Drug and alcohol dependence最新文献

{"title":"And then I blacked out - A qualitative interview study on alcohol intoxication events in adolescents under 18 years old","authors":"Louise E.M. Pigeaud ,&nbsp;Joris J. van Hoof ,&nbsp;Nico van der Lely","doi":"10.1016/j.drugalcdep.2025.112772","DOIUrl":"10.1016/j.drugalcdep.2025.112772","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the mechanisms influencing alcohol consumption in adolescents is crucial for developing effective strategies to minimize alcohol intoxication in this age group. This study seeks to explore the experiences of adolescents who have experienced an alcohol intoxication, aiming to better understand their motivations and inform the development of improved prevention strategies.</div></div><div><h3>Methods</h3><div>The study involved adolescents under 18 years old admitted for an alcohol intoxication at Reinier de Graaf Gasthuis in Delft, The Netherlands. Data from 24 semi-structured interviews, part of the \"Youth and Alcohol\" outpatient clinic's standardized follow-up program, were analysed. In-depth interviews were conducted 1–2 months after the intoxication event.</div></div><div><h3>Results</h3><div>Four key themes emerged from the interviews: (1) Context of alcohol consumption, (2) alcohol consumption patterns, (3) consequences of the alcohol intoxication event, and (4) reflections on the alcohol intoxication event and recommendations for preventive measures. A common observation was that many adolescents reported not recognizing when they became intoxicated, often describing a \"black-out\" experience. During the alcohol intoxication event, they often consume spirits in the evening/night, typically in social settings with friends, motivated by social and enhancement drinking motives. The adolescents who participated emphasised the importance of alcohol education, stricter advertising regulations, and stronger enforcement of alcohol laws as key measures to reduce alcohol intoxication and mitigating alcohol’s harmful consequences in their population.</div></div><div><h3>Conclusion</h3><div>This study provides valuable insights into alcohol consumption patterns and consequences in adolescents who had an alcohol intoxication. It underscores the need for tailored prevention strategies, suggested by the adolescents themselves, to effectively reduce alcohol intoxication in adolescents.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112772"},"PeriodicalIF":3.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buprenorphine and norbuprenorphine concentrations associated with clinical withdrawal during pregnancy","authors":"Steve N. Caritis ,&nbsp;Elizabeth E. Krans ,&nbsp;Raman Venkataramanan","doi":"10.1016/j.drugalcdep.2025.112771","DOIUrl":"10.1016/j.drugalcdep.2025.112771","url":null,"abstract":"<div><h3>Background</h3><div>Dosing of buprenorphine during pregnancy is based on dosing recommendations for non-pregnant people. This approach is not appropriate as buprenorphine concentrations, for a given dose, are lower in pregnant than non-pregnant people. Furthermore, it is unclear if buprenorphine concentrations preventing withdrawal are similar in pregnant and non-pregnant people.</div></div><div><h3>Methods</h3><div>We sought to determine the plasma buprenorphine and norbuprenorphine concentrations at the time of withdrawal symptoms in 20 pregnant persons on a stable dose of sublingual buprenorphine. Previous evening and study day morning doses were withheld and at arrival to our research center, blood was obtained while pupillary diameter, COWS and craving scores were recorded frequently until withdrawal symptoms occurred and then the usual morning dose of buprenorphine was administered, and all measurements repeated 6 times over the ensuing 2<!--> <!-->h.</div></div><div><h3>Results</h3><div>At withdrawal, the plasma concentration (mean ± SD) of buprenorphine was 0.79 ± 0.44<!--> <!-->ng/ml, range 0.3–1.7<!--> <!-->ng/ml and norbuprenorphine 1.54 ± 1.01<!--> <!-->ng/ml, range 0.3–4.7<!--> <!-->ng/ml. After dosing, these concentrations peaked after 30–45<!--> <!-->min while pupillary diameter, COWS and craving scores synchronously returned toward baseline but with maximal effects lagging the peak in plasma drug concentration by 45–60<!--> <!-->min.</div></div><div><h3>Conclusions</h3><div>The minimal concentration of buprenorphine required to suppress withdrawal symptoms is similar to that in non-pregnant people. The lag in the pharmacodynamic responses supports a central mu receptor effect of buprenorphine. The wide range of buprenorphine concentration at withdrawal suggests considerable variation in mu receptor responsiveness to buprenorphine and supports individualized dosing in pregnant people.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112771"},"PeriodicalIF":3.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 mental disorders and treatment retention among people with opioid use disorder receiving opioid agonist treatment: A systematic review and meta-analysis","authors":"Lucy T. Tran ,&nbsp;Rebecca McKetin ,&nbsp;Brodie Clark ,&nbsp;Christel Macdonald ,&nbsp;Emma Zahra ,&nbsp;Shalini Arunogiri ,&nbsp;Mark E. Montebello ,&nbsp;Louisa Degenhardt","doi":"10.1016/j.drugalcdep.2025.112768","DOIUrl":"10.1016/j.drugalcdep.2025.112768","url":null,"abstract":"<div><h3>Background</h3><div>Mental disorders are common among people with opioid use disorder. This review synthesised evidence of the association of comorbid mental disorders on retention with buprenorphine and methadone treatment.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase and PsycInfo was conducted in 2025, using search terms related to opioid use disorder and opioid agonist treatment medications of buprenorphine or methadone. Included studies reported on adults aged ≥ 18 years with opioid use disorder in any treatment setting, measured mental disorders or symptoms of mental disorders and retention in buprenorphine or methadone. Any retention data by mental disorders or symptoms of mental disorders were extracted for analysis.</div></div><div><h3>Results</h3><div>Of 16,056 papers screened, 48 cohorts were included for analyses, consisting of 151,570 individuals. Our meta-analyses indicated that people with mood or personality disorders are more likely to drop out of buprenorphine treatment at 12 and 24 months, compared to people without these specific disorders. At 24 months, people with depression, bipolar disorder, post-traumatic stress disorder, panic disorder and attention-deficit/hyperactivity disorder are more likely to have ceased buprenorphine treatment, compared to people with no mental disorder. People with psychotic and personality disorders were more likely to be retained in methadone treatment at 24 months compared to either people without these specific disorders or with no mental disorders.</div></div><div><h3>Conclusions</h3><div>Among people who have opioid use disorder, mental disorders are associated with poorer retention in buprenorphine treatment from 6 months. The small number of cohorts within each analysis emphasises a further need for studies examining the association between mental disorders and buprenorphine or methadone retention. This review highlights the importance of clinicians in assessing for comorbid mental disorders to facilitate appropriate long-term care and improve treatment outcomes.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112768"},"PeriodicalIF":3.9,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The null effect of stress on cognitive flexibility in individuals with and without alcohol use disorder","authors":"Erica N. Grodin ,&nbsp;Dylan E. Kirsch ,&nbsp;Steven Nieto ,&nbsp;Malia Belnap ,&nbsp;Yenashi Castillo ,&nbsp;Nirvana Baker ,&nbsp;Kate M. Wassum ,&nbsp;Kathleen A. Grant ,&nbsp;Lara A. Ray","doi":"10.1016/j.drugalcdep.2025.112767","DOIUrl":"10.1016/j.drugalcdep.2025.112767","url":null,"abstract":"<div><h3>Background</h3><div>Stress is a prominent motivator for drinking. Both stress and addiction are associated with impairments in cognitive flexibility. Preclinical work has explored the effect of stress on cognitive flexibility, but this has not been translated to clinical samples. Therefore, the present study tested whether acute stress decreased cognitive flexibility in individuals with and without AUD. It also explored if individuals with and without AUD recruit similar neurocircuitry during an acute stress provocation.</div></div><div><h3>Methods</h3><div>Sixty-five participants (AUD: N = 34; Control: N = 31) completed the Wisconsin Card Sorting Task at baseline, immediately prior to stress, and immediately following stress. Participants underwent the Montreal Imaging Stress Task during an fMRI scan to induce stress. Repeated measure ANCOVAs assessed the effects of stress, group, and stress X group interactions on ratings of stress and cognitive flexibility outcomes. Whole brain analyses examined group differences in the neural response to stress.</div></div><div><h3>Results</h3><div>Both groups reported increases in subjective stress following the stress-induction task (p’s &lt; 0.04), but there were no stress X group interactions. There were no significant effects of stress, group, or stress X group interactions on cognitive flexibility measures (p’s &gt; 0.09). The control group had significantly greater activation in the anterior cingulate cortex during stress compared to individuals with AUD (p = 0.002).</div></div><div><h3>Conclusions</h3><div>There were no significant effects of acute stress on cognitive flexibility in individuals with or without AUD. However, individuals with AUD had lower anterior cingulate activation during acute stress compared to matched controls, possibly indicating that the control group recruited more top-down processing during stress.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112767"},"PeriodicalIF":3.9,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mirtazapine reduces hypothetical methamphetamine demand in humans","authors":"Craig R. Rush ,&nbsp;Glenn-Milo Santos ,&nbsp;Vanessa M. McMahan ,&nbsp;Annie Fraser ,&nbsp;Jesse Clark ,&nbsp;Xochitl Luna Marti ,&nbsp;John E. Walker ,&nbsp;Steve Shoptaw ,&nbsp;Phillip O. Coffin","doi":"10.1016/j.drugalcdep.2025.112769","DOIUrl":"10.1016/j.drugalcdep.2025.112769","url":null,"abstract":"<div><h3>Background</h3><div>Previous trials showed mirtazapine reduces methamphetamine use. The present study determined the influence of mirtazapine treatment on the acute effects of methamphetamine.</div></div><div><h3>Methods</h3><div>We conducted a placebo-controlled, crossover, double-blind trial to determine the pharmacodynamic effects of intravenous methamphetamine (0, 30<!--> <!-->mg) after 5 days of mirtazapine (0, 30<!--> <!-->mg/day) treatment. Healthy adults with moderate to severe methamphetamine use disorder who had a positive baseline urine test for methamphetamine were enrolled. The order of mirtazapine and placebo was randomly assigned, and participants received a methamphetamine infusion during each treatment condition. Acute effects of methamphetamine were assessed using a drug purchasing task, a subjective effect questionnaire, and cardiovascular indices.</div></div><div><h3>Results</h3><div>Fifteen (15) participants (10 cisgender males, 4 cisgender females, 1 transgender female) enrolled in the trial. Intravenous methamphetamine produced prototypical stimulant-like effects (e.g., hypothetical drug demand; increased ratings of Like Effect, heart rate, blood pressure) when participants were treated with placebo. Mirtazapine significantly decreased methamphetamine demand. The subjective and cardiovascular effects of methamphetamine were similar during mirtazapine and placebo treatment. Mirtazapine and infusions of methamphetamine, alone and combined, were well tolerated.</div></div><div><h3>Conclusions</h3><div>Mirtazapine reduced hypothetical drug demand and was well tolerated with saline or methamphetamine infusions. Considering these favorable findings, along with those from previous clinical trials, mirtazapine should continue to be tested as a putative pharmacotherapy for methamphetamine use disorder.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112769"},"PeriodicalIF":3.9,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and race-ethnicity influences on opioid overdose deaths among veterans diagnosed with opioid use disorder between 2016 and 2021","authors":"Amar D. Mandavia ,&nbsp;Jennifer R. Fonda ,&nbsp;Anne N. Banducci ,&nbsp;Victoria E. Ameral ,&nbsp;Rebecca E. Sistad Hall ,&nbsp;Lauren B. Loeffel ,&nbsp;Clara E. Roth ,&nbsp;Tracy L. Simpson ,&nbsp;Michael D. Stein ,&nbsp;Brian P. Marx ,&nbsp;Justeen Hyde ,&nbsp;Michael Davenport ,&nbsp;Frank Meng ,&nbsp;Nicholas A. Livingston","doi":"10.1016/j.drugalcdep.2025.112764","DOIUrl":"10.1016/j.drugalcdep.2025.112764","url":null,"abstract":"<div><h3>Objective</h3><div>Given increases in opioid overdose rates, and policy changes expanding access to medications for OUD, during the COVID-19 pandemic, we sought to understand how the opioid overdose epidemic impacted veterans with opioid use disorder (OUD), from 2016 to 2021.</div></div><div><h3>Method</h3><div>We examined the prevalence and trends in opioid overdose deaths, and age at death, from 2016 to 2021, by sex and race/ethnicity among veterans with OUD enrolled in the Veterans Health Administration (VHA). We calculated the multiplicative and additive interactions between sex and age, and opioid overdose death.</div></div><div><h3>Results</h3><div>203,950 veterans enrolled in VHA from 2016 to 2021 had an OUD; 16 % (n = 32,640) died during this period. Opioid overdose contributed to 17.42 % (n = 5686) of all deaths. Although the total number of overdose deaths rose each year, the relative risk of dying from an opioid overdose decreased. Of those who died, veterans, ages 18–29 were significantly more likely to die of an opioid overdose than veterans over the age of 40. Female veterans were significantly more likely to die from an opioid overdose, with this risk manifesting significantly earlier and faster when compared to male veterans of the same age. Black and Asian veterans were significantly more likely to die by opioid overdose than White veterans.</div></div><div><h3>Conclusions</h3><div>Despite an overall decrease in relative risk of opioid overdose death during the first two years of the COVID-19 pandemic (2020–2021) there was a significant increase in risk of opioid overdose death among female and racial and ethnic minority veterans with OUD.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112764"},"PeriodicalIF":3.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing rapid changes in the prevalence and concentration of key compounds in Philadelphia’s street opioid retail supply, March 2024-March 2025","authors":"Karli Hochstatter ,&nbsp;Talia Nadel ,&nbsp;Edward Sisco ,&nbsp;Philippe Bourgois ,&nbsp;Sarah Laurel ,&nbsp;Meghan G. Appley ,&nbsp;Elise M. Pyfrom ,&nbsp;Fernando Montero","doi":"10.1016/j.drugalcdep.2025.112763","DOIUrl":"10.1016/j.drugalcdep.2025.112763","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this observational epidemiological study is to examine recent shifts in the street opioid supply of the largest U.S. open-air drug market, including changes in prevalence and concentration of key compounds.</div></div><div><h3>Methods</h3><div>From March 2024-March 2025, samples of street drugs sold as opioids were collected at a harm reduction program in Philadelphia’s Kensington neighborhood and shipped to the National Institute of Standards and Technology, where they underwent qualitative testing using direct analysis in real-time mass spectrometry and quantitative testing using liquid chromatography tandem mass spectrometry. Bootstrapped quantile regression models assessed changes in concentration over time.</div></div><div><h3>Results</h3><div>Among 260 samples, fentanyl (98 %) and xylazine (65 %) were the most prevalent psychoactive compounds. While fentanyl was consistently present, the median fentanyl concentration decreased significantly, from 9.6 % by mass in May 2024–5.3 % by mass in March 2025 (P = 0.020). Xylazine prevalence declined from 100 % in March 2024–58 % in March 2025. Conversely, lidocaine and tetracaine prevalence increased from 3 % each in March 2024–63 % each in March 2025. Two novel compounds, medetomidine and bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS), were first detected in April and June 2024, reaching prevalence rates of 83 % and 25 % by March 2025, respectively.</div></div><div><h3>Conclusion</h3><div>The street opioid supply in Kensington is erratic and volatile, with decreasing fentanyl concentrations alongside increasing adulteration with medetomidine and local anesthetics. These shifts underscore urgency for timely systematic drug checking and robust inquiry into the organization of street opioid retail markets to inform harm reduction strategies and prevent drug-related harms.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112763"},"PeriodicalIF":3.9,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline predictors of smoking cessation among individuals with current or past major depressive disorder following treatment with varenicline and intensive behavioral treatment","authors":"Brian Hitsman ,&nbsp;Michael D’Eletto ,&nbsp;Jacqueline K. Gollan ,&nbsp;Robert A. Schnoll ,&nbsp;George D. Papandonatos","doi":"10.1016/j.drugalcdep.2025.112761","DOIUrl":"10.1016/j.drugalcdep.2025.112761","url":null,"abstract":"<div><h3>Introduction</h3><div>In a 2 × 2 factorial clinical trial with 300 individuals with current or past major depressive disorder (MDD), varenicline significantly increased smoking cessation, compared to placebo, whereas behavioral activation for smoking cessation yielded similar quit rates compared to standard behavioral treatment. In this secondary analysis, we evaluated whether participant characteristics at baseline predicted abstinence or moderated the effects of behavioral treatment or pharmacotherapy on abstinence.</div></div><div><h3>Methods</h3><div>The sample was racially and socioeconomically diverse and spanned varied psychiatric presentations: 49 % of participants had current MDD, 44 % had other mental health disorders, and only 27 % were being treated for their depression. Self-reported 7-day point prevalence abstinence at end-of-treatment (EOT; Week 14) and long-term follow-up (Week 27) was confirmed using breath carbon monoxide (≤6 parts per million). <em>Results</em>: In a logistic regression model, greater likelihood of abstinence at EOT was associated with varenicline vs. placebo (OR=5.52, 95 % CI=2.62–11.60), lower cigarette dependence (OR=0.42, 95 % CI=0.19–0.90), and fast nicotine metabolism (OR=1.64, 95 % CI=1.06–2.54). In second logistic regression model, greater likelihood of Week 27 abstinence was associated with varenicline vs placebo (OR=3.06, 95 % CI=1.32–7.07) and fast nicotine metabolism (OR=2.06, 95 % CI=1.20–3.54). None of the baseline factors interacted with behavioral or pharmacological treatment to predict abstinence at either time point.</div></div><div><h3>Conclusions</h3><div>Varenicline should be a primary treatment consideration for individuals with MDD. Stable psychiatric status is not required for favorable treatment outcome. Further effort is needed to identify behavioral interventions that can be added to varenicline to improve quit rates for individuals with MDD.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112761"},"PeriodicalIF":3.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis use, risk of cannabis use disorder, and anxiety and depression among bisexual patients: A comparative study of sex and sexual identity differences in a large health system","authors":"Naira Setrakian ,&nbsp;Lillian Gelberg ,&nbsp;Julia Koerber ,&nbsp;Un Young Chung ,&nbsp;Whitney N. Akabike ,&nbsp;Pamina M. Gorbach ,&nbsp;Marissa J. Seamans ,&nbsp;Steven Shoptaw ,&nbsp;Alison Cerezo ,&nbsp;Marjan Javanbakht","doi":"10.1016/j.drugalcdep.2025.112762","DOIUrl":"10.1016/j.drugalcdep.2025.112762","url":null,"abstract":"<div><div>This study used electronic health record (EHR) data from 9869 sexual minority patients aged 18 and older who had a primary care visit within a Los Angeles university health system (June 2020–May 2023). Sexual minority patients, defined as lesbian, gay, or bisexual, were screened for cannabis use and risk of cannabis use disorder (CUD) during annual wellness visits. Mental health diagnoses were extracted from patients’ EHR. Multivariable regression models were used to assess associations between sexual identity, sex, and cannabis-related outcomes, including cannabis use, risk of CUD, mental health diagnoses among individuals reporting cannabis use, and cannabis use for symptom management among those with a corresponding diagnosis. All models controlled for age and race/ethnicity. Bisexual patients had higher adjusted odds of cannabis use compared to gay/lesbian patients (AOR females: 1.67; males: 1.47). Bisexual males had greater odds of risk of CUD (AOR: 1.48) and depression diagnosis (AOR:1.86) compared to gay males. Bisexual males with a diagnosis for depression had higher odds of cannabis use for managing depression or sadness symptoms (AOR: 2.44) compared to gay males. Bisexual females had higher odds of a severe stress diagnosis compared to gay/lesbian females (AOR: 2.44). These findings emphasize the importance of developing targeted primary care approaches that address both cannabis use and mental health concerns among bisexual patients.</div></div><div><h3>Purpose</h3><div>While the prevalence of cannabis use is higher among sexual minorities as compared to their heterosexual counterparts, few studies have examined the differences in cannabis use across sex and sexual identity among sexual minority individuals, especially in the context of health care. This study examines the association of sexual identity and sex with cannabis use, risk of cannabis use disorder (CUD), symptoms managed with cannabis use, and mental health diagnoses among sexual minority primary care patients.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study using electronic health record (EHR) data from 9869 patients ≥ 18 years of age who identified as sexual minority, defined as lesbian, gay, or bisexual, and had a primary care visit between June 2020 and May 2023 within a university-based health system in Los Angeles, CA. Routine screening for past 3-month cannabis use and risk of CUD was based on the Alcohol Substance Involvement Screening Test (ASSIST) and was conducted as part of all annual wellness visits. Patients were asked to report symptoms for which they used cannabis, and mental health diagnoses were extracted from patients’ EHR. Diagnoses meeting clinical threshold criteria were identified based on the International Classification of Diseases, Tenth Revision (ICD-10) codes and included anxiety disorders (ICD-10 F41), depressive disorders (ICD-10 F33), and severe stress (ICD-10 F43).</div><div>Differences in the prevalence of","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112762"},"PeriodicalIF":3.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnenolone reduces provoked craving and cocaine use in men and women with cocaine use disorder: A pilot trial","authors":"Elcin Sakmar,&nbsp;Stephanie Wemm,&nbsp;Nia Fogelman,&nbsp;Gretchen Hermes,&nbsp;Rajita Sinha,&nbsp;Verica Milivojevic","doi":"10.1016/j.drugalcdep.2025.112765","DOIUrl":"10.1016/j.drugalcdep.2025.112765","url":null,"abstract":"<div><h3>Aim</h3><div>Chronic cocaine use decreases neuroactive steroid (NAS) levels, contributing to continued cocaine use and high risk of return to use in individuals with cocaine use disorder (CUD). This pilot study assessed chronic treatment with two doses of the NAS precursor pregnenolone to boost endogenous NAS levels and affect provoked craving and cocaine use outcomes in an 8-week trial in men and women with CUD.</div></div><div><h3>Methods</h3><div>Fifty-five treatment-seeking individuals with CUD were randomly assigned to receive either placebo (PLA; n = 18; 12<!--> <!-->M/6<!--> <!-->F), 300<!--> <!-->mg PREG/day (n = 20; 15<!--> <!-->M/5<!--> <!-->F) or 500<!--> <!-->mg PREG/day (n = 17; 12<!--> <!-->M/5<!--> <!-->F) for 8 weeks. Plasma collected at weeks 2, 5 and 7 was assessed for pregnenolone levels. A subset participated in a 3-day experimental component of guided imagery exposure to stress, cocaine and neutral cues in about week 2 of the trial to assess craving response. Cocaine use outcomes were assessed during the treatment period. Intent-to-treat analyses were conducted using linear mixed effects models.</div></div><div><h3>Results</h3><div>Pregnenolone levels were higher in the 300<!--> <!-->mg and 500<!--> <!-->mg PREG groups compared to PLA (<em>p’s</em> &lt; 0.032). Stress (<em>p</em> &lt; .001) and cocaine cue (<em>p</em> &lt; .001) induced craving increased in PLA, but not in PREG groups. 300<!--> <!-->mg PREG used lower cocaine amounts compared to 500<!--> <!-->mg PREG group (<em>p</em> = 0.01) and PLA (<em>p</em> = .047). A non-significant reduction was observed for % days of cocaine used (<em>p</em> = .122).</div></div><div><h3>Conclusions</h3><div>These pilot findings suggest that PREG reduces cocaine craving and improves cocaine use outcomes in treatment seeking individuals with CUD, supporting further assessment of PREG in the treatment of CUD.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"274 ","pages":"Article 112765"},"PeriodicalIF":3.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}