American Journal on Addictions最新文献

Background and objectives: Although buprenorphine is effective and approved for treating opioid use disorder (OUD), it remains underutilized in primary care settings. This study's objective was to explore what primary care teams need to overcome barriers in treating OUD, and to assess whether those needs change after receiving education on OUD treatment.

Methods: The American Academy of Family Physicians hosted a 12-month Project ECHO® educational series on OUD for primary care teams. Thematic analysis was conducted on participant responses pre- and post-series to the survey item "Please list your most pressing needs related to OUD" (N = 92).

Results: Ninety-two participants from 25 primary care practices from the US and Canada responded to the pressing needs item across both surveys. The most prevalent need reported at baseline was Education and Training, which became second to Health System Resources at endpoint. Respondents cited organizational protocols for OUD treatment as a pressing need among other Health System Resources such as support for reimbursement. Needs relating to transportation and housing; engaging patients to start and continue in OUD treatment; and addressing stigma within the community and health system were indicative of overlapping barriers.

Discussion and conclusions: Responses from primary care teams echo previous studies on barriers to OUD treatment and provide specific, actionable insight to addressing these barriers.

Scientific significance: Actionable insights, for example, implementing health system-level OUD protocols and guidelines and promoting availability of OUD treatment and education, are ways that primary care teams could increase treatment of patients with OUD.

Background and objectives: Although Asian American and Pacific Island (AAPI) individuals are less likely to use alcohol than other racial/ethnic groups, health disparities regarding alcohol-related outcomes indicate a need to study factors relevant to the AAPI community that may be related to alcohol use and related problems. Experiences of racism are related to greater alcohol use and related problems, presumably due to alcohol use in an attempt to manage heightened negative affect due to experiencing racism. Yet, no known studies have tested whether negative affect specifically related to racism is associated with alcohol outcomes among AAPI individuals.

Methods: The current study tested this hypothesis among 411 (58.2% male, aged 18-75) nationally recruited AAPI adults who endorsed current alcohol use.

Results: Experiences of AAPI-based racism and racism-related negative affect were statistically significantly related to drinking quantity and use-related problems. Racism-related negative affect was robustly related to alcohol outcomes after controlling for variance attributable to relevant demographic variables, anxiety, and depression. The relation of racism to alcohol problems occurred via racism-related negative affect and typical drinking quantity.

Discussion and conclusions: Results highlight the deleterious effects of racism on mental and behavioral health among AAPI individuals.

Scientific significance: AAPI individuals have been underrepresented in research on alcohol use and related problems. The greater negative affect and alcohol problems associated with experiences of racism are concerning, given the high rates of racism experienced by AAPI individuals.

Background and objectives: Social media exposure may influence early nicotine experimentation, a behavior linked to later nicotine dependence and health risks. Few studies have examined the role of smoking expectancies (i.e., beliefs about the anticipated positive or negative effects of nicotine) as a pathway underlying this association, especially in early adolescence. The objective of this study is to examine the prospective association between social media use and nicotine experimentation in early adolescence, and whether smoking expectancies mediate this relationship.

Methods: Using longitudinal data from the Adolescent Brain Cognitive Development Study (N = 8292; mean age 12.0 years at Year 2; 2018-2020), we estimated associations between social media time (Year 2) and nicotine experimentation (Year 4), adjusting for confounders and testing positive and negative smoking expectancies (Year 3) as mediators using generalized structural equation modeling.

Results: Social media time at Year 2 was associated with nicotine experimentation at Year 4. Positive smoking expectancies (but not negative expectancies) were associated with nicotine experimentation. Positive smoking expectancies mediated 5.97% (95% CI: 1.27%-10.67%, p = .013) of the social media-nicotine experimentation association.

Discussion and conclusions: Early social media exposure may be associated with favorable beliefs about nicotine, increasing adolescents' risk of experimentation. Regulatory policies, clinical screening, and prevention programs could mitigate early nicotine use. Future research should explore how these relationships evolve across adolescence.

Scientific significance: This study advances understanding of how social media use contributes to early nicotine experimentation in adolescents by identifying positive smoking expectancies as a potential pathway.

Background and objectives: In 2022, over 6 million individuals in the United States were affected by opioid use disorder (OUD), and more than 81,000 died from opioid-related overdoses. This umbrella review synthesized evidence on the associations between a broad range of social determinants of health (SDoH) and OUD/overdose.

Methods: An umbrella review of meta-analyses and reviews on SDoH and OUD/overdose was conducted using PubMED, PsycINFO, Embase, and Web of Science. A total of 29 reviews were deemed appropriate for inclusion.

Results: Adverse childhood experiences and unemployment were associated with OUD outcomes. In the United States, immigrant status was associated with a lower risk of OUD, though this risk increased in subsequent generations. Individuals who experienced intimate partner violence and sexual minority individuals showed high prevalence of OUD. For overdose, associations were found in unemployment, low income, high poverty, and justice system involvement. Significant increases in odds of overdose were noted among individuals experiencing homelessness, lacking private insurance, engaging in sex work for pay, or witnessing an overdose.

Discussion and conclusions: This study identified SDoH associated with OUD outcomes and overdose risk, with findings having implications from a public health perspective for clinical practice, public health policy, and research priorities. There is a need for meta-analyses to clarify the magnitude of SDoH influences on OUD/overdose, with the goal of informing targeted interventions to reduce opioid-related morbidity and mortality.

Scientific significance: The most comprehensive umbrella review to date on intersections among SDoH, OUD outcomes, and overdose risk.

Background and objectives: Alcohol use disorder (AUD) is one of the deadliest psychiatric conditions. Previous studies indicate that AUD is linked to several neurological biomarkers in the human brain; however, how alcohol use manifests in brain volumes and the relationships between the subcortical brain regions affected by AUD and clinical outcomes are not fully understood. This study attempts to compare subcortical brain volume differences between patients with AUD and healthy controls (HC) to understand how alcohol use relates to brain volume changes.

Methods: Patients with AUD, as determined by alcohol dependence and abuse criteria from the DSM-IV, (n = 71) were recruited and matched with HC (n = 71) by demographic characteristics. We examined group differences in the volumes of 40 bilateral subcortical structures between patients with AUD and HC. We assessed the relationship between changes in subcortical brain volumes and common co-occurring psychiatric symptoms.

Results: Our results revealed a significant increase of third ventricle volume in patients with AUD compared to HC. Moreover, we also found a positive correlation between the third ventricle volume and generalized anxiety in patients with AUD.

Discussion and conclusions: Our findings indicate significant enlargement of the third ventricle volume in patients with AUD, as well as relatedness between the volume of this area and generalized anxiety.

Scientific significance: This study is the first in the literature to find volume alterations correlated with clinical outcomes among AUD patients, reflecting a complex relationship between brain volumes and psychological symptoms in this population.

Background and objectives: Prescription drug misuse (PDM) has serious health and social consequences, highlighting the importance of identifying early risk factors. This study examines longitudinal pathways linking low academic performance in adolescence, substance use in emerging adulthood, and PDM in young adulthood, with attention to sex differences.

Methods: Participants were 5114 individuals (54% female) from Waves 1, 3, and 4 of the National Longitudinal Study of Adolescent to Adult Health. A two-group structural equation model stratified by sex was performed to examine the pathways to PDM. Moderated mediation was also tested between males and females.

Results: Low academic performance in adolescence was associated with substance use in emerging adulthood for both males (p < .001) and females (p < .001), which in turn was associated with PDM in young adulthood (males: p < .001; females: p < .001). Only among females, low academic performance in adolescence was negatively associated with PDM in young adulthood (p < .001). The moderation effects of sex on the pathways from substance use to PDM (p < .05) and from low academic performance to PDM (p < .05) were significant at one-tailed test.

Discussion and conclusions: Adolescents with poor academic performance represent a high-risk group for later PDM, emphasizing the need for early preventions. Prevention strategies should consider sex-specific pathways, particularly targeting substance use in emerging adulthood.

Scientific significance: Identifying early academic and behavioral risk factors provides valuable insight for clinicians and prevention professionals aiming to reduce PDM across the life course.

Background and objectives: Despite the availability of treatments for alcohol use disorder (AUD), relapse prevalence and health-related consequences associated with AUD remains high. Using data-driven approaches that enhance generalizability can help elucidate relationships between treatment outcomes and alcohol consumption, aiding in the discovery of novel treatment targets for AUD subtypes.

Methods: We merged data (n = 2045) across four Phase 2 randomized clinical trials affiliated with the NIAAA Clinical Investigations Group and a Phase 3 trial (NIAAA Sponsored). Participants were clustered based on self-reported drinking during treatment maintenance. A gradient boosted machine learning model with end-of-treatment clinical features was used to predict the clusters we identified.

Results: We identified a three-cluster solution corresponding to low (M_{Standard Drinking Units (SDU)} = 1.68, n = 1677), moderate (M_SDU = 6.70, n = 253), and high (M_SDU = 12.92, n = 115) clusters of alcohol consumption during treatment maintenance. We achieved modest prediction of the clusters (Accuracy_Train= 71.0%; AUC_Train = 0.79) using demographics and end-of-treatment clinical and biological assessments. Between-cluster differences were observed between low and high clusters on measures of depression and anxiety (M_Difference= 0.49, SE = 0.13, p = .004), drinking consequences (M_Difference= 1.02, SE = 0.13, p < .001) and liver functioning (0.39 ≤ M_Difference ≤ 0.52, 0.12 ≤ SE ≤ 0.13, 0.001 ≤ p ≤ .005) DISCUSSION AND CONCLUSIONS: These findings suggest that generalizable clusters of alcohol consumption exist across these clinical trials characterized by core demographics, clinical, and biological phenotypes, irrespective of the treatment received. We further show that some assessments may not be useful in distinguishing between higher levels of consumption.

Scientific significance: Identifying predictive features of AUD subtypes, across different phases of treatment, can assist clinicians in identifying individuals who require additional support.

Background and objectives: Disproportionate use of tobacco among psychiatric patients exacerbates psychiatric symptoms, increases suicide risk, alters therapeutic drug levels, and negatively affects adherence. Patient-directed discharge (PDD) rates are higher among patients who smoke, and smoking cessation treatments have been reported to reduce this risk. This study investigates the association of tobacco use and cessation treatments with PDD rates.

Methods: A retrospective analysis was performed on a random sample of 25,829 adult patients admitted voluntarily to inpatient psychiatric facilities nationwide. Exclusion criteria included medical discharge, electroconvulsive therapy, hospital stays longer than 29 days, and incomplete demographic or smoking status data. Binary logistic regression with a Firth correction assessed the associations between PDD rates and smoking status, smoking cessation treatments, demographic variables, comorbidities, and smoking use patterns.

Results: Smoking was significantly associated with an increased likelihood of PDD (χ² = 49.42, p < .0001, OR = 2.16). Nicotine replacement therapy (NRT) alone significantly reduced PDD rates (χ² = 8.16, p < .01, OR = 1.42), whereas bupropion and varenicline did not show significant effects. Smoking-related PDD rates remained elevated despite treatment compared to non-smokers (χ² = 22.02, p < .0001, OR = 1.86).

Discussion and conclusions: A significant association was found between smoking status and PDD rate. NRT alone was associated with lower PDD rates.

Scientific significance: This study is the first to investigate the association of individual smoking cessation treatments with PDD rates. Contrary to previous findings, the risk remained elevated despite treatment in our large national sample.

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