Addiction最新文献

{"title":"Cannabis use, affect and emotion regulation in daily life: A 3-week experience sampling method study in people who smoke cannabis almost daily","authors":"Ana Paula Gonçalves Donate, Janna Cousijn, Emese Kroon, Kristine Rømer Thomsen","doi":"10.1111/add.70525","DOIUrl":"10.1111/add.70525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Although many people who use cannabis report mood-enhancing effects, affective responses are thought to vary within and between individuals. This study examined the bidirectional associations between momentary affect and cannabis use and the potential moderating role of emotion regulation in this.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Intensive longitudinal observational study using experience sampling method (ESM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Denmark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Adults in Denmark who use cannabis near daily (<i>n</i> = 113; Age: mean = 31.57 years, median = 29 years, standard deviation = 10.28, inter-quartile range = 23–36; 60.2% male).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method and measurements</h3>\u0000 \u0000 <p>Participants completed a baseline survey (substance use and emotion regulation difficulties) and 21 days of experience sampling (three assessments daily; affect and use). We used multilevel models to assess: (1) the associations between positive affect (PA) and negative affect (NA) and subsequent cannabis use, (2) whether cannabis use predicted changes in affect shortly after use (at the same assessment) and (3) whether cannabis use predicted changes in affect at a later moment (at the next assessment). Next, we assessed whether emotion regulation difficulties moderated associations tested in models 1 and 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Higher PA predicted a greater likelihood of cannabis use before the next assessment [odds ratio (OR) = 1.05, 95% confidence interval (CI) = 1.01–1.09], and cannabis use predicted increased PA at the same assessment (b = 0.59, 95% CI = 0.27–0.92), but not at the next assessment. NA was not related to use or vice versa at group level. Emotion regulation difficulties did not statistically significantly moderate the associations between PA or NA and subsequent cannabis use; however, emotion regulation difficulties moderated short-term effects of cannabis use on NA (b = −0.014, 95% CI = −0.027 to −0.002), with individuals with higher emotion regulation difficulties showing lower NA shortly after use compared with non-use moments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Within individuals","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"3053-3064"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148402882","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":"Perpetrator alcohol use and intimate partner violence in high-income countries: A systematic review and meta-analysis","authors":"Amany Tanyos, Bree Willoughby, Cassandra Hopkins, Gedefaw Diress Alen, Heng Jiang, Rebecca Jenkinson, Sarah MacLean, Anne-Marie Laslett","doi":"10.1111/add.70540","DOIUrl":"10.1111/add.70540","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Harmful alcohol use is commonly associated with intimate partner violence (IPV) perpetration. This systematic review estimated the association between harmful alcohol use and man-to-woman IPV (MWIPV) and woman-to-man IPV (WMIPV) in high-income countries (HICs), using national and community studies, and compared associations by key moderators such as abuse type and alcohol measurement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Systematic review and multi-level random-effects meta-analysis, registered in PROSPERO and reported in accordance with PRISMA guidelines. Eligible studies were peer-reviewed and published in English. All included studies were conducted in HICs and included adults aged 18 years and older in heterosexual intimate relationships, drawn from national and community-based studies. The exposure was perpetrator harmful alcohol use, including alcohol use disorder, dependence, binge/heavy drinking patterns and other harmful drinking measures. The outcomes were MWIPV and WMIPV models. Quality assessment of studies, moderator, subgroup and sensitivity analyses, heterogeneity using Cochran's Q test and I<sup>2</sup> statistics, and influence diagnostics were also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 5879 database records identified from MEDLINE, CINAHL, ProQuest, PsycINFO, PubMed and EMBASE between January 2011 and January 2024, 3062 duplicates were removed. After screening titles and abstracts of 2817 studies, 247 underwent full-text review. Backward citation searching identified five additional records, two of which were eligible. Overall, 21 studies, including 76 736 participants, were included in quality assessment and data extraction. Harmful alcohol use was significantly associated with increased odds of MWIPV and WMIPV [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.19–1.67; OR = 1.15, 95% CI = 1.04–1.27, respectively]. Univariate moderator models showed that among men, those who have an alcohol use disorder, dependence or binge/heavy drinking patterns (not just drinking sometimes) were much more likely to be violent toward their partners. For women, the alcohol–IPV link was stronger in national-sample studies than in community-sample studies and was evident when harmful drinking was measured categorically, but not when alcohol consumption was measured continuously, such as the number of drinks per week.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Harmful alcohol use appears to be associated with increased odds of man-to-woman and woman-to","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2880-2894"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70540","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434385","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":"Controlled breathing and heart rate variability biofeedback for substance use-related outcomes: A systematic review and meta-analysis","authors":"Ariel Dart Roxburgh, Bosco Rowland, Dan I. Lubman, Sukhjit Kaur Bains, May Anne Pek, Bernard Tso, Victoria Manning, Shalini Arunogiri","doi":"10.1111/add.70542","DOIUrl":"10.1111/add.70542","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aim</h3>\u0000 \u0000 <p>Substance use disorders (SUDs) contribute significantly to global social and economic burden. Breathing-based interventions offer a low-cost, scalable adjunct or alternative to traditional treatment, yet their effects on substance use-related outcomes has not been systematically evaluated. This study aimed to systematically review and meta-analyse the effectiveness of controlled breathing and heart rate variability biofeedback (HRVB) interventions in improving substance use-related outcomes among people using alcohol and other drugs, including nicotine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Web of Science, PsycINFO, MEDLINE, CINAHL, EMBASE, PubMed, Scopus and Cochrane were searched, with the final search conducted on 14 November 2025. The protocol was prospectively registered with the International Prospective Register of Systematic Reviews. Eligible studies were quantitative, with repeated-measure designs, with at least one substance use-related outcome; interventions were required to have controlled breathing as the primary mechanism and were categorised by inclusion of HRVB. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to estimate pooled effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 3502 studies identified, 20 met the inclusion criteria, of which 15 were eligible for meta-analyses. Breathing-based interventions produced lower craving than controls, with a small but statistically significant and consistent effect [Hedge's <i>g</i> = 0.30, 95% confidence interval (CI) = 0.12–0.48, heterogeneity (<i>I<sup>2</sup></i>) = 23.5%, 12 studies, 696 participants]. Effects on withdrawal symptoms were uncertain compared with controls (<i>g</i> = 0.46, 95% CI = −0.28 to 1.19, <i>I</i><sup>2</sup> = 89.7%, 4 studies, 289 participants), while larger effects were observed for substance dependence compared with control (<i>g</i> = 0.85, 95% CI = 0.21–1.48, <i>I</i><sup>2</sup> = 70.9%, 2 studies, 144 participants). For the craving outcome, no difference between type of breathing intervention (HRVB vs. other) was identified [Q between (1) = 0.17, <i>P</i> = 0.68].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In people who use substances, breathing-based interventions appear to lead to statistically significant reductions in craving compared with controls, supporting their potential as a low-cost and scalable strategy for managing craving in substance use disorders.</p>\u0000 </section>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2959-2971"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617638","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":"Discrepancies between self-reported alcohol use and breathalyzer results and factors associated with blood alcohol concentration positivity among road traffic injury patients in Cameroon","authors":"Serge Ngekeng, Rasheedat Oke, Odette Kibu, Elvis Tanue, Nicholas Tendongfor, Georges Nguefack-Tsague, Alan Hubbard, Steven Shoptaw, Alain Chichom-Mefire, Catherine Juillard","doi":"10.1111/add.70537","DOIUrl":"10.1111/add.70537","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>In low-resource settings such as Cameroon, blood alcohol concentration (BAC) testing is rarely available for road traffic injury (RTI) patients, necessitating confidence in self-reported alcohol use for screening purposes. While Western settings often rely on objective measures like BAC for identifying alcohol-related RTIs, self-reporting may be more viable in contexts with limited resources and different cultural norms. This study aimed to (1) compare self-reported alcohol use with breathalyzer-confirmed BAC results and (2) identify factors associated with BAC positivity among RTI patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This was a cross-sectional study of RTI patients conducted at two Cameroonian hospitals. Participants underwent structured interviews and breathalyzer testing upon presentation to the emergency department within six hours of injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Limbe Regional Hospital and Edea Regional Hospital Annex in Cameroon, both of which are part of the Cameroon Trauma Registry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>A total of 305 RTI patients aged 21 years and older who had acute injuries were included. The median age was 35 years (interquartile range = 16). More than ¾ of the population were male (76.4%) and most resided in urban areas (74.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Self-reported alcohol use within six hours of injury was compared with breathalyzer-measured BAC (threshold ≥0.01%). Diagnostic metrics [sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)] were calculated, and multivariable logistic regression was used to assess predictors of BAC positivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Self-reporting had a sensitivity of 84.3% and specificity of 71.1%. The NPV was high (93.8%), while the PPV was low (46.5%). Non-detection of BAC in positive self-report cases was common: 73.1% of those reporting 1–2 drinks were BAC-negative, but all who reported >2 drinks were BAC-positive. In adjusted models, male sex [adjusted odds ratio (AOR) = 3.99, 95% confidence interval (CI) = 1.4–13.6], alcohol use disorder (AOR = 8.11, 95% CI = 3.3–21.6) and nighttime injury (AOR = 4.42, 95% CI = 2.1–9.5) were independently associated with BAC positivity.</p>\u0000 ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2972-2980"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434309","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":"Comment on Tanyos et al: Alcohol policy as intimate partner violence prevention policy—Population-level implications","authors":"Carly Lightowlers","doi":"10.1111/add.70595","DOIUrl":"10.1111/add.70595","url":null,"abstract":"<p>Tanyos <i>et al</i>. [<span>1</span>] make an important contribution to the literature on alcohol and intimate partner violence (IPV) by demonstrating that harmful alcohol use is associated with increased odds of both man-to-woman IPV (MWIPV) and woman-to-man IPV (WMIPV) across high-income countries. The association was strongest for men's violence against women and for patterns of binge drinking, heavy drinking and alcohol dependence. On this basis, Tanyos and colleagues [<span>1</span>] call for alcohol-focused strategies to be integrated into IPV prevention and intervention efforts. Although this is an important conclusion, the wider policy implications of these findings merit further consideration. Although Tanyos <i>et al</i>. [<span>1</span>] rightly emphasise the value of alcohol-focused interventions, their findings also have broader policy implications that extend beyond the scope of the review.</p><p>Specifically, the review strengthens the case not only for alcohol-focused interventions, but also for population-level alcohol policy as a violence prevention strategy.</p><p>A notable strength of the review is its focus on national and community samples rather than clinical or treatment populations. This matters because it moves the discussion beyond a narrow focus on a small number of individuals. If harmful alcohol use predicts IPV in general population studies, then alcohol-related violence cannot be understood simply as the behaviour of a minority. Rather, it reflects a broader population-level pattern of harm. The review, therefore, provides evidence not only for interventions targeted at perpetrators and problem drinkers, but also for upstream approaches capable of influencing drinking behaviour across entire populations.</p><p>This implication becomes clearer when the findings are considered alongside the wider alcohol policy literature. A substantial body of evidence demonstrates that alcohol availability and affordability influence rates of violence, including violence occurring within intimate relationships. Higher densities of off-licence alcohol outlets have been associated with increased rates of domestic violence [<span>2, 3</span>], while interventions that increase alcohol prices through taxation have also been shown to reduce domestic violence [<span>4, 5</span>]. Taken together, this evidence suggests that alcohol policy should be viewed as a core component of violence prevention rather than solely a public health intervention aimed at reducing alcohol-related disease.</p><p>Importantly, recognising alcohol as a risk factor for IPV does not diminish perpetrator accountability. Some critics have argued that focusing on alcohol risks implying that violence is caused by intoxication rather than by the actions of perpetrators. However, acknowledging alcohol's role in increasing the likelihood or severity of violence is entirely compatible with recognising the gendered and patriarchal drivers of abuse [<span>6, 7</span>]. ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2895-2896"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70595","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975114","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":"Efficacy and safety of pharmacological interventions for the treatment of cocaine use disorder: A systematic review and network meta-analysis","authors":"Craig Paterson,&nbsp;Thomas Parkhouse,&nbsp;Chloe Burke,&nbsp;Monika Halicka,&nbsp;Jennifer C. Palmer,&nbsp;Hend Gabr,&nbsp;Rebecca Wilson,&nbsp;Katie E. Webster,&nbsp;Francesca Spiga,&nbsp;Sarah Dawson,&nbsp;Deborah M. Caldwell,&nbsp;Jennifer Scott,&nbsp;Julian P. T. Higgins,&nbsp;Jelena Savović","doi":"10.1111/add.70486","DOIUrl":"10.1111/add.70486","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Cocaine use disorder (CUD) is an increasingly widespread concern worldwide. Various pharmacological treatments have been investigated for CUD, but their efficacy remains unclear, and none have been licensed for treatment. Therefore, we assessed the comparative effectiveness, safety and acceptability of pharmacological interventions for the treatment of CUD and prevention of relapse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Systematic review and network meta-analyses (PROSPERO: CRD42024596434) of double-blind randomized controlled trials (RCTs) of pharmacological interventions specifically tested for the treatment of CUD with a minimum follow-up of 4 weeks in any in/outpatient setting, with no restriction on geographic location. Participants included adults with diagnosed CUD. Participants with co-occurring substance use disorders and/or common mental health conditions were eligible. We assessed risk of bias using the Cochrane Risk of Bias 2 tool and certainty of evidence was assessed using the Confidence in Network Meta-analysis framework. We assessed 12 effectiveness, three acceptability and two safety outcomes. Our primary outcomes were continuous abstinence, point abstinence, dropout for any reason and serious adverse events. We also examined longest duration of continuous abstinence, extent of cocaine use, craving, severity of dependence, dropout due to adverse events, adherence and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 218 reports of 163 studies (14 871 participants) assessing 89 unique medications, grouped into 8 categories (agonist/replacement approaches; antidepressants and other serotonergic agents; glutamate modulators; anticonvulsants and GABAergic agents; antagonist/blocker approaches; opioid agonists and antagonists; combination pharmacotherapy; other neuroactive agents). Most study results had some concerns or high risk of bias, and the results of syntheses were generally judged to be very low certainty evidence. As such, the findings ought to be interpreted with caution. No single treatment type showed consistent beneficial effects across all effectiveness outcomes and there was limited evidence that results varied by intervention type or presence of co-occurring comorbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a comprehensive network meta-analysis, we found no convincing evidence for the effectiveness of any pharmacological treatments for cocaine use disorder.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2897-2958"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546947","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":"Experimental peptides, GLP-1s and polypharmacy: Future directions for image- and performance-enhancing drug harm reduction","authors":"Luke A. Turnock,&nbsp;Lambros Lazuras","doi":"10.1111/add.70545","DOIUrl":"10.1111/add.70545","url":null,"abstract":"&lt;p&gt;We welcome the suggestion by Piatkowski and colleagues [&lt;span&gt;1&lt;/span&gt;] that public health must adapt to the needs of people who use anabolic-androgenic steroids (AAS), acknowledging the fundamental differences in pharmacology and use patterns that AAS have compared to conventional narcotics. Building on this, we believe the recent explosion in off-label GLP-1 medicine and experimental peptide use highlights further the need for public health to adapt to emerging forms of drug use in increasingly diverse populations.&lt;/p&gt;&lt;p&gt;Piatkowski and colleagues [&lt;span&gt;1&lt;/span&gt;] note that AAS use has expanded beyond elite sports to encompass a larger, more diverse population. Image- and performance-enhancing drug (IPED) use is increasing, with a growing population of anti-ageing and wellbeing-oriented consumers, along with recreational exercisers interested in fat loss or aesthetic enhancement, consuming an expanding range of compounds [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Experimental peptides like BPC-157, TB500 and CJC-1295 are increasingly available and consumed by a heterogeneous population engaging in recreational exercise that do not always align neatly with prior typologies of AAS use [&lt;span&gt;2, 4, 5&lt;/span&gt;]. Peptides may come with longer-term organ-based harms that are not currently understood, given the paucity of large human clinical studies on many of these substances [&lt;span&gt;6&lt;/span&gt;], and are subject to the same issues with quality and purity that Piatkowski and colleagues [&lt;span&gt;1&lt;/span&gt;] identify in relation to AAS. Research suggests illicit market peptides and GLP-1s are often substandard quality [&lt;span&gt;7, 8&lt;/span&gt;], signifying the need for urgent harm reduction interventions like testing services, education and outreach.&lt;/p&gt;&lt;p&gt;Although evidence regarding the effects GLP-1 receptor agonists in clinical populations is growing, off-label use may diverge substantially from approved indications and prescribing guidance [&lt;span&gt;9, 10&lt;/span&gt;]. Of particular concern is increasing interest in Retatrutide, an investigational agent that has not yet received regulatory approval [&lt;span&gt;11-13&lt;/span&gt;]. Use of unapproved products obtained outside regulated healthcare settings may expose individuals to additional risks related to product quality, dosing accuracy, safety monitoring and the absence of established regulatory oversight. There is also evidence that some individuals purchasing GLP-1 products online may be unaware that products obtained from unregulated sources may not meet pharmaceutical manufacturing standards or may differ from approved medicines [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Piatkowski and colleagues [&lt;span&gt;1&lt;/span&gt;] highlight polypharmacy as a high risk behaviour and we have also seen trends in risky polysubstance use among experimental peptide and GLP-1 users. Our prior research documented the ‘stacking’ of multiple GLP-1s and their ‘cycling’ in rapid succession, greatly increasing risks of severe negative health events [&lt;span&gt;9&lt;/span&gt;]. Although this work rel","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2872-2873"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70545","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416904","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":"Mortality and morbidity at legal drinking age thresholds: Evidence from a nationwide quasi-experimental study in Finland","authors":"Petri Böckerman,&nbsp;Mika Haapanen,&nbsp;Christopher Jepsen","doi":"10.1111/add.70556","DOIUrl":"10.1111/add.70556","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To examine the effect of the minimum legal drinking age (MLDA) on mortality and hospitalizations.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Exploiting sharp increases in legal alcohol access at ages 18 years (beer/wine, on-premises drinking and car driving) and 20 years (off-premises spirits) in a regression discontinuity (RD) design, we estimated local linear models of all-cause and cause-specific mortality and hospitalizations in monthly data 12 months before and after each threshold, separately by sex.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Finland.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Individuals born between 1955 and 1998 who were registered as living in Finland and observed reaching ages 18 years and 20 years in the administrative registers (&lt;i&gt;n&lt;/i&gt; ≈ 3 000 000).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Measurement&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The outcomes were all-cause and cause-specific mortality and hospitalizations due to external, alcohol-related, traffic-accident and suicide-attempt causes, measured as monthly rates per 100 000 person-months.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Reaching the legal drinking threshold of 18 years old was associated with a substantial increase in all-cause mortality among men [RD estimate = 1.62 deaths per 100 000 person-months, 95% confidence interval (CI) = 0.86–2.38], corresponding to a 26.9% increase relative to the pre-threshold mean. This effect was driven by external causes (RD = 2.03, 95% CI = 1.25–2.82) and particularly accidental deaths (RD = 1.49, 95% CI = 0.79–2.18) and alcohol-contributed deaths (RD = 0.65, 95% CI = 0.13–1.18). Among women, the increase in all-cause mortality at age 18 years was smaller and not statistically significant (RD = 0.45, 95% CI = −0.02 to 0.92), although alcohol-contributed deaths increased from a low baseline (RD = 0.18, 95% CI = −0.02 to 0.39). At age 20 years, legal access to spirits was associated with increases in alcohol-contributed mortality among men (RD = 0.88, 95% CI = 0.19–1.56) and accidental deaths (RD = 0.54, 95% CI = 0.09–0.99), whereas among women the main effect was an increase in hospital-treated suicide attempts (RD = 1.11, 95% CI = 0.11–2.11).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In Finland, reach","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"3000-3009"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148596750","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":"Beyond harm reduction? Steroids, social control and the limits of intervention","authors":"Kyle J. D. Mulrooney,&nbsp;Rick Collins,&nbsp;Jack Darkes","doi":"10.1111/add.70592","DOIUrl":"10.1111/add.70592","url":null,"abstract":"&lt;p&gt;Piatkowski &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] argue that harm-reduction models developed around psychoactive drugs cannot be transferred to anabolic–androgenic steroid (AAS) use, as they poorly capture practices in which risks may be more cumulative and shaped by duration, dosage, compound selection and product quality. Their call for a contextually appropriate response is welcome. Yet, it raises an important question: does expanding harm reduction move us beyond the dominant ‘narrative of harm’, or extend that narrative through a wider and more sophisticated apparatus of intervention?&lt;/p&gt;&lt;p&gt;We previously used the ‘narrative of harm’ to describe how AAS use is understood predominantly through health damage, aggression, pathology and irrationality, while pleasure, perceived benefit/outcome and consumer agency are marginalised [&lt;span&gt;2, 3&lt;/span&gt;]. Harm is the organising premise, while strength, confidence, wellbeing, aesthetic satisfaction, sexual vitality and the pleasures of disciplined bodily transformation are treated as incidental or pathological. Yet, these benefits are central to understanding why adults may experience AAS use as purposeful, worthwhile and rational.&lt;/p&gt;&lt;p&gt;Our subsequent examination of testosterone, identity and the body extended this critique from representation to classification [&lt;span&gt;4&lt;/span&gt;]. Distinctions between treatment and enhancement, health and disorder, and legitimate and illicit bodily transformation do not flow neutrally from pharmacology but reflect culturally contingent judgements about which embodied aspirations are ‘legitimate’. Attempts to bring phenotype into alignment with identity or aspiration may be affirmed and medically facilitated in one context and pathologised/criminalised in another.&lt;/p&gt;&lt;p&gt;Cohen [&lt;span&gt;5&lt;/span&gt;] showed how ‘progressive’ alternatives may coexist with punitive approaches rather than succeed one another. The net widens when new interventions capture people who would have remained outside formal oversight, it becomes denser when the focus shifts from discrete acts to individual health and anticipated risks, and it becomes more diffuse when control moves from bounded institutions into ordinary services and professional relationships; what Cohen described as ‘control without walls’.&lt;/p&gt;&lt;p&gt;Harm reduction can recognise people who use drugs as rational and rights-bearing while constructing them as responsible for monitoring and managing risks produced by structural conditions [&lt;span&gt;6&lt;/span&gt;]. Likewise, interventions may deliver health benefits while functioning as technologies for regulating risk and maintaining order [&lt;span&gt;7&lt;/span&gt;]. Harm reduction is better understood not as inherently emancipatory or controlling but as a heterogeneous assemblage, the effects of which depend on how practices are constituted and implemented [&lt;span&gt;8, 9&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Viewed through this lens, an AAS harm-reduction system may be both humane and expansive. Drug checking, dosing guidance, organ function m","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2876-2877"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70592","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904551","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":"What anabolic–androgenic steroids reveal about the limits of current harm reduction models","authors":"Timothy Piatkowski,&nbsp;Jason M. Nagata,&nbsp;Suzanne Nielsen","doi":"10.1111/add.70395","DOIUrl":"10.1111/add.70395","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Harm reduction has largely been shaped by responses to psychoactive drug use where the most urgent harms are acute. These models focus on overdose, blood-borne viruses, and rapid-onset toxicity related harms. When applied wholesale to anabolic–androgenic steroids (AAS), they obscure the distinctive pharmacology, consumer typologies, and slow-developing physiological risks that define people who use AAS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Argument</h3>\u0000 \u0000 <p>AAS use is often chronic, patterned, and long-term. Harms are often cumulative and organ-based rather than event-based. Routes of administration carry different risk profiles, with oral formulations being more hepatotoxic and commonly falsified through mislabelling or adulteration than injectable products. Despite this, most health services position injecting as inherently higher risk, applying paradigms developed for opioids and stimulants that have not been adapted for AAS use. Using evidence across pharmacology, delivery routes, dependence trajectories, and consumer types, this paper argues for expanding harm reduction models to consider the unique needs of different populations of people who use drugs, including AAS. We draw critically on lessons from other substances as well as multiple existing approaches including structured dosing frameworks, and supply-checking infrastructures, provide practical templates for expanding adaptation to AAS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To remain evidence-based, harm reduction must evolve to be contextually relevant. We have used AAS as an example of this evolution, attempting to highlight cross-substance learnings which integrate consumer-focused tools, workforce development, and peer-led support.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 11","pages":"2861-2869"},"PeriodicalIF":5.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429567","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}