Sarah J Miller, Sayward E Harrison, Steven B Harrod, Kimberly J Hills, Alain Litwin
{"title":"A scoping review of interventions for engaging adolescents and young adults in opioid use disorder treatment across the care cascade.","authors":"Sarah J Miller, Sayward E Harrison, Steven B Harrod, Kimberly J Hills, Alain Litwin","doi":"10.1080/00952990.2024.2443938","DOIUrl":"https://doi.org/10.1080/00952990.2024.2443938","url":null,"abstract":"<p><p><i>Background:</i> A high number of adolescents and young adults engage in opioid misuse and/or meet criteria for opioid use disorder (OUD). Youth also experience worse treatment outcomes when compared to adult counterparts.<i>Objectives:</i> This scoping review aimed to identify and summarize existing interventions designed to increase engagement of youth across the OUD care cascade, as well as describe clinical and research implications.<i>Methods:</i> Peer-reviewed literature was searched using PubMed, PsycInfo, and Web of Science. Studies were eligible if they presented outcomes of an intervention focused on engaging adolescents and young adults (ages 12-25 years) in the OUD care cascade and were published in English.<i>Results:</i> Nine articles met inclusion criteria that described interventions for adolescents and young adults across engagement, initiation, and retention in the OUD care cascade. Several strategies were used in interventions, including behavioral health and integrated health services, contingency management, meaningful family involvement, assertive outreach, and provider trainings/consultation. Only one intervention has been tested with a randomized control trial.<i>Conclusions:</i> Due to small sample sizes and lack of control groups, findings from existing intervention studies do not indicate which strategies are most effective. Further research is urgently needed to develop and evaluate effective interventions for youth with OUD. Providers working with youth should implement services to meet youth's individual needs. Providers should consider utilizing integrated services and referrals to behavioral health, involving family in treatment, and use of contingency management and assertive outreach. Continuing education for providers on OUD treatment and developmental concerns is also crucially needed.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-18"},"PeriodicalIF":2.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383589","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":"Applied statistical methods for identifying features of heart rate that are associated with nicotine vaping.","authors":"Puyang Zhao, James J Yang, Anne Buu","doi":"10.1080/00952990.2024.2441868","DOIUrl":"https://doi.org/10.1080/00952990.2024.2441868","url":null,"abstract":"<p><p><i>Background:</i> Wearable devices have been increasingly adopted to collect physiological data such as heart rate that may infer momentary risk of substance use. Yet, innovative methods capable for handling these complex time series data as presented in the statistics or data science literature may not be accessible to substance use researchers.<i>Objectives:</i> This study introduces a series of statistical methods to analyze heart rate data and identify features that are associated with nicotine vaping.<i>Methods:</i> Nontechnical description of the methods coupled with the information about open-source software packages that implemented these methods was provided. The analytical procedure included 5 steps: (1) de-noising by the singular spectrum analysis (SSA); (2) sleep region identification by the Sum of Single Effects (SuSiE) model; (3) repeated heart rate pattern identification by the matrix profile; (4) dimension reduction by the linear regression; and (5) comparing repeated heart rate patterns across non-vaping and vaping regions by the linear mixed model. Secondary analysis was conducted on heart rate and ecological momentary assessment (EMA) data collected from 35 young adult e-cigarette users (66% female) for 7 days.<i>Results:</i> Effectiveness of the methods was demonstrated by graphical presentations showing that the extracted features characterize sleep patterns and heart rate changes before and after vaping events quite well. Secondary analysis found that heart rate was higher and changed faster before vaping.<i>Conclusion:</i> Statistical methods can effectively extract useful features from heart rate data that may inform momentary vaping risk and optimal timings for delivering messages in mobile-phone based interventions.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-8"},"PeriodicalIF":2.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383613","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}
Sun Mi Gu, Yeung Bae Jin, Jin Mook Kim, Young-Hoon Kim, Jaesuk Yun, Hye Jin Cha
{"title":"Assessment of liability to substance use disorder induced by two emerging stimulants, 4,4'-dimethylaminorex and escaline, in mice.","authors":"Sun Mi Gu, Yeung Bae Jin, Jin Mook Kim, Young-Hoon Kim, Jaesuk Yun, Hye Jin Cha","doi":"10.1080/00952990.2024.2439365","DOIUrl":"https://doi.org/10.1080/00952990.2024.2439365","url":null,"abstract":"<p><p><i>Background:</i> The emergence of new psychoactive substances (NPSs) poses a serious global health threat. Although various groups of psychostimulants exist, this study specifically investigated two lesser-studied substances, 4,4'-dimethylaminorex (4,4'-DMAR) and escaline.<i>Objective:</i> To assess liability to substance use disorder (SUD), as evidenced via preclinical models, of the two psychostimulants.<i>Methods:</i> 4,4'-DMAR and escaline were evaluated, in mice, for their potential to exhibit rewarding and reinforcing effects, and for causing central dopaminergic activity. The climbing behavior test investigated whether the substances acted as dopaminergic agents and to determine the dose range for further evaluation. The rewarding and reinforcing effects of these substances were evaluated via the conditioned place preference (CPP) and self-administration (SA) tests.<i>Results:</i> The results showed that both test substances significantly increased climbing behavior at 1 mg/kg (<i>p</i> < .01). Mice treated with 0.1 and 1 mg/kg 4,4'-DMAR (<i>p</i> < .05) and with 1 mg/kg escaline (<i>p</i> < .01) exhibited increased duration of time spent in the substance-paired compartment in the CPP test compared to those treated with vehicle. Further, the frequency of infusions from the 5<sup>th</sup> to 7<sup>th</sup> sessions was significantly increased at 1 mg/kg/infusion of 4,4'-DMAR (<i>p</i> < .001) and at 0.01 and 0.1 mg/kg/infusion of escaline (<i>p</i> < .01) compared to controls.<i>Conclusion:</i> The findings suggest that 4,4'-DMAR and escaline have dopaminergic activity, exert reinforcing and rewarding effects, and may cause SUD. The findings can inform relevant authorities about the need to regulate these two new compounds.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383624","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":"Young sexual and gender minority men's perspectives on drug checking services in Metro Vancouver, Canada: a qualitative study.","authors":"Koharu Loulou Chayama, Pierre-Julien Coulaud, Cameron Schwartz, Olivier Ferlatte, Lianping Ti, Rod Knight","doi":"10.1080/00952990.2024.2443940","DOIUrl":"https://doi.org/10.1080/00952990.2024.2443940","url":null,"abstract":"<p><p><i>Background:</i> Young sexual and gender minority (SGM) men experience disproportionate risk of drug-related harms. Improving access to drug checking services (DCS), where people can receive information about the contents of their illicit drugs, is critical to facilitate safer drug use among this population. However, no research to date has explored their perspectives on DCS.<i>Objectives:</i> To explore perspectives on DCS among young SGM men in Metro Vancouver, Canada.<i>Methods:</i> Semi-structured interviews were conducted with 50 young (ages 18-30) SGM men living in Metro Vancouver in 2018. Interviews were audio-recorded, transcribed verbatim, and coded. Themes were identified using inductive-deductive approaches and interpreted by drawing on the Risk Environment Framework.<i>Results:</i> Two key themes emerged. First, participants generally had limited awareness and experience with DCS. Nevertheless, given concerns over the increasingly toxic drug supply, they perceived benefits to getting their drugs tested, including reducing their risk of overdose. Second, participants identified social (e.g. anti-drug stigma), policy/legal (e.g. drug criminalization), and physical (e.g. lack of services outside of downtown Vancouver) barriers in the current context of DCS. To improve access, participants encouraged the expansion of DCS in community settings (e.g. bars) and through community-based approaches (e.g. integration within community sexual health programming) tailored for young SGM men.<i>Conclusion:</i> Despite low levels of awareness and experience with DCS, young SGM men demonstrated a strong interest in accessing these services. Efforts to adapt and scale up DCS need to account for the social, policy/legal, and physical contexts that shape the lives of young SGM men.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383632","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":"Cannabis retail store density and county-level mortality from injury in the state of Washington from 2009-2020.","authors":"William C Kerr, Yu Ye","doi":"10.1080/00952990.2024.2436524","DOIUrl":"https://doi.org/10.1080/00952990.2024.2436524","url":null,"abstract":"<p><p><i>Background:</i> The state of Washington legalized cannabis for adult use in 2012 and retail stores began to open in 2014 with 31 stores, rising to 447 in 2020. Prior studies have evaluated impacts of legalization on state-level mortality from suicide, motor vehicle accidents and opioid poisonings with mixed findings.<i>Objectives:</i> To estimate relationships between county cannabis retail store density and county mortality rates from suicide, motor vehicle accidents, opioid poisoning, homicide and accidental poisonings.<i>Methods:</i> County mortality data for Washington state (39 counties) from individual death records for the years 2009-2020 used ICD-10 Multiple Cause of Death Files. County-level cannabis retail store counts in Washington were based on cannabis license and sales data. Fixed effect Poisson regression models predicted county-level yearly mortality rates for 2009-2020.<i>Results:</i> Deaths from 2009-20 in Washington were 12,933 (77% men) from suicide, 6761 (71% men) from motor vehicle accidents, 8858 (62% men) from opioid poisoning, 2408 (73% men) from homicide and 11,873 (64% men) from accidental poisonings. Store counts per 10,000 population were negatively associated with accidental poisonings (incidence rate ratio (IRR) of 0.83 (0.73-0.93)) and opioid mortality rates with (IRR of 0.83 (0.70-0.99)). No significant effects were found for motor vehicle accidents, homicide or suicide.<i>Conclusions:</i> County cannabis retail store density in Washington was associated with reduced accidental poisoning and opioid mortality while suicide and motor vehicle accident mortality rates did not appear to change. Results do not support any harmful effects on mortality from cannabis store expansion in Washington counties.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-9"},"PeriodicalIF":2.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383628","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}
Katherine Hill, Jeffrey M Rogers, Oliver Grundmann, David H Epstein, Kirsten E Smith
{"title":"At least four groups of kratom consumers in the United States: latent-class analysis of motivations for kratom use.","authors":"Katherine Hill, Jeffrey M Rogers, Oliver Grundmann, David H Epstein, Kirsten E Smith","doi":"10.1080/00952990.2024.2414319","DOIUrl":"https://doi.org/10.1080/00952990.2024.2414319","url":null,"abstract":"<p><p><i>Background:</i> Kratom is a plant with alkaloids acting at opioid, serotonergic, adrenergic, and other receptors. Consumers report numerous use motivations.<i>Objectives:</i> To distinguish subgroups of kratom consumers by kratom-use motivations using latent-class analysis.<i>Methods:</i> From July to November 2022, we utilized convenience sampling and surveyed regular kratom consumers (<i>n</i> = 395, 38.1 years (SD 11.2), 54.9% male, 81.3% White) regarding demographics, lifetime and past-year substance use and preferences, substance use disorder history, healthcare barriers, kratom-use motivations, and general health. We used latent-class analysis to identify subgroups by use motivation and calculated conditional probabilities (P<sub>c</sub>) for variables in each class.<i>Results:</i> A four-class model best fit our data. The largest class (32.4%) was characterized by the use of kratom for self-treatment of chronic pain (P<sub>c</sub> = .91). The smallest class (19.2%) also reported using kratom for self-treatment, but usually as a long-term replacement for other substances (P<sub>c</sub> = .75). The other two classes (24.8% and 23.5%) reported using kratom for management of anxiety (P<sub>c</sub> = .87-.95) and depressive symptoms (P<sub>c</sub> = .61-.89) and for recreation (P<sub>c</sub> = .56- .86). These were distinguished from one another by probability of at least moderate kratom use disorder (P<sub>c</sub> = .17 vs. .53), with greater probability observed in the class with greater anxiety (P<sub>c</sub> = .13 vs. .50) and depressive (P<sub>c</sub> = .34 vs. .82) symptom severity and more likely recreational use motivation (P<sub>c</sub> = .56 vs. .86).<i>Conclusion:</i> Kratom consumers can be classified by their use motivations. As with other psychoactive substances, the range of motivations is consistent with the range of likely effects. It is not yet clear whether some motivations might indicate the risk of problems.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-13"},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069060","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}
Jasmin Choi, Lane Burgette, Katherine Nameth, Katherine E Watkins, Karen Chan Osilla
{"title":"Examining how support persons' buprenorphine attitudes and their communication about substance use impacts patient well-being.","authors":"Jasmin Choi, Lane Burgette, Katherine Nameth, Katherine E Watkins, Karen Chan Osilla","doi":"10.1080/00952990.2024.2417820","DOIUrl":"https://doi.org/10.1080/00952990.2024.2417820","url":null,"abstract":"<p><p><i>Background:</i> While social support benefits those in treatment for opioid use disorder, it is unclear how social support impacts patient outcomes.<i>Objectives:</i> This study examines how support person attitudes toward buprenorphine and their communication about substance use are associated with the well-being of patients receiving buprenorphine treatment.<i>Methods:</i> We analyzed cross-sectional baseline data from 219 buprenorphine patients (40% female) and their support persons (72% female). Patients were recruited from five community health centers and asked to nominate a support person. Patient outcomes included symptoms of depression, anxiety, impairment due to substance use, and perceived social support. Support persons predictors included their attitudes toward buprenorphine from four statements (e.g. \"Buprenorphine is just replacing one drug for another\") and communication using two items (e.g. comfort and effectiveness discussing substance use).<i>Results:</i> More stigmatizing attitudes, such as believing patients should quit on their own without medication, were associated with increased patient substance use-related impairment (F = 4.53, <i>p</i> = .01). Effective communication was associated with lower patient depression (F = 10.15, <i>p</i> < .001), anxiety (F = 4.73, <i>p</i> = .001), lower impairment (F = 6.46, <i>p</i> < .001), and higher perceived social support (F = 3.68, <i>p</i> = .007).<i>Conclusions:</i> This study highlights how support person attitudes and communication dynamics significantly affect the mental health and impairment of individuals receiving buprenorphine treatment. Interventions that reduce stigma and promote effective communication between patients and their loved ones could enhance treatment outcomes and overall well-being among patients with OUD.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069108","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}
Dylan E Kirsch, Malia A Belnap, Annabel Kady, Lara A Ray
{"title":"A narrative review on alcohol use in women: insight into the telescoping hypothesis from a biopsychosocial perspective.","authors":"Dylan E Kirsch, Malia A Belnap, Annabel Kady, Lara A Ray","doi":"10.1080/00952990.2024.2419540","DOIUrl":"https://doi.org/10.1080/00952990.2024.2419540","url":null,"abstract":"<p><p><i>Background:</i> There has been a dramatic rise in alcohol consumption and alcohol use disorder (AUD) among women. Recently, the field has made substantial progress toward better understanding sex and gender differences in AUD. This research has suggested accelerated progression to AUD and associated health consequences in women, a phenomenon referred to as \"telescoping.\"<i>Objective:</i> To examine evidence for the telescoping hypothesis from a biopsychosocial perspective.<i>Methods:</i> This narrative review examined and integrated research on biological, psychological, and socio-environmental factors that may contribute to the development and progression of AUD in women.<i>Results:</i> Biopsychosocial research has revealed sex- and gender-specific risk factors and pathways to AUD onset and progression. Biological sex differences render females more vulnerable to alcohol-related toxicity across various biological systems, including the brain. Notably, sex and gender differences are consistently observed in the neural circuitry underlying emotional and stress regulation, and are hypothesized to increase risk for an internalizing pathway to AUD in women. Psychological research indicates women experience greater negative emotionality and are more likely to use alcohol as a means to alleviate negative emotions compared with men. Socio-environmental factors, such as familial and peer isolation, appear to interact with biological and psychological processes in a way that increases risk for negative emotionality and associated alcohol use in women.<i>Conclusion:</i> There appears to be a complex interplay of biopsychosocial factors that increase risk for AUD onset and progression in women through an internalizing pathway. Developing targeted interventions for women with AUD that specifically target internalizing processes is critical.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-17"},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048428","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}
Yajing Ma, Bronya Hi Kwan Luk, Wen Zhang, Cody Yu Cheung Cham, Haixia Ma
{"title":"Understanding the perspectives of police officers regarding men who use drugs and drug rehabilitation in China: a qualitative study.","authors":"Yajing Ma, Bronya Hi Kwan Luk, Wen Zhang, Cody Yu Cheung Cham, Haixia Ma","doi":"10.1080/00952990.2024.2447294","DOIUrl":"https://doi.org/10.1080/00952990.2024.2447294","url":null,"abstract":"<p><p><i>Background:</i> Drug use among men is a significant public health concern in China, with compulsory drug treatment centers being the primary approach. Police officers in these centers play a crucial role in shaping the interactions and experiences of men who use drugs (MWUD). However, little research exists on the attitudes of police officers toward MWUD in China.<i>Objectives:</i> This qualitative study aimed to explore the attitudes of police officers toward MWUD and drug rehabilitation approaches in China.<i>Methods:</i> Semi-structured individual interviews were conducted among 23 police officers recruited from two compulsory drug treatment centers in Jiangsu Province, China. Of the participants, two were females and 21 were males. Thematic analysis was employed to analyze the data.<i>Results:</i> Three key themes emerged: 1) Multifaceted perspectives on MWUD. Participants viewed MWUD as offenders, victims, and patients. 2) Dynamic interactions with MWUD. Relationships were characterized as either adversarial or supportive, influenced by participants' personalities, experiences, beliefs, workload, and psychological training. 3) Advocating for punitive measures in drug rehabilitation. While the participants generally favored strict penalties for MWUD, they acknowledged the value of community-based rehabilitation. Concerns about social stigma, privacy, motivation, and the costs of voluntary rehabilitation tempered their support.<i>Conclusions:</i> The study highlights the importance of raising awareness and challenging bias among police officers. It emphasizes the need for psychological training to enhance their capacity to provide humane care and foster positive interactions with MWUD. Additionally, ensuring access to affordable, accessible, and stigma-free voluntary rehabilitation is crucial for effective drug rehabilitation efforts.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048431","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}
Constanza de Dios, Robert Suchting, Charles E Green, Heather E Webber, F Gerard Moeller, Scott D Lane, Joy Schmitz
{"title":"The role of Iowa gambling task performance in response to citalopram treatment for cocaine use disorder.","authors":"Constanza de Dios, Robert Suchting, Charles E Green, Heather E Webber, F Gerard Moeller, Scott D Lane, Joy Schmitz","doi":"10.1080/00952990.2024.2420773","DOIUrl":"10.1080/00952990.2024.2420773","url":null,"abstract":"<p><p><i>Background:</i> Cocaine use disorder (CUD) is associated with executive functioning impairments linked to serotonergic function. Previous studies reported efficacy with the selective serotonin reuptake inhibitor citalopram in reducing cocaine use.<i>Objectives:</i> The current study explored moderation and mediation of citalopram effects on cocaine use by performance across executive function domains.<i>Methods:</i> We conducted a secondary analysis of a double-blind, placebo-controlled, randomized Bayesian adaptive trial investigating citalopram efficacy in CUD treatment-seeking adults. At baseline and mid-treatment, participants completed assessments of decision-making (Iowa Gambling Task; IGT), attention, response inhibition, and cognitive flexibility. Outcomes were longest duration of abstinence (LDA; count of consecutive cocaine-negative urine tests) and Treatment Effectiveness Score (TES; count of cocaine-negative urine tests from study midpoint to endpoint). Bayesian models estimated independent moderation and mediation effects of cognitive ability on the association between treatment (citalopram 40 mg vs. placebo) and LDA/TES.<i>Results:</i> Of the four assessments, only the IGT demonstrated concurrent moderation and mediation in the sample (<i>N</i> = 80; 82% males). Treatment effects on LDA (IRR = 1.02) and TES (IRR = 1.03) were strongest in participants with higher baseline IGT scores, which indicate less risky decision-making (posterior probabilities >93%). Models supported a positive indirect effect of treatment on TES (IRR = 1.12, posterior probability = 81.6%), with 52.3% of the total effect mediated by changes in IGT scores from baseline to mid-treatment.<i>Conclusion:</i> We found evidence for IGT as a moderator and mediator of citalopram's effects on cocaine use. Decision-making ability may play a role in predicting who responds to citalopram and how.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"1-12"},"PeriodicalIF":2.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034688","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}