American Journal of Drug and Alcohol Abuse最新文献

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.

Background: Hypoxia is a major driver of alcohol-related liver disease (ARLD), with hypoxia-inducible factor 1-alpha (HIF-1α) central to this response. Emerging evidence suggests HIF-1α regulates hepatic lipid metabolism via microRNA-185 (miR-185), though the mechanism remains unclear.Objectives: This work aims to unravel the molecular mechanisms by which the HIF-1α/miR-185 pathway regulates lipid uptake and transport in ARLD, and to explore its potential as a therapeutic target.Methods: Male C57BL/6J mice were administered a chronic ethanol-containing Lieber-DeCarli liquid diet for six weeks to induce ARLD, along with adeno-associated virus-mediated silencing of HIF-1α. Serum levels of liver function markers and lipid profile components were measured for biochemical analysis. ELISA evaluation was carried out for liver inflammatory markers. Liver sections were evaluated with H&E oil red O staining. HIF-1α, miR-185, scavenger receptor class B type I (SR-BI), and low-density lipoprotein receptor (LDLR) expressions were evaluated using RT-PCR and Western Blot.Results: Chronic alcohol exposure to mice was responsible for inducing liver steatosis, inducing HIF-1α, and increasing miR-185 (p < 0. 05, η² = 0.32). In alcohol-fed wild-type mice, the mRNA and protein levels of SR-BI decreased significantly (p < 0.05, η² = 0.29), while LDLR levels were enhanced (p < .05, η² = 0.25). HIF-1α silencing downregulated LDLR mRNA and protein expression in alcohol-fed mice (p < 0. 05, η² = 0.23).Conclusions:Alcohol-induced activation of the HIF-1α/miR-185 pathway disrupts hepatic lipid metabolism by modulating SR-BI and LDLR transcription, presenting a potential therapeutic target for lipid disorders in ARLD.

Background: People with opioid use disorder (OUD) experienced worse outcomes from the COVID-19 pandemic, which disrupted general medical care.Objectives: To quantify COVID-19 impact on OUD treatment disengagement among patients in office-based addiction treatment (OBAT) with buprenorphine.Methods: We recruited 112 outpatients actively on buprenorphine at enrollment from July 2021 to 2022 for telephone surveys within a prospective cohort study. Exposures were six COVID-19 impact domains: personal or family COVID-19 infection, difficulty accessing healthcare/medications, economic stressors, worsening physical or mental health, social isolation, and conflicts and disruptions in the home. The primary outcome was time to OBAT disengagement. We examined associations between each COVID-19 impact domain score and the composite COVID-19 pandemic impact score (a sum of all scores) with time to disengagement using Cox regression models.Results: Average age was 48 years, 56.3% male, 71.2% white/non-Hispanic, 67% Medicaid insurance and 92.9% housed. The majority (74/112) had started in OBAT prior to the pandemic. Median time to disengagement was 271 days. Neither unadjusted nor adjusted analyses showed significant associations between COVID-19 impact domains and time to disengagement. The adjusted hazard ratio for composite COVID-19 impact score was 1.00 (95% CI: 0.99, 1.02).Conclusions: Negative COVID-19 impacts were prevalent among patients in OBAT, but none were significantly associated with time-to-care disengagement. Most patients had multiple protective factors (male, white/non-Hispanic, housed, and Medicaid insurance) and this OBAT rapidly adopted telemedicine, which may have minimized treatment disruption. Preserving patient insurance access and telehealth may maximize OUD treatment retention despite pandemic stressors.

Background: Perceived Substance Use Disorder (SUD) stigma, defined as the awareness of negative societal attitudes toward individuals with SUDs, may discourage treatment-seeking and completion. Unlike self-stigma (negative beliefs about oneself), perceived stigma reflects individuals' perceptions of stigma from the public. While self-stigma has been widely studied, research on perceived stigma's role in shaping treatment outcomes remains limited.Objectives: This study aimed to examine whether higher perceived stigma at treatment intake predicts premature treatment discontinuation and hypothesized that greater perceived stigma would be associated with increased rates of premature treatment discontinuation.Methods: A total of 7,591 participants (70.2% male) from 75 SUD treatment facilities across the United States completed surveys at treatment intake and early in treatment. Perceived stigma was assessed using the Perceived Stigma of Addiction Scale (PSAS). Treatment completion, defined as standard discharge (recommended duration of care), served as the primary outcome. Mixed-effects models evaluated the relationship between perceived stigma and treatment discontinuation while adjusting for demographic, SUD, and mental health-related covariates.Results: Higher perceived stigma significantly predicted an increased likelihood of premature discontinuation (adjusted odds ratio [AOR] = 0.97, 95% CI [0.95, 0.99], p < .001). For each one-unit increase in PSAS score, the odds of treatment completion decreased by 3%. This relationship persisted across all models, even after accounting for covariates.Conclusion: These findings underscore the importance of addressing perceived stigma at treatment intake and its role in predicting treatment retention. Routine screening for stigma and implementing stigma-reduction interventions during care may contribute to better treatment outcomes for individuals with SUDs.