搜索结果：Addiction science & clinical practice

The Addictions Neuroclinical Assessment (ANA) provides a framework for assessing alcohol use disorder (AUD) with indices that may be both mechanistically and diagnostically informative. This study evaluated an array of measures from the three ANA domains in relation to AUD diagnostic status. This cross-sectional case-control study used receiver operating characteristic (ROC) curves to evaluate diagnostic classification validity using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Exploratory multivariate models using logistic regression were also evaluated using the same metrics. Participants were 189 general community adults (52% AUD+, 57% female, Mage = 32) recruited in Hamilton, Ontario, Canada. Classifiers included measures that conceptually mapped on to the three ANA domains of incentive salience (e.g. alcohol cue reactivity), negative emotionality (e.g. anxiety symptoms, coping motives) and executive function (e.g. NIH-toolkit cognition battery). The clinical criterion (reference standard) was AUD diagnostic status per structured clinical interview. Incentive salience indices had AUCs from 0.55-0.85; negative emotionality indices had AUCs from 0.67-0.89; and executive function indices had AUCs from 0.51-0.58. For incentive salience, cravings in the cue reactivity paradigm and enhancement motives identified AUD diagnosis above accepted benchmarks for clinical utility. For negative emotionality, coping motives exhibited high diagnostic validity, exceeding clinical utility benchmarks. Exploratory multivariate models combining these indices outperformed the single indicator models. This study broadly supports using the Addictions Neuroclinical Assessment (ANA) framework for assessing alcohol use disorder (AUD) - specifically the motivational indices from the incentive salience and negative emotionality domains - for the development of next generation diagnostic assessments of AUD using theoretically informed mechanisms. As such, it reflects a further step in moving ANA toward utilization in clinical research and practice.

Background/Objectives: Psilocybin has re-emerged as a promising intervention for neuropsychiatric disorders including major depressive disorder, treatment-resistant depression, anxiety associated with life-threatening illness, obsessive compulsive disorder, and substance use disorders. However, conventional randomized controlled trials (RCTs)-the current gold standard in evidence-based medicine-may not adequately capture the therapeutic complexity of psilocybin, which depends not only on pharmacological action but also on contextual, psychological, and interpersonal factors. This critical narrative review aimed to evaluate the adequacy of existing clinical research frameworks for assessing psilocybin's therapeutic potential and to explore alternative methodologies that may better reflect real-world clinical conditions. Methods: Using the Web of Science Core Collection database, we identified and analysed the ten most cited clinical studies on psilocybin published between 2015 and 2025 inclusive. Additional literature was included through reference cross-checking, systematic reviews, meta-analyses, and interdisciplinary sources covering neurobiology, history, and real-world evidence (RWE). The review synthesizes clinical outcomes, methodological constraints, and epistemic considerations relevant to psychedelic-assisted therapy. Results: Evidence from highly cited trials demonstrates rapid and sustained antidepressant and anxiolytic effects of psilocybin, with notable benefits also observed in addiction treatment. However, significant methodological limitations were identified, including selection bias, challenges in placebo design and blinding, small sample sizes, and the underrepresentation of diverse populations. Psilocybin outcomes were strongly influenced by subjective experience and contextual factors such as set and setting. Emerging RWE studies revealed heterogeneous patterns of response and provided insights unattainable through RCTs alone. Conclusions: Psilocybin shows considerable therapeutic promise, but current RCT methodologies capture only part of its clinical effects. Comprehensive evaluation will require larger and more diverse clinical trials, long-term follow-up, standardized psychotherapeutic protocols, and the integration of RWE to reflect real-world practice. Psychedelic-assisted therapy should be conceptualized as a complex intervention that combines pharmacological and psychotherapeutic components.

Temperament Based Therapy with Support (TBT-S) is an emerging, personalized treatment approach for eating disorders (EDs) that integrates patients' temperamental traits and neurobiological research into therapeutic strategies to reduce symptoms. While research on the efficacy of TBT-S is still in its infancy, the development of TBT-S as a treatment for EDs spans over two decades. The approach is unique in that it was formulated from neurobiological research, and utilizes treatment tools which were created collaboratively with individuals with lived experience. Hence, the aim of this review of the development of TBT-S is to share how clinical interventions can evolve from basic science through collaboration with the target population. The review provides a structured synthesis of how TBT-S progressed and explores the most current evidence and avenues for future research.

Despite availability of evidence-based alcohol reduction interventions (EBIs), unhealthy alcohol use (UAU) remains a barrier to HIV medication adherence, viral suppression, and retention in HIV care. While translation of alcohol EBIs into HIV clinical practice is important for comprehensive HIV care, their implementation in HIV settings is impeded by resource constraints, workflow challenges, and negative perceptions of alcohol-related care. Guided by the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks, we will conduct a Hybrid Type 3 effectiveness-implementation study testing whether external practice facilitation increases reach, adoption, implementation, and maintenance of stepped care for UAU in three Center for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) HIV clinics in the United States. We will secondarily test whether practice facilitation is associated with clinical outcomes. We will first conduct a mixed methods formative evaluation to tailor delivery of practice facilitation (including the tools, technical assistance, and content expertise offered) based on each site’s context and needs (Aim 1). We will then deliver practice facilitation across the three sites sequentially to implement a stepped-care model of alcohol treatment to patients with UAU. Stepped care, where non-responders to alcohol EBIs are offered a more intensive therapy, will specifically include person- or computer-delivered brief alcohol intervention, on-line cognitive behavioral therapy, and linkages to alcohol pharmacotherapy. Clinical outcomes will include: (1) clinic-level implementation outcomes of stepped care EBIs for alcohol use including reach, adoption, maintenance, using mixed methods (Aim 2a) and (2) patient-level outcomes using interrupted time series analysis with synthetic controls (Aim 2b). Finally, we will use summative evaluation to describe barriers and facilitators to implementation of the interventions at each site to describe maintenance and inform widespread sustainable implementation (Aim 3). This trial tests an implementation strategy to improve the delivery of stepped care, an evidence-based treatment approach for UAU in HIV clinics. Practice facilitation has shown promise for implementing evidence-based care for UAU in primary care but use of practice facilitation for this purpose in HIV clinics is novel. Results from this implementation study may support broader implementation of alcohol evidence-based practices in HIV care. The trial is registered with Clinicaltrials.gov, identifier NCT05241990 Date of submission 2/16/2022.

Due to the impact of high-potency synthetic opioids on medication for opioid use disorder (MOUD) initiation, hospital-based addiction clinicians adapted their practice to improve care, with decisions often guided by limited evidence. To derive expert consensus on best practices for hospital-initiated MOUD among patients with OUD using high-potency synthetic opioids. This survey study used a 2-round Delphi process conducted from January to April 2025. National experts were hospital-based physicians or advanced practice clinicians who treated at least 100 hospitalized patients with OUD in the last 2 years and self-identified as an expert in methadone and buprenorphine initiation. Experts were purposively sampled based on practice location and addiction board certification. Data were analyzed from April 2025 to March 2026. The main outcome was consensus on the appropriateness of specific practices. Appropriateness was evaluated using a 9-point Likert scale from 1, indicating very inappropriate to 9, very appropriate. The presence of consensus was determined using the RAND/UCLA appropriateness method; if consensus was obtained, it was stratified into inappropriate (median 1-3), uncertain (median 4-6), or appropriate (median 7-9). Of 48 experts, 42 (87.5%; median [IQR] age, 41 [36.0-45.8] years; 25 [59.5%] female) completed round 1 and 41 of these (97.6%) completed round 2. Most were physicians (36 participants [85.7%]); of those, 30 (83.3%) were board certified in addiction medicine, 3 (14.3%) in addiction psychiatry, 2 (5.6%) in both, and 1 (2.4%) in neither. Experts treated a median (IQR) of 200 (100-315) hospitalized patients with OUD in the past year. There was consensus that buprenorphine and methadone initiation were appropriate, while the appropriateness of naltrexone initiation was uncertain. Consensus was reached that rapid methadone initiation was appropriate. Regarding buprenorphine initiation practices, experts reached consensus that high- and low-dose initiation were appropriate, traditional initiation was of uncertain appropriateness, and rescue was inappropriate. There was consensus that provision of non-MOUD full agonist opioids was appropriate to treat opioid withdrawal during methadone initiation, as a bridge during buprenorphine initiation, and to treat withdrawal among patients declining MOUD. In this survey study of hospital-based addiction specialty clinicians, consensus was reached on hospital-initiated MOUD and treatment of opioid withdrawal. These best practices can inform current clinical approaches and reflect the need for more robust research to evaluate effectiveness and safety.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) in adulthood is frequently associated with complex psychiatric comorbidity, including high rates of Substance Use Disorders (SUDs), which may influence treatment outcomes. Although pharmacological treatments are effective for core ADHD symptoms, real-world response remains heterogeneous, and the contribution of specific substance-related and neurodevelopmental factors to treatment response is not fully understood. Methods: This retrospective observational study examined a real-world cohort of 67 adults with ADHD treated pharmacologically in a specialized outpatient setting. ADHD was diagnosed according to DSM-5-TR criteria using the Diagnostic Interview for ADHD in Adults (DIVA-5). Autism spectrum disorder (ASD) was recorded based on documented pre-existing specialist diagnoses and confirmed clinically at baseline. Psychiatric comorbidities and substance use disorders, including alcohol and cannabis use disorders, were assessed according to DSM-5-TR criteria. Clinical response was defined using the Clinical Global Impression-Improvement scale (CGI-I; responders = scores 1-3). Exploratory binary logistic regression analyses were used to identify clinical factors associated with treatment response. Given the limited sample size, revised multivariable models were specified parsimoniously on the basis of a priori clinical relevance. Results: At follow-up, 48 of 67 patients (71.6%) met criteria for clinical response. In revised parsimonious multivariable models, alcohol use disorder (OR ≈ 0.08-0.10, p = 0.010-0.026) and cannabis use disorder (OR ≈ 0.20-0.24, p = 0.014-0.028) were consistently associated with reduced odds of clinical response. Autism spectrum disorder showed a descriptive trend toward lower response rates but did not retain statistical significance after adjustment (p ≈ 0.11-0.15). Conclusions: In adults with ADHD treated in routine clinical practice, alcohol and cannabis use disorders were associated with a reduced likelihood of achieving clinically meaningful improvement under routine pharmacological care, whereas autism spectrum disorder showed a trend toward lower response that was not stable enough to support firm conclusions. These findings should be considered exploratory given the retrospective design, limited sample size, and lack of systematic treatment exposure measures.

With the recent publication of an updated clinical practice guideline for managing pediatric obesity in Canada, pediatricians, healthcare providers, and families have access to up-to-date, evidence-based recommendations to support shared decision making for children and adolescents living with obesity. This commentary provides a brief overview of the new guidelines including new methods and approaches used, recommendations regarding intervention effectiveness for behavioural and psychological interventions, pharmacological and surgical interventions, practical guidance to assist providers in implementing the guidelines in clinical practice, and a summary of areas in obesity management that need more attention.

Methamphetamine use disorder is a global health challenge for which there are no approved pharmacotherapies. The safety and effectiveness of mirtazapine, a promising candidate for methamphetamine use disorder, has not been established in routine clinical practice. To determine the safety and effectiveness of mirtazapine as a pharmacotherapy for methamphetamine use disorder in routine clinical practice. This phase 3, parallel-group, double-blind, placebo-controlled randomized clinical trial was conducted between November 16, 2022, and May 1, 2025, at 6 outpatient alcohol and other drug clinics in Australia among adults with moderate to severe methamphetamine use disorder. Data analysis was conducted from May to September 2025. Mirtazapine (30 mg daily for 12 weeks) or equivalent placebo. The primary end point was the change in days of methamphetamine use in the past 28 days from baseline to week 12. Secondary end points were depression, insomnia, HIV risk behavior, quality of life, and methamphetamine-negative oral fluid samples. Of 344 participants randomized, 339 participants received the intervention (167 in the placebo group and 172 in the mirtazapine group). Mean (SD) age was 42.0 (8.6) years, 126 participants (37.2%) were female, and participants had used methamphetamine for a median (IQR) of 24 days (17-28) of the past 28 days at baseline. The mean reduction in days of methamphetamine use from baseline to week 12 was greater in the mirtazapine group (7.0 days of 28 days) than in the placebo group (4.8 days of 28 days; mean difference, 2.2 days; 95% CI, -4.2 to -0.2 days; P = .02). More participants in the mirtazapine group reported drowsiness (47% vs 33%) and weight gain (10% vs 3%). Forty participants (23%) discontinued mirtazapine due to adverse events compared to 25 participants (15%) in the placebo group. No significant effects of mirtazapine on secondary end points were found. In this parallel-group randomized clinical trial, mirtazapine delivered in routine clinical practice reduced methamphetamine use in adults with methamphetamine use disorder. No unexpected safety concerns delivering mirtazapine in this setting were found; this finding has important clinical implications in the absence of any approved pharmacotherapies for methamphetamine use disorder. anzctr.org.au Identifier: ACTRN12622000235707.

Falls resulting from or related to opioid use are a major concern for morbidity and mortality in the United States. The Centers for Disease Control and Prevention's Clinical Practice Guideline for Prescribing Opioids for Pain - United States 2022 seeks to enhance the effectiveness and safety of pain treatment by improving function and quality of life for patients with pain while reducing opioid-related risks. The American College of Surgeons' Best Practices Guidelines in Geriatric Trauma Management and the 4 M's Framework of an Age-Friendly Health System both recommend incorporating fall prevention and safe mobility strategies into healthcare for older adults. In line with these guidelines and our review questions, this scoping review protocol aims to better understand the research on opioid prescribing practices and subsequent falls by identifying and mapping (1) the types of available evidence about opioid prescribing practices and subsequent falls and (2) the key characteristics of treatment and continuing care of falls with specific emphasis on opioid prescribing practices. Electronic database searches will be conducted in PubMed, Embase, CINAHL, and Scopus to identify evidence published in the United States from January 1, 2016, onward. This scoping review will consider primary literature, observational, quasi-experimental, and experimental, implementation, and quality improvement studies, as well as systematic reviews and meta-analyses. Eligible studies will focus on adults aged 18 years and older who have been prescribed opioids and subsequently experienced a fall. There is a gap in our understanding about opioid prescribing and subsequent falls. This scoping review will help fill this gap by mapping the recent available evidence-aligned with clinical guidelines about (1) prescribing practices and subsequent falls and (2) key characteristics of the treatment and continuing care of falls. Open Science Framework ID: https://doi.org/10.17605/OSF.IO/JP49Y. https://osf.io/jp49y.

Internet addiction (IA) has become an increasingly prevalent behavioral health concern among university students, with previous studies reporting substantial levels of problematic internet use among nursing students, including a multicenter study in China that found a prevalence of 23.3%. Because problematic internet use may be associated with poorer quality of life (QL), QL represents an important well-being outcome in this population. Mindfulness exercise (ME), as a movement-based mindfulness practice, may serve as a protective factor associated with better self-regulation and healthier behavioral functioning. However, limited research has examined whether ME is associated with QL directly and indirectly through self-control (SC) and IA among nursing students. A cross-sectional survey was conducted among 480 nursing students using validated measures of mindfulness exercise, self-control, internet addiction, and quality of life. Data were analyzed using partial least squares structural equation modeling (PLS-SEM). Reliability, convergent validity, and discriminant validity of the measurement model were confirmed. Bootstrapping with 5,000 resamples was applied to examine direct and mediating effects among the study variables. The results showed that mindfulness exercise was positively associated with self-control (&#x3b2;&#x2009;=&#x2009;0.435, p&#x2009;<&#x2009;0.001) and quality of life (&#x3b2;&#x2009;=&#x2009;0.181, p&#x2009;<&#x2009;0.001). Self-control was negatively associated with internet addiction (&#x3b2; = -0.304, p&#x2009;<&#x2009;0.001), and internet addiction was negatively associated with quality of life (&#x3b2; = -0.215, p&#x2009;<&#x2009;0.001). In addition, self-control significantly mediated the association between mindfulness exercise and internet addiction (&#x3b2; = -0.132, p&#x2009;<&#x2009;0.001), as well as the association between mindfulness exercise and quality of life (&#x3b2;&#x2009;=&#x2009;0.163, p&#x2009;<&#x2009;0.001). Furthermore, a significant sequential mediating effect of self-control and internet addiction was found in the association between mindfulness exercise and quality of life (&#x3b2;&#x2009;=&#x2009;0.028, p&#x2009;=&#x2009;0.001). Mindfulness exercise was associated with better quality of life among nursing students, both directly and indirectly through self-control and internet addiction. In particular, the findings support a sequential mediation pathway in which higher mindfulness exercise was associated with higher self-control, which in turn was associated with lower internet addiction and better quality of life. Given the cross-sectional design, these findings should be interpreted as associative rather than causal. Not applicable.

To investigate the risk factors of mobile phone addiction in adolescents, and to construct and conduct validation of the nomogram model of mobile phone addiction in adolescents. Selected secondary school students in a city in Henan Province from January to December 2023 for a convenience sampling, included 6878 cases of valid samples, distributed according to the ratio of 7:3, of which 4814 cases were in the training set and 2064 cases were in the testing set, collected general information and questionnaires of the research subjects. The questionnaires mainly included Self-esteem Scale(SES), Self-Control Scale(SCS), Simplified Social Anxiety Scale for Adolescents (SAS-A), and Mobile Phone Addiction Index(MPAI). LASSO regression was applied to screen the characteristic variables, and the regression model was constructed using multifactorial logistic regression with the corresponding nomogram plotted, and the differentiation, calibration and clinical validity of the nomogram model were evaluated through the subject work characteristics (ROC) curve, calibration curve and clinical decision curve (DCA), respectively. To further verify the model's stability and generalizability, an independent external validation dataset-comprising 200 secondary school students demographically consistent with the primary sample-was used to replicate the same evaluation metrics. Seven characteristic variables were screened by LASSO regression, namely gender, academic performance, emotional abuse, self-control, perception, somatisation and depression, and the model was constructed and confirmed by multifactorial logistic regression that all of the above seven variables were significantly associated with mobile phone addiction in adolescents(P&#x2009;<&#x2009;0.05); the area under the ROC curve(AUC) of the training set was 0.764[95% CI(0.75, 0.777)]; the AUC of the testing set was 0.756[95% CI(0.735, 0.777)], and the models showed good predictive ability; the goodness-of-fit tests of the training set and testing set as well as the net gain values performed well in terms of school accuracy and clinical validity. Further external validation with an independent sample yielded consistent performance, with an AUC of 0.752 [95% CI (0.676, 0.829)]. The nomogram model constructed by the seven variables of gender, academic performance, emotional abuse, self-control, perception, somatisation, and depression possesses potential utility as a preliminary screening tool to identify the risk of developing mobile phone addiction in adolescents.

Current screening tools for harmful alcohol consumption have fallen out of step with recent guidance on the health risks of alcohol. To address this gap, the Canadian Research Initiative in Substance Matters updated the screening recommendations for high-risk drinking and alcohol use disorder (AUD) in the 2023 national clinical practice guideline. Following a systematic review of literature published between Jan. 1, 2013, and Feb. 24, 2023, that examined screening tools for high-risk drinking and AUD, the updated recommendations were developed by a multidisciplinary national committee, which included people with lived and living experience. We scored the recommendations and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation tool. We used the Appraisal of Guidelines for Research and Evaluation II instrument and the Guidelines International Network's principles for disclosure of interests and management of conflicts to ensure the update met international standards for transparency, high quality, and methodological rigour. Acknowledging that time constraints are the most commonly reported barrier to universal alcohol screening, we developed 5 recommendations involving a simple screening method, to identify and address both unhealthy alcohol consumption and more serious problems related to alcohol. The recommendations include asking all patients about alcohol consumption and providing educational support to all those who drink above Canada's Guidance on Alcohol and Health's low-risk threshold. We propose a simple screening algorithm to optimize and tailor further intervention, including when to assess for possible AUD. The revised screening recommendations represent a timesaving and pragmatic approach intended to be a resource for universal screening for alcohol risks and problems. The recommendations streamline the process of identifying and addressing the health needs of those who consume alcohol in a hazardous way or may have more serious problems related to alcohol.

Gambling Dual Disorder (GDD) is a proposed clinical construct describing the co-occurrence of Gambling Disorder (GD) with other psychiatric conditions. Although preliminary evidence supports this model, clinical data remain limited. This multicenter, cross-sectional Italian study aimed to further characterize GDD by comparing patients with GD only and those with co-occurring psychiatric disorders. A total of 227 outpatients diagnosed with GD were consecutively recruited from two specialized psychiatric clinics in Milan. Patients were stratified into two subgroups: GD-only and GDD (i.e., GD plus &#x2265;1 additional DSM-5 psychiatric disorder). Sociodemographic and clinical variables were collected, including the distribution of lifetime comorbidities. Psychometric questionnaires were used to assess gambling severity and key psychopathological dimensions. Among the total sample, 137 patients (60.4%) met criteria for GDD. Compared to the GD-only group, GDD patients were significantly older (44.35&#xa0;&#xb1;&#xa0;14.85 vs. 36.76&#xa0;&#xb1;&#xa0;15.03 years; p&#xa0;<&#xa0;.05) and reported a later onset of gambling behavior (33.16&#xa0;&#xb1;&#xa0;13.13 vs. 26.03&#xa0;&#xb1;&#xa0;11.58 years; p&#xa0;<&#xa0;.005). The GDD group showed higher rates of lifetime suicidal ideation and suicide attempts, along with significantly greater emotional dysregulation. Personality disorders and mood disorders emerged as the most frequent psychiatric comorbidities. This study confirms that psychiatric comorbidities are highly prevalent among patients with GD and are associated with distinct sociodemographic and clinical features. These findings support the clinical relevance of the GDD model and underscore the importance of recognizing and integrating this model into clinical practice to enhance diagnostic accuracy, improve therapeutic strategies, and guide future investigations in refining the management of gambling-related disorders.

Although brain and heart conditions share overlapping risk factors and commonly co-occur, current cardiac and neurologic clinical guidelines are typically produced within specialty silos. The objective of this guideline from a Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) panel is to expand on current cardiovascular guidelines to include evidence from the neurologic and mental health literature, with specific recommendations for providers managing comorbid brain and heart conditions. The guideline development panel comprised an Executive Steering Committee; 10 expert subgroups to develop research questions and draft recommendations for specific brain-heart conditions; an Evidence Review Team to ensure the rigour and consistent application of the methodology; and an Implementation Committee to facilitate uptake of the recommendations by clinicians and into electronic medical records. The McMaster Evidence Review and Synthesis Team supported the literature searches and critical appraisal. A panel of people with lived experience of specific conditions and caregivers provided input on patient values and perspectives throughout the guideline development process. Our consensus process followed the Appraisal of Guidelines for Research and Evaluation II framework. We used an established evidence appraisal approach to determine the level of evidence and strength of each recommendation, and adhered to the Guidelines International Network's principles for managing competing interests. We developed 11 recommendations for the management of joint brain and heart diseases. Key recommendations include screening for cognitive decline in atrial fibrillation and depression in coronary artery disease; treatment of depression in coronary artery disease, cognitive impairment in hypertension, and dyslipidemia in stroke; and vaccination to prevent stroke, myocardial infarction, and dementia. We also recommend shared decision-making, including the use of evidence-based decision aids, to support patients with heart-brain diseases. We sought to produce an implementable and actionable guideline for patients with brain and heart comorbidity. It is primarily targeted to primary care providers, but also relevant to help address and individualize subspeciality care and for interprofessional teams caring for patients with joint brain and heart diseases.

Although buprenorphine is highly effective at preventing overdose, access is limited in rural areas. Rural primary care is a critical site to expand access; prescribing support tailored for this setting is urgently needed. To test the feasibility and preliminary effectiveness of a brief buprenorphine prescribing support program (BPSP) tailored for rural primary care professionals (PCPs). This cluster randomized pilot clinical trial compared 27 Ohio community health centers with 63 PCPs (10 physicians, 50 nurse practitioners, and 3 physician assistants) receiving the support program at baseline and immediately after the intervention with those receiving only copies of the American Society of Addiction Medicine's buprenorphine prescribing guidelines. Data were collected from July 25, 2024, to February 28, 2025. The BPSP is a brief, hour-long, asynchronous and online training program, followed by an optional, live booster session, that provides clinical skills on buprenorphine prescribing, addresses misinformation on the safety of buprenorphine, and addresses stigma toward buprenorphine. Health centers were randomized with 2 centers allocated to the intervention for every 1 allocated to the control condition. Primary implementation outcomes were feasibility (measured via the 4-item Feasibility of Intervention Measure [scale of 1 to 5, with higher scores indicating greater feasibility]), acceptability (measured via the 4-item Acceptability of Intervention Measure [scale of 1 to 5, with lhigher scores indicating greater acceptability]), and appropriateness (measured via the 4-item Intervention Appropriateness Measure [scale of 1 to 5, with higher scores indicating greater appropriateness]) of the BPSP; willingness to treat opioid use disorder (OUD) in primary care (using a measure developed and tested with a different sample of PCPs); and likelihood of prescribing buprenorphine in the next 6 months (measured via a 5-point Likert scale ranging from 1.00 [extremely unlikely] to 5.00 [extremely likely]). Of the 63 participating PCPs, 48 participants were allocated to the intervention condition and 15 to the control condition (49 female [78%]; mean [SD] age, 45.5 [11.4] years). Forty-nine participants (78%) practiced in rural areas and 10 (16%) had ever prescribed buprenorphine. Participants receiving the BPSP rated it as highly feasible (median score,&#x2009;4.25 [IQR, 4.00-5.00]), acceptable (median score, 4.88 of 5.00 [IQR, 4.00-5.00]), and appropriate (median score, 5.00 of 5.00 [IQR, 4.00-5.00]). Participants receiving the BPSP had significantly higher willingness to treat OUD; 86% of rank comparisons improved post intervention. Intention to prescribe buprenorphine in the next 6 months also significantly increased; 98% of rank comparisons improved post intervention. Participants who completed the BPSP showed significant improvements in having correct information about buprenorphine, had greater confidence treating addiction and prescribing buprenorphine, and had lower stigma and greater empathy toward patients with OUD. In this cluster randomized clinical trial of the BPSF, brief prescribing support was feasible, acceptable, and appropriate for implementation in rural primary care, and intentions to prescribe buprenorphine increased. A larger trial is needed to confirm preliminary findings. ClinicalTrials.gov Identifier: NCT05505227.

Patients presenting with cannabis-related adverse events (AEs) and other problems are becoming increasingly prevalent in health care settings across the U.S. and Canada, increasing the burden on providers and health systems. Understanding how healthcare providers perceive and respond to cannabis AEs can inform medical training and clinical practices, health policy, and systems-level interventions. The study was conducted in Washington State, a U.S. state that legalized cannabis for non-medical use in 2012. Health care providers were invited to complete an anonymous online survey between December 2024 and March 2025, eliciting frequency and seriousness of various cannabis-related AEs, related clinical practices and procedures, knowledge and confidence addressing such problems, level of concern, and barriers and facilitators to identifying and intervening in such events. Three hundred and eighty-eight valid survey responses were included in the analysis. Most respondents were mdical doctors and worked in hospitals or primary care clinics. Thirty-five percent of respondents reported seeing cannabis AEs and use-related problems frequently (at least 2-3 times a month) in clinical practice. Severe cyclic vomiting was most common (70% reported it ever occurred) and was second to psychosis as "most serious" (33% and 34%). While most providers saw screening and intervening as important (90%), only 39.1% reported universally screening for cannabis and identified many barriers to intervening. Health care providers in a legal cannabis state have encountered AEs and other complications related to cannabis use, and many are concerned about their frequency and severity. According to study participants, expanding access to clinical guidelines, validated tools, referral pathways, and specialized training may enhance their willingness and capacity to screen and intervene effectively.

Prolonged use of topical nasal decongestants such as xylometazoline or oxymetazoline can lead to rhinitis medicamentosa (RM). This medication-induced condition is characterized by rebound congestion and compulsive reuse. A debated question is whether RM signifies physiological dependence, addiction, or simply a habit. This commentary aimed to evaluate Lakatos et&#xa0;al.'s (2025) work, which investigated this issue through qualitative interviews with 20 affected individuals. Using directed content analysis based on Griffiths' (2005) components model of addiction, Lakatos et al., identified all six elements (salience, mood modification, tolerance, withdrawal, conflict, and relapse) in patient histories. Lakatos et&#xa0;al. (2025) performed a timely and conceptually sophisticated study that connects addiction theory to a common otorhinolaryngological condition. Their qualitative approach captures the everyday lived experience of patients with RM with robust ecological validity and clinical relevance. However, the theory-driven analysis risks confirmation bias by fitting data to Griffiths' addiction model, and the small, convenience-based sample limits generalizability. Despite these constraints, the paper offers valuable insight into how negative reinforcement and conditioned anxiety sustain compulsive nasal spray use. Overall, it successfully bridges clinical observation and theoretical debate, advancing understanding of iatrogenic dependence within everyday medical practice.

Homeless-experienced Veterans (HEVs) have higher rates of substance use disorders (SUDs) than housed Veterans, which impairs their ability to retain housing. The Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) initiative, which provides subsidized permanent housing and supportive services, contributed to the 50% reduction in Veteran homelessness over the past decade. However,&#x2009;~&#x2009;40% of Veterans exit HUD-VASH within two years, often due to untreated SUDs. We will use two strategies to support the implementation of Medications for Addiction Treatment (MAT) and Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) in 12 HUD-VASH sites; conduct an evaluation of this implementation effort; and generate an implementation playbook to support continued spread of MAT and CBT-SUD in HUD-VASH. We will use Replicating Effective Programs (REP) to implement MAT and CBT-SUD at 12 sites over 18&#xa0;months. After 9&#xa0;months of REP alone, half (n&#x2009;=&#x2009;6) of these sites will also receive Consumer Engagement (CE) for 9&#xa0;months, activating HEVs to adopt these practices via peer coaching. We will conduct a type 3 hybrid cluster-randomized trial to compare the impacts of REP versus REP&#x2009;+&#x2009;CE. Randomization will occur at two levels: implementation start date (3 cohorts) and the implementation strategy (REP versus REP&#x2009;+&#x2009;CE). We will use stratified block randomization to balance site size among sites receiving each strategy across cohorts. We will use mixed methods to assess the impacts of REP versus REP&#x2009;+&#x2009;CE on implementation outcomes (reach [primary outcome], adoption, and sustainment); Veteran outcomes (primarily housing); provider and Veteran experiences; and costs and budget impacts. We hypothesize that REP&#x2009;+&#x2009;CE will have higher implementation costs than REP but result in improved MAT and CBT-SUD implementation and Veteran outcomes, leading to a business case for REP&#x2009;+&#x2009;CE. Implementing MAT and CBT-SUD within HUD-VASH can improve HEVs' housing and health. By identifying effective strategies to support the implementation of these practices, we aim to inform other implementation efforts of behavioral health practices in homeless service settings. This project was registered with ClincialTrials.gov as "Coordinated Access for Addiction Recovery and Equity in VA Supportive Housing." Trial registration NCT07141394, registered 8/26/2025 ( https://clinicaltrials.gov/study/NCT07141394?term=CARE-VASH&rank=1 ).

Decision trees can use clinical predictors to determine whether to continue the same antidepressant or switch to a different treatment in older patients with major depressive disorder (MDD). We examined whether pharmacogenetic and pharmacokinetic variables could improve their performance. We analyzed 191 participants from the Incomplete Response in Late-Life Depression: Getting to Remission (IRL-Grey) trial who had not responded fully after 4 weeks of venlafaxine XR (150&#xa0;mg/d) and for whom venlafaxine up to 300&#xa0;mg/d was continued for 8 additional weeks. CYP2D6 genotypes were determined; venlafaxine, o-desmethylvenlafaxine (ODV), and active moiety (AM) exposures at week 4 were calculated using population pharmacokinetic modeling. Decision tree analysis was performed using 5 early clinical predictors of eventual nonresponse identified in previous research and 4 pharmacogenetic and pharmacokinetic potential predictors. One decision tree was designed to optimize specificity (k=0.3), and another to optimize sensitivity (k=0.7). Longer episode duration and lack of partial response at week 4 were retained as clinical predictors, and lower AM and ODV exposures were identified as additional predictors. Negative predictive values (NPVs) of the high-specificity and high-sensitivity trees (77.7% and 73.0%, respectively) were similar to NPVs in trees based solely on clinical predictors. Our methods can guide future studies combining clinical and biomarker data to address applied pharmacological questions relevant to day-to-day practice.