Addiction最新文献

{"title":"Efficacy of a personalised alcohol approach bias modification smartphone app in people accessing outpatient alcohol use disorder treatment: A randomised controlled trial.","authors":"Joshua B B Garfield, Bosco Rowland, Samuel K Liu, Hugh Piercy, Yvonne Bonomo, Danielle Whelan, Victoria Manning","doi":"10.1111/add.70184","DOIUrl":"https://doi.org/10.1111/add.70184","url":null,"abstract":"<p><strong>Background and aims: </strong>Several randomised controlled trials (RCTs) have demonstrated that delivering approach bias modification (ApBM) during residential alcohol use disorder (AUD) treatment helps prevent post-treatment relapse. However, few studies have examined ApBM's efficacy for AUD in outpatients. We trialled a personalised ApBM smartphone app in individuals receiving outpatient AUD treatment.</p><p><strong>Design: </strong>This double-blind RCT randomised participants to receive ApBM or sham training, adjunctive to treatment as usual.</p><p><strong>Setting: </strong>Participants were recruited from alcohol and other drug treatment services in Melbourne, Australia.</p><p><strong>Participants: </strong>79 participants (mean age 46.6 years; 45 male, 34 female) installed the app between May 2022 and January 2024.</p><p><strong>Intervention and comparator: </strong>In the ApBM condition, the app delivered personalised, gamified ApBM. Notifications prompted participants (n = 39) to complete 2 ApBM sessions weekly for 4 weeks. The control version prompted participants (n = 40) to complete a weekly sham-training task for 4 weeks.</p><p><strong>Measurements: </strong>The primary outcome was number of standard drinks (10 g pure alcohol) consumed in week 4 of the intervention period, self-reported in the app. Secondary outcomes included past-week standard drinks at 8-week and 16-week follow-ups, past-week drinking days, past-week heavy drinking days (HDDs; days when ≥5 standard drinks were consumed) and questionnaire measures of AUD severity, quality of life and alcohol craving. Primary analyses followed an intention-to-treat (ITT) approach, with secondary complete-case sensitivity analyses also conducted for all outcomes.</p><p><strong>Findings: </strong>Groups did not statistically significantly differ in the primary outcome [values from ITT negative binomial model: ApBM = 75.49 standard drinks, control = 71.34 standard drinks, difference = 4.16, 95% confidence interval (CI) = -42.37 to 50.69, P = 0.859]. Most analyses of secondary outcomes showed statistically non-significant effects, with the only exception being past-week standard drinks at the 16-week follow-up, where ApBM participants showed statistically significantly larger decreases than controls in past-week standard drinks (reduction of 14.6, relative to baseline, versus 2.1 in controls; interaction β = -12.53, 95% CI = -23.85 to -1.22; P = 0.030). Time x group interaction effects were statistically non-significant for all other secondary outcomes (Ps > 0.069).</p><p><strong>Conclusions: </strong>A smartphone app using approach bias modification showed no evidence for reducing alcohol use among alcohol use disorder outpatients after 4 weeks, or evidence for effects on most secondary outcomes, although 16-week follow-up results suggested that approach bias modification may have facilitated delayed/longer-term reductions in alcohol use.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991068","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":"Changes in alcohol-related social network composition mediate the effects of AA meeting attendance on drinking following a recovery attempt in adults with alcohol use disorder.","authors":"Emily E Levitt, Liah Rahman, Desmond Singh, Kyla Belisario, Amanda Doggett, Allan Clifton, Robert Stout, John F Kelly, James MacKillop","doi":"10.1111/add.70172","DOIUrl":"https://doi.org/10.1111/add.70172","url":null,"abstract":"<p><strong>Aims: </strong>To assess whether changes in social network drinking is a mechanism of behaviour change responsible for the benefits of attending Alcoholics Anonymous (AA) during a recovery attempt.</p><p><strong>Design: </strong>An observational longitudinal cohort study investigating mechanisms of behaviour change among adults with alcohol use disorder (AUD) reporting initiation of a substantial recovery attempt.</p><p><strong>Setting: </strong>Boston, Massachusetts, United States, and Hamilton, Ontario, Canada.</p><p><strong>Participants: </strong>From a larger observational cohort, participants were individuals who reported a substantive increase in AA attendance (increase of ≥1 + meetings/week) from baseline to 6 weeks (n = 71) and a propensity score-matched control group of participants who did not increase AA attendance (n = 71). Propensity score matching used demographics and baseline drinking.</p><p><strong>Measurements: </strong>Baseline assessment and a 6-week follow-up assessment, including outcome variables: diagnostic assessment of AUD, timeline followback interview [percent drinking days (%DD) and percent heavy drinking days (%HDD)]; and exposure variables: formal egocentric social network assessment collecting egocentric social network metrics and using up to 20 network alters.</p><p><strong>Findings: </strong>Compared with the control group, participants who increased AA participation statistically significantly reduced %DD [mean (M) = 5.67% (standard error of the mean, SEM = 1.81) vs 30.91% (3.59); F = 46.22, P < 0.001] and %HDD [5.21% (1.79) vs 23.32% (3.14); F = 28.34, P < 0.001] and exhibited statistically significantly improved social network indicators including reduced network drinking frequency [1.99 (0.08) vs 2.96 (0.09); F = 42.26, P < 0.001] and severity [1.68 (0.06) vs 2.34 (0.08); F = 40.51, P < 0.001]. Changes in social network drinking statistically significantly mediated the relationship between changes in AA attendance and reductions in %DD [b = -0.06 (0.02), P = 0.01] and %HDD [b = -0.05 (0.02), P = 0.04] at follow-up.</p><p><strong>Conclusions: </strong>Reduced social network drinking appears to be one mechanism of behaviour change associated with the positive effects of Alcoholics Anonymous on drinking behavior during recovery.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991027","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":"Exploring the impact on emotional wellbeing of having a spouse or cohabiting partner with elevated Problem Gambling Severity Index (PGSI) scores: Secondary analysis of cross-sectional health survey data.","authors":"Sarah Tipping, Heather Wardle, Robert Pryce","doi":"10.1111/add.70154","DOIUrl":"10.1111/add.70154","url":null,"abstract":"<p><strong>Background/aims: </strong>To conduct an exploratory analysis of the association between the mental health and emotional wellbeing of an individual and the Problem Gambling Severity Index (PGSI) scores of their spouse or cohabiting partner.</p><p><strong>Design: </strong>Observational study using two sources of secondary data: the Health Survey for England (HSE) and the Scottish Health Survey (SHeS). Data from 2012, 2015, 2016, 2017 (SHeS only) and 2018 (HSE only) were combined to create a single data set. The data contained household identifiers and a household grid, allowing cohabiting couples to be identified.</p><p><strong>Setting: </strong>England and Scotland.</p><p><strong>Participants: </strong>20 752 individuals (in 10 376 couples) where both partners had completed the PGSI.</p><p><strong>Measurements: </strong>Outcome measures were four self-reported measures of emotional wellbeing: a binary measure indicating a long-term mental health condition, a scale question on life satisfaction, the twelve-item General Health Questionnaire (GHQ-12) and the Warwick Edinburgh Mental Health and Wellbeing Scale (WEMWBS). Gambling harms were measured using the PGSI. Controls included socio-demographic/economic characteristics, and a binary variable indicating whether the individual had spent money in the last 12 months on gambling.</p><p><strong>Findings: </strong>Regression models showed a statistically significant association between lower emotional wellbeing, measured by WEMWBS [Coef. 0.022; 95% confidence interval (CI) = 0.004-0.040], GHQ-12 Likert scale (Coef. 0.021; 95% CI = 0.000-0.043) and life satisfaction (Coef. 0.036; 95% CI = 0.005-0.067), among individuals who themselves had a PGSI score of zero but whose partner had elevated PGSI scores, when controlling for the individual's own gambling participation and other socio-demographic household and individual characteristics. There was no evidence of an effect between partner's PGSI score and an increased likelihood of a long-term mental health condition amongst the same group.</p><p><strong>Conclusions: </strong>Decrements to an individual's emotional wellbeing appear to be strongly associated with increased Problem Gambling Severity Index (PGSI) scores among their spouse/cohabiting partner, with an individual's emotional wellbeing declining as their partner's PGSI score increases.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936600","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":"Polysubstance use in early adulthood and associated factors in the Republic of Ireland: An analysis of a nationally representative cohort.","authors":"Margaret M Brennan, Deirdre Mongan, Anne Doyle, Seán R Millar, Massimo Cavallaro, Lina Zgaga, Bobby P Smyth, Elizabeth Nixon, Jo-Hanna Ivers, Brian Galvin, Cathal Walsh, Cathal McCrory, Noel D McCarthy","doi":"10.1111/add.70182","DOIUrl":"https://doi.org/10.1111/add.70182","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and aims: &lt;/strong&gt;Alcohol and other drug use is common in early adulthood; however, research on contemporary polysubstance use patterns-defined as use of multiple psychoactive substances-and their associated factors is limited. This study aimed to identify groups with differing polysubstance use patterns and to examine associations with individual, family and socio-environmental factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a cohort study based on data from the Growing Up in Ireland (GUI) study. GUI employed a two-stage clustered sampling design, using the national primary school system as the initial sampling frame. Sampling was stratified by county, sex, disadvantaged status, religious denomination and total number of nine-year-old pupils.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;GUI is a nationally representative cohort of young people in the Republic of Ireland.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;This study includes 4695 participants (49.5% female) who completed all four waves of GUI. Wave 1 took place in 2007/2008 when participants were aged nine, followed by wave 2 at age 13 in 2011/2012, wave 3 at age 17/18 in 2015/2016 and wave 4 at age 20 in 2018/2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;We used eight indicators of substance use at age 20: Alcohol Use Disorders Identification Test (AUDIT) scores, e-cigarette, tobacco, cannabis, cocaine, ecstasy, ketamine and other drug use in a latent class analysis, and examined associations with age, sex, age at first alcohol, emotional and behavioural difficulties, socioeconomic status, household structure, non-parental address, region, familial, peer and neighbourhood substance use using survey-weighted multinomial regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Four latent classes were identified: limited use (33.8%), alcohol, tobacco and cannabis use (43.0%), polysubstance use (16.2%) and heavy polysubstance use (7.0%). Both polysubstance classes, which together accounted for 23.2% of the cohort, had elevated probabilities of using five or more substances, including risky alcohol use, tobacco, cannabis, cocaine and ecstasy, with individual substance use probabilities (P) ranging from 0.63 to 0.99. The heavy polysubstance class was characterised by more frequent and diverse substance use, notably including ketamine (P = 0.90). Male sex [adjusted odds ratio (aOR) 2.7, 95% confidence interval (CI) = 1.7-4.2], familial (aOR 3.8, 95% CI = 1.9-7.6) and peer substance use (aOR 13.5, 95% CI = 6.3-29.2), a non-parental address (aOR 2.3, 95% CI = 1.4-3.8) and living in the Dublin region (aOR 1.9, 95% CI = 1.1-3.3) were associated with heavy polysubstance use, relative to the limited use class.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Nearly one in four 20-year-olds in Ireland appears to engage in polysubstance use, representing a significant public health concern. Polysubstance use among 20-year-olds in Ireland appears to be associated with being male, having family members and peers who use subst","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936711","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":"A pilot randomized controlled trial of Kisoboka, a behavioral economic and motivational interviewing intervention to reduce high-risk alcohol use and improve antiretroviral therapy adherence for men in Uganda.","authors":"Susan M Kiene, Amanda P Miller, Michael Ediau, Doreen Tuhebwe, Katelyn M Sileo, Rose Naigino, Judith A Hahn, Elizabeth Reed, Asha Anecho, Barbara Mukasa, Chii-Dean Lin, Rhoda K Wanyenze, Nazarius Mbona Tumwesigye","doi":"10.1111/add.70169","DOIUrl":"10.1111/add.70169","url":null,"abstract":"<p><strong>Aims: </strong>We assessed the feasibility and preliminary efficacy of a multilevel intervention (Kisoboka) to reduce high-risk alcohol use and improve human immunodeficiency virus (HIV) treatment engagement among fisherfolk men in Uganda.</p><p><strong>Design: </strong>A parallel individually randomized controlled pilot trial with follow-up at 3 and 6 months.</p><p><strong>Setting: </strong>Five HIV clinics near Ugandan fishing communities.</p><p><strong>Participants: </strong>160 men (80 per arm), aged 18-50, living with HIV, reporting suboptimal antiretroviral therapy (ART) adherence and high-risk alcohol use, enrolled between January 2021 and March 2022.</p><p><strong>Intervention: </strong>Kisoboka applies behavioral economic principles and motivational interviewing to address contextual determinants of alcohol use and suboptimal HIV treatment through counseling sessions, text reminders about savings and health goals, and a structural component of assistance setting up mobile money accounts and use of mobile money to receive work pay. The comparator arm (S&R) received only brief alcohol screening feedback, referrals for alcohol counseling and HIV treatment counseling.</p><p><strong>Measurements: </strong>High-risk alcohol use assessed via phosphatidylethanol (PEth) level at baseline and 6 months and Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) (cutoff ≥9) at baseline, 3 and 6 months. Self-reported ART adherence (≥90% versus <90%) assessed at baseline, 3 and 6 months.</p><p><strong>Secondary outcomes: </strong>number of days with ≥5 drinks in the prior 28 days and HIV viral load. We assessed intervention fidelity by audio recording and transcribing sessions, then coding a random 20% sample for fidelity to protocol elements.</p><p><strong>Findings: </strong>Retention (92.5% completed all sessions) and fidelity (92.8-100% across sessions) were high. Relative to the comparator arm, PEth values decreased from baseline to 6-month follow-up in the Kisoboka arm [difference in change -126.87 ng/ml, 95% confidence interval (CI) = -264.29 to 10.55], which was a small effect size (adjusted time* arm interaction: d = 0.14). The proportion with AUDIT-C ≥9 decreased more in the Kisoboka arm between baseline and 6 months (-26.01%, 95% CI = -36.09% to -15.93%), a medium effect size time*arm effect (d = 0.68). Kisoboka did not improve adherence but protected against declines in optimal adherence observed in the S&R arm (difference in change: 20.96%, 95% CI = 7.15% to 34.77%), which was a medium effect size time*arm effect (d = 0.51).</p><p><strong>Conclusions: </strong>The Kisoboka multilevel intervention to reduce high-risk alcohol use appears to be feasible; it showed promising clinically meaningful small to medium size effects on reducing high-risk alcohol use and protected against decreases in antiretroviral therapy adherence in a setting with strong contextual determinants of behavior.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936512","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":"Impact of comprehensive tobacco control policies on stroke and acute myocardial infarction among patients with hypertension and type 2 diabetes in Beijing, China: An interrupted time-series analysis.","authors":"Ruotong Yang, Yunting Zheng, Huan Yu, Junhui Wu, Siyue Wang, Hongbo Chen, Mengying Wang, Xueying Qin, Tao Wu, Chun Chang, Yiqun Wu, Yonghua Hu","doi":"10.1111/add.70178","DOIUrl":"https://doi.org/10.1111/add.70178","url":null,"abstract":"<p><strong>Background and aims: </strong>Tobacco control policies enhance cardiovascular health at the population level, but their effects on high-risk individuals, such as those with type 2 diabetes mellitus (T2DM) or hypertension, remain unclear. This study evaluated the association between a tobacco control policy and hospital admissions for stroke and acute myocardial infarction (AMI) in hypertensive and T2DM individuals.</p><p><strong>Design: </strong>Interrupted time series study.</p><p><strong>Setting: </strong>Beijing, China.</p><p><strong>Participants: </strong>2 144 133 hypertensive and 1 446 750 T2DM patients residing in Beijing from January 2013 to June 2017.</p><p><strong>Intervention: </strong>A comprehensive tobacco control policy package, incorporating all MPOWER components, was implemented in June 2015.</p><p><strong>Measurements: </strong>Changes in admission rates and admissions for stroke and AMI.</p><p><strong>Findings: </strong>Patients with T2DM showed immediate decreases in stroke [-9.4% (95% confidence interval = -13.3% to -5.3%)] and AMI [-24.3% (-31.2% to -16.7%)] admission rates after the policy. Similarly, the immediate post-policy change in stroke and AMI admission rates for hypertensive patients was -7.5% (-10.9% to -3.9%) and -23.0% (-29.2% to -16.3%), respectively. However, these reductions did not differ from those without either condition (P-interaction >0.05). For long-term trends, significant decreases were only seen for stroke [T2DM: -32.9% (-39.9% to -25.1%); hypertension: -33.3% (-39.3% to -26.7%)], but not AMI admissions, and again did not differ from those without either disease (P-interaction >0.05). Compared with healthy controls without T2DM or hypertension, patients with both conditions showed greater long-term reductions in stroke admission rates [-29.2% (-37.0% to -20.5%) vs. -14.4% (-26.3% to -0.5%), P-interaction = 0.05), whereas the opposite trend was observed for AMI admissions [7.9% (-15.9% to 38.4%) vs. -29.9% (-46.9% to -7.3%), P-interaction = 0.02].</p><p><strong>Conclusions: </strong>Beijing's 2015 comprehensive tobacco control policy appears to be associated with reduced acute myocardial infarction and stroke admissions among high-risk groups (individuals with type 2 diabetes mellitus and hypertension), although admission rates showed no statistically significant difference between high-risk and non-high-risk populations.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936623","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":"Comparative effectiveness of urine drug testing schedules alongside opioid agonist treatment: Emulation of a population-based target trial in British Columbia, Canada.","authors":"Megan Kurz, Brenda Carolina Guerra-Alejos, Jeong Eun Min, Shaun R Seaman, Micah Piske, Paxton Bach, Julie Bruneau, Sander Greenland, Paul Gustafson, Kyle Kampman, Mohammad Ehsanul Karim, P Todd Korthuis, Robert W Platt, Uwe Siebert, M Eugenia Socías, Evan Wood, Bohdan Nosyk","doi":"10.1111/add.70171","DOIUrl":"https://doi.org/10.1111/add.70171","url":null,"abstract":"<p><strong>Background and aim: </strong>Urine drug testing is often utilized alongside opioid agonist treatment to assess client progress by validating self-reported substance use, monitoring for diversion and supporting clinical decisions for take-home dosing. However, there is a paucity of evidence to support the practice of urine drug testing. We aimed to determine the association of alternative urine drug testing frequencies with opioid agonist treatment discontinuation, compared with no monitoring, among individuals receiving methadone or buprenorphine/naloxone treatment.</p><p><strong>Design: </strong>Population-based retrospective cohort study and target trial emulation based on nine-linked administrative databases.</p><p><strong>Setting: </strong>British Columbia, Canada, between 1 January 2010 and 17 March 2020.</p><p><strong>Participants: </strong>Individuals with no history of cancer or palliative care, aged 18 or older and no indication of pregnancy who initiated methadone or buprenorphine/naloxone. A total of 18 988 methadone and 11 910 buprenorphine/naloxone recipients were included in the incident user design (individuals with no past opioid agonist treatment experience).</p><p><strong>Measurements: </strong>We used a clone-censor-weight approach to estimate hazard ratios with 95% compatibility (\"confidence\") intervals for treatment discontinuation (lasting at least 5 and 6 days for methadone and buprenorphine, respectively) and all-cause mortality on treatment within 12 months for static urine drug testing strategies.</p><p><strong>Findings: </strong>Under static monitoring strategies, weekly urine drug testing was associated with a slightly reduced risk of discontinuation in the first year of continuous retention in treatment [methadone: adjusted hazard ratio (aHR) = 0.96, 95% compatibility interval (CI) = (0.95-0.98); buprenorphine/naloxone: aHR = 0.95 (0.94-0.97)] compared with no monitoring. The estimated associations of weekly urine drug testing with all-cause mortality were similar in size but extremely imprecise [methadone: aHR = 0.95 (0.78-1.15), buprenorphine/naloxone: aHR = 0.99 (0.62-1.58)]. Less frequent testing demonstrated no observed difference on treatment discontinuation or all-cause mortality compared with no monitoring.</p><p><strong>Conclusion: </strong>Compared with no urine drug testing, weekly urine drug testing may be associated with improved opioid agonist treatment retention; however, the high costs attributable to frequent testing may not be cost-effective and requires further evaluation. There was no improvement associated with less frequent testing compared with no monitoring.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936582","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 relationship between 3,4-methylenedioxymethamphetamine (MDMA) use in young adulthood and anxiety or depressive disorders in the mid-30s: Findings from the Victorian Adolescent Health Cohort Study.","authors":"Zachary Bryant, Kirsten Morley, Jessica A Kerr, Craig A Olsson, Tim Slade","doi":"10.1111/add.70173","DOIUrl":"https://doi.org/10.1111/add.70173","url":null,"abstract":"<p><strong>Background and aims: </strong>MDMA (3,4-methylenedioxymethamphetamine or \"Ecstasy\") is the fourth-most used illicit substance globally. While previous research found links between MDMA use and mental health outcomes, the direction and nature of this relationship remain unclear. This study assessed whether MDMA use in early adulthood increases the risk of anxiety or depression in mid-30s.</p><p><strong>Design: </strong>A longitudinal, population-based study using doubly robust inverse probability treatment weighted regression analysis, a contemporary confounder adjustment technique, to examine the relationship between MDMA use in early adulthood (age 20-29) and subsequent anxiety or depression at age 35.</p><p><strong>Setting: </strong>Victoria, Australia.</p><p><strong>Participants: </strong>Data were drawn from the Victorian Adolescent Health Cohort Study (VAHCS), which began in 1992 with a statewide representative sample of 1943 Year 9 students (aged 14-15) from 44 Victorian schools. This paper uses data collected from wave 2 to wave 10 (ages 15-35).</p><p><strong>Measurements: </strong>Across waves 7-9 (ages 20-29), MDMA use was categorised as any use, persistent use (none, one wave, two or more waves) and frequent use (none, infrequent, frequent). Wave 10 (age 35) outcomes were 12-month diagnoses of major depressive disorder and anxiety disorders assessed using the Composite International Diagnostic Interview (CIDI).</p><p><strong>Findings: </strong>There was little evidence linking any pattern of MDMA use in early adulthood with depressive disorders by the mid-30s; however, compared with non-MDMA users, the adjusted odds of an anxiety disorder were higher in those who reported past 12-month MDMA use [odds ratio (OR) = 1.73, 95% confidence interval (CI) = 1.12-2.68), persistent MDMA use at two or more waves (OR = 2.05, 95% CI = 1.07-3.94), as well as infrequent (OR = 2.11, 95% CI = 1.14-3.92) and frequent MDMA use (OR = 2.56, 95% CI = 1.15-5.71).</p><p><strong>Conclusions: </strong>MDMA use (3,4-methylenedioxymethamphetamine or \"Ecstasy\") in early adulthood appears to be associated with increased odds of anxiety disorders but not depressive disorder by the mid-30s.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936761","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":"Removing arbitrary limitations on buprenorphine for opioid use disorder","authors":"Nicole Gastala,&nbsp;Brianna Hudak,&nbsp;Mai T. Pho,&nbsp;Harold A. Pollack,&nbsp;Katharine Wilcox","doi":"10.1111/add.70127","DOIUrl":"10.1111/add.70127","url":null,"abstract":"&lt;p&gt;The opioid crisis has sharply evolved over the past two decades, shifting first from prescription opioids to heroin and now to fentanyl and other synthetic opioids far more potent than their predecessors. Buprenorphine, a partial opioid agonist, has long been a cornerstone of opioid use disorder (OUD) treatment, demonstrating significant reductions in morbidity and mortality when prescribed appropriately. However, legacy dosing recommendations from an era preceding fentanyl's dominance have resulted in restrictive state and insurance policies that limit patient access to clinically necessary dosages. In the United States (US), recent US Food and Drug Administration (FDA) updates seek to mitigate this issue [&lt;span&gt;1&lt;/span&gt;], but broader structural and international policy shifts are needed to align buprenorphine treatment with the contemporary realities of opioid pharmacology and patient need.&lt;/p&gt;&lt;p&gt;The US FDA initially approved buprenorphine-based medications for OUD treatment in 2002, establishing a recommended target dose of 16 mg per day, with 24 mg per day cited as the upper limit beyond which no additional clinical benefit was believed to occur. These recommendations were based on studies conducted in the pre-fentanyl landscape. Today, fentanyl's high potency, low street price per morphine milligram equivalent (MME), and long half-life complicate withdrawal management, often necessitating higher doses of buprenorphine to suppress cravings and stabilize patients effectively [&lt;span&gt;2&lt;/span&gt;]. The growing body of evidence supporting higher doses has not yet translated into widespread policy reform. Instead, outdated dosage limits have been used by US states and insurers to justify restrictive prescribing practices that hinder effective treatment [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Local policies on buprenorphine dosing vary considerably, often in ways that can undermine patient care [&lt;span&gt;4&lt;/span&gt;]. Some US states, such as Kentucky, impose arbitrary dosage caps, while others, such as Tennessee and West Virginia, enforce dosage restrictions with cumbersome exceptions, such as chart documentation or required referral to an addiction specialist. Additional bureaucratic barriers—such as prior authorizations or excessive documentation requirements—further delay or prevent treatment escalation, disproportionately affecting Medicaid beneficiaries and uninsured individuals [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Additionally, insurance coverage for extended-release injectable buprenorphine (Sublocade), presents another significant hurdle. Originally approved for monthly administration, new data suggest that an accelerated induction phase—including a second 300 mg dose as early as day 8—may improve stabilization outcomes. Insurance coverage has not kept pace with these findings, leaving patients with inadequate options for stabilization and relapse prevention [&lt;span&gt;6&lt;/span&gt;]. Although barriers such as quantity limits and prior authorization are in place to ensure appropriate ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 10","pages":"1913-1915"},"PeriodicalIF":5.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936720","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 Harding et al.: Responding to ketamine use disorder—Integrating practice, research, and whole-system approaches to harm reduction","authors":"Rob Ralphs,&nbsp;Janine Day,&nbsp;Jonathan Dewhurst","doi":"10.1111/add.70181","DOIUrl":"10.1111/add.70181","url":null,"abstract":"<p>Harding and colleagues [<span>1</span>] recent study contributes to an established body of international evidence [<span>2-6</span>] on the physical harms associated with ketamine use disorder (KUD), including bladder dysfunction, abdominal pain (‘K-cramps’), nasal complications from insufflation and abstinence symptoms such as cravings, low mood, anxiety and irritability. More significantly, the study offers valuable insights into attitudes toward treatment services, revealing widespread reluctance to engage and dissatisfaction among those who did. These findings underscore the need to improve awareness, accessibility and responsiveness of treatment services for individuals with KUD, ensuring they are better aligned with users' needs and expectations.</p><p><b>Rob Ralphs:</b> Writing—review and editing (lead). <b>Janine Day:</b> Writing—review and editing (supporting). <b>Jonathan Dewhurst:</b> Writing—review and editing (supporting).</p><p>None.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 10","pages":"1980-1981"},"PeriodicalIF":5.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144936552","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}