Background: Previous work demonstrated that administration of saikosaponin A (SSA), one of the major components of the roots of Bupleurum falcatum, reduced oral alcohol self-administration, a validated measure of the reinforcing and motivational properties of alcohol, in Sardinian alcohol-preferring (sP) rats.Objectives: To evaluate whether SSA ability to reduce the reinforcing and motivational properties of alcohol extends to well-established binge-like drinking paradigms, characterized by intoxicating drinking patterns, in sP rats and C57BL/6J mice.Methods: Male sP rats (n = 48) were exposed to the 4-bottle [10%, 20%, and 30% (v/v)] alcohol vs water choice regimen, with limited and unpredictable time to access to alcohol. Male C57BL/6J mice (n = 56) were subjected to a single-bottle, 20% alcohol "drinking in the dark" protocol, initiated 3 hours into the dark phase. In both experiments, SSA (0, 1, 2, or 4 mg/kg) was administered acutely and intraperitoneally 15 min before the start of the drinking session. SSA was also tested on spontaneous locomotor activity in alcohol-naive sP rats (n = 48) and C57BL/6J mice (n = 39).Results: Alcohol binge-like drinking was prevented by administration of 2 and 4 mg/kg SSA in sP rats (p < .05; p < .005) and C57BL/6J mice (p < .005; p < .0001). However, the results of the locomotor activity experiments indicated that specificity of the reducing effect of SSA on alcohol intake was limited to sP rats and observed only at the dose of 2 mg/kg (p > .05).Conclusion: Overall, our findings support the potential of SSA as a treatment for binge alcohol drinking.
Background: Unrecorded alcohol refers to alcoholic beverages produced and consumed outside the formal market. Unrecorded consumption is a global issue with multiple implications that remains under-explored in Latin America, where most estimations rely on global statistical models and surveys, with a need for country-level estimations.Objectives: To 1) characterize unrecorded consumption in Argentina, describing the percentage of the population consuming unrecorded alcohol and the annual per capita consumption, 2) explore the types and quantities of unrecorded alcoholic beverages consumed, and 3) identify its main predictors.Methods: We conducted a survey with a non-probabilistic sample of 1125 adults (75.9% woman) in Argentina, using the World Health Organization's STEPwise approach. Estimates of unrecorded consumption were adjusted using external population data. Logistic regressions were used to explore predictors.Results: Nearly 47% of the sample reported unrecorded alcohol consumption in the past 12 months, and around 25% did so in the last 30 days. The most common types of unrecorded consumption in the last 12 months were alcoholic beverages bought at duty-free shops (22.6%), homemade fermented beverages (20.5%), and beverages made with pure alcohol bought at pharmacies (14.7%). Adjusted estimates suggest an annual per capita consumption of 2.43 l of pure unrecorded alcohol. Heavy episodic drinking was the strongest predictor of unrecorded alcohol use in the last year, increasing it by 86%.Conclusions: Unrecorded consumption is widespread in Argentina. These findings highlight the need for more inclusive and effective public health policies to address unrecorded alcohol use and its associated risks in the region.
Background: In Nepal, alcohol consumption is traditionally accepted within the religious and cultural practices of tribal communities. The Dhankuta district of Nepal, a hilly area of Eastern Nepal, is home to many indigenous and tribal communities. However, the socio-demographic and socio-contextual factors related to problematic alcohol drinking in these high-risk groups remain unexplored.Objectives: To examine how socio-demographic and socio-contextual factors contribute to predictors of problematic drinking in the Eastern Hills of Nepal.Methods: A case-control study was conducted in the Dhankuta district of Eastern Nepal in 2019. The CAGE questionnaire and AUDIT scale were used to identify problematic drinking. A sample size of 100 cases (male: female = 2.1) and 100 controls (male: female = 1.9) were purposively selected. Socio-demographic factors and socio-contextual factors were assessed. Bivariate and multiple logistic regression were used for analysis. The predictive ability of the regression model was assessed using diagnostic test characteristics.Results: In multivariable analysis, five factors remained significantly associated with problematic drinking after potential confounders were included: strongly disagreeing parental attitude toward individual's alcohol use [OR = 0.42 (0.18-0.98), p = .045], peer alcohol use [OR = 9.03 (1.21-67.38), p < .001], accepting alcohol offers made by friends (susceptibility) [OR = 33.10 (12.30-89.07), p < .001], lower socio-economic status [OR = 2.81 (1.12-7.04), p = .027] and nicotine use disorder [OR = 4.01 (1.28-12.54), p = .017]Conclusion: Predictors of problematic alcohol use in a tribal region of the Eastern Hills of Nepal resemble those observed globally, suggesting the potential applicability of cross-cultural public health strategies.
Background: Drug checking is a harm reduction intervention that uses chemical analytical methods to provide information on the composition of illicit drug mixtures. It is necessary to expand the reach of drug checks to fully meet the needs of populations who use drugs who are at risk of overdose. Technical barriers to drug checking, such as software that is challenging to use without extensive training and practice, hinder the expansion of these services.Objectives: This study describes the development, architecture, and deployment of a custom FTIR-based software framework. Components of this framework are useful across several models of drug checking.Methods: A kiosk application controls a spectrometer and uploads the spectral and survey data to a centralized database. An analysis suite facilitates spectral interpretation using libraries, a repository of previous data, and analysis tools. Individual drug checking results are accessible online. Aggregated data are viewed internally via a dashboard. Public-facing reports are tailored to different communities.Results: The software was successfully deployed with a total of 6 remote service sites operating by 2024. Between May 2022 and December 2024, 2673 drug samples were checked for 1926 clients, including hundreds accessing drug checking for the first time. Weekly and monthly reports of aggregate drug data were created.Conclusions: By lowering technical barriers and supporting real-time reporting, our software framework expanded service access and provided actionable data to both communities and public health stakeholders. This method represents a meaningful advancement in the technological infrastructure necessary to sustain and expand drug checking efforts.
Background: Alcohol use disorder (AUD) remains a major global health challenge with limited effective treatments. Ketamine, an NMDA receptor antagonist with rapid anti-craving and neuroplastic effects, has emerged as a promising novel therapy for AUD.Objective: To review the literature examining the safety and efficacy of ketamine for treating AUD.Methods: PubMed and Embase were searched to identify eligible studies published until December 2024. Studies were screened as per the eligibility criteria. Appropriate Joanna Briggs Institute tool was used for risk of bias assessment. A narrative synthesis of findings from the included studies was done. The review protocol was pre-registered in PROSPERO (CRD42022318120).Results: Six studies comprising a total of 605 patients (528 male) from three different countries (USA, UK, Russia) were reviewed. Five of them reported favorable effects of adjunctive ketamine treatment on a range of different alcohol-related outcomes such as abstinence rates or period, alcohol-related craving, and number of heavy drinking days. However, methodological differences including variations in ketamine dosing strategies (route: oral, IV, IM; dose/session: 0.5 mg/kg IV to 2.5 mg/kg IM; number of sessions: 1-3), treatment duration, sample characteristics, and method used for measuring study outcomes led to significant heterogeneity and limited comparability of results. No study reported any serious adverse event or ketamine misuse following ketamine treatment.Conclusion: This review underscored ketamine's potential as an adjunctive treatment for AUD. While promising, considerable variability in dosing, therapeutic approaches, and study designs limits the certainty of evidence. Future research examining the long-term safety and efficacy of ketamine is needed.
Background: East and Southeast Asia face a severe drug epidemic. A detailed analysis of specific drug use disorders (DUDs) is urgently needed to inform targeted interventions.Objective: To quantify trends in the burden of four DUDs in East and Southeast Asia from 1990 to 2021.Methods: Using Global Burden of Disease Study 2021 data, we analyzed trends (1990-2021) in incidence, prevalence, and DALYs for four DUDs across 20 countries/territories. Estimated annual percentage changes and age-period-cohort models assessed trends and independent effects.Results: Significant disparities were observed. Amphetamine DALYs were higher in East Asia (41-79 per 100,000), while cocaine DALYs peaked in high-income Asia-Pacific (15-16 per 100,000). Amphetamine-related DALYs declined sharply in East Asia (net drift: -3.08%; 95% CI: -3.20 to -2.95, p < .001) but increased in Southeast Asia (0.16%; 0.11 to 0.22, p < .001). Cannabis-related DALYs rose in East Asia (0.27%; 0.2 to 0.35, p < .001). Cocaine-related DALYs fell markedly (-3.81%; -3.95 to -3.68, p < .001). Age effects peaked at 15-34 years.Conclusions: The patterns of drug prevalence and their changing trends in East Asia and Southeast Asia show regional characteristics. The proliferation of amphetamines is becoming increasingly severe in Southeast Asia, while in East Asia, although some success has been achieved in controlling other drugs, risks related to cannabis are continuously rising. Public health strategies must focus on subregional interventions, prioritizing the growing problem of amphetamines in Southeast Asia and the emerging trend of cannabis use among young people.
Background: Alcohol-induced hypertension (HTN) is linked to a 2.3-fold increase in cardiovascular-related death.Objective: We aimed to identify temporal trends in alcohol-induced HTN mortality among United States (US) adults stratified by year, sex, age, race, and region.Methods: Data on alcohol-induced HTN mortality among adults (≥25 years) in the US from 1999 to 2020 were extracted from the CDC WONDER database, utilizing ICD-10 codes. Crude (CMRs) and age-adjusted mortality rates (AAMRs) were calculated. Temporal trends in AAMRs were assessed using Joinpoint regression. Mortality forecasts through 2030 were generated using the ARIMA model in STATA software (version 17.0).Results: From 1999 to 2020, 50,793 alcohol-induced HTN-related deaths were recorded in the US, with an overall AAMR of 0.858 per 100,000. The AAMR increased from 0.279 (95% CI: 0.257-0.302) in 1999 to 1.348 (95% CI: 1.305-1.390) in 2018, rising further to 2.014 (95% CI: 1.963-2.066) in 2020. Mortality was higher in males (AAMR 2.16) than in females (0.55). The highest burden occurred among American Indians/Alaska Natives (AAMR 2.392), while the lowest was observed in Asians/Pacific Islanders (0.206). The Western region had the highest AAMR (1.116). CMR peaked among individuals aged 55-64 years (2.416), with slightly higher rates in rural areas. Forecast analysis projected the overall AAMR to increase from 2.01 in 2020 to 4.18 by 2030.Conclusion: Rising mortality from alcohol-induced HTN highlights an urgent need for strengthened control policies for alcohol use, early identification of hazardous drinking, and integrated management of hypertension and alcohol use to reduce preventable cardiovascular mortality in the US.
Background: Kratom's rise in popularity during multiple overlapping drug use crises is potentially driving poor mental health outcomes and straining health systems.Objective: To investigate temporal changes in the compounding effect of kratom on serious mental illness (SMI) when co-used with other drugs.Methods: We used the National Survey of Drug Use and Health (2021-2023; N = 139,524; male n = 61,926; female n = 77,598) to identify SMI, a range of drug use disorders (SUD), and kratom use. Our focal predictor was whether an individual had 1) no SUD and no kratom use, 2) an SUD without kratom, 3) kratom use without an SUD, or 4) both an SUD and kratom use. We used multiple logistic regression to model whether SMI is associated with SUD/kratom status, year, and their interactions.Results: Roughly 6% of adults met the criteria for SMI. We found that the increase in SMI over 3 years was fastest and markedly different among those with both OUD and kratom use, such that the predicted SMI prevalence went from 20% in 2021 to 50% by 2023 (interaction p = .01), whereas SMI remained relatively stable for other drug combinations, including those with OUD without kratom use, kratom without OUD, and neither OUD nor kratom.Conclusion: Over a short period of 3 years, SMI more than doubled among those with concurrent kratom use and OUD. At a time of strained US treatment systems, high overdose rates, and a mental health crisis, we stress the multiplicative association between kratom, opioid use disorder, and SMI.
Background: American Indian communities consistently identify adolescent substance use as a major concern. However, limited empirical work has examined how culturally specific protective factors - such as family disapproval and cultural affiliation - interact to influence substance use behavior. Given the importance of kinship networks and cultural continuity, understanding these dynamics is critical for informing culturally grounded prevention strategies.Objectives: This study examines the moderating role of cultural affiliation in the association between family disapproval of substance use and actual use among American Indian adolescents, a population often excluded from national health datasets.Methods: Secondary analysis was conducted using self-report data from the Our Youth, Our Future study, a nationally representative sample of American Indian adolescents attending schools on or near reservations (N = 8,950; 51% female; Mage = 14.64 years, SD = 1.77).Results: Multilevel analyses revealed that family disapproval was negatively associated with lifetime alcohol (b = -0.15, p < .001) and cannabis use (b = -0.34, p < .001), controlling for age. Among adolescents who endorsed use, cultural affiliation moderated the relationship between family disapproval and past-year alcohol and cannabis use. Specifically, family disapproval was significantly associated with lower alcohol use at high (b = -0.01, p = .002) but not low (b = -0.07, p = .48) levels of cultural affiliation. For cannabis use, the association was stronger at high (b = -0.51, p < .001) versus low (b = -0.32, p = .005) levels.Conclusions: Cultural affiliation strengthens the protective effects of family disapproval on substance use among American Indian youth. Findings support culturally responsive, family-based prevention efforts that promote cultural identity and intergenerational communication.
Background: The immune system and inflammation have emerged as critical components in alcohol use disorder (AUD). The inflammatory molecule lipocalin-2 (LCN2) has been investigated in alcohol-associated liver disease, and assessment of LCN2 concentrations may aid in prevention and treatment of AUD. However, it is unknown how LCN2 concentrations fluctuate in response to acute and chronic alcohol exposure.Objectives: We examined plasma LCN2 concentrations in rats made alcohol-dependent via chronic, intermittent alcohol vapor exposure, and in people with AUD after acute alcohol administration. We hypothesized that chronic and/or acute alcohol exposure would alter LCN2 concentrations.Methods: Plasma LCN2 concentrations were measured in alcohol-dependent (n = 9) and nondependent (n = 8) male rats. LCN2 concentrations were also examined in two human laboratory studies with cue-reactivity and oral/intravenous alcohol administration in 15 (80% males) and 16 (68.8% males) participants with AUD, respectively.Results: A significant effect of Timepoint (morning versus afternoon; p = .001) but not of chronic alcohol exposure on LCN2 concentrations were found in rats. No significant effects were found after acute alcohol administration in humans.Conclusions: Chronic alcohol exposure in rats or acute alcohol administration in people with AUD had no impact on LCN2 concentrations. In rats, LCN2 concentrations were lower in the morning than in the afternoon, indicating time-related variations in LCN2 concentrations. Together, these findings suggest that LCN2 might play a role in the circadian rhythm, which is often disrupted in people with AUD. However, prospective studies are needed to further examine LCN2's potential clinical relevance in AUD.Clinical Trials Numbers: NCT01751386, NCT01779024.
Background: Although religious and cultural factors have been related to substance use in various populations, research is needed regarding associations for Arab Americans.Objectives: We examined how ethnic identity and religiosity relate to the odds and frequency of alcohol and cannabis use in Arab American college students during the COVID-19 pandemic, as well as differences by biological sex and Muslim upbringingMethods:Arab American college students (N = 173; Mage = 20.1, range 17-23; 60.7% female; 44.5% Christian upbringing, 43.9% Muslim upbringing) were recruited through electronic flyers and a psychology subject pool in California. Participants reported their ethnic identity affirmation (i.e. feeling positively about being Arab American) and search (i.e. learning about Arab culture), religiosity, and past-year alcohol and cannabis useResults: Greater ethnic identity affirmation was related to less frequent alcohol (OR = .68, p = .046) and cannabis use over the past year (OR = .58, p = .030), whereas greater ethnic identity search was related to lower odds of alcohol (OR = 0.66, p = .025) and cannabis use (OR = 0.68, p = .025). Greater ethnic identity search was also related to less frequent alcohol use among individuals from Muslim upbringings (OR = .37, p = .004). Greater religiosity was related to less frequent alcohol (OR = .61, p = .015) and cannabis use (OR = .44, p = .005). It was also related to lower odds of using alcohol and cannabis, with significantly stronger associations among individuals from Muslim upbringings (OR = .39, p = .040; OR = .40, p = .048)Conclusion: Ethnic identity and religiosity buffered substance use risk. Culturally tailored interventions and supporting cultural experiences may reduce Arab American students' substance use.
Background: The drug landscape in the US is rapidly shifting, and alternate methods of drug surveillance that do not involve human subjects may help overcome limitations of current methods. In this study, we focus on nightclubs, where use of cocaine, ketamine, and 3,4-methylenedioxymethamphetamine (MDMA) is prevalent.Objectives: In this proof-of-concept study, we assessed the feasibility of surface swabbing in nightclub venues in New York City as an environmental method for monitoring the presence of commonly used party drugs, and we compared findings from swabs collected from non-nightclub public settings.Methods: Swabbing was conducted inside 9 nightclub venues on 15 nights in 2025, yielding 46 separate surface samples. For comparison, 16 additional swabs were collected from non-nightclub public environments we considered "controls." Samples were analyzed via liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS).Results: Cocaine and ketamine were detected at every nightclub on every night. Across all nightclub swabs, cocaine was most often detected (83%), followed by ketamine (78%), and MDMA (26%). We also detected lidocaine (11%), levamisole (4%), phenacetin (4%), 2-methylmethcathinone (4%), 4-methylmethcathinone (4%), bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS; 4%), and quinine (4%). Detection of cocaine, ketamine, and MDMA was relatively consistent within the same night, and detection was also consistent by venue across nights with some variation in number of swabs testing positive. Among non-nightclub comparison swabs, cocaine and ketamine were detected on 44% and 13% of surfaces, respectively.Conclusions: This study demonstrated that surface swabbing can possibly serve as a useful method for drug monitoring at such venues.
Background: The Alcohol Use Disorders Identification Test (AUDIT) is a widely used screening tool for assessing problematic alcohol use. While strong cross-sectional psychometric support exists, little is known about its longitudinal performance, particularly within Australian populations and over extended intervals. Most prior studies have relied on short test - retest periods (2-6 weeks), simple correlations, and have not examined whether the AUDIT consistently measures the same constructs over time.Objectives: This study addresses these gaps by using longitudinal confirmatory factor analysis (CFA) to examine the AUDIT's factorial structure, test - retest reliability, and measurement invariance over a 12-month period.Method: A sample of 276 Australian adults (mean age = 31.86 years; SD = 9.94; 71% male), all current alcohol consumers, completed the AUDIT at two time points (2022 and 2023). Participants reported regular alcohol use, with an average AUDIT score of 7.14 at T1 and 7.78 at T2; 38.9% exceeded the threshold for hazardous drinking.Results: One-, two-, and three-factor models were compared, with the one-factor model showing the best fit (RMSEA = .078). The AUDIT demonstrated moderate test - retest reliability (r = .67) and partial longitudinal measurement invariance. Only a small number of factor loadings and intercepts were non-invariant. Full support was found for latent variance invariance, latent mean equivalence, and structural invariance.Conclusions: These findings offer novel longitudinal evidence for the psychometric stability of the AUDIT over 12 months in an Australian sample, supporting its value for monitoring alcohol use and evaluating treatment outcomes.
Background: Neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), Amyotrophic lateral sclerosis (ALS), and Huntington's disease (HD) represent a significant global public health problem. Alcohol consumption is a common lifestyle factor that has been implicated as both a risk factor and potential modifier of disease progression.Objectives: This review integrates evidence from human and experimental studies to characterize the effects of alcohol consumption on the onset and progression of major neurodegenerative diseases.Methods: A narrative review was undertaken examining the pathophysiological effects of alcohol on the brain and its disease-specific effects on neurodegenerative disorders, integrating findings from human cohort studies and mechanistic investigations in preclinical models.Results: Experimental evidence indicates that chronic alcohol consumption exacerbates neurodegeneration through multiple converging mechanisms, including oxidative stress, mitochondrial dysfunction, lipid peroxidation, inflammatory signaling, disruption of neurotrophic pathways, impairment of dopaminergic neurotransmission, and alcohol-induced gut microbiota dysbiosis with blood-brain barrier compromise. Epidemiological data suggest dose-dependent and disease-specific associations, with heavy and sustained consumption more consistently linked to increased risk or accelerated progression of AD and PD, while evidence in ALS and HD remains inconsistent.Conclusion: Alcohol exerts a multifaceted and context-dependent influence on neurodegenerative diseases. Accumulating evidence supports that long-term heavy alcohol consumption is associated with enhanced neurodegeneration. Minimizing alcohol consumption may present a pragmatic opportunity to reduce neurodegenerative risk.
Background: Despite the availability of efficacious opioid use disorder (OUD) medications (MOUD), there are racial and ethnic disparities in their use in the general population. Here, we examine the use of MOUD in a racially and ethnically diverse veteran sample.Objectives: To examine racial and ethnic differences in veterans' 1) likelihood of receiving MOUD and 2) treatment retention, dosage, and abstinence outcomes among veterans receiving buprenorphine treatment.Methods: Among 29,502 veterans with OUD, we examined the effects of race and ethnicity on 1) whether methadone or buprenorphine was prescribed as MOUD, and 2) among those prescribed buprenorphine, using multivariable logistic regression to adjust for potential confounders, the likelihood of receiving ≥180 days of treatment and achieving opioid abstinence.Results: Thirty percent of veterans with OUD received MOUD, with race being a significant predictor (p < .01): White veterans were most likely to receive buprenorphine (12%) or both medications (11%), while Black veterans were most likely to receive only methadone (16%). Among 5,768 veterans prescribed buprenorphine, retention was highest among American Indian/Alaska Native (59%), White (59%), and Other race (62%) veterans and lowest among multiracial (47%) and Black veterans (49%). In an adjusted analysis (n = 3,273, 92% male, 8% female), Black veterans had significantly lower odds of opioid abstinence than White veterans (aOR = 0.53, 95% CI = 0.43, 0.67).Conclusion: There are racial disparities in MOUD prescribing and rates of retention, particularly in the rate of abstinence among buprenorphine-treated veterans. Standardized criteria for MOUD selection may help guide clinical decisions and reduce racial disparities in treatment outcomes.
Background: Recent studies have quantified the rate of fatal overdoses that involve opioids, stimulants, and other drugs, but the proportion of overdose deaths attributable to these substances - after accounting for polysubstance use - has not been determined.Objective: We aim to generate the first estimates of the share of overdose deaths by substance type from 1999 to 2021.Methods: By analyzing the National Vital Statistics System's mortality files, we calculated the percent of overdose deaths (n = 1,043,852, 30% female) by substance type in the US for the years 1999 to 2021. We offer and rely on two novel methods: the single-substance method and the apportioned-substance method.Results: In 2021, opioids accounted for 56% (apportioned-substance) to 64% (single-substance) of overdose deaths and stimulants accounted for 30% (single-substance) to 34% (apportioned-substance), which means that opioids and stimulants accounted for 89% to 94% of overdose deaths. From 1999 to 2021, fentanyl became an increasing share of opioid deaths (from 12%-14% to 78%-87%; p < .01) and methamphetamine became an increasing share of stimulant deaths (from 11%-12% to 60%-70%; p < .01).Conclusion: Opioid deaths and stimulant deaths comprised at least 89% of overdose deaths, and methamphetamine and fentanyl represented rising proportions of fatal overdoses. To prevent drug deaths, resources should be directed primarily to therapies and interventions for opioids and stimulants.
Background: People who are unhoused have higher rates of alcohol use disorder (AUD). Understanding the contexts associated with alcohol avoidance motivation may inform interventions to increase motivation for behavior change within this population.Objectives: Aim 1 examined daily variations in motivation among people who were unhoused with probable AUD. Aim 2 examined if motivation was associated with alcohol urge, negative affect (NA), positive affect (PA), and social situations with/without alcohol. Aim 3 examined if morning motivation, urge, NA, PA, and social situation predicted later alcohol use.Methods: Secondary analyses from a clinical trial of adults with unstable housing and probable AUD (N = 70; nmale = 58, nfemale = 12) were conducted (NCT03746808). Participants completed ecological momentary assessments assessing motivation, urge, NA, PA, social situation, and alcohol use for 4 weeks. Multilevel models examined daily variability in motivation, as well as the between- and within-person effects of urge, NA, PA, and social situation on motivation and alcohol use.Results: On average, participants rated their motivation to avoid alcohol as "Neutral" which remained stable within day (mean = 3.23). At the between-person level, higher average alcohol avoidance motivation was associated with lower average urge (CI: -0.70 to -0.22) and with lower odds of alcohol use (CI: 0.15 to 0.78). At the within-person level, higher alcohol avoidance motivation was associated with lower urge (CI: -0.18 to -0.06), higher NA (CI: 0.05 to 0.21), and higher PA (CI: 0.07 to 0.20).Conclusions: This study identified situations that may be conducive to encouraging alcohol use change among people who are unhoused. Targeting in-the-moment affective and craving fluctuations may be keys to enhancing and maintaining motivation to avoid alcohol among people experiencing unstable housing.
Background: Kratom (Mitragyna speciosa), a Southeast Asian plant, has gained global prominence for its pharmacological properties and widespread use, particularly among vulnerable adolescents and youth, raising concerns about its impact.Objective: We reviewed existing studies to provide a comprehensive understanding of kratom use among adolescents and college students.Methods: We conducted a systematic review of studies published up to October 2024, using PubMed, Scopus, Web of Science, and Google Scholar databases. Search terms included "Kratom" or "Mitragyna speciosa" combined with terms related to adolescents and college students.Results: Six eligible studies conducted in Malaysia, Thailand, and the United States were identified. Distinct regional differences in patterns of kratom use were observed, shaped by cultural traditions in Southeast Asia and commercialization in the United States. Kratom use was more prevalent among males across regions, with variations shaped by socioeconomic status, psychosocial influences and recreational use. Available studies were limited to college students and those enrolled in a drug treatment program (one study). Generally, kratom was commonly used to self-manage withdrawal symptoms from opioids (heroin) and methamphetamines. Polydrug use emerged as a consistent theme across all studies, underscoring the complexity of kratom consumption in this population.Conclusion: The rising prevalence of kratom use among adolescents and college students demands attention. While kratom may hold potential as a harm reduction tool, evidence on its safety, efficacy, and long-term outcomes remain limited, highlighting the importance of distinguishing traditional practices from emerging recreational trends. This review points the need for targeted interventions, education, and regulatory frameworks.
Background: There is variation in the criminalization of substance use during pregnancy across U.S. states. How the context of criminal justice system involvement impacts outpatient substance use treatment outcomes among pregnant women is understudied.Objectives: This study tested associations of criminal justice referral status with 1) treatment completion and 2) reduced substance use among individuals at discharge who were pregnant and referred to outpatient treatment from the criminal justice system.Methods: Data were obtained from the 2015-2021 Treatment Episode Dataset-Discharges (TEDS-D). The sample consisted of 7881 justice-involved outpatient discharges who were pregnant. The independent variable was the type of criminal justice referral: court or diversionary program, probation or parole, or other. Outcome variables included treatment completion and reduced substance use. Multivariable logistic regression models were used to measure associations of referral type with treatment outcomes, adjusting for covariates.Results: Referrals from court or diversionary programs had higher odds of treatment completion than referrals from probation or parole (AOR = 1.40, 95% CI = 1.23-1.60). Among individuals at discharge who reported daily use prior to admission, those referred through court or diversionary programs had higher odds of reduced substance use at discharge compared to those referred through probation or parole (AOR = 1.85, 95% CI = 1.23-2.79).Conclusions: Overall, better outcomes were observed among those referred through courts or diversionary programs compared to those referred through probation or parole. These findings demonstrate the potential utility of drug courts and diversionary programs in facilitating positive treatment outcomes while also preventing exposure to more punitive forms of criminal justice system involvement.
Background: Emerging research suggests online racial discrimination may be related to alcohol use and smoking, though more studies are needed to clarify the associations in diverse populations.Objectives: To explore the associations between online racism and hazardous drinking, smoking status, and co-use among Black, Asian American/Native Hawaiian/Pacific Islander (AANHPI), and Multiracial "Generation Z" emerging adults.Methods: Emerging adults (2,801 Black American AANHPI and Multiracial; 49.3% female) were recruited via online quota-based sampling. Multivariable logistic regression models examined the association between online racism and substance use, adjusting for frequency of social media use, total internet use, and sociodemographic covariates. The Karlson - Holm - Breen method was used to examine the role of depression and anxiety.Results: Among Black emerging adults, online racism was associated with greater odds of substance use (OR = 1.04, p < .001) and current smoking (OR = 1.04, p = .001). A similar pattern emerged for AANHPI (hazardous drinking: OR = 1.05, p < .001), current smoking (OR = 1.06, p < .001), and co-use (OR = 1.07, p < .001), and multiracial (current smoking: OR = 1.06, p = .014; and co-use OR = 1.07, p = .003). Anxiety had more pronounced mediating associations for Black emerging adults, while depression had more pronounced mediating effects for AANHPI and multiracial emerging adults.Conclusion: The widespread and chronic nature of online racism may in aggregate negatively impact substance use at the population level. Addressing online racism may require coordinated action, with future directions including the development of accountability strategies, coping interventions, and affirming digital spaces.