Addiction最新文献

{"title":"Evaluating comparative effect of non-pharmacological interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analysis.","authors":"Bei Lv, Yu-Xin Zhang, Qing-Feng Tao, Li Lin, Xin-Yu Li, Bo-Zhu Chen, Hui Zheng","doi":"10.1111/add.70448","DOIUrl":"https://doi.org/10.1111/add.70448","url":null,"abstract":"<p><strong>Background and aims: </strong>Non-pharmacological therapies are critical for disease management, particularly when pharmacological approaches are limited. Investigating their role as adjuncts to pharmacotherapy to improve outcomes in opioid use disorder (OUD) is of substantial clinical importance. This study aimed to evaluate the efficacy of non-pharmacological therapies as adjuncts to opioid agonist therapy (OAT) management for OUD.</p><p><strong>Methods: </strong>We systematically searched PubMed, Cochrane Controlled Register of Trials, Embase and Web of Science from inception to 8 February 2025 for randomized controlled trials (RCTs) comparing OAT alone versus OAT combined with non-pharmacological interventions in OUD. Outcomes of interest included treatment retention [assessed via odds ratios (ORs)], negative urine test results (specimen and the longest duration of continuous drug abstinence) and opioid craving scores [both evaluated via standard mean differences (SMDs)]. Bayesian network meta-analysis (NMA) using a random-effects consistency model was conducted to compare the relative effects of all non-pharmacological interventions. Local inconsistency was evaluated through node-splitting analysis, and global inconsistency was assessed using the non-consistency model. The certainty of the evidence was assessed using the GRADE framework (Grading of Recommendations, Assessment, Development and Evaluation) for network meta-analysis.</p><p><strong>Results: </strong>Forty-two RCTs involving 5113 participants were included. For treatment retention, contingency management (CM) combined with OAT likely results in an increase [low-certainty evidence; OR = 1.64, 95% credible interval (CrI) = 1.03-2.57], while the combination of OAT with contingency management plus cognitive behavioral therapy (CBT + CM; very low-certainty evidence; OR = 2.47, 95% CrI = 1.10-5.67) or with enhanced methadone services (EMS; very low-certainty evidence; OR = 5.48, 95% CrI = 1.47-22.61) may result in an increase, compared with OAT alone. No intervention statistically significantly improved opioid-negative urine tests over OAT alone (very low certainty). For craving, acupuncture (very low certainty; SMD = -2.13, 95% CrI = - 3.09 to -1.15) and sham acupuncture (low certainty; SMD = -1.49, 95% CrI = - 2.69 to -0.31) combined with OAT may reduce craving scores.</p><p><strong>Conclusion: </strong>Contingency management, as adjunctive therapies for opioid agonist therapy (OAT), may improve treatment retention in patients with opioid use disorder compared with traditional OAT. Enhanced methadone services and contingency management plus cognitive behavioral therapy may improve treatment retention too but the evidence is very uncertain. Compared with OAT, sham acupuncture as an adjunct therapy may help reduce opioid cravings; acupuncture may reduce cravings too but evidence is very uncertain.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757567","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 psychometric properties of validated tools to assess cannabis use disorder: A systematic review and meta-analysis.","authors":"Janni Leung, Daniel Stjepanovic, Stephanie Fong, Dani Dawson, Giang Vu, Tesfa Yimer, Caitlin McClure-Thomas, Wayne Denis Hall, Gary Chung Kai Chan","doi":"10.1111/add.70438","DOIUrl":"https://doi.org/10.1111/add.70438","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To systematically review the evidence on the psychometric performance and accuracy of screening or diagnostic tools for cannabis use disorder.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Systematic review and meta-analysis which included studies conducted in clinical settings, schools, universities, community settings and population-based surveys in multiple countries and regions. Participants were adolescents, young adults, general adult populations, people who used cannabis, psychiatric and substance use treatment attendees, and specialised groups such as justice involved youth and military personnel. The tools assessed included The Cannabis Abuse Screening Test (CAST), the Cannabis Use Disorders Identification Test-Revised (CUDIT-R), the Severity of Dependence Scale (SDS), the Cannabis Problems Questionnaire (CPQ), the Cannabis Problems Questionnaire for Adolescents (CPQ-A), the Cannabis Use Problems Identification Test (CUPIT), the Tobacco, Alcohol, Prescription medication, and other Substance use tool (TAPS), the Marijuana Screening Inventory-X (MSI-X), the DSM-Guided Cannabis Screen, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), the Marijuana Problem Index (MAPI), the Toronto Cannabis Risk Screening Tool (TCRUST), the Nigerian Cannabis Use Disorder Scale, and the Problematic Use of Marijuana measure (PUM). These were assessed for internal consistency, test-retest reliability, as well as diagnostic accuracy using measures of sensitivity, specificity and area under the curve (AUC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty studies met inclusion criteria (2000-2025), including data from N = 23 175 participants. Methodological quality was generally moderate to high, though some studies relied on self-reported symptom checklists rather than structured diagnostic interviews. The most frequently studied tools were the CAST (k = 13 studies), CUDIT-R (k = 8), SDS (k = 5), CPQ and CPQ-A (k = 4), and CUPIT (k = 2). Across instruments, internal consistency was generally acceptable to excellent (α = 0.66-0.92), with fair to excellent discriminative validity (AUC = 0.71-0.96) for detecting cannabis use disorder or dependence. Optimal cut-offs varied statistically significantly by population and setting. In clinical samples, the tools generally performed stronger with the use of standard or higher cut-offs to prioritize specificity and avoid misclassifying non-cases. In general population samples, particularly youth, the tools had better performance with lower cut-offs to prioritize sensitivity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There is a lack of sufficient studies on screening or diagnostic tools for cannabis use disorder for clear evidence. Based on this limited current evidence, several brief screening or diagnostic tools are useful in identifying disorder or problem cannabis use in diverse settings, including the CAST, CUDIT-R, and SDS. Variation in optimal thresholds by age, clinical status and cultural context s","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757942","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":"Nation-wide trends in prevalence and mortality of high-risk drinking among adult men with and without disabilities in South Korea between 2009 and 2017.","authors":"Bo Hui Park, So Young Kim, Kyoung Eun Yeob, Yeon Yong Kim, Jong Hyock Park","doi":"10.1111/add.70423","DOIUrl":"https://doi.org/10.1111/add.70423","url":null,"abstract":"<p><strong>Background and aims: </strong>Excessive alcohol consumption contributes substantially to the global burden of disease, yet population-level evidence on disparities in high-risk drinking among people with disabilities remains limited. We aimed to estimate and compare trends in the prevalence of high-risk drinking and all-cause mortality associated with drinking behavior among men with disabilities and those without disabilities.</p><p><strong>Design: </strong>Nation-wide serial cross-sectional study.</p><p><strong>Setting: </strong>South Korea, using linked administrative national health check-up and mortality databases.</p><p><strong>Participants: </strong>A total of 7 551 340 adult men who participated in the National Health Insurance Service health check-up program in 2017, including 450 536 men with registered disabilities and 7 100 804 men without disabilities.</p><p><strong>Measurements: </strong>High-risk drinking was defined as consumption of seven or more standard drinks per occasion at least twice per week, based on self-reported health check-up questionnaires. Age-standardized prevalence of high-risk drinking was estimated annually from 2009 to 2017. Associations between disability characteristics and high-risk drinking were estimated using multivariable logistic regression in 2017. All-cause mortality occurring within 2017 was ascertained through deterministic linkage to the national death registry using unique personal identifiers.</p><p><strong>Findings: </strong>In 2017, age-standardized prevalence of high-risk drinking was 17 141 per 100 000 among men with disabilities and 23 226 per 100 000 among men without disabilities. Among men aged 20-49 years, prevalence was 29 710 per 100 000 in those with mild disabilities and 26 332 per 100 000 in those without disabilities. In 2017, compared with men without disabilities, mild disability was associated with higher odds of high-risk drinking [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 1.11-1.13], whereas brain injury was associated with lower odds (aOR = 0.61, 95% CI = 0.58-0.65). In 2017, age-standardized mortality rates were 131.4 per 100 000 among non-drinkers, 99.2 among high-risk drinkers, 77.3 among moderate drinkers and 59.9 among low-risk drinkers. Across drinking categories, several disability groups had adjusted odds ratios greater than 1.0 for all-cause mortality compared with those for men without disabilities within the same drinking category.</p><p><strong>Conclusion: </strong>High-risk drinking prevalence among South Korean men was lower among those with disabilities than among those without disabilities from 2009 to 2017, with declining trends in both groups. High-risk drinking prevalence among South Korean men appears to differ by disability characteristics. Mortality odds ratios within drinking categories vary by disability type and severity when compared with men without disabilities in the same drinking category.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757948","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":"Substance-related intrusive memories in cocaine use disorder are different from but associated with craving.","authors":"Amelie Zacher, Lina Dietiker, Victoria Häffner, Francesco Bavato, Birgit Kleim, Boris B Quednow","doi":"10.1111/add.70449","DOIUrl":"https://doi.org/10.1111/add.70449","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and aims: &lt;/strong&gt;Cocaine use disorder (CUD) is a significant global health concern, characterized by persistent craving despite severe consequences. Recent theories highlight maladaptive memory processes - such as intrusive, vivid recollections of past substance use that arise spontaneously in daily life - as key contributors to craving and relapse; however, empirical studies examining such substance-related intrusions in naturalistic contexts remain scarce. This study therefore used ecological momentary assessment (EMA) to investigate the frequency, phenomenology and emotional and behavioural correlates of substance-related memory intrusions in individuals with CUD, and how these relate to craving, cocaine use severity (CUS) and psychotherapy experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A 14-day EMA study captured event-based reports of intrusions, craving and related experiences in participants diagnosed with CUD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was conducted in Switzerland in a naturalistic setting, with data collected via individuals' smartphones.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;N = 43 participants (recruited in Switzerland, 16% female; 18-59 years old, median compliance rate 82.8%) with a current DSM-5 diagnosis of CUD made a total of n = 360 event-based reports that were analysed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;EMA reports included intrusion episode types (pure intrusions, intrusions with subsequent or simultaneous craving or pure craving), intrusion characteristics (vividness, intrusiveness, modalities), craving intensity, episode triggers and cognitive-behavioural, emotional and physiological responses. CUS was assessed based on use quantity, duration and obsessive-compulsive use symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Participants recorded an average of 8.4 episodes (standard deviation = 5.8) across 14 days. Intrusions frequently occurred independently of craving (42.4%) but were statistically significantly associated with greater craving intensity when more vivid (unstandardized regression coefficient b = 0.53, P = 0.002) and intrusive (b = 0.48, P &lt; 0.001). Episodes involving craving were characterized by greater distress (b = 1.52-2.17, all P &lt; 0.001) and greater loss of control (b = 2.41-3.22, all P &lt; 0.001) and were associated with higher odds of reporting obtaining cocaine (odds ratio = 19.90, P &lt; 0.001). Higher CUS predicted more frequent intrusion episodes (unstandardized regression coefficient β = 0.52, P &lt; 0.001), while psychotherapy experience was associated with lower vividness (b = -1.45, P = 0.008), intrusiveness (b = -1.33, P = 0.004) and craving intensity (b = -1.56, P = 0.010).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Substance-related memory intrusions in people with cocaine use disorder are distinct cognitive-affective events that often occur independently of craving but are closely linked to its intensity, particularly when experienced as vivid and emotionally charged. Targetin","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757906","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":"High temporal resolution monitoring of illicit drug consumption across England via wastewater analysis.","authors":"Helena Rapp-Wright, Keng Tiong Ng, Derryn Grant, William Francis, Margarita White, Dimitris Evangelopoulos, Yuxing Liu, Konstantina Dimakopoulou, Sofia Zafeiratou, Dylan Wood, Chryshanthi Christy, Stav Friedman, Timothy W Gant, Klea Katsouyanni, Leon P Barron","doi":"10.1111/add.70398","DOIUrl":"https://doi.org/10.1111/add.70398","url":null,"abstract":"<p><strong>Aim: </strong>To monitor community-level consumption of 20 illicit drugs across urban areas of England using wastewater-based epidemiology (WBE) surveillance at high temporal resolution.</p><p><strong>Design, setting, cases: </strong>This study was conducted over a 12-month period in 2022 sampling 24-hour composite wastewater samples at 15 wastewater treatment plants (WWTPs) covering catchment population equivalents ranging from ~100 000 to >1 million. Analysis was conducted using rapid liquid chromatography-tandem mass spectrometry methods. The sampled WWTPs collectively covered 21% of the national population.</p><p><strong>Measurements: </strong>Primary data outcomes were the population-normalised daily loads (PNLs) entering the WWTP, estimated population-normalised consumption (both in mg/1000 people/day) and total mass (g/day) of 20 targeted illicit drugs and total mass in each catchment, quantified using suitable drug target residue markers in 1746 wastewater samples. Covariables included temporal indicators (e.g. public holidays, events) and regional factors. Presence, quantity and correlation of WBE-derived drug use data were used to infer drug use patterns.</p><p><strong>Findings: </strong>Of the 20 illicit drugs investigated, 18 were detected in at least one sample. Cocaine exhibited the highest average daily PNL (2770 ± 829 mg/1000 people/day), followed by heroin (382 ± 248), ketamine (287 ± 183), amphetamine (272 ± 268), 3,4-methylenedioxymethamphetamine (MDMA) (80 ± 57) and methamphetamine (60 ± 99) across 2022. When comparing PNLs to Sewage analysis CORe group-Europe (SCORE) and European Drugs Agency WBE data for 109 other WWTPs across Europe from March to May, 2022 cocaine and ketamine PNLs from sites in England were ranked statistically higher [cocaine: Wilcoxon rank-sum test statistic (W) = 971, adjusted P = 0.000115; ketamine: W = 264, adjusted P = 0.0000389]. Importantly, seven English WWTPs recorded higher mean ketamine PNLs than any other European site over the same period in 2022. Temporal spikes in drug consumption aligned with public holidays and major events. A notable decrease in cocaine use coincided with a 3.7-t UK seizure. Strong inter-drug correlations were observed across catchments, particularly for benzoylecgonine/ketamine and benzoylecgonine/cocaethylene. Extrapolation to generate a representative national average consumption estimate is not recommended, as the WWTPs studied were mostly classified as urban areas and found not to be representative of the entire population of England.</p><p><strong>Conclusions: </strong>Wastewater analysis revealed widespread and temporally variable illicit drug use across England in 2022, with ketamine use exceeding European levels at multiple sites. The findings highlight wastewater-based epidemiology's capacity to monitor drug use trends and identify community-level impacts of interventions and events.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757736","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":"Characterizing public comments via Regulations.gov in response to proposed cannabis rescheduling in the United States.","authors":"Vijay M Tiyyala, Cerina Dubois, Clarissa Madar, Ryan Vandrey, Johannes Thrul, Mark Dredze, John W Ayers","doi":"10.1111/add.70410","DOIUrl":"https://doi.org/10.1111/add.70410","url":null,"abstract":"<p><strong>Aims: </strong>The United States Drug Enforcement Administration's (DEA) proposed rescheduling of cannabis from Schedule I to Schedule III under the Controlled Substances Act marks a significant shift in federal policy. Understanding public sentiment toward this policy is critical for guiding the current cannabis rescheduling effort as well as future reforms. The objective of this study is to characterize public comments submitted to Regulations.gov regarding the DEA's cannabis rescheduling proposal and identify underlying justifications for support or opposition.</p><p><strong>Design: </strong>A mixed-methods analysis was conducted.</p><p><strong>Setting: </strong>Online public comments submitted to Regulations.gov regarding the DEA's cannabis rescheduling proposal.</p><p><strong>Participants: </strong>42 913 public comments submitted between 21 May and 22 July 2024.</p><p><strong>Measurements: </strong>Comments were analyzed for sentiment towards the proposed rescheduling (support, oppose or insufficient rescheduling) and thematic justifications using manual and automated natural language processing techniques. A two-stage annotation approach was employed: manual coding of 200 randomly sampled comments by multiple independent evaluators, followed by automated classification of all 42 913 comments using open source Large Language Model (LLM) validated against the manual annotations.</p><p><strong>Findings: </strong>Using LLM-based classification validated against human annotations [88% agreement, F1 (harmonic mean of precision and recall) = 0.86], we found that among 42 913 comments, 28.85% [95% confidence interval (CI) = 28.44%-29.24%] supported rescheduling, 6.74% (95% CI = 6.50%-6.99%) opposed and 63.50% (95% CI = 63.06%-63.99%) deemed the proposal insufficient, favoring further rescheduling or complete de-scheduling of cannabis. Among the 200 manually annotated comments, therapeutic benefits (56.7%, 95% CI = 46.7%-66.7%) and economic impacts (27.8%, 95% CI = 18.9%-37.8%) were the most common justifications among supporters. Public health risks (100.0%, 95% CI = 100.0%-100.0%), addictiveness concerns (71.4%, 95% CI = 42.9%-100.0%) and concerns about underage use (57.1%, 95% CI = 14.3%-85.7%) were predominant in opposing comments. Insufficient rescheduling comments cited therapeutic benefits (37.8%, 95% CI = 28.5%-48.0%), economic impacts (28.6%, 95% CI = 19.4%-37.8%) and criminal justice reform (26.5%, 95% CI = 18.4%-35.7%) as primary justifications.</p><p><strong>Conclusions: </strong>Public sentiment on Regulations.gov supports the United States Drug Enforcement Administration's proposal for cannabis rescheduling, though the majority views the proposed Schedule III classification as inadequate and supports further rescheduling or complete de-scheduling of cannabis.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757560","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":"'Emptiness filled with love': A reflexive thematic analysis of chemsex trajectories among gay, bisexual and other men who have sex with men in Almaty, Kazakhstan, using a life course framework.","authors":"Nikolay Lunchenkov, Nadezhda Cherchenko, Elena German, Susanna Rinne-Wolf","doi":"10.1111/add.70454","DOIUrl":"https://doi.org/10.1111/add.70454","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and aims: &lt;/strong&gt;The intentional use of psychoactive substances to enhance sexual experiences, known as chemsex, is associated with human immunodeficiency virus (HIV) transmission, psychological distress and social isolation among gay, bisexual and other men who have sex with men (GBMSM). While research has predominantly focused on high-income countries, gaps remain in our understanding of the dynamics in Eastern Europe and Central Asia, where structural homophobia, restrictive drug policies and limited healthcare access uniquely shape chemsex-related risks. There is limited research on how chemsex engagement evolves over time. This study aimed to identify the stages of chemsex engagement and examine how social, psychological and structural factors shape transitions between these stages among GBMSM in Kazakhstan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study is a secondary analysis of data from a cross-sectional qualitative study conducted in Almaty, Kazakhstan, between July and September 2023. Twenty-one GBMSM who had engaged in chemsex within the past 12 months participated in semi-structured interviews lasting between 60 and 90 minutes. All participants reported using mephedrone and/or alpha-PHP (α-Pyrrolidinohexiophenone). Deductive reflexive thematic analysis, guided by Life Course Theory, was used to reconstruct chemsex trajectories from retrospective participant accounts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five distinct themes related to different trajectory stages were developed. Initiation occurred through trusted social networks in intimate settings, taking the form of unplanned encounters that fulfilled emotional needs for connection and belonging. Maintenance was characterised by self-imposed temporal and dosage limits; however, participants reported a decline in satisfaction with sober sex. Escalation involved a breakdown of protective boundaries, an increased frequency and quantity of use and a deeper involvement in chemsex social networks, despite mounting physical and psychological consequences. Dependence was characterised by a narrowed agency under escalating constraints, with substance use shifting from enhancing pleasure to coping with withdrawal, resulting in substantial impairment across life domains. Disengagement attempts described recursive trajectories with diverse recovery goals ranging from cessation to managed use. Sustained abstinence was rare and dependent on affirming care and supportive resources. Throughout all stages, structural stigma constrained individual agency, while chemsex networks provided crucial emotional safety that was unavailable in mainstream environments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Chemsex trajectories among gay, bisexual and other men who have sex with men in Kazakhstan represent dynamic processes shaped by the interaction between individual agency and structural constraints, in which substance use functions as an emotional regulation strategy and a social survival stra","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757608","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":"Drug sellers' use of a drug checking service amid the overdose crisis in British Columbia, Canada.","authors":"Pablo Gonzalez-Nieto, Bruce Wallace, Collin Kielty, Irene Shkolnikov, Ava Margolese, Jaime Arredondo Sanchez Lira, Chris Gill, Dennis Hore","doi":"10.1111/add.70429","DOIUrl":"https://doi.org/10.1111/add.70429","url":null,"abstract":"<p><strong>Aims: </strong>This study examined the use of a drug checking service by drug sellers in British Columbia, Canada, to assess motivations for service use and substances intended for distribution, focusing on risks associated with an unstable illicit drug market.</p><p><strong>Design: </strong>A retrospective analysis was conducted using data from an anonymous intake survey and drug checking results. The survey captured frequency of service use, expected substances and reasons for service access.</p><p><strong>Setting: </strong>The study was set in Victoria, British Columbia, where participants accessed a free confidential drug checking service between January 2021 and December 2024.</p><p><strong>Participants: </strong>A total of 2332 drug sellers were included in the analysis, accounting for 16.2% of all service users. They submitted 5528 samples (21.6% of total samples), averaging 2.4 samples per visit, compared to 1.7 among non-sellers.</p><p><strong>Measurements: </strong>The primary outcomes measured included the frequency of drug check use, the expected and actual composition of the samples, pre- or post-consumption analysis and the reasons for engaging with the service. Secondary outcomes focused on the reported potency and the presence of unexpected substances.</p><p><strong>Findings: </strong>A statistically significant portion of sellers continuously used the service, particularly for opioid samples, which comprised 69.2% of seller submissions compared with 35.1% among non-sellers [X² (1, n = 20 864) = 2055.57, P < 0.001]. Sellers reported using the service to mitigate risks associated with the illicit drug market, including overdose, showing a proactive interest in ensuring the safety of their customers. Despite greater confidence in the composition of their products, sellers were less likely than non-sellers to have their samples confirmed as \"expected\" [38.4% vs. 51.9%; X² (1, n = 12 520) = 313.76, P < 0.001]; unexpected substances were detected in 44.8% of their samples. Notably, protective strategies employed by sellers were identified, demonstrating the role of drug checking as a supply-focused harm reduction intervention.</p><p><strong>Conclusions: </strong>In Victoria, British Columbia, drug sellers appear to be increasingly using drug checking services as a preventive measure, positioning them as potential partners in harm reduction efforts.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757586","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":"Profiles of youth initiating use of nicotine pouches, vapes and cigarettes: National findings from the Population Assessment of Tobacco and Health (PATH) study, 2022-2023.","authors":"Olufemi Erinoso, Karin Kasza","doi":"10.1111/add.70436","DOIUrl":"https://doi.org/10.1111/add.70436","url":null,"abstract":"<p><strong>Background and aims: </strong>Nicotine pouches have risen in appeal and use among United States (U.S.) youth and young adults. However, less is known about the initiation determinants of pouch use, and how they compare with those of e-cigarettes or cigarettes. This study compared the demographic, behavioral, and exposure profiles of adolescents and young adults (AYAs) who initiated nicotine pouch-use with those who initiated nicotine vaping and those who initiated smoking in a nationally representative U.S.</p><p><strong>Cohort: </strong></p><p><strong>Design and settings: </strong>We used a longitudinal study design. The study setting was the United States (US) with data from the Population Assessment of Tobacco and Health (PATH) Study (Waves 7 and 7.5, 2022-2023).</p><p><strong>Participants: </strong>AYAs aged 12-22 (n = 14 326).</p><p><strong>Measurements: </strong>The primary outcomes at follow-up were initiation of nicotine pouches (never use [2022] to ever use [2023]), vaping, and cigarette smoking. Study predictors at baseline (2022) included demographics, substance and tobacco use, mental health, and social and behavioral exposures. As a secondary objective, susceptibility to vape or smoke at baseline was examined as a predictor of pouch initiation. Separate multi-variable logistic regression models assessed factors associated with the initiation of each product.</p><p><strong>Findings: </strong>The study population comprised 50.6% males, and 45.4% were between the ages 18-22 years, 15-17 years (21.2%), and 12-14 years (33.4%). In 2023, initiation rates were 2.4% for pouch use, 6.2% for vaping, and 3.2% for smoking. Current smoking at baseline was associated with initiating pouch use (adjusted odds ratio [AOR] = 2.8, 95% confidence interval [95% CI]: 1.7-4.4) and initiating vaping (AOR = 5.3, 95% CI: 2.0-13.7) at follow-up. Current vaping was associated with higher odds of pouch initiation (AOR = 7.9, 95% CI: 5.1-12.4), but current pouch use was not associated with vaping initiation (AOR = 2.4, 95% CI: 0.3-16.2) at follow-up. Having important peers who use pouches (vs. none) was associated with pouch initiation (AOR = 2.2, 95% CI: 1.2-4.3), similarly for vaping but not for smoking at follow-up. Among pouch initiators (n = 335), most vaped nicotine at follow-up (37.9%), 19.7% vaped nicotine and smoked, and 5.2% smoked cigarettes and did not vape.</p><p><strong>Conclusions: </strong>Cigarette smoking appears to be associated with both nicotine pouch initiation and vaping initiation among United States adolescents and young adults. Current vaping appears to be associated with pouch initiation, but current pouch use does not appear to be associated with vaping initiation. Important peers using pouches appear to be associated with pouch initiation and vaping initiation but not cigarette smoking. Most pouch initiators in this study concurrently vaped at one-year follow-up.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757877","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":"Working with, learning from and giving back: Principles for collaborative research with people who use drugs.","authors":"Magdalena Harris","doi":"10.1111/add.70434","DOIUrl":"https://doi.org/10.1111/add.70434","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757923","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}