Individuals with opioid use disorder (OUD) frequently present with co-occurring mental health conditions such as depression and posttraumatic stress disorder (PTSD), along with other mental health substance use disorders, physical health conditions and social determinants that together comprise 'clinical complexity.' Collaborative care (CC), a primary care-based behavioral health integration model, aims to improve outcomes through coordinated, patient-centered treatment. This study examined heterogeneity in baseline clinical complexity among participants in the CLARO (Collaboration Leading to Addiction Treatment and Recovery from Other Stresses) trial and assessed whether the effects of CC versus enhanced usual care (EUC) differed across clinical complexity groups. Secondary analysis of CLARO, a pragmatic randomized clinical trial (n = 797) of CC versus EUC for adults with OUD and depression and/or PTSD, conducted in 18 low-resourced primary care clinics in New Mexico and California, USA. Latent class analysis of baseline data identified subgroups defined by mental health and substance use as the main characteristics along with physical health and social challenges. Six-month treatment effects were estimated using one-step models that jointly estimated latent class membership and class-specific outcomes, incorporating class × treatment interactions. Outcomes included depression symptom severity, PTSD symptom severity, and buprenorphine utilization and prescribing duration. Three subgroups were identified: (1) low complexity (43%), with relative clinical and social stability; (2) mental health complexity (34%), with high psychiatric symptoms but lower substance use and moderate social adversity; and (3) high dual complexity (23%). Compared with EUC, CC was associated with lower depression severity at follow-up for the low-complexity class, but not for other classes. CC and EUC did not differ statistically significantly with respect to PTSD outcomes in any class. Buprenorphine utilization and prescribing duration outcomes were similar across CC and EUC treatment arms. The effects of collaborative care may vary according to patients' baseline clinical complexity. Collaborative care appears to be associated with more favorable depression outcomes than enhanced usual care among participants with lower clinical complexity but not among those with higher clinical complexity.
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.
We evaluated whether community-level naloxone distribution, medication for opioid use disorder treatment and retention and incident high-risk opioid prescribing rates were associated with opioid overdose death rates. Observational cohort conducted using 2019 to 2023 community-level data as an exploratory analysis of the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS). Exposures included: (1) community-level naloxone distribution, past 12-months, categorized as ≤1000 units per 100 000 population vs. 1001-3000 units per 100 000 population vs. >3000 units per 100 000 population; (2) individuals treated with buprenorphine per 100 000 adult population in the current quarter; (3) individuals retained on buprenorphine for ≥ 180 days per 100 000 adult population in the current quarter; and (4) incident high-risk opioid prescribing per 100 000 adult population in the current quarter. Population-based study of 67 communities with 8.2 million adults in Kentucky, Massachusetts, New York and Ohio, USA, with required annual opioid overdose death rates of > 25 per 100 000 adult population and at least 30% rural. Across the 67 communities participating in the HCS, the adult population was 31% 18-34 years, 31% 35-54 years, 38% 55 years and over, 52% female, 73% non-Hispanic White, 15% non-Hispanic Black and 7.4% Hispanic. Quarterly community-level opioid overdose death rates from 2020 through 2023. The 2019 annual rates were 40.4 opioid overdose deaths, 1287 naloxone rescue units distributed, 977.7 people received buprenorphine treatment, 546.3 people retained for more than 180 days on buprenorphine and 1266.7 high-risk opioid prescribing incidents per 100 000 population. In models adjusted for state, community age, sex, race/ethnicity, rurality, HCS intervention group assignment, 2019 rates of opioid overdose death, naloxone distribution, buprenorphine and high-risk opioid prescribing, and the ratio of opioid overdose deaths involving fentanyl, an increase in 100 people treated with buprenorphine per 100 000 population was associated with a decrease of 0.92 [95% confidence interval (CI) = -1.30 to -0.55] in the quarterly opioid overdose death rate, while an increase of 100 people retained on buprenorphine for more than 180 days per 100 000 population was associated with a decrease of 1.3 (95% CI = -1.8 to -0. 76). There were no statistically significant associations between naloxone distribution or incident high-risk opioid prescribing with change in quarterly opioid overdose death rates. In this exploratory analysis, increases in both buprenorphine treatment and retention were statistically significantly associated with decreases in opioid overdose death rates, after adjusting for baseline rates of buprenorphine treatment and retention.
This study evaluated a three-year residential rehabilitation programme, which aimed to support recovery from problem substance use via peer support and social enterprise activities. The aims were to clarify programme mechanisms and identify contextual factors associated with variation in outcomes. The study took place within River Garden, a residential rehabilitation for problem substance use, based in South Ayrshire, Scotland. A mixed-methods realist-informed process evaluation was undertaken, using participant observation, repeated qualitative interviews and routinely collected admissions data. Fieldwork was conducted with residents, staff and trustees between April 2019 and November 2020. Nine (of ten) residents were recruited into the study. All residents were male, aged 20-47 years (median 35 years) and were White Scottish or English. Data collection and analysis was guided by Medical Research Council guidance on process evaluation and informed by selected principles from realist evaluation. Three key contextual factors and six key mechanisms were associated with variation in resident outcomes. The severity of residents' substance use problems, their physical and mental health and their socioeconomic backgrounds shaped whether they responded to the programme's instrumental and relational resources with trust, respect or motivation (constituting six mechanisms, e.g. instrumental-respect, relational-trust). The programme was most beneficial for residents for whom intended outcomes were less constrained by contextual moderators. In residential rehabilitation for substance use disorders, residents with higher problem severity, worse physical and mental health and greater socioeconomic disadvantage appear to be less likely to respond to rehabilitation resources with trust, respect or motivation compared with the other residents. These findings may support the development of strategies to improve outcomes for residents with greater contextual barriers to change.
Oral nicotine pouches (NPs) are a new class of non-combustible nicotine products that have gained rapid popularity. Despite rising sales and marketing, evidence of their prevalence and risk perceptions remains limited. This systematic review aimed to synthesize the available global evidence on the prevalence and patterns of nicotine pouch use and to summarize reported risk perceptions from population-based studies. Four electronic databases (Scopus, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched in March 2024 and searches were updated in September 2025. Observational studies reporting the prevalence of NPs use among general populations were selected. Study quality was assessed using an adapted Newcastle-Ottawa Scale, and findings were synthesized narratively. From 6752 records, 16 studies met the inclusion criteria and were included in this systematic review. The studies conducted surveys on NPs use in the United States, United Kingdom, Canada, Switzerland, the Netherlands, Finland, Poland, and Saudi Arabia (overall sample size = 184 497). Reported ever (defined as lifetime use) and current use (defined as use within the past 30 days) varied by country and demographic group. In the US, ever use ranged from 0.6% to 17.9%, while current use ranged from 0.8% to 12.0%; most studies were conducted among youth (<18 years) and young adults (18-29 years). In Europe, current use ranged from 0.06% in a population aged ≥13 years in the Netherlands to 3.7% among adults in Finland and 4.3% among adults in Poland, while lower rates were observed among adults in the United Kingdom and youth in Switzerland with 0.2% and 3.0%, respectively. In Canada, current use among secondary-school students was 2.6%, and in Saudi Arabia, 11.9% of medical university students reported ever use. Across studies, use was higher among adults aged 18-40 years compared with youth and older age adults and was also higher among males than females. NPs were frequently used concurrently with cigarettes, e-cigarettes, and smokeless tobacco. Perceptions generally indicated lower harm, lower addictiveness, and greater social acceptability than cigarettes. Marketing emphasizing flavors or cessation benefits increased appeal and intentions to use, particularly among youth perceiving low risk. Current global prevalence of oral nicotine pouch use remains low but varies by country and population group, with higher use reported among younger adults and males. Nicotine pouches are commonly used concurrently with other nicotine products and are generally perceived as less harmful and more socially acceptable than cigarettes.
Swap to Stop is a government scheme to promote smoking cessation. Local authorities in England were given e-cigarette (vape) starter kits to provide alongside behavioural support in a wide range of settings. This study evaluated (i) scheme uptake by region of England, (ii) proposed delivery settings and the type and length of support, (iii) proposed targeting of priority populations and (iv) product-cost per 4-week quit. From October 2023 to October 2024, local authorities submitted 218 expressions of interest (EOIs) to participate in Swap to Stop. We analysed a sample of 115 (53%) EOIs and associated cost information provided by the Department of Health and Social Care. NHS Quarterly Returns data (April 2024-September 2024) provided 4-week quit rates. Outcomes were the number of kits requested per adult who smokes in each region of England, the proposed delivery settings and the type and length of support and proposed targeting of priority populations categorised as 'specific' (exclusive to certain populations) or 'targeted' (accessible to all but targeting particular groups). Product-cost per 4-week quit was estimated from the 4-week quit rates and product cost. Regional uptake varied, from 39 kits per 100 people who smoke in the Southwest to 5 per 100 in the Midlands. Most EOIs (75.7%) proposed supplying kits via existing local government funded stop smoking services, followed by physical health care settings (37.4%). A proposed duration of supply of 4 weeks was the most common (48.7%). Thirty-two percent of the EOIs described specific services, including services exclusively for pregnant women (14.8%) and people experiencing deprivation (13.9%). Frequently targeted were socioeconomically less advantaged groups (e.g. routine/manual workers, 57.4% of EOIs) and people with mental health conditions (36.5% of EOIs). The self-reported 4-week quit rate for those who received a kit was 34.3% and the average kit cost was £38.78 (the maximum cost was £40), giving an estimated product-cost per 4-week quit of £113.17, not including additional costs incurred by service providers. Swap to Stop in England, a government scheme to promote smoking cessation through provision of free e-cigarette starter kits, demonstrated variation in both uptake and the types of services offering free vapes, yet the early quit rates, and consequently the product-cost per quit, were comparable to those observed in similar smoking cessation schemes. There is potential for further targeting of priority populations with increased investment to ensure people have the best chance of quitting.
Gambling-related harm is not concentrated solely among individuals meeting criteria for problematic or disordered gambling. Tackling harm at a population level is essential to reducing the total burden of harm and preventing escalation to more severe harms. The public health approach to gambling recognises this and the need to address both individual and systemic factors that shape people's risk of harm. Despite this, research and policy in the field remain largely focused on interventions that target individual responsibility, such as educational messages, warnings, and voluntary tools. Chater and Loewenstein's i-frame (individual-frame) and s-frame (system-frame) distinction provides a compelling basis for reorienting gambling harm prevention efforts. I-frame interventions target individual decision-making and self-regulation, while s-frame interventions seek systemic changes through restrictions and structural reforms. This paper argues that s-frame approaches are better suited to preventing gambling harms, particularly lower-level harms at the population level, because they [1] do not rely on individuals to recognise and effectively navigate the complex mathematical properties and potentially misleading features inherent in many gambling products, [2] apply universally without requiring individual engagement, and [3] can counter commercial interests without depending on consumer self-restraint. Reframing gambling harm prevention through the i-/s-frame lens offers conceptual clarity, highlights the opportunity costs of an overreliance on individual-focused interventions, and exposes incentives that perpetuate the status quo. This paper explains why i-frame approaches have dominated to date and how we can make the shift towards the s-frame. Rather than abandoning i-frame approaches, research priorities should be rebalanced toward understanding, implementing, and evaluating systemic solutions. While i-frame interventions remain valuable for individuals seeking help, preventing population-level harms requires proportionate investment in structural solutions that make gambling products safer by design.
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To measure trends in alcohol treatment episodes in Australia, disaggregated by age, period and birth cohort. Age, period, cohort modelling with restricted cubic splines, using Australian alcohol treatment administrative data from July 2002 to June 2022. 1 253 548 closed treatment episodes where alcohol was the primary drug of concern from people aged 10 to 100 years who received treatment for their own substance use in publicly funded specialist alcohol and other drug treatment services. Count of alcohol treatment episodes by age, period, birth cohort and sex. Alcohol treatment episode rates increased over time, peaking in 2022 (330.11 per 100 000 population). Age trends first peaked at around 21 years of age [cross-sectional prevalence = 444.30, 95% confidence interval (CI) = 440.82-447.80; longitudinal prevalence = 462.45, 95% CI = 458.06-466.89], followed by a lifetime peak between 37 and 44 years and declining with older age. Cohorts born from 1974 to 1979 had the highest alcohol treatment episode rates, and the oldest and youngest birth cohorts had the lowest alcohol treatment episode rates. Males were overall 1.8 times as likely as females to have an alcohol treatment episode, but this gap closed with more recent birth cohorts. Alcohol treatment episode rates increased in Australia between 2003 and 2022, and particularly from 2017. Young to middle-aged adults and people born in the 1970s were most at risk, alongside a persistent but narrowing gap between males and females.
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Cannabis is among the most widely used psychoactive substances globally and is often consumed alongside tobacco. Cannabis use has been associated with impairments in attention, learning, and memory, whereas nicotine can acutely enhance, but chronically impair, certain cognitive functions. Most studies examine cannabis in isolation, leaving the cognitive impact of tobacco co-use unclear. This study aimed to estimate differences in cognitive performance between individuals with cannabis use disorder (CUD) and healthy controls, to determine whether cognition relates to heaviness of cannabis use or CUD symptom severity, to test moderation by daily tobacco use, and to assess whether baseline cognition was associated with cannabis outcomes one year later. Cross-sectional and one-year longitudinal study. The Netherlands and Texas, USA. A total of 231 participants aged 18-30 participated: 130 with CUD (57.7% male) and 101 controls (43.6% male). Participants completed tasks assessing interference control, attentional bias, sustained attention, executive functions, emotion recognition, delayed recall memory, working memory, and intelligence quotient (IQ). Primary outcomes were cognitive task scores; predictors included heaviness of cannabis use, CUD symptom severity, and daily tobacco use. Compared with controls, individuals with CUD performed worse on interference control (rank biserial correlation [rrank] = 0.080, p < 0.001), immediate recall memory (rrank = 0.089, p = 0.009), delayed recall memory (rrank = 0.090, p = 0.013), executive functions (rrank = 0.089, p = 0.016), and estimated IQ (rrank = 0.081, p < 0.001). Within the CUD group, cognitive performance was unrelated to heaviness of use or CUD severity. Before correction, daily tobacco use moderated the link between CUD severity and working memory (p = 0.011, unstandardized beta [B] = -1.83), with poorer performance observed only among non-tobacco users. Lower attentional bias (p = 0.027, B = -1.78) and sustained attention (p = 0.023, B = -27.88) were modestly associated with greater CUD severity at one-year follow-up. Cannabis use disorder (CUD) appears to be associated with deficits in several cognitive domains independent of use intensity or severity. Tobacco and cannabis co-use appears to be related to relatively better working memory. Attention-related cognition appears to have limited associations with later CUD outcomes.
On 9 June 2022, Thailand changed its cannabis legislation, expanding access to individuals aged >18 years. Evidence suggests that such changes could increase the risk of cannabis use and related harms, and could influence patterns of use of other substances among adolescents. This study measured the potential impact of these legislative changes on adolescent substance-related hospital admissions. An interrupted time-series study to assess the impact of cannabis legalisation on substance-related hospitalisations using anonymised admission records from the Thai Health Information Portal. Nationwide study in Thailand spanning from 1 October 2016 to 30 September 2023, with 9 June 2022 marking cannabis legalisation. Adolescents aged 10-19 years in Thailand. Based on International Classification of Diseases, 10th Revision diagnostic codes, hospitalisation records were classified as relevant or irrelevant to each of eight predefined substance categories: stimulants (excluding cocaine), alcohol, cannabis, sedatives (including opioids and narcotics), volatile solvents, nicotine, hallucinogens and cocaine. There were an additional 25.5 weekly cannabis-related hospitalisations (95% prediction interval = 23.5-27.2) compared with counterfactual predictions, resulting in 1762 excess cases over the 68-week post-legalisation period. Statistically significant excess admissions were also observed for stimulants, nicotine, volatile solvents and hallucinogens, corresponding to additional admissions of 9.1, 1.4, 0.5 and 0.5 per week, respectively (95% prediction intervals = 0.3-15.4, 0.4-2.1, 0.3-0.7 and 0.2-0.7, respectively). No statistically significant changes were observed for alcohol-, sedative- or cocaine-related hospitalisations. Cannabis legalisation in Thailand was followed by a marked rise in adolescent hospitalisations related to cannabis, alongside an increase in stimulant-, nicotine-, volatile solvent- and hallucinogen-related hospitalizations. These findings highlight the potential unintended consequences of cannabis legalisation in Thailand and underscore the need for preventive strategies to reduce adolescent exposure and related harm.
Higher dose naloxone products (HDN) have recently been approved and marketed in the United States; however, evidence on the relative advantage of these products to standard 4 mg products has not been substantiated by prior research. People who use drugs are the primary beneficiaries and consumers of naloxone products. This study aimed to characterize their willingness to use HDN products and technical understanding of these products. We conducted in-depth interviews with syringe service program clients following an interview guide. Interviews were recorded and transcribed before being analyzed using a hybrid deductive-inductive qualitative approach. Interviews were conducted in partnership with community-based syringe service programs in three distinct regions of the state of Maryland, USA: a rural county, Baltimore city and a surrounding suburban community. Twenty-two interviews were completed. All participants had used opioids and responded to an overdose using naloxone in the past 3 months. The majority of participants were men (73%), non-Hispanic white (64%) and currently experiencing housing instability (59%). Participants demonstrated high willingness to use HDN, motivated by volatility in the local drug supply and perceived inefficiency of naloxone against potent synthetic opioids. Participants believed that the relative advantage of HDN was that it would reverse overdoses more quickly than existing products; however, many participants wanted increased control in overdose situations, including the ability to titrate and combine dosages to reduce the severity of precipitated withdrawal. Skepticism towards HDN products was rooted in general skepticism of pharmaceutical companies, as well as the belief that perceptions of lower dose naloxone being ineffective could be attributed to user error. Development of novel overdose reversal products should be informed by the experiences of primary consumers and beneficiaries of these products. A high level of transparency is needed in the marketing of these products to promote consumer trust and confidence in their safety and utility.
Early initiation to cannabis use in adolescence is linked to cognitive and mental health risks. Having friends who use cannabis is a strong risk factor for initiation, but the mechanisms underlying this relationship are unclear. This study examined the role of perceived ease of access to cannabis in the association between close friends' cannabis use and cannabis initiation. Observational longitudinal investigation using data from the COMPASS study. A convenience sample of 11 high schools in Québec, Canada, from 2017 to 2019. 1768 students who had not initiated cannabis use before 2019. Having ≥1 close friend who uses cannabis and perceived ease of access to cannabis were measured in 2018, while cannabis initiation in the past 12 months was assessed in 2019. Covariates measured in 2017 included sociodemographic factors, substance use history, lifestyle behaviors and school-related variables. We compared the risk of cannabis initiation across groups defined jointly by friends' cannabis use and perceived access. Generalised estimating equations with bootstrap resampling, inverse probability weighting for attrition and multiple imputation for missing data were used to estimate these associations. Natural effect models were then applied to estimate total, direct and indirect effects with initiation as the outcome and perceived access as the mediator. Within the COMPASS cohort, 14% of cannabis-naive adolescents in 2018 initiated use in 2019. Using students with no close friends who use cannabis and who perceive access as difficult as the reference group, the risk difference (RD) for having at least one friend who uses cannabis while still perceiving access as difficult was 3.2 [95% confidence interval (CI) = -3.8 to 10.2]. Perceiving access as easy but having no friends who use cannabis yielded an RD of 8.4 (95% CI = 3.0-13.7). Friends' cannabis use combined with easy access acted synergistically, producing an RD of 21.6 (95% CI = 15.5-27.7). According to the natural effect models, perceived ease of access mediated about 39% of the association between having ≥1 close friend who uses cannabis and subsequent initiation, suggesting a possible explanatory pathway. In Canada, cannabis initiation risk appears to be highest among adolescents with both exposure to close friends who use cannabis and perceived easy access. Perceived access may help explain part of this association. Preventive strategies should address the influence of friends and accessibility through school policies, public education and stricter enforcement of access restrictions to delay adolescent cannabis use.
NEET (Not in Employment, Education or Training) youth represent a vulnerable population from a public health perspective, facing multiple health challenges, including elevated substance use. Tobacco and cannabis are the most commonly used psychoactive substances among young people, with early initiation associated with long-term health and social consequences. While evidence suggests associations between NEET status and substance use, data remain limited regarding patterns of use and potential variations across different NEET profiles. This study aimed to characterise tobacco and cannabis use within the NEET population, taking into account the diversity of profiles, and to compare it with that of the general population, including employed youth and students, in order to inform targeted prevention strategies. A systematic review and meta-analysis included observational studies examining tobacco and cannabis use among NEET youth aged 15-29 years. A search was conducted for observational studies available on PubMed, PsycINFO, Cairn and Web of Science databases and published between 1999 and 2025. Analyses studied the variations in use among NEET profiles and compared NEET against employed youth, student and general population controls. Random-effects models generated pooled crude odds ratios. Sensitivity and subgroup analyses were conducted based on study quality, gender and type of comparison population. Twenty-five studies were included and analysed, including a total of 91 085 individuals. A statistically significant association between NEET status and both tobacco use [odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.46-2.53] and current cannabis use (OR = 2.14, 95% CI = 1.68-2.71) was found. Current smoking was statistically significantly more prevalent among NEET than among students (OR = 3.05, 95% CI = 2.31-4.03), but not statistically significantly different compared with young workers (OR = 1.10, 95% CI = 0.91-1.34). NEET demonstrated statistically significantly higher cannabis use compared with both students (OR = 1.81, 95% CI = 1.34-2.44) and workers (OR = 1.67, 95% CI = 1.21-2.31). A higher prevalence of cannabis use disorder among young people with NEET status (31.93%) was observed compared with their non-NEET peers (12.12%), but no statistically significant association was found. Youth Not in Employment, Education or Training (NEET) appear to show higher tobacco and cannabis use compared with their peers. Given these findings, targeted prevention strategies addressing substance use in NEET populations are essential to reduce social health inequities.
Protective behavioral strategies (PBS) are designed to minimize negative alcohol-related consequences. They include limiting/stopping, manner-of-drinking (e.g. avoiding shots or drinking games) and serious harm reduction strategies. This secondary analysis measured day-level, within-person associations between PBS and alcohol-related consequences (including alcohol-induced blackout) among young adults enrolled and not enrolled in college. Observational study using ambulatory assessments each morning for 30 days. United States. Young adults (n = 153, 35% male, 58% White, mean age = 22 y) with a history of alcohol-induced blackout. Fifty-nine participants (39%) were enrolled in college. Participants completed an orientation interview, baseline self-report measures and 30 days of prospective morning reports. Multilevel logistic regression was used to analyze data. Within persons, participants had lower odds of experiencing any same-day alcohol-related consequence [odds ratio (OR) = 0.36; 95% confidence interval (CI) = 0.25-0.53], including blackout (OR = 0.24; 95% CI = 0.14-0.42) on days they used manner-of-drinking strategies compared with days they did not. Conversely, experiencing an alcohol-related consequence was not associated with use of manner-of-drinking (OR = 1.06; 95% CI = 0.76-1.48) or limiting/stopping (OR = 1.06; 95% CI = 0.76-1.49) strategies on the next drinking day. College enrollment did not moderate any of the associations. Manner-of-drinking strategies appear to reduce the odds of alcohol-related harm at the event level among young adults in the United States, whether or not they are enrolled in college. We speculate that limiting strategies (e.g. counting drinks) appear less effective because they are more difficult to implement in real-life drinking contexts.
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Memory loss from alcohol use ('blackout') is a prevalent and costly indicator of substance-related harm. While alcohol-induced blackouts can be assessed retrospectively via self-report, no tool exists to identify blackouts objectively in real time, hindering progress in research as well as intervention efforts. This study tested the feasibility and diagnostic accuracy of real-time memory tasks in identifying alcohol-induced blackouts in situ. Prospective diagnostic study. United States. Young adults (18-30 years of age; n = 63) reporting recurrent memory loss as a result of alcohol use were recruited from across the United States between December 2022 and January 2024. Participants completed a baseline survey and orientation interview, followed by 30 days of ecological momentary assessments (EMA). EMA included recall and recognition tests for visual stimuli during drinking events (index tests) and subsequent self-reports of blackout (reference standard). At the end of the protocol, participants also completed a Timeline Followback interview of blackout events during the assessment period. Primary outcomes, which were specified prior to data collection, were (a) feasibility of memory task completion during drinking events and (b) diagnostic accuracy of memory tasks in identifying blackout at the event level. Data were analyzed using Bayesian logistic multilevel models. Of the 63 participants included [mean age = 23.2, standard deviation (SD) = 3.3; 78% female, 51% White], 38 (60%) self-reported a blackout during the assessment protocol. On average, participants completed 85% of memory tests prompted (SD = 16.42). Within days, both greater-than-average number of drinks [odds ratio (OR) = 1.74; 95% confidence interval (CI) = 1.41-2.19] and failure of 1 + recall memory test (OR = 15.53; 95% CI = 5.96-36.27) were associated with increased odds of blackout. In model-predicted probabilities, blackout probability was ~0.01 if a person consumed their average number of drinks, ~0.21 if they had five more drinks than average and ~0.34 if they failed 1 + recall test. Participants self-reported blackout on 39% of the days that they failed 1 + recall memory test (positive predictive value; 95% CI = 30-49); however, they reported not having a blackout on 92% of days that they correctly recalled all memory tests (negative predictive value; 95% CI = 89-95). Objective measures of alcohol-induced blackout can be implemented in real-life contexts. Failing a visual memory test while intoxicated is not necessarily indicative of blackout; however, correct recall indicates that blackout is highly unlikely.
Excessive alcohol consumption contributes substantially to the global burden of disease, yet population-level evidence on disparities in high-risk drinking among people with disabilities remains limited. We aimed to estimate and compare trends in the prevalence of high-risk drinking and all-cause mortality associated with drinking behavior among men with disabilities and those without disabilities. Nation-wide serial cross-sectional study. South Korea, using linked administrative national health check-up and mortality databases. A total of 7 551 340 adult men who participated in the National Health Insurance Service health check-up program in 2017, including 450 536 men with registered disabilities and 7 100 804 men without disabilities. High-risk drinking was defined as consumption of seven or more standard drinks per occasion at least twice per week, based on self-reported health check-up questionnaires. Age-standardized prevalence of high-risk drinking was estimated annually from 2009 to 2017. Associations between disability characteristics and high-risk drinking were estimated using multivariable logistic regression in 2017. All-cause mortality occurring within 2017 was ascertained through deterministic linkage to the national death registry using unique personal identifiers. In 2017, age-standardized prevalence of high-risk drinking was 17 141 per 100 000 among men with disabilities and 23 226 per 100 000 among men without disabilities. Among men aged 20-49 years, prevalence was 29 710 per 100 000 in those with mild disabilities and 26 332 per 100 000 in those without disabilities. In 2017, compared with men without disabilities, mild disability was associated with higher odds of high-risk drinking [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 1.11-1.13], whereas brain injury was associated with lower odds (aOR = 0.61, 95% CI = 0.58-0.65). In 2017, age-standardized mortality rates were 131.4 per 100 000 among non-drinkers, 99.2 among high-risk drinkers, 77.3 among moderate drinkers and 59.9 among low-risk drinkers. Across drinking categories, several disability groups had adjusted odds ratios greater than 1.0 for all-cause mortality compared with those for men without disabilities within the same drinking category. High-risk drinking prevalence among South Korean men was lower among those with disabilities than among those without disabilities from 2009 to 2017, with declining trends in both groups. High-risk drinking prevalence among South Korean men appears to differ by disability characteristics. Mortality odds ratios within drinking categories vary by disability type and severity when compared with men without disabilities in the same drinking category.
Despite the well-documented benefits of opioid substitution treatment (OST) in treating opioid dependence (OD), many people diagnosed with OD desire to live a drug-free life. The transition to abstinence involves detoxification: a gradual dose reduction of OST to zero milligrams. Despite these aspirations, only a minority of patients undertake detoxification, and successful completion remains limited. This mixed-methods systematic review aimed to identify the barriers and facilitators to detoxification from OST, to help provide a better understanding of what can be done to support patients and improve outcomes in OD. Four databases were searched until 22 January 2025: PubMed, Embase, APA PsycINFO and CINAHL. Qualitative, quantitative and mixed methods studies of individuals with a diagnosis of OD undergoing detoxification from OST, or staff responsible for providing the treatment, were included. Studies of only pharmacological interventions were excluded. An integrated approach to data synthesis was used, transforming quantitative data into textual descriptions to integrate them with qualitative data and form one set of themes. Joanna Briggs Institute checklists were used to assess the quality of included papers. From 1999 studies identified, 41 papers were deemed eligible. Studies originated from the USA (22), UK (7), Sweden (6), Canada (1), Ireland (1), Norway (1), Switzerland (1), Australia (1) and China (1). The medications explored included methadone (28), buprenorphine (5), both forms (6) and unspecified OST (2). Studies were conducted in outpatient settings (29), inpatient settings (7), mixed settings (4) and a prison setting (1). Participants included patients (37), treatment providers (1) and mixed populations (3). Factors affecting detoxification were present at an individual and structural level, with overlap between influences at the initiation and completion phases. Eight themes emerged, comprising psychological and emotional factors (particularly around fear of detoxification), personal motivation, withdrawal symptoms, clinical and demographic factors, environmental factors, social factors, professional support and treatment models/interventions. 54% of included studies were rated high quality, and 37% of medium quality. Detoxification from opioid substitution treatment appears to be commonly hindered by fear, emotional resurgence, low confidence, environmental turbulence, negative social influences and insufficient professional/pharmacological support, while facilitators include psychological readiness, life stability, supportive relationships, psychological interventions, inpatient facilities and adjunctive medications.