Drug and alcohol dependence最新文献

{"title":"Rising and disparate trends in the private/for-profit acquisition of nonprofit substance use treatment facilities, US, 2019–2024","authors":"George Pro ,&nbsp;Jonathan Cantor ,&nbsp;Mofan Gu ,&nbsp;Kari Weber ,&nbsp;Brooke Montgomery","doi":"10.1016/j.drugalcdep.2026.113045","DOIUrl":"10.1016/j.drugalcdep.2026.113045","url":null,"abstract":"<div><h3>Background</h3><div>Private acquisition of public and nonprofit healthcare facilities is increasing throughout the United States (US). While privatization can be beneficial, growing evidence has demonstrated higher costs, larger patient volumes, and worsening outcomes. These trends are also apparent in substance use disorder (SUD) treatment facilities at a time when overdose and treatment demand are at an all time high. This study was designed to measure whether increases in private acquisitions of nonprofit substance use treatment facilities are happening faster in underrepresented and underresourced communities.</div></div><div><h3>Methods</h3><div>We used the Mental health and Addiction Treatment Tracking Repository (MATTR) to identify SUD treatment facilities that were nonprofit/public owned in 2019 (N = 2826 facilities). Our outcome was whether a facility became privatized and owned by a for-profit company by 2024. We linked MATTR to demographic census data and modeled privatization using a generalized estimating equation with a modified Poisson distribution, log link function, and robust standard errors.</div></div><div><h3>Results</h3><div>Twenty percent (n = 572) of public/nonprofit SUD treatment facilities were privatized between 2019 and 2024. Privatization of nonprofit/public facilities was more common in communities with lower household incomes (p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Private acquisition of nonprofit/public SUD treatment facilities increased between 2019 and 2024. Acquisitions were disproportionately located in communities with higher rates of low-income households. Private acquisition can be beneficial for some facilities, but a growing evidence base is demonstrating how privatization is generally followed by worsening health outcomes in the process of restructuring and reselling at a profit. Treatment systems must not be extractive. Oversight and community involvement may help ensure mutual beneficence.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113045"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973939","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":"Are there differences in gradual versus abrupt smoking cessation quit attempts and success by social grade? A population study in England","authors":"Sharon Cox ,&nbsp;Lion Shahab ,&nbsp;Claire Garnett ,&nbsp;Nicola Lindson ,&nbsp;Sarah Jackson","doi":"10.1016/j.drugalcdep.2025.113017","DOIUrl":"10.1016/j.drugalcdep.2025.113017","url":null,"abstract":"<div><h3>Background and aims</h3><div>Smoking rates remain higher among individuals from less advantaged social grades, who tend to be less successful when they try to quit. Abrupt quitting may be more successful than cutting down first, though evidence is mixed. It is not clear whether the quit methods chosen, and their effects, differ by social grade. This study aimed to: (1) compare the prevalence of gradual versus abrupt quit attempts across social grades; (2) examine the association between quit method and quit success; and (3) assess whether social grade moderates this association.</div></div><div><h3>Methods</h3><div>We used data from 27,390 adults in England who reported a past-year quit attempt in the Smoking Toolkit Study (2006–2025). Quit method used (gradual vs. abrupt) and quitting success were self-reported. Logistic regression analyses examined the two-way interaction between quit method and social grade (ABC1 =more advantaged vs. C2DE=less advantaged) and success, adjusting for sociodemographic and smoking-related covariates.</div></div><div><h3>Results</h3><div>People from less advantaged social grades were less likely to attempt to quit abruptly (53.2 % [95 % CI: 52.3–54.0 %] vs. 57.4 % [56.4–58.4 %]). Abrupt quitting was associated with higher odds of success compared with gradual quitting (OR = 1.70; 95 % CI: 1.58–1.84) providing no clear evidence this was moderated by social grade (interaction OR = 1.13; 95 % CI: 0.97–1.33, <em>p</em> = 0.14).</div></div><div><h3>Conclusion</h3><div>People who choose to quit abruptly are more likely to quit successfully than people who choose to quit gradually, irrespective of their social grade. However, people from less advantaged social grades are less likely to choose to quit abruptly.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113017"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914266","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":"Use of gabapentin with or without a prescription in substance use treatment settings: A national analysis of urine drug testing data, 2016–2023","authors":"Matthew S. Ellis ,&nbsp;Penn Whitley ,&nbsp;Steven D. Passik","doi":"10.1016/j.drugalcdep.2026.113020","DOIUrl":"10.1016/j.drugalcdep.2026.113020","url":null,"abstract":"<div><h3>Background</h3><div>Gabapentin prescriptions have increased due to off-label use, including managing withdrawal/comorbidities in substance use disorder (SUD) treatment, despite gaps in evidence bases and corresponding increases in nonmedical use. This study sought to identify trends in gabapentin use with and without a prescription in SUD treatment settings.</div></div><div><h3>Methods</h3><div>This retrospective, serial cross-sectional study analyzed urine drug tests (UDT) (n = 206,161) ordered from 2053 SUD settings in all 50 U.S. states, from 2016 to 2023. Specimens were analyzed by liquid chromatography–tandem mass spectrometry to assess positivity for gabapentin and other prescription and illicit drugs, with prescribed medications documented in requisitions. Multivariable regression assessed characteristics/diagnoses associated with gabapentin use with and without a prescription.</div></div><div><h3>Results</h3><div>Gabapentin was prescribed to 5.9 % of the sample, increasing from 3.9 % in 2016–7.6 % in 2023. Use of gabapentin without a prescription was identified in 11.3 % of the sample, decreasing from 15.2 % to 9.9 %. Gabapentin prescribing was associated with anxiety/mood disorders, insomnia, pain, and sedative, alcohol, or stimulant SUDs. Use without a prescription was associated with anxiety/mood disorders, and sedative or opioid SUDs. Detection was higher across all illicit substances among those engaged in gabapentin use without a prescription.</div></div><div><h3>Conclusions</h3><div>Gabapentin prescribing significantly increased in SUD treatment settings despite a lack of strong evidence bases for its utility. While rates of gabapentin use outside a prescription were nearly double than for prescribed use, this appears to be decreasing over time. Polysubstance use and potential gaps in multimorbidity care may contribute to the use of gabapentin without a prescription.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113020"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919507","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":"Population reach, feasibility and acceptability of digital therapeutics for smoking cessation among people living with HIV: Results of the Quitting Matters pilot trial","authors":"R. Vilardaga ,&nbsp;F.J. McClernon ,&nbsp;O. Akingbule ,&nbsp;P. Mannelli ,&nbsp;S.M. Thomas ,&nbsp;J.M. Davis ,&nbsp;M.F. Gray ,&nbsp;C. Arnold ,&nbsp;I. Chow Kai Reyes ,&nbsp;R. Ashare ,&nbsp;M. Paukner ,&nbsp;L.R. Pacek","doi":"10.1016/j.drugalcdep.2025.113015","DOIUrl":"10.1016/j.drugalcdep.2025.113015","url":null,"abstract":"<div><h3>Introduction</h3><div>Tobacco use is disproportionately prevalent among people living with HIV (PWH) and is a significant contributor to morbidity and mortality in this population. Reaching communities of PWH to facilitate smoking cessation is challenging. Digital Therapeutics (DTx) can facilitate widespread implementation and adoption of smoking cessation treatments for PWH.</div></div><div><h3>Methods</h3><div>We compared the feasibility and acceptability (primary outcomes) and preliminary efficacy (secondary outcome) of a DTx tailored to PWH -- Learn to Quit-HIV (LTQ-<em>H</em>) -- versus a gold standard smoking cessation DTx (QuitGuide) in a remote pilot randomized controlled trial. All participants received nicotine replacement therapy and were assessed at weeks 4, 8, and 12.</div></div><div><h3>Results</h3><div>During a 13-month period, we remotely recruited a sample of PWH (n = 41) across the United States, with randomization leading to a higher proportion of LTQ-<em>H</em> users with high levels of cannabis use. Digital markers of DTx use indicated that compared to QuitGuide, assignment to LTQ-<em>H</em> led to significantly greater number of device interactions (3610 vs 2086; RR=93.14; 95 % CI: 14.70–590; p &lt; 0.001), and a four-fold increase in mean interactions with active smoking cessation content (8.5 vs. 2.15; Cohen’s d=0.91; p &lt; 0.001). At week 12, in an adjusted model, LTQ-<em>H</em> resulted in numerically greater, but not statistically significant, biochemically verified 7-day point prevalence abstinence versus QuitGuide (18.2 % vs 15.8 %; aOR=6.97, 95 % CI: 0.65–74.33).</div></div><div><h3>Conclusions</h3><div>While participants assigned to LTQ-<em>H</em> had proportionally more features known to predict low quit rates (e.g. cannabis use), LTQ-<em>H</em> showed promising population reach, device engagement, and smoking outcomes. A hybrid effectiveness-implementation trial will evaluate this novel DTx in a larger sample of PWH.</div></div><div><h3>Implications</h3><div>The study highlights the potential of DTx to address the high prevalence of tobacco use among people with HIV. Compared to QuitGuide (gold standard DTx developed by NCI), LTQ-<em>H</em> showed promising participant engagement and smoking cessation outcomes. These findings suggest that LTQ-<em>H</em> could be a valuable tool for smoking cessation in people with HIV, warranting further investigation in larger trials to evaluate its effectiveness and implementation feasibility.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113015"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923353","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":"Impact of a brief fentanyl educational intervention on demand for cocaine mixed with fentanyl","authors":"Cecilia Nunez ,&nbsp;Benedicta Anighoro ,&nbsp;Jin H. Yoon ,&nbsp;Margaret C. Wardle","doi":"10.1016/j.drugalcdep.2026.113042","DOIUrl":"10.1016/j.drugalcdep.2026.113042","url":null,"abstract":"<div><h3>Background</h3><div>People who use cocaine are at increased risk of overdose related to fentanyl in the cocaine supply, yet few interventions address fentanyl risks among this population. Demand tasks use hypothetical decisions about drug purchases to quantify likely real-world behavior. Our cocaine demand task, the Adulterated Cocaine Purchasing Task, contrasts planned purchases of cocaine when there is 0 % probability (no chance) the cocaine is mixed with fentanyl vs. 10 % probability (in 10 chance) the cocaine is mixed with fentanyl.</div></div><div><h3>Methods</h3><div>Using a between-subjects design, participants who reported purchasing cocaine in the past year (N = 58) were randomly assigned to complete test measures either following (intervention group; n = 30) or before receiving (control group; n = 28) fentanyl education. Test measures consisted of the Adulterated Cocaine Purchasing Task, self-reported fentanyl knowledge, and harm reduction strategies. Demographics and substance use history were also assessed.</div></div><div><h3>Results</h3><div>Findings suggested providing brief fentanyl education significantly increased fentanyl knowledge. Results also indicated higher probability (1 in 10 chance) of fentanyl admixture was consistently related to decreased cocaine demand across multiple demand indices (e.g., reducing their consumption when cocaine is free). However, providing brief education did not lead to reduced demand for cocaine mixed with fentanyl relative to those in the control group. Results also showed fentanyl education did not affect endorsement of harm reduction behaviors.</div></div><div><h3>Conclusion</h3><div>Our findings further suggest the urgent need to prioritize strategies aside from education to address overdose risk among people who use cocaine.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113042"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004878","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":"Explainable machine learning for predicting opioid-related aberrant behavior: A multimodal approach using clinical text and structured data","authors":"Mubashir Farooq ,&nbsp;Asif Ali Banka","doi":"10.1016/j.drugalcdep.2026.113021","DOIUrl":"10.1016/j.drugalcdep.2026.113021","url":null,"abstract":"<div><h3>Purpose</h3><div>The rising misuse of opioids, overdose deaths, and opioid use disorder (OUD) associated with chronic pain treatment present a significant public health challenge, continuing to fuel the opioid epidemic. Since opioid-related aberrant behaviours (ORABs) are early indicators of potential misuse, it is crucial to develop advanced predictive models for safe opioid management.</div></div><div><h3>Methods</h3><div>This study introduces an explainable machine learning framework to predict confirmed aberrant behaviours by integrating clinical text with structured data from the Opioid-Related Aberrant Behavior Detection Dataset (ODD). A multimodal, clinically applicable, and explainable predictive model is developed in this study. The study used GloVe (Global Vectors for Word Representation) embeddings and ClinicalBERT contextual embeddings for EHR text, applied Synthetic Minority Oversampling Technique (SMOTE) for data balancing, and trained various machine learning algorithms.</div></div><div><h3>Results</h3><div>The performance of models was assessed using multiple evaluation metrics. Additionally, SHAP (Shapley Additive exPlanations) was employed to address explainability concerns and to assess feature importance via an ablation study. Results demonstrated that Opioid Risk Ensemble achieved an AUROC of 96.0 % and an accuracy of 98.8 %, indicating that opioids, benzodiazepine prescriptions, and factors related to the central nervous system are significant predictors, as confirmed by SHAP analysis. Furthermore, the Opioid Risk Neural Network, applied with ClinicalBERT embeddings, achieved an AUROC of 98.75 % and an accuracy of 98.47 % on the held-out test set, with SHAP interpretation providing insights into the most influential clinical note terms.</div></div><div><h3>Conclusion</h3><div>The multimodal, explainable AI approach will be valuable for modern healthcare decision-making, supporting risk prediction for ORABs.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113021"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013862","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":"Sustained effects of reduced nicotine cigarettes and co-use of non-combusted alternative nicotine delivery systems: A one-month follow-up to a randomized clinical trial","authors":"Elias M. Klemperer ,&nbsp;Xianghua Luo ,&nbsp;Qing Cao ,&nbsp;Dana M. Carroll ,&nbsp;F. Joseph McClernon ,&nbsp;Neal L. Benowitz ,&nbsp;Andrew A. Strasser ,&nbsp;Jennifer W. Tidey ,&nbsp;Eric C. Donny ,&nbsp;Dorothy K. Hatsukami","doi":"10.1016/j.drugalcdep.2026.113051","DOIUrl":"10.1016/j.drugalcdep.2026.113051","url":null,"abstract":"<div><h3>Introduction</h3><div>The US FDA has proposed a nicotine-reducing standard for cigarettes. A recent trial found that, with access to alternative nicotine delivery systems (ANDS; i.e., e-cigarettes, nicotine medicines), participants randomized to very low nicotine content (VLNC) vs normal nicotine content (NNC) cigarettes achieved greater smoking reduction. This secondary analysis compared effects of the VLNC+ANDS-access versus NNC+ANDS-access conditions on post-intervention cigarette smoking.</div></div><div><h3>Methodology</h3><div>Adults who smoke were randomized to 12 weeks of an experimental marketplace with VLNC (0.4<!--> <!-->mg nicotine/gram tobacco) vs NNC (15.8<!--> <!-->mg/g) cigarettes. All participants had access to non-combusted ANDS. Multivariable regressions were used to examine effects of VLNC vs NNC condition and co-use of ANDS with cigarettes on smoking and cessation-related outcomes during follow-up, when no study products were provided (weeks 12–16).</div></div><div><h3>Results</h3><div>Among those who completed follow-up (n = 336), VLNC vs NNC participants achieved more 7-day point-prevalence smoking abstinence (VLNC=19.6 % vs NNC=11.0 %; <em>p</em> = 0.031), had more smokefree days (VLNC mean=9.7 vs NNC mean=4.9; <em>p</em> = 0.043), and smoked fewer cigarettes/day (VLNC mean=7.3 vs NNC mean=10.7; <em>p</em> &lt; 0.001). Among participants smoking at week-12 (n = 281), co-use of ANDS vs exclusive smoking was associated with more quit attempts (25.5 % vs 13.0 %; <em>p</em> = 0.005) and fewer cigarette/day (mean=9.3 vs mean=12.4; <em>p</em> &lt; 0.001) during follow-up.</div></div><div><h3>Conclusions</h3><div>Switching to VLNC cigarettes with access to non-combusted ANDS produced sustained effects on smoking abstinence. Among those who continued smoking, co-use of ANDS was associated with fewer cigarettes/day and more attempts to quit. Findings provide further support for a nicotine-reducing standard for cigarettes in the context of a marketplace which includes ANDS.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113051"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032097","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":"Alcohol consumption in the Western Province of Sri Lanka: Prevalence, patterns, and health implications","authors":"Prasad Katulanda ,&nbsp;Sanduni Gamage ,&nbsp;Tharindu Bandara ,&nbsp;Akhila Imantha Nilaweera ,&nbsp;Desha Rajni Fernando ,&nbsp;Gaya Wijeweera Katulanda ,&nbsp;Vithanage Pujitha Wickramasinghe ,&nbsp;Eranga Wijewickrama","doi":"10.1016/j.drugalcdep.2026.113049","DOIUrl":"10.1016/j.drugalcdep.2026.113049","url":null,"abstract":"<div><h3>Introduction</h3><div>Alcohol contributes to global morbidity and mortality. This study aimed to describe the prevalence and patterns of alcohol use, its correlates with health related quality of life (HRQoL) and chronic medical conditions in the Western Province of Sri Lanka.</div></div><div><h3>Methods</h3><div>A cross-sectional study (2018–2020) was conducted in Western Province recruited 1800 adults (&gt;20 years) via multi-stage stratified cluster sampling. Data collection included interviewer-administered questionnaires, physiological, anthropometric, and biochemical measurements. Alcohol consumption patterns were assessed with Alcohol Use Disorders Identification Test and CAGE tools, and HRQoL with RAND-36.</div></div><div><h3>Results</h3><div>A total of 1333 adults participated. Alcohol consumption at any point in their life was reported by 25.5 % of participants (95 %CI:18.9–32.1), and 21.3 % (95 %CI:16.8–25.7) had consumed alcohol in the past year. The prevalence was highest among males (56.8 %;95 %CI:46.2–67.4), those aged 40–49 (27.9 %;95 %CI:20.9–34.6), residents of Gampaha district (33.2 %;95 %CI:21.4–44.9), rural dwellers (27.9 %;95 %CI:18.3–37.6), and those earning $300–400 monthly (46.5 %;95 %CI:28.4–64.6). Daily consumption was 5.2 % (95 %CI:1.9–8.3), harmful alcohol use was 28.1 % (95 %CI:19.5–36.7), and clinical alcoholism was 26.6 % (95 %CI:19.5–33.8) among alcohol consumers. Those without clinical alcoholism had higher quality of life than those with the condition. Comorbidities among consumers included dyslipidemia (81.3 %, undiagnosed:58.5 %), hypertension (61.6 %, undiagnosed:33.9 %), diabetes (41.4 %, undiagnosed:11.3 %), and prediabetes (33.8 %).</div></div><div><h3>Conclusions</h3><div>One-fourth of Western Province adults reported alcohol consumption, highest among middle-aged, middle-income, and residents in Gampaha district. Cardio-metabolic diseases were high among individuals who consume alcohol, many remaining undiagnosed. Non-communicable diseases programs should focus high-risk screening, alcohol control, and preventive community initiatives.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113049"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032136","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":"Identification of hazardous alcohol use in outpatient psychiatric care: A comparison of biomarker phosphatidylethanol (PEth) and self-report","authors":"Lena Lundholm ,&nbsp;Johan Skånberg ,&nbsp;Sara Wallhed-Finn ,&nbsp;Fabian Lenhard","doi":"10.1016/j.drugalcdep.2026.113047","DOIUrl":"10.1016/j.drugalcdep.2026.113047","url":null,"abstract":"<div><h3>Background</h3><div>Phosphatidylethanol (PEth) is a reliable biomarker of recent hazardous alcohol use but is resource-intensive and not always feasible in routine mental health care. The Alcohol Use Disorders Identification Test (AUDIT-10) and its short form, AUDIT-C, are widely used self-report tools that may offer practical alternatives. This study examined whether AUDIT scores can serve as proxies for PEth and whether machine learning models enhance prediction.</div></div><div><h3>Methods</h3><div>Data were collected from 4063 psychiatric outpatients who completed both PEth testing and AUDIT assessments. Regression models evaluated associations between AUDIT scores and PEth concentrations. Receiver Operating Characteristic (ROC) analyses determined cut-offs for hazardous alcohol use (PEth ≥ 0.3 µmol/L). Logistic regression, random forest, and XGBoost models were trained using AUDIT-10/AUDIT-C scores, age, and gender.</div></div><div><h3>Results</h3><div>AUDIT-10 and AUDIT-C correlated strongly with PEth (pseudo-R² = 30–47 %). ROC analyses showed good discrimination for hazardous use: AUDIT-10 AUC = 0.80 (optimal cut-off ≥5) and AUDIT-C AUC = 0.83 (optimal cut-off ≥4). XGBoost models improved classification modestly, yielding AUCs of 0.90 (AUDIT-10) and 0.88 (AUDIT-C), with balanced accuracies of 79–83 %, outperforming logistic regression and random forest.</div></div><div><h3>Conclusions</h3><div>AUDIT-10 and AUDIT-C are effective, accessible tools for identifying hazardous alcohol use in psychiatric populations, supporting their role as practical alternatives when PEth testing is unavailable. Machine learning methods offer incremental gains, but simple cut-off scores remain clinically useful. Findings highlight the value of integrating brief alcohol screening into psychiatric care to guide timely interventions, while considering PEth’s biological variability.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113047"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973938","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":"Successful hepatitis C elimination through decentralized treatment in Dutch addiction care: A RE-AIM based evaluation","authors":"Daan W. Von den Hoff ,&nbsp;Floor A.C. Berden ,&nbsp;Annemarie Noordeloos ,&nbsp;Thomas Knuijver ,&nbsp;Arnt F.A. Schellekens ,&nbsp;Joost P.H. Drenth","doi":"10.1016/j.drugalcdep.2025.113014","DOIUrl":"10.1016/j.drugalcdep.2025.113014","url":null,"abstract":"<div><h3>Background</h3><div>People who use drugs (PWUD) are an important population of focus for hepatitis C virus (HCV) elimination. Case-finding and treatment of these patients in outpatient specialist care is a challenge due to population specific barriers. Screening and treatment integrated in addiction care might overcome these barriers. With this study we aim to evaluate the implementation of a decentralized PWUD-HCV care model.</div></div><div><h3>Methods</h3><div>We conducted a multicenter prospective observational study in Dutch addiction care centers to assess a decentralized HCV care pathway for PWUD. Implementation of HCV-care within addiction care was evaluated using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework. Viral elimination, defined as the proportion of identified HCV-RNA positive PWUD achieving sustained virologic response (SVR), was the primary outcome.</div></div><div><h3>Results</h3><div>Reach: 870 anti-HCV tests were performed, 29 HCV-RNA positive PWUD were enrolled. Effectiveness: 23 patients initiated and completed on-site treatment, three patients were referred for treatment, two patients were lost to follow-up and one patient refused treatment. All patients tested for SVR achieved SVR, one patient was lost to follow-up before SVR test. The elimination rate was 86 % (25/29). Adoption: five out of eleven addiction care organizations (45 %) implemented decentralized HCV care within addiction care. Implementation fidelity was high.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that successfully implemented decentralized HCV care within addiction services is feasible and highly effective, achieving an elimination rate of 86 %. However, adoption of decentralized HCV care was limited, underscoring the need for targeted strategies to enhance implementation. Our findings support expanding of decentralized HCV care models in addiction settings to meet HCV elimination targets.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"279 ","pages":"Article 113014"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923351","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}