El grupo de trabajo de ámbito laboral del Consejo Español de Drogas y Adicciones (CEDOA), compuesto por expertos de los sectores sanitario, sindical y empresarial, ha elaborado un documento de consenso en el que se esbozan 12 elementos esenciales para la prevención y la intervención en materia de adicciones en el lugar de trabajo. En él se afirma que trabajar contra las adicciones en el lugar de trabajo es un compromiso compartido que implica a todas las partes interesadas. Difundir la realidad es el primer paso para abordar las adicciones, junto con el reconocimiento de que los trastornos por consumo de sustancias y las adicciones comportamentales son afecciones tratables. La prevención requiere promover entornos de trabajo protectores, comprender los factores sociodemográficos asociados y generar conocimientos y establecer indicadores. Las empresas y organizaciones son actores clave y deben desarrollar estrategias integrales. En este contexto, un Plan de Prevención de Adicciones (PPA) ayuda a las empresas, refuerza la cultura preventiva y confirma que cualquier trabajador puede ser un agente de cambio con el apoyo adecuado. Por último, reconocer los esfuerzos de las empresas y establecer alianzas con la comunidad son esenciales para garantizar un enfoque coordinado y sostenible.
Intervention about addictive behaviours, especially in substance use, has been advancing from traditional therapeutic communities and drug-free programs to comprehensive care networks and harm reduction programs. Addiction recovery is based on the development of capabilities, skills, and competencies that allow the person who has had an addiction problem to generate an alternative lifestyle to the use of substances (or other addictive behaviours) and not only approach treatment from the presence or absence of the main substance. During the 21st century, the so-called Recovery Science has been developed, identifying the theoretical and practical aspects, concepts and constructs of addiction recovery. This article presented a narrative review of the main theories, aspects, and strengths of Recovery Science, as well as its limitations and applications. The main findings are that recovery-based programs are highly effective for the individuals for whom they are designed, but are more difficult for specific groups (women, especially those with children; young people with conduct disorders; users of new psychoactive substances). In conclusion, it is necessary to strengthen experimental and quasi-experimental studies that allow for a better understanding of what works and what doesn't in Recovery Science. La intervención sobre conductas adictivas, especialmente en el uso de sustancias, ha ido avanzando desde las tradicionales comunidades terapéuticas y los programas libres de drogas hasta las redes integrales de atención y los programas de reducción del daño. La recuperación de adicciones (con sustancia o comportamentales) se basa en el desarrollo de capacidades, habilidades y competencias que permitan que la persona que ha presentado un problema de adicción genere un estilo de vida alternativo al uso de sustancias (u otras conductas adictivas), y no únicamente en abordar el tratamiento desde la presencia o ausencia de la sustancia principal. Durante el siglo XXI se ha desarrollado la llamada Ciencia de la Recuperación, identificando los aspectos, conceptos y constructos teóricos y prácticos de la recuperación de adicciones. En el presente artículo se realizó una revisión narrativa sobre las principales teorías, aspectos y fortalezas de la Ciencia de la Recuperación, así como de sus limitaciones y aplicaciones. Como principales resultados, los programas basados en recuperación son muy eficaces para las personas para las que han sido diseñados, presentando más dificultades para grupos específicos (mujeres, sobre todo con hijos; personas jóvenes con trastornos de conducta; consumidores de nuevas sustancias psicoactivas). Como conclusión, es necesario potenciar los estudios experimentales y cuasiexperimentales que permitan una mayor comprensión de qué funciona y qué no en la Ciencia de la Recuperación.
Addictive behaviors are an important direct cause of avoidable morbidity and mortality in Spain. Our aim was to evaluate the available data on addictions in the most recent health plans and specific addiction plans of the autonomous cities and communities (AACC) of Spain, and to examine the systems of information and surveillance used. A review of the different institutional websites of each autonomous city and community was performed; the search was completed in August 2025, and those plans whose final implementation period extended into the last decade (after 2014) were selected. Seventeen autonomous health plans and nineteen specific addiction plans were selected. The substance addictions covered in these plans differed according to the Autonomous community, but most included data on tobacco, alcohol, hypnosedatives, and cannabis. Cantabria, the Community of Madrid, the Valencian Community, the Principality of Asturias, and Melilla focused exclusively on substance addictions in their addiction plans. Gambling and compulsive use of the Internet were the most common non-substance addictions. The main sources of information and surveillance that provided data on prevalence were the EDADES and ESTUDES surveys, regional health or drug surveys, and state or regional systems of information on drug addictions. The Autonomous Observatories on drugs were present in eleven AACC. The data included in the regional plans and the sources of information on addictions are heterogeneous. It is necessary to update, extend and homogenize the health and addiction plans, as well as the systems of information and surveillance, of each AC to be able to adequately analyze and monitor addictive behaviors. Las conductas adictivas son una importante causa directa de morbimortalidad evitable en España. Nuestro objetivo fue evaluar el contenido sobre adicciones disponible en los planes de salud y sobre adicciones más recientes de las comunidades y ciudades autónomas (CC. AA.), así como examinar los sistemas de información y vigilancia utilizados. Se realizó una revisión de los diferentes sitios web institucionales de cada comunidad y ciudad autónoma; la búsqueda se completó en agosto de 2025, y se seleccionaron aquellos planes cuyo periodo final de aplicación abarcaba la última década (posterior al año 2014). Se seleccionaron diecisiete planes autonómicos de salud y diecinueve sobre adicciones. Las adicciones con sustancia contempladas en dichos planes diferían según la comunidad autónoma (C. A.); si bien, la mayoría incluían datos sobre tabaco, alcohol, hipnosedantes y cannabis. Cantabria, la Comunidad de Madrid, la Comunidad Valenciana, el Principado de Asturias y Melilla abordaban exclusivamente las adicciones con sustancia en su plan sobre adicciones. El juego con dinero y el uso compulsivo de internet fueron las adicciones sin sustancia más contempladas. Las principales fuentes de información y vigilancia que aportaron datos sobre la prevalencia fueron las encuestas EDADES y ESTUDES, encuestas autonómicas de salud o drogas, así como sistemas estatales o autonómicos de información sobre toxicomanías. Once CC. AA. disponían de Observatorios Autonómicos sobre drogas. Los datos incluidos en los planes autonómicos y las fuentes de información de las adicciones son heterogéneos. Es necesario actualizar, ampliar y homogeneizar los planes de salud y sobre adicciones, además de los sistemas de información y vigilancia, de cada C. A. para poder analizar y monitorizar adecuadamente las conductas adictivas.
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Persuasive narratives have been shown to be effective in influencing health behaviors. However, their impact on at-risk populations, such as justice-involved juveniles who use cannabis, has received limited attention. This study analyzes the response of 93 juveniles with judicial measures in detention centers to persuasive video-based narratives. These narratives were developed in accordance with the Health Action Process Approach (HAPA) and were gender-adapted. Additionally, variables influencing resistance to the persuasive message, assessed in terms of favorability, were examined. Prior to exposure to the narrative, motivational variables such as risk perception, outcome expectancies (both positive and negative) of cannabis non-use, and self-efficacy for action were measured. Following the viewing, generated thoughts (cognitive responses) and engagement with the narrative, focusing on identification with the protagonist and narrative transportation, were assessed. The results revealed that the thoughts generated focused on the message content of the message and personal experiences, with favorable thoughts predominating. No significant differences were found between males and females. Furthermore, narrative transportation acted as a significant mediator between risk perception and message favorability. This study provides empirical evidence on the effect of persuasive narratives in this population, indicating that their design, based on health behavior change theories, enhances receptivity. The findings support their integration into prevention programs within the context of juvenile justice. Las narrativas persuasivas han demostrado ser efectivas para influir en los comportamientos de salud. Sin embargo, su impacto en poblaciones en riesgo, como menores en conflicto con la ley que consumen cannabis, ha sido poco explorado. Este estudio analiza la respuesta de 93 menores que cumplen medidas judiciales en centros de internamiento ante narrativas persuasivas en formato video. Estas narrativas se elaboraron conforme al modelo del Proceso de Acción en Salud (Health Action Process Approach, HAPA) y adaptadas por género. Asimismo, se investigaron las variables que influyen en la resistencia al mensaje persuasivo, evaluada en términos de favorabilidad. Antes de la exposición a la narrativa, se midieron variables motivacionales como percepción del riesgo, expectativas (positivas y negativas) de resultados del no consumo de cannabis y autoeficacia para la acción. Tras la visualización, se analizaron los pensamientos generados (respuestas cognitivas) y el engagement con la narración, a través de la identificación con el/la protagonista y el transporte narrativo. Los resultados revelaron que los pensamientos se centraron en contenido del mensaje y en experiencias personales, predominando aquellos de carácter de favorable. No se encontraron diferencias significativas entre hombres y mujeres. Además, el transporte narrativo actuó como mediador significativo entre la percepción del riesgo y la favorabilidad. Este estudio aporta evidencia empírica sobre el efecto de las narrativas persuasivas en esta población, demostrando que su diseño, basado teorías de cambio de conducta de salud, favorece la receptividad. Los hallazgos respaldan su integración en programas de prevención en el contexto de la justicia juvenil.
Background/Objectives: Pediatric palliative care seeks to relieve suffering and improve the quality of life of children with severe conditions and their families. This prospective cohort study assessed changes in quality of life following enrollment in a pediatric palliative care program at a tertiary care center in Mexico and explored factors associated with these changes. Methods: Children with life-limiting or severe disabling conditions were followed at baseline, 3 months, and 6 months. Quality of life was measured using the Pediatric Quality of Life Inventory (PedsQL™) Cancer Module for oncologic patients and the PedsQL™ Family Impact Module for all families. Results: A total of 166 families completed the Family Impact Module questionnaires, and 116 oncologic patients completed the Cancer Module. Mean children's PedsQL Cancer Module scores improved from 58.9 to 77.9, and family scores improved from 60.1 to 78.8 over six months (both p < 0.001). Families of oncologic patients and those residing outside the Mexico City metropolitan area had lower baseline scores (adjusted differences -9.84, 95% CI: -15.9 to -3.77; and -6.9, 95% CI: -12.38 to -1.44, respectively); however, the latter group showed a greater rate of improvement over time, contrary to our initial hypothesis-survival varied by diagnosis, with longer survival observed in children with neurologic or intracranial conditions. Conclusions: The quality of life of families and pediatric oncologic patients showed improvement over time following enrollment in a specialist pediatric palliative care program in a middle-income setting. Equitable access should be ensured for families affected by chronic conditions, particularly those living beyond major urban areas.
Misinformation is one of the main global risks threatening public health. During public health crises, which often involve a high degree of scientific uncertainty and a high social demand for information, the infodemic contributes to misinformation. The objective of this article is to analyze how to communicate effectively to contribute to the fulfillment of the public health mission while avoiding misinformation. Strategic communication, one of the essential functions of public health, involves not only providing the right message at the right time, delivering it to the right messenger, and disseminating it through the appropriate channels (mass, community, and interpersonal media), but also defending against the corporate capture of public health. In public health crises, the goal of communication is to enable people to make informed decisions to reduce risk and mitigate the impact of the crisis, recognizing and addressing community concerns and emotions, providing clear and truthful information, without hiding the uncertainties. Traditional media and social media are the primary sources of public health information for the population, especially during crises, so the active presence of public health institutions and professionals in these media is essential. Interinstitutional collaboration between levels of government with expertise in public health, including primary care professionals, and community leaders increases the coherence and effectiveness of messages, avoiding confusion and promoting public trust.
The effects of MCH11, a novel monoacylglycerol lipase inhibitor, were evaluated on binge-like ethanol consumption using the drinking-in-the-dark paradigm in male and female C57BL/6J mice. Rodents underwent 4 weeks of binge drinking, and MCH11 (20 and 40 mg kg-1, i.p.) was administered acutely (day 4, DID-3) or repeatedly (days 1-4, DID-4). Quantitative PCR assessed tyrosine hydroxylase (Th) in the ventral tegmental area (VTA); dopamine receptor 2 (Drd2) in the prefrontal cortex (PFC) and nucleus accumbens (NAc); and mu-opioid receptor (Oprm1), cannabinoid 1 (Cnr1), and cannabinoid 2 (Cnr2) receptors in the NAc. Across the DID paradigm, females consistently consumed more ethanol than males. Acute MCH11 (40 mg kg-1, i.p.) significantly reduced ethanol intake in both sexes. Following repeated administration, ethanol consumption decreased in females at both tested doses. In contrast, in males, this effect was observed only at the higher dose, indicating sex-related differences in dose sensitivity under chronic treatment conditions. Ethanol exposure induced sex-specific transcriptional adaptations, including male-predominant increases in Th in the VTA and Cnr1 in the NAc, and opposite regulation of Drd2 in the NAc between sexes. Oprm1 in NAc was upregulated in both, with a greater magnitude in males, whereas Cnr2 in NAc and Drd2 in PFC decreased equally. MCH11 modulated ethanol-associated transcriptional changes in males at 40 mg kg-1 and in females at 20 and 40 mg kg-1, in parallel with the observed behavioral effects. Together, these findings demonstrate that MCH11 attenuates binge-like ethanol consumption, with dose- and sex-related differences, and highlight its therapeutic potential to modulate binge drinking behavior.
Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease (MND) characterized by progressive degeneration of both upper and lower motor neurons, along with skeletal muscles innervated by them. The identification of key molecules involved in disease pathology remains crucial for ALS, as no curative treatment is currently available. Pleiotrophin (PTN) and midkine (MK) are closely related, heparin-binding cytokines with overlapping effects. These molecules have been shown to be neuroprotective by modulating neuroinflammation, supporting neuronal survival, growth, and differentiation, and enhancing synaptic strength and plasticity. Despite their reported neuroprotective properties, the involvement of PTN and MK signaling in ALS has not been previously investigated. In this study, we characterized the expression of the PTN/MK pathway in the lumbar spinal cords (SCs) of TDP-43A315T mice across different disease stages. We report a significant upregulation of Ptn, Mdk, and its receptor protein tyrosine phosphatase zeta (Ptprz1) mRNA levels at end-stage of disease in the lumbar SC of TDP-43A315T mice compared with age-matched wild-type littermates. Protein levels of PTN and MK were also upregulated at end-stage of disease. By immunofluorescence analysis, we also observed an upregulation of the immunostaining of both cytokines in neurons, astrocytes, microglia, and pericytes-like structures at end-stage of disease in the SC of TDP-43A315T mice. These findings open a new avenue to further study the potential role of the PTN/MK signaling axis in the pathogenesis of ALS. Trial Registration: Animal Ethics Committee of the Hospital Nacional de Parapléjicos in Toledo (Spain): Approval No. 26/OH 2018.
To describe differences in the expression of genes encoding cannabinoid receptors (CNR1, CNR2), the associated receptor GRP55 and the enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MGLL) between individuals with alcohol use disorder (AUD) and controls in key mesocorticolimbic brain regions. Case-control, observational postmortem study comparing gene expression in brain tissue from individuals diagnosed with AUD and matched controls. The study was not pre-registered and should therefore be considered exploratory. Brain collection from the New South Wales Tissue Resource Centre (NSWTRC) at the University of Sydney, Australia. Brain samples were obtained from 18 patients with AUD (mean alcohol use = 35.5 ± 8.7 drinking years) and 18 controls (C). Groups were matched for age (AUD: 55.8 ± 9; C: 56.3 ± 9.4) and postmortem interval (AUD: 39.7 ± 16.9 h; C: 31.8 ± 13.2 h). Relative gene expression of CNR1, CNR2, GPR55, FAAH and MGLL was quantified using real-time polymerase chain reaction (qPCR) in the prefrontal cortex (PFC) and nucleus accumbens (NAc). Compared with controls, individuals with AUD showed higher CNR1 in the PFC (+125%) and NAc (+78%) and lower CNR2 expression in both regions (PFC: -50%; NAc: -49%). GPR55 was higher in the PFC (+19%) and lower in the NAc (-51%). FAAH expression was lower in the PFC (-15%) and higher in the NAc (+24%), whereas MGLL expression did not differ in the PFC and was lower in the NAc (-15%). This descriptive postmortem study identifying region-specific differences in endocannabinoid system gene expression between individuals with alcohol use disorder (AUD) and controls supports an involvement of the endocannabinoid system in the neuropathological features associated with AUD, although causal relationships cannot be inferred.
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The coexistence of substance use disorders (SUD) and other mental disorders - commonly referred to as dual disorders (DD) - is highly prevalent and clinically significant. Although various terms have been used over time (e.g., psychiatric comorbidity, dual pathology), the lack of a standardised definition has created inconsistencies in diagnosis, communication, research, and treatment. Epidemiological studies estimate that 30-80% of individuals with SUD have co-occurring psychiatric disorders, with prevalence depending on the substance involved, gender, age, and the population studied (general population, people in emergency rooms, mental health addiction facilities, harm reduction facilities, prison). Compared to individuals with a single disorder, people with DD exhibit more severe psychopathological symptoms, higher suicide risk, increased relapse rates, poorer treatment adherence, more medical comorbidities, and worse psychosocial outcomes, including unemployment, homelessness, and social exclusion. Despite extensive evidence, both SUD and other mental disorders often remain underdiagnosed and undertreated, partly due to diagnostic complexities such as overlapping symptomatology and the syndromic nature of psychiatric classifications. Additional barriers include the structural separation between mental health and addiction services and limited integrated care expertise. The "wrong door syndrome" exemplifies how patients are frequently directed to services unable to address both conditions, leading to suboptimal outcomes. Furthermore, individuals with DD are often excluded from clinical research, limiting the evidence base for tailored interventions. Improving the detection and treatment of DD is a major challenge for mental health and addiction systems. Integrated, holistic treatment approaches from the outset are essential to optimise outcomes for this highly vulnerable population.
The glucagon-like peptide-1 receptor (GLP-1R) has emerged as a promising therapeutic option for alcohol use disorder (AUD), yet the underlying mechanisms and neurocircuitry involved remain unclear. This study aimed to analyze GLP-1R gene expression changes in brain regions associated with alcohol's effects, including the prefrontal cortex (PFC), nucleus accumbens (NAc), and hippocampus (HIP), in mice following 42 days of voluntary ethanol consumption (VEC; 10% v/v) and postmortem samples from 18 patients with AUD. Additionally, we examined the expression of OPRM1 (mu-opioid receptor) and BDNF (brain-derived neurotrophic factor), key targets related to alcohol intake and reward, in the NAc and HIP, respectively. GLP-1R gene expression was significantly reduced in all brain regions of ethanol-exposed mice and AUD patients. These reductions paralleled decreased OPRM1 and BDNF expression in the NAc and HIP, respectively. Pearson and Spearman correlation analyses revealed no significant associations between gene expression and age, RIN, pH, postmortem interval (PMI), body mass index (BMI), smoking status, age of onset of alcohol use, or years of drinking. In summary, chronic alcohol consumption in humans or mice was associated with decreased GLP-1R gene expression in brain regions involved in the reinforcing effects of ethanol. These findings open new avenues for further research into how this emerging receptor could serve as a potential biomarker and therapeutic target in AUD.
Efficient and accurate screening tools are crucial for improving early identification and treatment outcomes among individuals with obsessive-compulsive disorder (OCD). This study evaluated the sensitivity and specificity of two OCD screening measures: the Obsessive-Compulsive Inventory-4 (OCI-4) and the Florida Obsessive-Compulsive Inventory-II (FOCI-II) severity scale. The measures were administered in a large transnational sample of Spanish speaking Latin American adults (N = 1696) with elevated obsessive-compulsive symptomatology. Participants completed diagnostic interviews (MINI and Y-BOCS) and self-report assessments across 23 sites in 11 countries. Both measures significantly distinguished OCD from non-OCD cases, with the FOCI-II demonstrating somewhat better predictive performance (AUC = .79) compared to the OCI-4 (AUC = .69). A score of 7 or greater for both the OCI-4 (64 % sensitivity, 66 % specificity) and FOCI-II severity scale (74 % sensitivity, 70 % specificity) were found to be the most appropriate cutoffs across the overall sample. Findings provide some support in the use of both tools in clinical and research contexts, with some comparative benefits of the FOCI-II.
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Suicide is one of the most common causes of death in correctional settings. This study aimed to analyse prison suicide prevention policies and procedures across Latin America. For this multiple case study, we collected data on prison suicide prevention in policies (laws), programmes (institutional framework) and protocols (procedures) from 17 Latin American countries, from (1) the public domain and (2) archival records held by prison administrations. The search was conducted using Google, through hand search on prison administration websites and requests to public information departments and prison administrations. Theory-driven thematic analysis was conducted based on 11 key components of suicide prevention in prison. Presence and quality of policies, programmes and protocols were assessed using tailored instruments. Between-country comparisons were made by cross-case analysis. Data were retrieved from 17 Latin American jurisdictions. Nine cases had a policy or law, 6 had an institutional plan or programme and 13 had suicide prevention protocols. In 6 of the 17 cases (Argentina, Chile, Colombia, Ecuador, Mexico and Panama), the three elements were present. Among the 13 cases with protocols, 7 (Argentina, Brazil, Chile, Colombia, Mexico, Paraguay and Uruguay) had high, 2 had medium and 4 cases had low quantity and quality of key components. In the composite quality assessment of policies, programmes and protocols, three cases (Argentina, Colombia and Mexico) had high quality, four cases had medium quality and the other seven cases had low quality of suicide prevention in place. Many Latin American countries still need to draft policies and develop institutional frameworks for suicide prevention in prison. Most countries may review their suicide prevention protocols in prisons to cover all key components with clear procedures. Prison administrations in Latin America should publish internal plans and protocols for prison suicide prevention to facilitate cross-country policy evaluations and research.
Non-suicidal self-injury (NSSI) and gambling are considered notable public health challenges, each linked to emotion dysregulation, impulsivity, and heightened mental health risks. Although examined separately, their co-occurrence may reflect overlapping vulnerabilities. The present study examined the prevalence, correlates, and predictors of NSSI among ndividuals who gamble online and identified distinct behavioral subgroups using latent class analysis. A cross-sectional study was conducted among individuals with past-year online gambling (N = 1047; 50% males; mean age = 39.60 years [SD = 12.46]). Measures included psychometric scales assessing problem-gambling severity, NSSI, impulsivity, sleep difficulties, and psychological distress. Multinomial logistic regressions tested associations between gambling severity and NSSI, and latent class analysis (LCA) was conducted to identify NSSI subgroups. Hierarchical multinomial regressions assessed demographic, gambling-related, and psychological predictors of class membership. Lifetime NSSI was reported by 64% of participants, with higher odds among those with scores reflecting problem gambling. LCA identified three subgroups: low/no self-harming (61.6%), moderate/occasional self-harming (23.2%), and high/multi-method self-harming (15.2%), reflecting stepwise increases in frequency and method diversity. NSSI class membership was significantly associated with problem-gambling severity (χ2[3] = 45.0, p < .001). Younger age, insomnia, impulsivity, and psychological distress predicted higher NSSI class membership, with insomnia and distress emerging as the strongest independent predictors. NSSI is a prevalent and clinically significant correlate of online gambling, emerging even at lower levels of problem-gambling severity, underscoring the importance of integrating emotion regulation and distress-focused support into interventions targeting problem gambling. The study's findings deepen the understanding of psychological pathways linking gambling and self-injury among adults.
Gambling is a common activity that becomes problematic in some vulnerable individuals, with gambling disorder (GD) now recognised as a bona fide mental/brain disorder. Several factors are associated with vulnerability to developing GD, including other mental disorders and pathological personality traits like high impulsivity. This clinical condition, referred to as Dual Gambling Disorder (GDD), better captures the broader psychopathological spectrum of GD. This narrative review addresses recent advances in neuroscience and psychiatry that can help design more effective prevention strategies for GD. After establishing the current state of the art regarding GD/GDD from a biopsychosocial perspective, we assess the scientific evidence supporting approaches to GDD prevention. Following an overview of GD/GDD, we examine how precision psychiatry can not only shape therapeutic interventions but also, evidence-based prevention strategies for GD, and how these strategies align with advances in clinical neuroscience and precision psychiatry. Prevention is analyzed across multiple levels: primordial, primary, secondary, and tertiary. Finally, we outline key elements to be considered when designing scientifically grounded prevention strategies for specific target populations. The development of preventive strategies for GD, particularly when arising alongside other mental disorders, must be grounded in scientific evidence from neuroscience and precision psychiatry. Gambling disorder is a mental, and therefore a brain disorder, that is becoming an increasingly important problem worldwide, in part due to the widespread development of online gaming platforms.Like many addictive disorders, people with gambling disorder often have some other mental disorder (in up to 96% of cases), which is why it is proposed to use the term gambling dual disorder.According to scientific evidence, brain dysfunctions precede the appearance of gambling dual disorder and must be evaluated from the biological, psychological and social perspective, in that order. Prevention must be based on the identification of populations at high risk.The phenotypic diagnosis of gambling disorder should be completed with a precision diagnosis that identifies endophenotypes or biotypes, such as high impulsivity or the presence of other mental disorders, not only categorical but also dimensional.Treatment should be biological, psychological and social, in that order. A clear barrier is the lack of neurobiological treatments approved by regulatory agencies (FDA, EMA) for gambling disorders. However, a diagnosis of gambling dual disorder that includes other symptoms, phenotypes, or mental disorders may allow us to use effective biological treatments.We propose that, to adequately manage gambling dual disorder, it is necessary to design and implement evidence-based prevention strategies that incorporate recent advances in clinical neuroscience, addressing different levels (primary, secondary and tertiary) and involving all stakeholders (e.g., patients/families, clinicians/clinicians, social workers, etc.).
Background: Methamphetamine (MA) use in people living with HIV (PLWH) has been linked to neurocognitive and behavioral dysregulation. We hypothesized that PLWH with active MA use (MAHIV) would show poorer cognitive performance, greater emotional and sleep burden, higher behavioral risk, and alterations in circulating biomarkers of immune activation and neuronal injury, relative to PLWH without MA use and HIV-negative Controls. Methods: Cross-sectional analytic study of 121 adults: PLWH with MA use (MAHIV, n = 40), PLWH without use (n = 42), and HIV-negative Controls (n = 39). Outcomes were ART discontinuation, physical activity, neurocognition (MoCA), depression (BDI), anxiety (GAD-7), sleep (PSQI), and substance use (ASSIST). Circulating biomarkers measured by ELISA: sCD14, neuron-specific enolase (NSE), S100B, and neurofilament light chain (NfL). Results: MAHIV participants had more frequent ART discontinuation than PLWH and the lowest physical activity. Chemsex with polysubstance use, condomless sex, and multiple partners were most prevalent in MAHIV. This group showed the highest anxiety and depressive burdens, and the greatest sleep disturbances. Global cognition (MoCA) was lowest in MAHIV, with significant deficits in executive function, memory, attention, and language; 82.5% had at least mild cognitive impairment. sCD14 was significantly higher in MAHIV than in PLWH and Controls, and NSE was elevated in both MAHIV and PLWH versus Controls. sCD14 correlated inversely with MoCA and positively with GAD-7 and BDI-II. Conclusions: Among PLWH, MA use is associated with greater ART nonadherence, syndemic mental-health and sleep disturbances, broader neurocognitive deficits, and elevations in circulating sCD14 and NSE. The sCD14-cognition and sCD14-mood relationships highlight chronic immune activation as a candidate pathway for neurocognitive and affective impairment and support sCD14 and NSE as potential stratification and monitoring biomarkers in MA-using PLWH.