Addiction最新文献

{"title":"Commentary on Piatkowski et al.: Anabolic-androgenic steroid testing sites are necessary to identify specific anabolic-androgenic steroid types that are commonly faked putting users at risk","authors":"Thomas O'Connor","doi":"10.1111/add.70068","DOIUrl":"10.1111/add.70068","url":null,"abstract":"<p>The majority of anabolic-androgenic steroid (AAS) are obtained on the illicit black market, where quality and specificity of desired AASs are known to be substandard [<span>1</span>]. Evidence presented in the study by Piatkowski and colleagues [<span>2</span>] support the fact that AAS users are concerned for the chemical purity and specificity, when obtaining AAS from illicit sources. Therefore, identifying safe, accurate quality AAS compounds for the user should be a societal priority, in line with harm-reduction strategies. Having a network of high quality AAS testing sites throughout the world would substantially support this goal. The AAS user must not only navigate drug purity issues because AAS compounds are commonly contaminated with dangerous impurities but also with safety issues caused by other counterfeit AAS that are not intended to be used. The nuances among AAS agents in terms of clinical utility are not as subtle as one might assume. For example, in the class of nor-19–derived AAS, there are two classic agents that need to be distinguished from one another: nandrolone decanoate is typically more sought after for bulking as compared with nandrolone phenylpropionate, which has become more commonly added to a testosterone regimen for subtle performance attributes. These two AAS are commonly available in the illicit market and their consumption can risk serious side effects, including hypertension, androgen induced erythrocytosis, venous thrombosis, pulmonary embolism, heart attacks and strokes. Healthcare providers, regulators, government officials and the general public need to better recognize the motivations of different groups to take these drugs.</p><p>None.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778627","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 Day et al.: Singapore's approach toward drug rehabilitation.","authors":"Salina Samion, Jasmin Kaur, Chi Ching Leung","doi":"10.1111/add.70063","DOIUrl":"https://doi.org/10.1111/add.70063","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778626","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 Young et al.: Clinical guidance is required for stimulant co-prescription with opioid agonist therapy","authors":"Nadine Ezard,&nbsp;Krista J. Siefried,&nbsp;Brendan Clifford","doi":"10.1111/add.70061","DOIUrl":"10.1111/add.70061","url":null,"abstract":"&lt;p&gt;Young &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] present new findings on the lack of a relationship between prescribed stimulants and opioid overdose from a Canadian cohort of people on opioid agonist therapy (OAT). The authors drew from a linked database of fatal and non-fatal opioid overdose in the province of British Columbia from 2015 to 2020. The authors found no association between stimulant co-prescription and overdose. Importantly, as the authors point out, the incidence of fatal overdose was low (1/500/year) [&lt;span&gt;1&lt;/span&gt;], testimony to the protective role of OAT [&lt;span&gt;2&lt;/span&gt;] and underscoring the importance of community access to effective OAT. Promoting effective initiation onto [&lt;span&gt;3&lt;/span&gt;] and retention in [&lt;span&gt;2&lt;/span&gt;] OAT is increasingly important in face of the rise of potent synthetic opioids and co-use with synthetic stimulants [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Stimulant prescription among people on OAT is an emerging therapeutic area that may have additional benefits over OAT alone. Prescription stimulants are first line pharmacotherapy for adults with attention-deficit hyperactivity disorder (ADHD) [&lt;span&gt;5&lt;/span&gt;], which coexists with an important proportion of people with opioid use disorder (recent meta-analytic data suggest 20% [&lt;span&gt;6&lt;/span&gt;]) and is associated with more severe opioid dependence and psychiatric comorbidity [&lt;span&gt;7&lt;/span&gt;]. Young &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] reported 4.4% of the 9395 participants had an ADHD diagnosis recorded; of those, 31% (212 participants) were prescribed a stimulant. Consistent with the literature [&lt;span&gt;8&lt;/span&gt;], these data suggest a likely under-recognition and under-treatment of ADHD in an OAT population. Treatment of ADHD may improve retention in OAT [&lt;span&gt;9&lt;/span&gt;]. Although the study was not designed to assess reasons for or patterns of stimulant prescription, more work is needed to explore the role of effective treatment of ADHD among people with opioid use disorder. Diagnosis of ADHD in adults with coexisting opioid use disorder (with or without concomitant non-prescribed stimulant use) is complicated by overlap in symptoms and lack of validated screening measures for substance use disorder populations. Consensus guidelines recommend routine screening and prompt diagnosis and treatment in people presenting with substance use disorder [&lt;span&gt;10&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Emerging evidence suggests there may be a role for stimulant prescription for the management of stimulant use disorder at doses higher than for ADHD [&lt;span&gt;11&lt;/span&gt;]. Co-use of stimulants with opioids is implicated in rising fatalities in North America, suggesting coexisting stimulant use disorder with opioid use disorder may be increasing at least in those countries. Yet only 38 people (0.4%) of the sample of 9395 people Young &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] report on were noted to have a stimulant use disorder diagnosis, and only six (0.9%) of those prescribed a stimulant had a stimulant use disorder diagnosis. Indeed, th","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1195-1197"},"PeriodicalIF":5.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778628","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":"Rare but relevant: Ketamine-induced cystitis - an in-depth review for addiction medicine.","authors":"Asem Abdelrahman, Mo Belal","doi":"10.1111/add.70052","DOIUrl":"https://doi.org/10.1111/add.70052","url":null,"abstract":"<p><p>Ketamine-induced cystitis is an increasingly recognized complication associated with the addictive use of ketamine, a dissociative anesthetic. This article provides a comprehensive overview, focusing on its pathophysiology, clinical presentation, diagnosis, management strategies, and implications for addiction treatment. The British Association of Urological Surgeons consensus serves as a foundational reference for management, while additional literature is integrated to highlight the multifaceted nature of Ketamine Bladder and its impact on individuals with substance use disorders.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778648","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":"Longitudinal patterns of e-cigarette use initiation and progression to frequent vaping from mid-to-late adolescence to young adulthood.","authors":"Junhan Cho, Alyssa F Harlow, Adam M Leventhal, Mary Ann Pentz, Dayoung Bae, Dae-Hee Han, Rob McConnell, Sandrah P Eckel, Jessica L Barrington-Trimis","doi":"10.1111/add.70042","DOIUrl":"https://doi.org/10.1111/add.70042","url":null,"abstract":"<p><strong>Aims: </strong>This exploratory study aimed to describe longitudinal patterns of e-cigarette use initiation and progression to frequent use across mid-to-late adolescence and young adulthood and determine risk factors for and consequences of these initiation patterns.</p><p><strong>Design: </strong>Using 12 waves of a prospective cohort data across 2014-2023, we identified latent classes with distinct patterns of timing of e-cigarette use initiation and frequent use progression (20 + days/month). We then estimated: (1) associations of baseline risk factors with membership in latent classes and (2) associations of latent classes with e-cigarette/other substance use frequency and e-cigarette dependence at a subsequent 1-year follow-up.</p><p><strong>Setting: </strong>Southern California, United States.</p><p><strong>Participants: </strong>Baseline e-cigarette never users [n = 2291; mean age (standard deviation) = 15.0 (0.4) years; 55.1% female; 44.6% Hispanic].</p><p><strong>Measurements: </strong>Repeated self-reported e-cigarette use initiation and past-30-day frequency, other substance use and e-cigarette dependence.</p><p><strong>Findings: </strong>Four distinct groups were identified: (1) early high school/gradual progression (13.9%); (2) late high school/gradual progression (4.3%); (3) young adulthood/quick progression (21.3%); and (4) low initiation risk/no progression (60.5%). In addition to two high school initiator groups with gradual progression to frequent vaping over 3 years, we identified the young adulthood/quick progression group who initiated e-cigarette use after high school and progressed to frequent use within 1.2 years. Late initiators who progressed quickly reported the highest prevalence of JUUL use as their first device (34.2%) and the highest levels of vaping frequency and e-cigarette dependence at the final assessment, compared with the other groups.</p><p><strong>Conclusions: </strong>In the United States, there appear to be four distinct classes of developmental patterns of e-cigarette use initiation and progression to frequent use during mid-to-late adolescence and young adulthood, including a newly identified group characterized by late use initiation (post secondary school) and rapid progression (1.2 years) to frequent use. Rapid progression from late initiation to frequent use may be influenced by the widespread availability and usage of JUUL among US youth in 2018-2019.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770794","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 Coelho et al.: Ecological momentary assessments may be key to the future of cannabis studies","authors":"Lucy Chester,&nbsp;François-Olivier Hebert,&nbsp;Didier Jutras-Aswad","doi":"10.1111/add.70066","DOIUrl":"10.1111/add.70066","url":null,"abstract":"&lt;p&gt;The study of cannabis use and cannabis-associated health outcomes currently centres primarily around two distinct methods of research: experimental trials using fixed doses of Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), and observational studies of naturalistic cannabis use. The former method has the advantage of producing accurate dose-effect data, but is limited to acute dosing in controlled, clinical environments. And while the latter allows us to track real-world cannabis consumption over extended periods of time, previous attempts to accurately record dosing have proven rudimentary and imprecise. The ecological momentary assessment (EMA) methodology presented by Coelho &lt;i&gt;et al&lt;/i&gt;. [&lt;span&gt;1&lt;/span&gt;] could help to fill this critical gap in the research by allowing the collection of precise, time-sensitive, and ecologically relevant cannabinoid dosing data across a variety of product types and modes of administration. Importantly, as alternative forms of use have become increasingly popular [&lt;span&gt;2&lt;/span&gt;], it has become more necessary than ever for a meaningful index of cannabis use to aggregate all such products and routes.&lt;/p&gt;&lt;p&gt;There are several points to consider when moving forward with this proposed methodology. First, it is imperative to consider and assess the generalizability across populations of interest, from otherwise relatively healthy consumers to populations displaying comorbid conditions (e.g. physical or mental health disorders) or other vulnerability factors. In addition, while there is evidence of overlap in medical and non-medical reasons for use [&lt;span&gt;3&lt;/span&gt;], the conditions in which medical and non-medical cannabis users utilize cannabis (e.g. alone or with company, exact measured dosing or ad libitum, etc.) and report their cannabis use will also likely differ, as will the effects that these populations experience.&lt;/p&gt;&lt;p&gt;It is also important to consider how this tool may be used in longer studies. The present study was conducted for 14 days to reduce the burden on participants, but the major cannabis-related harms of interest, such as cannabis use disorder, development or worsening of psychotic symptoms, etc., typically occur only over much longer periods of use. Longer follow-up would also be desirable for evaluating the safety and efficacy of self-directed medical cannabis use, such as in the management of chronic pain or insomnia. Such longer-term studies would need to limit the burden on participants, by making data input as fast and simple as possible (e.g. allowing users to save product characteristics to be automatically input again), and possibly having distinct periods of EMA data entry, for example, 1 or 2 weeks every 3 months, alternating with traditional retrospective data collection, such as timeline followback (TLFB) or enhanced TLFB (eTLFB) [&lt;span&gt;4, 5&lt;/span&gt;]. In addition, this methodology would be a more powerful research tool when incorporated into more comprehensive studies of cannab","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1182-1183"},"PeriodicalIF":5.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770783","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":"Is big money distorting the global drug policy conversation?","authors":"Bobby P. Smyth","doi":"10.1111/add.70059","DOIUrl":"10.1111/add.70059","url":null,"abstract":"&lt;p&gt;The Open Society Foundation (OSF) appears to have a large and distorting influence upon the current global drug policy conversation.&lt;/p&gt;&lt;p&gt;The United Nations (UN) Conventions on Narcotic Drugs stand as a massive obstacle for those with drug legalization ambitions [&lt;span&gt;1&lt;/span&gt;]. OSF is a wealthy opponent of the drug conventions, being led by the multi-billionaire, George Soros [&lt;span&gt;2, 3&lt;/span&gt;]. The funding of this think-tank has been assessed as being ‘highly opaque’ [&lt;span&gt;4&lt;/span&gt;]. OSF supports groups who put forward alternatives to prohibition and who support legalization [&lt;span&gt;2&lt;/span&gt;], saying ‘the vast majority of our grants are awarded to organizations that we approach directly’ and it funds those ‘who share our values’ [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The annual meeting in Vienna of the Commission on Narcotic Drugs (CND) is a key event in the annual calendar for those interested in the drug conventions. The program involves plenaries and dozens of organised official side events [&lt;span&gt;6&lt;/span&gt;]. OSF was among the non-governmental organizations (NGOs) at the meeting in 2024 and was formally involved in the running of 11 side events.&lt;/p&gt;&lt;p&gt;The funding relationship between OSF and the 49 other NGO contributors to these 11 OSF-involved side events was explored. It emerged that 38 (78%) had recent (2016–2023) OSF funding. OSF helpfully lists grantees on its own website [&lt;span&gt;7&lt;/span&gt;]. This confirmed funding in 31 instances. Financial support for individual NGOs ranged from $25 000 to $18 million over the 8 years. These 31 entities shared over $82 million from OSF across this period. In the other seven cases, funding was confirmed by the NGO's own website or via media reports. There were at least another 10 OSF funded NGOs involved in supporting other side events at CND 2024 [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;OSF has also recently funded both the Joint UN Programme on HIV/AIDS and Office of the UN High Commissioner for Human Rights (OHCHR) who each supported seven of the OSF-involved side events. The OHCHR received an average of $100 000 annually from OSF across 2018 to 2022 [&lt;span&gt;7&lt;/span&gt;]. This increased to $1.52 million in 2023. In 2023, OHCHR issued a report on drug policy urging countries to ‘consider developing a regulatory system for legal access to all controlled substances’ [&lt;span&gt;8&lt;/span&gt;]. The UN High Commissioner recently called for ‘responsible regulation’ at a conference on the ‘sensible regulation of drugs’ [&lt;span&gt;9&lt;/span&gt;]. This echoes the views of the OSF funder and conflicts with a current UN Convention.&lt;/p&gt;&lt;p&gt;A decade ago, Forbes magazine declared George Soros to be the biggest drug reformer in the United States [&lt;span&gt;10&lt;/span&gt;]. This influence now appears truly global, OSF attending this CND meeting with an army of over 50 NGOs and UN offices who are financially beholding to his think-tank.&lt;/p&gt;&lt;p&gt;Some of the funded entities at the CND meeting are university based and contribute research on drug policy. OSF additionally funds other","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1284-1285"},"PeriodicalIF":5.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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