Journal of Addiction Medicine最新文献

{"title":"Managing the Hospital Capacity Challenges of Medetomidine Withdrawal: A Retrospective Report of Dexmedetomidine Use in Intermediate Care Units.","authors":"Philip A Durney, Dennis Goodstein, Elise Paquin, Gamal Fitzpatrick, TaReva Warrick-Stone, Maeve Montesi, Lara Carson Weinstein, Christopher Martin, Kory London","doi":"10.1097/ADM.0000000000001789","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001789","url":null,"abstract":"<p><strong>Objectives: </strong>Medetomidine, a veterinary alpha-2-adrenergic agonist, has emerged as a dominant adulterant in the Philadelphia illicit opioid supply, producing a severe withdrawal syndrome requiring significant inpatient support. We developed an intravenous dexmedetomidine protocol for intermediate care units (IMCU) and describe the safety and feasibility of delivering this care outside the intensive care unit (ICU).</p><p><strong>Methods: </strong>A retrospective descriptive analysis of patients who received dexmedetomidine under an IMCU orderset for alpha-2 withdrawal was conducted at two urban medical centers in Philadelphia, PA, from April 2024 to February 2026. Encounters were classified as protocol-concordant or protocol-discordant by dosing and level of support; the concordant cohort was primary. Variables included demographics and addiction consult status. Outcomes included length of stay (hospital and IMCU), ICU admission, rapid response team activation, intubation, and discharge disposition.</p><p><strong>Results: </strong>Of 487 encounters, 449 (92.2%) were protocol-concordant and 38 (7.8%) protocol-discordant. All subsequent results describe the protocol-concordant cohort (n=449) unless otherwise noted. The cohort was predominantly male (58.1%) with a mean age of 41.8 years. Median hospital stay was 6.0 days and median IMCU stay was 2.2 days. ICU admission was not required in 50.1% of encounters. Rapid response team activation occurred in 38 encounters (8.5%), the majority for escalating withdrawal management. Patient-directed discharge occurred in 41.4% of encounters.</p><p><strong>Conclusions: </strong>An IMCU dexmedetomidine protocol deployed across seven monitored units at 2 hospitals offers a replicable framework for managing medetomidine withdrawal while potentially mitigating critical care capacity challenges. Identified opportunities include modification of titration and dosing strategies and further investment in addiction consult infrastructure.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine Use Disorder and Entrenchment of Delusional Beliefs: A Case Report.","authors":"Samuel Sukmin Yang, Rachel Goud, Jeremy Weleff","doi":"10.1097/ADM.0000000000001788","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001788","url":null,"abstract":"<p><strong>Background: </strong>Ketamine has gained increasing attention for its therapeutic potential, yet concerns remain regarding its misuse and the associated complications of its use. Ketamine use and ketamine use disorder can induce psychotic symptoms, but the persistence of such symptoms with chronic use and effective treatment of these symptoms is poorly characterized. Although case reports of ketamine use and medical and psychiatric consequences exist in the literature, there is limited evidence regarding the treatment of ketamine use disorder (KUD).</p><p><strong>Case summary: </strong>We present the case of a 36-year-old man who developed persistent delusional beliefs and medical complications over 2 years of heavy, chronic ketamine use. In the absence of any prior psychiatric diagnoses other than alcohol use disorder, he met DSM-5-TR criteria for KUD. His beliefs were primarily grandiose and hyper-religious in content, incorporating fringe online content. Although there was a limited impact on his functioning, his beliefs were maintained in delusional intensity. Written informed consent was obtained from the patient.</p><p><strong>Conclusions: </strong>This case report illustrates a manifestation of enduring delusional beliefs in the setting of chronic ketamine use and other important medical sequelae of its use. Limited literature exists concerning the treatment of ketamine use disorder or related psychotic symptoms, and there is a need for standardized treatment guidelines so interventions may be provided promptly to prevent serious psychiatric and medical complications.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Transplantation Outcomes in Patients With and Without Alcohol Use Disorder Diagnosis: Evidence From a Nationwide Cohort Study.","authors":"Yu Si Chen, Paola Lavin, Samuel Cyr, Kellie Elkrief, Kyle T Greenway, Irina Kudrina, Steven Tate, C William Pike, Gavin Hui, Simon Dubreucq, Philippe Willems, Michael Ostacher, Didier Jutras-Aswad, Anna Lembke, Nicolas Garel","doi":"10.1097/ADM.0000000000001777","DOIUrl":"10.1097/ADM.0000000000001777","url":null,"abstract":"<p><strong>Objectives: </strong>Alcohol-related liver disease is the primary indication for liver transplantation, yet posttransplant outcomes among recipients with an alcohol use disorder (AUD) diagnosis remain inconsistent. This study assesses whether AUD is associated with adverse liver transplantation (LT) outcomes after adjustment for clinical and sociodemographic factors.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult LT recipients (2015-2024) using a nationally representative electronic health record database (Atropos). Recipients with AUD within 1 year before transplantation were compared with recipients without the diagnosis. Outcomes included mortality, graft rejection, and hospitalization. Confounding was addressed using unmatched analyses, demographic matching, and high-dimensional propensity score matching (HDPSM). One-year outcomes were assessed with odds ratios (ORs) and long-term outcomes with Cox models and Kaplan-Meier analyses.</p><p><strong>Results: </strong>Among 24,865 recipients of LT, the ones who had an AUD diagnosis (n=2393) presented an association with higher posttransplant mortality across all analytic approaches. In the adjusted HDPSM analysis, AUD was associated with increased 1-year mortality (OR: 3.20, 95% CI: 1.81-5.64) and greater long-term mortality risk (HR: 1.81, 95% CI: 1.24-2.62). Elevated risks of graft rejection and hospitalization were observed in less-adjusted models; however, these associations were no longer statistically significant after HDPSM adjustment (eg, 1-y graft rejection OR: 1.13, 95% CI: 0.85-1.48; long-term hospitalization HR: 0.91, 95% CI: 0.78-1.05).</p><p><strong>Conclusions: </strong>AUD is associated with increased post-LT mortality even after adjustment. Differences in graft rejection and hospitalization were attenuated after HDPSM, suggesting influence from comorbidity and health care utilization rather than AUD alone.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visiting Nurse Services-facilitated Outpatient Low-dose Buprenorphine Initiation and Engagement in Severe Mental Illness and Ongoing Fentanyl Use: A Case Report.","authors":"Fabiola Arbelo Cruz, Jean C Castillo, Nicolas Pérez Palmer","doi":"10.1097/ADM.0000000000001784","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001784","url":null,"abstract":"<p><strong>Background and objectives: </strong>Outpatient low-dose buprenorphine initiation (LDBI) is challenging for individuals with severe mental illness and poor treatment adherence. Visiting nurse services (VNS) may support LDBI in these complex patients.</p><p><strong>Methods: </strong>We present a 64-year-old male with opioid use disorder, schizoaffective disorder, and post-traumatic stress disorder who underwent outpatient LDBI supported by VNS.</p><p><strong>Results: </strong>VNS managed medication administration and adherence monitoring, facilitating successful LDBI and sustained engagement.</p><p><strong>Discussion and conclusions: </strong>VNS facilitated outpatient LDBI and buprenorphine treatment engagement in a patient with fluctuating psychiatric illness and ongoing fentanyl use.</p><p><strong>Scientific significance: </strong>This case suggests that VNS may facilitate outpatient LDBI and engagement among clinically complex patients in the fentanyl era.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping Review of Implementation Science in Digital Intervention Research for Substance Use Disorders.","authors":"Deepika Rao, Madison K Clement, Caitlin M Reardon, Lisa Saldana, Aimee N C Campbell, Sarah E Lord","doi":"10.1097/ADM.0000000000001780","DOIUrl":"10.1097/ADM.0000000000001780","url":null,"abstract":"<p><strong>Objectives: </strong>Digital substance use interventions (DSUI) have demonstrated effectiveness in preventing, treating, and supporting recovery of substance use disorders (SUD), but their large-scale adoption and sustained implementation remain limited. To highlight the state of the science for DSUI implementation research, we conducted a scoping review of relevant studies of implementation of DSUI.</p><p><strong>Methods: </strong>We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review guidelines. Search was conducted using keywords (eg, technology, substance use, implementation) in Medline, PsycINFO, and Health Technology Assessment databases. Studies without implementation data, protocols, reviews, editorials, and non-English papers were excluded. Publications were included through February 2023. We screened 4178 abstracts and 148 full texts using Covidence software. We extracted implementation-related data from the included studies and organized it using standardized terminology for implementation determinants, strategies, and outcomes.</p><p><strong>Results: </strong>The 48 studies represented implementation (n=7), determinant (n=8), and combined effectiveness and implementation studies or hybrid studies (n=33). Most common DSUI were treatment and recovery support approaches for general drug use, most frequently delivered as electronic programs on computers. Only 12 of 48 studies used implementation frameworks. Implementation strategies were rarely described. Acceptability was the most evaluated implementation outcome (n=26), and no study evaluated implementation costs. Evaluation of patient-level implementation determinants and longer-term sustainment outcomes was lacking.</p><p><strong>Conclusions: </strong>To accelerate translation and improve research rigor, future DSUI research should systematically apply implementation science frameworks to evaluate implementation determinants (including patient-level), document and test implementation strategies, and evaluate outcomes, including fidelity, cost, and sustainment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of a 3-day Benzodiazepine Detoxification Protocol With Continuous Subcutaneous Flumazenil Infusion: An Open-label Pilot Study.","authors":"Damian A Visser, Erik P Paling, Daphne S Everaerd, Nens van Alfen, Janneke R Zinkstok, Indira Tendolkar, Cornelis Kramers, Arnt F A Schellekens","doi":"10.1097/ADM.0000000000001786","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001786","url":null,"abstract":"<p><strong>Objectives: </strong>Abstinence rates of benzodiazepine tapering in individuals with sedative, hypnotic, or anxiolytic use disorder (SHA‑UD) are approximately 50%. Continuous subcutaneous flumazenil infusion during tapering may increase success rates and shorten tapering regimens; however, data on safety and effectiveness remain limited. We therefore aimed to assess the safety, withdrawal symptoms, and abstinence rates associated with flumazenil‑assisted 3-day benzodiazepine tapering in individuals with SHA‑UD.</p><p><strong>Methods: </strong>This exploratory, single‑arm, open‑label pilot study included adult participants with SHA‑UD (n=31) who had experienced at least one previous unsuccessful professionally guided tapering attempt. Participants received a 6‑day continuous subcutaneous flumazenil infusion (4 mg/24 h), while benzodiazepines were fully tapered during the first 3 days. Outcomes included adverse events, interictal epileptiform discharges (IEDs) on EEG, withdrawal severity, anxiety, and abstinence rates at 3‑month follow‑up.</p><p><strong>Results: </strong>After a withdrawal seizure occurred in one of the first 4 participants, valproate prophylaxis was introduced; no further seizures were observed thereafter. IEDs were detected in 6 participants during or after flumazenil infusion. Supportive medication (eg, propranolol, promethazine) was required in 87% of participants to manage withdrawal symptoms. Withdrawal severity and anxiety increased during detoxification, peaking during the final days of flumazenil infusion (P=0.023). Sixteen participants (52%) were confirmed abstinent at 3-month follow-up by self-report and urinalysis.</p><p><strong>Conclusions: </strong>These findings warrant further investigation of flumazenil-assisted benzodiazepine detoxification in individuals with SHA-UD. Controlled studies are needed to further establish its safety profile and comparative effectiveness.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Buprenorphine Was Not Enough: Methadone Treatment of Tianeptine Use Disorder.","authors":"David Tyler Coyle, Morgan Kitano, Susan Calcaterra","doi":"10.1097/ADM.0000000000001782","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001782","url":null,"abstract":"<p><strong>Introduction: </strong>Tianeptine, approved in 25 countries for depression treatment, is an atypical tricyclic with clinically relevant µ-opioid receptor agonist activity at high doses. Tianeptine is not approved by the Food and Drug Administration in the United States, and until recently, was illegally marketed as an over-the-counter \"supplement.\" Tianeptine's pharmacological activity at the µ-opioid receptor and opioid withdrawal-like syndrome have prompted clinicians to use buprenorphine and methadone to manage tianeptine withdrawal and treat tianeptine use disorder. This case report describes successful treatment of tianeptine use disorder using methadone in a patient without an active opioid use disorder (OUD).</p><p><strong>Case report: </strong>A 51-year-old woman with hypothyroidism, major depressive disorder, and OUD in sustained remission presented to an opioid treatment program (OTP) seeking treatment for tianeptine use disorder. The patient reported that 24 mg/d buprenorphine was ineffective in managing her tianeptine cravings and withdrawal symptoms. Her stated goal was to abstain from tianeptine use. The patient initiated methadone at 30 mg/d and reached a steady-state methadone dose of 86 mg/d. She has abstained from tianeptine for 3 years and demonstrated sustained treatment stability allowing for multiple weeks of take-home methadone doses.</p><p><strong>Discussion: </strong>Patients with tianeptine use disorder, and with use disorders resulting from regular use of substances characterized as nonopioid but with µ-opioid receptor agonist effects, may follow a similar clinical course to patients with OUD. This case highlights an emerging treatment gap for use disorders involving substances with clinically relevant µ-opioid receptor agonist effects that do not fall within the OUD-based OTP treatment framework.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights About Nitazene Use From Self-reported Experiences on Reddit Obtained Using Natural Language Processing.","authors":"Pranav Sompalle, Jeanmarie Perrone, Rachel Wightman, Jennifer Love, JaMor Hairston, Sahithi Lakamana, Abeed Sarker","doi":"10.1097/ADM.0000000000001760","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001760","url":null,"abstract":"<p><strong>Introduction: </strong>Nitazenes are an emerging class of highly potent synthetic opioids not approved for clinical use. Knowledge of nitazene-associated practices and clinical effects remains limited. Reddit contains nitazene-related discussions describing self-reported experiences. We analyzed nitazene mentions to characterize these experiences.</p><p><strong>Methods: </strong>Nitazene-mentioning posts between 01/2019 and 10/2025 were extracted via natural language processing-based lexical filters, and a random sample of 293 mentions was qualitatively reviewed and annotated for themes consolidated via consensus discussion. Repeated findings more specific than themes were synthesized as subthemes, and a validated GPT-4o-based pipeline was applied to all mentions to forecast the theme distribution.</p><p><strong>Results: </strong>A total of 31,638 mentions were extracted; frequency increased between 2022 and 2024 (mean 584 mentions/month, P<0.01 increase compared with 2019-2021's mean of 197 mentions/month). Ten themes were curated, with source (31.3%), potency and dose (26.5%), and uncertainty (25.9%) most prevalent in the annotated sample. Across the full dataset, automated characterization predicted that general experience (44.7%), general comment (37.9%), and potency and dose (27.6%) were the most prevalent thematic labels. Nine subthemes included information about counterfeit pills, withdrawal management difficulties, motivating factors for use, benzodiazepine adulteration, and vascular injury associated with intravenous administration.</p><p><strong>Discussion: </strong>Increasing nitazene mentions on Reddit may reflect increasing interest and use. Thematic characterization identified patterns in nitazene use, effects, and distribution relevant to clinical practice and public health. Insights provided by subthemes align with laboratory potency assessments and emerging evidence from case series and health alerts.</p><p><strong>Conclusion: </strong>These findings can inform public health monitoring, overdose prevention, and clinical characterizations of nitazene use.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Hospital Substance Use: A Qualitative Study of Patient and Staff Experiences.","authors":"Taylor Baisey, Madeleine Peitz, Elyssa Samayoa, Kelly Knight, Jane Caporiccio, Gillian Otway, Marlene Martín, Leslie W Suen","doi":"10.1097/ADM.0000000000001776","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001776","url":null,"abstract":"<p><strong>Objectives: </strong>To understand patient and staff experiences with in-hospital substance use (IHSU) and develop recommendations to better support patients and staff navigating IHSU.</p><p><strong>Methods: </strong>Semi-structured qualitative interviews with patients engaging in and hospital staff responding to IHSU in the past year at a safety-net hospital in San Francisco, California, from July 2024 to August 2025. We used iterative thematic analysis to identify major themes.</p><p><strong>Results: </strong>Patients (n=19) were recruited from the community (84.2%) and hospital (15.8%). Most identified as men (73.7%), White (63.2%), and unhoused (57.9%); most used fentanyl during hospitalization (57.9%). Staff (n=21) included clinicians (28.6%), nurses (28.6%), nurse leaders (19.0%), administrators (14.3%), and other staff members (9.5%); primary work areas were administration (23.8%), the addiction consult team (19.0%), and medical-surgical departments (19.0%). We identified seven themes regarding patient and staff experiences: (1) IHSU helped patients endure hospitalization; (2) punitive responses exacerbated patient experiences of mistrust, stigma, and distress; (3) patient-centered responses improved patient and staff experiences; (4) staff were concerned for patient and staff safety; (5) nurses were concerned about personal liability; (6) nurses felt unheard in concerns; and (7) staff felt underprepared to respond to IHSU.</p><p><strong>Conclusions: </strong>IHSU helped patients avoid patient-directed discharge but distressed staff-especially nurses-due to a lack of training and support. To improve patient and staff experiences, hospitals can implement standardized addiction medicine training, proactive evidence-based inpatient addiction treatment, trauma-informed IHSU responses, and evidence-based patient-centered policies for responding to IHSU that support patients and staff.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Alcohol Use are Associated With Changes in Depression Severity Among People With HIV.","authors":"Mindy Dai, Joseph A C Delaney, Geetanjali Chander, Heidi M Crane, Laura Bamford, Greer Burkholder, Edward Cachay, Katerina Christopoulos, Kenneth H Mayer, Sonia Napravnik, Michael S Saag, Bridget M Whitney, George A Yendewa, Mary E McCaul, Lydia N Drumright","doi":"10.1097/ADM.0000000000001769","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001769","url":null,"abstract":"<p><strong>Objectives: </strong>High-risk alcohol use is associated with depressive symptoms. It is unclear if changes in alcohol use are correspondingly associated with changes in depression severity among people with HIV (PWH).</p><p><strong>Methods: </strong>Data were from clinical assessments of patient-reported outcomes (PROs) completed by PWH receiving primary care at 7 sites of the Center for AIDS Research Network of Integrated Clinical Systems. Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores, range (lower to higher risk): 0-12, and Patient Health Questionnaire-9 (PHQ-9) scores, range for depressive symptom burden: 0-27 (≥10 indicative of clinically relevant depression), from PROs were identified as observation pairs (PHQ-9 and AUDIT-C on the same day) occurring 1-2 years apart. We used linear regression with clustered standard errors to estimate the association between changes in AUDIT-C and changes in PHQ-9 stratified by baseline alcohol consumption.</p><p><strong>Results: </strong>A total of 7806 PWH contributed 13,302 observation pairs with a baseline mean age of 45.4 (SD: ±11.4); 15% were female and 55% identified with a non-White race/ethnicity. Each 1-point increase in AUDIT-C was associated with a 0.30-point (95% CI: 0.15-0.44), 0.26-point (95% CI: 0.14-0.37), and 0.20-point (95% CI: 0.10-0.30) increase in PHQ-9 for PWH with no alcohol use, low-to-moderate risk alcohol use, and high-risk alcohol use at baseline, respectively. Estimates were essentially stable after adjusting for sex, age, and race/ethnicity.</p><p><strong>Conclusions: </strong>There is a modest, statistically significant association between change in AUDIT-C and change in PHQ-9. These findings highlight the importance of routinely monitoring alcohol use and depression in HIV primary care settings. Future studies exploring causal directions are warranted.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}