Addiction Science & Clinical Practice最新文献

Background: Virtual reality (VR) technology has been increasingly employed to develop innovative treatments for Alcohol use disorder (AUD) and overcome limitations of currents therapies. However, previous research in this field has yielded inconclusive results. To improve the quality and comparability of studies, a critical analysis of the research methodology employed in this field is necessary.

Objectives: This scoping review aims to provide an overview of existing studies with a focus on their objectives, methodology, treatment paradigms, and VR design characteristics.

Methods: A systematic literature research was conducted in the electronic databases MEDLINE (PubMed), APA PsychInfo, APA PsychArticles, PSYINDEX (EBSCOhost), Scopus, Web of Science and by search in the reference list of included publication to identify relevant publications. Clinical studies and study protocols using VR for the assessment or treatment of patients with AUD were included.

Results: The literature search yielded 1.197 studies, of which 22 met the inclusion criteria. Completed trials (n = 16) and study protocols (n = 6) were included. The majority of the studies (n = 19) used a VR cue exposure paradigm to induce craving. The studies can be classified either as assessment (n = 9) or treatment studies (n = 13). The duration (7-60 min) and number of applied sessions (1-13) varied significantly depending on the type of study. Craving outcomes were based on subjective and physiological measurements. All studies used alcoholic beverages and VR scenarios such as bars, pubs, parties and restaurants, with additional scenarios varying, except for one study using a hospital and subway scenario as aversive scenarios. Moreover, synchronized olfactory stimuli were frequently used.

Conclusions: Despite the heterogeneity of VR software features and VR interventions, it was possible to identify a similarity within the main VR scenarios employed, as well as consistent positive results concerning the induction of subjective craving by alcohol-associated VR cues. While VR interventions for AUD show methodological progress, future research should adopt standardized protocols, include objective psychophysiological outcomes, and evaluate long-term efficacy and feasibility in clinical settings. Integration of emerging VR paradigms and technologies may further enhance the therapeutic potential.

Background: Cigarette smoking remains the leading preventable cause of death, posing heightened risks for vulnerable populations. World Trade Center (WTC) disaster responders face an elevated burden of respiratory diseases, and despite access to an evidence-based tobacco cessation program, a subset continues to smoke cigarettes. Treatment engagement remains a critical barrier, as many people who smoke fail to enroll in or adhere to programs, particularly when participation requires decisions to actively opt-in to treatment. This randomized controlled trial integrates tobacco treatment into an existing low-dose computed tomography (LDCT) lung cancer screening program and compares the effectiveness of an Enhanced Care intervention with opt-out enrollment and biofeedback to Standard Care with opt-in enrollment and standard treatment.

Methods: The trial includes retired Fire Department of the City of New York (FDNY) responders aged 50 years or older who have a smoking history that satisfies either the National Comprehensive Cancer Network criteria of at least 20 pack-years or a simplified criterion of at least 20 years of smoking. Participants are randomized to either Enhanced Care, featuring opt-out enrollment in tobacco treatment with tailored counseling using biofeedback from chest LDCT and spirometry results, or Standard Care, requiring opt-in enrollment and standard tobacco treatment without biofeedback. Both arms receive a varenicline regimen with 4 weeks of pre-loading. Primary outcomes are treatment enrollment and biochemically verified 7-day abstinence. Factors associated with enrollment and abstinence, including retention, adherence, and quit motivation, will be evaluated.

Discussion: This trial addresses a key gap in tobacco cessation research by testing an innovative intervention for a high-risk occupational cohort participating in LDCT screening. The Enhanced Care model integrates opt-out enrollment, personalized biofeedback, and varenicline preloading to reduce smoking rates and health burdens in FDNY responders. Findings aim to inform scalable cessation strategies for both occupational and general populations, highlighting the need for novel approaches for hard-to-treat individuals who smoke.

Trial registration: This trial was registered at ClinicalTrials.gov under the identifier NCT05997225.

Background: Individuals with opioid use disorder (OUD) are frequently hospitalized for injection-related medical complications, yet they often receive inadequate treatment for the OUD itself. We previously conducted a qualitative study to adapt an existing remotely delivered intensive outpatient program (IOP) specifically for hospitalized patients with OUD. We then conducted a pilot feasibility and acceptability study to assess the program.

Methods: The 4-week IOP consisted of asynchronous video content and in-person peer support. The primary outcomes were the feasibility of recruitment, acceptability of the treatment as assessed by the completion of videos, and engagement with the peer recovery coach. Secondary outcomes included OUD treatment retention.

Results: Of the 12 participants, the mean age was 40.9 years, 58.3% were female, and 58.3% had an injection-related serious infection. Results demonstrated potentially acceptable recruitment feasibility (70.6%, 95% CI [48.9-92.3]), but the median percentage of video completion was only 2% (range: 0-16%) and the median percentage of engagement with recovery coach was 31.8% (range: 16.7-66.7%). All participants received medications for OUD (MOUD) during the hospital stay (methadone 83%, buprenorphine 17%), and 33.3% remained retained in MOUD treatment at 28 days.

Conclusions: Hospitalized patients with OUD desired additional support through an IOP along with MOUD. While recruitment feasibility was acceptable, the overall program was not. Future research should explore IOP content that is more personalized and engaging while also including peer support.

Background: Spatial accessibility of substance use disorder (SUD) treatment is a crucial component of access and a comprehensive analysis can help to identify if and where a lack of spatial accessibility is a barrier to treatment.

Methods: We conducted a cross-sectional analysis of spatial accessibility of SUD treatment (outpatient, opioid treatment program, and residential) in New York State (NYS). We estimated two measures of spatial accessibility: one-way travel time (i.e., drive time for NYS outside of New York City [NYC] and public transit time for NYC) and robustness (i.e., the difference in travel time between the closest and fifth closest facility). Comparison facilities included Federally Qualified Health Centers, dialysis facilities, and hospitals. We compared travel time and robustness by urbanicity (NYC, urban non-NYC, rural) and NYS economic development region using population-weighted paired t-tests.

Results: The percentage of NYS residents within 30 min travel time was 97.2% for outpatient SUD treatment programs and 82.3% for opioid treatment programs. Mean statewide travel time to outpatient SUD treatment programs was comparable to travel time to Federally Qualified Health Centers (difference: 1.0 min [95%CI 0.9 to 1.1; P < 0.001]) and dialysis facilities (difference: 0.1 min [95%CI 0.03 to 0.2; P = 0.01]), and significantly shorter than to hospitals (difference: 5.6 min [95%CI 5.4 to 5.7; P < 0.001]). Travel time to opioid treatment programs was significantly longer than to Federally Qualified Health Centers (difference: -7.4 min [95%CI - 7.6 to - 7.2; P < 0.001]), dialysis facilities (difference: -8.2 min [95%CI - 8.4 to - 8.1; P < 0.001]), and hospitals (difference: - 2.8 min [95%CI - 3.0 to - 2.6; P < 0.001]). Compared with NYC, mean travel time to each type of SUD treatment program was significantly shorter in urban non-NYC areas and longer in rural areas. For robustness, compared with NYC, there was no significant difference in urban non-NYC areas for outpatient and residential SUD treatment programs, but more limited robustness for opioid treatment programs in urban non-NYC areas and all types of SUD treatment programs in rural areas.

Conclusion: We identified widespread spatial accessibility of SUD treatment facilities across NYS. Recent opportunities such as revised federal regulations on opioid treatment program mobile medication units, increased flexibility in using telehealth in opioid treatment programs and other settings, and opioid settlement funding can be leveraged to increase access in rural areas.

Background: Most opioid use disorder (OUD) treatment guidelines target community medical settings, and the subsequent recommendations were established to prioritize safety and reduce diversion prior to the fentanyl era. For people with OUD who use unregulated fentanyl, slow induction onto opioid agonist therapy (OAT) with gradual dose titration is often ineffective or insufficient for reducing withdrawal symptoms and cravings, thereby hampering engagement and retention in treatment. Given the severe risks associated with continued use of the increasingly toxic unregulated drug supply, new and innovative approaches to the management of OUD are urgently needed. We have developed an alternative induction protocol, using a rapid intravenous symptom-inhibiting fentanyl induction (SIFI) to optimize rotation onto oral OAT.

Methods: An open-label, single arm, prospective pilot clinical trial is being conducted in an outpatient setting to assess the safety, feasibility, and efficacy of a rapid symptom-inhibiting intravenous fentanyl induction protocol to establish starting doses of methadone or sustained-release oral morphine (SROM) based on individual opioid requirements, as a treatment strategy for individuals with OUD who use unregulated fentanyl. The primary outcome is safety, as defined by occurrence of study drug-related adverse events (including but not limited to opioid toxicity and QT interval prolongation) that require intervention during induction and the first 7 days on OAT. Secondary objectives are to determine whether the SIFI protocol will result in use of higher-than-standard starting doses of methadone and SROM, and to determine whether implementation of this protocol will be acceptable to participants and will result in reduced withdrawal symptoms, improved retention, and better long-term outcomes on OAT.

Discussion: This is the first study to rapidly and objectively estimate opioid tolerance and use it to calculate individualized starting doses of oral OAT in an outpatient setting among people who use unregulated fentanyl. We predict that starting methadone or SROM with individually-tailored doses will lead to therapeutic target concentrations being achieved quickly, safely, and with good patient satisfaction. This approach has the potential to more effectively and safely initiate OAT, to minimize opioid withdrawal and cravings, and in turn to decrease unregulated fentanyl use and increase retention on life-saving OAT.

Trial registration: ClinicalTrials.gov, NCT05905367; date of registration: June 15, 2023; latest update posted July 18, 2024. https://clinicaltrials.gov/study/NCT05905367 Protocol version: 4.0, April 22, 2024.

Background: The Western Cape region of South Africa has one of the highest global rates of Fetal Alcohol Spectrum Disorder (FASD), underscoring the urgent need for effective interventions. This qualitative study, designed as a process evaluation, explores pregnant and lactating participants' perceptions and experiences of a text message and contingency management (CM) intervention.

Methods: The study involved post-intervention interviews with 10 pregnant participants and 10 post-partum lactating participants. Coding and a thematic analysis approach were applied to the collected data using NVivo 12.

Results: Participants identified key factors influencing their engagement in the intervention. Participants faced logistical barriers, but supportive social networks and flexible program components encouraged participation. Increased self-efficacy and external accountability also facilitated behavior change. Furthermore, participants suggested improvements for accessibility and tailored support, highlighting important considerations for future interventions.

Conclusion: The findings highlighted the potential benefits of the intervention in improving individuals' health behaviors. However, logistical barriers and the need for expanded support services were identified, emphasizing the importance of refining intervention strategies in resource-limited settings.

Clinical trial registration: NCT05319977.

Widespread use of fentanyl in combination with methamphetamine in carceral settings presents unique health risks and public health challenges. To contribute to continued efforts to understand drug use among first-time arrestees, this study characterizes the nature and extent of urine drug screenings (UDS) positive for fentanyl and/or methamphetamine among first-time arrestees receiving healthcare in 25 jails across the U.S. This study used the same data source, data extraction, sample selection, and UDS variables as those reported by Schumacher et al. (2025) and a similar data analytic strategy which included 81,842 arrestees with a UDS or 28.8% of total arrestees (283,884). Among first-time arrestees with complete results (43,553), 32,561 or 74.8% of arrestees tested positive for any drug and among those, 14,426 (44.3%) were positive for fentanyl and/or methamphetamine. Of those, 59.8% and 11.5% were only positive for methamphetamine or fentanyl, respectively, while 28.7% were positive for both. Demographically, individuals testing positive for both fentanyl and methamphetamine were predominantly white young adults (aged 20-39), with similar co-occurrence patterns in males and females. Fentanyl alone was more common in southern and midwestern jails and mega-sized jails, methamphetamine was more common in medium-large and southern jails, and their co-occurrence was most common in western and large jails. Approximately 97.5% of first-time arrestees tested positive for two or more drugs, with individuals testing positive for five or more drugs significantly more likely to test positive for both fentanyl and methamphetamine. This study highlights the significant prevalence of methamphetamine and/or fentanyl use among first-time arrestees, underscoring the urgent need for targeted interventions, improved in-jail substance use treatment, and post-release support to mitigate overdose risks and enhance public health outcomes.

Background: People with HIV (PWH) are disproportionately affected by cigarette use, with a 40 - 70% prevalence rate. Although many express a strong interest in quitting, many PWH who smoke experience lower cessation rates with traditional treatments, in part due to their comorbid anxiety and depressive symptoms. Psilocybin, a classic psychedelic referred to as "breakthrough therapy" by the U.S. Food & Drug Administration (FDA), has been shown to have potential as a therapeutic treatment for psychiatric symptoms, (e.g., anxiety and depression) and substance use disorders, including tobacco dependence. Preliminary evidence has shown that administering psilocybin to people who smoke and have been previously unable to quit with traditional treatments resulted in impressive smoking abstinence rates (80%) at 6-months in a smoking cessation pilot study.

Objective: Explore, using qualitative methods, the perceptions and acceptability of a psilocybin-assisted treatment for smoking cessation among PWH who smoke.

Methods: Semi-structured, in-depth qualitative interviews were conducted with PWH who smoke. Interviews were audio-recorded, transcribed verbatim, and analyzed using rapid thematic analysis.

Results: Twenty-five participants were enrolled: 15 cis male, 9 cis female, and 1 transgender female. Five main themes emerged: varying previous experiences with psilocybin; uncertainty about psilocybin's effects and concern over potential side effects; need for trusted sources of information and testimonials; ultimately willing to try psilocybin-aided therapy for tobacco treatment; and, set and setting of psilocybin use matters.

Conclusions: Psilocybin-assisted smoking cessation treatment appears to be acceptable among PWH who smoke. Participants highlighted the importance of addressing key concerns related to an emerging therapy to increase acceptability and willingness to try it. Further research is needed to evaluate the safety and effectiveness of psilocybin prior to incorporating this emerging therapy for smoking cessation into tobacco treatment clinical services for PWH.

Background: Alcohol consumption is associated with poor health outcomes in people with HIV (PWH). Although various alcohol reduction strategies exist, little is known about PWH's past experiences or future preferences. This study describes the previous strategies PWH had used, their perceived effectiveness, among people who ever drank, and the strategies PWH who endorsed heavy drinking would consider trying in the future. It also examines how these experiences and preferences vary by sociodemographic factors and past 12 month drug use.

Methods: A cross-sectional analysis was conducted on data from 453 PWH enrolled in the Florida Cohort Wave III study (2020-2023; mean age 50 years, 60% men). Participants who attempted to reduce or quit drinking (n = 321) were asked about their use of eight alcohol reduction strategies and rated the effectiveness of each on a 4-point Likert scale. Participants reporting heavy drinking (n = 170) were asked about their willingness to try seven strategies in the future. Chi-square and Fisher's exact tests analyzed differences by sex, age, race/ethnicity, and past 12 month drug use.

Results: Among the 321 who had ever tried to reduce or quit drinking, endorsed strategies including "on my own"/ complete cessation (80%), prayer (61%), Alcoholics Anonymous (AA) (38%), counseling/therapy (31%), inpatient/outpatient detox (23%), self-monitoring (11%), and medication (7%). The strategies with the highest self-reported effectiveness were for prayer (59%), "on my own"/ complete cessation (58%), and in-patient detox (50%). Prayer was significantly more common among females and non-Hispanic Black or Hispanic participants. Those with past 12 month drug use were significantly more likely to have tried most strategies, except medications or prayer. Among 170 who reported heavy drinking, "on my own"/ complete cessation (43%), AA (24%), and counseling/therapy (21%) were the most endorsed strategies they would try in the future. No significant differences in future preferences were found by demographics, but those with past 12 month drug use showed more interest in formal treatment approaches.

Conclusion: Commonly used alcohol reduction strategies among PWH were non-medical, easily accessible, and perceived as very effective. Incorporating safe and effective patient-driven methods into treatment guidelines may improve strategy uptake.

Background: Text messaging-based interventions (TMIs) have demonstrated effectiveness in reducing tobacco use in many populations. However, such interventions have not been tailored to meet the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). We describe the process of adapting the SmokefreeTXT message library so that it is applicable to all forms of tobacco use, addresses issues specifically facing PLWH who use tobacco, and is culturally appropriate for use in Uganda and Zambia.

Methods/design: Participants were PLWH who currently used tobacco and health services workers recruited from HIV clinics in two regions of Uganda and two regions of Zambia. Eight focus groups (N = 48) were conducted with PLWH tobacco users and four focus groups (N = 28) were conducted with healthcare providers to adapt the TMI content for the cultural context and HIV status. A subsample of PLWH focus group participants (N = 14) provided feedback on the adapted TMI after using it for three weeks on their own phone. Focus group transcripts were analyzed for key themes based on the moderator guides using Dedoose software™. Means and percentages were calculated for survey data to assess the TMI's acceptability and feasibility.

Results: Focus group feedback on facilitators and barriers to quitting tobacco, as well as strengths and limitations of the TMI-based intervention approach, were used to finalize the adapted TMI's content and delivery for usability testing. PLWH identified multiple barriers to quitting tobacco including addiction, lack of support and education, and community perceptions. Health service workers highlighted the need for community-level interventions, improved provider knowledge on tobacco cessation, and tailored support strategies. Usability testing participants rated the TMI as helpful and relevant, emphasizing the interactive features as supportive and beneficial. Further, they reported few problems using it over three weeks, except for difficulty keeping their phone charged.

Conclusions: Results suggest that an adapted version of SmokefreeTXT is a feasible and acceptable option for PLWH in Uganda and Zambia who are interested in quitting tobacco use.

Trial registration: ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.