Addiction最新文献

{"title":"Is big money distorting the global drug policy conversation?","authors":"Bobby P. Smyth","doi":"10.1111/add.70059","DOIUrl":"10.1111/add.70059","url":null,"abstract":"<p>The Open Society Foundation (OSF) appears to have a large and distorting influence upon the current global drug policy conversation.</p><p>The United Nations (UN) Conventions on Narcotic Drugs stand as a massive obstacle for those with drug legalization ambitions [<span>1</span>]. OSF is a wealthy opponent of the drug conventions, being led by the multi-billionaire, George Soros [<span>2, 3</span>]. The funding of this think-tank has been assessed as being ‘highly opaque’ [<span>4</span>]. OSF supports groups who put forward alternatives to prohibition and who support legalization [<span>2</span>], saying ‘the vast majority of our grants are awarded to organizations that we approach directly’ and it funds those ‘who share our values’ [<span>5</span>].</p><p>The annual meeting in Vienna of the Commission on Narcotic Drugs (CND) is a key event in the annual calendar for those interested in the drug conventions. The program involves plenaries and dozens of organised official side events [<span>6</span>]. OSF was among the non-governmental organizations (NGOs) at the meeting in 2024 and was formally involved in the running of 11 side events.</p><p>The funding relationship between OSF and the 49 other NGO contributors to these 11 OSF-involved side events was explored. It emerged that 38 (78%) had recent (2016–2023) OSF funding. OSF helpfully lists grantees on its own website [<span>7</span>]. This confirmed funding in 31 instances. Financial support for individual NGOs ranged from $25 000 to $18 million over the 8 years. These 31 entities shared over $82 million from OSF across this period. In the other seven cases, funding was confirmed by the NGO's own website or via media reports. There were at least another 10 OSF funded NGOs involved in supporting other side events at CND 2024 [<span>6</span>].</p><p>OSF has also recently funded both the Joint UN Programme on HIV/AIDS and Office of the UN High Commissioner for Human Rights (OHCHR) who each supported seven of the OSF-involved side events. The OHCHR received an average of $100 000 annually from OSF across 2018 to 2022 [<span>7</span>]. This increased to $1.52 million in 2023. In 2023, OHCHR issued a report on drug policy urging countries to ‘consider developing a regulatory system for legal access to all controlled substances’ [<span>8</span>]. The UN High Commissioner recently called for ‘responsible regulation’ at a conference on the ‘sensible regulation of drugs’ [<span>9</span>]. This echoes the views of the OSF funder and conflicts with a current UN Convention.</p><p>A decade ago, Forbes magazine declared George Soros to be the biggest drug reformer in the United States [<span>10</span>]. This influence now appears truly global, OSF attending this CND meeting with an army of over 50 NGOs and UN offices who are financially beholding to his think-tank.</p><p>Some of the funded entities at the CND meeting are university based and contribute research on drug policy. OSF additionally funds other","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1284-1285"},"PeriodicalIF":5.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Carlon et al.: High hopes—Integrating positive psychological interventions into substance use disorder treatment","authors":"Adam W. Carrico","doi":"10.1111/add.70062","DOIUrl":"10.1111/add.70062","url":null,"abstract":"<p>Neurobehavioral models underscore the potential clinical relevance of positive psychological interventions (PPIs) in people who use substances [<span>1, 2</span>]. The hedonic model proposes that substance-induced increases in mesolimbic dopamine levels are linked to experiences of reward that serve a positive reinforcment for continued use [<span>3</span>]. Furthermore, because hypo-responsivity to reward and anhedonia are implicated in substance use disorder (SUD) etiology and maintenance [<span>4</span>], experiencing positive emotions is one primary motivation for using substances. PPIs could support more proactive responses to anhedonia to increase experiences of reward unrelated to substance use that, in turn, reduce the likelihood of the overlearned response of substance use. On the other hand, negative reinforcement models highlight that symptoms of withdrawal such as depression serve as triggers for substance use [<span>5</span>]. Evidence-based skills (e.g. gratitude and mindfulness) in PPIs that increase positive psychological outcomes in the broader population could assist with more effectively managing negative emotions as triggers for substance use [<span>6</span>].</p><p>A recent systematic review and meta-analysis by Carlon and colleagues [<span>7</span>] examined the efficacy of PPIs among people who use alcohol or other substances. There were small and nonsignificant effects of PPIs on increases in positive psychological outcomes and reductions in substance use across eight randomized controlled trials (RCTs). PPIs integrate various evidence-based skills aimed at improving positive psychological outcomes [<span>7</span>], which has strengths and limitations. On one hand, interventions that incorporate multiple skills, such as cognitive-behavioral therapy, could potentially yield larger effect sizes. At the same time, substantial variability in the PPIs tested across RCTs makes it difficult to determine their overall efficacy and identify which intervention component(s) are most beneficial. To address these limitations, future RCTs should develop a unified protocol for PPIs, leverage dismantling and multi-phase optimization strategy designs to determine the best combinations of components, and establish the dose of PPIs necessary to improve outcomes in diverse groups of people who use alcohol, tobacco, and other substances.</p><p>Identifying the underlying mechanisms of PPIs is essential for improving their effectiveness in reducing substance use. A significant challenge in interpreting findings across prior RCTs is the heterogeneity in the positive psychological outcomes assessed. Some RCTs assessed positive psychological traits such as resilience and optimism, which may be more difficult to change compared to state measures like positive emotions (e.g. happiness, gratitude). Guided by revised stress and coping theory [<span>8</span>] as well as the broaden and build model [<span>9</span>], positive emotions are thought to be","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 7","pages":"1325-1326"},"PeriodicalIF":5.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Ezard et al.: Prescribed psychostimulant medications for methamphetamine use disorder – an urgent path forward","authors":"Adam Bisaga","doi":"10.1111/add.70058","DOIUrl":"10.1111/add.70058","url":null,"abstract":"<p>Over the last decade, methamphetamine-related hospitalizations, emergency visits and fatalities have steadily increased in the USA [<span>1</span>], highlighting a growing public health crisis. Despite these trends, no medication for stimulant (methamphetamine or cocaine) use disorder (StUD) has yet received approval by the US Food and Drug Administration (FDA). While psychosocial interventions effectively reduce stimulant use [<span>2</span>], their adoption in community settings in the USA remains challenging [<span>3, 4</span>].</p><p>Given the critical gap in treatments for StUD, researchers and clinicians have looked to the medical model used in opioid use disorder (OUD) care, where the prescribed opioid agonists methadone and buprenorphine serve as first-line therapies – reducing illicit opioid use, lowering overdose risk and improving quality of life. This successful approach prompted parallel efforts to explore agonist-based treatments for methamphetamine and cocaine use disorders, with prescription amphetamines and methylphenidate as the main candidates. Although initial attempts with prescribed amphetamines as substitution therapy in the 1960s–1970s were unsuccessful, owing to safety concerns, subsequent efforts in the 1990s in the UK – drawing on methadone maintenance experience – showed more favorable outcomes [<span>5</span>]. Around the same time in the USA, case series and early controlled studies [<span>6, 7</span>] indicated the feasibility, safety and benefits of an agonist-based approach for StUD, prompting calls for further systematic research [<span>8</span>]. This debate on the merits of such an approach has persisted for the past three decades [<span>9</span>].</p><p>Over that period, numerous controlled trials, and subsequent systematic reviews and meta-analyses, have explored agonist-like medications in StUD treatment; with prescription amphetamines demonstrating promise for cocaine use disorder, and with methylphenidate showing benefits in methamphetamine use disorder [<span>10-14</span>]. The latest study by Ezard and colleagues [<span>15</span>] adds to this body of evidence by indicating that high-dose prescription amphetamines can have small but significant benefit for individuals with severe methamphetamine use. Generally, higher doses of stimulant medications have produced more favorable outcomes than lower doses [<span>11, 14</span>], indicating a dose–response relationship, consistent with an agonist-type mechanism. This highlights the importance of dose optimization and calls for caution when interpreting negative findings from lower-dose trials. Nonetheless, high attrition rates, heterogeneity in outcomes and difficulties with medication blinding contribute to the overall low quality of evidence [<span>11</span>].</p><p>Although safety has been a key concern in repurposing stimulants for StUD, clinical trials to date indicate that severe adverse events are no more frequent in participants receiving prescribe","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 7","pages":"1360-1362"},"PeriodicalIF":5.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic validity of drinking behaviour for identifying alcohol use disorder: Findings from a representative sample of community adults and an inpatient clinical sample","authors":"Molly L. Garber, Andriy Samokhvalov, Yelena Chorny, Onawa LaBelle, Brian Rush, Jean Costello, James MacKillop","doi":"10.1111/add.70037","DOIUrl":"10.1111/add.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Alcohol consumption is an inherent feature of alcohol use disorder (AUD), and drinking patterns may be diagnostically informative. This study had three aims: (1) to examine the classification accuracy of several individually analysed drinking behavior measures in a large sample of US community adults; (2) to extend the findings to an adult clinical sample; and (3) to examine potential sex differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>In cross-sectional epidemiological and clinical datasets, receiver operating characteristic (ROC) curves were used to evaluate diagnostic classification using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Participants</h3>\u0000 \u0000 <p>Two samples were examined: a large random sample of US community adults who reported past-year drinking (<i>n</i> = 25 773, AUD = 20%) and a clinical sample from a Canadian inpatient addiction treatment centre (<i>n</i> = 1341, AUD = 82%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Classifiers included measures of quantity/frequency (e.g. drinks/drinking day, largest drinks/drinking day, number of drinking days and heavy drinking frequency). The clinical criterion (reference standard) was AUD diagnostic status per structured clinical interview (community sample) or a symptom checklist (clinical sample).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>All drinking indicators were statistically significant classifiers of AUD (AUCs = 0.60–0.92, <i>P</i>s<0.0001). Heavy drinking frequency indicators performed optimally in both the community (AUCs = 0.78–0.87; accuracy = 0.72–0.80) and clinical (AUCs = 0.85–0.92; accuracy = 0.77–0.89) samples. Collectively, the most discriminating drinking behaviours were number of heavy drinking episodes and frequency of exceeding drinking low-risk guidelines. No substantive sex differences were observed across drinking metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Quantitative drinking indices appear to perform well at classifying alcohol use disorder (AUD) in both a large community adult and inpatient sample, robustly identifying AUD at rates much better than chance and above accepted clinical classification benchmarks, with limited differences by sex. Thes","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 7","pages":"1431-1440"},"PeriodicalIF":5.2,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drinking and pleasure: Interdisciplinarity points the way forward","authors":"James Nicholls, Geoffrey Hunt","doi":"10.1111/add.70065","DOIUrl":"10.1111/add.70065","url":null,"abstract":"<p>We thank our commentators for their thoughtful reflections on how alcohol research can better engage with pleasure. In writing the original article [<span>1</span>], we admit to some trepidation about how it would be received. We are encouraged by the positive and constructive responses, which identify a range of opportunities for innovative future research.</p><p>We strongly agree with Pennay and Livingston [<span>2</span>] on the critical importance of interdisciplinary collaboration. Drinking motives, cultures, behaviours and pleasures – as well as risks – are far too complex to be captured by either a single discipline or a single methodological approach. The social, natural and applied sciences, and, we would add, the humanities, all offer unique contributions to better understanding the protean role of drinking in both different cultures and the lives of individuals within those environments. We would welcome the kind of large-scale interdisciplinary project Pennay and Livingston propose, and hope the case for such an approach, even if exploratory in terms of both methods and possible findings, can be made effectively to funders.</p><p>Morris and Davies [<span>3</span>] provide critical insights into the challenges of effective alcohol health messaging. While we noted that negative framings may not align with the experiences of those who drink for pleasure, they expand significantly on this with key insights from experimental psychology. As they show, the issue is not only that ‘no safe level’ messaging may fail to resonate with drinkers, but that it may provoke psychological resistance – especially among heavier drinkers, who may be the primary target.</p><p>Acuff and Strickland [<span>4</span>] take a different approach, arguing not only for interventions that acknowledge the pleasures of drinking (even while encouraging less risky behaviours), but also for those that promote alternative pleasures not involving, though perhaps adjacent to, intoxication. This notion has deep historical roots, from the 19th century ‘rational recreation’ campaigns to the contemporary ‘sober curious’ movement [<span>5, 6</span>]. They also highlight key experimental research on wider determinants of alcohol-related reward, which we would see as complementing sociological studies on the social structuring of intoxication and pleasure.</p><p>These commentaries helpfully expand on the three domains highlighted in our article. They speak to the need for a broader epistemology of intoxication, one that will necessarily be interdisciplinary. They also add psychological depth to our thoughts on the pragmatics of health communication. Furthermore, they highlight that a rigid prioritisation of long-term health over shorter-term rewards cannot survive contact with the reality of how and why people drink. Acuff and Strickland's compromise – acknowledging but not emphasising pleasure – is attractive. However, we would also reiterate our challenge for clarity on questi","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1088-1089"},"PeriodicalIF":5.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledging the crucial role of Max Glatt in the development of the Jellinek curve and the enduring relevance of his model of recovery from problem drinking.","authors":"Kevin McInerney, David Best","doi":"10.1111/add.70053","DOIUrl":"https://doi.org/10.1111/add.70053","url":null,"abstract":"<p><strong>Background and aims: </strong>Shortly after Max Glatt published a 'Chart of Alcohol Addiction and Recovery' in 1954, a misnomer emerged and it became known as the 'Jellinek Curve'. The current article aims to investigate the contributions that both Max Glatt and Morton Jellinek made towards the misnamed 'Jellinek Curve', how the misnomer may have emerged and the relevance of Jellinek's addiction concept and Glatt's model of recovery with contemporary theories of addiction and recovery.</p><p><strong>Method: </strong>Warlingham Park Hospital housed the first residential alcohol detoxification and rehabilitation unit in the UK's National Health Service, a model created and developed by Max Glatt. Much of the data that informed Glatt's model came from ex-Warlingham Park Hospital patients in recovery. The current article assumes an ethnographic approach. Literature searches were undertaken and the Warlingham Park Hospital archives were scrutinized.</p><p><strong>Conclusions: </strong>Max Glatt's 'Chart of Alcohol Addiction and Recovery' has mistakenly been referred to as the 'Jellinek Curve' for the last seven decades. 'The Matthew Effect' presents a possible explanation for the misnomer: the notion that eminent scientists are likely to receive greater credit than lesser-known scientists, regardless of their contribution. The recovery slope of Glatt's 'Chart' may be just as relevant today as when it was first published.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addiction Lives: Shekhar Saxena","authors":"Virginia Berridge","doi":"10.1111/add.70034","DOIUrl":"10.1111/add.70034","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 7","pages":"1484-1485"},"PeriodicalIF":5.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Kersbergen et al.: Same Price, same choices? Proportional pricing and the heaviest drinkers","authors":"Robyn Burton,&nbsp;Nick Sheron","doi":"10.1111/add.70046","DOIUrl":"10.1111/add.70046","url":null,"abstract":"&lt;p&gt;Kersbergen &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] provide experimental evidence that proportional pricing—where alcohol is priced consistently per litre across different package sizes of the same brand—can shift purchasing preferences toward smaller products in hypothetical scenarios. While this approach changes purchasing incentives, it does not directly address the affordability of cheap or high-strength alcohol. These limitations raise important questions about its effectiveness, particularly for the heaviest drinkers.&lt;/p&gt;&lt;p&gt;Heavy daily drinkers face exponentially higher risks of alcohol-related harm [&lt;span&gt;2&lt;/span&gt;], making them a key target for policy intervention. They typically seek out the cheapest alcohol [&lt;span&gt;2-4&lt;/span&gt;], but were not included in Kersbergen &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] study. Unlike minimum unit price (MUP), which directly raises the price of the lowest-cost alcohol [&lt;span&gt;5, 6&lt;/span&gt;], proportional pricing removes bulk discounts within brands, but does not necessarily increase the absolute price of the cheapest products.&lt;/p&gt;&lt;p&gt;From a public health perspective, stronger alcohol should cost more because of its greater harm potential. A typical serving of wine results in a higher peak blood alcohol concentration than beer, whereas for spirits, the peak is nearly twice that of beer and reached more quickly [&lt;span&gt;7&lt;/span&gt;]. Volumetric taxation, recently adopted in the United Kingdom [&lt;span&gt;8&lt;/span&gt;], links price to alcohol content, making higher-strength products relatively more expensive and discouraging excessive consumption [&lt;span&gt;9, 10&lt;/span&gt;]. In contrast, proportional pricing equalises cost per litre within brands but does not account for alcohol strength. As a result, a stronger product may still be cheaper per unit than a weaker one, depending on retailer pricing strategies.&lt;/p&gt;&lt;p&gt;Proportional pricing raises the cost of larger products by aligning their per-litre price with smaller equivalents, but its impact on real-world pricing strategies remains uncertain. Retailers have previously adapted to policy changes, as seen following Scotland's multi-buy discount ban, where straight (single unit) discounts became more common [&lt;span&gt;11, 12&lt;/span&gt;]. A similar response could occur if retailers offset price increases for larger products by reducing the per-litre costs of smaller ones. If so, the overall cost of alcohol would remain unchanged, limiting the policy's impact.&lt;/p&gt;&lt;p&gt;A further consideration is how heavy daily and dependent drinkers purchase alcohol. While there is limited research on portion sizes in this group, anecdotal clinical experience suggests that some may buy alcohol daily in quantities just sufficient for that day. This may be an attempt to manage their consumption, as purchasing a larger volume intended to last multiple days could result in it being consumed more quickly than planned. If proportional pricing were to reduce the cost of smaller portions, this could unintentionally make alcohol more affor","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 5","pages":"871-872"},"PeriodicalIF":5.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewers","authors":"","doi":"10.1111/add.70056","DOIUrl":"https://doi.org/10.1111/add.70056","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 5","pages":"1064-1066"},"PeriodicalIF":5.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How effective are remote and/or digital interventions as part of alcohol and drug treatment and recovery support? A systematic review and meta-analysis","authors":"Irene Kwan,&nbsp;Helen Elizabeth Denise Burchett,&nbsp;Wendy Macdowall,&nbsp;Preethy D'Souza,&nbsp;Claire Stansfield,&nbsp;Dylan Kneale,&nbsp;Katy Sutcliffe","doi":"10.1111/add.70021","DOIUrl":"10.1111/add.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Although remote drug/alcohol interventions have been widely reviewed, their effectiveness specifically for people in treatment remains unclear. We aimed to systematically review the effectiveness of remote interventions (delivered by telephone or computer) in alcohol/drug treatment and recovery support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched 29 databases including Medline and PsycINFO for randomised controlled trials (RCTs) of remote interventions for adults diagnosed with alcohol/drug use disorder conducted in Organization for Economic Co-operation and Development (OECD) countries published 2004–2023. We grouped interventions according to whether they supplemented or replaced/partially replaced in-person care. We used random effects meta-analyses to estimate pooled odds ratios (OR) for relapse, and standardised mean differences (SMD) for days of alcohol/drug use. We appraised outcomes using Cochrane Risk of Bias 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 34 RCTs (6461 participants) evaluating 42 remote interventions, with diverse therapeutic approaches. Over 70% of outcomes were judged to be at high risk-of-bias. When remote interventions supplemented in-person care, there was a 39% lower odds of relapse [17 interventions; OR 0.61; 95% confidence interval (CI) = 0.46, 0.81; <i>P</i> = 0.001; I² = 40.3%) and a reduction in the mean days of use (17 interventions; SMD −0.18; 95% CI = −0.28 to −0.08; <i>P</i> = 0.001; I² = 27.3%) compared with in-person care alone. When remote interventions replaced/partially replaced in-person care, there was a 49% lower odds of relapse (7 interventions; OR 0.51; 95% CI = 0.34, 0.76; <i>P</i> = 0.001; I² = 39.7%) and a very slight and uncertain reduction in mean days of use (8 interventions; SMD −0.08; 95% CI = −0.24 to 0.07; <i>P</i> = 0.301; I² = 48.4%) compared with in-person care. Subgroup analyses by type of substance and therapeutic approach were mixed and inconclusive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Remote interventions which supplement in-person alcohol/drug treatment appear to reduce relapse and days of use. The evidence is less conclusive regarding remote interventions that replace/partially replace in-person care due to a smaller body of evidence and uncertainty (days of use). High risk-of-bias means findings should be interpreted with caution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 8","pages":"1531-1550"},"PeriodicalIF":5.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}