Substance use & addiction journal最新文献

Background: Substance use disorder (SUD) is a chronic and recurrent condition posing a significant health burden. The integration of out-on-pass (OOP) or day leave privileges during inpatient rehabilitation has been theorized to support recovery by enhancing social reintegration and preparing patients for discharge. However, evidence on the impact of inpatient OOP on post-discharge relapse rates is scant. This study investigates the effect of OOP during inpatient treatment and relapse outcomes.

Methods: A retrospective cohort design was used to analyze data from 72 patients discharged from the Umm Salal Treatment and Rehabilitation Center in 2023, focusing on OOP during rehabilitation and urine drug test results during aftercare. Key variables included OOP frequency, comorbid personality disorders, forensic history, and relapse indicators. Statistical evaluation utilized logistic regression, chi-squared tests (Fisher's exact test where appropriate), and survival analysis to identify predictors of relapse, adjusted for potential confounders.

Results: Of the participants, 28 (38.9%) were granted OOP during inpatient treatment, while 44 (61.1%) were not. Relapse, defined by a positive urine drug screening post-discharge, occurred in 29 patients (40.3%). The median time-to-relapse was 28 days, with a longer duration observed among those granted OOP. Specifically, during the 26-week study period, 25% of patients with OOP relapsed compared to 50% of those without OOP (statistically significant difference; P = .04892). Survival analysis revealed that time-to-relapse was substantially longer for patients who were granted OOP compared to those who were not (P = .034). Furthermore, the granting of OOP during inpatient treatment of SUD was associated with a 73.2% reduction in relapse hazards ratio (P = .00876).

Conclusion: This study highlights the potential of OOP as a therapeutic strategy and tool to support sustained recovery in patients with SUD. While relapse remains a significant challenge, OOP may contribute to extended abstinence periods and reduced relapse rates.

Background: Glucagon-like peptide 1 (GLP-1) analogs were initially developed to treat obesity and type 2 diabetes mellitus, but recently they have shown potential for treating substance use disorders (SUDs) and other addictive behaviors. Their mechanism of action, which involves modifying reward pathways in the brain, has shown potential in lowering addictive behaviors, including those associated with substance use and eating-related challenges.

Methods: A literature review of preclinical and early clinical studies was conducted, focusing on the effects of GLP-1 analogs on addiction. The search included databases such as PubMed and Cochrane, using keywords like "GLP-1 analogs," "addiction," and "substance use disorders."

Results: GLP-1 analogs have demonstrated to decrease substance use, including alcohol and nicotine, on rodents and non-human primates by modifying neurotransmitter activity. These medications also provide neuroprotective effects by reducing oxidative stress and neuroinflammation caused by chronic substance use.

Conclusion: GLP-1 analogs represent a promising therapeutic option for the treatment of SUDs. While long-term adverse effects are not yet fully understood, they show potential in addressing the limited success rates of existing alcohol use disorder pharmacotherapies and the overall lack of effective treatment options for SUDs. While early clinical trials provide promising insights, further research is needed before GLP-1 analogs can be confidently incorporated into addiction treatment regimens.

Background and aims: There is an increasing interest in the use of psychedelics for the treatment of substance use disorders (SUDs) and to improve overall health and wellbeing. We aimed to update and complement research syntheses that have focused only on results from clinical trials by synthesizing the research across diverse methods to discuss implications from a broad and multi-faceted literature.

Methods: We conducted a narrative review of research focused on substance use and SUDs and both classic and non-classic/atypical psychedelics published between 1990 and 2025, synthesizing the evidence across population/survey studies, observational research, and clinical trials.

Results: There is growing investment in clinical research on psychedelics, yet methodological concerns within and across studies present challenges to the validity and generalizability of results. Research across population/survey studies, observational studies, as well as clinical trials suggest that symptom reduction is associated with a range of pharmacological, spiritual, and interpersonal processes. Findings from population surveys and observational studies align with growing clinical evidence in support of the use of psychedelics in the treatment of SUDs, indicating a need for more research to improve generalizability, understanding of safety concerns, the role of psychotherapies, and ethical implications of giving psychedelics to vulnerable populations.

Conclusions: There is a need for more transparency in clinical research design and reporting, as well as for larger studies that track long-term outcomes. Studies with diverse methodological approaches are important to fill in knowledge gaps concerning treatment safety, tolerability, real-world effectiveness, accessibility, and respect for religious, traditional, and Indigenous communities. We specifically encourage more investment in observational, naturalistic, population-level, and survey research that can provide broad public health data on psychedelic-related SUD treatments and/or highly contextualized and historicized data on treatment methods, delivery, and experiences.

Background: Fatal opioid overdoses in the United States have rapidly increased since 1999. While several risk factors for overdose are known, the association of overdose risk perception with subsequent overdose is not well understood.

Methods: We used data from a randomized trial of a counseling intervention to reduce opioid overdose among overdose survivors who use nonprescribed opioids. Participants were followed up for 16 months with visits every 4 months. At study visits participants were asked how likely they were to overdose in the next 4 months (risk perception) and whether they had overdosed since their last visit. Responses of "extremely likely" or "likely" were considered "higher risk perception," and those of "neutral," "unlikely," and "extremely unlikely" were considered "lower risk perception." We conducted an adjusted generalized estimating equation among participants in the control group to examine the association of higher versus lower risk perception and subsequent overdose. We adjusted for visit, recent overdose, and sociodemographic characteristics that were selected a priori due to known associations with risk perception or opioid overdose.

Results: Among 135 control participants, median age was 42 years (interquartile range: 34-49) and over half were male (59%). Higher risk perception was associated with 2.65 times the adjusted odds of having a subsequent overdose compared with lower risk perception (95% confidence interval: 1.35-5.23, P = <.01).

Conclusions: Incorporating an assessment of risk perception into opioid overdose prevention efforts may help prioritize prevention efforts.

Background: Opioid-involved overdose fatalities among African Americans continue to rise. The current study examines African Americans who reported use of opioids in the past 6 months and declined overdose education and free naloxone.

Method: Eligible participants included African American Kentuckians who used opioids in the past 6 months and consented to a larger study examining their opioid use. This paper qualitatively explored their reasons for declining overdose education and naloxone using an adjusted and inductive application of structural tabular thematic analysis.

Results: Out of 588 participants, 70 (12%) declined naloxone: the most cited reason for declining naloxone was already possessing the medication. Additional reasons range from not needing or wanting naloxone to no longer using opioids.

Conclusions: The findings suggest that African Americans' hesitancy to carry naloxone can be due to pervasive structural issues. Despite these findings, there remain disproportionate drug treatment rates and mortality from overdose among African Americans.

Pharmacists are uniquely poised for harm reduction work due to their accessibility, medication expertise, and direct patient interaction. They can provide non-prescription syringes, dispense naloxone and medication for opioid use disorder, offer human immunodeficiency virus and hepatitis C virus testing, administer vaccines for hepatitis B virus and human papillomavirus, and prescribe pre- and post-exposure prophylaxis. Despite these advancements, ongoing barriers such as restrictive pharmacy policies and stigma persist, and gaps in education contribute to the problem. Currently, harm reduction education is underrepresented in the Doctor of Pharmacy curriculum. This commentary highlights existing gaps in pharmacist training, emerging pilot programs, and makes practical recommendations for integration of harm reduction education, including minimal competencies, curricular mapping, and implementation strategies to facilitate uptake.

Deaths related to substance use disorders and mental health concerns are leading causes of maternal mortality, particularly in the postpartum period. Integrated perinatal substance use care that streamlines substance use disorders (SUD) treatment and prenatal care into a single setting improves perinatal outcomes, including postpartum follow-up and engagement in treatment for SUD, which may ultimately reduce maternal mortality. Native pregnant and postpartum people have identified a lack of culturally responsive care, as well as stigma, bias, and racism, as barriers to entry into SUD care and prenatal care. Through a partnership between the University of Utah Health and Sacred Circle Healthcare, the Culturally Engaged Recovery - MOms connected through Native communitY (CEREMONY) project aims to adapt and test the clinical and implementation effectiveness of integrated perinatal SUD care for Native pregnant people. The protocol for this 7-year, NIH-funded project centers on a bidirectional partnership and acknowledges Native sovereignty, data safety, and ethics of research with Native and Indigenous communities. Within this ethical and community-engaged framework, we rely on the ADAPT-ITT model, human-centered design, and the Implementation Research Logic Model to map the adaptation and iteration of a culturally responsive integrated perinatal SUD care model. Following adaptation, our protocol outlines a Hybrid Type 1 implementation science study to evaluate the clinical and implementation effectiveness of the adapted intervention. The work of CEREMONY has the potential to create implementation protocols for use in other settings as well as to reduce maternal morbidity among Native pregnant people in Utah.The CEREMONY study is registered in ClinicalTrials.Gov under NCT06747442.

Aim: To analyze how psychoactive substance (PS) use among Latin American women is addressed between 2000 and 2024, considering theoretical perspectives, dimensions, variables employed, and methodological strategies.

Methods: This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. An intersectional perspective was employed for the analysis. The literature search included databases such as PubMed and Scielo, covering studies from 2000 to 2024. Eligibility criteria included empirical studies in Spanish, English, or Portuguese. Five researchers evaluated and extracted data. The information was organized in tables and figures.

Results: A total of 53 studies were selected out of 556, based on inclusion criteria related to gender, substance use, and regional context. Brazil and Mexico led the academic production, with most studies published between 2004 and 2024, primarily using quantitative descriptive methods. The studies are grouped into 5 themes: prevalence, sociocultural aspects, violence and risks, vulnerable groups, and interventions and treatments. Alcohol and tobacco use were the most studied, followed by marijuana, cocaine, and crack. However, polydrug use and recreational consumption were less explored, as were the experiences of transgender and gender-diverse individuals. Only 4 studies applied an intersectional approach, while most analyses were limited to binary gender perspectives.

Discussion: PS use among women reflects complex inequalities tied to gender, race, and class, amplified by structural violence and socioeconomic barriers. Strengthening regional collaboration, adopting intersectional approaches, and diversifying study populations are essential for designing inclusive and effective interventions. Research must overcome current gaps and address underexplored topics like recreational consumption and gender-diverse experiences.

Substance use (SU) and mental health disorders are the leading cause of maternal deaths in the United States, and individuals living in rural communities and those who identify as Native American or Alaska Native are disproportionately affected. The new ELEVATE Maternal Health Center of Excellence brings together an interdisciplinary team and strong community partnerships to help address these concerns by rigorously developing and evaluating interventions to improve the care of, and reduce mortality and morbidity for, pregnant patients with SU disorder (SUD) with a focus on rural and Native populations. ELEVATE is comprised of a Community Engagement Core, a Training Core, an Implementation Integration Core, and 2 large-scale research projects focused on reducing maternal morbidity from SUD. ELEVATE members are actively engaged with community partners across the state with interests in Native health, minority health, rural health, and SUD through Community Advisory Board meetings and bidirectional communication. The 2 research projects focus on (1) adaptation of a culturally sensitive clinical program for Native mothers with SUD in the perinatal time period and (2) development of a healthcare provider training to reduce stigma and improve evidence-based care for patients with SUD who are giving birth. Information gleaned from these projects will be disseminated across Utah, and nationally, to improve outcomes for pregnant and postpartum people with SUD and ultimately help eliminate preventable maternal deaths. The multipronged approach of the ELEVATE Center will reduce maternal morbidity from SU in Utah while training the next generation of scientists focused on morbidity reduction.

Background: Gender-related disparities in access to alcohol-related care exist in the Department of Veterans Affairs' (VA) health care system. Understanding differences in the use of alcohol-related care in the context of potentially important covariates (e.g., race, ethnicity, younger age, and military sexual trauma [MST]) is critical to support the health and well-being of women Veterans. This study examined differences in the use of alcohol preventive care among women Veterans.

Methods: From VA administrative data (2010-2016), we drew a sample of women Veterans (n = 280) who screened positive for at-risk drinking in inpatient/outpatient settings. We conducted a chart review to abstract variables from the medical record. Then, we employed logistic regression to predict receipt of any follow-up (brief intervention and/or referral to treatment) and initiation of treatment, as with covariates of race, ethnicity, age, and clinical characteristics such as MST.

Results: Seventy-four percent (n = 207) of the sample received any follow-up. Of those referred to treatment (n = 115), 73% (n = 84) initiated treatment. Hispanic women were 71% less likely to receive follow-up care than non-Hispanic women. Women Veterans 21 to 24 years were less likely to initiate treatment than those 25 to 29 years. While women Veterans who endorsed MST were more likely to receive follow-up care than others, they were no more likely to initiate treatment.

Conclusions: Given the rapid growth of the women Veteran population, their access to alcohol-related care is vital. Without culturally competent, clinically and developmentally appropriate alcohol prevention messaging for Hispanic and younger women Veterans with trauma, differences in access to care and disparities in outcomes will persist.