2.5, p < .005), positive religious coping (d = 1.1, p = .01), anxiety (d = - .9, p = .03), craving (d = - 2, p < .005), commitment to sobriety (d = 1.4, p = .005), confidence on staying sober (d = 1.4, p = .005), abstinence self-efficacy (temptation: d = 1.6, p = .001; confidence: d = .9, p = .03) and desire for abstinence (overall: d = 1.3, p = .004; intention: d = 1.4, p = .002; attitude: d = 1.1, p = .01; subjective norm: d = .9, p = .03; perceived control: d = 1.4, p = .002). Interview data revealed two main themes: Characteristics of highly affiliated individuals and Characteristics of low/nonaffiliated individuals.Conclusion: Highly affiliated individuals are more likely to maintain sobriety, obtain spiritual benefits, improve their mental health, and become committed to recovery. Low/nonaffiliated individuals can still receive some benefits from attending AA meetings.

Background: Unrecorded alcohol refers to alcoholic beverages produced and consumed outside the formal market. Unrecorded consumption is a global issue with multiple implications that remains under-explored in Latin America, where most estimations rely on global statistical models and surveys, with a need for country-level estimations.Objectives: To 1) characterize unrecorded consumption in Argentina, describing the percentage of the population consuming unrecorded alcohol and the annual per capita consumption, 2) explore the types and quantities of unrecorded alcoholic beverages consumed, and 3) identify its main predictors.Methods: We conducted a survey with a non-probabilistic sample of 1125 adults (75.9% woman) in Argentina, using the World Health Organization's STEPwise approach. Estimates of unrecorded consumption were adjusted using external population data. Logistic regressions were used to explore predictors.Results: Nearly 47% of the sample reported unrecorded alcohol consumption in the past 12 months, and around 25% did so in the last 30 days. The most common types of unrecorded consumption in the last 12 months were alcoholic beverages bought at duty-free shops (22.6%), homemade fermented beverages (20.5%), and beverages made with pure alcohol bought at pharmacies (14.7%). Adjusted estimates suggest an annual per capita consumption of 2.43 l of pure unrecorded alcohol. Heavy episodic drinking was the strongest predictor of unrecorded alcohol use in the last year, increasing it by 86%.Conclusions: Unrecorded consumption is widespread in Argentina. These findings highlight the need for more inclusive and effective public health policies to address unrecorded alcohol use and its associated risks in the region.

Background: Peer recovery support services (PRSS) improve engagement and retention in treatment for substance use disorders (SUDs), but limited evidence exists on their economic effectiveness. Understanding implementation costs may inform replication efforts of PRSS.Objective: This study evaluated the costs of implementing the Substance Use Disorder Telehealth Treatment in the Emergency Department/Inpatient Units by Peer Support Workers (PSWs) (STTEP) program at a hospital in New Mexico, and how to make the implementation more efficient if replicated elsewhere.Methods: The STTEP program identified adults at risk of an SUD in emergency and inpatient settings and facilitated treatment linkage and retention. Cost data were collected from 11/2022 to 11/2023 using the Drug Abuse Treatment Cost Analysis Program covering personnel, facilities, equipment, and other expenses. We estimated precise costs associated with implementing the STTEP program. We extrapolated potential costs of implementing this intervention using estimates for participant engagement time, resource use, idle time, PSW turnover, participant no-show rates, and number of participants served. Finally, we conducted a sensitivity analysis by varying these factors.Results: The annual cost for the STTEP program was $256,150.10 (average per-participant cost of $3,201.88). Most costs were related to personnel (91.42%). Extrapolated results, which include modified aspects such as idle no-show rates and PSW turnover rate, indicated that a more efficient program could operate at $117,043.70 annually, with an average per-participant cost of $1,463.05.Conclusions: Expanding the responsibilities of PSWs to better utilize downtime and reducing turnover and no-show rates could improve efficiency and lower costs of PRSS.

Background: Justice-involved youth have high rates of mental health and substance use disorders which are linked to re-offending. However, research on the impact of behavioral health issues, especially among those on community supervision, is limited.Objectives: This study examines the effects of co-occurring mental health and substance use indicators on recidivism among youth on probation using data from the JJ-TRIALS multi-site cooperative. We compare hazard rates for recidivism by type of behavioral health indicator.Methods: The sample includes 3,023 female and 9,617 male (N = 12,649) youth who were followed for up to 1,415 days after initial probation referral.Results: Cox proportional hazard models revealed that those with mental health issues only (HR = 1.5, p < .001), substance use only (HR = 1.5, p < .001), and co-occurring conditions (HR = 3.5, p < .001) had a greater recidivism hazard than those with no behavioral health issues. Survival analysis indicated that those with co-occurring indicators had a faster time to recidivism compared to other behavioral health groups. There was a significant interaction between behavioral health status and treatment initiation, particularly for those with substance use (HR = 0.34, p < .001) and co-occurring indicators (HR = 0.89, p = .02).Conclusion: Behavioral health affects recidivism among justice-involved youth. Treatment initiation, while shown to reduce recidivism, may differentially impact reoffending depending on specific behavioral health needs. Findings highlight the need for enhanced assessment and expanded co-occurring treatment and emphasize the importance of matching youth to appropriate community-based, integrated services to improve justice-related outcomes.

Background: US smoke shop prevalence is growing and stores are diversifying products beyond nicotine vape supplies, often selling non-regulated psychoactive substances.Objectives: Investigate health claims and safety information provided by smoke shop employees regarding hemp-derived tetrahydrocannabinol (THC) and kratom.Methods: Secret shopper visits were conducted at 100 San Antonio and Austin, Texas smoke shops. Using scripted questions, shoppers assessed whether the shop sold THC and kratom, what these products could be used for, and adverse effects. Shoppers documented product availability, disease states referenced, health claims made, adverse effects mentioned, and guidance for use related to pregnancy. Descriptive statistics were calculated to characterize shopper reports.Results: THC (100%) and kratom (94%) were routinely stocked by smoke shops. Most employees made at least one health claim regarding THC (50%) or kratom (81%). Claims regarding pain (50%), insomnia (31%), and mental health disorders (27%) were most commonly discussed for THC, while drug withdrawal/cravings (76%), pain (69%), and mental health conditions (31%) were most frequent for kratom. When specifically asked about adverse effects, 22% and 24% of smoke shop employees, respectively, did not disclose any risks about THC or kratom; most others provided minimal information. The most common risks discussed were sedation (36%) and psychiatric (31%) adverse effects for THC, and dependence (59%) and gastrointestinal (24%) adverse effects for kratom.Conclusion: Efforts to develop evidence-based consumer information regarding kratom and hemp-derived THC, improve health information provided by smoke shop employees, and incentivize store owners to devote resources to employee education are needed.