The Addictions Neuroclinical Assessment (ANA) provides a framework for assessing alcohol use disorder (AUD) with indices that may be both mechanistically and diagnostically informative. This study evaluated an array of measures from the three ANA domains in relation to AUD diagnostic status. This cross-sectional case-control study used receiver operating characteristic (ROC) curves to evaluate diagnostic classification validity using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Exploratory multivariate models using logistic regression were also evaluated using the same metrics. Participants were 189 general community adults (52% AUD+, 57% female, Mage = 32) recruited in Hamilton, Ontario, Canada. Classifiers included measures that conceptually mapped on to the three ANA domains of incentive salience (e.g. alcohol cue reactivity), negative emotionality (e.g. anxiety symptoms, coping motives) and executive function (e.g. NIH-toolkit cognition battery). The clinical criterion (reference standard) was AUD diagnostic status per structured clinical interview. Incentive salience indices had AUCs from 0.55-0.85; negative emotionality indices had AUCs from 0.67-0.89; and executive function indices had AUCs from 0.51-0.58. For incentive salience, cravings in the cue reactivity paradigm and enhancement motives identified AUD diagnosis above accepted benchmarks for clinical utility. For negative emotionality, coping motives exhibited high diagnostic validity, exceeding clinical utility benchmarks. Exploratory multivariate models combining these indices outperformed the single indicator models. This study broadly supports using the Addictions Neuroclinical Assessment (ANA) framework for assessing alcohol use disorder (AUD) - specifically the motivational indices from the incentive salience and negative emotionality domains - for the development of next generation diagnostic assessments of AUD using theoretically informed mechanisms. As such, it reflects a further step in moving ANA toward utilization in clinical research and practice.
Addiction-related behaviors, such as loss of control eating (LOC), cigarette smoking and alcohol consumption, have been associated with high body mass index (BMI). This study aimed to assess genetic and environmental contributions to these associations over time. A longitudinal twin study using data from waves 2 and 3 of the Center on Antisocial Drug Dependence study, employing additive genetic (A), shared environmental (C), nonshared environmental (E) influences and cross-lagged models. Colorado, USA. The sample included 764 male and 997 female same-sex twins. BMI was calculated using self-reported height and weight. LOC was self-reported. Cigarettes smoked per day (CPD) and drinks per week (DPW) were assessed during interviews. We conducted three cross-lagged models: LOC and BMI in males, LOC and BMI in females and CPD and BMI in females, after excluding small phenotypic correlations (|r| < 0.10). Trait stability over time was largely attributable to genetic factors, accounting for 62% of the variance in BMI (both sexes), 11% in LOC (males), 18% in LOC (females) and 56% in CPD (females) at wave 3. Residual effects were mostly from nonshared environmental factors, accounting for 38% of the variance in BMI (both sexes), 76% of LOC (females), 71% of LOC (males) and 44% of CPD (females) at wave 3. A small but statistically significant cross-lagged effect occurred from wave 2 BMI to wave 3 LOC, explaining 12% (males) and 3% (females) of the variance in wave 3 LOC, with genetic factors accounting for most of this effect. No cross-lagged effects emerged from LOC or CPD to BMI. Genetic factors contributing to higher body mass index at an earlier age may also increase the risk of developing loss of control eating later in life, highlighting the importance of early weight-related interventions to prevent the onset of disordered eating behaviors.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Mindfulness-based relapse prevention (MBRP) has been shown to be beneficial to individuals with substance use disorder (SUD) in the West. The current pilot study aimed at testing the feasibility of MBRP in a Chinese population. This pilot study adopted a design of randomized controlled trial comparing MBRP with treatment-as-usual group (TAU). Participants were recruited from residential detox centers, community addiction counseling centers and substance abuse clinics specialized addiction treatment clinics in Hong Kong. A total of 81 adults (85.2% male) with SUD (illicit drugs only) were recruited. The intervention group participants (n = 41) attended a 1-hour orientation session followed by 2-hour weekly MBRP sessions for 8 weeks, delivered by a qualified MBRP teacher. The TAU group participants (n = 40) continued their service received from their referral agency. (After completion of all study assessments they were offered the same 8-week MBRP course.) MEASUREMENTS: Feasibility was measured by attendance, course satisfaction and retention rate. Participants' change in substance use and other related outcomes were captured by self-reported drug use, urine drug tests and a list of psychometric scales at baseline, immediately after MBRP and 3- and 6-month follow-up. The MBRP course satisfaction was high, and the attendance (57.4%) and retention rates (63.4%-85.4%) were comparable to previous trials. No statistically significant differences were observed between the MBRP and TAU groups for any outcomes, including craving, depression, anxiety, mindfulness and health-related quality of life; however, improvement trends were noticed in the MBRP group in self-efficacy in managing high-risk situations at post intervention, as well as in addiction severity and psychological flexibility at the 6-month follow-up. Mindfulness-based relapse prevention was shown to be feasible for substance use disorder treatment in a Chinese population. In this small study there was only limited evidence of abstinence efficacy, and no evidence of a benefit on other secondary outcomes.
Despite similar substance use levels, Black adults experience greater family, legal, employment and other social-contextual challenges related to recovery than other groups. Substance use treatments that address both substance use and social-contextual factors are uniquely positioned to address these substance-related problems and produce more sustainable improvements in social functioning than treatment as usual (TAU) or behavioral controls (Control). The aim of this study was to evaluate changes in substance-related problems among Black adults, focusing on the comparative effectiveness between social-contextual treatments and TAU/Control. Individual-level data synthesis based on secondary analysis of Black adults enrolled in the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN). All data were collected in the primary studies between 2001 and 2008 at clinics across the United States. Black adults who reported cocaine and/or opioid use across nine studies within the NIDA CTN. The sample used herein consisted of individuals from five of these studies who provided data on substance-related problems (n = 532; mean age = 39.34; standard deviation = 9.6). There were two treatment conditions: Social-contextual (e.g. Motivational Interviewing, Seeking Safety, STAGE 12) and TAU/Control. Moderated nonlinear factor analysis estimated latent scores for substance-related problems, using subscales from the Addiction Severity Index, while accounting for measurement noninvariance across studies, time and covariates. Linear mixed models estimated latent score differences over time between social-contextual treatments and TAU/Control during treatment and from the end of treatment through 12-month follow-up. Both treatment groups improved across substance-related problem areas from baseline to the end-of-treatment (Cohen's d = -0.10 to d = -0.47), with effects maintained at 12-month follow-up. Although social-contextual treatments did not statistically significantly outperform TAU/Control from baseline to end-of-treatment, they showed greater effects from end of treatment to 12-month follow-up in family/social [Cohen's d difference (Δd) = -0.47, 95% confidence interval (CI) = -0.57 to -0.38], legal (Δd = -0.20, 95% CI = -0.31 to -0.10) and psychiatric problems (Δd = 0.29, 95% CI = -0.38 to -0.20) than TAU/Control. Sensitivity analyses indicated that Seeking Safety and STAGE 12 predominantly drove post-treatment improvements in family/social problems. Substance use treatment may yield broader, delayed benefits beyond substance use reduction among Black adults in the United States. Compared with treatment-as-usual, social-contextual treatments can yield more sustainable effects in legal, family and psychiatric areas among Black adults, with interventions such as Seeking Safety and STAGE 12 showing particular benefits in addressing family-related challenges.
To monitor community-level consumption of 20 illicit drugs across urban areas of England using wastewater-based epidemiology (WBE) surveillance at high temporal resolution. This study was conducted over a 12-month period in 2022 sampling 24-hour composite wastewater samples at 15 wastewater treatment plants (WWTPs) covering catchment population equivalents ranging from ~100 000 to >1 million. Analysis was conducted using rapid liquid chromatography-tandem mass spectrometry methods. The sampled WWTPs collectively covered 21% of the national population. Primary data outcomes were the population-normalised daily loads (PNLs) entering the WWTP, estimated population-normalised consumption (both in mg/1000 people/day) and total mass (g/day) of 20 targeted illicit drugs and total mass in each catchment, quantified using suitable drug target residue markers in 1746 wastewater samples. Covariables included temporal indicators (e.g. public holidays, events) and regional factors. Presence, quantity and correlation of WBE-derived drug use data were used to infer drug use patterns. Of the 20 illicit drugs investigated, 18 were detected in at least one sample. Cocaine exhibited the highest average daily PNL (2770 ± 829 mg/1000 people/day), followed by heroin (382 ± 248), ketamine (287 ± 183), amphetamine (272 ± 268), 3,4-methylenedioxymethamphetamine (MDMA) (80 ± 57) and methamphetamine (60 ± 99) across 2022. When comparing PNLs to Sewage analysis CORe group-Europe (SCORE) and European Drugs Agency WBE data for 109 other WWTPs across Europe from March to May, 2022 cocaine and ketamine PNLs from sites in England were ranked statistically higher [cocaine: Wilcoxon rank-sum test statistic (W) = 971, adjusted P = 0.000115; ketamine: W = 264, adjusted P = 0.0000389]. Importantly, seven English WWTPs recorded higher mean ketamine PNLs than any other European site over the same period in 2022. Temporal spikes in drug consumption aligned with public holidays and major events. A notable decrease in cocaine use coincided with a 3.7-t UK seizure. Strong inter-drug correlations were observed across catchments, particularly for benzoylecgonine/ketamine and benzoylecgonine/cocaethylene. Extrapolation to generate a representative national average consumption estimate is not recommended, as the WWTPs studied were mostly classified as urban areas and found not to be representative of the entire population of England. Wastewater analysis revealed widespread and temporally variable illicit drug use across England in 2022, with ketamine use exceeding European levels at multiple sites. The findings highlight wastewater-based epidemiology's capacity to monitor drug use trends and identify community-level impacts of interventions and events.
暂无摘要（点击查看详情）
To systematically review the evidence on the psychometric performance and accuracy of screening or diagnostic tools for cannabis use disorder. Systematic review and meta-analysis which included studies conducted in clinical settings, schools, universities, community settings and population-based surveys in multiple countries and regions. Participants were adolescents, young adults, general adult populations, people who used cannabis, psychiatric and substance use treatment attendees, and specialised groups such as justice involved youth and military personnel. The tools assessed included The Cannabis Abuse Screening Test (CAST), the Cannabis Use Disorders Identification Test-Revised (CUDIT-R), the Severity of Dependence Scale (SDS), the Cannabis Problems Questionnaire (CPQ), the Cannabis Problems Questionnaire for Adolescents (CPQ-A), the Cannabis Use Problems Identification Test (CUPIT), the Tobacco, Alcohol, Prescription medication, and other Substance use tool (TAPS), the Marijuana Screening Inventory-X (MSI-X), the DSM-Guided Cannabis Screen, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), the Marijuana Problem Index (MAPI), the Toronto Cannabis Risk Screening Tool (TCRUST), the Nigerian Cannabis Use Disorder Scale, and the Problematic Use of Marijuana measure (PUM). These were assessed for internal consistency, test-retest reliability, as well as diagnostic accuracy using measures of sensitivity, specificity and area under the curve (AUC). Forty studies met inclusion criteria (2000-2025), including data from N = 23 175 participants. Methodological quality was generally moderate to high, though some studies relied on self-reported symptom checklists rather than structured diagnostic interviews. The most frequently studied tools were the CAST (k = 13 studies), CUDIT-R (k = 8), SDS (k = 5), CPQ and CPQ-A (k = 4), and CUPIT (k = 2). Across instruments, internal consistency was generally acceptable to excellent (α = 0.66-0.92), with fair to excellent discriminative validity (AUC = 0.71-0.96) for detecting cannabis use disorder or dependence. Optimal cut-offs varied statistically significantly by population and setting. In clinical samples, the tools generally performed stronger with the use of standard or higher cut-offs to prioritize specificity and avoid misclassifying non-cases. In general population samples, particularly youth, the tools had better performance with lower cut-offs to prioritize sensitivity. There is a lack of sufficient studies on screening or diagnostic tools for cannabis use disorder for clear evidence. Based on this limited current evidence, several brief screening or diagnostic tools are useful in identifying disorder or problem cannabis use in diverse settings, including the CAST, CUDIT-R, and SDS. Variation in optimal thresholds by age, clinical status and cultural context suggest that the utility of these screening or diagnostic tools depends on the population.
Electronic cigarettes (EC) are considered a smoking cessation tool in some countries, such as the United Kingdom, but uncertainty remains internationally over whether their benefits outweigh potential harms when used for this purpose. This overview (1) synthesised existing evidence from systematic reviews (SR) on the effectiveness and safety of ECs to explore and address these uncertainties and disagreements and (2) mapped primary intervention studies to identify priorities for further research. Overview of SRs published from 1 January 2015 and meeting the inclusion criteria of the Cochrane review of EC for smoking cessation. We searched seven databases to April 2024. We followed Cochrane screening and data extraction methods. We adapted Campbell Collaboration and 3ie methods for the Evidence and Gap Map (EGM). We assessed review quality using AMSTAR-2. We included 14 reviews of intervention studies (7 high quality; 7 low quality), with search dates from 2014 to 2023, in adult populations including the general population, people at risk of lung cancer, with comorbid health conditions and pregnant people. Eighteen studies were included across multiple reviews, some of which included multiple meta-analyses. Across 21 meta-analytic comparisons of nicotine EC versus other interventions, all reported point estimates favouring nicotine EC for smoking cessation, with relative risks/odds ratios typically in the range 1.17-1.67 versus nicotine replacement therapy and 1.46-2.09 versus non-nicotine EC, with higher-quality reviews giving more consistent estimates. Of 13 reviews that meta-analysed serious adverse events (SAEs), two reported point estimates suggesting increased SAEs with nicotine EC; other estimates included the possibility of no difference. For adverse events, pooled estimates generally indicated little or no difference between groups. Our EGM mapped 90 primary, complete studies and identified absolute gaps in evidence comparing the effects of nicotine EC to cytisine, bupropion and nicotine pouches. Most studies used collected data from high-income countries. Meta-analyses of electronic cigarettes (EC) for smoking cessation report point estimates favouring higher ≥6-month smoking cessation rates with nicotine EC compared with nicotine replacement therapy, non-nicotine EC/placebo, behavioural or no support and mixed support. Evidence on serious adverse events (SAEs) remains inconclusive. Evidence gaps were identified in SAE data and in studies from low- and middle-income countries.
Mandated reduction of the nicotine content of cigarettes to reduce addictiveness to minimal levels has the potential to substantially reduce combusted cigarette use and promote public health. This paper examined the hypothesis that when people who smoke cigarettes are switched to very low nicotine content (VLNC) cigarettes and provided with access to non-combusted alternative nicotine delivery systems (ANDS), they will titrate nicotine to maintain baseline levels of nicotine intake with the use of ANDS. This is a secondary analysis of a recently published randomized clinical trial. Clinical trial number NCT03272685. Multicenter clinical trial conducted in the United States. 438 individuals who smoked 5 to 40 cigarettes per day, mean age 44 (range 20-73). Smokers were randomized 1:1 for 12 weeks of smoking Spectrum brand research cigarettes containing VLNC (0.4 mg nicotine/g tobacco) or normal nicotine content (15.8 mg nicotine/g, NNC). Participants purchased tobacco products from an experimental marketplace containing non-combusted ANDS, including electronic cigarettes, nicotine replacement medications and oral nicotine products. Measures taken at baseline, 4, 8 and 12 weeks included cigarettes smoked per day (CPD) and measures of ANDS use, assessed using past 3-day daily diary data, which would roughly account for nicotine intake as measured by urine total nicotine equivalents (TNE). Based on self-report and biomarker data at weeks 4, 8 and 12, we characterized three product-using groups of participants as cigarette-only users, ANDS-only users and dual users. Nicotine titration was assessed as the ratio of urine TNE at various research cigarette study weeks compared with baseline (smoking their own cigarettes). Combusted product abstinence was examined using expired carbon monoxide (CO) and adherence to smoking VLNC by urine anatabine. Median titration at 12 weeks in cigarette-only participants was 0.84 (interquartile range 0.68-1.18) in the NNC group and 0.05 (0.01-0.12) in the VLNC group. Median titration at 12 weeks in ANDS-only participants was 0.81 (0.69-1.16) in the NNC group and 0.89 (0.49-1.58) in the VLNC group. Median titration at 12 weeks in dual use participants was 1.0 (0.78-1.29) in the NNC group and 0.91 (0.61-1.25) in the VLNC group. Most adults who smoke, when switched to very low nicotine content cigarettes, will use available alternative nicotine delivery systems (ANDS) to supplement their intake of nicotine. Provision of ANDS appears to be associated with a high degree of nicotine titration. Making less harmful ANDS widely available may make a mandated nicotine reduction intervention more acceptable to people who smoke. Clinical Trial Registration Details: NCT03272685.
Cannabis use disorder (CUD) is a pressing public health concern in the United States, and understanding trends in prevalence requires considerations of how changes in measurement influence identification of CUD. Starting in 2021, the National Survey on Drug Use and Health (NSDUH) assessed CUD using all 11 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria in their entire sample; before then, studies could use a nine-criteria DSM-5-proxy measure based on shared DSM-IV criteria. We aimed to identify sociodemographic characteristics associated with additionally identified CUD when using the full DSM-5 measure compared with the DSM-5-proxy measure. Observational study using nationally representative data. United States. 39 973 participants ages 12 + who reported past-year cannabis use in the 2021-2023 NSDUH (weighted N = 57 872 556). Additionally identified mild, moderate, or severe CUD was defined as meeting 2-3, 4-5, or 6 + of the 11 DSM-5 criteria and not meeting the same thresholds with the nine DSM-5-proxy criteria. Multinomial logistic regression models compared characteristics of people with additionally identified mild (vs. none), moderate (vs. mild), and severe (vs. moderate) CUD. We also calculated the percentage of people meeting each of the 11 criteria who had additionally identified CUD. Among people who reported past-year cannabis use, 30.5% had DSM-5 CUD, including 7.9% with additionally identified mild CUD not previously identified using the DSM-5-proxy measure, 6.9% with additionally identified moderate CUD and 3.4% with additionally identified severe CUD. People who were younger (vs. 35-49); multiracial (vs. white); non-Hispanic American Indian or Alaska Native (vs. white); or publicly insured or uninsured (vs. privately insured only) were more likely to have additionally identified CUD and/or CUD severity. People who were older (vs. 35-49); Hispanic (vs. white); were non-Hispanic Asian, Native Hawaiian, or Pacific Islander (vs. white); reported female sex (vs. male); or had annual income greater than $75 000 (vs. <$20 000) were less likely to have additionally identified CUD and/or CUD severity. Additionally identified CUD was most common among those meeting "craving" (25.0%), "withdrawal" (20.3%), and "spending time" (14.8%) criteria. The full Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) measure of cannabis use disorder (CUD) additionally identified CUD differentially across sociodemographic groups in the United States, compared with the DSM-5-proxy measure. Some groups (e.g., people younger than 35 years old, people with any public or no insurance, and people who are multi-racial or non-Hispanic American Indian or Alaska Native) may need more CUD-related services and support than previously expected.
Recent studies have shown that Black men and women have been disproportionately impacted by overdose deaths within recent years, with their mortality rates rising sharply compared with their White counterparts. As the United States is in the fourth wave of the polysubstance use overdose crisis, it is unclear if polysubstance use is contributing to these disparate patterns of overdose mortality across race and gender. This study aimed to measure gender-specific racial disparities in opioid related polysubstance use drug mortality in the United States from 2004 to 2022. In this population-level study of all deaths occurring in the United States, we obtained finalized death records of overdose fatalities identified using codes in the International Classification of Diseases, Tenth Revision (ICD-10) from Centers for Disease Control (CDC) and Prevention's Wide-Ranging Online Database for Epidemiologic Research (WONDER) Multiple Cause of Death file, from 2004 to 2022. Annual Percent Change (APC) and Annual Average Percent Change (AAPC) in age-adjusted mortality rates (AAMR) for White men, White women, Black men, Black women, Hispanic men and Hispanic women were determined using joinpoint regression in this cross-sectional study. Joinpoint regression was used to examine mortality rates for opioid-only, opioids with a stimulant, opioids with benzodiazepines, among racial/gender groups to measure temporal trends in age-adjusted overdose mortality due to polysubstance-related overdose. The final analytic sample included n = 627 793 opioid-only deaths, n = 196 001 opioid-stimulant and n = 117 322 opioid-benzodiazepine overdose deaths. Opioid-involved deaths increased across all groups, with the highest absolute rate change experienced by non-Hispanic Black men (53.55 per 100 000, AAPC: 17.3%) and pronounced increases shown to occur between 2011 and 2022 (APC: 29.0%). Opioid-stimulant polysubstance use deaths had the largest increases among non-Hispanic Black men and women, with a 39.5% APC (2011-2022) for men and 36.2% APC (2012-2022) for women. Among Hispanic men, the rates accelerated 33.8% per year (2012-2022). For opioid-benzodiazepine polysubstance use deaths, non-Hispanic White men and women experienced the highest absolute rate change of 3.39 and 2.41 per 100 000, respectively. In the United States from 2004 to 2022, overdose deaths from polysubstance use escalated sharply across all racial and ethnic groups, with disproportionate increases across non-Hispanic Black and Hispanic individuals, particularly in opioid-stimulant and opioid-only profiles.
To situate Jordan within evolving Middle East and North Africa (MENA) substance-use dynamics and summarise national patterns of substance use, related harms, and policy responses, with attention to transit-to-consumption transitions, surveillance limitations, and vulnerable populations. Structured regional synthesis of government reports, peer-reviewed literature, and data from the Ministry of Health, the Anti-Narcotics Department, and international agencies. The review integrated national statistics (2019-2025) with findings from population, student, and clinical studies to outline prevalence, treatment, and regulatory contexts. Across MENA, conflict, displacement, demographic pressure, and shifting trafficking routes have coincided with expanding stimulant and pharmaceutical markets. In Jordan, a comparatively stable setting with a large youth population, available estimates suggest national substance use disorder [SUD] prevalence of ~0.9-1.7%, but substantially higher levels among students (7-17%), indicating concentrated risk and likely underestimation in population surveys due to stigma and underreporting. Cannabis and amphetamine-type stimulants (including Captagon) feature prominently in seizures and treatment presentations, alongside rising nonmedical use of benzodiazepines and gabapentinoids linked to regulatory gaps and pharmacy access. Tobacco use remains extremely high (66% of men), while alcohol consumption appears low in population surveys yet disproportionately represented in clinical and forensic data, highlighting hidden harm and surveillance constraints. Treatment is largely centralised in two public centres; opioid agonist therapy is limited (methadone primarily for inpatient detoxification in private settings). Harm-reduction coverage (e.g., needle-syringe programming, overdose prevention) remains low and shaped by legal, funding, and human-rights considerations. The 2022-2026 National Mental Health and Substance Use Action Plan prioritises integration into primary care. Jordan is progressing toward a coordinated national response to substance use and substance use-related problems, yet major gaps persist in epidemiological surveillance, harm-reduction, and gender- and youth-specific interventions. Continued investment in research and evidence-based policy evaluation remains essential for sustainable progress. Jordan's trajectory reflects broader shifts across the Middle East and North Africa (MENA) region, where traditionally low-prevalence settings are confronting rising stimulant markets, prescription drug misuse, and constrained harm-reduction capacity.
People with substance-use disorders (SUDs) have increased mortality risk, yet Chilean estimates of SUD-based mortality are scarce. This study aimed to quantify all-cause and cause-specific mortality following SUD treatment in Chile compared with the general population and assess variation across key clinical and demographic subgroups. National-level registry-based retrospective data linkage cohort study. Publicly funded SUD psychosocial treatments offered by the Chilean National Drug Agency, linked with official national mortality records from 2010 to 2020. 70064 adults aged 18-64 years (24% women, median age 35 at treatment entry) were followed after their first treatment episode until death or 31 December 2020. Primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality by the International Classification of Diseases, 10th revision, underlying and external causes. We estimated age-sex-calendar year directly standardized rates (DSR), and standardized mortality ratios (SMR) compared with the expected rate for the (sub)population. We also stratified rates and ratios by sex (men/women), attained age (18-29, 30-44, 45-59, 60+), setting (ambulatory/residential), primary substance (alcohol; illicit: predominantly cocaine paste base, marijuana and cocaine hydrochloride) and treatment compliance (not completed/completed). Additionally, we estimated rates and SMRs for underlying and external causes of mortality. Over a median 4.9-year follow-up (353 826 person-years), 2996 deaths occurred [DSR = 10.6, 95% confidence interval (CI) = 8.6-13.1]. Overall SMR was 3.65 (95% CI = 3.52-3.79). Excess risk was particularly pronounced for women (SMR = 5.57, 95% CI = 5.14-6.03), patients admitted due to alcohol use disorder (SMR = 4.59, 95% CI = 4.33-4.86), in residential care (SMR = 4.91, 95% CI = 4.45-5.42) and treatment noncompletion (SMR = 4.04, 95% CI = 3.85-4.24). Cause-specific mortality revealed elevated external-cause excess risk for SUD patients, including intentional self-harm (SMR = 6.67, 95% CI = 6.05-7.36), unintentional injuries (SMR = 5.37, 95% CI = 4.79-6.02) and assaults (SMR = 4.98, 95% CI = 4.16-5.96). Notable excess risk was also observed for non-external mortality causes: digestive system (SMR = 8.20, 95% CI = 7.62-8.83), symptoms and signs (SMR = 5.18, 95% CI = 4.29-6.26) and respiratory diseases (SMR = 5.18, 95% CI = 4.47-5.99) were greater than expected. In Chile, patients with a history of publicly funded substance-use disorder treatment appear to have an all-cause mortality up to 3.7 times higher than the general population, driven predominantly by digestive and respiratory causes, as well as self-harm, unintentional injuries and assaults.
Few studies have examined multiple domains of sleep deficiency among patients receiving methadone treatment (MT). This study investigated sleep deficiency classes and their associations with demographics, clinical characteristics and one-year treatment outcomes among patients receiving MT. Longitudinal study using patient-completed questionnaires on demographics, sleep, pain interference with sleep and psychological symptoms in August 2023. We used latent class analysis to group patients into sleep deficiency classes and employed multinomial logistic regression to investigate their demographic and clinical correlates. Treatment continuity and urine toxicology results over the subsequent year were analyzed in August 2024. A not-for-profit federally certified opioid treatment program in Connecticut, USA. 1237 patients receiving MT. Sleep questionnaires included the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Brief Index of Sleep Control, STOP questionnaire and the first two items from the Cambridge-Hopkins Restless Legs Syndrome Questionnaire. Urine toxicology results and treatment continuity were extracted from the medical chart. We identified four classes. Class I (28.0%): normal sleep/no sleep deficiency. Class II (24.8%): late sleep with increased risk for obstructive sleep apnea and restless legs syndrome. Class III (20.5%): poor sleep quality with short and late sleep. Class IV (26.6%): severe sleep deficiency. Compared with Class I, participants in Classes II-IV had statistically significantly higher odds of reporting psychological symptoms [Class II adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.10-1.81; Class III aOR = 1.58, 95% CI = 1.23-2.03; Class IV aOR = 2.21, 95% CI = 1.72-2.84] and pain interference with sleep (for three or more days per week: Class II aOR = 5.52, 95% CI = 2.93-10.38; Class III aOR = 5.04, 95% CI = 2.62-9.69; Class IV aOR = 13.16, 95% CI = 6.98-24.84). Over the subsequent year, compared with Class I, participants in Class III had statistically significantly higher rates of positive urine toxicology results for benzodiazepines, while participants in Class IV had statistically significantly higher rates of positive urine toxicology results for fentanyl and benzodiazepines. Treatment continuity did not differ across the four classes after one year following baseline. Varieties of sleep deficiency compared with normal sleep appear to be associated with more severe psychological symptoms and pain interference with sleep among patients receiving methadone treatment and may serve as risk factors for substance use.