Journal of Addiction Medicine最新文献

{"title":"Feasibility and Acceptability of a Pilot Contingency Management Intervention for Stimulant Use Disorder in a Hospital Setting.","authors":"Emma Garrod, Kaye Robinson, Karen McCrae, Melissa Nicholson, JinCheol Choi, Maria Eugenia Socias, Nadia Fairbairn","doi":"10.1097/ADM.0000000000001730","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001730","url":null,"abstract":"<p><strong>Objectives: </strong>Contingency management (CM) is effective for stimulant use disorder (STUD) in community settings. This pilot study assessed the feasibility, acceptability, and preliminary effectiveness of a CM intervention for STUD in a Vancouver, Canada hospital that supports patients to complete medical treatment despite ongoing substance use.</p><p><strong>Methods: </strong>Medical inpatients with STUD received a CM intervention involving twice-weekly gift card rewards for stimulant-negative urine drug tests and/or achieving SMART health care goals. Feasibility was defined by recruitment, retention, engagement until discharge, and lack of interference with medical care. Acceptability was assessed through weekly and exit surveys; preliminary effectiveness was determined through self-reported stimulant use via Timeline Followback and survey data on substance use and hospital experience.</p><p><strong>Results: </strong>Forty-two participants enrolled; 21 (50%) had severe STUD and 34 (81%) had concurrent opioid use disorder. Thirty-five participants engaged with CM; 33 (79%) participated until discharge, contributing 227 encounters (median 5 per participant, interquartile range 3.5-8). Weekly surveys indicated high acceptability, including improved hospital experience (90%, 86/96 responses) and desire to continue CM postdischarge (97%, 93/96 responses). Twenty (57%) reported decreased stimulant use compared with baseline Timeline Followback. Exit interviews highlighted CM as motivating behavioral change. Staff (n=6) reported improved patient engagement and no negative impact on care delivery.</p><p><strong>Discussion: </strong>CM for STUD appears feasible and acceptable in hospital settings and may improve patient experience and engagement. Further research is needed to examine the effectiveness of hospital-based CM on patient outcomes during admission and postdischarge.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584255","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":"Advance Care Planning for Patients With Substance Use Disorder.","authors":"Jasmine Hudnall, Charles W Schauberger, Garrett Donaldson, Alexander M Barnett, Barbara Miller, Mary C Oldenburg, Thomas D Harter","doi":"10.1097/ADM.0000000000001753","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001753","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with substance use disorder (SUD) have a higher risk of mortality and changes in medical decision-making capacity than patients in the general population. However, little is known about their use of advance care planning (ACP). Our aim was to determine the rate of, and variables associated with ACP completion in patients with an SUD diagnosis.</p><p><strong>Methods: </strong>The electronic health records (EHRs) of all patients with an SUD diagnosis from August 2011 through December 2019 were retrospectively reviewed to determine their rate of ACP compared with that of patients without an SUD diagnosis. The presence of an advance directive (AD) in the EHR indicated ACP. Retrospectively matched cohorts, SUD and no SUD, were compared using unadjusted and adjusted statistical methods.</p><p><strong>Results: </strong>Two thousand four hundred forty-four individuals with SUD were identified and propensity-matched with 4888 patients. Patients with SUD had a significantly greater unadjusted rate of ADs (9.9% vs 0.7%, P<0.001) than that of patients with no SUD. Patients with SUD had slightly higher baseline Charlson Comorbidity Index (CCI) scores, a higher rate of Medicaid/Medicare payor status, and higher rates of health care encounters per year. Significant difference in the rate of ADs persisted after adjusting for noted baseline differences in patients with and without SUD.</p><p><strong>Conclusions: </strong>Patients with SUD diagnoses were more likely to have an AD in their EHR than those without. Patients with an SUD diagnosis also had slightly higher CCI scores at baseline, more health care system encounters, and a higher death rate during the study period. Our population was relatively younger than the age at which people typically complete ADs. Further study is warranted to support appropriate communication and documentation regarding this population's health care preferences.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584262","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":"Using Digital Health Technologies to Help Manage Symptoms of Opioid Use Disorder: A Discrete Choice Experiment to Examine Patient Preferences.","authors":"Claudia M Squire, Avery A Tilley, Ryan S Paquin, Jenna E Reno, Anindita Saha, Roxane Modares, David Gebben, Jisun Yi, Leeda Rashid, Anita Bajaj, Sergio de Del Castillo, Gioia M Guerrieri","doi":"10.1097/ADM.0000000000001754","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001754","url":null,"abstract":"<p><strong>Objectives: </strong>There has been an increased interest in the development and use of digital health technologies (DHTs) to help treat patients with opioid use disorder (OUD), but information on the needs and preferences of the patients seeking treatment for it is lacking. This study's objective was to collect data on preferences for DHTs that are intended to support patients with OUD.</p><p><strong>Methods: </strong>A discrete choice experiment was conducted with 500 respondents who self-reported a diagnosis of OUD. The experiment included 6 attributes identified based on earlier phases of the study. These attributes included the benefit of the DHT, data sharing with one's care team, data sharing with third parties, personalized goal tracking, community support, and health care support.</p><p><strong>Results: </strong>Tools that allow patients to connect with their care team, connect with peers, or set and track their own goals were highly valued by respondents. In general, respondents who participated in the study preferred DHTs that improve the chance of abstaining from nonprescribed opioid use over those that improve the chance of staying in treatment or reducing the chance of opioid overdose. However, we also observed heterogeneity in preferences for benefits and data-sharing features within OUD treatment, suggesting that different patients may exhibit different preferences for OUD treatment in clinical settings.</p><p><strong>Conclusions: </strong>DHTs can be designed to target different outcomes and can include various features that support patients being treated for OUD. Although some outcomes and features emerged as being preferred by respondents, there was significant heterogeneity in the results. It will be important for developers to think about the various needs and preferences of target users (eg, patients) for their specific DHT rather than viewing the patient population with OUD as homogenous.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584277","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":"Elevated Blood Alcohol Level May Not Preclude Capacity to Consent for Research in Acute Alcohol Withdrawal Treatment.","authors":"Jeong Hoo Lee, Alexander Wu, Samuel Maddams, Joji Suzuki","doi":"10.1097/ADM.0000000000001747","DOIUrl":"10.1097/ADM.0000000000001747","url":null,"abstract":"","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470559","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":"An Institutional Provider Survey Evaluating Access and Implementation of Opioid Use Disorder Treatment in the Intensive Care Unit.","authors":"Aurora N Quaye, Janelle M Richard, Wendy Y Craig, Elizabeth Scharnetzki, Alysse G Wurcel","doi":"10.1097/ADM.0000000000001739","DOIUrl":"10.1097/ADM.0000000000001739","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with opioid use disorder (OUD) are increasingly admitted to intensive care units (ICUs) due to complications stemming from undertreated OUD. Rural hospitals are disproportionately affected. Hospitalization represents a critical opportunity to initiate OUD treatment; however, no ICU-specific guidance exists. We conducted a survey to assess the knowledge and practices of providers caring for patients with OUD in critical care settings, focusing on differences between rural and urban hospitals.</p><p><strong>Methods: </strong>We conducted a survey of providers in 9 ICU and acute care units at MaineHealth, the largest integrated health system in northern New England, from April to December 2024. Survey domains included access to addiction services, medications for OUD (MOUD) utilization, buprenorphine prescribing knowledge, and naloxone prescribing. Differences were assessed using the χ 2 or Fisher exact tests.</p><p><strong>Results: </strong>Fewer than half of respondents (46.2%) felt adequately supported to manage OUD. Methadone and buprenorphine were always continued in only 10% and 8.6% cases, respectively. A total of 30.0% of respondents correctly identified that any provider with Schedule III authority can prescribe buprenorphine. Fewer rural providers reported access to consultative OUD teams (39.3% vs. 70.0%, P =0.023) but were more likely to prescribe naloxone (71.4% vs. 35.9%, P =0.013). Overall, 69.2% indicated that naloxone was rarely or never prescribed to patients at the time of self-directed discharge.</p><p><strong>Discussion: </strong>Our survey identified that both rural and urban hospitals reported low rates of MOUD utilization and knowledge gaps regarding buprenorphine prescribing. These findings reinforce the need for system-level efforts to expand access to MOUD and improve provider education across intensive care settings.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470618","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":"Patient Access to Buprenorphine at Community Pharmacies: A Scoping Review of Audit Studies.","authors":"Grace Trull Marley, Rosalie Gordon, Elizabeth George, Delesha Carpenter","doi":"10.1097/ADM.0000000000001751","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001751","url":null,"abstract":"<p><strong>Background: </strong>Buprenorphine is an evidence-based treatment for Opioid Use Disorder (OUD) that can be dispensed from community pharmacies. However, barriers like wholesale ordering thresholds and pharmacist stigma limit its availability.</p><p><strong>Objectives: </strong>The objective of this review is to synthesize studies that utilized an audit study design to assess buprenorphine and buprenorphine/naloxone (BUP/NX) availability in US community pharmacies and to identify key access barriers patients may face when receiving buprenorphine at the pharmacy.</p><p><strong>Methods: </strong>A scoping review of PubMed, Embase, Scopus, and CINAHL databases was conducted. Included studies utilized an audit study design to evaluate buprenorphine availability in the US and were published in English. The search occurred in June 2025. Three independent researchers screened articles for eligibility and extracted key information on methods and results.</p><p><strong>Results: </strong>Seven articles met eligibility criteria. There was variation in methodology, including auditor training, measures of availability, and outcomes assessed. Buprenorphine/naloxone (BUP/NX) availability at pharmacies ranged from 31% to 70% at audited pharmacies, and availability was lower in nonmetropolitan areas and in independent pharmacies when compared with chain pharmacies.</p><p><strong>Conclusions: </strong>Collectively, audit studies documented suboptimal buprenorphine availability at community pharmacies, with relatively lower availability at independent and nonmetropolitan pharmacies. These results underscore the need for implementation strategies that improve pharmacy-based access to buprenorphine, particularly in settings where availability appears most limited. Future work should standardize audit study design to strengthen comparability across studies and inform interventions to reduce pharmacy-level barriers to treatment.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446973","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":"Community Pharmacist Perspectives on Observing and Dispensing Methadone for Opioid Use Disorder: Cross-sectional Survey Study.","authors":"Delesha M Carpenter, Caroline Shubel, Grace T Marley, Carolyn T Thorpe, Bayla Ostrach","doi":"10.1097/ADM.0000000000001742","DOIUrl":"10.1097/ADM.0000000000001742","url":null,"abstract":"<p><strong>Objectives: </strong>To document community pharmacists' perceptions of the acceptability, appropriateness, and feasibility of dispensing methadone and observing methadone doses; willingness to dispense and observe doses; and perceived benefits, barriers, and negative consequences of methadone dispensing.</p><p><strong>Methods: </strong>A convenience sample of community pharmacists completed a cross-sectional survey from February to April 2025 that assessed pharmacists' perceived acceptability, appropriateness, and feasibility of observing methadone doses and dispensing methadone on a 5-point scale, with 3 being a neutral midpoint. T tests compared unadjusted scores, and linear regressions assessed whether pharmacist role, years in practice, pharmacy type, and rurality were associated with scores. Descriptive statistics were calculated for newly developed measures of willingness, benefits, barriers, and negative consequences of methadone dispensing.</p><p><strong>Results: </strong>The response rate was 21.9% (n=875). Pharmacists' mean acceptability, appropriateness, and feasibility scores were slightly negative to neutral, ranging from 2.75 to 3.10. Scores were significantly lower for observed dosing compared with dispensing. Urban pharmacists, independent pharmacists, pharmacy owners, and pharmacists newer to practice had more positive acceptability, appropriateness, and feasibility perceptions. Most pharmacists (71.7%) were willing to dispense take-home doses weekly; 48.6% were willing to observe doses daily. However, logistical barriers related to time and staffing and negative attitudes towards patients with opioid use disorder were also reported.</p><p><strong>Conclusions: </strong>Despite slightly negative to neutral perceptions of acceptability, appropriateness, and feasibility, many pharmacists are willing to implement methadone services, particularly dispensing take-home doses. Workflow integration tools and stigma reduction training may be needed to support implementation of pharmacy-based methadone services in the future.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430443","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":"Innovations for Substance Use Disorders (I4SUD): Entrepreneurship Education to Help Substance Use Disorder Scientists Translate Ideas Into Effective Solutions.","authors":"Supriya Munshaw, Kelly E Dunn, Patrick H Finan, Phillip H Phan, Sean Tackett","doi":"10.1097/ADM.0000000000001750","DOIUrl":"10.1097/ADM.0000000000001750","url":null,"abstract":"<p><strong>Objectives: </strong>Substance use disorders (SUDs) are a persistent health issue in the United States that demand interdisciplinary strategies. A major obstacle has been turning scientific innovations into successful commercial products. Our aim was to teach technology commercialization to a national group of SUD researchers, boosting their ability to develop and implement effective SUD solutions.</p><p><strong>Methods: </strong>With the Office of Translational Initiatives and Program Innovations at the National Institute on Drug Abuse (NIDA), we created a 7-week program at Johns Hopkins Carey Business School called Innovations for SUD (I4SUD). Participants visited Baltimore for 3.5 days of in-person lectures, workshops, networking, and a visit to local SUD treatment centers. Online were 7 asynchronous modules (3-4 hours each), 3 1.5-hour synchronous sessions, and office hours. Each year, I4SUD ended with a 3-hour, 2-round \"pitch\" competition where one innovation received a $10,000 award. We report the evaluation of the first 3 cohorts.</p><p><strong>Results: </strong>Out of 265 applicants, we enrolled 100 participants from 45 academic institutions from 2023 to 2025. Most had limited experience with basic technology commercialization concepts but improved significantly across 5 core learning objectives in pre- and post-assessments. Over 75% were motivated to seek additional funding at the program's conclusion. Participants rated highest the clinic site visits, workshops on defining unmet needs, office hours with NIDA and I4SUD experts, and pitch sessions.</p><p><strong>Conclusions: </strong>I4SUD provides a successful model of entrepreneurship education for SUD scientists that can be adapted to other settings, helping innovations reach the market and potentially impact people with SUDs.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430509","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":"Substance-specific Mortality Risk Stratification Among Adults With Substance Use Disorders During Acute Respiratory Infection: A 3.4-Million-patient N3C Cohort Study.","authors":"Meredith C B Adams, Tanzy Love, Catherine Xie, Sharad Singh, Sydney Pargman, Aniket Patil, Anik De, Elaine L Hill, Robert W Hurley","doi":"10.1097/ADM.0000000000001737","DOIUrl":"https://doi.org/10.1097/ADM.0000000000001737","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify 30-day all-cause mortality associated with pre-existing substance use disorders (SUDs) during acute SARS-CoV-2 infection, to compare mortality risk across major SUD subtypes (tobacco, alcohol, opioid, cannabis, cocaine, amphetamine, inhalant, and unspecified), and to evaluate the extent to which documented comorbidity burden accounts for observed SUD-associated mortality differences.</p><p><strong>Methods: </strong>Retrospective cohort study of adults aged 18-65 years or older with confirmed SARS-CoV-2 infection (March 2020-June 2023) from 63 US healthcare organizations contributing to the National COVID Cohort Collaborative (N3C). Confirmed infection required any 1 of an International Classification of Diseases, 10th Revision (ICD-10) diagnosis code of U07.1, a positive SARS-CoV-2 laboratory test (polymerase chain reaction or antigen), or a nirmatrelvir-ritonavir (Paxlovid) prescription. Multivariable logistic regression estimated adjusted odds ratios (aORs) for 30-day mortality associated with any SUD and with each SUD subtype, adjusting for age, sex, race and ethnicity, body mass index, and tobacco smoking status. Sensitivity analyses added the Elixhauser Comorbidity Index (ECI) and used an unrestricted cohort.</p><p><strong>Results: </strong>Among 3,435,480 adults with confirmed SARS-CoV-2 infection, 406,064 (11.8%) had a pre-existing SUD documented before the index date, and 14,866 (0.43%) died within 30 days of the index date. Thirty-day mortality was higher among individuals with SUDs than those without (1.05% vs. 0.35%). SUDs were associated with more than doubled adjusted odds of mortality (aOR 2.38; 95% CI: 2.28-2.49). Additional adjustment for comorbidity burden attenuated but did not eliminate the association (aOR 1.53; 95% CI: 1.46-1.61). Alcohol use disorder (AUD) (aOR 2.63; 95% CI: 2.48-2.78) and opioid use disorder (OUD) (aOR 2.53; 95% CI: 2.35-2.74) conferred the highest risks. Mortality differentials between individuals with and without SUD persisted throughout the study period despite overall declines in COVID-19 mortality.</p><p><strong>Conclusions: </strong>Pre-existing SUDs, particularly alcohol (AUD) and opioid use disorders (OUD), identified a population at substantially increased 30-day all-cause mortality after COVID-19 diagnosis. Because unmeasured structural, behavioral, and treatment-related factors likely contribute to the residual excess risk beyond measured comorbidity, SUD is best interpreted as a clinically useful marker of heightened vulnerability rather than as an independent biological cause of mortality. SUD status, AUD, and OUD in particular, warrant explicit incorporation into short-term risk stratification for respiratory infections in both routine clinical care and pandemic preparedness planning.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381963","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":"Attitudes About Alcohol Misuse Among Alaska Native People in a Tribal Health Care System.","authors":"Denise A Dillard, Luciana E Hebert, Lisa G Dirks, Jennifer L Shaw, Susan Brown Trinidad, Kate Lillie, Dennis M Donovan, Wylie Burke, Evette J Ludman","doi":"10.1097/ADM.0000000000001564","DOIUrl":"10.1097/ADM.0000000000001564","url":null,"abstract":"<p><strong>Objectives: </strong>Attitudes about alcohol misuse influence help-seeking behaviors. We assessed attitudes among Alaska Native/American Indian (AN/AI) patients, providers, and leaders to inform outreach, prevention, and treatment.</p><p><strong>Methods: </strong>Participants included a cross-sectional sample of 72 AN/AI providers/leaders and 704 AN/AI adult patients in randomly selected clinics within a tribal health care system. Attitudes associated with addiction models (Psychosocial, Moral, Disease, Environment, Nature) were assessed using a survey developed for AN/AI people. Independent variables included role (patient, provider/leader), sex, age, residence type (urban, rural, mixed, other), alcohol misuse or behavioral health issue in self, family, or friends, and alcohol or behavioral health help-seeking.</p><p><strong>Results: </strong>Attitudes corresponding to Psychosocial and Disease models were more highly endorsed than Nature or Moral models. The Environment model was moderately endorsed. The Disease model was more highly endorsed by AN/AI patients with alcohol help-seeking but less endorsed by providers/leaders. AN/AI patients who were male, had rural residence, and a self-reported behavioral health issue had higher endorsement of the Moral model. Male patients and providers/leaders more highly endorsed the Nature model. Roughly one-third (35%) of patient participants were men.</p><p><strong>Conclusions: </strong>Efforts to counteract moralistic attitudes about alcohol misuse among male and rural AN/AI people, as well as beliefs that alcohol misuse will spontaneously resolve, may facilitate prevention and treatment efforts. Leaders should also be aware of the potential negative impacts of local laws restricting alcohol. Holistic treatment approaches that address psychosocial factors and contextual issues are indicated. Oversampling of male AN/AI patients may also be warranted.</p>","PeriodicalId":14744,"journal":{"name":"Journal of Addiction Medicine","volume":" ","pages":"437-443"},"PeriodicalIF":3.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029770","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}