Existing evidence shows that chemsex practice can contribute to adverse health outcomes. However, the presence of addictive disorders based on DSM-5 criteria remains underexplored in this population. The present study aimed to assess the overall prevalence and associated factors of substance use disorders (SUDs) and chemsex addiction among individuals engaged in chemsex, using an online self-report questionnaire. The sample included 132 French adults having engaged in chemsex within the previous 12 months. Sociodemographic characteristics, substance use patterns, DSM-5 criteria for substance use disorders and DSM-5 criteria adapted to assess chemsex addiction, associated consequences, and sexual practices were collected. Univariate analyses and logistic regression models were conducted to explore factors associated with substance and chemsex-related addictions. The most frequently used substances were synthetic cathinones, followed by GHB/GBL and stimulants. Addictive disorders were highly prevalent, particularly cathinone use disorder and addiction to chemsex practice, which were associated with increased negative consequences, notably mental health problems and suicidal ideation. The presence of cathinone use disorder was associated with GHB/GBL use disorder, loss of control over sexual behavior, craving for sex, and chemsex addiction. Both cathinone use disorder and craving for sex significantly predicted chemsex addiction. This study highlights the importance of assessing addictive disorders in the context of chemsex by integrating both substance and behavioral addictions, given the strong interconnection between substance use and sexuality. Multidimensional and integrated treatment approaches are needed to adequately prevent and manage specific addictive patterns and associated risk-taking behaviors among individuals engaged in chemsex.
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.
Online addictive behaviors are common among adolescents and may reflect efforts to cope with inner emptiness, loneliness, or emotional pain. These behaviors suggest a deeper form of emotional disconnection that existing constructs do not fully capture. To address this gap, the present study developed the Sense of Absence Scale (SoAS), a measure designed to assess adolescents' experiences of inner void, relational invisibility, and reduced engagement in daily life. Participants included 1,555 non-clinical adolescents aged 14-18 years. Psychometric analyses included Exploratory Graph Analysis (EGA), Confirmatory Factor Analysis (CFA), and Item Response Theory (IRT). Additionally, we examined correlations between the SoAS and several external self-report measures assessing loneliness, hope, suicidal ideation, and online addictive behaviors to consider convergent and nomological validity. EGA indicated a stable item structure, which was confirmed by the CFA (χ2(77) = 588.35, p < .01, CFI = .96, TLI = .95, RMSEA = .050). IRT analyses showed strong discrimination and high reliability (α ≈ .97). The seven point response format provided the best fit. Convergent validity was high within SoAS items and moderately strong with emptiness. Higher SoAS scores were strongly related to emptiness and mental pain, moderately associated with suicidal ideation, loneliness, and online addictive behaviors, and negatively related to hope and self-compassion. The SoAS has psychometric support among a general population of adolescents. Future studies should examine its functioning in clinical populations and its potential in intervention development.
Steven Hyman, former director of the National Institute of Mental Health (2012), argued that neuroscience research in psychiatry frequently inherits the DSM's assumption that disorders are discrete entities, even though empirical boundaries between conditions are often porous. In response, Hyman and colleagues advanced the Research Domain Criteria (RDoC), which organizes psychopathology around core neurobiological domains that cut across diagnoses. In a conceptually similar direction, Blum (1995) introduced Reward Deficiency Syndrome (RDS) as a transdiagnostic construct intended to unify substance-related and behavioral addictions. To date, PubMed includes more than 1,650 reports referencing "reward deficiency" and 281 specifically referencing RDS. Recent genome-wide association and pharmacogenomic findings in very large cohorts (88.8 million subjects) are interpreted as supporting dopaminergic dysregulation as a key phenotype underlying RDS vulnerability. The Genetic Addiction Risk Severity (GARS®) panel was developed to estimate liability for RDS and "preaddiction." Notably, many conditions listed in DSM-5 share overlapping genetic polymorphisms, with frequent convergence on pathways involved in dopaminergic neurotransmission. Building on this framework, we propose a biphasic prevention and treatment strategy for both substance (e.g., alcohol, nicotine) and non-substance (e.g., highly palatable food/glucose-related) addictive behaviors. In the acute setting, harm-reduction approaches may require targeted modulation of postsynaptic dopamine receptors (D1-D5) within the nucleus accumbens (NAc). Over longer time horizons, however, durable recovery may depend on restoring dopamine signaling-specifically, promoting dopamine activation and release within the NAc to support dopamine homeostasis. Failure to balance short-term and long-term dopaminergic interventions may contribute to affective instability, maladaptive behavior, and, in vulnerable individuals, suicidal ideation. Individuals with serotonergic/dopaminergic receptor deficits and/or high catechol-O-methyltransferase (COMT) activity may be more likely to self-medicate using substances or behaviors that transiently increase dopamine release. A growing body of evidence suggests that increasing D2 receptor expression in genetically vulnerable populations could reduce addictive risk. Although D2 agonists can downregulate receptors in vivo, in vitro work indicates that sustained stimulation may promote receptor proliferation, and gene-transfer studies producing DRD2 overexpression reduce alcohol and cocaine seeking in rodent models. Finally, naturalistic dopaminergic repletion strategies may represent a safer long-term approach to normalize dopaminergic function, support recovery, and improve quality of life across RDS-related behaviors. (WC 286).
Obesity is associated with societal pressure to eat "healthy", potentially increasing the risk of orthorexia nervosa (ON), an obsession with healthy eating characterized by food hyperselectivity. This observational study explored ON traits in obesity, focusing on food hyperselectivity and categorization strategies. A total of 114 participants with obesity (91 women, 20 men, 3 gender-diverse; Age = 44.6 ± 10.5; BMI = 39.6 ± 7.4) were assessed through an online food categorization task and questionnaires, including the Eating Habits Questionnaire, Eating Disorders Examination Questionnaire, Yale Food Addiction Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorders-7. Quantitative data were analyzed using correlations and regression models. Participants scored high on eating disorders, addictive-like eating behaviors, anxiety, and depression, but not ON traits. However, those with higher ON traits displayed distinct food categorization strategies compared to those with lower ON traits, avoiding categorizing unhealthy foods as healthy. Participants with addictive-like eating behaviors exhibited similar categorization patterns alongside heightened scores for eating disorders, anxiety, and depression. ON traits correlated with risk-averse food evaluation strategies in obesity, emphasizing caution towards "unhealthy" foods, potentially exacerbating restrictive eating behaviors. Integrating these insights into psychological or nutritional interventions could improve support by addressing maladaptive food evaluation.
Excessive engagement in online gaming and gambling is increasingly prevalent among young individuals, particularly first-year university students, and is associated with significant psychosocial damage. The aim of the present study was to identify empirical clusters among university students reporting problematic online gaming and gambling behaviors and to examine the extent to which these clusters differ from a control group of students without gaming- and gambling-related problems. The sample included 273 first-year university students (180 women and 93 men, aged 18-25 years). Participants were first classified into a subgroup with problematic online gaming or gambling (n = 100) and a non-problematic (control) group (n = 173), based on DSM-5 criteria. A two-step cluster analysis was then conducted exclusively within the problematic subgroup to identify latent profiles, using indicators of addictive behavior severity, engagement with social networks and the internet, impulsivity, emotion dysregulation, gambling-related cognitive distortions, and psychological distress. Subsequently, the identified clusters were compared with each other and with the control group across a broad range of psychological and behavioral indicators. Two clusters were identified, primarily differentiated by the severity of gaming-gambling involvement and associated psychological vulnerabilities. Cluster profiles revealed distinct patterns of impulsivity, emotional deficit, and cognitive biases. Both clusters significantly differed from the control group, with higher scores on all clinical and cognitive measures except for the social internet use and sensation seeking. The findings provide empirical support for the heterogeneity of problematic gaming and gambling among young university students. The identification of discrete subgroups underscores the relevance of individualized prevention and intervention strategies, tailored to the severity and psychological correlates of the addictive behavior(s). These results also highlight the need to refine screening and diagnostic tools within this target population.
Reports the notice of retraction of "Preventing tobacco and alcohol use among high school students through a hybrid online and in-class intervention: A randomized controlled trial" by Christopher Williams, Kenneth W. Griffin, Sandra M. Sousa and Gilbert J. Botvin (Psychology of Addictive Behaviors, 2025[Sep], Vol 39[6], 528-540; see record 2025-86677-001). The published paper reported an incorrect registration number for https://clinicaltrials.gov/. When comparing the correct https://clinicaltrials.gov/ trial registration (NCT03219190) and the published article, there were several discrepancies between the protocol as reported in the published paper and the appropriate https://clinicaltrials.gov/ registry, which deviated from accepted standards for the reporting of RCTs. The outcomes reported in the published article were not specified as primary or secondary outcomes of the trial. The Allocation (randomized) sample size (n = 1804) was markedly less than the registered Anticipated sample size of n = 3000. The age range for the population listed in the https://clinicaltrials.gov/ registration (11-14 years old) was younger than the average age of participants in the published paper (mean age = 15.2). (The following abstract of the original article appeared in record 2025-86677-001.) Objective: School-based health promotion programs can have a positive effect on behavioral and social outcomes among adolescents. Yet, limited classroom time and suboptimal program implementation can reduce the potential impact of these interventions. In the present randomized trial, we tested the effectiveness of a classroom-based substance use prevention program that was adapted for hybrid implementation. The hybrid adaptation included eight asynchronous e-learning modules that presented didactic content and eight classroom sessions designed to facilitate discussion and practice of refusal, personal self-management, and general social skills. Nineteen high schools were randomly assigned to intervention or control conditions. Students (N = 1,235) completed confidential online pretest and posttest surveys to assess the effects of the intervention on tobacco and alcohol use and life skills. The sample was 50.7% female and 35.5% non-White with a mean age of 15.2 years. Analyses revealed significant program effects on current cigarette smoking, alcohol use, drunkenness, and intentions for future use. There were also program effects for communication, media resistance, anxiety management, and refusal skills. Taken together, these findings suggest that hybrid approaches can produce robust prevention effects and may help reduce barriers to the widespread adoption and implementation of evidence-based prevention programs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Problematic social network use (PSNU) has gained increasing attention as a potential disorder due to addictive behavior. However, evidence regarding underlying cognitive mechanisms remains inconsistent. Implicit cognitive processes, such as implicit associations and approach-avoidance tendencies, have been proposed as relevant factors in substance use disorders and behavioral addictions, but their role in PSNU is still unclear. Given similarities in usage behavior between PSNU and tobacco use disorder (TUD), a direct comparison may help to identify converging and diverging mechanisms. In a laboratory study, a sample of N = 178 participants was classified into four groups using a structured diagnostic interview: individuals with PSNU (n = 53), risky use (n = 61), non-problematic use (n = 48), and TUD (n = 16). Implicit cognitions were assessed using the Implicit Association Test (IAT) and the Approach-Avoidance Task (AAT) with behavior-specific stimuli. Group differences were analyzed using ANOVA and ANCOVA, the latter statistical approach controlling for age and psychopathological symptoms. Significant group differences emerged for the IAT, in individuals with PSNU and risky use showing more positive implicit associations towards behavior-related stimuli than the TUD group but did not remain stable when controlling for age and comorbid psychopathological symptoms. No significant group differences were found for approach-avoidance tendencies across all groups. Our results suggest that implicit cognitions may play a more complex role in PSNU than previously assumed. Implicit associations may already occur in early stages of addictive behaviors and approach-avoidance tendencies may depend on contextual and intraindividual factors. Future research should further address these factors, also by using advanced ecologically valid methods.
Problematic Use of Licit Substances is an increasing public health concern in Lebanon, where political and economic instability, alongside cultural and religious diversity, may intensify risk behaviors, while social desirability and conformity can influence their reporting. This study aims to assess the profiles of participants related to social desirability and conformity pressures and their association with licit substance use and problematic use. A cross-sectional online survey was conducted among 460 adults in Lebanon (February-March 2025). Data on cigarette, waterpipe, and alcohol use were collected alongside validated measures of social desirability and conformity. A two-step cluster analysis was first conducted to determine the optimal number of clusters, followed by K-means clustering to classify participants based on their social desirability and conformity scores, with subsequent regression analyses examining sociodemographic and cluster membership correlation with substance use behaviors. Three clusters emerged: Norm Internalizing Perfectionists (N = 127 (29.2%)); Detached Autonomists (N = 143 (32.9%)); and Strategic Conformists (N = 165 (37.9%)). The risk of problematic substance use was higher in the detached/autonomous phenotype and increased with age and among male gender participants, while religious prohibition appeared strongly protective. Differential results were found for waterpipe and alcohol, in comparison with problematic cigarette use. Considering social desirability and conformity allows for more precise identification of problematic substance use clusters, guiding targeted prevention and intervention. This complex interplay of personality traits, cultural values, age, gender, and education highlights the need for culturally sensitive, gender-specific, and cluster-tailored public health and psychosocial interventions rather than universal approaches.
Research on young adult alcohol use often overlooks the influence of specific social network members on daily alcohol use. This pilot study combined egocentric social network methods with a daily diary design to examine how network members influence drinking at the day level. Participants (N = 21) identified six social network members they frequently drank with and saw in person and then reported on these individuals in a 21-day study. Daily reports captured self-reported alcohol use and social network members presence and alcohol use from the previous day. Across 417 morning reports, participants drank on 77 days (18.5%), consuming an average of 2.36 drinks (SD = 1.70) on those days. Linear mixed-effects models showed that being with a given network member who was drinking was associated with consuming 1.75 more drinks than the participant's average. Network members who contributed to higher alcohol use were more likely to be people the participant intended to drink with in the future and who had frequently consumed alcohol in the past month, regardless of whether it was with the participant. The findings from this pilot study provide preliminary evidence that the drinking of and anticipating future drinking with certain network members contributes to greater alcohol use and suggests that interventions could use personalized feedback to help individuals recognize the network members who facilitate heavier drinking.
Reward learning can contribute to addictive behaviors by shaping attention and action selection. While reward-associated stimuli are known to capture attention, it remains unclear whether such learning can also guide behavior without stimulus-outcome contingency awareness. This study examined whether implicitly learned reward associations influence both attention and action selection, and how these effects relate to risky alcohol use. Eighty university students (40 low-risk and 40 high-risk drinkers) completed a Pavlovian-to-instrumental transfer task combined with an emotional attentional blink paradigm. During learning, conditioned stimuli and responses were probabilistically paired with monetary rewards. Awareness of stimulus-outcome contingencies was assessed at the individual level, using the Bayesian Awareness Categorization Technique. Reward-related influences on attention and response selection were then tested in a transfer phase. We observe no evidence of Pavlovian-to-instrumental transfer in either participants aware or unaware of reward contingencies. Similarly, reward associations did not modulate attention. The absence of effects in both aware and unaware participants makes it difficult to determine whether Pavlovian influences on attention and behavior are truly absent or simply not detectable under the current task conditions. However, exploratory analyses show that high-risk drinkers present greater preference for high-probability, low-value responses in the transfer phase. The observed preference for high-probability rewards in high-risk drinkers may reflect altered reward sensitivity. Together, these findings underscore the importance of evaluating reward-driven attentional and behavioral biases under well-controlled conditions and highlight the value of publishing null results to refine theoretical models of Pavlovian influences in addiction.
The growing popularity of various gambling platforms, the dispositional greed to indulging in it, and the emotional attachment associated with it have led to an unusually alarming attractiveness to gambling behaviors in most young males. This study established a mechanism and adopted Ryan and Deci (2017) self-determination theory(STD) to explain problem gambling through dispositional greed and emotional regulation. A total of 1123 Southeastern Nigerian male sample whose ages ranged from 18 to 30 years (mean age = 24 years, SD = 3.80) participated in the study.The study adopted a cross-sectional design, and participants responded to Problem Gambling Severity of Index (PGSI), Emotion Regulation Questionnaire (ERQ), and Greed Scale. Results of the correlation analysis and Hayes Process Macro showed that emotion regulation was not associated with problem gambling. However, the expressive suppression dimension became positively associated with problem gambling after being enhanced by dispositional greed, which positively associated with problem gambling and further mediated its relationships with both dimensions of emotion regulation. Interventions targeting emotional regulations and dispositional greed may be effective in reducing problem gambling behaviors.
This repeated cross-sectional study examined trends and behavioral correlates of excessive screen time among Swedish adolescents across 2017, 2020 and 2023. Specifically, this study examined 1) temporal trends of variables used, 2) correlates of pooled screen time, and 3) correlates of specific screen modalities (gaming, social media, and film/TV viewing). Data were collected from n=8,300 upper secondary school students in Jönköping County (n=2,319 in 2017; n=3,056 in 2020; n=2,925 in 2023). Measures used included risk behaviors (e.g., alcohol, smoking), physical activity, psychosocial trust, exposure to violence and victimization, sleep duration, psychosomatic symptoms, absenteeism and living arrangement. General linear models (GLM; UNIANOVA) were conducted, adjusting for relevant covariates. Alcohol use, smoking, shorter sleep duration, higher psychosomatic symptoms, and school absenteeism were associated with higher pooled screen time, whereas physical activity, female gender, and living with both parents were associated with lower pooled screen time. Across modality-specific analyses, shorter sleep duration, lower physical activity, living without both parents, and school absenteeism were consistently associated with higher screen use across gaming, social media, and film/TV viewing, while substance-use and gender associations varied by modality. Sleep, physical activity, family structure, and school absenteeism appear to be robust correlates across screen modalities, supporting the importance of targeting these factors in adolescent health promotion and digital media guidance. These findings highlight the need for parents, researchers, and health professionals to pay closer attention to adolescents' digital media use.
Objective: Although compulsive internet use reflects interactions between personal vulnerabilities and situational triggers, adolescents' day-to-day screen time patterns, especially in non-Western contexts, remain understudied. We aim to examine temporal patterns of screen time among Moroccan adolescents and their associations with compulsive internet use (CIU) and sociodemographic factors. Methods: This study uses an intensive daily design to capture short-term fluctuations in screen use across a week, identifying weekday-weekend shifts and other dynamics. A total of 334 Moroccan high school students (Mage = 16.02 years, 52 % female) from three public schools in urban and rural areas reported their daily screen time and CIU over seven consecutive days, their platform-specific usage and their scores on the CIUS. Latent class analysis (LCA) was used to identify subgroups with distinct weekly trajectories, and latent growth modeling (LGM) was used to assess temporal change. Linear mixed-effects models tested predictors, including age, sex, CIUS scores, school type, device preference, and primary internet activity. Results: Two distinct usage profiles emerged: steady-low and weekend-high. The weekend-high profile was more common among older girls and showed strong Sunday peaks. Mixed-effects and latent class models showed that higher CIUS scores, being female, and the day of the week (especially Sunday, with an increase of 74 min compared to weekdays) predicted heavier, multi-platform engagement. Conclusions: Moroccan adolescents show heterogeneous temporal patterns of screen use, with compulsive use linked to heavier, weekend-centered engagement. Prevention efforts should target overall exposure and high-risk time windows, especially on weekends.
Tobacco and alcohol use are linked to health disparities. In recent years, food insecurity, an indicator of disparities, has increased in Great Britain. This study examined the associations between food insecurity and tobacco or alcohol use. Data were drawn from a representative cross-sectional study of people aged ≥16 years in Great Britain (N = 4,056), conducted in January‒February 2025. Food insecurity was measured with the 6-item Household Food Security Scale, divided into high/marginal, low, or very low food security. Logistic regression models with food insecurity (combining low and very low food insecurity) as the outcome and adjusted for age, gender, nation of residence, socioeconomic position, financial hardship and smoking or alcohol consumption (measured using AUDIT-C score), were used to derive odds ratios (ORadj). Overall, 7.9 % (95 % CI: 6.9, 8.9) reported low and 9.6 % (8.6, 10.7) very low food security. Smoking was associated with food insecurity (ORadj = 1.75; 95 % CI: 1.32, 2.31). People who abstained from alcohol were more likely to be food insecure compared with those who drank at increasing (AUDIT-C 5: ORadj = 0.62; 0.41, 0.93) or higher risks of harm (AUDIT-C 8: ORadj = 0.63; 0.40, 0.97); however, this relationship was moderated by psychological distress. Food insecurity was associated with higher smoking prevalence. Among people experiencing distress, those abstaining from alcohol and at risk of dependence appeared more likely to experience food insecurity than those drinking at other levels. These findings suggest the need for interventions that offer support for smoking, alcohol and which address underlying stressors of food insecurity.
Loneliness is a pervasive public health problem, especially among individuals with problematic substance use (PSU). To date, however, scarce research has examined the prevalence and correlates of loneliness in vulnerable segments of the population, such as US military veterans. Data were analyzed from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of US veterans. The Three-Item Loneliness Scale was used to assess clinically significant loneliness (≥6). Multivariable logistic regression and relative importance analyses were conducted to identify correlates of loneliness in 593 veterans with PSU. Nearly half of US veterans with PSU (47.4%) reported clinically significant loneliness. In a multivariable analysis, loneliness was independently associated with being unmarried/unpartnered, greater current psychological distress (depressive and posttraumatic stress symptoms), lifetime suicide attempt, and physical disability, smaller social network size, and lower levels of purpose in life and optimism. In a relative importance analysis, major depressive and posttraumatic stress symptoms (35.4%), smaller social network size (16.7%), and lower purpose in life (15.0%) and optimism (13.6%) explained the majority of the variance in loneliness. Purpose in life also moderated the link between depressive symptoms and loneliness: among veterans with depressive symptoms, those with higher purpose in life had a lower likelihood of loneliness. Nearly half of US veterans with PSU report significant loneliness. Prevention and treatment strategies that address psychological distress, foster meaningful social connections, and enhance veterans' sense of purpose may help mitigate the burden of loneliness in this population.
Excessive marijuana use is associated with greater negative consequences, especially among youth. Identifying factors influencing these outcomes is crucial. While the Big Five personality traits are considered distal risk factors, marijuana motives act as more proximal mechanisms to marijuana use. This study aimed to examine the mediating role of marijuana motives (Coping, Enhancement, Social, Expansion, and Conformity) in the associations between the Big Five personality traits and marijuana use frequency and negative consequences, and to test the generalizability of these results across college students from the U.S., Argentina, Spain, and the Netherlands. A cross-sectional sample of 1031 university students who reported past-month marijuana use completed measures of the Big Five traits, marijuana motives, and marijuana-related negative consequences. Structural equation modeling was conducted to test the model and to test model invariance across countries. In the whole sample, coping, expansion, and enhancement motives were significantly related to higher marijuana use frequency, while coping motives were significantly related to higher negative consequences. Furthermore, coping motives mediated the association of low emotional stability and marijuana outcomes, while expansion motives mediated the association of openness with marijuana frequency. Only minor differences arose across countries. The present findings suggest two risky personality pathways for marijuana use and misuse: a negative affect regulation pathway common to other drugs such as alcohol, and a second one related to openness to marijuana expansion effects. Personality-targeted interventions and prevention programs could benefit from additionally considering this last pathway in prevention/intervention efforts.
Cannabis is often used alongside other substances, including cigarettes and alcohol. The objective of this study was to identify how the combination of these substances may affect sleep health. Data from an online, national survey of 518 adults (35.2 ± 13.4 years old; 65% female) were analyzed. Respondents reported their cannabis, cigarette, and alcohol use. Hazardous cannabis use was assessed using the Cannabis Use Disorder Identification Test - Revised (CUDIT-R). Sleep, insomnia, and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS), respectively. Sleep health was assessed using PSQI and ISI items about sleep quality, satisfaction, trouble staying awake, bedtime, waketime, sleep efficiency, and duration. Linear regression models examined associations of CUDIT-R and substance use with sleep scales and the individual sleep items, adjusting for sociodemographic factors. One-quarter used only cannabis, 45% alcohol and cannabis, 12% cigarettes and cannabis, and 19% all three substances (polysubstance use). Average scores were 10.4 ± 5.7 on the CUDIT-R, 8.0 ± 4.1 on the PSQI, 11.3 ± 6.2 on the ISI, and 6.4 ± 4.2 on the ESS. A higher CUDIT-R was associated with higher PSQI (β = 0.09, 95% CI = 0.01, 0.17) and ESS scores (β = 0.16, 95% CI = 0.07, 0.26). Compared to individuals who only use cannabis, individuals with polysubstance use had higher PSQI, ISI, and ESS scores and reported worse sleep quality and less sleep satisfaction. Sleep quality and satisfaction were most impaired by polysubstance use, whereas hazardous cannabis use increased sleepiness. The combined use of substances is detrimental to sleep health and highlights an area for public health messaging and awareness.
Injection drug use (IDU) is a major public health concern linked to HIV and hepatitis C infections, overdose deaths, and other adverse health and social welfare outcomes. We examined the role of self-reported painkiller dependence in shaping the timing and progression of IDU initiation. Data are from the National HIV Behavioral Surveillance (NHBS) survey conducted in San Francisco in 2022. Cumulative IDU initiation patterns were analyzed, stratified by prior painkiller dependence and other background characteristics using survival analysis. The chi-square was used to examine differences in age at first injection and related characteristics. Of 519 people who inject drugs (PWID) surveyed, 23.3% reported initiating IDU before the age of 18 years and 35.3% reported being hooked on painkillers before initiating IDU. Early IDU initiation was also associated with bisexual sexual orientation, lower educational attainment, younger age, and starting injection before 1990. Participants hooked on painkillers showed earlier and faster progression to injection drug use, with 50% initiating by age 40 compared to after age 50 among those not previously hooked (P < 0.001). By race/ethnicity, divergence in age at initiating IDU was evident after the late 20s and early 30s, with Black PWID having a later and slower onset of IDU compared to other groups (P < 0.001). We found a strong continuing association between prior self-reported painkiller dependence and earlier progression to IDU. These findings underscore the critical need for comprehensive public health interventions that address the root causes of opioid misuse and effectively target the transitions contributing to IDU.
Protective Behavioral Strategies (PBS) are cognitive-behavioural strategies that are promising to reduce risky alcohol consumption among students. This research investigates 1) the role of psychosocial determinants of drinking (motives and perceived social norms) as potential barriers to their use, and 2) the protective value of the four‑PBS against risky consumption. Two longitudinal studies (two-waves, one-year interval) in French university students were conducted. Latent Change Score Model (N = 164) tested how changes in psychosocial determinants were related to within-person changes in four PBS use. Cross-Lagged Panel Model (N = 188) examined reciprocal associations between each PBS and typical drinking quantity. Firstly, modifying the manner of drinking strategy (MOD; i.e., inhibiting risky drinking) showed the largest within-person change over one year, increasing as students grew older and decreased in social motives. Secondly, higher MOD use was consistently associated with fewer drinks per occasion, whereas other PBS domains showed mainly same-wave links with drinking. Prior drinking also strongly predicted later consumption, indicating that MOD operates as a protective factor beyond the relative stability of students' drinking patterns. Findings highlight MOD strategy as a priority target for reducing student alcohol consumption. Strengthening MOD may help reduce typical number of drinks, but interventions must also tackle social drinking motives that discourage its use. Student-focused prevention programmes could therefore prioritise presenting MOD as socially acceptable and compatible with enjoyable nights out, helping students to preserve social connection and pleasure while shifting towards safer, more sustainable patterns of alcohol use.