搜索结果：Journal of addictive diseases

Hospitalized patients with opioid use disorder present unique clinical challenges, including higher rates of patient-directed discharge (PDD), incomplete treatment courses, and frequent readmissions. To compare outcomes in hospitalized patient encounters involving OUD and bacteremia that were ordered medications for opioid use disorder versus high-dose opioid agonist therapy (HDOAT) alone. This single-center, retrospective study included 268 OUD patients, 383 encounters, and 303 cases of bacteremia admitted to Temple University Hospital from Jan 1, 2020 through Dec 31, 2022. Outcomes of interest included PDD, 7 and 30-day readmission, inpatient mortality, length of stay (LOS), one&#x2009;year mortality and antibiotic completion. Bacteremia is a serious illness and requires long term treatment, thus it is an optimal model for this work. Of 383 encounters, 234 involved MOUD, and 149 involved HDOAT alone. Among the HDOAT group, doses were up to 2,070 MMEs/day. MOUD included buprenorphine and methadone. HDOAT included non-MOUD full agonist such as oxycodone and/or hydromorphone. For case-level outcomes, MOUD was associated with higher antibiotic completion (35.0% vs 23.3%, OR 1.77, p&#x2009;<&#x2009;0.05). For encounter-level outcomes, MOUD was associated with lower PDD rates (38.5% vs 69.8%, OR 0.27, p&#x2009;<&#x2009;0.0001) and longer LOS (8d vs 3d), seven-days readmission and inpatient mortality rates were similar between groups. However, 30-day readmission rate was lower in the MOUD group (32.9% vs 43.0%, OR 0.65, p&#x2009;<&#x2009;0.05). PDD, readmission and mortality were similar regardless of timing of MOUD initiation (<72&#x2009;h vs > 72h) or severity of opioid dependence. Notably, 23% of HDOAT cases successfully completed antibiotics, often across multiple encounters. MOUD initiation was associated with lower PDD and higher antibiotic completion rates. Timing of MOUD initiation did not affect outcomes. HDOAT may serve as a second-line approach to support continuity of care in patients declining MOUD.

According to the Centers for Disease Control and Prevention (CDC), in 2023 alone, there were approximately 35,000 deaths that involved methamphetamine. Because methamphetamine is commonly used with alcohol, our objective was to investigate risk factors for concurrent use, which are underexplored. This was a secondary analysis of deidentified publicly available data (2021-2023) collected by the National Survey of Drug Use and Health (NSDUH). Our primary aim was to identify risk factors for concurrent use of methamphetamine and alcohol. We used the random forest method and conducted variable importance analyses to identify the most important predictors for concurrent use, and subsequently binomial logistic regression for identifying risk factors. Between 2021 and 2023, there were a total of 219 (0.13% of all respondents) respondents (449,590 respondents weighted) that reported concurrent use of methamphetamine and alcohol. The top three predictors per the random forest model were (reflective of past year behaviors): driving under the influence of a selected illicit drug (Gini: 0.08), emergency department visit for substance use (Gini: 0.05), and fentanyl misuse (Gini: 0.046). Of the top 10 most important predictors, only 3 were statistically significant: income (p&#x2009;<&#x2009;0.001), driving under the influence of any drug (aOR: 18.6, p&#x2009;<&#x2009;0.0001); and perceived health status (p&#x2009;=&#x2009;0.02). Our study identified several important predictors and risk factors for concurrent use of methamphetamine and alcohol. Due to our study's low rate for the outcome of interest, future studies should further investigate risk factors and targeted interventions should be put into place to mitigate risky behaviors.

There is active scientific debate about the nature of addiction as a mental disorder, but with comparatively little discussion of nosology itself. To contribute to the ongoing dialogue, this review provides a concise history of the formal medical diagnoses used to define addiction clinically and vanguard contemporary perspectives. The history of addiction as a medical diagnosis starts at the beginning of the 20th century in the first International Classification of Diseases (ICD) and was present in 1953 in the first edition of the Diagnostic and Statistical Manual (DSM). Across iterations of both systems, the evolving nosology can be broadly divided into three epochs, an early primeval period (1900-1948), reflecting coarse definitions subsumed within personality disorder; a phenomenological period (1948-1980), reflecting descriptive definitions; and an empirically-informed period (1980 to the present), comprising operational definitions of polythetic syndromes, increasingly informed by empirical findings. Contemporary priorities suggest an emerging fourth epoch, prioritizing a diagnostic nomological network of objective etiologically-informed tests via, for example, the Research Domain Criteria (RDoC) and Addictions Neuroclinical Assessment (ANA) frameworks. Both RDoC and ANA focus on using objective mechanistic indicators to decrease subjectivity in diagnosis and increase alignment between etiology and diagnosis. Next-generation diagnostic approaches are anticipated to enhance incisiveness in psychiatric diagnosis and in turn improve clinical outcomes. Tracing the vicissitudes of addiction nosology over the past century reveals an evolution that is both more humane and scientific, from moral weakness and personality defect toward diagnostic definitions and practices that are grounded in empirical evidence.

Alcohol may confound or complicate diagnosis of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD). Though phosphatidylethanol (PETH) testing is widely available, its use among patients with MASLD has not been well established. This study set out to determine both the frequency of PETH testing and the rate of positive PETH tests among patients initially diagnosed with MASLD. We conducted a retrospective cohort study at a single institution of patients diagnosed with MASLD. Patient demographics, metabolic comorbidities, labs, and rate of PETH testing were collected. We compared characteristics of patients with and without PETH testing as well as those with positive results. LASSO regression was then used to identify predictive factors of a positive PETH test. We identified 10,208 patients who met the inclusion criteria; PETH testing was performed in only 700 patients (6.9%). Among those who underwent PETH testing, 275 patients (39.6%) had a positive PETH. Positive PETH results were associated with younger age, male sex, a lower BMI, the absence of diabetes, and elevated AST, ALT, and MCV values. However, using patient factors, the LASSO model demonstrated a poor ability to predict a positive PETH (AUC 0.64). Although PETH testing was only sent in a minority of patients diagnosed with MASLD, over a third were elevated. We found that patient and laboratory parameters were insufficient to predict potentially injurious alcohol use. These findings suggest that use of PETH testing may better inform care of patients with MASLD.

Comorbidity between opioid use disorder (OUD) and chronic pain is substantial. Pain has been shown to be a motivator for OUD onset, maintenance, relapse, and treatment delay. A cluster of pain conditions known as chronic overlapping pain conditions (COPCs), also now referred to in contemporary ICD classification as primary pain conditions, are particularly refractory to traditional forms of pain treatment, and likely adversely impact comorbid OUD. This cross-sectional descriptive study sought to obtain a better understanding of the prevalence of COPCs among individuals with OUD. The COPCs screener was originally developed to address the challenges of readily assessing for multiple of these conditions; which is important given that the number of said conditions acts as a marker for the likely presence of nociplastic&#xa0;pain. This screener was used alongside supplementary survey items to describe COPCs and pain distribution in a sample of individuals with active OUD recruited from a syringe exchange program. Comparisons of COPC prevalence between the study sample and global prevalence estimates found that among those with OUD, there is a significantly higher-than-expected prevalence of chronic low back pain, myalgic encephalomyelitis/chronic fatigue syndrome, chronic migraine headache, and fibromyalgia. Results support further investigations into COPCs in the context of OUD. Further research may reveal methods of enhancing OUD treatment and identifying additional targets for intervention and prevention.

The tobacco 'endgame' concept proposes moving beyond traditional tobacco control measures towards a tobacco-free future. The aim of this study is to investigate the perceptions of tobacco control stakeholders in Africa on their agreement with what endgame approaches are suited for the region to achieve a tobacco-free society. Data were collected using a web-based cross-sectional survey hosted on Redcap. A total of 146 stakeholders from 28 African countries took the survey. Participants rated agreement with 11 proposed endgame approaches drawn from the literature and the qualitative phase of this study. Descriptive analysis was used to summarize stakeholders' level of agreement while bivariate (chi-squared and Fisher's exact tests) and adjusted modified Poisson regression analyses examined association between agreement/disagreement to endgame approaches and demographic factors. Data were analyzed using STATA v17. All participants agreed to an integrated endgame approach while over 90% agreed with six measures (having non-addictive cigarettes, making cigarette unappealing, tobacco-free generation, regulated market model, quota/sinking lid and specific approaches for Africa). Agreements ranged from 70-85% for price caps, performance-based regulation, and non-combustible nicotine products, while only 35% supported government takeover of tobacco companies. Adjusted Poisson regression analyses showed that female stakeholders were less likely to support restricting tobacco sales by year of birth (relative risk ratio, RRR=0.89) and price caps (RRR=0.78), while PhD holders were more likely to support restricting tobacco sales by year of birth (RRR=1.29) and price caps (RRR=1.27). Stakeholders from Southern Africa were less likely to support a state takeover of tobacco companies (RRR=0.40) and performance-based regulation (RRR=0.76). Having more than 20 years of tobacco control experience lowered the support of price caps endgame measures (RRR=0.45). Policymakers are encouraged to use insights from this study to consider multifaceted approaches aimed at addressing the problem of commercial tobacco in the African region and pave the way for a tobacco-free Africa.

The behavioral addictions field lacks clinically useful behavior frequency measures. This study evaluated the psychometric performance of the new 'Red Box, Green Box' method for measuring gaming behavior with a focus on its utility for gaming disorder (GD) screening. A prospective, cross-sectional survey study was conducted using an online crowdsourcing platform. Participants were 1149 male gamers aged 18-35&#x2009;years from Australia, Canada, United States, United Kingdom and Asia, reporting &#x2265;12&#x2009;hours of weekly gaming. Gaming time was measured using a conventional weekly hours item, Red Box hours (gaming instead of fulfilling responsibilities) and Green Box hours (gaming during free or leisure time). GD was assessed by the Internet Gaming Disorder Test (IGDT-10), with International Classification of Diseases, 11th Revision (ICD-11) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) scoring approaches. Psychological distress [Depression, Anxiety and Stress Scale - 21 Items (DASS-21)] and impulsivity [Barratt Impulsiveness Scale-short form (BIS-15)] were measured. Gamers with GD reported higher Red Box hours [mean (M) = 21.1, standard deviation (SD)&#x2009;=&#x2009;11.3] than those without (M&#x2009;=&#x2009;8.7, SD&#x2009;=&#x2009;8.4; P&#x2009;<&#x2009;0.001), and greater Red Box proportion (41.9% vs. 26.8%; P&#x2009;<&#x2009;0.001). Red Box hours demonstrated superior diagnostic accuracy for GD [area under the curve (AUC)&#x2009;=&#x2009;0.86, sensitivity&#x2009;=&#x2009;0.94, specificity&#x2009;=&#x2009;0.63] and Internet gaming disorder (IGD) (AUC&#x2009;=&#x2009;0.76, sensitivity&#x2009;=&#x2009;0.88, specificity&#x2009;=&#x2009;0.56), outperforming comparative measures. A Red Box response of &#x2265; 9.5&#xa0;hours had a 94% likelihood of indicating ICD-11 GD. The 'Red Box, Green Box' method appears to effectively identify International Classification of Diseases, 11th Revision, gaming disorder risk among males. Red Box hours demonstrated greater classification validity than the conventional weekly hours approach. This method provides a simple tool for epidemiological research, routine screening (e.g. outpatient consultation) and clinical assessment and treatment planning. Further validation in clinical populations and longitudinal studies is needed.

Stigmatizing language describing substance use behaviors in clinical documentation and in patient education materials can harm patients and their families. Recent literature has discouraged the use of stigmatizing language in treatment settings and medical documentation. However, large language models (LLMs) generate output using previously generated text, including sources such as electronic health records which may include stigmatizing language. While artificial intelligence (AI) developers continue to update and create LLM products, these developers might prioritize other issues over reducing stigmatizing language surrounding substance use disorders. These diverging priorities make it possible that updated and new LLMs might not eliminate the problem of stigmatizing language in LLM output, even as researchers explore methods to reduce the impact of stigmatizing language in AI models. The potential for LLM output to include stigmatizing language warrants caution on the part of clinicians as AI developers release products intended to facilitate clinical documentation. This article identifies stigmatizing language regarding substance use disorders and explores the potential for LLM output to include stigmatizing language. The author also discusses several challenges that clinicians may face in preventing stigmatizing language from transferring from LLM output into medical records, including randomness inherent in LLM output, balancing appropriate versus inappropriate uses of potentially stigmatizing language, and the need for continued human review of medical documentation even in the face of potentially increased patient volumes. Finally, the author proposes that practicing clinicians be included in an ongoing, active process of iterative refinement of LLM output for clinical use to reduce the risk of perpetuating stigmatizing language regarding substance use disorders.

Since the recognition of internet gaming disorder (IGD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and gaming disorder (GD) in the eleventh revision of the International Classification of Diseases, significant progress has been made toward standardizing assessment practices. However, the present paper argues that three key lessons can be derived when considering the advancements in the field over the past decade. Firstly, rather than developing additional instruments, the field would greatly benefit from unifying existing assessment frameworks and establishing a clinical 'gold standard' based on current diagnostic criteria. Secondly, continued development of psychometric assessment alone is insufficient because the field urgently needs a robust theoretical framework that is able to distinguish between excessive and disordered gaming effectively. Without sound a theory, assessment and treatment practices risk ongoing conceptual drift and fragmentation. Finally, despite recent criticisms regarding the use of psychometric instruments and self-report measures, these methodologies remain necessary. While more objective gaming data can be valuable, they also present with important limitations that need to be fully considered. A potential way forward for an effective assessment approach may involve combining both psychometrically robust self-report data with objective data. However, future research must still ensure that assessment instruments undergo rigorous psychometric validation beyond reliability and validity alone. The paper concludes that instead of prioritizing the development of new assessment tools, the field would benefit more from strengthening its theoretical foundation and rigorously evaluating existing diagnostic frameworks and psychometric instruments.

Patients who inject drugs disproportionately experience frequent patient-directed discharge and readmissions. Assessment of quality of life may provide insight into individual barriers limiting health and addiction treatment. The relationship between QoL and discharge outcomes is unclear, particularly in the context of PWID in the inpatient setting. This study aimed to characterize the relationship between QoL, discharge outcomes, and treatment decisions of PWID in the inpatient setting. This was a single-centered study conducted at an urban tertiary care center during a six-month period. Patients self-administered a modified Drug User QoL scale. Demographic information, disposition, and medication therapies were obtained retrospectively. Comparisons were made based on disposition and treatment. Of 58 eligible participants, 36 completed the DUQOL. The median age was 38&#x2009;years; 48% were male, and 54% reported homelessness. DUQOL scores were lower for PDD patients than non-PDD patients. Patients who initiated medications of opioid use disorder inpatient had higher DUQOL scores compared to those who declined. Initiation of MOUD was associated with significantly lower odds of PDD; however, there was no significant difference in 30-day readmission. DUQOL domains that had a discordance between importance and satisfaction on the DUQOL included "Housing," "Health," "Sense of Future," "Feeling Good," and "Being Useful." Higher QoL was observed to have better clinical outcomes and MOUD acceptance. DUQOL scores, particularly domains where there is a high discordance between satisfaction and importance, may serve as an important tool in predicting clinical outcomes and guiding treatment decisions.

Marijuana usage is on the rise. It is becoming more dangerous because of the significantly greater amounts of tetrahydrocannabinol (THC) and more accessible because of legalization. This paper aims to examine the usage of cannabis in adolescents aged 12-17 and determine the multifaceted effects and dangers that come with the usage. This study queried data from the National Survey on Drug Use and Health. The database was queried and tested until significant numbers were found. Age was added as a control variable to ensure the data was of just adolescents aged 12-17 and not a wide array of ages. We compared adolescents who use marijuana to adolescents who did not use marijuana in four topics: gender, race, number of school days missed,and grades. The overall pooled prevalence of cannabis use in adolescents ages 12-17 is 11.4% (95% CI: 10.70-12.20%). Cannabis use was slightly more prominent among females than males and in white adolescents, Hispanics, and blacks. The higher the marijuana use, the more likely adolescents are to skip class and the less likely they are to perform well grade-wise. Approximately 1 in 10 individuals who try marijuana get develop a use disorder.When narrowing the pool down to just teenagers, that number increases to one in six adolescentswho try marijuana being with marijuana addiction.Therefore, there is a need to educate teenagers and their families about the effects and consequences of marijuana use. These consequences are greater and more severe than most think.

In this retrospective case-control study we enrolled 283 patients with AUD (261 men, 22 women) admitted between 2021 and 2024, of whom 80 had AIPD. Baseline levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroxine (T4) and triiodothyronine (T3) were measured at the time of admission. A second measurement was performed three to four weeks&#xa0;after detoxification. Baseline values were compared with those of 300 age- and sex-matched healthy controls. Longitudinal changes within the AUD cohort and differences between AIPD and non-AIPD subgroups were analyzed by paired t-tests and chi-square tests as appropriate. Mean serum levels of FT4, FT3, T4 and T3 were significantly lower in AUD patients than in healthy controls, while TSH had no significant change. In the same comparison, the proportion of individuals with abnormal thyroid parameters was higher in the AUD group than in controls. Among AUD patients, women, showed a higher proportion of elevated TSH, and reduced FT4, FT3 and T3 than men with AUD. The level of thyroid hormone in patients with AIPD was higher than that in patients with Non-AIPD, and after detoxification treatment, thyroid function may not necessarily return to normal, but showed a trend of thyroid hormone decreased and TSH increased, which was more pronounced in AIPD patients. AUD can lead to thyroid dysfunction. Patients with AUD should closely monitor their thyroid hormone levels to prevent the worsening of psychiatric and neurological symptoms.

The South-East Asia Region (SEAR) faces a growing burden of non-communicable diseases (NCDs), shaped in part by complex commercial determinants of health (CDoH). This analysis considers how aggressive marketing, policy interference and addictive product design by the tobacco, alcohol and ultra-processed food (UPF) industries contribute to this burden. SEAR's distinctive demographic, cultural and economic conditions create both vulnerabilities and opportunities. Rapid urbanisation, high population density, rising disposable incomes and uneven policy enforcement create environments in which commercial actors can expand market reach and influence consumption patterns. These industries frequently target youth and lower socioeconomic groups through tailored marketing, sponsorships, digital engagement and strategic product placement. Cultural norms further shape consumption in SEAR, including the longstanding use of smokeless tobacco, socially embedded alcohol consumption in several countries and the growing incorporation of UPFs into daily diets. These patterns are strengthened by expanding digital and e-commerce ecosystems that increase exposure, accessibility and the normalisation of health-harming products across diverse populations. Despite challenges, the region can address CDoH by adapting evidence-based strategies like marketing restrictions, excise taxes on sugar-sweetened beverages and safeguards against industry interference to local policies.Strengthening regulatory frameworks, enforcing comprehensive marketing restrictions and adopting WHO 'best buy' interventions are critical steps. In parallel, international cooperation and capacity building in low- and middle-income countries are essential, as is the engagement of civil society and academia to enhance accountability and support effective policy implementation. Collectively, these strategies can help SEAR accelerate progress in reducing NCD risks and improving population health.

Substance use disorders (SUDs) are a growing public health concern with high relapse rates. Noninvasive brain stimulation techniques are emerging as potential adjunctive therapies; however, recruitment challenges persist in related clinical trials. To use systematic review and meta-analysis to determine the rate and reasons for nonparticipation in randomized controlled trials (RCTs) involving noninvasive brain stimulation for substance-related and addictive disorders. Major databases (PubMed, CENTRAL, and Google Scholar) were searched from inception to January 2025 for RCTs of noninvasive brain stimulation and SUD. Of 3589 abstracts searched, 55 RCTs met the inclusion criteria. Eligible studies were peer-reviewed, published in English and examined any form of noninvasive brain stimulation in individuals with substance-related or behavioral addictions. Studies were required to report the number of individuals screened and ultimately randomized. Non-randomized studies, those involving invasive brain stimulation, were excluded.Following PRISMA guidelines, data were extracted independently by two reviewers, with discrepancies resolved by a third. Risk of bias (RoB) was assessed using the Cochrane RoB tool. Random-effects model was used for meta-analysis. A total of 55 randomized trials were included which involved diverse SUDs and behavioral addictions. The pooled nonparticipation rate was 55.9% (95% CI: 45.9-65.8%; I2&#xa0;=&#xa0;99.56%, p&#xa0;<&#xa0;0.001). Majority of the studies reported craving as an outcome measure. Key reasons included failure to meet inclusion criteria (reported in over 25 studies), refusal to participate due to anxiety or lack of motivation (&#x2265;15 studies), and logistical barriers such as travel or session frequency (&#x2265;10 studies). Nonparticipation in noninvasive brain stimulation trials for SUD are high, largely due to stringent eligibility criteria, procedural apprehension, and practical burdens faced by participants. Addressing these barriers through broader inclusion criteria, participant education, incentives, and flexible scheduling is essential to enhance recruitment, trial generalizability, and future clinical applicability of NIBS in addiction treatment.

The prevalence of addictive disorders has surged globally, exacerbated by the coronavirus disease 2019 pandemic, leading to increased consumption of alcohol, nicotine, and engagement in other addictive behaviors. Considering this alarming trend, this study examined the prevalence and associated factors of addictive disorders-specifically alcohol use disorder, tobacco use disorder, and internet gaming disorder-using data from the 2021 National Mental Health Survey of Korea. The study analyzed data from 5,511 adults aged 18-79, assessing socio-demographic information, mental diseases, physical activity levels, and non-suicidal self-injury (NSSI) through standardized interviews and self-reported questionnaires. Complex-sample logistic regression identified significant factors associated with addictive disorders. NSSI emerged as the most significantly associated factor, increasing the likelihood of addiction over 9-fold (odds ratio [OR], 9.26; 95% confidence interval [CI], 4.52-18.93). While walking was associated with lower odds of addiction (OR, 0.98; 95% CI, 0.96-1.00), moderate-to-high exercise (OR, 1.01; 95% CI, 1.00-1.03) was linked to increased odds of addictive disorders. Addictive behaviors, such as NSSI and excessive exercise, are significantly associated with an increased risk of addictive disorders.

Over 48 million Americans were diagnosed with a substance use disorder in 2023. However, only 4.5% of individuals with addiction received treatment. To effectively treat people with substance use disorders, comprehensive addiction medicine education should be required in all medical schools. This study evaluated the effectiveness of an addiction medicine curriculum intervention across two universities. Students at Michigan State University (College of Human Medicine and College of Osteopathic Medicine) (MSU) and Keck School of Medicine (KSOM) of University of Southern California (USC), were surveyed before and after taking two- and four- week addiction medicine electives. The ten-question Likert scale survey assessed attitudes toward addiction and addiction treatment. In both MSU AND USC cohorts, pre and post scores were matched for analysis. The paired t-test and sign rank tests were used to compare pre- vs. post-test scores within schools and combined. The Wilcoxon rank sum test was employed to compare pre-post change in scores between universities. Significance was determined at p&#x2009;<&#x2009;0.05. There were 251 respondents. Significant within-group improvements were observed in seven of the ten questions. MSU showed significant change in seven questions, while USC showed significant change in four questions. Between-group comparisons showed that MSU and USC significantly differed on both pretest responses and post-test responses. These findings suggest that the addiction medicine curriculum did have an impact at both schools, but the differences need to be further studied.

Alcohol withdrawal delirium (AWD) is the most severe and potentially fatal manifestation of alcohol withdrawal syndrome (AWS). Early identification of patients at risk is critical for preventing medical complications and optimizing withdrawal management. Although the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar), is widely used to assess AWS severity, its predictive value for AWD remains unclear, particularly in Asian inpatient settings. To examine the incidence of AWS and AWD among patients with alcohol use disorder (AUD) in a Japanese rehabilitation center and to identify admission factors associated with AWD onset. Among 295 consecutively admitted patients, 273 were analyzed; 22 were excluded for ongoing AWD at admission. AWS was evaluated using CIWA-Ar throughout hospitalization. Associations between admission variables and AWD onset were analyzed using logistic regression and receiver operating characteristic (ROC) analysis. Of 273 patients, 152 (55.7%) exhibited AWS and 24 (8.8%) developed AWD during hospitalization. Stepwise logistic regression identified only the CIWA-Ar score at admission as a significant predictor (odds ratio = 1.50; 95% confidence interval, 1.28-1.74; p&#x2009;<&#x2009;0.001). ROC analysis yielded an area under the curve (AUC) of 0.906 with a CIWA-Ar cutoff of 4 (sensitivity 91.7%, specificity 84.3%). The admission CIWA-Ar score is a strong and practical predictor of AWD in AUD inpatients. Even mild withdrawal symptoms may indicate early autonomic hyperactivity and high AWD risk, underscoring the need for vigilant monitoring and timely intervention.

Adverse effects on wellbeing associated to the excessive usage of video games have prompted the introduction of Internet Gaming Disorder (IGD) as provisional diagnosis by the American Psychiatric Association [APA] in 2013, and the formal classification of Gaming Disorder (GD) by the World Health Organisation [WHO] in 2019. Despite these milestones, ongoing debate surrounds the diagnostic validity and cross-cultural applicability of these classifications. Consequently, the aims of the present review involve to (i) comparably introduce the WHO and the APA suggested criteria related to disordered gaming, whilst taking into consideration the available psychometric evidence internationally; (ii) illustrate the suggested criteria's broader strengths and weaknesses and; iii) identify areas of priority for further empirical research to contribute to the available knowledge in the field identify areas of priority for further empirical research to contribute to the available knowledge in the field, whilst concurrently synthesizing the available evidence through the lenses of the recently proposed Cyber-Developmental Framework. With the increasing prevalence of disordered gaming and screen-related addictive behaviours as significant mental health concerns globally, this review highlights the need for enhanced diagnostic precision and greater consistency in assessment methodologies across diverse community, clinical, and national populations.

Substance use disorder is a chronic, relapsing illness, and craving plays an important factor in relapse. High-definition transcranial direct current stimulation is a novel noninvasive brain stimulation technique which employs focal stimulation of the brain and has minimal adverse effects. However, its efficacy across substance use disorders remains underexplored. This systematic review and meta-analysis aimed to assess the efficacy of HD-tDCS on craving in substance use disorders. Five databases, including PubMed, CENTRAL, EMBASE, Scopus and Google Scholar, were searched from inception to April 2025. Review included randomized controlled trials comparing HD-tDCS vs sham intervention, which reported craving as an outcome. Pooled effect size was measured by random-effect model, and heterogeneity was estimated by I2. Risk of bias was assessed by the revised Cochrane risk-of-bias tool (RoB 2.0). Out of 3155 records, three RCTs (n&#x2009;=&#x2009;138) met the inclusion criteria. Substances studied included opioid, cannabis and methamphetamine use disorders. HD-tDCS protocols were almost similar across the studies. Pooled analysis demonstrated a moderate reduction in craving compared to sham stimulation (g&#x2009;=&#x2009;-0.596; 95% CI: -1.039 to -0.152; p&#x2009;=&#x2009;0.008) across all the studies, with minimal heterogeneity (I2 = 0%). Risk of bias ranged from low to moderate. HD-tDCS intervention produced a moderate, statistically significant reduction in craving across substance use disorder, with favorable tolerability. However, the small number of studies and smaller sample size of trials limits its generalizability. Larger and more substance-specific randomized trials are warranted to confirm the efficacy and optimize stimulation parameters.