BACKGROUND:The present study aimed to develop and evaluate the preliminary validity of the Stress Burden of Electronic Cigarette Smoking Scale (SBECSS), a new measure designed to assess the level of stress burden associated with the co-occurring perceptions of electronic cigarette (e-cigarette) use and efforts to quit within an individual. METHOD:To achieve this, 400 adult dual users of combustible cigarettes and e-cigarettes (52.8% female; 90% non-Hispanic White; Mage = 37.8, SD = 9.7) participated in an online survey. Items were developed in accordance with the operational definition, reviewed by field experts, and evaluated post-data collection for inter-item correlations and theoretical alignment. RESULTS:Confirmatory factor analysis was conducted to compare the unidimensional, two-factor correlated, second order, and bifactor models. Factor analysis supported a unidimensional factor structure (X2[170] = 343.557, p < 0.001; RMSEA = 0.051 [90% CI: 0.043, 0.059], p = 0.413; CFI = 0.970; SRMR = 0.021), and measurement invariance was supported across sex. The SBECSS demonstrated construct validity with measures of e-cigarette related and affective processes. CONCLUSIONS:These findings suggest that the SBECSS is a reliable and valid tool for measuring and understanding the stress burden of using or quitting e-cigarettes among dual tobacco users.
BACKGROUND:Opioid use disorder (OUD) is a severe public health crisis in the Americas. This study aimed to comprehensively evaluate the spatiotemporal trends, socioeconomic inequalities, and future projections of the OUD burden across the region from 1990 to 2050. METHODS:Data from the Global Burden of Disease 2023 study were utilized to extract incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for OUD. Trends were quantified using average annual percent change (AAPC). Health inequalities were assessed via the Slope Index of Inequality (SII) and Socio-demographic Index (SDI) correlations. Bayesian Age-Period-Cohort models were employed to project the burden to 2050. RESULTS:In 2023, High-income North America bore the most severe OUD burden, with an age-standardized mortality rate (ASMR) of 19.08 per 100,000, surging dramatically since 1990 (AAPC: 8.35). Latin America exhibited a stable incidence but rising mortality. The burden was disproportionately concentrated in higher SDI regions, with absolute inequality in fatal outcomes widening significantly. Projections indicate a catastrophic escalation in mortality across the Americas by 2050. CONCLUSION:The OUD epidemic in the Americas is escalating and profoundly unequal. Urgent, context-specific interventions and enhanced surveillance are critical to mitigate this worsening crisis.
BACKGROUND:Chemsex is an increasingly recognized public health concern, remains inconsistently defined and often framed through risk-based perspectives. This cross-sectional survey (N = 401) examined chemsex engagement patterns and psychosocial correlates among gay, bisexual and other men who have sex with men in Australia. METHODS:We included demographic factors, substance use, chemsex engagement, perceptions of substances and psychosocial constructs. Descriptive statistics, bivariate analyses and logistic regression models were used to estimate associations between recent chemsex engagement and personal characteristics. RESULTS:Nearly 60% (59.9%) of participants reported lifetime chemsex engagement and 39.2% in the past three months. Demographic factors were not significant correlates. Psychosocial models explained modest variance, with higher drug-taking confidence associated with increased odds of recent chemsex engagement, and higher sex-positivity associated with lower odds. Participants' definitions of chemsex varied. Polysubstance use was common, with a mean of 2.9 (SD = 1.2) substances/session. Frequent co-use patterns included methamphetamine, gamma-hydroxybutyrate, and poppers. CONCLUSIONS:Chemsex was relatively common in this sample, with considerable variation in frequency of engagement, perceptions of which substances constitute chemsex, and patterns of substance use. Findings highlight definitional variability, limited explanatory power of individual-level correlates, and the importance of addressing polysubstance use in research and harm reduction.
BACKGROUND:Young adult (YA) alcohol and cannabis co-use may amplify use-related risks. We examined YA co-use in relation to problematic use and driving-under-the-influence (DUI). METHODS:We analyzed 2023 data among 2,953 US YAs (18-34) reporting past-month alcohol-only use (33.4%), cannabis-only (17.9%), or alcohol-cannabis co-use (48.8%). We assessed self-reported: 1) alcohol-only use vs. alcohol-cannabis co-use, alcohol use frequency, and simultaneous use frequency in relation to problematic alcohol use and DUI of alcohol (DUIA); 2) cannabis-only use vs. co-use, cannabis use frequency, and simultaneous use in relation to problematic cannabis use and DUI of cannabis (DUIC); and 3) alcohol, cannabis, and simultaneous use in relation to DUI of alcohol and cannabis (DUIAC), controlling for sociodemographics and state legalization. RESULTS:Co-use and more alcohol use were associated with greater problematic alcohol use (B = 0.38, SE = 0.04; B = 0.02, SE = 0.01) and DUIA (aOR = 1.35, 95%CI = 1.07-1.72; aOR = 1.07, 95%CI = 1.05-1.08). Co-use and less cannabis use were associated with problematic cannabis use (B = 0.12, SE = 0.04; B=-0.01, SE = 0.003), and more cannabis use was associated with DUIC (aOR = 1.04, 95%CI = 1.03-1.05). Simultaneous use was associated with problematic alcohol (B = 0.02, SE = 0.01) and cannabis use (B = 0.03, SE = 0.01), DUIA (aOR = 1.08, 95%CI = 1.06-1.11), DUIC (aOR = 1.05, 95%CI = 1.02-1.07), and DUIAC (aOR = 1.09, 95%CI = 1.05-1.14). CONCLUSIONS:Interventions should consider addressing both substances, particularly co-use, given related risks.
BACKGROUND:Symptom validity assessment is crucial in clinical neuropsychology, especially in populations prone to under- or overreporting, such as patients with Substance Use Disorders (SUD). This study investigated symptom validity using the Structured Inventory of Malingered Symptomatology (SIMS) in a SUD inpatient population. OBJECTIVES:To establish the SIMS failure rates in SUD patients, and examine the relationship between symptom validity, psychological distress, and performance validity. METHODS:Retrospective data were analyzed from 55 patients with SUD admitted to a closed addiction ward. Symptom validity was measured with the SIMS, psychological distress with the Symptom Checklist-90-Revised (SCL-90-R), and performance validity with the Visual Association Test - Extended (VAT-E). RESULTS:Using the traditional SIMS cutoff (>16), 32.7% of patients exceeded the threshold, compared to 12.7% using a more conservative cutoff (>23). SIMS total scores showed a strong positive correlation with psychological distress (SCL-90-R total; ρ = 0.71, p < 0.001), and weak agreement between SIMS and SCL-90-R classifications (κ = 0.46, p < 0.001) when using a liberal cutoff, and minimal agreement using a more conservative cutoff (κ = 0.17, p = 0.026). No significant associations were observed between SIMS scores and VAT-E indices of performance validity. CONCLUSIONS:Elevated SIMS scores were relatively common in this SUD sample and were strongly associated with self-reported psychological distress, while showing no relationship with performance validity. These findings highlight the conceptual distinction between symptom validity and performance validity and underscore the importance of a multimethod approach when assessing response validity in patients with SUDs.
BACKGROUND:Chronic pain and hazardous drinking often co-occur among U.S. veterans. Research examining associations between pain interference and alcohol use has yielded mixed findings, with some studies linking greater pain interference to lower levels of alcohol consumption, and others linking it with increased odds of alcohol dependence. However, there has been a paucity of research examining these relations among veterans. The novel contribution of the present study was to test whether combat-deployment status moderated the association between pain interference and AUDIT total scores among veterans with chronic pain. METHODS:Data were drawn from a Qualtrics Panel survey of 430 U.S. veterans with chronic pain who endorsed past-month alcohol use. Participants had a mean age of 56.7 years (SD = 14.81), and 76.3% were male. RESULTS:Greater pain interference was positively associated with higher AUDIT total scores. Significant interactions were observed, such that this association was more pronounced among combat veterans, particularly among those reporting severe pain interference. CONCLUSIONS:Among veterans with chronic pain, greater pain interference was associated with higher AUDIT total scores, and this relationship was especially pronounced among combat veterans. Tailored interventions addressing pain interference and hazardous drinking among veterans may be warranted, with attention to combat-related experiences.
BACKGROUND:Prison-based substance use disorder treatment programs aim to enhance the assets and skills available to individuals in recovery before their release from prison; however, research examining how these gained assets and skills predict recovery outcomes in the community is limited. This study addresses this gap using a recovery capital framework. METHODS:Data were collected from 393 individuals who participated in prison-based substance use disorder treatment as part of the Geographic Variation in Opioid Addiction Treatment (GATE) study. We assessed the relationship between a recovery capital score indicating remission and its individual domains during incarceration and three outcomes after prison release: return to drug use, employment, and stable housing. RESULTS:Recovery capital scores indicative of remission predicted a lower likelihood of returning to drug use (OR: 0.38, p ≤ 0.01), increased likelihood of gaining employment (OR: 3.12, p ≤ 0.001), and increased likelihood of gaining stable housing (OR: 1.93, p ≤ 0.05) after prison release. Results varied across individual recovery capital domains for each outcome. CONCLUSIONS:By assessing the post-release outcomes of returning to drug use, establishing employment, and obtaining stable housing by individual domains of RC, this research provides meaningful insight that may further support existing or novel programming in prisons to meet individuals' needs.
BACKGROUND:Social exclusion is an important but understudied aspect of recovery among individuals receiving mandated addiction treatment under deferred prosecution. METHODS:Using a cross-sectional survey of 288 participants in Taiwan (85.4% male; mean age = 41.01 years, SD = 10.09), this study tested associations of internalized stigma, recovery capital, and family support with social exclusion, and examined recovery capital as a mediator of the stigma-exclusion association. RESULTS:Internalized stigma was positively associated with social exclusion, while recovery capital and family support were negatively associated. In the final regression model (43.2% variance explained), recovery capital (β = -0.441, p < 0.001) and family support (β = -0.217, p < 0.001) remained independently associated with lower social exclusion, whereas internalized stigma was no longer significant (β = 0.109, p = 0.061). Recovery capital significantly mediated the stigma-exclusion association even after adjustment for family support (indirect effect = 0.41, 95% CI [0.22, 0.64]). CONCLUSIONS:These results indicate that social exclusion in this population reflects psychosocial vulnerability, recovery-supporting resources, and relational context, and point to the importance of addressing exclusion directly in recovery and reintegration efforts.
BACKGROUND:Given the increasing prevalence of young adult (YA) cannabis use and medical cannabis (MC) use, which is particularly relevant to cancer-related symptoms, we examined MC use and related factors among YA cancer survivors (ages 18-39). METHODS:In 2025, we conducted qualitative interviews with 23 YA survivors reporting past-month cannabis use (Mage=33.65 ± 5.99, 73.9% female, 73.9% White, M = 1.22 ± 1.09 years post-treatment), assessing: implications of cannabis legalization, MC information sources, healthcare provider interactions, and symptoms/conditions MC managed. Data were analyzed using thematic analysis. RESULTS:During treatment, 56.5% lived in states with MC-only legal and 34.8% fully legal cannabis; at time of interview, 21.7% lived in states with MC-only and 73.9% fully legal. Themes included: (1) importance of legal context in facilitating or impeding MC access/use; (2) reliance on dispensaries, social networks, and personal research/experimentation for MC information; (3) varied experiences communicating with healthcare providers (little communication, provider hesitancy, providers supporting MC use, contradictory information, stigma-related concerns, desiring shared healthcare decision-making); (4) conditions/symptoms managed and effectiveness; (5) hopes future healthcare better incorporates MC; and (6) concerns/cautions about MC use vs. alternatives. CONCLUSIONS:Findings highlight MC's perceived utility in managing symptoms among YA cancer survivors, alongside fragmented policies/systems impeding evidence-based information or healthcare provider input.
OBJECTIVES:Adolescent involvement in the criminal legal system (CLS) may function as a significant stressor with long-term behavioral health consequences. This study examined whether CLS involvement before age 18 influences the odds and trajectories of substance use (alcohol, cigarette, marijuana, and illicit drug use) from ages 18-28, and whether these effects vary by severity of involvement. METHOD:Data were drawn from the 1997-2011 surveys of the National Longitudinal Survey of Youth 1997 (N = 8,961; approximately 50% male), a nationally representative cohort. Random intercept and growth curve models were estimated to examine the effects of CLS involvement before 18 on the odds of substance use from 18-28 (alcohol, cigarette, marijuana, and illicit drug use). RESULTS:Being arrested, incarcerated in a juvenile facility, or incarcerated in an adult facility before 18 was associated with an increased odds illicit drug use (OR = 2.080, p < 0.001; OR = 2.132, p < 0.001; OR = 2.598, p < 0.001) from 18-28 (respectively). The growth curve models suggested that CLS involvement before 18 could result in more persistent substance use. CONCLUSIONS:These findings suggest that youth CLS involvement could influence substance use and more persistent patterns of substance use in adulthood. The combination of cognitive behavioral therapy and substance use treatment should be considered for reentering youth.
OBJECTIVE:To develop more effective intervention strategies for substance use disorder (SUD), it is essential to create models that evaluate the relative influence of various risk factors. This study constructed an integrated biopsychosocial model to examine the associations of different risk vulnerability domains with SUD severity. METHOD:251 community adults aged 18-55 (female = 48.2%; White = 64.1%, Black = 26.7%, Asian American = 8.0%, American Indian/Alaska Native = 2.0%, Native Hawaiian/Pacific Islander = 1.6%, Hispanic =7.6%), completed clinical diagnostic interviews, neuropsychological testing, behavioral tasks, and surveys to assess SUD severity and an array of risk factors. We created latent variables to represent Disordered Personality, Cognitive Ability, and Social Determinant domains expected to contribute to SUD severity. We used structural equation modeling to model the cross-sectional associations of SUD severity with the latent variables (Disordered Personality, Cognitive Ability, and Social Determinant) and Delay Discounting. RESULTS:An integrated model showed that Social Determinants (β = 0.77, z-test = 6.06, p < 0.001; 95% CI [0.72, 0.82]), Disordered Personality (β = 0.17, z-test = 2.23, p = 0.026; 95% CI [0.05, 0.29]) and Delay Discounting (β = 0.16, z-test = 3.13, p = 0.002; 95% CI [0.04, 0.28]) explained variance in SUD severity. In contrast, Cognitive Ability was not associated with SUD severity in the integrated model (β = 0.18, z-test = 1.56, p > 0.05). CONCLUSIONS:These cross-sectional findings support biopsychosocial models of SUD and underscore the role of social determinant risk factors in understanding SUD severity. Further research is needed to refine these models for improved assessment and treatment strategies.
BACKGROUND:Recovery homes vary in their governance structures, yet little is known about how these differences shape recovery-relevant social environments. This study examined democratic decision-making, rule implementation, and perceived social climate in peer-run Oxford Houses compared to staff-run recovery homes. METHODS:Using data from 306 Oxford House residents and 80 traditional recovery home residents who completed the Social Setting Democracy Scale, analyses tested relationships among governance processes and outcomes. RESULTS:Greater resident participation in decision-making was associated with more positive social environments, and this relationship was statistically linked to perceptions of fair and transparent rule implementation. Oxford House residents reported significantly higher levels of decision-making participation, implementation fairness, rule clarity, and positive social climate compared to residents of staff-run homes. CONCLUSION:These findings suggest that the enactment of governance processes. particularly fair implementation, may represent an important mechanism through which recovery environments influence functioning. Democratic governance is discussed as a potentially active ingredient of peer-run recovery models, with implications for recovery housing design and evaluation.
BACKGROUND:Drug use disorders are a major public health concern. Although inpatient care can reduce exposure to drug-related cues, the effectiveness of psychosocial interventions is unclear. This systematic review synthesized randomized controlled trials (RCTs) of inpatient psychosocial interventions for drug use disorders. METHODS:Following the PRISMA 2020 guidelines, we searched PubMed, Embase, the Cochrane Library, and PsycINFO from inception to August 20, 2024, for RCTs of psychosocial interventions for drug use disorders and then screened for trials conducted in inpatient settings. Reviewer pairs screened records, extracted data, and assessed risk of bias. Given heterogeneity in interventions and outcomes, we synthesized findings narratively. RESULTS:Eleven RCTs evaluated cognitive-behavioral, motivational, mindfulness-based, emotion-regulation, pharmacotherapy-supported psychosocial, and activity-based approaches in diverse clinical settings and populations. One trial was interpreted cautiously because the participants' primary substances were not identified. Several trials reported beneficial effects on short-term or proximal outcomes (e.g., craving and treatment motivation), especially when intervention components extended beyond discharge, whereas other trials showed no benefit or worse outcomes. Study quality was variable; small sample sizes, lack of blinding, and inconsistent follow-up were common issues. CONCLUSIONS:Inpatient psychosocial interventions may contribute to improvements in short-term or proximal outcomes (e.g., motivation/engagement and craving) and may support linkage to continuing care, but the evidence for sustained post-discharge abstinence or relapse prevention is limited and mixed. Larger, methodologically robust trials with standardized outcomes and longer follow-up are needed.
METHODS:This research compares characteristics related to receipt of medications for OUD (MOUD) across treatment episodes referred by the criminal justice system and those referred by other sources, utilizing 639,199 cases from the 2018 U.S. Treatment Episode Data Set-Discharges. RESULTS:MOUD receipt was more than twice as likely in the non-criminal justice sample than the criminal justice sample (33% compared to 15%, respectively). The impact of demographics, substance use, need for and characteristics of treatment, and access to treatment on MOUD receipt vary considerably across the two samples. CONCLUSIONS:Understanding characteristics that inhibit and facilitate MOUD access can strengthen the public health approach to intervention, particularly for justice-involved individuals.
OBJECTIVE:Impulsivity is thought to reflect a vulnerability to alcohol-related problems. Research suggests that impulsive individuals may engage in heavier alcohol use in stimulating environments. However, prior studies have not tested this assumption using an in vivo approach (i.e., daily diary). This study examined whether both high sensory stimulating contexts and heavy peer drinking contexts moderate the association between impulsivity and alcohol consumption. METHOD:Over a two-week period, participants (N = 102; 61.8% female) responded to daily notifications assessing their alcohol consumption and the drinking event context. At the initial laboratory visit, participants completed a measure of impulsivity. RESULTS:Analyses revealed a significant interaction between impulsivity and heavy peer drinking contexts. Specifically, impulsivity was moderated by heavy peer drinking contexts, such that highly impulsive individuals engaged in heavier alcohol use in heavy peer drinking contexts. No significant interaction was found between impulsivity and high sensory stimulating contexts. CONCLUSIONS:Highly impulsive individuals appear particularly sensitive to heavy peer use, relative to individuals with lower levels of impulsivity. The findings highlight the importance of examining the influence of heavy peer drinking as a potential intervention target, particularly for individuals high in impulsivity.
BACKGROUND:Sober Living Houses (SLHs) adopt a social model approach, which emphasizes peer helping. Although SLHs appear to be effective, little is known regarding why. This longitudinal study examined whether higher SLH social model adherence produces better resident outcomes by increasing resident helping. METHODS:Baselines were conducted with 205 residents entering 28 SLHs, with follow-ups through 6 months. Measures included 1-month perceived SLH social model adherence; 2-month help given to and received from SLH residents; and 6-month alcohol use and severity. Analyses were lagged, multivariate mediation models accounting for clustering within SLH. Separate models examined help given and received for each outcome, yielding four model tests. RESULTS:The hypothesized model was unsupported, with all four tests showing nonsignificant indirect effects. However, exploratory post-hoc tests showed significant indirect effects between higher 1-month resident helping and better 6-month alcohol outcomes via higher 1-month SLH social model adherence. Effects held across three of four model tests. CONCLUSIONS:Results suggest that residences adhering to social model principles do not achieve better outcomes by stimulating helping, but rather that more resident helping may foster a supportive SLH social environment, which itself drives better outcomes. Thus, residences might emphasize both resident helping and social model principles.
ABSTACTAlcohol consumption remains a major public health challenge and a leading preventable cause of morbidity and mortality worldwide. Although the Alcohol Use Disorders Identification Test (AUDIT) is widely used to identify hazardous alcohol use, reliance on total scores may obscure clinically meaningful heterogeneity in drinking behaviors. This study aimed to identify latent alcohol consumption typologies among Colombian adults using AUDIT response patterns and to examine their sociodemographic and psychosocial correlates. Latent class analysis (LCA) was conducted using ten dichotomized AUDIT items from 14,131 adults who reported alcohol consumption during the previous 30 days in the 2019 Colombian National Survey of Psychoactive Substance Use. Competing models were evaluated according to statistical fit, parsimony, classification accuracy, and interpretability. A three-class solution was selected, comprising Low Risk (50.7%), Hazardous Binge Drinking (38.5%), and Harmful/Dependence (10.8%) profiles. Although the two higher-risk classes showed similarly high probabilities of heavy episodic drinking, the Harmful/Dependence profile was characterized by substantially greater probabilities of dependence symptoms and alcohol-related consequences. Early alcohol initiation, peer heavy drinking, and depressive symptoms were associated with more severe profiles, whereas female sex and higher socioeconomic status were protective. These findings highlight the value of person-centered approaches for identifying heterogeneous alcohol use patterns and informing targeted prevention, screening, and intervention strategies.
BACKGROUND:The harms of using combined cannabis and alcohol include injuries, social problems, and exacerbating existing conditions. No studies have compared substance use risk factors pre and post pandemic in a large national sample among those who use these substances together. The goal of our study was to determine the relationship between the pandemic and shifts in substance use among those who use cannabis and alcohol together. METHODS:This was a review of data collected by the National Survey of Drug Use and Health for the time frames (2015-2019 [pre-COVID], 2023 [post-COVID]). We analyzed data pertaining to whether respondents used cannabis during their last alcohol use. We analyzed demographic characteristics (e.g., age, gender, etc.), trends in treatment, and conducted random forest analyses followed by regression models for identifying significant predictors. RESULTS:Between 2015 and 2023 (including years 2020-2022), there were a total of 24,526 (5%) respondents who reported co-use and this increased during the study period (p < 0.001). Pre-COVID, 274 (2.1%) reported receipt of treatment and this increased to 141 (4.2%) (p < 0.0001). Pre-COVID, cannabis accessibility (aOR: 13.9, p < 0.0001) and amphetamine/methylphenidate products (aOR: 5.6, p < 0.001) were associated with co-use. Post COVID, cannabis accessibility (aOR: 10.6, p < 0.001) and psychotherapeutic misuse (aOR: 2.7, p < 0.001) were significant. DISCUSSION:Remnants of the COVID-19 pandemic, including the rise in mental health diagnoses, may have had a lasting influence on substance co-use. Efforts should be made to improve treatment rates in this population.
BACKGROUND:Substance exposure among pediatric emergency department (ED) patients may be underrecognized because routine urine immunoassays have limited analytical sensitivity, and objective confirmatory toxicological data in pediatric ED populations remain limited. METHODS:This dual-phase observational study included patients aged 6-18 years who underwent toxicological assessment in two tertiary pediatric EDs in Central Anatolia, Türkiye. The retrospective phase (2018-2021) tested each sample by either immunoassay or LC-MS/MS, depending on time of collection, but not both. The prospective phase (January 2022-2023) enrolled clinically suspected cases, all tested by both methods regardless of screening result. Logistic regression evaluated factors associated with liquid chromatography-tandem mass spectrometry (LC-MS/MS)-confirmed positivity in the prospective cohort. Results: A total of 1039 patients were included (852 retrospective; 187 prospective). In the retrospective cohort, immunoassay screening (n = 570) identified positivity in 19.8% (113/570), while LC-MS/MS on a separate subset (n = 282) identified 32.6% (92/282); these derive from non-overlapping subsets, not paired testing. In the prospective cohort, LC-MS/MS positivity was 11.2% (21/187) by standard cutoff and 18.8% (35/187) with an exploratory limit of quantitation (LOQ)-supported benzodiazepine interpretation (after excluding 18 pseudoephedrine/ephedrine-only patients). Benzodiazepines and amphetamine-type stimulants were most frequently detected. Younger age, psychiatric illness, and daily screen exposure >3 h were independently associated with positivity. Immunoassay screening showed high specificity but limited sensitivity against LC-MS/MS. Conclusions: Routine immunoassay screening may substantially underestimate pediatric substance exposure in ED settings. LC-MS/MS provides broader and more sensitive toxicological detection, though differences also partly reflect broader analyte coverage rather than sensitivity alone.
