American Journal of Drug and Alcohol Abuse最新文献

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.

Background: Recent studies have quantified the rate of fatal overdoses that involve opioids, stimulants, and other drugs, but the proportion of overdose deaths attributable to these substances - after accounting for polysubstance use - has not been determined.Objective: We aim to generate the first estimates of the share of overdose deaths by substance type from 1999 to 2021.Methods: By analyzing the National Vital Statistics System's mortality files, we calculated the percent of overdose deaths (n = 1,043,852, 30% female) by substance type in the US for the years 1999 to 2021. We offer and rely on two novel methods: the single-substance method and the apportioned-substance method.Results: In 2021, opioids accounted for 56% (apportioned-substance) to 64% (single-substance) of overdose deaths and stimulants accounted for 30% (single-substance) to 34% (apportioned-substance), which means that opioids and stimulants accounted for 89% to 94% of overdose deaths. From 1999 to 2021, fentanyl became an increasing share of opioid deaths (from 12%-14% to 78%-87%; p < .01) and methamphetamine became an increasing share of stimulant deaths (from 11%-12% to 60%-70%; p < .01).Conclusion: Opioid deaths and stimulant deaths comprised at least 89% of overdose deaths, and methamphetamine and fentanyl represented rising proportions of fatal overdoses. To prevent drug deaths, resources should be directed primarily to therapies and interventions for opioids and stimulants.

Background: The 2018 U.S. Farm Bill led to a rapid expansion of derived cannabinoid products. Prior studies examining their use rely on self-reported data, which can be unreliable. Nightclubs offer a unique environment for biological surveillance due to their high prevalence of substance use.Objectives: We used biological measures to better understand the prevalence of specific cannabinoids.Methods: Throughout 2024, adults entering New York City nightclubs (n = 1,024; 45.9% female) were surveyed and had their saliva tested for cannabinoids including tetrahydrocannabinolic acid A (THCA-A) and cannabinol (CBN). We calculated the prevalence and correlates of detection for these two compounds.Results: Tetrahydrocannabinol (THC) was detected in 30.8% of the sample, THCA-A in 11.7% and CBN in 8.9%. Compared to males, females had lower odds of testing positive for THCA-A (aOR = 0.28, 95% CI: 0.16-0.48) and CBN (aOR = 0.47, 95% CI: 0.27-0.83), and compared to white participants, black participants had higher odds of testing positive for THCA-A (aOR = 2.04, 95% CI: 1.12-3.72) and CBN (aOR = 3.74, 95% CI: 1.94-7.23). Compared to those with a college degree or higher, those with a high school diploma or less had higher odds of testing positive for THCA-A (aOR = 4.02, 95% CI: 2.40-6.74) and CBN (aOR = 2.49, 95% CI: 1.34-4.63) and those with some college had higher odds of testing positive for CBN (aOR = 2.02, 95% CI: 1.10-3.72).Conclusions: A sizable proportion of nightclub attendees had detectable levels of THCA-A and CBN, highlighting the need to screen for derived cannabinoids alongside THC. Biological drug testing with self-report may improve public health surveillance.

Background: American Indian communities consistently identify adolescent substance use as a major concern. However, limited empirical work has examined how culturally specific protective factors - such as family disapproval and cultural affiliation - interact to influence substance use behavior. Given the importance of kinship networks and cultural continuity, understanding these dynamics is critical for informing culturally grounded prevention strategies.Objectives: This study examines the moderating role of cultural affiliation in the association between family disapproval of substance use and actual use among American Indian adolescents, a population often excluded from national health datasets.Methods: Secondary analysis was conducted using self-report data from the Our Youth, Our Future study, a nationally representative sample of American Indian adolescents attending schools on or near reservations (N = 8,950; 51% female; Mage = 14.64 years, SD = 1.77).Results: Multilevel analyses revealed that family disapproval was negatively associated with lifetime alcohol (b = -0.15, p < .001) and cannabis use (b = -0.34, p < .001), controlling for age. Among adolescents who endorsed use, cultural affiliation moderated the relationship between family disapproval and past-year alcohol and cannabis use. Specifically, family disapproval was significantly associated with lower alcohol use at high (b = -0.01, p = .002) but not low (b = -0.07, p = .48) levels of cultural affiliation. For cannabis use, the association was stronger at high (b = -0.51, p < .001) versus low (b = -0.32, p = .005) levels.Conclusions: Cultural affiliation strengthens the protective effects of family disapproval on substance use among American Indian youth. Findings support culturally responsive, family-based prevention efforts that promote cultural identity and intergenerational communication.

Background: Understanding which subgroups of vocational education students are more likely to use tobacco and/or alcohol is critical for designing interventions. Previous research has not explored important student subgroups.Objectives: This exploratory study examined tobacco use, risky alcohol consumption not meeting Australian guidelines, and concurrent use by type of vocational training and whether previously unexplored factors were associated with these health behaviors among vocational education students.Methods: A cross-sectional online survey was conducted among 1057 students (66% male) attending 14 Technical and Further Education campuses in New South Wales, Australia.Results: Type of vocational training was not associated with tobacco use, risky alcohol consumption, or concurrent use. Participants who were married/living with a partner (adjusted odds ratio (AOR): 0.69; 95% Confidence Interval (CI) 0.48, 0.99), or unemployed (AOR: 0.60; 95% CI 0.36, 0.99) had significantly lower odds of tobacco use. Indigenous students (AOR: 1.82; 95% CI 1.19, 2.80) or those who experienced symptoms of depression (AOR: 1.69; 95% CI 1.12, 2.55) had significantly higher odds of tobacco use. Participants aged ≥25 years (AOR: 0.59; 95% CI 0.40, 0.88), female (AOR: 0.42; 95% CI 0.29, 0.62), or unemployed (AOR: 0.57; 95% CI 0.37, 0.88) had significantly lower odds of risky alcohol consumption. Unemployed participants (AOR: 0.53; 95% CI 0.30, 0.95) had significantly lower odds of concurrent use. Those who experienced symptoms of anxiety (AOR: 1.55; 95% CI 1.02, 2.37) had significantly higher odds of concurrent use.Conclusion: Vocational education institutes could provide tailored and culturally appropriate interventions targeting students at increased risk of tobacco and/or alcohol use to prevent diseases.

Background: The Alcohol Use Disorders Identification Test (AUDIT) is a widely used screening tool for assessing problematic alcohol use. While strong cross-sectional psychometric support exists, little is known about its longitudinal performance, particularly within Australian populations and over extended intervals. Most prior studies have relied on short test - retest periods (2-6 weeks), simple correlations, and have not examined whether the AUDIT consistently measures the same constructs over time.Objectives: This study addresses these gaps by using longitudinal confirmatory factor analysis (CFA) to examine the AUDIT's factorial structure, test - retest reliability, and measurement invariance over a 12-month period.Method: A sample of 276 Australian adults (mean age = 31.86 years; SD = 9.94; 71% male), all current alcohol consumers, completed the AUDIT at two time points (2022 and 2023). Participants reported regular alcohol use, with an average AUDIT score of 7.14 at T1 and 7.78 at T2; 38.9% exceeded the threshold for hazardous drinking.Results: One-, two-, and three-factor models were compared, with the one-factor model showing the best fit (RMSEA = .078). The AUDIT demonstrated moderate test - retest reliability (r = .67) and partial longitudinal measurement invariance. Only a small number of factor loadings and intercepts were non-invariant. Full support was found for latent variance invariance, latent mean equivalence, and structural invariance.Conclusions: These findings offer novel longitudinal evidence for the psychometric stability of the AUDIT over 12 months in an Australian sample, supporting its value for monitoring alcohol use and evaluating treatment outcomes.

Background: Prescription opioid misuse (POM) remains a significant public health concern among college students, yet few studies have examined POM prevalence, misuse behaviors among those with prescriptions, and how students access opioids in college settings.Objectives: Assessing the prevalence of POM, patterns of opioid sourcing (i.e. prescribed vs. illicit), and the trends of misuse of one's own prescription (i.e. higher dosage and/or frequency) among college students.Methods: Data from the 2019-2022 American College Health Association-National College Health Assessment III survey, including responses from 331,156 students (64.4% cisgender female), were analyzed. Descriptive analyses assessed POM prevalence and misuse patterns, while multivariable logistic regression identified factors linked to illicit opioid sourcing and prescribed opioid misuse (higher dosage and/or increased frequency).Results: Lifetime POM was reported among 3.9% (n = 12,983) of students and past three-month POM was reported among 0.7% of all students (n = 2,327). Of participants with recent misuse, 55.5% used opioids that were not prescribed to them, and 44.5% used their own prescriptions. Among those with prescriptions, 26.0% exceeded the recommended dosage, and 22.7% shortened the dosing interval. Illicit sourcing was more common among gender-diverse students (aOR: 2.72, 95% CI: 1.62-4.71, p < .0001) and those with severe psychological distress (aOR: 1.42, 95% CI: 1.11-1.82, p = .0053). Misuse of higher dosages (aOR: 2.92, 95% CI: 2.07-4.32, p < .0001) and increased use frequency (aOR: 1.79, 95% CI: 1.23-2.63, p = .0026) was linked to suicidal risk.Conclusion: Prescription monitoring, substance use education, and harm reduction strategies to mitigate misuse risks are needed.

Background: Anxiety is a common reason for cannabis use, yet how symptoms evolve among medical cannabis patients over time remains underexplored. Characterizing anxiety trajectories in this population may inform clinical care and guide patient support.Objectives: To assess anxiety longitudinally among medical cannabis patients alongside concurrent changes in health and cannabis use.Methods: Between 2021-2023, 526 Pennsylvania-based medical cannabis patients (59% female) completed at least two quarterly GAD-7 anxiety assessments over 12 months. Latent class growth analysis identified longitudinal anxiety profiles and their predictors. Parallel changes in health and cannabis use were examined across profiles.Results: Three longitudinal anxiety profiles emerged: Minimal (43%), Moderate (36%), and Severe (21%), with minimal-decreasing, moderate-decreasing, and severe-stable GAD-7 scores, respectively. In Minimal and Moderate groups, anxiety declined but reductions were not clinically meaningful. Younger age and female sex predicted Moderate and Severe profiles, while lifetime PTSD and anxiety disorders as a primary qualifying condition predicted the Severe group only (p < .05). Depression, interference from anxiety and depression, and health-related quality of life aligned with anxiety profiles and significantly differed across them (p < .001). The Severe group had higher baseline levels of benzodiazepine prescriptions and cannabidiol use than the Minimal group (p < .05). Across profiles, prescription rates for anxiety medications remained stable, and cannabis use was near-daily.Conclusion: Anxiety trajectories varied, aligning with other mental health indicators. Only less severe profiles showed anxiety reductions, so patients with severe anxiety may require support. Potential co-use of cannabis and anxiety medications warrants clinical attention.

Background: Adverse childhood experiences (ACEs) are linked to negative health outcomes. Yet how ACEs patterns are associated with non-fatal overdose among people who use drugs (PWUD) is underexplored, despite disproportionate rates of ACEs among this population.Objectives: We examined latent classes of ACEs and their associations with non-fatal overdose in PWUD in New York City (NYC).Methods: We conducted a latent class analysis based on self-reported exposure to ACEs: emotional/physical neglect; emotional, physical, and sexual abuse; household mental illness; household substance use; domestic violence; parental separation/death; and household incarceration. Multivariable logistic regression assessed associations of ACEs classes with lifetime non-fatal overdose.Results: Of 247 PWUD, 74.9% were men and 43.3% reported a lifetime non-fatal overdose. Identified classes were: 1) no/low ACEs (26.3%), 2) household dysfunction (parental separation/death, household substance use) (25.1%), 3) household dysfunction + emotional, physical, and sexual abuse (19.4%), 4) emotional and physical abuse (16.2%), and 5) experienced all ACEs (13.0%). Compared to no/low ACEs, those in the experienced all ACEs class (aOR 4.92; 95%CI 1.71-14.9) and in the household dysfunction class (aOR 3.14; 95%CI 1.31-7.77) had higher odds of experiencing a non-fatal overdose. Other factors associated with non-fatal overdose included unstable housing (aOR 2.73; 95%CI 1.40-5.42), moderate/high cocaine use disorder (aOR 2.60; 95%CI 1.05-6.71), and moderate/high opioid use disorder (aOR 4.25; 95%CI 2.07-9.14).Conclusions: Findings suggest that those who experience a broad spectrum of ACEs may be at higher risk of non-fatal overdose. Addressing early-life adversity in harm reduction and treatment interventions may help mitigate overdose risk in this population.