Substance use & addiction journal最新文献

Background: Previous research indicated that having made previous quit attempts increased the likelihood of achieving smoking cessation, and that people with depressive symptoms have more difficulties in quitting smoking. However, how previous quit attempts may affect the relationship between depressive symptoms and long-term smoking cessation has not been studied. This study aims to investigate the interactive effect of previous quit attempts in the relationship between depressive symptoms and cessation at the 12-month follow-up after a psychological intervention for smoking cessation.

Methods: The sample comprised 509 participants who smoked (M_age = 45.35, 61.7% female) requesting treatment to quit smoking. Depressive symptoms were assessed at baseline using the Beck Depression Inventory-II. Participants who did not smoke in the previous 30 days were considered to have quit smoking at the 12-month follow-up.

Results: Regression analyses showed a significant interaction between depressive symptoms and previous quit attempts. Concretely, those participants with higher depressive symptoms and no previous quit experiences were less likely to report quitting at 12-month follow-up compared to those who reported two or more previous quit attempts (OR = 0.45, P = .016). These findings were confirmed by stratified regression models, which showed that depressive symptoms were significantly negatively associated with cessation only among those participants without previous quit attempts (OR = 0.43, P = .004).

Conclusion: Findings of the present study suggest that not having previous experience in quitting smoking may impact the relationship between depressive symptoms and long-term cessation in seeking-treatment people who smoke. These findings could be used in clinical practice to improve long-term smoking cessation success.

Objectives: To estimate the effect of the passage of state laws targeting patient brokering on opioid-related outcomes.

Background: In response to growing awareness of unethical substance use disorder (SUD) treatment practices, several states in the United States have passed laws targeting patient brokering and deceptive marketing. Patient brokering and deceptive marketing laws are intended to reduce the chances individuals with SUD interact with bad actors or suffer from adverse outcomes related to inappropriate SUD treatment, but the effectiveness of these laws is unknown.

Methods: Matched event study analysis comparing early population-level outcomes in 6 states that passed laws targeting patient brokering between 2018 and 2019 and 24 comparison states with similar census region and presence of recovery residence regulations, anti-kickback laws, state SUD task forces. Outcomes, analyzed through 2019, included monthly rates of opioid-related mortality and quarterly rates of opioid-related emergency department visits and hospitalizations per 100,000 residents, and state-year prevalence of unusual patterns of claims for SUD-related services.

Results: In 2018, there was a mean of 326.9 (SD = 72.0) opioid-related hospitalizations/100k state residents, 234.6 (SD = 37.7) opioid-related ED visits/100k state residents, and 122.9 (SD = 73.6) opioid-related deaths/100k state residents in the states in our treatment group. We did not observe evidence that passage of state laws targeting patient brokering or deceptive marketing was associated with changes in any of our outcomes.

Conclusions: The passage of state laws targeting patient brokering is not associated with significant changes in opioid-related outcomes. Additional resources may be needed to accompany implementation and enforcement efforts before desired policy effects are realized.

Background: Benzodiazepines and opioids are among the most frequently misused psychoactive substances, but their patterns of co-use (polysubstance use) in rural areas are unclear. As resources to address substance use are disproportionally scarce in rural areas, a better understanding of this polysubstance use is critical to allocate and direct interventions.

Methods: The Rural Opioid Initiative comprises 8 research cohorts spanning 10 states and 65 rural counties. Participants were recruited from January 2018 to March 2020 and eligibility included past 30-day opioid use by any route or past 30-day injection of any substance. Analyses were restricted to participants reporting past 30-day opioid use and either benzodiazepine or stimulant use. We described bivariate cross-sectional associations between benzodiazepine+opioid use, compared with stimulant+opioid use, and substance use behaviors, health outcomes, injection drug use, addiction treatment, and criminal legal system involvement.

Results: Of the 1107 ROI participants that met inclusion criteria, 10% (n = 107) reported benzodiazepine+opioid use, and 90% (n = 1000) reported stimulant+opioid use. The benzodiazepine+opioid group, compared with the stimulant+opioid group, had a higher use of opioid pain medication (73% vs 55%), gabapentin (43% vs 23%), and clonidine (12% vs 4%) to get high and used these substances more frequently; they also reported more frequent heavy episodic drinking (6.1 days per 30 days, SD = 9.4 vs 4.1 days, SD 7.5). The benzodiazepine+opioid group reported a lower prevalence in the past 6 months of law enforcement stop-and-search incidents (29% vs 48%), arrests (11% vs 28%), probation (22% vs 34%), jail/prison (18% vs 41%), and fewer days in jail/prison (4.7, SD = 19.1 days vs 15.9, SD = 35.7 days).

Conclusion: We found that benzodiazepines+opioids use was associated with more heavy episodic drinking and gabapentin use, and lower prevalence of criminal legal system involvement. These data suggest that individuals reporting benzodiazepines+opioids use have distinct behavioral patterns and outcomes that require targeted interventions for rural populations.

Background: To address the opioid use disorder (OUD) public health crisis, the ADvancing Pharmacological Treatments for OUD (ADaPT-OUD) external facilitation randomized trial was conducted in 8 intervention and 27 matched control low-performing Veterans Health Administration (VHA) facilities to increase the prescribing of medications for OUD (MOUD). Facilities were considered low-performers if they were in the bottom quartile of the facility ratio of Veterans with OUD who received MOUD. The objective of this analysis was to evaluate the healthcare expenditures of Veterans with OUD who received care in ADaPT-OUD intervention facilities compared to those receiving care in matched control facilities.

Methods: Difference-in-differences (DID) design was used to compare the overall, outpatient, and inpatient expenditures (extracted from the VHA data warehouse) of Veterans diagnosed with OUD or receiving MOUD between the 2 groups 12 months before and after the intervention.

Results: A total of 7348 Veterans with a diagnosis of OUD or prescribed MOUD on at least 1 encounter 12 months after ADaPT-OUD intervention at all sites (92.39% male and 83.26% white) were included for analysis. ADaPT-OUD intervention did not have a substantial impact on overall healthcare costs. However, we reported 4% fewer total encounters in the intervention sites (DID, 95% confidence intervals [CI]: 0.96 [0.92-1.00]) compared to the control sites, driven by a decline in non-VA services. Notably, the outpatient psychiatric-related costs were $391 (95% CI: $49-$733) higher per Veteran within the year after the intervention sites received external facilitation compared to control sites.

Conclusions: Veterans at intervention sites with an OUD history had higher outpatient psychiatric-related costs, which could be explained by increased access to optimal mental health services at VHA. Improving access to OUD treatment at VA may lead to more coordinated and comprehensive treatment of both OUD and other associated mental health and physical comorbidities.

Background: The rise of suicidal thoughts and behaviors (STBs) in the United States and their association with substance use disorders, including the emerging concern over Kratom-a psychoactive substance-necessitates an investigation into its role in STBs. This study provides the first epidemiologic assessment of the association between Kratom use and STBs in the United States.

Methods: This study leveraged data from the 2021 National Survey on Drug Use and Health (NSDUH) to examine the association between Kratom use and STBs. The NSDUH was carried out among a representative sample of American individuals. Our study sample comprised 47 291 individuals aged 18 and older across the United States. Lifetime Kratom use was the exposure, while outcomes included past-year suicidal thoughts, plans, and attempts.

Results: Persons who use Kratom (PWUK) exhibited higher odds of reporting past-year suicidal thoughts (odds ratio [OR]: 2.14), plans (OR: 1.95), and attempts (OR: 2.50) compared to persons who never used Kratom. The associations also varied by sex and race, with pronounced effects among male and Black individuals. Specifically, subgroup analyses revealed higher odds of suicidal thoughts among Black PWUK (OR: 11.00) and among male PWUK (OR: 2.74).

Conclusions: The findings suggest a significant association between Kratom use and STBs in the U.S. adult population, with variations by sex and race. These results highlight the need for further research examining the causal relationships between Kratom use and STBs, including whether episodic use differs from addiction, as well as assessing the associations of Kratom use with other mental health conditions. This understanding is crucial for informing the development and implementation of targeted interventions, policies, and programs aimed at addressing Kratom use and its mental health consequences.

Background: Fentanyl contributes to the majority of overdose deaths in the United States but the risk of fatal overdose increases when other substances are involved. Although polysubstance overdose involving fentanyl and stimulants has been characterized as increasing nationally and in urban coastal cities, little is known about patterns of drugs involved in fatal overdose in the urban Midwest.

Methods: The current study examined drug-involved death data from St. Louis City and County. Cases included were drug overdose deaths occurring from 2016 to 2021 (N = 4088; 73% male; 50% white, 49% black). Latent class analysis was used to examine prototypical patterns and demographic associations.

Results: Results indicated fentanyl was involved in the majority (75.0%) of overdose deaths. A five-class solution best fit the data, characterized by deaths involving: predominant fentanyl (48.5%), fentanyl and heroin (20.0%), fentanyl and psychostimulants (12.8%), prescription opioid/undifferentiated (10.6%), and predominant cocaine (8.0%). Relative to predominant fentanyl, decedents in the fentanyl and heroin class and predominant cocaine class were more likely to be black (Ps < .05) whereas those in the fentanyl and methamphetamine class and prescription opioid/undifferentiated class were more likely to be white (Ps < .05). Females comprised a larger proportion of decedents in the fentanyl and heroin, predominant cocaine, and prescription opioid/undifferentiated classes (Ps < .05). Deaths in the predominant fentanyl class were more likely to occur in urban versus suburban environments (Ps < .05).

Conclusions: Findings diverge from previous research and national patterns highlighting the importance of local data for informing health care and policy in mid-sized and Midwest cities. Overdose prevention that addresses both intentional ingestion and unintentional ingestion of fentanyl with other substances, particularly stimulants, are warranted as its ubiquity in the drug supply persists.

This commentary article examines the landscape of youth substance use prevention efforts in sub-Saharan Africa over the past decade (2014-2024), highlighting both the progress made and the challenges that remain. It reviews current evidence-based prevention programs, including Keepin' it REAL and the Unplugged Program, discussing their implementation, cultural adaptation, and effectiveness. The article also acknowledges other promising prevention initiatives and capacity-building efforts across the region. The review concludes that the region's great diversity is also reflected in the state of prevention science in different countries. There is, however, a shared need for more access to evidence-based prevention interventions and a need to strengthen local capacity to lead the efforts. We introduce the Global Center for Applied Health Research's African Initiative as a specific approach to strengthening local capacity, conducting feasibility studies, and culturally adapting evidence-based interventions. The model emphasizes sustainability, cultural congruence, and community-based participatory research approaches. We discuss the implications for future research, stressing the need for culturally adapted, evidence-based interventions that address the complex socio-cultural, economic, and political landscapes of sub-Saharan Africa. The article calls for greater involvement of local researchers and youth in the design and implementation of prevention programs, as well as an increase in funding for prevention science research to inform policy changes. This commentary proposes a specific strategy in support of in-country researchers, policymakers, educators, and health professionals as they work toward reducing substance use among youth in sub-Saharan Africa. The article concludes by advocating for a multilevel approach to prevention science that goes beyond studying proximal risk factors to consider broader structural determinants.

Background: While smoking has been associated with alertness, it has also been reported as a stress relief and sleep aid. However, evidence on tobacco self-medication to improve sleep remains limited, particularly among adolescents. Therefore, the aim of this study was to explore the prevalence of tobacco self-medication in adolescents and analyze the association with sleep quality.

Methods: A cross-sectional descriptive study was conducted with 1,121 Spanish adolescents (mean age = 16.2 ± 0.7; 57.1% female) from public secondary schools. Participants completed assessments on their sleep quality and Cigarette Use. Analysis of variance and multinomial logistic regression analyses were conducted.

Results: Among adolescents, 5.4% (n = 61) reported smoking cigarettes as a sleep aid in the past month, accounting for a third of those who had smoked in that timeframe (19.9%; n = 225). Adolescents smoking cigarettes for self-medication showed significantly higher cigarette consumption compared to those with past-month use only (mean diff. = 2.1; η² = .10) and longer regular use (mean diff. = 6.9 months; η² = .08). Self-medication was associated with poorer sleep quality, shorter sleep, longer sleep onset latency, and frequent nighttime awakenings. Adolescents experiencing poor sleep and frequent awakenings had twice the likelihood of using tobacco as a sleep aid in the past month (OR = 2.1 and OR = 2.2, respectively).

Conclusions: This study brings attention to adolescent self-medication practices and their associations with poor sleep outcomes. Findings underscore the need for further investigation into self-medication with implications for prevention strategies during adolescence.

Background: Despite increasing research on substance use among migrants and refugees, little attention has been paid to the instruments assessing substance use in these populations. This systematic review examines the suitability of substance use instruments for use in migrant and refugee populations and the quality of the instruments.

Methods: A systematic search of the electronic databases PubMed, Web of Science, PsychINFO, and EMBASE was performed. Articles were eligible if they assessed substance use among refugees using a standardized instrument. Instrument properties were assessed using a standardized checklist, and the measurement properties were evaluated according to Terwee's criteria.

Results: In total, n = 2654 studies were retrieved. Of those, we included n = 55 studies. The most frequently used instrument was the Alcohol Disorder Identification Test (n = 20, 36.4%) followed by the CAGE/CAGE4M and the Mini International Neuropsychiatric Interview (n = 7 studies each, 12.7%). Out of 24 instruments, 18 (75%) were developed in English. Content validity, cross-cultural validity, and criterion validity were unreported for most instruments (n = 13, 54.2%). None of the instruments were developed with input from refugees. Completion time of the instruments ranged from 1 to 120 minutes. Psychometric properties were either not assessed in refugees or were moderate.

Conclusion: None of the assessed instruments met all the psychometric criteria sufficiently. Therefore, it will be necessary to develop a rationale for instruments to better fit the needs of diverse groups of migrants and refugees. Accordingly, these instruments fitted to specific groups will allow for better measurement of substance use, diagnosis, and monitoring of treatment.

Background: Hospitalizations are important opportunities to deliver evidence-based opioid use disorder (OUD) care, yet most hospital-based generalist physicians receive minimal OUD training. We describe a novel OUD training for generalists and mixed-methods evaluation in a large urban hospital.

Methods: Training Description: Hospital-based generalist physicians received a single, 1-hour, small-group, in-person OUD training (OUD diagnosis, initiating medications for OUD [MOUD], and discharge planning) and post-training support. Evaluation: We examined self-reported changes in knowledge, confidence, skill, and frequency of providing OUD care; barriers and facilitators to applying training skills; and suggestions for training modification. Data collection included the following: (1) end-of-training questionnaires; (2) 12-month follow-up questionnaires (retrospective pre-post-design); and (3) qualitative interviews and a focus group. Stuart Maxwell tests were used to examine pre-/post-differences in knowledge, confidence, and skill. Rapid qualitative analysis identified barriers and facilitators to applying training skills.

Results: Nineteen generalist physicians participated, with 11 (58%) providing 12-month follow-up data. At 12 months, compared to pre-training, more participants agreed or highly agreed that after the training, they had adequate knowledge (100% vs 44%), confidence (100% vs 44%), and skill (89% vs 44%) in OUD care, but differences were not statistically significant. Self-reported frequency of providing OUD care was unchanged. During qualitative interviews (2 participants) and the focus group (3 participants), participants appreciated the training format but described confidence declining over time. Ongoing barriers to MOUD initiation included challenges with counseling patients about MOUD, discharge planning, accessing OUD care protocols and decision aides, lack of interprofessional collaboration, and time pressures.

Conclusion: Generalist physicians reported increases in knowledge, confidence, and skill with OUD training, but a single session was insufficient to maintain confidence and change practice. Additional training sessions emphasizing patient counseling and discharge planning should be developed and evaluated in a larger sample. Simultaneous efforts to address systemic barriers are also needed.