Addiction Science & Clinical Practice最新文献

Objective: To evaluate the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on alcohol-related outcomes in adults with or without alcohol use disorder (AUD).

Methods: A systematic review and meta-analysis following PRISMA guidelines searched PubMed, Embase, and Cochrane Library up to May 3, 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies assessing GLP-1RAs (e.g., Semaglutide, Liraglutide, Exenatide, and Dulaglutide) versus placebo, no treatment, or other interventions in adults. Outcomes were alcohol consumption (defined as total intake or drinks per drinking day, measured as standardised mean difference [SMD]), alcohol craving (SMD), and alcohol-related events (hazard ratio [HR]). Random-effects models with Restricted Maximum Likelihood estimation and Hartung-Knapp adjustment were used. Separate AUD and SUD meta-analyses addressed outcome heterogeneity, with intoxication reported narratively.

Results: Three RCTs (N = 430) and six observational studies (N = 2,740,207) were included. RCTs showed non-significant reductions in alcohol consumption (SMD: -0.24, 95% CI: -0.70, 0.23), drinks per drinking day (SMD: -0.23, 95% CI: -0.64, 0.19), and craving (SMD: -0.14, 95% CI: -2.84, 2.55), with Semaglutide showing greater craving reduction (p = 0.024). Observational studies showed reduced alcohol-related events (HR: 0.64, 95% CI: 0.59-0.69, p < 0.001), with separate analyses confirming effects for AUD (HR: 0.66, 95% CI: 0.63-0.70) and SUD (HR: 0.66, 95% CI: 0.18-2.48), and intoxication (HR: 0.50). Semaglutide and GIP/GLP-1RAs had more potent effects (p < 0.001).

Conclusion: Observational studies suggest a decrease in alcohol-related events, but RCTs have effects on alcohol consumption and craving that remain non-significant. Larger RCTs are needed.

Prospero id: CRD420251045294.

Background: Veterans with HIV/AIDS (VWH) frequently report alcohol misuse, which can impact antiretroviral therapy (ART) adherence and lead to poorer clinical outcomes. The TRAC (Tracking and Reducing Alcohol Consumption) intervention was developed to help VWH reduce alcohol use and its associated consequences. TRAC is delivered via mobile device, incorporates eight counseling sessions based in cognitive behavioral therapy and motivational interviewing, and utilizes mobile surveys and breathalyzers for daily monitoring of alcohol and ART use.

Methods: We conducted a pilot randomized waitlist-controlled trial (N = 50). Participants were allocated to an immediate intervention group (N = 26), which received the TRAC intervention and completed twice-daily monitoring of alcohol and ART use for 8 weeks, or to a waitlist-control (n = 24), which started TRAC after 8 weeks. Participants provided ratings of intervention sessions and completed questionnaires assessing alcohol use, ART adherence, and treatment self-efficacy at baseline, 8, 16, and 24 weeks. Analyses included correlations and descriptive statistics for examining feasibility and acceptability, difference-in-differences analyses to compare changes between groups at the 8-week timepoint, matched pair tests to assess changes in alcohol use during the intervention, and general linear models to investigate long-term effects on outcomes with a pooled sample.

Results: Results indicated high feasibility and acceptability: 84% of participants were retained through the intervention and all follow-ups, average intervention session ratings were 9.6 (out of 10), and participants completed a median of 85% and 78% of mobile surveys and breathalyzer readings, respectively. While not statistically significant due to low power, there was a trend of decreased binge drinking episodes and fewer missed HIV medication doses in the intervention group compared to control. When pooling data among participants from both groups to examine long-term effects, TRAC was associated with reductions in several drinking-related outcomes.

Conclusions: High acceptability and feasibility, as well as preliminary evidence that the intervention may reduce alcohol use relative to control, suggest that the TRAC intervention is promising for VWH and warrants further evaluation in a randomized controlled trial with adequate power to detect effects. If shown to be efficacious, TRAC has potential to be a highly scalable and acceptable intervention for delivery among VWH.

Trial registration: This study was registered on ClinicalTrials.gov, #NCT03746600. Registration date: 09/24/2018.

Background: The utilisation of online evidence-based written educational resources is crucial in addressing problematic alcohol and other drugs (AOD) use through prevention, treatment, and intervention strategies. However, low health literacy among one in five Australian adults raises concerns regarding the effective understanding of health information. This study aims to evaluate the content, suitability, and readability of AOD resources in New South Wales (Australia), recognising the importance of accessible and informative resources in supporting AOD demand reduction strategies.

Methods: In this research, a comprehensive desktop search was conducted to analyse one to two-page AOD resources readily accessible through the internet in New South Wales, published by government and not-for-profit organisations. The content was thoroughly analysed for its coverage of key AOD topics. The Suitability Assessment of Materials (SAM) instrument evaluated visual and written elements, examining aspects like layout, typography, and illustrations. Readability was assessed using Flesch -Kincaid Grade Level (FKGL), Gunning Fog Index (FOG), Simplified Measure of Gobbledygook (SMOG), and Flesch Reading Ease tools. Descriptive statistics, including frequency, percentage, and standard deviation were calculated.

Results: The study analysed 88 AOD resources. Most resources had a target audience, but only three resources involved consumers in the development process. The content analysis showed 66% focused on drug-related topics, 20% on alcohol-related topics, and 14% covered both. Topics such as alcohol use during pregnancy and breastfeeding were well addressed in alcohol resources. Additionally, 90% of the resources had headings and subheadings. However, only 28% scored 'superior' for layout, and none achieved 'superior' ratings for typography. Furthermore, 74% did not use illustrations to highlight key messages. Most resources used an active voice and conversational style, but complex sentences were common. The average reading grade level of the resources was 9 ± 2.6 with FOG and Flesch's reading ease indicating 10th-grade difficulty, while FKGL and SMOG suggested a 7th-grade level.

Conclusions: The evidence strongly suggests the need for the development of AOD resources that are accessible to individuals with low literacy levels without sacrificing content coverage. A key recommendation is to involve consumers in both developing and reviewing these resources.

Background: Permanent supportive housing (PSH) is an evidence-based intervention for people experiencing homelessness which integrates permanent housing with voluntary support services. PSH tenants are at high risk for overdose death, yet little research to date has examined overdose in PSH. We sought to examine overdose risk and existing responses in PSH, which can shed light on opportunities for future overdose prevention efforts.

Methods: We conducted focus groups with PSH tenants, staff, and leaders in New York City and New York's Capital Region. Focus groups were recorded and professionally transcribed. Two investigators independently completed rapid turnaround qualitative analysis, completing templated summaries of each focus group and compiling key content in an analysis matrix, which a third investigator reviewed; discrepancies were resolved by consensus.

Results: From October to December 2022, we held 8 focus group sessions with PSH tenants (3 focus groups, n = 10 total participants), staff (3 focus groups, n = 13), and leaders (2 focus groups, n = 11) grouped by role and region. Participants were diverse in age (26-67 years), gender (18 women, 16 men), race (3 Asian, 12 Black, 11 White, 5 multiracial, 3 other), and ethnicity (5 Latinx, 29 not Latinx). Analysis revealed four main themes: (1) Overdose was a large concern in PSH and created significant trauma for tenants and staff; (2) Environmental factors in PSH contributed to overdose risk; (3) There was heterogeneity in PSH buildings' current overdose prevention efforts and adoption of harm reduction principles; and (4) Multifactorial barriers resulted in limited tenant use of opioid agonist treatment.

Conclusions: Overdose is a major concern for PSH tenants, staff, and leaders. Our findings shed new light on overdose in PSH settings, providing insight into risk factors, existing responses, and barriers and facilitators to future overdose prevention efforts. These findings can inform future overdose prevention interventions within PSH.

Trial registration: ClinicalTrials.gov, NCT05786222, registered 27 March 2023.