Drug and alcohol dependence最新文献

Introduction: Cannabis is the most used illicit substance among workers in Australia, yet the epidemiology of frequent use and risk of harm remains underexplored. This study investigated the prevalence and determinants of, as well as absenteeism associated with, weekly illicit cannabis use and risk of cannabis-related harm among Australian workers.

Method: The study used data from the 2019 and 2022-23 National Drug Strategy Household Surveys (N = 24,954).

Results: Weekly cannabis use was reported by 5.0 % (SE = 0.2) of respondents, while 2.2 % (SE = 0.1) were classified as at risk of harm. Workers in construction and hospitality, as well as labourers and tradesmen, exhibited elevated rates of use and harm. Significant determinants of weekly illicit cannabis use identified in multivariate regression models include being male, younger (14-39 years), never married, born in Australia, smoking (current or former), and heavy episodic drinking (HED). Determinants of being at risk of harm were being male, never married, born in Australia, residing in a major city, experiencing psychological distress, smoking (current or former), and HED. Current smoking showed the strongest associations with both outcome measures. Weekly illicit cannabis use and being at risk of harm were associated with 2.8 and 6.9 additional days absent from work due to illness or injury, respectively.

Conclusions: By identifying the determinants and consequences of frequent illicit cannabis use and being at risk of harm among employed individuals, these findings provide key insights necessary to develop targeted behavioural change and workplace substance use interventions.

Background: Artificial intelligence (AI)-powered large language models like ChatGPT are increasingly used by the public to access health information. These platforms may be particularly appealing for high-risk conditions such as substance use disorder (SUD), where anonymity and nonjudgmental responses are valued. Despite growing interest in AI-assisted health education, limited research has assessed the quality of ChatGPT's content when it comes to accuracy and completeness on complex behavioral health topics. This study evaluated the accuracy and clinical consistency of ChatGPT's responses to SUD-related questions compared to national health guidelines.

Methods: This descriptive study, using a content analysis approach, analyzed ChatGPT 3.5's and 5's responses to 14 clinically relevant SUD-related questions, drawn from over 200 FAQs sourced from six leading U.S. health organizations in comparison to the top SUD questions asked by US adults using ChatGPT. Each response was independently assessed by a multidisciplinary team for accuracy, clarity, and appropriateness using an evidence-informed rating system. Responses were categorized as excellent, satisfactory requiring minimal clarification, satisfactory requiring moderate clarification, or unsatisfactory. Discrepancies were resolved through consensus.

Results: Among the 14 responses, 3 were rated excellent, 9 were satisfactory requiring minimal clarification, and 2 were satisfactory requiring moderate clarification. None were rated unsatisfactory. ChatGPT responses were generally accurate for straightforward questions but lacked clinical nuance and specificity in more complex scenarios, particularly regarding individualized care recommendations, withdrawal management, and treatment planning.

Conclusion: As AI becomes more integrated into health information-seeking behaviors, continued evaluation of its role and potential impact in addiction medicine is essential.

Background: Sex differences in substance use disorder (SUD) treatment outcomes remain unclear; protocols focused on male prevalence may overlook female-specific needs. This study tested interactions among sex, the telescoping effect, and comorbid profiles in outcomes.

Methods: Retrospective multisite electronic health record study (N = 4818) of patients with co-occurring disorders. Interaction regressions and latent class analysis tested sex moderation of links between years of substance use (telescoping) and outcomes within SUD and co-occurring diagnostic groups.

Results: Slower progression from substance use onset to diagnosis was associated with lower readmission likelihood at 3 years in males than females; similar patterns appeared at 18 and 24 months for alcohol dependence and at 18 months for co-occurring mood disorders. Six comorbid classes were identified (feature-based labels): behavioral dysregulation (Class 1), anxious distress (Class 2), adolescence-cannabis (Class 3), emotional-interpersonal dysregulation (Class 4), affective-alcohol (Class 5), and reality distortion (Class 6). Only Classes 2 and 4 showed the telescoping effect. Latent-class moderation revealed males in Classes 1 and 3 had higher readmission over 3 years, whereas females in Class 4 had lower adherence to scheduled appointments and higher predicted readmissions across all follow-ups. Females in Class 6 showed better appointment adherence than males.

Conclusions: Telescoping and sex differences may contribute to higher readmission in females, particularly with alcohol dependence and mood or personality disorders. Males with impulse-control or childhood disorders may require more post-treatment care. Sex-specific interventions and moderation/latent class approaches may improve targeting.

Background: Effective working relationships between drug courts and community providers are critical to improving access to medications for opioid use disorder (MOUD), but collaboration is often inadequate. We adapted and piloted a package of implementation strategies (Clinical Organizations and Legal Agency Alliance Building; COLAAB) designed to enhance collaboration between recovery courts and MOUD agencies. COLAAB activities included structured interagency meetings, agency tours, academic liaison, and development of local resource guides.

Methods: After the implementation of COLAAB in three courts, we conducted semi-structured interviews (n = 24) with drug court and MOUD staff to assess the impact of COLAAB on collaboration, communication, and referrals. Data were analyzed using a modified iterative categorization approach.

Results: Drug court and MOUD agency staff perceived COLAAB as facilitating interagency relationships and referrals to MOUD, increasing MOUD agencies' understanding of drug courts, improving communication quality, strengthening understanding and trust in MOUD providers and drug courts, and reducing time to referrals to MOUD. COLAAB also increased the MOUD agency staff's awareness of other community providers and helped build their potential referral networks. COLAAB may have also enhanced drug court staff's willingness to speak with clients about MOUD and MOUD provider staff's willingness to discuss clients' criminal legal involvement.

Discussion: Our pilot study provides preliminary evidence that court-MOUD agency collaborations can be enhanced through active learning about one another's practices and services, participation in regularly scheduled meetings or activities, and the identification and use of resources that support efficient interagency referral processes.

Introduction: Using multiple tobacco and cannabis products is common among young adults and raises concerns about addiction and health risks. Few studies address daily use patterns of multiple products on the same day. We used daily diaries to identify patterns of substance use and associated factors among young adults who reported vaping nicotine and cannabis.

Methods: We collected smartphone-based daily diaries from 113 California young adults (mean age=23.8) who vaped nicotine or cannabis for 20 +  days in the past month. For 30 consecutive days, participants reported their daily use of nicotine/tobacco, cannabis, alcohol, craving for nicotine and cannabis vaping, and mood. We used multilevel latent class analysis to identify daily substance use patterns and mixed-effects logistic regression to identify factors associated with these patterns, controlling for baseline covariates (e.g., demographics, nicotine/cannabis dependence).

Results: Three latent classes emerged: Class 1 - "Nicotine vaping days" (52.7 % of the assessments), Class 2 - "Nicotine and cannabis co-vaping days" (39.9 %), and Class 3 -"Combustible tobacco and cannabis use days" (7.4 %). Higher levels of feeling sad on a given day were associated with increased likelihood of that day belonging to Class 1 (adjusted OR = 1.11, 95%CI95 %CI = 1.01 - 1.23). Higher cravings for cannabis vaping on a given day were associated with increased likelihood of that day belonging to Class 2 (adjusted OR = 1.81, 95 % CI = 1.63 - 2.01).

Conclusion: Interventions should be tailored to varying daily substance use patterns among young adults who vape. Efforts targeting vaping cessation may also address combustible product use.

Objective: To analyze the burden of disease from drug use disorders (DUD) in Mexico by state from 1990 to 2021 and to assess the association of this burden of disease with the Healthcare Access and Quality Index (HAQI).

Methods: Secondary data analysis from the GBD-2021 study. The paper analyzes mortality, premature mortality, disability and disability-adjusted life years (DALYs). A log-linear segmented regression model to analyze trends in DUD DALYs over time was used. The information was disaggregated by age-groups and sub-causes, at the national and state levels.

Results: DUD mortality increased by 27.9 % over the last three decades. The DUD burden of disease remained stable with DALY rates of 85.8 per 100000 in 1990 and 86.9 in 2021. Males showed mortality rates over four times higher than females. In 2021, DUD premature mortality was higher for males (35.6 vs. 8.2 per 100000 among females), while disability rates were higher for females (70.7 vs. 59.7 among males). The highest DUD DALYs occurred among individuals aged 20-29, with cocaine and opioid use disorders as the leading contributors to the DUD DALYs, with notable differences between males and females. Regionally, the northern states, especially Baja California and Chihuahua, exhibited the highest DUD DALYs, whereas central states like Tlaxcala and the State of Mexico had the lowest. A complex relationship between DUD DALYs and the HAQI was observed.

Conclusions: There is also an urgent need for age- and gender-responsive public health strategies, evidence-based harm reduction programs, and comprehensive policy interventions to lessen the impact of DUD in Mexico.

Background: Graphic warning labels (GWLs) on cigarette packaging have been implemented in many countries. In the U.S., however, GWLs have faced legal challenges based on concerns that their aversive imagery elicits excessive emotional arousal without sufficient data to support its beneficial impact. This longitudinal study examined how GWLs' level of arousal affects cigarette craving and neural responses related to emotional processing.

Methods: A total of 158 adults who smoked cigarettes were exposed to either high-arousal (n = 79) or low-arousal (n = 79) GWLs attached to their cigarette packs for 4 weeks. Cigarette craving and brain responses to GWLs were measured using functional magnetic resonance imaging before and after the exposure period. The amygdala, a key region involved in emotional processing, was the brain region of interest.

Results: At baseline, high-arousal GWLs elicited a greater reduction in craving and stronger amygdala activation than low-arousal GWLs. However, by week 4, the differences in craving reduction and amygdala response between groups were no longer significant. Amygdala activity mediated the effect of GWLs on craving reduction, with the mediation effect being more pronounced in the high-arousal group than the low-arousal group at baseline but not at week 4.

Conclusions: The impact of GWL-induced arousal on cigarette craving appears to diminish over time, likely due to habituation in amygdala reactivity. High-arousal GWLs do not provide sustained advantages over low-arousal ones. Low-arousal GWLs may represent a more practical and legally defensible approach to tobacco control in the U.S.

Background: The role of cannabis reform in shaping North America's overdose and addiction crisis remains hotly contested. People who inject drugs (PWID) sometimes substitute cannabis for opioids. Yet, no research has examined the effects of cannabis legalization on opioid use among PWID-- despite major potential for PWID to benefit from policy interventions reducing opioid-related harms. We examined whether legalizing cannabis for medical use (MCL) vs. both MCL and adult/recreational use (MCL+RCL) was associated with changes in substance use among PWID, overall and by sex and race/ethnicity.

Methods: This serial cross-sectional observational study used staggered adoption difference-in-differences models to analyze data (2012, 2015, 2018, 2022) from 28,069 PWID from 13 states. We examined associations between time-varying implementation of MCLs and MCL+RCLs and self-reported past 12-month daily use of cannabis and non-medical opioid use.

Results: Compared to MCL, MCL+RCL was associated with a 9-11 % decrease in the probability of daily opioid misuse (95 % CIs: [any opioids: -14.0, -4.0]; [injected opioids, -19.0, -2.0]). The probability of daily cannabis use increased from 15 % to 20 % for non-Latinx White PWID in states transitioning from no legalization to MCL (95 % CIs: 14.0, 17.0; 17.0, 23.0).

Conclusions: Cannabis legalization may shape daily opioid consumption among PWID, potentially reducing drug-related harms. Differences in cannabis use following legalization may reflect disparate impact by race, due to structural racism or other factors. Future research examining whether policy attributable changes in substance use manifest health benefits among PWID is critical to developing evidence- based cannabis reform.

Background: With evolving legislation and attitudes towards cannabis in the United States, individuals receiving long-term opioid therapy (LTOT) for chronic pain increasingly use cannabis intending to relieve pain and reduce opioid consumption. Although they might also use cannabis to compensate for emotion dysregulation, the role of emotion regulation capacity in this population's patterns of cannabis use has not been investigated. This study examined whether deficits in emotion regulation capacity, an endophenotype assessed via psychophysiological measures, are associated with more frequent cannabis use among individuals receiving LTOT for chronic pain.

Methods: We analyzed data from 104 participants (mean age=51.12 years; 68.35 % female; 88.46 % White) receiving LTOT for chronic pain. Cannabis use frequency was quantified by days of use over 90 days. Emotion regulation capacity was indexed using skin conductance response (SCR) and corrugator electromyography (fEMG) during passive viewing or cognitive reappraisal of negative stimuli. Pain severity was assessed using the Brief Pain Inventory.

Results: Smaller reductions in SCR (β=-0.018, p < 0.001) and corrugator fEMG (β=-9.59, p < 0.001) difference scores, signifying weaker emotion regulation capacity, were associated with more days of cannabis use. Pain severity was not significantly associated with cannabis use frequency (β=0.026, p = 0.370).

Conclusions: These findings suggest that impaired emotion regulation capacity might be a more critical endophenotype associated with frequent cannabis use than pain severity and support the notion that cannabis use might primarily modulate affective processes in this population. These results highlight the potential for targeted emotion regulation interventions to address heavy cannabis use among pain patients receiving LTOT.

Background and objective: Medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring mental and physical conditions, and new adjunctive interventions are needed to improve treatment. Mindful Awareness in Body-oriented Therapy (MABT) teaches interoceptive awareness skills to promote well-being. This study evaluated the longitudinal effects of MABT as an adjunct to MOUD treatment.

Methods: Patients stable on MOUD recruited from six community clinics were randomly assigned to MABT+MOUD or MOUD. Five assessments delivered over one year (N = 303) examined abstinence from non-prescribed opioid and overall substance use (primary outcomes), and secondary outcomes of mental and physical health distress, interoceptive and mindfulness skills, and opioid craving. An intent-to-treat approach to examine change across time involved generalized estimating equations and linear mixed multilevel models.

Results: This sample demonstrated high percent days abstinence from non-prescribed opioids and other substances, resulting in no statistical between-group differences over time. Significant overall longitudinal effects for MABT+MOUD vs. MOUD were evident on secondary outcomes of physical symptom frequency, and interoceptive awareness. In addition, significant baseline to 12 month between-group improvements were evident on PTSD symptoms, emotion regulation difficulties, and mindfulness skills.

Conclusions: While stable on MOUD, this sample had high levels of chronic pain and mental health distress. The results highlight improved longitudinal health outcomes in response to MABT critical to support recovery on MOUD. The MABT completion rate and maintained use of MABT skills over 12 months demonstrates MABT implementation feasibility and positive intervention response as an adjunct to MOUD treatment. PREREGISTRATION CLINICALTRIALS.GOV: NCT04082637.