Journal of Addiction Medicine最新文献

{"title":"Characteristics of Ongoing Clinical Trials for Cocaine Use Disorder Registered on Global Clinical Trial Databases.","authors":"Fernanda Gushken, Thiago Marques Fidalgo, Vítor S Tardelli","doi":"10.1097/ADM.0000000000001580","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001580","url":null,"abstract":"<p><strong>Objectives: </strong>Cocaine use disorder (CUD) affects 1.4 million people in the United States, yet no FDA-approved treatments exist. In 2023, the Food and Drug Administration (FDA) released a draft guideline on treatments for stimulant use disorders, providing direction for trial design, outcomes, and population selection. In this study, we aimed to review ongoing clinical trials for CUD and assess their alignment with the FDA's recommendations.</p><p><strong>Methods: </strong>We conducted a systematic search of the 6 major clinical trial databases (United States, Australia, Canada, Iran, Netherlands, and Switzerland) to identify ongoing interventional studies for CUD. We included trials evaluating pharmacological, behavioral, device-based, and mixed treatments. We extracted data on intervention type, target population, study design, duration, and primary outcomes. Trials were assessed for alignment with 5 key FDA recommendations, including trial duration, use of both self-reported and biological outcome measures, randomization, placebo control, and double blinding.</p><p><strong>Results: </strong>In total, 38 trials were identified, primarily from the United States (32). Most trials were randomized: 36 (94.7%), while 21 (55.3%) trials had combined endpoints or a 3-month minimum duration. Only 7 trials (18.4%) met all 5 key FDA recommendations. New treatment approaches were identified, including psilocybin and the dAd5GNE vaccine, as well as digital platforms for behavioral therapies.</p><p><strong>Conclusions: </strong>A variety of promising treatments for CUD are under investigation. However, many trials fall short of current FDA design recommendations. Improved adherence to regulatory guidance and stronger collaboration between researchers and regulators will be essential to advance effective, scalable treatments for CUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015390","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":"DSM-5 Stimulant Use Disorder Severity, Stimulant Craving, and Other Clinical Characteristics Based on Stimulant Type (Cocaine, Methamphetamine, Nonmedical Prescription Stimulants, or Polystimulants).","authors":"Joshua Truchan, Ty S Schepis, Emily Pasman, Vita V McCabe, Sean Esteban McCabe","doi":"10.1097/ADM.0000000000001563","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001563","url":null,"abstract":"<p><strong>Objectives: </strong>This study examined DSM-5 stimulant use disorder (StimUD) symptom severity, stimulant craving, and clinical characteristics associated with different stimulant types.</p><p><strong>Methods: </strong>Nationally representative cross-sectional data from the 2021-2022 National Survey on Drug Use and Health (N = 117,103) was analyzed to determine the past-year prevalence and adjusted odds of DSM-5 StimUD symptom severity, stimulant craving, psychological distress, suicidality, and major depressive episodes among individuals who used crack cocaine, methamphetamine, non-crack cocaine, nonmedical prescription stimulants (NPSU), or polystimulants (≥2 stimulants).</p><p><strong>Results: </strong>Past-year DSM-5 StimUD was most prevalent and severe among individuals who used crack cocaine, methamphetamine-only, or polystimulants, versus non-crack cocaine-only and NPSU-only. Stimulant craving was the most prevalent DSM-5 StimUD symptom, highest among those reporting polystimulant use (56.6%), followed by methamphetamine-only (51.2%), crack cocaine (48.0%), non-crack cocaine-only (18.6%), and NPSU-only (16.6%). Stimulant craving showed a dose-response association with more frequent use. Polystimulant use was associated with the highest rates of psychological distress, suicidal ideation, suicide attempt, and major depressive episodes. In controlled analyses, adjusted odds of impaired control, social impairment, risky use, pharmacologic indicators, and craving were greater among those using crack cocaine, methamphetamine-only, and polystimulants, relative to NPSU-only. Individuals reporting non-crack cocaine use-only had lower odds of psychological distress [AOR = 0.63 (95% CI = 0.44-0.92)] and major depressive episodes [AOR = 0.61 (95% CI = 0.40-0.91)] compared with NPSU-only.</p><p><strong>Conclusions: </strong>Individuals using different stimulant types differ in DSM-5 StimUD symptoms, craving, and other clinical characteristics, especially those engaged in crack cocaine, methamphetamine, and polystimulant use. Health care professionals should consider these differences when treating individuals who use stimulants.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954862","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":"Buprenorphine Salivary Gland Accumulation Sustaining High Oral Fluid Exposure and Increasing the Risk of Streptococcus mutans Biofilm Formation.","authors":"Zicong Zheng, Jie Chen, Songpol Srinual, Vesna Tumbas Šaponjac, Taijun Yin, Bing-Yan Wang, Rongjin Sun, Ming Hu","doi":"10.1097/ADM.0000000000001401","DOIUrl":"10.1097/ADM.0000000000001401","url":null,"abstract":"<p><strong>Objectives: </strong>The US Food and Drug Administration (FDA) issued a warning about buprenorphine-induced dental caries of unknown mechanism in 2022. To investigate the potential mechanism, the association between local buprenorphine exposure and dental biofilm formation will be explored in this study.</p><p><strong>Methods: </strong>Female F344 rats were dosed with sublingual buprenorphine film or intravenous injection to explore the oral cavity exposure of the buprenorphine. The buprenorphine distribution in salivary glands after the sublingual and intravenous administration was also evaluated. To investigate the effects of buprenorphine exposure on dental caries formation, buprenorphine's impact on the biofilm formation of S. mutans in vitro was measured.</p><p><strong>Results: </strong>The absolute sublingual bioavailability of buprenorphine in rats was 17.8% with a high ratio of oral fluid exposure to blood concentration in the pharmacokinetic study. Salivary gland concentrations of buprenorphine and its active metabolite norbuprenorphine were significantly higher than their blood concentrations after both sublingual (s.l.) and intravenous (i.v.) administration. Correlation analysis showed that the oral fluid concentration of buprenorphine and norbuprenorphine was highly correlated to salivary gland concentration rather than blood concentration. These data indicate that the salivary gland serves as an accumulation organ for buprenorphine, allowing prolonged oral fluid exposure to buprenorphine. Lastly, buprenorphine and its metabolites contributed to the biofilm formation of S. mutans in high concentration.</p><p><strong>Conclusions: </strong>Sublingual administration substantially increased the salivary gland distribution of buprenorphine and norbuprenorphine. Depot effects following sublingual dosing and salivary gland accumulation likely sustained high oral fluid exposure to buprenorphine and stimulated the biofilm formation of S. mutans.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"520-528"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication for Opioid Use Disorder for Hospitalized Patients at Six New York City Public Hospitals With an Addiction Consult Service.","authors":"Yasna Rostam-Abadi, Jennifer McNeely, Thaddeus Tarpey, Jasmine Fernando, Noa Appleton, Adetayo Fawole, Medha Mazumdar, Roopa Kalyanaraman Marcello, Caroline Cooke, Johanna Dolle, Samira Siddiqui, Daniel Schatz, Carla King","doi":"10.1097/ADM.0000000000001450","DOIUrl":"10.1097/ADM.0000000000001450","url":null,"abstract":"<p><strong>Objectives: </strong>We explored medications for opioid use disorder treatment (MOUD) utilization in six New York City public hospitals that implemented the \"Consultation for Addiction Care and Treatment in Hospitals (CATCH)\" program.</p><p><strong>Methods: </strong>CATCH rolled out between October 2018 and February 2020. Data from the electronic health record were analyzed for the first year post-implementation. Eligible cases included adults with an opioid-related diagnosis admitted to inpatient departments served by CATCH, with a stay of ≥1 night. Patients were classified as receiving an MOUD order if there was at least 1 order of buprenorphine, methadone, or naltrexone. Logistic regression modeled the impact of CATCH consults on MOUD orders, controlling for demographic and clinical characteristics with hospital as a random effect.</p><p><strong>Result: </strong>Among 2117 eligible patients, 71.4% were male, with a mean age of 51.2 years, and 27.2% identified as Black, 21.2% as White, and 34.5% as Hispanic. MOUD was ordered in 60.9% of admissions, and 41.5% had a completed CATCH consult. Patients identified as Black had lower odds of receiving a MOUD order than those identified as White (OR: 0.52, 95% CI: 0.38-0.71; P  < 0.001). Patients with a CATCH consult had higher odds of receiving a MOUD order (OR: 3.22, 95% CI: 2.54-4.07; P  < 0.001).</p><p><strong>Conclusion: </strong>Majority of patients in our sample received a MOUD order, with higher odds among those with a CATCH consult. Further research is needed on the drivers of racial disparities in MOUD, and other contextual, organizational, and population-specific barriers and facilitators contributing to receipt of hospital-based addiction consult services and MOUD.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"557-564"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254066","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":"Association Between Buprenorphine Adherence Trajectories, Health Outcomes, and Health Care Costs Among Medicaid Enrollees.","authors":"Olajumoke A Olateju, Chijioke Okeke, Mina Shrestha, Douglas Thornton","doi":"10.1097/ADM.0000000000001458","DOIUrl":"10.1097/ADM.0000000000001458","url":null,"abstract":"<p><strong>Objectives: </strong>To identify distinct buprenorphine adherence trajectories among patients with opioid use disorder (OUD) and evaluate their associations with health events and health care costs.</p><p><strong>Methods: </strong>A retrospective longitudinal cohort study was conducted using the Merative Multi-state Medicaid database. The study analyzed 12,244 Medicaid enrollees aged 18-64 years who were diagnosed with OUD and initiated buprenorphine treatment between July 1, 2017 and June 30, 2019. Group-based trajectory models were used to identify adherence patterns during the first 180 days of treatment. Cox proportional hazard models were used to evaluate the associations between adherence trajectories and time to opioid overdose, substance use disorder-related hospitalization, and all-cause hospitalization. Generalized linear models were used to compare health care costs across trajectories.</p><p><strong>Results: </strong>Four buprenorphine adherence trajectories were identified: completely adherent (50.8%), initially adherent with later decline (13.6%), increasing adherence with later decline (9.9%), and continuously declining nonadherence (25.8%). Compared to the completely adherent group, patients in other groups had a higher risk of opioid overdose, hospitalization and increased health care costs. The continuously declining nonadherent group demonstrated the highest risks, with an opioid overdose hazard ratio (HR) of 1.92 (95% CI, 1.46-2.39), all-cause hospitalization of HR of 1.71 (95% CI: 1.58-1.85), and substance use disorder (SUD)-related hospitalization HR of 2.01 (95% CI: 1.82-2.15). Additionally, healthcare costs were notably higher compared to the completely adherent group, with an increase of $1482.45 (95% CI: $745.45-$2756.01) in the increasing adherence with later decline group and $1698.46 (95% CI: $432.57-$3087.78) in the continuously declining nonadherence groups.</p><p><strong>Conclusions: </strong>Almost half of Medicaid beneficiaries with OUD exhibited varying degrees of nonadherence to buprenorphine within 180 days of treatment initiation. This nonadherence was associated with adverse clinical outcomes and increased health care costs. Health care providers should consider adherence challenges when designing therapeutic interventions with buprenorphine.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"578-590"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458072","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":"Outpatient Alcohol Withdrawal Management in a Substance Use Disorder Bridge Clinic: An Opportunity for Low-barrier Engagement and Shared Decision-making.","authors":"Alyssa F Peterkin, Jordana Laks, Natalija Farrell, Karrin Weisenthal, Jessica L Taylor","doi":"10.1097/ADM.0000000000001463","DOIUrl":"10.1097/ADM.0000000000001463","url":null,"abstract":"<p><strong>Objective: </strong>To describe the implementation of outpatient alcohol withdrawal management in a low-barrier substance use disorder (SUD) bridge clinic and short-term clinical outcomes.</p><p><strong>Methods: </strong>A bridge clinic in Boston, MA implemented outpatient benzodiazepine tapers for alcohol withdrawal in patients at low risk of alcohol withdrawal seizures or delirium tremens. We conducted a retrospective chart review of patients who received one or more benzodiazepine doses between April 2021 and January 2023. We described patient characteristics and evaluated rates of taper completion, clinical complications, and medication for alcohol use disorder (AUD) initiation.</p><p><strong>Results: </strong>Forty-six patients with alcohol withdrawal were treated during the study period. Their mean age was 43 years and the majority identified as male (76%); ∼30% were Black/African American and 30% Hispanic/Latinx, and 24% spoke a primary language other than English. Most had severe AUD (76%), and 30% had a history of complicated withdrawal, counter to typical clinical eligibility criteria. Over a third of patients (19/46, 41.6%) completed their planned withdrawal treatment course, 18 (39.1%) patients did not follow up in the bridge clinic within the first 3 days, and 1 (2%) experienced a documented seizure during treatment. Twenty-four patients (52%) initiated medication for AUD.</p><p><strong>Conclusion: </strong>Outpatient alcohol withdrawal management in a bridge clinic provides an opportunity to engage patients from marginalized groups, including those at higher risk for complicated alcohol withdrawal who decline inpatient care. More work is needed to improve patient follow-up and assess treatment outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"624-627"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440535","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":"ASAM/AAAP Clinical Practice Guideline (CPG) for Stimulant Use Disorder (StUD) Management: Commentary on Research Priorities.","authors":"Javier Ballester, Dawn Lindsay, Kevin Simon, Lara Weinstein, Stephanie Weiss, Ray Denny, Daniel Ciccarone","doi":"10.1097/ADM.0000000000001494","DOIUrl":"10.1097/ADM.0000000000001494","url":null,"abstract":"<p><p>This commentary highlights significant research gaps identified during the creation of the ASAM/AAAP Clinical Practice Guideline (CPG) on the Management of Stimulant Use Disorder (StUD). These included further research into the implementation of contingency management for StUD, pharmacotherapy options for StUD, evaluation and treatment of stimulant-induced psychosis, harm reduction techniques, and better defining a stimulant overdose. Further research concerning other populations impacted by stimulant use, including adolescents, pregnant and incarcerated individuals, and minoritized populations, is also urgently needed.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"512-514"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540250","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":"The Impact of Frequency of Cannabis Use on Hypertensive Disorders During Pregnancy.","authors":"Nichole Nidey, Erica Raff, Md Tareq Ferdous Khan, Shannon Lea Watkins, Jennifer M Jm McAllister, Laura Kair, Mishka Terplan, Andrea Greiner","doi":"10.1097/ADM.0000000000001454","DOIUrl":"10.1097/ADM.0000000000001454","url":null,"abstract":"<p><strong>Objectives: </strong>Cannabis is one of the most commonly used substances during pregnancy, and there is mixed evidence of its impact on maternal outcomes, such as hypertensive disorders. Prior research on cannabis use during pregnancy has not accounted for use frequency, which might explain mixed results across studies. The objective of this study was to examine how frequencies of use during pregnancy are associated with hypertensive disorders.</p><p><strong>Methods: </strong>This was a retrospective cohort study of the 2017-2018 Pregnancy Risk Assessment Monitoring System survey (n = 10,911/weighted n = 587,486). Frequency of cannabis use was categorized for analysis as follows: no use, minimal use (1 time per month or less), moderate use (2 times per month to 1 day per week), and frequent use (2-6 times per week to daily). Multivariable logistic regression models were used to examine how the frequency of cannabis use influenced the odds of experiencing hypertensive disorders during pregnancy.</p><p><strong>Results: </strong>Cannabis use, measured as a binary exposure variable (yes/no), was not associated with higher odds of hypertension during pregnancy (odds ratio, 0.86; 95% confidence interval, 0.54, 1.35). However, among those with any cannabis use, frequent use (vs minimal use) was associated with higher odds of hypertensive disorders (odds ratio, 3.44; confidence interval, 1.40, 8.43).</p><p><strong>Conclusions: </strong>Identifying cannabis use frequency during pregnancy can help identify maternal risk of hypertensive disorders.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"611-614"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menstrual Pain and Substance Use in Women Receiving Inpatient Treatment for Substance Use Disorders.","authors":"Dawn E Sugarman, Mia A Haidamus, R Kathryn McHugh, Margaret L Griffin, Roger D Weiss, Laura A Payne","doi":"10.1097/ADM.0000000000001468","DOIUrl":"10.1097/ADM.0000000000001468","url":null,"abstract":"<p><strong>Objectives: </strong>Pain is a risk factor for substance use and can negatively affect outcomes of substance use disorder (SUD) treatment. Menstrual pain is common among menstruating women yet has received little attention in the substance use literature. This study aimed to characterize menstrual pain and explore the association between menstrual pain and substance use in women receiving SUD treatment.</p><p><strong>Methods: </strong>Participants in SUD inpatient treatment were recruited for a cross-sectional self-report survey study. The current analyses focused on participants who reported a menstrual cycle in the past 6 months (N=56) and completed a questionnaire to assess menstrual cycle characteristics, menstrual pain severity, and menstrual pain interference. Substance use (eg, alcohol, cocaine) and misuse of medications to relieve menstrual pain (ie, used without a prescription or in any way other than prescribed) was also assessed.</p><p><strong>Results: </strong>Half of the participants (n=28) reported using substances for menstrual pain; the most commonly used substances were cannabis, alcohol, and nicotine/tobacco. Menstrual pain severity was associated with substance use to manage menstrual pain ( B =0.34, SEB=0.11, P <0.01); higher pain interference was associated with higher odds of using substances to manage menstrual pain ( B =0.55, SEB=0.16, P <0.001).</p><p><strong>Conclusions: </strong>These results indicate that menstrual pain is highly prevalent in this population and may be a risk factor for substance use among women in SUD treatment. Conducting menstrual history assessments with patients seeking SUD treatment might be clinically helpful. It may also be helpful for clinicians to closely monitor the impact of menstrual pain on substance use and treatment outcomes.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"628-630"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441030","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":"Diagnosis of Alcohol Use Disorder and Deaths Related to Alcohol, Drug Overdose, or Suicide Among Post-9/11 Active Duty Service Members and Veterans Following Traumatic Brain Injury.","authors":"Kangwon Song, Megan E Amuan, Rachel Sayko Adams, Eamonn Kennedy, Adam J Gordon, Kathleen F Carlson, Terri K Pogoda, Eric G Meyer, Jerry Cochran, Christopher Spevak, Mary Jo Pugh","doi":"10.1097/ADM.0000000000001445","DOIUrl":"10.1097/ADM.0000000000001445","url":null,"abstract":"<p><strong>Objectives: </strong>The association between traumatic brain injury (TBI) and alcohol use disorder (AUD) is known, but the extent of TBI's role in developing AUD remains unclear. This study examines the association between TBI severity with subsequent AUD diagnosis, and hazard for death due to alcohol, drug overdose, or suicide.</p><p><strong>Methods: </strong>Data from a national US military/veteran cohort (October 1999-September 2016, followed until September 2020) were analyzed using Fine-Gray competing risk models to investigate the relationships between TBI exposure, subsequent AUD, and hazards of death due to specific causes (alcohol, drug overdose, or suicide).</p><p><strong>Results: </strong>TBI severity correlated with an increased likelihood of an incident AUD diagnosis: mild TBI (hazard ratio [HR]: 1.25, 95% confidence interval [CI] 1.22-1.27), moderate-severe TBI (HR: 1.34, 95% CI 1.32-1.37), and penetrating TBI (HR: 1.90, 95% CI 1.86-1.94). For those who developed AUD, TBI was associated with a higher hazard of death from specific causes such as alcohol, drug overdose, or suicide (HR: 2.47 (95% CI 2.03-3.02) for mild TBI, 4.25 (95% CI 3.49-5.17) for moderate-severe TBI, and 3.39 (95% CI 2.80-4.13) for penetrating TBI.</p><p><strong>Conclusions: </strong>Veterans with TBI were more likely to develop AUD and experience increased mortality, even after adjusting for demographic and clinical factors. Care strategies that are sensitive to the cognitive and/or emotional impairments associated with varying levels of TBI may lead to better outcomes, reducing both AUD and mortality rates. Further research is needed to develop evidence-based methods for integrating TBI and AUD care.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"536-544"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080159","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}