American Journal of Drug and Alcohol Abuse最新文献

{"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_c) 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_c = .91). The smallest class (19.2%) also reported using kratom for self-treatment, but usually as a long-term replacement for other substances (P_c = .75). The other two classes (24.8% and 23.5%) reported using kratom for management of anxiety (P_c = .87-.95) and depressive symptoms (P_c = .61-.89) and for recreation (P_c = .56- .86). These were distinguished from one another by probability of at least moderate kratom use disorder (P_c = .17 vs. .53), with greater probability observed in the class with greater anxiety (P_c = .13 vs. .50) and depressive (P_c = .34 vs. .82) symptom severity and more likely recreational use motivation (P_c = .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}

{"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}

{"title":"Withdrawal catastrophizing scale: initial psychometric properties and implications for the study of opioid use disorder and hyperkatifeia.","authors":"Orman Trent Hall, Michael Vilensky, Julie E Teater, Craig Bryan, Kara Rood, Julie Niedermier, Parker Entrup, Stephanie Gorka, Anthony King, David A Williams, K Luan Phan","doi":"10.1080/00952990.2023.2298257","DOIUrl":"10.1080/00952990.2023.2298257","url":null,"abstract":"<p><p><i>Background:</i> Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.<i>Objectives:</i> We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).<i>Methods:</i> Prospective observational study (<i>n</i> = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.<i>Results:</i> WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (r_s (99) = 0.237, <i>p</i> = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (r_s (119) = 0.357, <i>p</i> < .001); withdrawal-motivated OUD treatment avoidance (r_s (119) = 0.421, <i>p</i> < .001), history of leaving the hospital against medical advice (r_s (119) = 0.373, <i>p</i> < .001) and buprenorphine-precipitated withdrawal (r_s (119) = 0.369, <i>p</i> < .001).<i>Conclusion:</i> This study provides first evidence of <i>withdrawal catastrophizing</i> as a clinically important phenomenon with implications for the future study and treatment of OUD.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"31-43"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177358","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":"Withdrawal interference scale: a novel measure of withdrawal-related life disruption in opioid use disorder and alcohol use disorder.","authors":"Orman Trent Hall, Tommy Gunawan, Julie Teater, Craig Bryan, Stephanie Gorka, Vijay A Ramchandani","doi":"10.1080/00952990.2024.2350057","DOIUrl":"10.1080/00952990.2024.2350057","url":null,"abstract":"<p><p><i>Background:</i> <i>Hyperkatifeia</i> describes amplified emotional and motivational withdrawal due to addiction-related sensitization of brain-stress-systems. Hyperkatifeia has been proposed as a target for addiction treatment development. However, translation of basic research in this area will require new tools designed to measure <i>hyperkatifeia</i> and related phenomena outside of laboratory settings.<i>Objectives:</i> We define a novel concept, <i>withdrawal interference</i>, and introduce a new tool - the <i>Withdrawal Interference Scale</i> (WIS) - which measures the impact of withdrawal on daily life among individuals with OUD or AUD.<i>Methods:</i> Described are the combined results of three separate cross-sectional studies. The structural validity, convergent validity, construct validity, trans-diagnostic (AUD/OUD) configural, metric, and scalar invariance, internal consistency, and composite reliability of WIS was tested among three independent samples of 1) treatment-seeking adults with OUD (<i>n</i> = 132), 2) treatment-seeking adults with AUD (<i>n</i> = 123), and 3) non-treatment-seeking adults with OUD (<i>n</i> = 140). Males numbered 218 and females were 163.<i>Results:</i> WIS exhibited structural validity (1 factor), convergent validity (average variance extracted .670-.676), construct validity, trans-diagnostic configural (χ2/df = 2.10), metric (Δχ2 = 5.70, <i>p</i> = .681), and scalar invariance (Δχ2 = 12.34, <i>p</i> = .338), internal consistency (α .882-928), and composite reliability (.924-.925).<i>Conclusion:</i> These results suggest WIS is a valid and reliable instrument for measuring withdrawal-related life disruption in AUD and OUD. Further, given our findings of transdiagnostic measurement invariance, WIS scores of individuals with AUD and OUD can be meaningfully compared in future statistical analyses.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"44-56"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297019","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":"Associations between college enrollment and trends in substance use among young adults in the US from 2015 to 2019.","authors":"James Aluri, Himani Byregowda, Amelia Arria","doi":"10.1080/00952990.2024.2400923","DOIUrl":"10.1080/00952990.2024.2400923","url":null,"abstract":"<p><p><i>Background:</i> Substance use among college students has negative academic and health outcomes. Identifying substances that are more commonly used by students than non-students can reveal specific risks in the college environment.<i>Objectives:</i> To examine associations between college enrollment and prevalence and trends of use of a comprehensive list of substances.<i>Methods:</i> The sample included 2015-2019 participants in the National Survey on Drug Use and Health who were aged 18 to 22 and who were full-time enrolled or not enrolled in college. Prevalence of substance use was calculated for four subgroups: college males (<i>n</i> = 6,707), college females (<i>n</i> = 8,284), non-college males (<i>n</i> = 10,019), and non-college females (<i>n</i> = 9,266). Multivariate logistic regression was used to model the relationships between enrollment and substance use. Temporal trends in substance use prevalence were calculated for each subgroup.<i>Results:</i> College enrollment was associated with prescription stimulant misuse (aOR 1.50, 95% CI: 1.35-1.67), alcohol use (aOR 1.36, 95% CI: 1.27-1.47), and binge drinking (aOR 1.22, 95% CI: 1.15-1.30). From 2015 to 2019, the only substance whose use significantly increased among any subgroup was cannabis. The increase occurred among females only (+4.7% in college females and +5.6% in non-college females; both <i>p</i> < .01).<i>Conclusions:</i> College enrollment is most strongly associated with prescription stimulant misuse, suggesting that colleges should consider explicitly including stimulant misuse prevention in their health promotion strategies. The increasing use of cannabis among females warrants clinicians' attention to routine screening for use and provision of information about the mental health impacts of cannabis.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"96-106"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677589","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":"A case series examining the efficacy of gabapentin as a substitution therapy for the treatment of pregabalin use disorder.","authors":"Olivier Lejeune, Mathieu Chappuy, François Bailly, Benjamin Rolland","doi":"10.1080/00952990.2025.2467458","DOIUrl":"10.1080/00952990.2025.2467458","url":null,"abstract":"<p><p><i>Background:</i> Gabapentinoids are ligands of a brain calcium channel, which are approved for different indications, including epilepsy, neuropathic pain, or generalized anxiety disorder. Among gabapentinoids, pregabalin has been increasingly associated with a risk of pregabalin use disorder (PUD). To date, there is no recommended medical treatment for PUD. However, gabapentin, which has a lower abuse potential, could be used as a substitution therapy to reduce pregabalin withdrawal and craving.<i>Objectives:</i> To report on the experimental use of high dose of gabapentin among those with PUD.<i>Methods:</i> Case series of four patients (3 males and 1 female) with severe PUD (average daily doses ranging from 1,200 to 8,400 mg of pregabalin), in whom high dose of gabapentin was prescribed as a substitution treatment.<i>Results:</i> Upon gabapentin being administered as substitution therapy for pregabalin, all four patients experienced intense craving and distress. Despite receiving high doses of gabapentin, due to the observed levels of craving and distress, all four patients had to be rapidly switched back to pregabalin.<i>Conclusions:</i> Preliminary clinical findings suggest that gabapentin is unlikely to be a suitable, lower-risk alternative treatment for people with PUD. Additional examination of candidate medications, including other gabapentinoids, could be useful to identify an effective treatment for PUD.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"68-72"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494339","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":"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":"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":"14-30"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","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}

{"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":"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^th to 7^th 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":"57-67"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","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":"Alcohol use and drinking motives across five countries: a post-COVID-19 pandemic update.","authors":"Joana Rupprecht, Bettina Spitzweck, Gabriele Oettingen, A Timur Sevincer","doi":"10.1080/00952990.2024.2442467","DOIUrl":"10.1080/00952990.2024.2442467","url":null,"abstract":"<p><p><i>Background:</i> It is necessary to understand drinking motives to inform tailored interventions counteracting high-risk alcohol use and alcohol use disorder. Research suggests that, during the COVID-19 pandemic, drinking to cope with the current situation (i.e. coping motive) increased. This was alarming since the coping motive is a predictor of alcohol use and alcohol-related problems.<i>Objective:</i> In the current study, we aimed to elucidate whether this COVID-19-induced increase in coping-motivated alcohol use outlasted the COVID-19 pandemic in the USA, Great Britain, Mexico, Spain, and Germany. We provide a 2023 post-COVID-19 update on alcohol use and drinking motives.<i>Methods:</i> In spring 2023, 1032 participants recruited via Prolific (48% female) across the five countries completed a cross-sectional online survey, including the Alcohol Use Disorder Identification Test (AUDIT) for alcohol use patterns and the Drinking Motives Questionnaire-Revised (DMQ-R) for drinking motives.<i>Results:</i> Across all five countries, 20-30% of the participants exceeded the AUDIT cutoff score for high-risk alcohol use. The ranking of all four motives for alcohol use was cross-nationally consistent: Social > Enhancement > Conformity > Coping.<i>Conclusion:</i> Compared to most research before the pandemic, with a Social > Enhancement > Coping > Conformity motive ranking, and research during COVID-19, with an Enhancement > Coping > Social > Conformity motive ranking, our data suggests that post-COVID drinking to socialize and to enhance one's own mood, are again the most important motives to drink alcohol. Furthermore, it seems like the increase in the coping motive found in research during the pandemic, did luckily not persist but conversely, post- compared to pre-COVID, the conformity motive seems more important than coping motive.</p>","PeriodicalId":48957,"journal":{"name":"American Journal of Drug and Alcohol Abuse","volume":" ","pages":"85-95"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411327","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 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":"73-84"},"PeriodicalIF":2.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899305/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}