Addiction最新文献

{"title":"‘Deaths of despair’: A term that needs to be retired","authors":"Shane Darke, Michael Farrell, Wayne Hall, Julia Lappin","doi":"10.1111/add.70030","DOIUrl":"10.1111/add.70030","url":null,"abstract":"<p>The term ‘deaths of despair’ gained a great deal of currency as shorthand for three causes of death—drug overdoses, suicides and alcohol-related liver disease [<span>1</span>]. In 2015, Case and Deaton [<span>1</span>] noted that life expectancy in the United State declined between 1999 and 2013 and that this was attributable to large increases in deaths from these three causes. These collectively came to be described as ‘deaths attributable to despair’ [<span>1, 2</span>]. As they later noted, what began as a descriptive tag resonated with the media and captured the interest of many researchers [<span>2</span>]. We believe that the term is well intentioned but mistaken in theory, of doubtful validity, and misleading in its implications for policies likely to reduce premature death.</p><p>The term ‘deaths of despair’ collates deaths caused by substance poisoning, suicide and alcohol-related disease to form a distinct epidemiological phenomenon driven by cumulative economic disadvantage [<span>1, 2</span>]. Socio-economic factors such as high unemployment and a loss of traditional social structures are argued to be responsible for a high level of societal despair. This despair is proposed to be the common factor driving substance poisoning, suicide and alcohol-related disease. Since its postulation in the United States, the terminology has been used across a range of other jurisdictions including Eastern Europe, the United Kingdom and Canada [<span>3-5</span>].</p><p>There are undoubtedly commonalities between events such as overdose, suicide and harmful alcohol use, which include social deprivation and trauma, and the term does serve to highlight such deprivation. A simple interpretation of the term that suggests a common entity and a central causal role for despair, however, does not capture the complexity of these phenomena. Let us first consider substance use and overdose. There is little evidence that despair is the primary driver of the initiation of substance use, its continuation, dependent use or overdose. Certainly, self-medication plays a role in problematic substance use, but the initiation of drug use involves a complex range of factors. Foremost in the United States was a massive increase in the prescribing and promotion of opioids in the 1990s [<span>6</span>]. Individual risks play important roles, and include impulsivity, attitudes and one's social network [<span>7</span>]. Once use has commenced, dependence becomes its own driver of continued use, involving a range of psychological, behavioural, social and physiological signs and symptoms [<span>8</span>]. For drugs such as the opioids or hypnosedatives, tolerance and withdrawal are powerful motivators for continued use [<span>8</span>]. There are a range of well-established risk factors for overdose including a history of overdose, dependence, higher drug purity/doses, the concomitant consumption of other drugs, reinstatement after a period of abstinence and injection as a ro","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1072-1074"},"PeriodicalIF":5.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497733","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":"National profile on substance use, substance use-related problems and policy: The case of Chile.","authors":"Alvaro Castillo-Carniglia","doi":"10.1111/add.70031","DOIUrl":"https://doi.org/10.1111/add.70031","url":null,"abstract":"<p><strong>Aim: </strong>To provide a comprehensive overview of substance use, related problems, and policy responses in Chile, highlighting epidemiological trends, institutional contexts, and research findings.</p><p><strong>Methods: </strong>Narrative review of policy documents, published government and academic research, and primary analysis of national drug surveys and administrative data. It estimates trends in substance use prevalence, analyzes the regulatory landscape for tobacco, alcohol, and other drugs, and syntheses the current state of substance use research in Chile.</p><p><strong>Results: </strong>Chile exhibits a high prevalence of substance use, particularly for alcohol and cannabis, compared with other South American countries. Tobacco use has declined since the early 2000s, while alcohol use has remained stable. Cannabis use increased significantly between 2010 and 2016, reaching the highest prevalence in Latin America, but has since declined. While opioids and injecting substances are rare, alcohol and cocaine base paste are responsible for the largest health burden, representing 70% of all publicly funded treatments. Chile has approved and implemented various policy measures, including restrictions on alcohol sales and advertising, smoke-free legislation, and reforms to drug laws that include home cultivation of cannabis for medical purposes. Research on substance use in Chile has increased in recent years, with only a few studies focusing specifically on policy evaluation.</p><p><strong>Conclusion: </strong>Although Chile has made progress in implementing evidence-based substance use policies and expanding treatment services, substantial policy evaluation and enforcement gaps remain.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497734","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 association between buprenorphine doses above 16 milligrams and treatment retention in a multi-payer national sample in the United States, 2014 to 2021","authors":"Erin J. Stringfellow,&nbsp;Huiru Dong,&nbsp;Seyedeh Nazanin Khatami,&nbsp;Hannah Lee,&nbsp;Mohammad S. Jalali","doi":"10.1111/add.70002","DOIUrl":"10.1111/add.70002","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;Buprenorphine-naloxone reduces overdose deaths in people with opioid use disorder (OUD). Treatment retention increases with higher daily doses. No national studies exist on retention's association with 24, 32 and 40 mg. This study aimed to: (1) estimate the effect on treatment retention of buprenorphine-naloxone doses between 4 and 40 mg compared with 16; and (2) compare the effect on treatment retention of 24, 32 and 40 mg doses.&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;Observational cohort study in a national, multi-payer sample of prescription claims (IQVIA) of episodes involving buprenorphine-naloxone for OUD. Incident episodes started between 1 January 2014 and 31 March 2020, with a washout of 180 days. New episodes started with a 14+ day gap between prescriptions.&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;United States of America.&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;The sample involved 620 229 episodes across 498 879 patients [42.3% female; mean age 37.9 (standard deviaion: 11.9)] who were dispensed prescriptions of buprenorphine-naloxone for OUD.&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 exposure was the maximum daily dose of buprenorphine-naloxone reached in the first 30 days of an episode, ranging from 4 to 40 mg. The outcome, treatment retention, was defined as having an active prescription at 1, 3, 6, 12, or 18 months. Covariates were age, sex, race and ethnicity, primary payer, and year of episode initiation.&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;Daily doses of 24, 32 and 40 mg increased retention compared with 16 mg at 1–18 months [adjusted odds ratio (aOR) range = 1.17; 95% confidence interval (CI) = 1.14, 1.20 at 18 months to 1.52 (CI = 1.49, 1.54) at 1 month, both for 24 mg]. In pairwise comparisons, 32 mg was favorable to 24 mg at 6, 12 and 18 months [aOR = 1.06 (95% CI = 1.02, 1.10) at 6 months; aOR = 1.09 (95% CI = 1.04, 1.14) at 12 months; aOR = 1.12 (95% CI = 1.06, 1.19) at 18 months], and 40 mg was favorable to 24 mg at 12 and 18 months [aOR = 1.10 (95% CI = 1.01, 1.21) at 12 months; aOR = 1.18 (95% CI = 1.06, 1.30) at 18 months].&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;Daily buprenorphine-naloxone doses of 24 mg appear to be associated with increased treatment retention compared with 16 mg and, for 6+ month episodes, 32 and 40 mg appear to be associated with increased","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1198-1206"},"PeriodicalIF":5.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490188","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":"Outcomes of an organisational change program aimed at increasing smoking cessation support within Australian community managed mental health organisations: A cluster randomised controlled trial","authors":"Laura Twyman,&nbsp;Scott Walsberger,&nbsp;Amanda L. Baker,&nbsp;Sima Ahmadi,&nbsp;Christopher Oldmeadow,&nbsp;Marianne Weber,&nbsp;Sharon Lawn,&nbsp;Marita Hefler,&nbsp;Jennifer Bowman,&nbsp;Philippa Boss,&nbsp;Karina Ko,&nbsp;Alexandra Scott,&nbsp;Brigitte Fienberg,&nbsp;Christina Watts,&nbsp;Alecia Brooks,&nbsp;Rebecca Ireland,&nbsp;Billie Bonevski","doi":"10.1111/add.16733","DOIUrl":"10.1111/add.16733","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To test the effectiveness of an organisational change intervention aimed at increasing the offer of nicotine replacement therapy (NRT) in community managed mental health organisations.&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 pragmatic cluster randomised controlled trial with cluster as the unit of randomisation and six- and nine-month follow-up from baseline.&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;Twelve clusters comprising 26 sites providing community based, psychosocial support to people with severe mental illness in New South Wales, Australia, were randomised to control (&lt;i&gt;n&lt;/i&gt; = 13 sites, &lt;i&gt;n&lt;/i&gt; = 118 consumers) or intervention (&lt;i&gt;n&lt;/i&gt; = 13 sites, &lt;i&gt;n&lt;/i&gt; = 139 consumers) arms between 2018 and 2019.&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;Eligible consumers (aged 16 years and older; self-reported daily or occasional cigarette use) completed surveys at baseline (&lt;i&gt;n&lt;/i&gt; = 257) and at six- (&lt;i&gt;n&lt;/i&gt; = 162, 63%) and nine-month follow-up (&lt;i&gt;n&lt;/i&gt; = 144, 56%).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Intervention&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The intervention included a financial grant, face-to-face and on-line training and proactive monthly support to guide implementation. The active control condition included on-line training and generic, scheduled support via email.&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 was whether consumers reported receiving an offer of NRT at nine-month follow-up. Secondary outcomes at the consumer, staff and organisational level were also measured.&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;Consumers in the intervention group had statistically significantly higher odds of being offered NRT at nine-month follow-up compared with control (intention to treat missing = no offer: 38% versus 7%, odds ratio 5.72, 95% confidence interval = 2.2, 14.9). There were no statistically significant differences in seven-day point prevalence or continuous abstinence at six- or nine-month follow-ups.&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;An organisational change-based program led to an increase in the offer of nicotine replacement therapy (NRT) nine months after program initiation in community managed mental health organisations, compared with active control. There was evidence of greater NRT use in the intervention condition at","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 5","pages":"937-950"},"PeriodicalIF":5.2,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481645","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":"Deficits in general and smoking-specific response inhibition in the Go/No-Go task in individuals who smoke: A cross-sectional analysis.","authors":"Franziska Motka, Simone Kühn, Charlotte E Wittekind","doi":"10.1111/add.70003","DOIUrl":"https://doi.org/10.1111/add.70003","url":null,"abstract":"<p><strong>Background and aims: </strong>Previous studies on response inhibition deficits in smoking have often been conducted in small, young, age-homogeneous samples, without controlling for covariates or testing moderating effects. The primary research question compared response inhibition between a large, age-diverse smoking sample and non-smoking controls, and examined whether deficits were exacerbated toward smoking-related stimuli. By accounting for key covariates and moderators, this study aimed to extend understanding of individual differences in response inhibition deficits in smoking.</p><p><strong>Design and setting: </strong>Cross-sectional study conducted at a university laboratory in Munich, Germany.</p><p><strong>Participants: </strong>The large (n = 122, 57% female), age-diverse (M_age = 41.4, range: 21-70 years) smoking group comprised individuals with moderate to severe tobacco dependence participating in a smoking reduction intervention study. Controls comprised n = 69 healthy individuals with no smoking history.</p><p><strong>Measurements: </strong>Primary outcomes were commission error (CE) rates and mean reaction times in Go trials (Go-RT) in general and smoking-specific Go/No-Go tasks (GNGTs). Covariates included age, sex and IQ. Smoking-related variables were cigarettes per day (CPD), tobacco dependence severity and craving.</p><p><strong>Findings: </strong>General GNGT: The smoking group exhibited significantly higher CE rates (P-value < 0.001, medium effect, BF₁₀ = 9.06) than the control group. Higher craving was associated with faster Go-RTs (β = -1.487, P-value = 0.041). Smoking-specific GNGT: CE rates were significantly higher in the smoking group only when controlling for covariates (β = 1.272, P-value = 0.040). Higher craving was associated with higher CE rates during smoking-related trials (β = 0.108, P-value = 0.010). The smoking group showed significantly faster Go-RTs in response to smoking-related compared with neutral stimuli, relative to the control group (β = -3.326, P-value = 0.027). Preliminary evidence indicated that greater deficits were associated with higher scores in smoking-related variables, but only in older individuals.</p><p><strong>Conclusions: </strong>Individuals who smoke appear to exhibit response inhibition deficits, although these are not uniform and seem to be exacerbated during higher reported craving or in response to smoking-related stimuli. Age may moderate the relationship between deficits and smoking-related variables.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447485","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":"Efficacy of cannabidiol alone or in combination with Δ-9-tetrahydrocannabinol for the management of substance use disorders: An umbrella review of the evidence","authors":"Bertrand Redonnet,&nbsp;Filiz Eren,&nbsp;Guillaume Avenin,&nbsp;Maria Melchior,&nbsp;Murielle Mary-Krause","doi":"10.1111/add.16745","DOIUrl":"10.1111/add.16745","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Substance use disorders (SUD) lead to a high burden of disease, yet treatment options are limited. Cannabidiol (CBD) is being investigated as a potential therapeutic target due to its pharmacological properties and mode of action in the endocannabinoid system. Recent systematic reviews (SR) on CBD and SUDs have shown inconsistent results. The objective of this umbrella review was to determine whether CBD alone or in combination with Δ-9-tetrahydrocannabinol (THC) is effective for managing and treating SUDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following a registered protocol, we searched PubMed, Web of Science and Epistemonikos databases for SRs, with or without a meta-analysis, of randomized controlled trials focusing on interventions dispensing CBD, alone or in combination with THC, to treat SUDs, published from 1 January 2000 to 15 October 2024. Screening, data extraction and quality assessment with the AMSTAR 2 tool were performed by two researchers in parallel and duplicated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>22 SRs were included, 5 of which performed a meta-analysis. We found mixed evidence regarding the efficacy of CBD to manage and treat SUDs. Findings were interpreted in light of the quality of the SRs. Nabiximols, which contains CBD and THC, demonstrated positive effects on cannabis withdrawal and craving symptoms. Evidence supporting the efficacy of CBD is limited and inconclusive for abstinence, reduction or cessation of use of cannabis, tobacco, alcohol, opiates and other psychoactive substances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cannabidiol (CBD) monotherapy does not appear to be efficacious for treatment of substance use disorders. CBD primarily exhibits effects on cannabis withdrawal and craving when combined with Δ-9-tetrahydrocannabinol (THC). Existing data on the efficacy of CBD alone with regard to other outcomes related to substance use disorders are limited.</p>\u0000 </section>\u0000 </div>","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 5","pages":"813-834"},"PeriodicalIF":5.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.16745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes to our Editorial Team","authors":"","doi":"10.1111/add.70025","DOIUrl":"https://doi.org/10.1111/add.70025","url":null,"abstract":"","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 4","pages":"572"},"PeriodicalIF":5.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143612399","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 BMI is a specific risk factor for drug-related mortality in patients receiving methadone: A case control study.","authors":"Thikra Algahtani, Tom Le Ruez, John Strang, David Morgan, Martin Smith, Caroline S Copeland","doi":"10.1111/add.70015","DOIUrl":"https://doi.org/10.1111/add.70015","url":null,"abstract":"<p><strong>Background and aims: </strong>Long-term treatment of opioid dependence with the opioid agonist therapy (OAT) methadone can lead to significant weight gain. This study investigated whether OAT patients with a body mass index (BMI) deemed overweight (≥25) are at increased risk of mortality.</p><p><strong>Methods: </strong>A retrospective case-control study was performed with anonymised data collected from living and deceased persons registered as receiving OAT from Derbyshire or Teesside drug and alcohol services in the United Kingdom. Height, weight, age, gender, OAT type and dose, smoking status and postcode of usual address were collected. Cause of death was collected from deceased individuals. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated using regression models.</p><p><strong>Results: </strong>Data were collected for 1574 living and 233 deceased individuals. Mean BMI of all individuals (25.75 ± 6.56) was above the threshold considered a healthy weight, and was higher in deceased (26.63 ± 7.87) than living individuals (25.61 ± 6.34; P < 0.05). A BMI of 30 corresponded to an average 7.7% increased risk of mortality, increasing to 37.2% for those with a BMI of 35 and 107.3% for those with a BMI of 40. Risk of death also increased by an average of 43.6% for those deemed underweight (BMI 15). People who were older (mean aOR = 1.019; 95% CI = 1.002-1.036), smoked (mean aOR = 2.917; 95% CI = 1.726-4.934) and lived in more deprived areas (mean aOR = 0.891; 95% CI = 0.831-0.956) were more likely to have died, as were those prescribed methadone (vs buprenorphine) (mean aOR = 1.916; 95% CI = 1.138-3.227). There was no significant effect of gender (mean aOR = 0.844; 95% CI = 0.612-1.162) or methadone dose (aOR = 0.995; 95% CI = 0.988-1.001) on incidence of death. Acute drug toxicity was the predominant underlying cause of death for healthy and overweight people (46% of cases in both groups), with cancer (21% of cases) and infection (18% of cases) greater contributors to cause of death in underweight people.</p><p><strong>Conclusions: </strong>Opioid agonist therapy (OAT) patients with a body mass index outside of the 'healthy' range appear to have an increased risk of death compared with OAT patients within the 'healthy' range.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412460","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":"Disentangling the effects of nicotine versus non-nicotine constituents of tobacco smoke on major depressive disorder: A multivariable Mendelian randomisation study","authors":"Chloe Burke,&nbsp;Gemma Taylor,&nbsp;Tom P. Freeman,&nbsp;Hannah Sallis,&nbsp;Robyn E. Wootton,&nbsp;Marcus R. Munafò,&nbsp;Christina Dardani,&nbsp;Jasmine Khouja","doi":"10.1111/add.70001","DOIUrl":"10.1111/add.70001","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;There is growing evidence that tobacco smoking causes depression, but it is unclear which constituents of tobacco smoke (e.g. nicotine, carbon monoxide) may be responsible. We used Mendelian randomisation (MR) to measure the independent effect of nicotine on depression, by adjusting the effect of circulating nicotine exposure [via nicotine metabolite ratio (NMR)] for the overall effect of smoking heaviness [via cigarettes per day (CPD)] to account for the non-nicotine constituents of tobacco smoke.&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;Univariable MR and multivariable MR (MVMR) were used to measure the total and independent effects of genetic liability to NMR and CPD on major depressive disorder (MDD). Our primary method was inverse variance weighted (IVW) regression, with other methods as sensitivity analyses.&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;For the exposures, we used genome-wide association study (GWAS) summary statistics among European ancestry individuals for CPD (&lt;i&gt;n&lt;/i&gt; = 143 210) and NMR (&lt;i&gt;n&lt;/i&gt; = 5185). For the outcome, a GWAS of MDD stratified by smoking status was conducted using individual-level data from UK Biobank (&lt;i&gt;n&lt;/i&gt; = 35 871–194 881).&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;Genetic variants associated with NMR (&lt;i&gt;n&lt;/i&gt; = 6) and CPD (&lt;i&gt;n&lt;/i&gt; = 53).&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;Univariable MR-IVW indicated a causal effect of CPD on MDD [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04–1.23, &lt;i&gt;P&lt;/i&gt; = 0.003] but no clear evidence for an effect of NMR on MDD (OR = 0.98, 95% CI = 0.97–1.00, &lt;i&gt;P&lt;/i&gt; = 0.134). MVMR indicated a causal effect of CPD on MDD when accounting for NMR (IVW: OR = 1.19, 95% CI = 1.03–1.37, &lt;i&gt;P&lt;/i&gt; = 0.017; Egger: OR = 1.13, 95% CI = 0.89–1.43, &lt;i&gt;P&lt;/i&gt; = 0.300) and weak evidence of a small effect of NMR on MDD when accounting for CPD (IVW: OR = 0.98, 95% CI = 0.96–1.00, &lt;i&gt;P&lt;/i&gt; = 0.057; Egger: OR = 0.98, 95% CI = 0.96–1.00, &lt;i&gt;P&lt;/i&gt; = 0.038).&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;The role of nicotine exposure in risk of depression cannot be entirely dismissed. However, the causal effect of tobacco smoking increasing depression risk appears to be largely independent of circulating nicotine exposure, which implies the role of alternative causal pathways.&lt;/p&gt;\u0000 ","PeriodicalId":109,"journal":{"name":"Addiction","volume":"120 6","pages":"1240-1252"},"PeriodicalIF":5.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389572","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":"Relapse in substance-induced psychosis and associated risk factors. A Nationwide register-linkage study from Sweden.","authors":"Venla Ellilä, Heidi Taipale, Jari Tiihonen, Ellenor Mittendorfer-Rutz, Solja Niemelä","doi":"10.1111/add.70014","DOIUrl":"https://doi.org/10.1111/add.70014","url":null,"abstract":"<p><strong>Background and aims: </strong>Substance-induced psychoses (SIP) have the potential to relapse and convert into schizophrenia-spectrum disorders. However, risk factors associated with SIP relapse remain unknown. The aim of this study was to measure the incidence and risk of SIP relapse and associating risk factors.</p><p><strong>Design, setting and participants: </strong>Population based register study that identified people with first-time SIP between 2006 and 2016 (n = 7320) from Swedish nation-wide registers to examine incidence of relapse and associated risk factors during 2-year follow-up. Participants were censored to death, emigration and the diagnosis of other psychotic illness. Risk factors associated with relapse were studied using multivariable Cox models.</p><p><strong>Measurements: </strong>SIP was measured via related diagnostic codes (ICD-10: F1x.5) collected from the National Patient Register (NPR). SIP relapse was measured as hospitalization due to SIP during 2-year follow-up also collected from the NPR. Potential risk factors included demographic characteristics, psychiatric comorbidities, sickness absence and disability pension collected from nationwide registers.</p><p><strong>Findings: </strong>Of the study population (n = 7320), 20.0% (n = 1463) had a SIP relapse during the follow-up (median time 126 days, interquartile range 56-321) and 83.3% had the same type of SIP as their first SIP. Relapse was most common for those whose first SIP was induced by cannabis (25.7%), followed by multi-substance use (23.8%) and (meth)amphetamine (19.7%). Factors associated with SIP relapse were previous substance use disorder [hazard ratio (HR) = 1.37, 95% confidence interval (CI) = 1.20-1.56], younger age (16-29 years, HR = 1.29, 95% CI = 1.05-1.58, versus 50-65), being born abroad (HR = 1.23, 95% CI = 1.07-1.41), attention deficit hyperactivity disorder (HR = 1.21, 95% CI = 1.05-1.39), having had 1-90 days sick leave during the previous year (HR = 1.19, 95% CI = 1.01-1.44), and cannabis- (HR = 2.42, 95% CI = 1.98-2.96), (meth)amphetamine- (HR = 1.49, 95% CI = 1.23-1.81) or multi-substance- (HR = 1.81, 95% CI = 1.52-2.15) induced psychosis compared with alcohol-induced psychosis.</p><p><strong>Conclusions: </strong>In Sweden, 20% of people with substance-induced psychosis between 2006 and 2016 had a relapse within 2 years follow-up. Cannabis-induced psychosis had the shortest time lapse between episodes. Risk factors for relapse included attention deficit hyperactivity disorder, substance-use disorder, younger age, previous sickness absence and being born outside Sweden.</p>","PeriodicalId":109,"journal":{"name":"Addiction","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397633","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}