Addiction最新文献

{"title":"Stop calling it self-medication: Tobacco smoking is not medicine","authors":"Jentien M. Vermeulen, Jorien L. Treur, Robyn E. Wootton, Gemma Taylor","doi":"10.1111/add.70451","DOIUrl":"10.1111/add.70451","url":null,"abstract":"<p>Smoking is the world's leading cause of preventable illness and death. One in two people who smoke will die from a smoking-related disease unless they quit [<span>1</span>]. Although prevalence has fallen sharply in high-income countries, smoking remains disproportionately common among people with mental illness [<span>2</span>]. The rates are the highest for individuals with severe mental illness, such as bipolar and schizophrenia, with up to two-thirds smoking cigarettes [<span>3</span>].</p><p>Despite being as motivated to quit [<span>4</span>], people with mental illness are less likely to succeed, with 19% lower odds of long-term abstinence among individuals with depression, for example [<span>5</span>]. However, a combination of varenicline and behavioural counselling is safe and effective, even in people with schizophrenia who smoke, where the odds of quitting are the lowest [<span>6</span>]. Converging evidence from different types of research [<span>7</span>] shows that smoking contributes to the onset of mental illness through plausible biological pathways [<span>8</span>], while quitting improves mental health once withdrawal symptoms dissipate [<span>9</span>]. Importantly, when presented with evidence on the health risks, people with mental illness acknowledge smoking's harms and recognise the mental health benefits of cessation [<span>10</span>].</p><p>Given this health inequality, it is important to scrutinise the language we use to explain smoking, particularly in people with mental illness. The term ‘self-medication’ [<span>11</span>] has been widely applied by researchers, treatment providers, laypersons, patients, but it is misleading and unhelpful. Figure 1 presents the use of this term in the title and abstracts of scientific literature, showing increasing numbers since 2000. The term contributes to maintaining smoking in this population instead of encouraging starting the process of stopping smoking.</p><p>In turn, this might further reinforce health inequalities and legitimise tobacco use in people who are already faced with many challenges, including an addiction to smoking and a severe mental illness. Furthermore, they are systematically targeted by the tobacco industry and exposed to inconsistent policy protection from tobacco-related harms (including limited access to cessation support).</p><p>Below, we outline why the term ‘self-medication’ should be retired to not increase stigma toward people who smoke, but rather clarify addiction and withdrawal mechanisms and expand access to support in a constructive manner.</p><p>The phrase self-medication suggests something purposeful and positive, akin to taking prescribed medicine. In 1997, Khantzian [<span>11</span>] reviewed this hypothesis showing that clinical observations and empirical studies suggest that states of painful affect or distress are important psychological determinants in using, becoming dependent on and relapsing to addictive substances. Khantzian [<span","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2588-2590"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147872501","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":"Balancing harm prevention and liberty preservation when implementing financial risk assessments for gambling in the United Kingdom: Insights from open banking data","authors":"Robert M. Heirene, Philip Newall","doi":"10.1111/add.70513","DOIUrl":"10.1111/add.70513","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>The United Kingdom (UK) and Dutch governments have recently implemented mandatory financial risk (affordability) assessments for online gambling as a harm prevention measure. Assessments should trigger at a level of gambling expenditure that strikes a balance between harm prevention (most at-risk consumers should surpass the threshold) and liberty preservation (most no-/lower-risk consumers should gamble below it), yet little empirical research exists to guide threshold setting. We aimed to demonstrate how research can inform the harm-prevention, liberty-preservation trade-off in this context and evaluate the UK's proposed implementation of financial risk assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting and participants</h3>\u0000 \u0000 <p>We reanalysed a dataset that combines self-reported Problem Gambling Severity Index (PGSI) scores and open banking data from consumers who gamble (<i>n</i> = 424) to (1) simulate the impact of the UK's rolling 30-day £150 net-deposit (deposits minus withdrawals) threshold for financial risk assessments, and (2) identify optimal threshold values for these assessments under different circumstances. Participants were UK residents who had gambled in the past year, recruited via Prolific in April 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Participants completed a survey containing the PGSI and agreed to provide their past 12 months' banking records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Over 12 months, two-thirds of at-risk (PGSI ≥1) and nearly half of no-/lower-risk participants crossed the UK's £150 threshold [area under the curve = 0.66, 95% confidence intervals (CIs) = 0.62–0.71], demonstrating a greater emphasis on harm prevention over liberty preservation. Increasing the value to £186.9 (95% CIs = £69.5–£401.7) slightly improved this balance, although £150 remained within the range of appropriate values. Optimising for harm prevention in our sample required lowering the threshold to £39.0 (95% CIs = £29.6–£58.8), while emphasising liberty preservation increased it to £716.5 (95% CIs = £508.5–£990.9). We found that using a more conservative definition of risk (≥2 PGSI harms) resulted in higher thresholds, and lower thresholds may be appropriate for younger adults (<30 years). Finally, our findings suggest that thresholds based on spending with all operators—rather than single operators as implemented in the UK—may be better able to differentiate at-risk from no-/lower-risk consumers, although the added benefit of this approach in our sample ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2646-2658"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70513","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306324","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":"A cross-sectional and prospective examination of alcohol use and misuse among adult twin and sibling pairs discordant for neighborhood socio-economic disadvantage","authors":"Wendy S. Slutske, Timothy B. Baker, Thomas M. Piasecki","doi":"10.1111/add.70533","DOIUrl":"10.1111/add.70533","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine whether the association between neighborhood disadvantage and alcohol use and misuse can be explained by a potentially causal effect of neighborhoods or by between-family genetic and environmental confounding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional and prospective discordant twin and sibling study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>United States national sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>1477 adult twin and sibling pairs (217 monozygotic twin, 336 dizygotic twin and 924 full biological sibling pairs) from the National Longitudinal Study of Adolescent to Adult Health (mean age = 28.49 years, 53% female). Most twin and sibling pairs were discordant for the level of disadvantage in their neighborhood (70%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>The predictor was wave 4 neighborhood disadvantage, along with wave 4 individual-, family- and neighborhood-level covariates. The outcomes were any alcohol use, quantity x frequency of alcohol use (alcohol QF) and frequency of binge drinking assessed at wave 4 in the cross-sectional models and at wave 5 in the prospective models. Neighborhood disadvantage for the two members of a twin/sibling pair was used to create two orthogonal within- and between-pair variables to be used to decompose the neighborhood/alcohol association into a within-pair (i.e. potentially causal) effect and a between-pair association (i.e. family level confounding).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>In fully adjusted models including all covariates, only between-pair (not within-pair) neighborhood disadvantage was cross-sectionally [odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.88–0.98] and prospectively (OR = 0.92, 95% CI = 0.85–0.98) associated with lower odds of any alcohol use in the past year. Between-pair neighborhood disadvantage was cross-sectionally, but not prospectively, associated with increased alcohol QF in the past month among women [mean ratio (MR) = 1.09, 95% CI = 1.03–1.15], but not among men (MR = 1.01, 95% CI = 0.96–1.06). Within-pair disadvantage was also cross-sectionally, but not prospectively, associated with increased alcohol QF in the past month (MR = 1.04, 95% CI = 1.01–1.07). Neighborhood disadvantage was not significantly associated with binge drinking.</p>\u0000 ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2713-2724"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70533","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343457","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":"Prenatal opioid exposure, and health, social and educational outcomes for school-aged children: A systematic review","authors":"Louise Marryat, Dawood Gashgari, Shona Shinwell, Vicky Mitchell, Catriona Connell, Gale Macleod, Senga Robertson, Anne Whittaker, Alison McFadden","doi":"10.1111/add.70510","DOIUrl":"10.1111/add.70510","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Recent decades have seen a rise in the number of pregnancies exposed to opioids. Whilst evidence of the impact of such exposure on pregnancy and infant outcomes is fairly robust, the impact of prenatal opioid exposure (POE) on longer-term outcomes for children and young people remains unclear. This systematic review aimed to examine comprehensively the evidence of the association between prenatal exposure to illicit opioids or medication for opioid use disorder (MOUD) and school-age health, social and educational outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Web of Science, Scopus and CINAHL were searched for papers published between 1 January 2015 and 13 February 2025, with a follow-up search conducted on 28 October 2025. Grey literature was searched through Google. Eligible studies could be quantitative or qualitative in nature, reporting empirical findings exploring POE (illicit opioids or MOUD) and health, educational or social outcomes at ages 5–18 years. Editorials, case reports, literature reviews, commentaries and conference abstracts, as well as non-English language papers, were excluded. Records were screened by two authors. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies – of Exposure (ROBINS-E) Tool. Due to heterogeneity within both exposures and outcomes, results were synthesised narratively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-two papers comprising 16 studies were identified. Quality was mixed: 17/32 papers had high/very high risk of bias, primarily stemming from longitudinal attrition and lack of controlling for confounding. Five very high risk papers were excluded, leaving 27 included papers. Overall, 31 104 children exposed to opioids and 5 430 272 controls were included. Papers spanned 10 countries, primarily in North America, Australasia and Europe. Study designs included prospective birth cohort studies (<i>n</i> = 10), retrospective administrative data studies (<i>n</i> = 11), a combination of those two designs (<i>n</i> = 5) and one cross-sectional study. The most robust evidence of an association with POE was for poorer visual outcomes (e.g. general eye disorders, failure of standard visual assessments and specific impairments including strabismus and nystagmus) (4/4 studies indicating an association) and increased hyperactivity and attention difficulties (3/3 studies reporting an association). A majority of studies (<i>n</i> = 7/10) reported an association with increased cognitive difficulties across various measures. Results for physical health and brain structure/functioning were inconclusive. Evidence was based o","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2633-2645"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70510","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534582","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 Heirene and Newall: The architecture of risk assessment must be co-produced","authors":"Fay Laidler","doi":"10.1111/add.70579","DOIUrl":"10.1111/add.70579","url":null,"abstract":"<p>Heirene and Newall [<span>1</span>] offer a valuable methodological contribution to calibrating financial risk assessment thresholds. Using open banking data fused with Problem Gambling Severity Index (PGSI) [<span>2</span>] scores, they suggest that the United Kingdom’s (UK's) £150 net-deposit threshold [<span>3</span>] weights harm prevention over liberty preservation. However, the analysis rests on assumptions deserving scrutiny and raises questions the data alone cannot answer.</p><p>The first concerns who defines risk. Gambling research's most widely used screening instrument, the PGSI, is a clinically derived tool built in 2001, before the involvement of people with lived experience was standard practice [<span>2</span>]. It treats financial harm as just one of nine symptoms, weighted no differently from guilt, and captures neither the scale of losses nor the harms borne by affected others—the very harms that people with lived experience identify as central [<span>4, 5</span>]. Any assessment calibrated against PGSI scores inherits these blind spots, most often missing people whose harm hides behind proportionate-looking spending or whose losses are absorbed by partners or employers.</p><p>A further problem sits inside the risk classification itself. Two definitions of risk produce two policy answers. Calibrated against PGSI ≥1, reached by answering ‘sometimes’ to a single question, the optimal threshold is £187, with £150 comfortably within its confidence bounds. Calibrated against ≥2 PGSI harms, it rises to £367. The ‘optimal’ balance point nearly doubles on a definitional choice about who counts as at risk. Raising the clinical bar does not concentrate protection on the most severely harmed. It reduces intervention overall, because everyone below the new cut-off moves from the harm-prevention to the liberty-preservation side of the ledger. People scoring a single point, or experiencing harms the PGSI does not register, do not stop being harmed when the classification changes, yet they are recoded as having liberties to be preserved. The trade-off is only as sound as the account of harm the instrument supplies.</p><p>Heirene and Newall acknowledge the PGSI's limitations as a proxy for financial vulnerability, but the implications run deeper than a measurement caveat. If the goal is to identify and protect people experiencing harm, then the architecture of risk assessment (the definitions, instruments and thresholds determining who counts as at risk and what counts as harm) must be built with those people, not inherited from instruments predating co-production [<span>6, 7</span>]. Harms-based measures grounded in lived experience accounts, such as the Short Gambling Harm Screen [<span>8</span>], show alternatives exist.</p><p>The second concerns whose liberty counts. The harm-prevention/liberty-preservation framing is consistent with UK policy discourse, but not neutral. The liberty at stake is almost always consumers' freedom to spend ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2659-2660"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70579","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757090","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":"Tobacco and cannabis use in the young ‘Not in Employment, Education or Training’ population: A systematic review and meta-analysis","authors":"Clara Eyraud, Claire Collin, Philippe Martin, Corinne Alberti, Laëtitia Minary, Agnès Dumas, Enora Le Roux","doi":"10.1111/add.70477","DOIUrl":"10.1111/add.70477","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>NEET (Not in Employment, Education or Training) youth represent a vulnerable population from a public health perspective, facing multiple health challenges, including elevated substance use. Tobacco and cannabis are the most commonly used psychoactive substances among young people, with early initiation associated with long-term health and social consequences. While evidence suggests associations between NEET status and substance use, data remain limited regarding patterns of use and potential variations across different NEET profiles. This study aimed to characterise tobacco and cannabis use within the NEET population, taking into account the diversity of profiles, and to compare it with that of the general population, including employed youth and students, in order to inform targeted prevention strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis included observational studies examining tobacco and cannabis use among NEET youth aged 15–29 years. A search was conducted for observational studies available on PubMed, PsycINFO, Cairn and Web of Science databases and published between 1999 and 2025. Analyses studied the variations in use among NEET profiles and compared NEET against employed youth, student and general population controls. Random-effects models generated pooled crude odds ratios. Sensitivity and subgroup analyses were conducted based on study quality, gender and type of comparison population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five studies were included and analysed, including a total of 91 085 individuals. A statistically significant association between NEET status and both tobacco use [odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.46–2.53] and current cannabis use (OR = 2.14, 95% CI = 1.68–2.71) was found. Current smoking was statistically significantly more prevalent among NEET than among students (OR = 3.05, 95% CI = 2.31–4.03), but not statistically significantly different compared with young workers (OR = 1.10, 95% CI = 0.91–1.34). NEET demonstrated statistically significantly higher cannabis use compared with both students (OR = 1.81, 95% CI = 1.34–2.44) and workers (OR = 1.67, 95% CI = 1.21–2.31). A higher prevalence of cannabis use disorder among young people with NEET status (31.93%) was observed compared with their non-NEET peers (12.12%), but no statistically significant association was found.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Youth Not in Employment, Education or Training (NEET) appear to","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2591-2606"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142102","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":"Discontinuation of medications for alcohol use disorder in the United States: Patient, prescriber and medication predictors","authors":"Alisa B. Busch,&nbsp;Dominic Hodgkin,&nbsp;Alene Kennedy-Hendricks,&nbsp;Grant A. Ritter,&nbsp;Lori Uscher-Pines,&nbsp;Constance M. Horgan,&nbsp;Haiden A. Huskamp","doi":"10.1111/add.70498","DOIUrl":"10.1111/add.70498","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Little is known about medication for alcohol use disorder (MAUD) adherence. The goal of this study was to examine patient, prescriber and medication characteristics associated with time to discontinuation of MAUD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting and participants</h3>\u0000 \u0000 <p>Observational cohort study from Optum Labs de-identified administrative claims data of a United States national sample of commercial and Medicare Advantage enrollees with alcohol use disorder (AUD) who initiated MAUD (naltrexone, acamprosate, disulfiram, topiramate) January 2017–June 2024 (<i>n</i> = 51 915). Using an accelerated failure time (AFT) log logistic survival model, we examined MAUD discontinuation, adjusting for patient demographic and clinical characteristics established within 6 months prior to or on date of initiation, specific MAUD initiated with, MAUD prescriber type and study year. We defined effect size of at least 10% change in AFT survival (i.e. AFT estimates &gt; +/− 0.100) as being of clinical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements</h3>\u0000 \u0000 <p>Time-to-discontinuation of MAUD, defined as a gap in pharmacy fills or medication administrations of MAUD days-supply &gt;7 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>In unadjusted analyses, the median time to MAUD discontinuation was 30 days; median days-supply prior to discontinuation varied by medication (e.g. 30 days for acamprosate and naltrexone, 56 for disulfiram, 60 for topiramate). Adjusted analyses showed that among the patient characteristics, longer MAUD duration was associated with older age [e.g. AFT duration estimate (95% confidence interval) for age ≥65 vs. 18–30 = 0.164 (0.088–0.240)], while lower county median household income was associated with shorter duration [e.g. &lt;$40 000 vs. ≥$200 000: −0.106 (−0.136 to −0.076)]. MAUD initiations via topiramate (vs. naltrexone) were associated with longer duration [0.339 (0.311–0.366)], as were initiations via disulfiram [0.103 (0.076–0.131)]. MAUD duration increased in recent study years, except 2024 [(e.g. 2023 vs. 2017 = 0.116 0.087–0.144)].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among the few individuals in the United States who receive medication for alcohol use disorder (MAUD), early discontinuation is common, minimizing the opportunity for MAUD to support patients' recovery goals. While MAUD duration has increased in recent years, the improvements are small.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2691-2700"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209402","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":"Pioglitazone for the treatment of alcohol use disorder: A randomized controlled trial","authors":"Eric Dieperink,&nbsp;Katherine Anderson,&nbsp;Kathryn Dockter,&nbsp;Meredith Evenson,&nbsp;Paul Thuras,&nbsp;Peter Hauser","doi":"10.1111/add.70508","DOIUrl":"10.1111/add.70508","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;Current medications for alcohol use disorders (AUD) are under-used and of moderate benefit; new or improved treatments are much needed. Preclinical and small clinical studies indicate that pioglitazone, a thiazolidinedione agonist of the peroxisome proliferator-activated receptor gamma, may reduce alcohol use. The primary purpose of this study was to evaluate, in a randomized trial, the effect of pioglitazone on alcohol use and craving in adults with AUD.&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;A double-blind, placebo-controlled randomized trial.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Enrollment occurred in the United States at two Veterans Affairs Health Care Centers (VAHCS) from July 2019 to March 2024.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One hundred eighty-five Veteran men and women older than 18 years with at least a moderate AUD and current alcohol use.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Intervention and comparator&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Oral pioglitazone was given at dosages of 0 (placebo) (&lt;i&gt;n&lt;/i&gt; = 92), or 45 mg (&lt;i&gt;n&lt;/i&gt; = 93) over 14 weeks. All participants received Brief Behavioral Compliance Enhancement Treatment at each visit.&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;The primary outcome measure was the number of heavy drinking days during week 14 as measured by the Timeline Follow Back (TLFB). Secondary measurements included the number of standard drinks consumed per week, the rate of no heavy drinking days over the last 8 weeks of the study, alcohol craving, anxiety, depression and post-traumatic stress disorder symptoms. Exploratory outcome included change in alcohol use based on inflammation (C-reactive protein) at baseline.&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;There was no difference between groups on the primary outcome (pioglitazone mean = 2.43, placebo mean = 2.01, difference = 0.43, 95% confidence interval = −0.25 to 1.10, &lt;i&gt;P&lt;/i&gt; = 0.22). No differences were found between groups in secondary alcohol use measures or a measure of craving. Participants with elevated inflammation at baseline treated with pioglitazone had a greater decrease in heavy drinking days over time compared with placebo (z = 2.21, &lt;i&gt;P&lt;/i&gt; = 0.03). Pioglitazone was safe and well tolerated.&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;Piogli","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2661-2670"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215514","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":"Factors associated with the percentage of individuals who initiate and discontinue naltrexone as a relapse prevention pharmacotherapy in opioid use disorder: A systematic review, meta-analysis and meta-regression","authors":"Emmert Roberts,&nbsp;Elizabeth Sanderson,&nbsp;Thomas Santo Jr.,&nbsp;Matthew Hickman,&nbsp;Michael Farrell,&nbsp;Louisa Degenhardt","doi":"10.1111/add.70502","DOIUrl":"10.1111/add.70502","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;Naltrexone is a pharmacotherapeutic option for relapse prevention in opioid use disorder (OUD); however, studies highlight low rates of initiation and high rates of discontinuation as limiting its effectiveness. We aimed to (1) estimate the percentage of individuals with OUD who (having undergone withdrawal and wish to remain abstinent) initiate and discontinue naltrexone and (2) examine participant- and study-level factors that contribute to variation in initiation and discontinuation rates.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We undertook a systematic review, random-effects meta-analysis and meta-regression searching Medline, Embase, PsychINFO and CENTRAL from database inception to 19 February 2025 for studies of any design from any geographical region involving individuals with OUD eligible to receive naltrexone as a relapse prevention pharmacotherapy (i.e. those completing opioid withdrawal and wishing to remain abstinent). Measurements included the percentage of individuals who initiate or discontinue oral, long-acting injectable depot or implantable formulations of naltrexone at 1, 3 or 6 months. Certainty was assessed using the GRADE framework.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Twenty-two studies, including 124 016 individuals, reported initiation and 95 studies, including 16 969 individuals, reported discontinuation. The pooled percentage initiating oral naltrexone among those eligible was 60.3% [95% confidence interval (CI) = 38.9%–80.0%, 2014 participants, 15 studies] and depot was 18.2% (95% CI = 2.7%–42.5%, 57 383 participants, 4 studies). The pooled percentage discontinuing oral was 50.0% (95% CI = 41.9%–58.1%, 7340 participants, 34 studies) at 1 month, 61.3% (95% CI = 50.9%–71.2%, 2347 participants, 29 studies) at 3 months and 71.0% (95% CI = 57.3%–83.0%, 1889 participants, 19 studies) at 6 months. The pooled percentage discontinuing depot was 26.1% (95% CI = 19.5%–33.3%, 3589 participants, 33 studies) at 1 month, 46.7% (95% CI = 38.4%–55.1%, 3302 participants, 33 studies) at 3 months and 60.0% (95% CI = 43.2%–75.8%, 3071 participants, 22 studies) at 6 months. Statistically significantly higher percentages initiated oral naltrexone if it was the only offered pharmacotherapy (meta-regression coefficient 33.6%, 95% CI = 8.1%–59.2%, &lt;i&gt;P&lt;/i&gt; = 0.014) and statistically significantly lower percentages discontinued oral naltrexone at 3 and 6 months if administration was supervised (meta-regression coefficient −18.6%, 95% CI = −36.6% to −1.0%, &lt;i&gt;P&lt;/i&gt; = 0.043 and −27.3%, 95% CI = −50.1% to −4.4%, &lt;i&gt;P&lt;/i&gt; = 0.022, respectively). There was no clear evidence that study set","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2620-2632"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70502","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238666","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":"E-cigarette and cannabis use and co-use patterns and dependence trajectories among young adults in the United States","authors":"Pallav Pokhrel,&nbsp;Kristina T. Phillips,&nbsp;Michael M. Phillips,&nbsp;Crissy T. Kawamoto,&nbsp;Thaddeus A. Herzog","doi":"10.1111/add.70501","DOIUrl":"10.1111/add.70501","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;Co-use of cannabis and e-cigarettes for nicotine is increasing among younger adults in the United States (US). This study aimed to determine (1) the patterns of cannabis and e-cigarette use and co-use over time and (2) the trajectories of e-cigarette and cannabis dependence symptoms across latent classes representing different patterns of use and co-use.&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;Prospective cohort study, with data collected every six months at six time points.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Hawaii, USA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;&lt;i&gt;N&lt;/i&gt; = 1305 individuals [mean age = 25.0 (standard deviation = 2.2); 52% women], who reported past-30-day cannabis and/or e-cigarette use at any of the six data collection time points between March 2021 and February 2024.&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;For the repeated measures latent class analysis (RMLCA): past-30-day cannabis use, e-cigarette use and co-use (any past-30-day use of both cannabis and e-cigarettes for nicotine). RMLCA covariates: demographic variables and cigarette smoking. For the latent growth curve analyses: e-cigarette dependence [Penn State E-Cigarette Dependence Index (PSEDI), range: 0–20] and cannabis dependence symptoms [Cannabis Abuse Screening Test (CAST), range: 0–24].&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;Four latent classes were identified: individuals who, across time points, consistently showed (1) low probabilities (≤ 0.17) of using e-cigarettes or cannabis, including co-use (44% of the sample); and (2) high probabilities (&gt; 0.50) of primarily e-cigarettes-only use (18%); (3) primarily cannabis-only use (20%); and (4) primarily co-use (18%). For co-use class, the average trajectory for cannabis dependence remained flat [mean linear slope (LS) = 0.01 (standard error [SE] = 0.03), &lt;i&gt;P&lt;/i&gt; &gt; 0.05] whereas that for e-cigarette dependence increased over time [LS = 0.15 (0.03), &lt;i&gt;P&lt;/i&gt; &lt; 0.0001] before showing a slight decline [mean quadratic slope (QS) = −0.02 (0.007), &lt;i&gt;P&lt;/i&gt; &lt; 0.01]. For e-cigarette-only use class, e-cigarette dependence increased over time [LS = 0.91 (0.05), &lt;i&gt;P&lt;/i&gt; &lt; 0.0001], before showing a slight decline [QS = −0.02 (0.006), &lt;i&gt;P&lt;/i&gt; &lt; 0.0001]. The levels of e-cigarette dependence were higher for e-cigarette-only class than the co-use class across all time points. For cannabis-only class, the average trajectory of cannabis dependence s","PeriodicalId":109,"journal":{"name":"Addiction","volume":"121 10","pages":"2780-2793"},"PeriodicalIF":5.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325308","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}