Addiction最新文献

{"title":"A return on investment analysis for the 2017 increase in alcohol excise taxation in Lithuania.","authors":"Jürgen Rehm, Pol Rovira, Ahmed S Hassan, Claire de Oliveira, Shannon Lange, Mark J Thompson, Ilona Tamutienė, Vaida Liutkutė-Gumarov, Lukas Galkus, Mindaugas Štelemėkas","doi":"10.1111/add.70083","DOIUrl":"https://doi.org/10.1111/add.70083","url":null,"abstract":"<p><strong>Aims: </strong>To conduct a return on investment analysis of Lithuania's 2017 increase in alcohol excise taxation of 112% for beer, 111% for wine, and 23% for ethyl alcohol (spirits), resulting in a marked decrease in alcohol affordability.</p><p><strong>Methods: </strong>Economic analyses based on costs of the increased taxation and economic benefits derived from a societal perspective. Costs were measured according to World Health Organization standards, based on Lithuanian public data. Benefits were derived from the difference of direct (healthcare, childcare, legal) and indirect costs between 12 months pre- and post-enactment of the policy. All costs and benefits were expressed in 2023 Euros (€).</p><p><strong>Results: </strong>Overall, there were net benefits from reductions in productivity losses and increases in tax revenue. Tax revenue increased by 20%, or more than €100 million, in the first-year post enactment, and productivity losses decreased over the same time period by about €35.3 million (95% confidence interval [CI]: -51.9 to -17.1; proportionally -7%; 95% CI: -11.0% to -4.0%), the latter based on marked reductions in premature mortality in all alcohol-attributable causes of death. In addition, healthcare costs decreased by about €3.8 million (95% CI: -8.4 to +0.1; proportionally -5%; 95% CI: -11.0% to +0.1%). On the other hand, childcare and legal costs increased compared with the year before, by €5.3 million (no 95% CI possible; proportionally: +7%) and €4.6 million (95% CI: +0.2 to +8.0; proportionally +5%; 95% CI: +0.3 to +8.7%), respectively. The final return on investment was 420 to 1, i.e. for each Euro invested, the return was €420. In the sensitivity analyses, the return on investment varied between 292 to 1 and 530 to 1, meaning that all assumptions resulted in a very positive return.</p><p><strong>Conclusions: </strong>The increase in excise taxation for alcohol on March 1, 2017 in Lithuania created a large return on investment and reduced alcohol-attributable mortality and hospitalizations.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953658","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":"Associations of emotional experience with gaming duration and risk of gaming disorder among adolescent gamers: An ecological momentary assessment study.","authors":"Camilla K M Lo, Edward W W Chan, Frederick K Ho, Lu Yu, William W H Chui, Ko Ling Chan","doi":"10.1111/add.70088","DOIUrl":"https://doi.org/10.1111/add.70088","url":null,"abstract":"<p><strong>Background and aims: </strong>Affect has been shown to be associated with gaming disorder (GD), but little is known about how its temporal tendency may predict excessive gaming. We aimed to evaluate how affect intensity and fluctuations may predict gaming duration and risk of GD among adolescent gamers.</p><p><strong>Design: </strong>A longitudinal study with ecological momentary assessment (EMA) to collect participants' data at four time points throughout the day during a 14-day observation period.</p><p><strong>Setting: </strong>July and August 2023 in Hong Kong SAR, China.</p><p><strong>Participants: </strong>A total of 317 adolescents (37.2% female; M_age = 15.5) who self-identified as regular gamers.</p><p><strong>Measurements: </strong>The major measures were daily game time, GD (Internet Gaming Disorder Scale; IGDS9-SF) and affect intensity (the Positive and Negative Affect Schedule; PANAS), while affect fluctuations were captured by obtaining the root mean squared of successive differences of the PANAS scores.</p><p><strong>Findings: </strong>Both overall negative affect intensity [β = 0.3816, 95% confidence interval (CI) = 0.0941-0.6691, P = 0.0095] and fluctuations (β = 0.5123, 95% CI = 0.0567-0.9679, P = 0.0277) were statistically significantly associated with the follow-up IGDS9-SF score. In terms of positive affect, only affect fluctuations were statistically significantly associated with IGDS9-SF score (β = 0.4457, 95% CI = 0.0279-0.8636, P = 0.0367). At within-person level, both daily negative affect intensity (exponentiated β = 1.0159, 95% CI = 1.0018-1.0302, P = 0.0265) and fluctuations (exponentiated β = 1.0144, 95% CI = 1.0030-1.0258, P = 0.0130) were statistically significantly associated with daily game time. Daily positive affect intensity (exponentiated β = 1.0136, 95% CI = 1.0025-1.0248, P = 0.0166) was statistically significantly associated with increased daily game time at within-person level. The association between daily positive affect fluctuations and game time was statistically non-significant.</p><p><strong>Conclusions: </strong>Both intensity and fluctuations of negative affect may predict gaming duration and risk of gaming disorder among Hong Kong adolescents. For positive affect, emotion intensity may be more related to gaming duration, and emotion fluctuations may be more related to adolescents' risk of gaming disorder.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952957","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 much does the absence of the 'hidden population' from United Kingdom household surveys underestimate smoking prevalence?","authors":"Emma Beard, Lion Shahab, Jamie Brown, Sharon Cox","doi":"10.1111/add.70071","DOIUrl":"https://doi.org/10.1111/add.70071","url":null,"abstract":"<p><strong>Background and aim: </strong>Sampling frames used by population surveys may result in an underestimation of smoking prevalence as those not residing in households, also known as the 'hidden population', are not sampled. This includes people living in care and residential homes, populations experiencing homelessness, as well as those who have an \"absent or \"temporary\" household status (e.g. bed and breakfasts, unsupported temporary accommodation, and those in prison). This study estimated the impact of including these populations on smoking prevalence in the UK.</p><p><strong>Methods: </strong>Data from UK government reports and published studies were used to derive estimates of the size of the hidden populations and rates of smoking within these populations. The impact of including the 'hidden population' on overall smoking prevalence in the UK was estimated, along with a correction factor to account for their exclusion.</p><p><strong>Results: </strong>The hidden population over the age of 18 was estimated to be around 1.9 million with a smoking prevalence of between 58% and 66%. Accounting for this hidden population in smoking prevalence surveys may inflate estimates by a correction factor of 1.12 to 1.14. This means smoking prevalence in 2022 would increase from a reported 12.9% to an adjusted range of 14.5-14.8%.</p><p><strong>Conclusion: </strong>The absence of the 'hidden population' from smoking prevalence surveys leads to underestimation of smoking rates in the UK. Based on the estimated correction factor, and assuming smoking continues to decline at current rates, achieving the UK government's target of <5% by 2030 would be substantially delayed.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951701","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":"Effectiveness and safety of psychosocial interventions for the treatment of cannabis use disorder: A systematic review and meta-analysis.","authors":"Monika Halicka, Thomas L Parkhouse, Katie Webster, Francesca Spiga, Lindsey A Hines, Tom P Freeman, Sabina Sanghera, Sarah Dawson, Craig Paterson, Jelena Savović, Julian P T Higgins, Deborah M Caldwell","doi":"10.1111/add.70084","DOIUrl":"https://doi.org/10.1111/add.70084","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the effectiveness, safety and cost-effectiveness of psychosocial interventions for cannabis use disorder (CUD).</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials (RCTs; PROSPERO protocol CRD42024553382) of psychosocial interventions for CUD lasting >4 sessions, delivered synchronously, to individuals with CUD aged ≥16 years, in inpatient, outpatient or community-based settings. We searched databases (MEDLINE/PsycInfo/Cochrane CENTRAL) to 12 June 2024. We assessed results using Risk of Bias 2 and conducted pairwise meta-analyses. Primary outcomes were continuous- and point-abstinence and withdrawal intensity at the end of treatment, treatment completion and adverse events.</p><p><strong>Results: </strong>We included 22 RCTs (3304 participants). Relative to an inactive/non-specific comparator, cognitive-behavioural therapy with motivation enhancement (MET-CBT) increased point abstinence [odds ratio (OR) = 18.27; 95% confidence interval (9.00-37.07)] and continuous abstinence [OR = 2.72; (1.20-6.19)], but reduced treatment completion [OR = 0.53; (0.35-0.85)]. Dialectical behavioural/acceptance and commitment therapy increased point abstinence versus inactive/non-specific comparator [OR = 4.34; (1.74-10.80)]. The effect of MET-CBT plus affect management versus MET-CBT on point abstinence was OR = 7.85 (0.38-163.52). The effect of MET-CBT plus abstinence-based contingency management versus MET-CBT on point abstinence was OR = 3.78 (0.83-17.25), and on continuous abstinence OR = 1.81 (0.61-5.41). For MET-CBT plus abstinence-contingency management versus MET-CBT plus attendance-contingency management, the effect on point abstinence was OR = 1.61 (0.72-3.60), and on continuous abstinence OR = 2.04 (0.75-5.58). The effect of community reinforcement on point abstinence was OR = 0.29 (0.04-1.90) versus MET-CBT, and on continuous abstinence OR = 47.36 (16.00-140.21) versus non-specific comparator. Interventions other than MET-CBT may not affect treatment completion. No adverse events were reported. No study reported withdrawal intensity. Two economic evaluations reported higher costs for more complex interventions and contingency management.</p><p><strong>Conclusions: </strong>Cognitive-behavioural therapy with motivation enhancement and dialectical behavioural/acceptance and commitment therapy may increase abstinence among people with cannabis use disorder relative to an inactive/non-specific comparator. The conclusions remain tentative due to low- to very low-certainty evidence and the small number of studies.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957372","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":"Development and evaluation of a machine learning model to predict acute care for opioid use disorder among Medicaid enrollees engaged in a community-based treatment program.","authors":"Lingshu Xue, Ruofei Yin, Evan S Cole, Wei-Hsuan Lo-Ciganic, Walid F Gellad, Julie Donohue, Lu Tang","doi":"10.1111/add.70079","DOIUrl":"https://doi.org/10.1111/add.70079","url":null,"abstract":"<p><strong>Aims: </strong>To develop machine-learning algorithms for predicting the risk of a hospitalization or emergency department (ED) visit for opioid use disorder (OUD) (i.e. OUD acute events) in Pennsylvania Medicaid enrollees in the Opioid Use Disorder Centers of Excellence (COE) program and to evaluate the fairness of model performance across racial groups.</p><p><strong>Methods: </strong>We studied 20 983 United States Medicaid enrollees aged 18 years or older who had COE visits between April 2019 and March 2021. We applied multivariate logistic regression, least absolute shrinkage and selection operator models, random forests, and eXtreme Gradient Boosting (XGB), to predict OUD acute events following the initial COE visit. Our models included predictors at the system, patient, and regional levels. We assessed model performance using multiple metrics by racial groups. Individuals were divided into a low, medium and high-risk group based on predicted risk scores.</p><p><strong>Results: </strong>The training (n = 13 990) and testing (n = 6993) samples displayed similar characteristics (mean age 38.1 ± 9.3 years, 58% male, 80% White enrollees) with 4% experiencing OUD acute events at baseline. XGB demonstrated the best prediction performance (C-statistic = 76.6% [95% confidence interval = 75.6%-77.7%] vs. 72.8%-74.7% for other methods). At the balanced cutoff, XGB achieved a sensitivity of 68.2%, specificity of 70.0%, and positive predictive value of 8.3%. The XGB model classified the testing sample into high-risk (6%), medium-risk (30%), and low-risk (63%) groups. In the high-risk group, 40.7% had OUD acute events vs. 16.5% and 5.0% in the medium- and low-risk groups. The high- and medium-risk groups captured 44% and 26% of individuals with OUD events. The XGB model exhibited lower false negative rates and higher false positive rates in racial/ethnic minority groups than White enrollees.</p><p><strong>Conclusions: </strong>New machine-learning algorithms perform well to predict risks of opioid use disorder (OUD) acute care use among United States Medicaid enrollees and improve fairness of prediction across racial and ethnic groups compared with previous OUD-related models.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951420","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":"Craving self-reports as outcome measures in drug addiction trials: A systematic review of ClinicalTrials.gov.","authors":"Matin Toulami, Keyvan Ghasemi, Parnian Rafei, Arshiya Sangchooli, Nastaran Nafissi, Arash Khojasteh Zonoozi, Hossein Mohaddes Ardabili, Mohsen Ebrahimi, Tara Rezapour, Hamed Ekhtiari","doi":"10.1111/add.70064","DOIUrl":"https://doi.org/10.1111/add.70064","url":null,"abstract":"<p><strong>Background and aims: </strong>The subjective experience of drug craving is characterized by an overwhelming urge to consume substances. Due to strong validity and ease of use, self-report measures are widely employed to assess substance-related motivational dynamics. Multi-item questionnaires are increasingly favored for capturing the multidimensional nature of craving, providing valuable insights for clinical care and relapse prediction. This review aimed to summarize craving self-report measurement tools registered in clinical trials and examine their methodological parameters.</p><p><strong>Methods: </strong>A search was conducted in November 2022 and updated in November 2024 using the same methodology on ClinicalTrials.gov for trials reporting drug craving as an outcome measure. Trials using craving measurement tools were screened and included.</p><p><strong>Results: </strong>From 5383 initial trials, 1255 met eligibility criteria. Craving was reported as the only primary outcome measure in 14.6%, one of the primary outcomes in 21.3% and as secondary or exploratory in 64.1% of the studies. The most studied substances were nicotine (32.5% of studies) and alcohol (27.5%), followed by opioids (14.2%). Multi-item questionnaires were the most frequently used approach (55.4%), followed by single-item questionnaires (27.3%) to measure craving. Among 107 identified multi-item questionnaires, only 38 were used three or more times. The most common multi-item questionnaires were the Questionnaire on Smoking Urges (20%), Penn Alcohol Craving Scale (12.1%) and Alcohol Urge Questionnaire (9.8%). Most trials focused on evaluating phasic (now) craving (51.6%) over tonic (in a certain time-interval) craving (38%).</p><p><strong>Conclusion: </strong>Craving, measured through self-reports, is increasingly targeted as a primary outcome measure in drug addiction trials registered on ClinicalTrials.gov. Craving self-reports are highly variable, underscoring the need for standardized tools to enhance comparability across studies.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952821","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":"Sludge, dark patterns and dark nudges: A taxonomy of on-line gambling platforms' deceptive design features.","authors":"Philip Newall","doi":"10.1111/add.70085","DOIUrl":"https://doi.org/10.1111/add.70085","url":null,"abstract":"<p><strong>Background: </strong>Gambling research has highlighted various aspects of deceptive design. For example, land-based casinos are physically designed to encourage people to gamble there for longer. Similarly, various electronic gambling products, such as electronic gaming machines, exhibit \"structural characteristics\" that likely encourage people to continue using them. Here I argue that the deceptive design of on-line gambling platforms is an important yet relatively neglected topic, representing the digital equivalent of land-based gambling venue design. This topic's importance is underscored by on-line gambling's international growth.</p><p><strong>Argument: </strong>On-line gambling platforms' deceptive design features can be categorized using three terms from the interdisciplinary field of behavioral science. \"Sludge\" refers to detrimental frictions, which feature for example in online gambling platforms' withdrawal processes. \"Dark patterns\" refers to deceptive user-interface design more broadly, which includes sludge-based features and other design features such as high suggested deposit/bet sizes. Finally, \"dark nudges\" refers to all of these as well as other aspects of deceptive design, such as presenting gambling as a fun activity.</p><p><strong>Conclusions: </strong>The complexity of on-line gambling platforms poses challenges for researchers, to understand what effects various design features have on behavior, and also for policymakers, to ensure fairer outcomes for people. Increased awareness and collaboration are needed from many stakeholders to better understand deceptive design features' behavioral impacts and to give them the appropriate regulatory attention in comparison to other determinants of harm.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951577","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":"The association of parental or caregiver alcohol use with child maltreatment: A systematic review and meta-analysis of longitudinal studies.","authors":"June Yue Yan Leung, Karl Parker, En-Yi Lin, Taisia Huckle","doi":"10.1111/add.70055","DOIUrl":"https://doi.org/10.1111/add.70055","url":null,"abstract":"<p><strong>Background and aims: </strong>Caregiver alcohol use is a risk factor for child maltreatment, but a previous meta-analysis was limited to physical abuse only. We aimed to quantify the association of parental or caregiver alcohol use with child maltreatment and assess if this differs by incidence or recurrence of maltreatment and level of caregiver alcohol use.</p><p><strong>Methods: </strong>We undertook a systematic review and meta-analysis of longitudinal studies according to a registered protocol on PROSPERO (CRD42020211585). We searched the databases MEDLINE, PubMed, Scopus, PsycINFO, CINAHL and the Cochrane Library in November 2024. We included studies that reported the association of interest. We excluded studies that only assessed prenatal alcohol use or caregiver substance use, and studies that did not adjust for socio-economic position. Two reviewers independently screened the retrieved articles for relevance, extracted data from the included studies and assessed the methodological quality of studies using criteria adapted from the Newcastle-Ottawa scale. We performed meta-analyses using inverse variance weighting and random effects models.</p><p><strong>Results: </strong>We included seven studies on child maltreatment incidence and five on recurrence. All were cohort studies in high-income countries: three in Australia, one in Denmark, one in New Zealand, two in South Korea, one in the United Kingdom and four in the United States. The sample size ranged from 501 to 84 245 (median 4782). Caregiver alcohol-related diagnoses were associated with higher child maltreatment incidence [odds ratio (OR) = 2.32, 95% confidence interval (CI) = 1.10-4.89] and recurrence (OR = 1.92, 95% CI = 1.13-3.28) compared with caregivers without alcohol-related diagnoses. An association of any caregiver drinking with child maltreatment incidence could not be ruled out (OR = 1.22, 95% CI = 0.72-2.08). The review was limited by high heterogeneity and variable reporting of alcohol use and child maltreatment; however, we obtained similar results after sensitivity analysis and adjustment for reporting bias.</p><p><strong>Conclusions: </strong>Caregiver alcohol use may be an important risk factor for child maltreatment, adding to the growing body of evidence on alcohol's harm to others and calling for stronger actions to reduce alcohol harm.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953177","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":"Effects of legal access versus illegal market cannabis on use and mental health: A randomized controlled trial.","authors":"Lavinia Baltes-Flueckiger, Regine Steinauer, Maximilian Meyer, Adrian Guessoum, Oliver Herrmann, Christoph Felix Mosandl, Jens Kronschnabel, Eva-Maria Pichler, Marc Vogel, Marc Walter","doi":"10.1111/add.70080","DOIUrl":"https://doi.org/10.1111/add.70080","url":null,"abstract":"<p><strong>Aims: </strong>We measured the effects of public health-oriented cannabis access compared with the illegal market on cannabis use and related mental health outcomes in adult cannabis users.</p><p><strong>Design: </strong>This was a two-arm, parallel group, open-label, randomized controlled trial. Follow-up outcome measurement took place after 6 months.</p><p><strong>Setting: </strong>The study was conducted in Basel-Stadt, Switzerland.</p><p><strong>Participants: </strong>A total of 378 adult (aged ≥18 years) cannabis users were enrolled and randomized between August 2022 and March 2023, although only 374 users who completed baseline measures could be included.</p><p><strong>Intervention and comparator: </strong>Participants were randomly assigned to the intervention group with public health-oriented recreational cannabis access in pharmacies (regulated cannabis products, safer use information, voluntary counseling, no advertisement; 189/188) or the illegal market control group (continued illicit cannabis sourcing; 189/186).</p><p><strong>Measurements: </strong>The primary outcome was self-reported severity of cannabis misuse after 6 months, as measured by the Cannabis Use Disorders Identification Test - Revised (range 0-32). Secondary outcomes involved depressive, anxiety, and psychotic symptoms, cannabis consumption amount, alcohol, and drug use.</p><p><strong>Findings: </strong>Ten participants were not followed (2.7%). Primary analysis included those with complete data (182 vs. 182). There was some evidence of a difference in cannabis misuse between the legal cannabis intervention group (mean [M] = 10.1) and the illegal market control group (M = 10.9; β = -0.69, 95% confidence interval [CI] = -1.4 to 0.0, P = 0.052). These results were supported by an intention-to-treat multiple imputation analysis (n = 374). Additional sub-group analysis by whether the participant used other drugs or not suggested that any reduction in cannabis misuse was confined to those in the legal cannabis intervention group who used other drugs (P_Interaction < 0.001). We found no statistically significant changes in any of the secondary outcomes.</p><p><strong>Conclusions: </strong>Public health-oriented recreational cannabis access may decrease cannabis use and cannabis-related harms, especially among those using other drugs.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952015","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":"The landscape of ketamine use disorder: Patient experiences and perspectives on current treatment options.","authors":"Rebecca E Harding, Tamsin Barton, Maeve Niepceron, Ella Harris, Emily Bennett, Emily Gent, Flora Fraser, Celia J A Morgan","doi":"10.1111/add.70073","DOIUrl":"https://doi.org/10.1111/add.70073","url":null,"abstract":"<p><strong>Aims: </strong>To report the symptoms and aetiology of ketamine use disorder (KUD), gauge the effectiveness of current treatment services and identify strategies to enhance patient access and outcomes.</p><p><strong>Design: </strong>Mixed-methods, cross-sectional questionnaire. Electronic survey from November 2023 to April 2024.</p><p><strong>Setting: </strong>Participants were recruited through snowball sampling, social media and referrals from UK addiction treatment services. The survey was open to international participants, with responses collected from the United Kingdom, United States, Canada, Europe and Australia.</p><p><strong>Participants/cases: </strong>A total of 274 individuals with self-identified KUD, including both treatment-seeking (40%) and non-treatment-seeking (60%) current or former ketamine users. Participants' ages ranged from 18 to 67 years old, with 47.7% identifying as male. Additionally, 58.8% reported a diagnosed mental health disorder. On average, participants consumed 2.0 g of ketamine per day, with treatment-seeking individuals reporting higher average use (M = 2.67 g) than non-treatment-seeking users (M = 1.68 g) (P < 0.001).</p><p><strong>Measurements: </strong>Participants completed an online questionnaire addressing their attitudes toward ketamine and treatment services, including questions pertaining to their symptoms of problematic ketamine use, perceptions of education and awareness about KUD, opinions of existing treatment options, and facilitators for seeking treatment.</p><p><strong>Findings: </strong>The study identified various physical symptoms associated with KUD, with bladder problems (60%), nasal problems (60%) and 'K-cramps' (56%) being commonly reported among all users. In response to these symptoms, the majority (56%) did not seek treatment; among treatment-seeking users only 36% reported feeling satisfied with their care. Symptoms of abstinence syndrome were also identified, including cravings (71%), low mood (62%), anxiety (59%) and irritability (45%). Treatment-seeking participants reported that the services they used had little (31%) or some (31%) awareness of ketamine, were not tailored to ketamine use (43%) and were generally only somewhat effective (43%). Fifty-nine percent of participants reported that there was \"definitely not\" sufficient awareness in education and peer groups about the risks associated with ketamine use. When asked about the most important factors when choosing a treatment program, cost/affordability was the most cited for all participants.</p><p><strong>Conclusions: </strong>Ketamine use disorder (KUD) appears to be associated with a high prevalence of physical and psychological symptoms, including some specifically linked to abstinence. Despite this, most individuals with KUD do not seek treatment, and existing services are often perceived as ineffective.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957133","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}