Drug and alcohol dependence最新文献

{"title":"Buprenorphine-naloxone versus buprenorphine for opioid use disorder during pregnancy: A systematic review and meta-analysis","authors":"Fernanda Ribeiro de Lima ,&nbsp;Gabriela Oliveira Gonçalves Molino ,&nbsp;Mariano Gallo Ruelas ,&nbsp;Eduardo Cerchi Barbosa ,&nbsp;Pedro Henrique Costa Matos da Silva ,&nbsp;Felipe Bandeira de Melo Guimarães ,&nbsp;Arthur Bezerra Cavalcanti Petrucci ,&nbsp;Giovanna Hanike Santos da Silva ,&nbsp;Ângelo Eduardo Espíndola Sbardelotto ,&nbsp;Saulo Bernardo Lança ,&nbsp;Alicja Garbacka","doi":"10.1016/j.drugalcdep.2025.112632","DOIUrl":"10.1016/j.drugalcdep.2025.112632","url":null,"abstract":"<div><h3>Background</h3><div>The standard of care for treating opioid use disorder (OUD) during pregnancy includes either buprenorphine or methadone. Although buprenorphine-naloxone presents an alternative due to the reduced risk of misuse , evidence regarding its impact on pregnancy and infant health remains limited. This systematic review and meta-analysis aims to compare buprenorphine-naloxone <em>vs</em> buprenorphine alone for OUD during pregnancy, assessing gestational and neonatal outcomes.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, Embase, and Cochrane Library databases to identify studies comparing buprenorphine-naloxone versus buprenorphine for OUD during pregnancy. The primary outcome assessed was neonatal abstinence syndrome (NAS). Pooled risk ratios (RR) and mean differences (MD) with 95 % confidence intervals (CI) were calculated using R statistical software and quality assessment was performed following Cochrane recommendations.</div></div><div><h3>Results</h3><div>Six retrospective cohorts were included, encompassing 9348 mother-infant dyads, of whom 38.3 % received buprenorphine-naloxone. NAS requiring treatment (RR 0.77; 95 % CI 0.71–0.84; p &lt; 0.01) and small for gestational age infants (RR 0.86; 95 % CI 0.76–0.98; p = 0.03) were significantly less frequent in the buprenorphine-naloxone group. No significant differences were found between the groups for cesarean delivery (RR 1.04; 95 % CI 0.98–1.11; p = 0.20), low birth weight (RR 1.07; 95 % CI 0.91–1.24; p = 0.41), and preterm delivery (RR 1.07; 95 % CI 0.96–1.21; p = 0.22).</div></div><div><h3>Conclusion</h3><div>Pregnant people treated with buprenorphine-naloxone had neonates with a lower risk of small for gestational age and NAS. Further research is needed to confirm these findings and explore other pregnancy-related and neonatal outcomes.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112632"},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600491","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":"Detection of benzodiazepines in the unregulated drug supply using point of care and confirmatory drug checking technologies: A validation study","authors":"Hannah Crepeault ,&nbsp;Samuel Tobias ,&nbsp;Jennifer Angelucci ,&nbsp;Stephanie Dubland ,&nbsp;Mark Lysyshyn ,&nbsp;Evan Wood ,&nbsp;Lianping Ti","doi":"10.1016/j.drugalcdep.2025.112631","DOIUrl":"10.1016/j.drugalcdep.2025.112631","url":null,"abstract":"<div><h3>Objective</h3><div>Benzodiazepine adulteration in British Columbia's (BC) unregulated opioid supply has risen. Given the health risks associated with co-ingestion of opioids and benzodiazepines, accurate detection of benzodiazepines using point-of-care drug checking technologies is critical. This study aimed to validate the use of Fourier-transform infrared spectroscopy (FTIR) and benzodiazepine immunoassay strips compared to gold standard laboratory technologies.</div></div><div><h3>Methods</h3><div>From October 2018 to November 2023, drug samples submitted to harm reduction sites in BC were analyzed using FTIR and benzodiazepine immunoassay strips. A subset of these samples was sent for confirmatory analysis using quantitative nuclear magnetic resonance spectroscopy, gas chromatography-mass spectrometry, and/or liquid chromatography-mass spectrometry. We calculated measures of diagnostic accuracy (e.g., sensitivity, specificity) for the point-of-care technologies.</div></div><div><h3>Results</h3><div>Of 1922 samples with point-of-care and confirmatory results, 390 (20 %) tested positive for a benzodiazepine. FTIR sensitivity was 26 % (95 % confidence interval [CI]:21–30 %) and specificity was 99 % (95 % CI:99–100 %). Immunoassay strip sensitivity was 67 % (95 % CI:62–72 %) and specificity was 82 % (95 % CI:79–85 %), respectively. When FTIR and immunoassay strip results were combined, sensitivity was 75 % (95 % CI:70–79 %) and specificity was 82 % (95 % CI: 79–84 %). When etizolam was excluded, the sensitivity and specificity of immunoassay strips were 98 % (95 % CI:94–99 %) and 83 % (95 % CI:81–86 %), respectively.</div></div><div><h3>Conclusions</h3><div>FTIR did not consistently detect the presence of benzodiazepines and related compounds at point-of-care. However, sensitivity improved when FTIR was combined with immunoassay strips, underscoring the importance of using both technologies in tandem. As etizolam is not a true benzodiazepine, it poses considerable challenges using existing point-of-care drug checking technologies.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112631"},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing inequities in buprenorphine treatment across the care cascade","authors":"Alyssa S. Tilhou ,&nbsp;Sarah Gasman ,&nbsp;Jiayi Wang ,&nbsp;Katherine Standish ,&nbsp;Laura F. White ,&nbsp;Ally Cogan ,&nbsp;Morgan Devlin ,&nbsp;Marc Larochelle ,&nbsp;William G. Adams","doi":"10.1016/j.drugalcdep.2025.112636","DOIUrl":"10.1016/j.drugalcdep.2025.112636","url":null,"abstract":"<div><h3>Objective</h3><div>Describe buprenorphine treatment gaps across the care cascade by race, ethnicity, age, sex and key clinical characteristics.</div></div><div><h3>Design</h3><div>Observational cohort study of new opioid use disorder (OUD) treatment episodes, 1/1/15–12/31/21</div></div><div><h3>Participants</h3><div>Individuals 16–89 years at Boston Medical Center and affiliated Boston-area clinics with OUD or buprenorphine prescription following 90-day washout</div></div><div><h3>Main outcomes and measures</h3><div>Buprenorphine initiation (by 14d), engagement (second prescription by 34d), and retention (continuous buprenorphine through 180d without &gt;14d gap). Covariates: sex, race and ethnicity, age, past 12-month buprenorphine, past 12-month overdose, co-occurring substance use disorder (SUD) and psychiatric diagnosis.</div></div><div><h3>Results</h3><div>24,165 episodes (14,182 individuals) included the following characteristics: female (34.1 %); Black (21.5 %), Latino (16.2 %), White (59.2 %); 16–25 years (4.1 %), 65–89 years (4.9 %). Initiation, engagement and retention were low: 39.3 %, 19.3 %, and 12.4 %. In adjusted models, compared with males, females’ lower probability of overall retention reflected lower engagement conditional on initiation (41 % vs. 53 %; OR:0.61, 95 %CI:0.56–0.67, p &lt; 0.001). Black individuals’ lower probability of retention overall reflected lower initiation than White individuals (28 % vs 44 %; OR:0.50, 95 %CI:0.46–0.55, p &lt; 0.001). The retention disadvantage for younger and older groups reflected cascade-wide gaps. Lower overall retention associated with co-occurring SUDs reflected lower initiation (OUD only:46 %; OUD plus: alcohol:19 % OR:0.27, 95 %CI:0.21–0.34, p &lt; 0.001; sedatives:21 %, OR:0.31, 95 %CI:0.20–0.49, p &lt; 0.001; stimulants:25 %, OR:0.40, 95 %CI:0.33–0.48, p &lt; 0.001; ≥3 SUDs:25 %, OR:0.40, 95 %CI:0.37–0.43, p &lt; 0.001).</div></div><div><h3>Conclusions and relevance</h3><div>Inequities in buprenorphine use emerged across the care cascade with unique patterns by sociodemographic and clinical subgroup. Health systems aiming to reduce buprenorphine inequities should identify the optimal cascade step based on the population of interest.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112636"},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548297","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":"Overdose and overwork: First responder burnout and mental health help-seeking in Missouri's overdose crisis","authors":"Anna La Manna ,&nbsp;Saad Siddiqui ,&nbsp;Garland Gerber ,&nbsp;Zach Budesa ,&nbsp;Kyle Vance ,&nbsp;Jeremiah Goulka ,&nbsp;Leo Beletsky ,&nbsp;Phil Marotta ,&nbsp;Rachel Winograd","doi":"10.1016/j.drugalcdep.2025.112590","DOIUrl":"10.1016/j.drugalcdep.2025.112590","url":null,"abstract":"<div><div>As the overdose crisis continues to spiral, high volume and intensity of drug poisoning calls are impacting first responders’ mental health. This study examined burnout and attitudes towards mental health help-seeking among first responders in Missouri. The study included 3059 participants, of which 76.4 % were law enforcement officers (LEO) and 23.6 % were emergency medical services personnel/firefighters (EMS/FF). Participants mainly comprised of men (80 %), and a majority had witnessed an overdose fatality (53 %). A descriptive analysis and Structured Equation Model (SEM) of field experience, mental health help-seeking, and burnout indicate that [1] emotional exhaustion and depersonalization levels were higher among LEO than EMS/FF (β= 0.25 and β = 0.28, respectively, p &lt; .001), [2] EMS/FF had higher personal accomplishment scores than LEO (β = −0.10, p = .046), [3] higher levels of depersonalization and emotional exhaustion were associated with lower levels of mental health help-seeking (β = 0.27 and β = 0.50, respectively, p &lt; .001), [4] higher levels of personal accomplishment was associated with higher levels of mental health help-seeking (β = −0.37, p &lt; .001), and 5) there was lower burnout among EMS/FF than LEO. This study highlights important differences in burnout within and across first responder professions. Additionally, this study sets the foundation for targeted research to focus on how burnout manifests itself within these individuals, how it affects their work, and how work environments are impacted. Moving forward, research and practice should prioritize exploring how mental-health help seeking influences burnout.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112590"},"PeriodicalIF":3.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600492","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":"Effects of volatile organic compounds found in cigarette smoke on intracranial self-stimulation in rats","authors":"Andrew C. Harris ,&nbsp;Peter Muelken ,&nbsp;Sam Howard ,&nbsp;Sarah Wilde ,&nbsp;Mark G. LeSage","doi":"10.1016/j.drugalcdep.2025.112633","DOIUrl":"10.1016/j.drugalcdep.2025.112633","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the role of non-nicotine constituents in tobacco use disorder (TUD) could inform the development of more effective treatments for TUD and tobacco control policies. Cigarette smoke contains considerable levels of various volatile organic compounds (VOCs) including acetaldehyde, toluene, and benzene. While acetaldehyde and toluene can have substance use disorder (SUD)-related effects and/or potentiate the TUD-related effects of nicotine in some preclinical models, their role in TUD is not fully understood, and effects of benzene have not been evaluated in any preclinical model of SUDs. This study evaluated the SUD-related effects of parenteral (s.c.) administration of these VOCs in an intracranial self-stimulation (ICSS) model in male and female rats. The ability of acetaldehyde and benzene to influence nicotine’s effects on ICSS was also examined. <em>Methods and Results.</em> In Experiment 1, acetaldehyde (10–150<!--> <!-->mg/kg) did not lower ICSS thresholds, suggesting a lack of SUD-related effects. Rather, 100<!--> <!-->mg/kg acetaldehyde elevated ICSS thresholds, indicating aversive/anhedonic effects. Benzene (600–1500<!--> <!-->mg/kg) reduced ICSS thresholds, while toluene (100–1500<!--> <!-->mg/kg) did not affect ICSS. Nicotine (1.0<!--> <!-->mg/kg) and methamphetamine (0.3 or 0.56<!--> <!-->mg/kg) (positive controls) increased and decreased ICSS thresholds, respectively. In Experiment 2, acetaldehyde (60<!--> <!-->mg/kg) did not influence nicotine’s (0.125–1.0<!--> <!-->mg/kg) effects on ICSS, whereas benzene (600<!--> <!-->mg/kg) produced a downward shift in the nicotine ICSS dose-response function in males but not in females. <em>Conclusions.</em> Benzene, but not acetaldehyde or toluene, had SUD-related effects in an ICSS model. As such, benzene may contribute to the TUD-related effects of combusted tobacco products, particularly in males.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"271 ","pages":"Article 112633"},"PeriodicalIF":3.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675121","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":"Non-fatal opioid overdose and unmet need for medications for opioid use disorder among recently incarcerated people who inject drugs","authors":"Valerie Madera-Garcia ,&nbsp;Dita Broz ,&nbsp;Amy R. Baugher ,&nbsp;Rebecca B. Hershow ,&nbsp;Sharoda Dasgupta ,&nbsp;Alice Asher ,&nbsp;Rose Hefferon ,&nbsp;Nancy Worthington ,&nbsp;Susan Cha ,&nbsp;for the NHBS Study Group","doi":"10.1016/j.drugalcdep.2025.112634","DOIUrl":"10.1016/j.drugalcdep.2025.112634","url":null,"abstract":"<div><h3>Background</h3><div>Medications for opioid use disorder (MOUD) are key to preventing opioid overdose. Despite the high risk of opioid overdose among recently incarcerated people who use drugs, missed opportunities for engagement in MOUD treatment persist in this population. We examined the association between unmet need for MOUD and non-fatal opioid overdose among recently incarcerated people who inject drugs (PWID) and assessed prevalence of non-fatal opioid overdose by selected characteristics.</div></div><div><h3>Methods</h3><div>We analyzed 2022 data from the National HIV Behavioral Surveillance (NHBS) system among PWID from 20 large U.S. cities. Adjusted prevalence ratios (aPR) and 95 % confidence intervals (95 % CI) were calculated to examine the association between unmet need for MOUD and non-fatal opioid overdose.</div></div><div><h3>Results</h3><div>Among 1648 recently incarcerated PWID, 28 % reported an unmet need for MOUD and 39 % reported a non-fatal opioid-involved overdose in the past 12 months. Experiencing homelessness in the last 12 months (aPR=1.43, 95 % CI=1.27–1.61) and living in the Midwest region of the U.S. (aPR=1.18, 95 % CI=1.01–1.38) were significantly associated with reporting a non-fatal opioid overdose. Recently incarcerated PWID with an unmet need for MOUD were 1.4 times as likely to report a non-fatal opioid overdose in the past 12 months (50 %; aPR=1.42, 95 % CI=1.29–1.56) compared with recently incarcerated PWID without an unmet need for MOUD (35 %).</div></div><div><h3>Conclusions</h3><div>Unmet need for MOUD was significantly associated with non-fatal opioid overdose among PWID who were incarcerated in the past 12 months, suggesting the need to investigate specific strategies to improve to MOUD treatment among recently incarcerated PWID.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112634"},"PeriodicalIF":3.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548309","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":"Environmental enrichment attenuates reinstatement of heroin seeking and reverses heroin-induced upregulation of mesolimbic ghrelin receptors","authors":"Apoorva Vashisht ,&nbsp;George Adamson ,&nbsp;Zuzu Gacso ,&nbsp;Joseph Slama ,&nbsp;Matthew Freund ,&nbsp;Sneha Vinod ,&nbsp;Natalie Sandoval ,&nbsp;Ziv Nachshon ,&nbsp;Sami Gubin ,&nbsp;Elizabeth Corso ,&nbsp;Zhi-Bing You ,&nbsp;Robert Ranaldi ,&nbsp;Ewa Galaj","doi":"10.1016/j.drugalcdep.2025.112635","DOIUrl":"10.1016/j.drugalcdep.2025.112635","url":null,"abstract":"<div><div>We have shown that environmental enrichment (EE) can effectively reduce reinstatement and facilitate true abstinence in animal models of drug use. Here, we investigated whether EE is effective against reinstatement of heroin seeking in long access (LA) model, which has been argued to capture the compulsive features of human drug addiction. We also explored the neurobiology by which EE produces its anti-drug addiction effects. In particular, we focused here on the ghrelin system, which is known for its involvement in reward-motivated behaviors and upregulation following intravenous drug self-administration. Following LA to heroin, rats were housed in either non-EE or EE conditions. During extinction and cue-induced reinstatement test, EE rats showed a significant reduction in active lever responding compared to non-EE rats, suggesting that EE facilitates extinction of drug seeking and reduces the capacity of drug-associated stimuli to elicit and maintain drug seeking. Using Western Blotting, we found that rats with LA to heroin IVSA showed a significant increase in ghrelin receptor (GHS-R1a) expression in the ventral tegmental area and nucleus accumbens, the brain regions implicated in resumption of drug use . Exposure to EE attenuated heroin-induced upregulation of GHS-R1a receptor in these regions but produced no significant changes other brain regions. Our findings suggest that EE can be an effective behavioral approach to diminish drug seeking even following LA to heroin. Compulsive drug taking and seeking seem to be correlated with an upregulation of GHS-R1a expression in the limbic regions, and EE can reverse these neuroadaptations, potentially contributing to a reduction in drug seeking.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112635"},"PeriodicalIF":3.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519944","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":"Adapting and applying tobacco dependence indicators to cannabis dependence","authors":"Robert J. Wellman ,&nbsp;David R. Strong ,&nbsp;Erin K. O'Loughlin ,&nbsp;Marie-Pierre Sylvestre ,&nbsp;Jennifer L. O’Loughlin","doi":"10.1016/j.drugalcdep.2025.112613","DOIUrl":"10.1016/j.drugalcdep.2025.112613","url":null,"abstract":"<div><h3>Objectives</h3><div>Dependence on addictive substances is indicated by impaired control, strong desires/craving, withdrawal symptoms with abstinence, challenges with quitting, etc. Most measures of dependence are substance-specific, which inhibits comparisons across substances. In light of increasing prevalence of cannabis and tobacco co-use, we aimed to adapt indicators of tobacco dependence to assess cannabis dependence (CD).</div></div><div><h3>Methods</h3><div>In 2024, past-year cannabis consumers (<em>n</em> = 320; <em>M</em>age = 35) from an ongoing 24-year longitudinal study completed self-report questionnaires. We examined the factor structure and measurement invariance across sex of the adapted 15-item scale, assessed the likelihood of endorsing and discriminative power of each item in participants with different degrees of CD, and explored the internal consistency, and construct and criterion-related validity of the scale.</div></div><div><h3>Results</h3><div>Items loaded strongly on a single factor, and strict measurement invariance across sex was confirmed. Items demonstrated strong discriminative power among individuals with varying degrees of CD. The scale demonstrated high internal consistency (ω_cat=0.94), excellent convergent reliability (<em>r</em> = 0.76 with the Cannabis Abuse Screening Test), and a small though statistically significant inverse correlation with age at first use (<em>ρ</em>=−0.20). There was a dose-response relationship with frequency of cannabis use (<em>ρ</em>=0.81).</div></div><div><h3>Conclusions</h3><div>The adapted scale has excellent psychometric properties and is invariant across sex. Additional research is needed to determine whether these properties hold with larger and more diverse samples and across types of cannabis products (e.g., leaf, edibles, hashish). The scale may permit direct comparison of dependence across tobacco vs. cannabis consumers.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112613"},"PeriodicalIF":3.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143508093","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":"Adaptive interventions for alcohol misuse and violent behaviors among adolescents and emerging adults in the emergency department: Outcomes from a sequential multiple assignment randomized controlled trial","authors":"Maureen A. Walton ,&nbsp;Laura Seewald ,&nbsp;Patrick M. Carter ,&nbsp;Quyen Ngo ,&nbsp;Frederic C. Blow ,&nbsp;Carrie Bourque ,&nbsp;Claire Pearson ,&nbsp;Katherine A. Battisti ,&nbsp;Larry An ,&nbsp;Mari Wank ,&nbsp;Yanruyu Zhu ,&nbsp;Kelley M. Kidwell","doi":"10.1016/j.drugalcdep.2025.112615","DOIUrl":"10.1016/j.drugalcdep.2025.112615","url":null,"abstract":"<div><h3>Introduction</h3><div>Harnessing technology for delivery of behavioral health interventions to reduce alcohol use and aggression may reduce morbidity among youth. This paper describes the outcomes from a sequential, multiple assignment, randomized trial (SMART) testing interventions for youth (ages 14–20) in the emergency department (ED).</div></div><div><h3>Methods</h3><div>Youth (n = 400) in the ED screening positive for binge drinking and aggression received the SafERteens brief intervention (BI) and were randomly assigned to boosters: Text Messages (TM) or Health Coach (HC) (1st stage; weeks 1–4). Participants completed 8 weekly surveys, with outcomes assessed at 4- and 8-months. After the 1st stage, response/non-response was determined (e.g., binge drinking or aggression). Responders were re-randomized to continued or minimized condition; non-responders were re-randomized to continued or intensified condition (2nd stage; weeks 5–8). Analyses examined outcomes from the initial randomization; and comparisons between responders and non-responders on primary (alcohol consumption, aggression), secondary (alcohol consequences, violence consequences) and exploratory (alcohol misuse, victimization, drug use, drug consequences) outcomes.</div></div><div><h3>Results</h3><div>There were no significant differences in outcomes between 1st stage boosters or 2nd stage boosters for non-responder or responder groups. However, significant changes over time were observed across all participants, with the odds of abstaining from alcohol increased at 4 (OR 3.97, 95 % CI 2.46–6.41) and 8-months (OR 4.36, 95 % CI 2.11–9.02), while the odds of aggression (OR 0.39, 95 % CI 0.16–0.94) decreased at 8-months; significant decreases were also observed for other outcomes.</div></div><div><h3>Conclusions</h3><div>Findings support the promise of digital health interventions for youth with binge drinking and aggression.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112615"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512628","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":"Patient–navigator working alliance and hepatitis C treatment cascade outcomes among persons who inject drugs: The HERO study","authors":"Snehal S. Lopes ,&nbsp;J. Edward Dotherow ,&nbsp;Irene Pericot-Valverde ,&nbsp;Paula J. Lum ,&nbsp;Lynn E. Taylor ,&nbsp;Shruti H. Mehta ,&nbsp;Judith I. Tsui ,&nbsp;Judith Feinberg ,&nbsp;Arthur Y. Kim ,&nbsp;Brianna L. Norton ,&nbsp;Kimberly Page ,&nbsp;Cristina Murray-Krezan ,&nbsp;Jessica Anderson ,&nbsp;Alison Karasz ,&nbsp;Julia Arnsten ,&nbsp;Phillip Moschella ,&nbsp;Moonseong Heo ,&nbsp;Alain H. Litwin ,&nbsp;the HERO study group","doi":"10.1016/j.drugalcdep.2025.112617","DOIUrl":"10.1016/j.drugalcdep.2025.112617","url":null,"abstract":"<div><h3>Introduction</h3><div>Integrating patient navigation (PN) interventions in hepatitis C virus (HCV) elimination efforts enhances HCV treatment cascade outcomes from screening to cure. Nonetheless, little is known about how the patient–navigator working alliance influences the effectiveness of PN interventions. This study among persons who inject drugs (PWID) living with HCV aimed to assess the association between patient–navigator working alliance and HCV treatment cascade outcomes.</div></div><div><h3>Methods</h3><div>This study utilized the Hepatitis C Real Options (HERO) study data for a subset of participants from the PN arm who responded to the patient–navigator working alliance survey at the end-of-treatment timepoint (N = 227). Working alliance was measured using the 16-item Brief Alliance Inventory (BAI). The average BAI overall and subscales (‘bonds’ and ‘tasks/goals’) scores were calculated. Outcomes included sustained virologic response (SVR), HCV treatment adherence, duration, completion and HCV reinfection. Linear and logistic regression models were used for continuous and binary outcomes, respectively.</div></div><div><h3>Results</h3><div>Stronger overall working alliance was associated with a higher likelihood of achieving SVR [aOR (95 % CI) = 6.31 (1.68, 23.77); p = .007]. Similarly, the likelihood of SVR was higher for stronger ‘bonds’ [7.65 (1.79, 32.76); p = .006] and 'tasks/goals’ [4.50 (1.35, 15.02); p = .014] working alliance. However, working alliance was not significantly associated with the other outcomes.</div></div><div><h3>Discussion</h3><div>A stronger patient–navigator working alliance is associated with achieving HCV cure but not treatment adherence or completion. More studies are needed to understand the factors that enhance patient–navigator working alliance so that future PN interventions may further incorporate those features to improve HCV outcomes among PWID.</div></div>","PeriodicalId":11322,"journal":{"name":"Drug and alcohol dependence","volume":"270 ","pages":"Article 112617"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527514","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}