Addiction最新文献

{"title":"Questionable generalizability of Alcohol Use Disorders Identification Test-Consumption scoring warrants caution when used for outcome monitoring: Evidence from simulated and real-world trial data.","authors":"Danilo Romero, Magnus Johansson, Anne H Berman, Philip Lindner","doi":"10.1111/add.70074","DOIUrl":"https://doi.org/10.1111/add.70074","url":null,"abstract":"<p><strong>Background and aims: </strong>The \"Alcohol Use Disorders Identification Test - Consumption\" (AUDIT-C), designed for primary-care screening, is frequently repurposed for outcome monitoring in brief intervention trials targeting problematic alcohol use. This repurposing may distort the instrument's internal structure and introduce right censoring, potentially undermining its ability to meaningfully capture problematic use and change thereof. The aim of the current study was to examine these concerns.</p><p><strong>Design: </strong>Psychometric study.</p><p><strong>Setting and participants: </strong>Data from three sources were used: (1) individual-participant data from an internet-based brief intervention trial (n = 1169); (2) aggregated data from k = 15 additional brief intervention trials; and (3) k = 20 000 simulated cohorts generated using statistics from general-population samples.</p><p><strong>Measurements: </strong>Internal structure of the AUDIT-C was examined through cross-item correlations, item step response functions (ISRF), and more. Responsiveness was assessed using interaction analysis, with changes in alcohol standard units (SU_t2-t1) as the outcome, AUDIT-C_t2-t1 and baseline SU as predictors, and further probing using a simple slopes approach.</p><p><strong>Findings: </strong>In contrast to general-population cohorts, most brief intervention trials (68.8%) exhibited non-positive associations between frequency and quantity items. Congruently, ISRFs revealed non-monotonic patterns, disrupting ordinal measurement. Simulations suggested that negative frequency-quantity correlations appear at cut-offs of four (r = -0.04, 95% confidence interval [CI]: -0.019 - -0.068) or three (r = -0.13, 95% CI: -0.101 - -0.149). A one-unit AUDIT-C_t2-t1 change represented greater average change in SU_t2-t1 at higher baseline consumption, supported by an interaction (β = 0.05, SE = 0.02, p = 0.005) and sequential contrasts between simple slopes (e.g. 80th vs. 90th percentile: β = 0.31, SE = 0.11, p = 0.035).</p><p><strong>Conclusions: </strong>When used with typical brief intervention samples, using the AUDIT-C for outcome monitoring risks right-censoring (and thereby false negatives) and non-meaningful total scores. Researchers and clinicians should reconsider repurposing the AUDIT-C as an outcome measure in future alcohol intervention studies and re-examine prior trials that relied on it, to improve the quality of evidence.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953328","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":"Tusi use among the New York City nightclub-attending population.","authors":"Joseph J Palamar, Nina Abukahok, Patricia Acosta, Alex J Krotulski, Sara E Walton, Brianna Stang, Charles M Cleland","doi":"10.1111/add.70069","DOIUrl":"https://doi.org/10.1111/add.70069","url":null,"abstract":"<p><strong>Background and aims: </strong>'Tusi', also known as 'tusibí' or 'pink cocaine', is a drug concoction which previously emerged in Latin America and Europe and has recently acquired popularity in the United States (US). Consumers are often unaware that Tusi contains a mixture of ketamine and other drugs, and the concoction can be confused with 2C/2C-B (ring-substituted phenethylamines/4-bromo-2,5-dimethoxyphenethylamine) or cocaine. This study aimed to estimate the prevalence and correlates of past-year Tusi use in the electronic dance music (EDM) nightclub-attending population in New York City (NYC), US.</p><p><strong>Design and setting: </strong>This cross-sectional study included surveys and optional saliva testing of adults entering randomly selected EDM events in NYC in 2024.</p><p><strong>Participants: </strong>Adults aged ≥18 years entering EDM events at nightclubs (n = 1465).</p><p><strong>Measurements: </strong>Exposures were demographic characteristics and past-year use of other drugs. The primary outcome was self-reported past-year use of Tusi, and in a subsample, biologically confirmed exposure to various drugs determined by saliva testing.</p><p><strong>Findings: </strong>Based on self-report, an estimated 2.7% [95% confidence interval (CI) = 1.9-3.9] of adults in the NYC EDM nightclub-attending population have used Tusi in the past year. Compared with white individuals, Hispanic individuals were at higher odds for use [adjusted odds ratio (aOR) = 5.10, 95% CI = 1.96-13.25]. Compared with those who did not use, those who used ecstasy/3,4-Methylenedioxymethamphetamine (MDMA) (aOR = 6.59, 95% CI = 1.60-27.16), ketamine (aOR = 3.44, 95% CI = 1.18-10.08) and/or 2C series (aOR = 14.82, 95% CI = 4.77-46.04) in the past year were at higher odds for use. Compared with those not reporting Tusi use, those reporting past-year use were more likely to have saliva test positive for cocaine, ketamine, MDMA, methamphetamine and/or synthetic cathinones (Ps < 0.001). They were also more likely to test positive for cocaine, ketamine or methamphetamine after not reporting past-year use (Ps < 0.01).</p><p><strong>Conclusions: </strong>An estimated 2.7% of electronic dance music-nightclub attending adults in New York City appear to have used Tusi in the past year, with higher use among Hispanic individuals and people exposed (sometimes unintentionally) to other drugs.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953555","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":"Isaac Campos. Home grown: Marijuana and the origins of Mexico's war on drugs.","authors":"Wayne Hall, Sarah Yeates","doi":"10.1111/add.70072","DOIUrl":"https://doi.org/10.1111/add.70072","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953612","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":"Deaths of despair","authors":"Susanne MacGregor,&nbsp;Karen Duke,&nbsp;Aileen O’Gorman","doi":"10.1111/add.70077","DOIUrl":"10.1111/add.70077","url":null,"abstract":"&lt;p&gt;No! It is not time to retire the term ‘deaths of despair’ [&lt;span&gt;1&lt;/span&gt;]. The concept is needed more than ever today in countries where drug-related deaths remain at high levels. It draws attention to the need for comprehensive public health and social policies to reverse the damaging upstream conditions, which form the context for these deaths.&lt;/p&gt;&lt;p&gt;It may be that the idea has been misappropriated and is unhelpful in a clinical context. Some in the addiction field seem to have plucked it from its original base in political economy and transported it into discussions about clinical encounters. Such thinking commits the fundamental error of considering a concept as a separate, distinctive phenomenon, divorced from its surrounding theoretical framework.&lt;/p&gt;&lt;p&gt;Addiction psychiatry and psychology focus on the accumulating risk factors which help to explain an individual's overdose, embedding these concepts in an explanatory framework revolving around individual attributes and behaviours. However, the ‘we’ of the addiction field is wider than clinicians. Discussions on the causes of drug-related deaths need to look not only at patterns of drug use, but also at the wider context within which these behaviours develop and become entrenched. The Editorial writers accept this with their brief—rather dismissive—reference to ‘societal despair’, which might be addressed by ‘broad economic improvements’. However, it is precisely with these questions that the concept ‘deaths of despair’ is concerned, looking at issues of regional disparities, left-behind areas, poverty, inequality, deprivation and exclusion.&lt;/p&gt;&lt;p&gt;The influential research by economists Anne Case and Angus Deaton (a Nobel Prize winner) documented the increase in mortality among American men and women without a college degree from suicides, alcoholic liver disease and, most important, drug overdoses. They drew attention to the need to improve the lives of working class Americans, pointing to economic insecurity, widening income inequality and decreasing prosperity over the generations, as well as America's unique failure in healthcare provision [&lt;span&gt;2, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Even after the financial crisis of 2008, in recession and austerity, most European countries did not evidence the slowdowns and reversals in mortality rates found in the United States. The only other wealthy industrialised country at risk of developing in a similar way is the United Kingdom with its long time decline in working class lives [&lt;span&gt;3&lt;/span&gt;]. This issue has also recently been thoroughly examined by Walsh and McCartney [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;While the Editorial quite rightly supports policies and practices like drug treatment programmes, naloxone distribution and safer prescribing practices, these should be set within more general social policies. Case and Deaton recommend inter alia sanctioning the behaviour of the pharmaceutical companies, expansion of Medicaid to cover drug treatment, adoption of NICE-like","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 7","pages":"1486-1487"},"PeriodicalIF":5.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953577","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":"Changes in vaping trends since the announcement of an impending ban on disposable vapes: A population study in Great Britain.","authors":"Sarah E Jackson, Lion Shahab, Harry Tattan-Birch, Vera Buss, Jamie Brown","doi":"10.1111/add.70057","DOIUrl":"https://doi.org/10.1111/add.70057","url":null,"abstract":"<p><strong>Background/aim: </strong>There has been a rapid rise in vaping prevalence among youth and young adults in Great Britain since disposable vapes started to become popular in 2021. In January 2024, the government announced plans to introduce new vaping policies, including a ban on disposable vapes, to tackle youth vaping. This study measured whether trends in current vaping and use of disposable vapes have changed since this announcement.</p><p><strong>Methods: </strong>Segmented regression analysis of data collected monthly between January 2022 and January 2025 as part of the Smoking Toolkit Study, a representative household survey in Great Britain. We ran generalised additive models using data from all participants aged ≥16y (n = 88 611; 'adults') and from a subset aged 16-24y (n = 9276; 'young adults'). Main outcome measures were changes in trends in (a) the prevalence of current vaping and (b) the proportion of vapers mainly using disposable devices.</p><p><strong>Results: </strong>Before January 2024, vaping prevalence was increasing by 23.4% per year [relative risk (RR)_trend = 1.234, 95% confidence interval (CI) = 1.184-1.287] and use of disposable vapes was increasing by 17.7% per year (RR_trend = 1.177, 95% CI = 1.105-1.255). These trends changed after the new policy measures were announced (RR_Δtrend = 0.782, 95% CI = 0.696-0.878, and RR_Δtrend = 0.573, 95% CI = 0.487-0.673, respectively). Instead of increasing, vaping prevalence stabilised and there was a substantial decline in the proportion of vapers mainly using disposables from 43.6% (40.1-47.3%) in January 2024 to 29.4% (26.3-32.9%) in January 2025. Similar changes were observed among young adults (vaping prevalence: RR_Δtrend = 0.799, 95% CI = 0.645-0.990; use of disposable vapes: RR_Δtrend = 0.547, 95% CI = 0.435-0.688), with vaping prevalence stabilising between January 2024 and January 2025 and the proportion of vapers mainly using disposables falling from 63.2% (58.8-67.8%) to 35.2% (30.4-40.8%).</p><p><strong>Conclusions: </strong>Following the announcement of an impending ban on disposable vapes and other potential vaping policies, recent increases in vaping prevalence in Great Britain stalled, including among young adults. In addition, there was a shift away from using disposable vapes, with people increasingly opting to use devices that can be refilled and recharged.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958195","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":"Examining the longer-term efficacy of brief, alcohol-focused personalized feedback interventions for individuals with internalizing distress: Secondary analysis of a randomized controlled trial.","authors":"Marilyn L Piccirillo, Scott Graupensperger, Katherine Walukevich-Dienst, Elizabeth Lehinger, Kirstyn N Smith-LeCavalier, Katherine T Foster, Mary E Larimer","doi":"10.1111/add.70044","DOIUrl":"https://doi.org/10.1111/add.70044","url":null,"abstract":"<p><strong>Background and aims: </strong>Efficacy of brief alcohol interventions for young adults with internalizing distress (i.e. symptoms of depression, anxiety and stress) is unclear. We tested the moderating effect of internalizing distress on the efficacy of alcohol single- and multicomponent personalized feedback interventions (PFIs).</p><p><strong>Design: </strong>Secondary data were analyzed from a randomized controlled trial (RCT) testing the efficacy of single and multicomponent PFIs, compared with an attention-only control condition.</p><p><strong>Setting: </strong>Participants were sampled from two West Coast universities in the United States. All study protocols were completed online.</p><p><strong>Participants: </strong>Participants (n = 1137) were college students (63% female; M_age = 20.1 years; 62.6% non-Hispanic white) who reported on internalizing distress at baseline. Some individuals reported clinically significant symptoms (depression: mild/moderate = 24.0%, severe/extremely severe = 10.5%; anxiety: mild/moderate = 19.6%, severe/extremely severe = 11.4%; and stress: mild/moderate = 37.5%, severe/extremely severe = 6.0%).</p><p><strong>Interventions: </strong>There were four different alcohol single-component PFIs administered and an attention-only PFI control. Alcohol PFIs varied in their complexity and single-component PFIs (i.e. personalized normative feedback) were compared with multicomponent PFI (i.e. containing additional alcohol-focused psychoeducation).</p><p><strong>Measurements: </strong>Baseline levels of internalizing distress were measured using the summed total of the Depression, Anxiety and Stress Scales (DASS). Drinking outcomes (alcohol consumption, peak eBAC, alcohol-related consequences) were measured at baseline, 3, 6 and 12 months post-intervention.</p><p><strong>Findings: </strong>Alcohol PFI (compared with attention-only control) reduced alcohol consumption and related consequences at 6-month [rate ratio (RR)_Consumption = 0.85, P = 0.004] or 12-month follow-ups (RR_Consumption = 0.76, P < 0.001; RR_Consequences = 0.85, P = 0.020), regardless of baseline DASS score. Participants with higher DASS scores (compared with those with lower DASS scores) reported lower 6-month alcohol consumption after receiving a single-component intervention (RR = 0.80, P < 0.001). However, individuals with higher DASS scores (compared to those with lower DASS scores) reported more 6-month alcohol-related consequences after receiving a multicomponent intervention (RR = 0.78, P = 0.004).</p><p><strong>Conclusions: </strong>Personalized feedback interventions may demonstrate efficacy towards reducing drinking in young adults and appear similarly beneficial across levels of internalizing distress, although lower-complexity interventions may be more efficacious.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809980","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 impacts of policies controlling the spatial availability of take-away alcohol on consumption and harms: A systematic narrative review.","authors":"Shima Shakory, Brendan T Smith, Rachel Jansen, Breanne Reel, Erin Hobin","doi":"10.1111/add.70070","DOIUrl":"https://doi.org/10.1111/add.70070","url":null,"abstract":"<p><strong>Aim: </strong>To systematically review the evidence on the impacts of policies regulating the spatial availability of off-premises alcohol on consumption and harms.</p><p><strong>Methods: </strong>Narrative review that examined peer-reviewed studies published from 2016 to 2024 on policy changes affecting the spatial availability of off-premises alcohol. Outcomes of interest were alcohol consumption, alcohol-related harms and mortality.</p><p><strong>Results: </strong>The review identified 20 observational studies, primarily natural experiments, examining four policy types: malt liquor restrictions, sales expansion to retail outlets, privatization and changes to allowable alcohol content. Across studies, there was a suggestion that allowing alcohol sales in gas station convenience stores was associated with increased consumption and harms, whereas expanding to grocery stores was not. There was no clear evidence that restricting malt liquor reduces crime. Similarly, privatization was not associated with crime or health outcomes, though it was accompanied by price increases. Increases in allowable alcohol content were not associated with higher consumption, but decreases were associated with fewer alcohol-related emergency visits and hospitalizations.</p><p><strong>Conclusions: </strong>The impact of policy changes in spatial alcohol availability depends on the policy details and retail outlet types. To mitigate public health impacts, policymakers should consider comprehensive alcohol control measures, such as regulating convenience store sales and accompanying grocery store expansions with minimum unit pricing, taxation and marketing restrictions. High-quality natural experiments with pre-post designs, control groups and confounder adjustments are needed to better understand how these policies impact both the general population and high-risk subgroups.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952046","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":"Within-week associations between alcohol and other substance use and interaction with naltrexone among sexual and gender minority men in San Francisco, California, USA.","authors":"Caitlin M Turner, Joy M Schmitz, Janet Ikeda, Glenn-Milo Santos","doi":"10.1111/add.70054","DOIUrl":"https://doi.org/10.1111/add.70054","url":null,"abstract":"<p><strong>Aims: </strong>To determine whether there were within-week associations between changes in alcohol use and changes in cannabis, cocaine or amphetamines use and, if so, to ascertain whether these associations varied by naltrexone use among adult sexual and gender minority men (SGMM) with mild and moderate alcohol use disorder (AUD).</p><p><strong>Design: </strong>Secondary analyses of data from the Say When study, a double-blind placebo-controlled trial comparing targeted oral naltrexone (50 mg) to placebo for AUD over 12 weeks.</p><p><strong>Setting: </strong>Procedures were conducted at the San Francisco Department of Public Health from May 2015 to November 2020, in San Francisco, California, USA.</p><p><strong>Participants: </strong>98 of 120 SGMM who reported substance use beyond alcohol.</p><p><strong>Measurements: </strong>Mixed effects logistic regression models tested associations between alcohol exposures [ethyl-glucuronide (EtG)-positive urine screens, past-week binge drinking and past-week binge drinking frequency] and same-week use of other substances (positive urine screens for cannabis, cocaine or amphetamines), adjusting for age, race/ethnicity, income, depression score and treatment assignment. Associations by treatment assignment (naltrexone or placebo) were also evaluated.</p><p><strong>Findings: </strong>Having a positive EtG urine screen was associated with higher odds of positive urine screens for cannabis [adjusted odds ratio (aOR) = 2.93, 95% confidence interval (95% CI) = 1.37-6.30, P = 0.006) or cocaine (aOR = 3.08, 95% CI = 1.52-6.23, P = 0.002). Each additional binge drinking day was associated with higher odds of having a positive urine screen for cocaine (aOR = 1.29, 95% CI = 1.04-1.60, P = 0.018). Among those receiving naltrexone, greater binge drinking days was associated with increased odds of having a positive urine screen for cocaine (aOR = 1.64, 95% CI = 1.18-2.27, P = 0.003), while results for cannabis and amphetamines were not statistically significant.</p><p><strong>Conclusions: </strong>Among adult sexual and gender minority men enrolled in a clinical trial, alcohol use was positively associated with cannabis and cocaine use. Naltrexone may mitigate cocaine use in this group by moderating binge drinking or diminishing the rewarding effects of cocaethylene. Findings highlight the potential of targeted naltrexone as an intervention to address alcohol and cocaine co-use and improve treatment outcomes in this underserved group.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952159","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":"Naloxone dosing in the era of synthetic opioids: Applying the Goldilocks principle.","authors":"Mariana Gonzalez Utrilla, Edward Chesney, Joanne Neale, Nicola Metrebian, Nicola Kalk, Arne Kristian Skulberg, Paul Dietze, Martin Smith, John Strang","doi":"10.1111/add.70060","DOIUrl":"https://doi.org/10.1111/add.70060","url":null,"abstract":"<p><p>The opioid overdose epidemic remains a critical public health crisis. In recent years, synthetic opioids like fentanyl and nitazenes, have driven a sharp rise in deaths. Naloxone, an opioid receptor antagonist, has been established as a key intervention for reversing opioid overdoses and saving lives. However, there remains a critical need to optimize naloxone dosing strategies. This article examines the challenges of both under-dosing and over-antagonism in naloxone administration, emphasizing the importance of a tailored approach to overdose management. A 'just the right dose' approach is essential for minimizing the risks of over-antagonism while still reversing opioid overdose. This involves starting with a modest naloxone dose and carefully titrating it based on the patient's response, considering factors such as opioid type, overdose severity, and opioid tolerance. A tailored approach to naloxone dosing may present challenges for non-medically trained responders but it can ensure that as many people as possible receive the right dose of naloxone when they need it. Training programs should also emphasize the importance of first aid and supportive care, including airway management and alerting emergency services, as well as careful monitoring of the patient's response.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on Johnstone et al.: Mechanisms underlying extended pre-quit varenicline treatment for smoking cessation","authors":"Jed E. Rose","doi":"10.1111/add.70067","DOIUrl":"10.1111/add.70067","url":null,"abstract":"&lt;p&gt;Currently available smoking cessation pharmacotherapies (nicotine replacement therapy, bupropion and varenicline) have limited effectiveness, and one strategy for improving on them has been to initiate treatment several weeks before the quit date. Not only does this increase efficacy [&lt;span&gt;2-5&lt;/span&gt;], but pre-quit initiation of treatment also affords an opportunity to assess predictors of efficacy and adapt treatment before a target quit date. [&lt;span&gt;6&lt;/span&gt;] This new research by Johnstone &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] sought to identify behavioral mechanisms underlying the efficacy of extended pre-quit treatment with varenicline.&lt;/p&gt;&lt;p&gt;Consistent with the hypothesis that varenicline attenuates nicotine reinforcement, the authors found that pre-quit reductions in smoking rate occurred, which, along with decreased pre-quit craving and increased self-efficacy, mediated abstinence. Surprisingly, however, subjective rewarding or aversive effects of cigarettes were not mediators of abstinence. These results are amenable to two quite different interpretations.&lt;/p&gt;&lt;p&gt;One interpretation is that the reinforcement mechanisms maintaining cigarette use and dependence are dissociable from the evaluative conditioning that underlies ratings of subjective reward. That is, the smoking response/nicotine reinforcement outcome association can be degraded by varenicline without substantially changing the subjective evaluation of cigarettes. Indeed, evaluative conditioning has been found to be resistant to extinction and counterconditioning [&lt;span&gt;7&lt;/span&gt;]. Previous studies have found that some subjective responses such as ‘craving reduction’ after smoking do not appear to be affected by varenicline [&lt;span&gt;8&lt;/span&gt;]. A related concept that might apply is ‘automatic reinforcement’ [&lt;span&gt;9&lt;/span&gt;], whereby a behavior becomes reinforcing in itself, apart from signaling a subsequent outcome such as nicotine reinforcement. The persistence of smoking cigarettes with little or no nicotine content [&lt;span&gt;10, 11&lt;/span&gt;] is consistent with this general view that subjective ratings of reward can be partially dissociated from nicotine reinforcement. Neural correlates of this dissociation have been identified in the dorsal striatum, premotor cortex and other brain regions [&lt;span&gt;12&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;A second interpretation, however, is that the perceived rewarding value of cigarettes is dissociated from abstinence because individuals adjust their rate of smoking to compensate for the reduction in anticipated reward. A cigarette smoked after a period of abstinence, such as the first one of the day, is often rated more rewarding than others [&lt;span&gt;13&lt;/span&gt;]. Therefore, reducing smoking frequency by spacing cigarettes farther apart would tend to offset the reward attenuation by varenicline and obscure a relationship between subjective reward and abstinence outcomes. Actual subjective reward could appear unchanged even if anticipated subjective reward were reduced and mediated ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1238-1239"},"PeriodicalIF":5.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802028","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}