Substance use & addiction journal最新文献

{"title":"Predictors and Processes of Early Buprenorphine Discontinuation: Study Protocol.","authors":"Vanessa C Somohano, Alison C Eckhardt, Olivia Reynolds, Ambrosia R Sanchez, Sarah Shull, Dylan Waller, Travis I Lovejoy, Benjamin J Morasco, Adam J Gordon, Meike Niederhausen, Elizabeth Hooker, Jessica J Wyse","doi":"10.1177/29767342261454138","DOIUrl":"10.1177/29767342261454138","url":null,"abstract":"<p><p>Buprenorphine and other medications for opioid use disorder are recommended as standard of care and associated with positive health and addiction-related outcomes. Although observational research suggests at least 180 days of continuous buprenorphine therapy as a measure of treatment quality, more than 50% of patients discontinue before this time period. The drivers of early discontinuation have not been well studied. Prior research, largely utilizing retrospective administrative data, has identified demographic and clinical correlates of discontinuation, including polysubstance use, younger age, minoritized race or ethnicity, male birth sex, higher pain interference and low buprenorphine dose, but why or how such factors are linked with early discontinuation remains unknown. This prospective cohort study will use a convergent parallel mixed methods design to obtain administrative, quantitative survey and qualitative interview data addressing early buprenorphine discontinuation. We will enroll a national sample of N = 965 veterans initiating buprenorphine, stratifying recruitment by sex, race/ethnicity and rurality and collect longitudinal quantitative surveys at baseline, 6 and 12 months to identify modifiable barriers to treatment retention and learn about participant experiences sustaining versus discontinuing buprenorphine. Electronic health record data supplemented by medical record review will identify provider- and system-level factors associated with early discontinuation. Qualitative interviews with a subset of discontinuing participants and their buprenorphine-prescribing clinicians will identify motivations for, and experiences with, discontinuation and contextualize results from surveys and medical record review. This study will provide key information from which to develop interventions targeting the modifiable causes of early buprenorphine discontinuation.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1224-1231"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Patient Access to Buprenorphine for Opioid Use Disorder Through Pharmacist Independent Prescriptive Authority.","authors":"Michelle D Colvard, Terri L Jorgenson, Veldana Alliu, Tera D Moore, Haley E Pals, Jacob D Baylis, Michael Tran, Roisin M Sabol, Adam J Gordon","doi":"10.1177/29767342261467580","DOIUrl":"10.1177/29767342261467580","url":null,"abstract":"<p><p>In the United States, despite evidence that medication treatment for OUD (MOUD) improves outcomes, buprenorphine MOUD (B-MOUD) treatment rates remain suboptimal. The Mainstreaming Addiction Treatment (MAT) Act, passed in 2022, removed federal prescribing restrictions which allowed any health care provider, including pharmacists, with a DEA (Drug Enforcement Administration) registration to prescribe B-MOUD unless otherwise restricted by their state of licensure. As of March 2026, only 16 states allow pharmacists to obtain DEA licensure for controlled substance prescriptive authority. The SUPPORT for Patients and Communities Reauthorization Act of 2025 indicates that pharmacists may prescribe B-MOUD independently where state law allows and sends a signal for states to align in this practice. Pharmacists have demonstrated the ability to provide comprehensive medication management in OUD treatment with positive outcomes of increased access, cost savings, reduced physician burden, enhanced medication utilization and adherence, improved treatment retention, and high patient satisfaction. Since implementation of the MAT Act, DEA-registered pharmacists in the Department of Veterans Affairs Veterans Health Administration (VHA) have independently prescribed B-MOUD. Clinical Pharmacist Practitioners (CPPs) within VHA practice as members of the interprofessional team and have independent prescriptive authority under a scope of practice based on their qualifications and competencies. This commentary describes CPP independent B-MOUD prescribing within VHA as an effective practice that could model pharmacist care in other large health care systems. Benefits of this model include increased B-MOUD access and retention while maintaining high quality, team-based care and use of telehealth to expand access to underserved areas. Major limitations include state legislative barriers that restrict pharmacist-controlled substance and B-MOUD prescribing. We call for advancements to state practice laws that authorize controlled substance prescriptive authority for pharmacists and reimbursement for services which are essential to continue expanding CPP B-MOUD prescribing within and beyond the VHA.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"963-973"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atomoxetine Versus Placebo for Cognitive Deficits in Stimulant Use Disorder: A Systematic Review.","authors":"Douglas Barroso, Martin Kotochinsky, Mateus Rodrigues Alessi, Wellgner Fernandes Oliveira Amador, Diogo Carrazzoni Godoi, Rohan Sabloak, Samuel Izaias Dos Santos Pereira, Yusuf-Zain Ansari, Karolina Guedes Amorim, Gabriel Barbosa, Alvaro Texeira","doi":"10.1177/29767342261443842","DOIUrl":"10.1177/29767342261443842","url":null,"abstract":"<p><strong>Background: </strong>Stimulant use disorder (StUD), particularly involving cocaine and amphetamines, is associated with significant cognitive impairments that impede recovery and increase relapse risk. Atomoxetine, a selective norepinephrine reuptake inhibitor, has been proposed as a potential treatment given its role in enhancing executive function and its established efficacy in attention-deficit/hyperactivity disorder (ADHD). This systematic review aimed to evaluate the efficacy, cognitive, and mood effects of atomoxetine compared with placebo in individuals with StUD.</p><p><strong>Methods: </strong>A comprehensive literature search of PubMed, Cochrane CENTRAL, and Embase databases was conducted to identify randomized controlled trials (RCTs) evaluating atomoxetine for StUD. Eligible studies compared atomoxetine with placebo and assessed outcomes related to cognition (attention and response inhibition), stimulant use or abstinence, mood symptoms, and safety. Data were extracted and synthesized qualitatively due to methodological heterogeneity across studies.</p><p><strong>Results: </strong>Nine RCTs met the inclusion criteria. Findings on cognitive outcomes were inconsistent: Some studies reported improvements in attentional bias and inhibitory control, while others showed no significant effects. Atomoxetine did not significantly reduce stimulant use, craving, or sustain abstinence compared with placebo. Limited mood-related benefits were observed, particularly among male participants, although results were variable. Across studies, atomoxetine was well tolerated, with most adverse events mild and transient.</p><p><strong>Conclusion: </strong>Despite a compelling neurobiological rationale and evidence of modest cognitive and mood benefits, atomoxetine has not demonstrated consistent efficacy as a monotherapy for StUD. Its favorable safety profile may warrant further investigation in carefully defined populations, such as individuals with comorbid ADHD or in combination with behavioral interventions.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1232-1243"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Health Messaging for Perinatal Cannabis Use: Perspectives From Postpartum Individuals With Use During Early Pregnancy.","authors":"Shannon N Ogden, Tara R Foti, Monique B Does, Andrea Altschuler, Esti Iturralde, Deborah Ansley, Carley Castellanos, Kelly C Young-Wolff","doi":"10.1177/29767342261449036","DOIUrl":"10.1177/29767342261449036","url":null,"abstract":"<p><strong>Background: </strong>Perinatal cannabis use has become more common in the United States. However, the evidence that associates prenatal cannabis use with increased risk for adverse maternal and child health outcomes is also growing. Therefore, it is important to include perinatal cannabis risks in standard health warnings to perinatal patients. As health messaging that resonates with perinatal individuals who use cannabis regularly has not yet been identified, further testing is needed. Therefore, we sought to gain perspectives from postpartum individuals who used cannabis regularly in early pregnancy on perinatal cannabis use health messages.</p><p><strong>Methods: </strong>This analysis used data from a larger qualitative study that recruited participants who were 4 to 12 months postpartum and self-reported daily or weekly cannabis use during early pregnancy (at ~8 weeks gestation) at prenatal care entry. We used a semi-structured interview guide to solicit participants' thoughts on 4 different messages containing perinatal cannabis use health information and warnings. We conducted interviews in April to May 2022. We used thematic analysis to identify key aspects of acceptable perinatal cannabis health messaging.</p><p><strong>Results: </strong>Sixteen participants provided feedback on the health messages. Participants were 21 to 33 years old, 6 to 11 months postpartum, and self-identified as black (n = 4), Hispanic (n = 4), and white (n = 8). None of the messages were wholly accepted across participants, but we identified 3 key aspects of acceptable health messaging for perinatal cannabis use: (1) use of neutral language and images, (2) inclusion of evidence for health risks, (3) present options or alternatives for cannabis use.</p><p><strong>Conclusion: </strong>Findings provide evidence for perinatal cannabis use clinical health messaging that could resonate with perinatal patients who use cannabis and encourage open dialogue with their health care providers. Further research is needed to understand the actual impact of message exposure on perinatal cannabis use.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1198-1204"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RAMP-UP: Pharmacist-Led Methadone Titration for Hospitalized Patients With Opioid Use Disorder.","authors":"Emily R Casey, Tanya Uritsky, Liana Soyfer, Lin Xu, Kevin G Lynch, Samantha Zwiebel, Margaret Lowenstein, Ashish Thakrar","doi":"10.1177/29767342261433344","DOIUrl":"10.1177/29767342261433344","url":null,"abstract":"<p><strong>Background: </strong>Hospitals increasingly start methadone treatment for opioid use disorder (OUD). Rapid methadone titration has been described in hospitals with addiction consult teams; however, most hospitals lack these specialty services. We evaluated whether a pharmacist-led rapid methadone titration protocol (\"RAMP-UP\") increased the proportion of hospitalizations that reached a minimally therapeutic dose of methadone (≥60 mg) before discharge.</p><p><strong>Methods: </strong>We conducted a retrospective, quasi-experimental, pre-post study comparing outcomes 7 months before versus 7 months after the implementation of RAMP-UP. The study included all adults admitted to a large academic medical center between March 2022 and April 2023 who newly initiated methadone for OUD. We used multivariable regression with generalized estimating equations to evaluate the primary outcome of achieving a total daily methadone dose of at least 60 mg by hospital discharge. Secondary outcomes included days to therapeutic dose, total daily methadone dose, and opioid-related safety events.</p><p><strong>Results: </strong>We identified n = 155 admissions, 55 pre-intervention and 100 post-intervention, among 124 unique patients with OUD. After RAMP-UP, a higher proportion of encounters reached ≥60 mg total daily dose (TDD) of methadone, but this difference was not significant in adjusted analyses (45.5% pre-implementation vs 60.0% post-implementation, <i>P</i> = .06). Post-implementation encounters had higher methadone TDD on discharge (62 vs 55 mg; <i>P</i> = .04) and, among those who reached 60 mg TDD, achieved this dose faster (9.0 vs 4.0 days, <i>P</i> < .001). Safety events were uncommon and similar (11.0% vs 12.7%; <i>P</i> = .80).</p><p><strong>Conclusions: </strong>Pharmacist-guided rapid titration accelerated attainment of therapeutic methadone doses and did not increase adverse events. Although the adjusted increase in the proportion achieving ≥60 mg TDD by discharge was not statistically significant, these findings demonstrate how inpatient clinical pharmacists can modernize inpatient OUD care.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1027-1034"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuum of Care for Substance Use Disorders in Pregnancy: Evidence From the National Survey on Drug Use and Health.","authors":"Brooke N Lombardi, Anna Parisi, Maria Gaiser, Hanna Erhardt, Brianna M Lombardi","doi":"10.1177/29767342261442453","DOIUrl":"10.1177/29767342261442453","url":null,"abstract":"<p><strong>Background: </strong>Substance use during pregnancy is a growing public health concern, yet little is known about how universal screening translates into the identification of a substance use disorder (SUD) and treatment engagement, across the perinatal SUD continuum of care. Persistent disparities in screening, identification, and treatment may contribute to missed opportunities for timely intervention and exacerbate inequities in maternal health. This study examined national patterns of substance use screening, SUD prevalence, and treatment engagement among pregnant women in the United States.</p><p><strong>Methods: </strong>Data were drawn from the 2021 to 2023 National Survey on Drug Use and Health. The sample consisted of pregnant females aged 12 to 49 years (N = 2 051; weighted population estimate 2,037,128). Outcomes included healthcare professional-initiated screening for drug and alcohol use, SUD diagnosis, and SUD treatment engagement. Researchers estimated the prevalence of each outcome and conducted survey-weighted logistic regression to assess sociodemographic, clinical, and structural correlates.</p><p><strong>Results: </strong>Nearly two-thirds of pregnant women (64.7%) reported being screened for substance use in the past year, 14.3% met criteria for a past-year SUD, and only 10% of those with SUD received treatment. Screening and SUD prevalence varied significantly by age, race/ethnicity, educational attainment, income level, insurance type, mental health status, and criminal justice involvement. Screening alone was not associated with treatment receipt; however, a provider-initiated conversation about treatment options and/or substance use was associated with more than 10-fold higher odds of treatment engagement. Substantial attrition between screening and treatment was observed, with disparities across sociodemographic and geographic groups.</p><p><strong>Conclusion: </strong>Most pregnant women receive substance use screening nationwide, but few who meet the criteria for a SUD ultimately receive treatment, indicating critical gaps in the perinatal SUD care continuum. Findings underscore the need to strengthen post-screening follow-up, including provider communication, care coordination, and integrated obstetric-behavioral health models, to ensure that identification leads to timely, patient-centered treatment. Addressing the barriers and inequities in screening, diagnosis, and treatment engagement is essential for advancing maternal health equity and improving outcomes for pregnant women with SUD.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1060-1071"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of a Scattered-Site Managed Alcohol Program for People With Alcohol Use Disorder in Halifax, Nova Scotia: A Mixed-Methods Study.","authors":"Candis Lepage, Leah Genge, Thomas D Brothers","doi":"10.1177/29767342261444527","DOIUrl":"10.1177/29767342261444527","url":null,"abstract":"<p><strong>Background: </strong>Managed alcohol programs (MAPs) are harm reduction services that provide regular, measured doses of beverage-grade alcohol alongside social and health services, aiming to reduce nonbeverage alcohol consumption and harms associated with excessive intoxication and withdrawal. Most MAPs are paired with supportive housing, which can be at a single building (\"single-site\") or more uncommonly across multiple apartments (\"scattered-site\"). The North End Community Health Centre - Mobile Outreach Street Health (MOSH) in Halifax, Nova Scotia, established Atlantic Canada's first MAP, using a scattered-site model, in April 2020 - during the COVID-19 pandemic. We aimed to describe program participants, summarize outcomes, and understand stakeholder perceptions of program successes and challenges.</p><p><strong>Methods: </strong>Parallel, mixed methods program evaluation. Quantitative arm involved retrospective review of weekly program assessments documenting presence or absence of outcomes (April 2020-December 2022). Qualitative arm included 4 focus groups with key stakeholders (May-June 2021).</p><p><strong>Results: </strong>Over the first 33 months, 38 people enrolled in MAP. At the time of our study, 9 had died and 9 left the program. Of the 20 remaining participants, 13 consented to chart review (92% male; age mean 46, SD 11 years) and 9 had weekly outcome data available. Comparing year 1 to year 2, participants had mean person-week prevalence of any nonbeverage alcohol consumption (eg, hand sanitizer): 9% and 3%; acute alcohol-related harms: 25% and 9%; and seizures: 4% and 1%. Mean person-week prevalence of out-of-program drinking was 34% in year 1 and 33% in year 2. Focus groups highlighted MAP improved participants' health and decreased frequency of nonbeverage alcohol consumption, survival behaviors, and violence. Challenges included out-of-program drinking and lack of social programming.</p><p><strong>Conclusion: </strong>This scattered-site MAP may support positive health and social outcomes for people with severe alcohol use disorder. Identified program gaps can be explored to better meet participant needs and reduce out-of-program drinking.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1118-1129"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Noticing Product Features in Cannabis Vape Product Advertisements and Product Use Perceptions Among Young Adults: A Heatmap Experiment.","authors":"Kathryn La Capria, Sarah D Kowitt, Kimberly G Wagoner, Ollie Ganz, Siyan Meng, Julia Chen-Sankey","doi":"10.1177/29767342261453196","DOIUrl":"10.1177/29767342261453196","url":null,"abstract":"<p><strong>Background: </strong>Advertising for cannabis vape products (CVPs) often highlights product features related to their functions and perceived benefits. Such messages may encourage CVP use among young adults (YAs), a group with rising prevalence and heightened vulnerability to CVP use. We examined the associations between noticing product feature messages in CVP ads and product use perceptions among US YAs of varying CVP-use statuses.</p><p><strong>Methods: </strong>YAs (n = 2024) who either use CVPs or are susceptible to CVP use completed an online heatmap (a visualization tool representing attention data) experiment in 2024. Participants viewed 6 CVP ads that each portrayed 3 of the following 9 types of product feature messages: creativity, physical health benefits, social enhancement, mental health benefits, relaxation, positive flavor sensation, positive mood effects, convenience/discreetness, and elevated potency. Participants clicked on the message that most attracted their attention in each ad and then reported use intentions, positive use expectancy, and perceived mental and physical health benefits related to using the advertised products. We examined associations between noticing product feature messages and perception outcomes, controlling for covariates.</p><p><strong>Results: </strong>Noticing messages about physical health benefits was positively associated with product use intentions (coef. = 0.343, <i>P</i> = .000), positive use expectancy (coef. = 0.107, <i>P</i> = .002), and perceived physical (coef. = 0.189, <i>P</i> = .000) and mental (coef. = 0.171, <i>P</i> = .000) health benefits. Noticing messages about social effects was positively associated with product use intentions (coef. = 0.410, <i>P</i> = .000), positive use expectancy (coef. = 0.163, <i>P</i> = .000), and perceived mental health benefits (coef. = 0.229, <i>P</i> = .000). Additionally, noticing messages about creativity was positively associated with product use intentions (coef. = 0.164, <i>P</i> = .007).</p><p><strong>Conclusions: </strong>Attention to several product feature messages in CVP ads was associated with intentions and positive perceptions of using the advertised CVPs among YAs, which may lead to future use. Results from this study can inform strategies for reducing the appeal and influence of CVP marketing among this vulnerable population.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1035-1046"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common Challenges in Predicting Opioid-related Outcomes Using Machine Learning.","authors":"Chandan Saha, Alan Davalos Guzman, Yutong Li, Chunhui Gu, Emily Ward, Venkat Bhat, Jake Hayward, Jeremy Weleff, S Monty Ghosh, Russell Greiner, Andrew Greenshaw, Yang S Liu, Bo Cao","doi":"10.1177/29767342261467589","DOIUrl":"10.1177/29767342261467589","url":null,"abstract":"<p><p>Machine learning (ML) models have been commonly utilized to predict various opioid-related outcomes and risks, including post-operative opioid use, opioid use disorder (OUD), misuse, or overdose. Despite their promising performance, the clinical utility and cross-study comparability of ML models are constrained. This is mainly due to variability in outcome definitions, data heterogeneity, class imbalance and analysis concerns, inadequate external or prospective validation, and limited real-world deployment and ethical concerns. Herein, we present an updated overview of these challenges in predicting opioid-related outcomes and outline strategies to improve the clinically meaningful applications of ML in this domain.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1006-1011"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Comorbid Psychological Distress on Stimulant Use Disorder Treatment Outcomes.","authors":"Himani Byregowda, Masoumeh Amin-Esmaeili, Ryoko Susukida, Ramin Mojtabai, Rosa M Crum","doi":"10.1177/29767342261448422","DOIUrl":"10.1177/29767342261448422","url":null,"abstract":"<p><strong>Background: </strong>Psychological distress is common among individuals with stimulant use disorder (StUD) and may affect treatment outcomes, with potential differences in men and women. We examined the impact of comorbid psychological distress on StUD treatment outcomes across behavioral interventions, with a focus on differences by sex.</p><p><strong>Methods: </strong>Data were pooled from 4 randomized controlled trials of behavioral interventions (eg, motivational interviewing, 12-step, and smoking-cessation) for StUD (n = 1858) from the National Institute on Drug Abuse Data Share. Psychological distress was assessed using the Addiction Severity Index-psychiatric problems subscale (≥0.246 cutoff). Outcomes included (a) any reduction in stimulant use frequency from baseline to the end of trial, (b) stimulant-positive urine test, and (c) other drug-positive urine tests at the end of trial. We used individual participant data meta-analysis with regression models, adjusting for sociodemographic factors, treatment arms and trial duration, and clustering by trials. We used inverse probability weighting to address missing data. Analyses were conducted on the full sample and stratified by sex.</p><p><strong>Results: </strong>Overall, 57.1% of women and 38.7% of men experienced psychological distress. Among men, psychological distress was associated with decreased odds of reducing stimulant use (adjusted odds ratio [aOR] = 0.70, 95% confidence interval [CI] = 0.49, 0.99), and increased odds of having a stimulant-positive urine test (aOR = 1.23, 95% CI = 1.03, 1.47). Among women, distress was not significantly associated with reduced stimulant use or with having a stimulant-positive urine test. However, psychological distress moderated the treatment effect: women with psychological distress who received behavioral interventions were more likely to reduce stimulant use than those without psychological distress.</p><p><strong>Conclusion: </strong>Psychological distress was associated with poorer treatment outcomes for men but appeared to enhance treatment response for women. Screening and addressing psychological distress may improve StUD treatment. Sex differences highlight the need for sex-specific approaches to managing psychological distress in StUDs.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"1164-1174"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148214040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}