This manuscript presents a conceptual reframing of a construct that has traditionally played a central role within the cognitive-behavioral model of problematic Internet use: the Preference for Online Social Interactions (POSI). This concept has been introduced to capture a key cognitive risk factor for the lack of control over multidimensional Internet use, particularly Internet communicative services (e.g., online social networks). Given the evolution of digital communication, POSI’s original definition—based on a binary distinction between online and offline social relationships—may no longer have the same pervasiveness and effectiveness in describing, representing, and encapsulating the individual experience that may serve as a gateway to problematic Internet uses. Drawing on a narrative review of studies that have examined POSI in relation to various forms of problematic Internet use, we propose that this concept should now be reframed to emphasize rigidity and a predominant orientation toward the online environment. Under this updated conceptualization, POSI may still function as a relevant cognitive precursor of the behavioral dimensions—e.g., loss of control—characterizing several problematic Internet-related behaviors. Although the relevance of POSI might vary across these behaviors, we discuss theoretical and empirical reasons to consider it involved in Problematic Social Media Use (PSMU), Gaming Disorder (GD), Gambling Disorder, Compulsive-Shopping Disorder (CSD), Compulsive Sexual Behavior Disorder (CSBD), Problematic Pornography Use (PPU) and even in the emerging use of Artificial Intelligence (AI) as a surrogate for human relationships.
Loneliness is an important public health concern among individuals with opioid use disorder (OUD), where stigma and social marginalization may contribute to social isolation. This review summarizes evidence on the prevalence of loneliness in adults with OUD, its associations with treatment outcomes, and related psychosocial and clinical factors. Following PRISMA guidelines, PubMed, Embase, Web of Science, and Scopus were searched, identifying 12 studies (8 unique datasets; n = 1,634). Study quality was assessed using Joanna Briggs Institute critical appraisal tools, and findings were narratively synthesized because of methodological heterogeneity. All studies were conducted in the USA or China, and most used cross-sectional designs. Reported loneliness prevalence ranged from 49.2
Medetomidine is a veterinary α2-adrenergic agonist that has been an adulterant of illicitly manufactured opioids since 2022. We review its pharmacology, detection, intoxication, withdrawal, and management, and assess why severe withdrawal has emerged in some regions but not others. Medetomidine has spread through North American drug markets yet evades most toxicology testing. Roughly two hundred times more potent than xylazine, with greater α2 selectivity and imidazoline-1 activity, it causes intoxication resembling other α2 agonists: sedation and bradycardia. The dominant clinical problem is withdrawal: autonomic dysregulation, intractable vomiting, and encephalopathy frequently requiring intensive care. Treatment requires multimodal α2-agonist therapy, often escalating to parenteral dexmedetomidine. Where it is established, withdrawal encounters and hospital admissions have risen. We hypothesize that both local prevalence and drug concentration determine where withdrawal appears. This syndrome exposes gaps in both assessment and treatment; prospective multicenter research, a validated withdrawal instrument, and integrated addiction-critical care models are needed.
Psychedelic-assisted therapy (PAT) has re-emerged as a potential intervention for substance use disorders (SUDs), yet the psychological mechanisms underlying behaviour change remain poorly synthesised. This scoping review mapped and evaluated proposed psychological processes underpinning PAT in adults with SUDs. Peer-reviewed English-language empirical studies involving adults with SUDs or harmful substance use that examined psychological mechanisms of PAT were eligible for inclusion. Systematic searches of Embase, PubMed, PsycINFO and Scopus were conducted through 30 June 2026. Data were charted using a predefined extraction framework. Thirty-seven publications representing 23 unique cohorts (n = 1003) met the inclusion criteria. Across studies of classical (psilocybin, ayahuasca) and non-classical psychedelics (ketamine, MDMA, ibogaine), six transdiagnostic mechanism domains were identified: (1) emotional processing, (2) insight, meaning-making and worldview change, (3) self-experience and identity transformation, (4) mystical or peak-type experiences, (5) relational and interpersonal shifts, and (6) motivation, values and behavioural regulation. Evidence ranged from qualitative and exploratory quantitative findings to preliminary quantitative studies explicitly examining associations between candidate psychological mechanisms and substance use outcomes. Mystical-type experiences were the most frequently examined and were associated with reductions in substance use and craving, although evidence remains largely correlational, with only one randomised trial demonstrating mediation. Qualitative findings highlighted the importance of therapeutic, relational, and sociocultural context in translating acute psychedelic experiences into psychological and behavioural change. PAT appears to operate through interacting psychological processes rather than a single mechanism. Although recent studies have begun to explicitly examine candidate psychological mechanisms in relation to substance use outcomes, causal mechanisms remain to be established. Clarifying these mechanisms across populations and psychedelic compounds will be critical for optimising treatment models and guiding future research.
Simulated gambling games (SGGs) combine features of gaming and gambling in social casino games, practice games, and games with mini gambling components. SGGs may act as a gateway to monetary gambling and gambling harm through a stimulus exposure effect. Alternatively, people with certain psychological or other characteristics may tend to use both activities, reflecting a selection effect. SGGs might also help to suppress the allure of gambling and satisfy gambling urges, reducing gambling harm for some people. This review aims to help clarify these relationships by synthesising empirical evidence on the co-occurrence and migration between SGGs and monetary gambling, including harmful gambling. All cross-sectional studies of adolescents and adults have found positive relationships between engagement in SGGs and monetary gambling, and increased risk of harmful gambling. Longitudinal and experimental studies support a stimulus effect of SGGs on monetary gambling, with little evidence of a suppression effect. The most compelling evidence is from a 24-week randomised controlled trial where the number of simulated slots sessions played per week reliably predicted increases in slots expenditure in real gambling venues the following week. Minimal research exists on migration pathways between SGGs and harmful gambling. SGGs are most likely to stimulate monetary gambling; by contrast, evidence for any suppression effect is limited. While causal relationships are unclear, people already experiencing gambling harm are particularly attracted to SGGs, which expose them to additional gambling stimuli. Strengthening consumer protections in SGGs and restricting underage access may help reduce these risks.
Gambling marketing is pervasive. Evidence suggests that greater exposure to gambling marketing can increase gambling engagement and elevate the risk of gambling harm. The effects of marketing are likely to vary across population groups and across different types of marketing. This systematic review summarises qualitative empirical evidence regarding the perceived effects of gambling marketing on gambling behaviours and attitudes in different population groups and across various marketing formats. The sample consisted of 46 peer-reviewed articles published between 2009 and 2025. Most research was conducted in Australia, followed by the UK. The results indicate that marketing–particularly the association of gambling with sports–normalises gambling within societies and can encourage increased gambling. Inducements and direct marketing are associated with higher levels of gambling consumption, particularly amongst young people and individuals experiencing gambling problems. While young men interested in sports are viewed as the primary intended audience of gambling marketing, children and young people are highly susceptible to marketing content featuring sports, athletes, celebrities, and influencers, potentially contributing to future gambling intentions. Due to extensive marketing, and limited risk-mitigation measures, both children and adults reported annoyance and called for restrictions on marketing. Gambling marketing can have both direct and indirect implications for gambling behaviours, but the effects vary across marketing formats and population groups. Stricter, population-level regulations are needed to reduce exposure to gambling marketing and mitigate associated harms.
This scoping review focused on gambling treatments tailored to East Asian populations, highlighting the importance of cultural adaptation. Problem gambling is a growing public health concern, particularly among East Asian populations, where help-seeking behaviours might be hindered by cultural beliefs, social stigma, and limited access to culturally tailored treatments. Despite a substantial body of literature on gambling interventions, there remains a significant gap in how these treatments can be effectively adapted for East Asian populations. A systematic literature search yielded 769 articles and eight studies met the inclusion criteria (articles written in English, related to gambling, conducted in East Asian samples, and discussing treatment). Across studies, treatment adaptations were limited, but culturally responsive interventions were associated with improved outcomes for problem gambling. The adaptations included tailored cognitive behavioural therapy, culturally sensitive messaging, and family-centred approaches. Author recommendations, drawn from the literature and cultural adaptation frameworks, include extending adaptations beyond language translation, incorporating cultural frameworks for acculturation, comprehensive need assessments, stigma reduction strategies, adding an emotional regulation component into treatment, and trust-building measures to develop effective culturally adapted treatment models. Future research should focus on refining culturally responsive gambling treatments and evaluating their efficacy within diverse East Asian communities.
To summarize current evidence regarding the epidemiology, risk factors, diagnosis, and treatment of opioid use disorder (OUD) in older adults, with emphasis on age-specific challenges related to screening, clinical presentation, pharmacologic management, and emerging treatment approaches. OUD among older adults is increasing despite declining opioid prescribing rates, with rising rates of opioid-related hospitalization and overdose mortality. Diagnosis remains challenging because age-related physiologic changes, polypharmacy, and cognitive impairment may obscure traditional manifestations of OUD. Existing screening instruments and diagnostic criteria have important limitations in elderly populations. Medications for opioid use disorder (MOUD) remain the cornerstone of treatment, with buprenorphine being favored for its safety profile and flexible formulations. Older adults represent a clinically distinct and understudied population with OUD. Current evidence supports individualized use of MOUD while accounting for comorbidities, polypharmacy, and age-related physiologic changes. Future research should prioritize geriatric-specific screening tools, diagnostic frameworks, treatment protocols, and clinical outcomes.
This review examines alcohol use during pregnancy with a focus on individual, provider, and system-level barriers and facilitators to treatment engagement. Recent systematic reviews and meta-analyses confirm that brief psychosocial interventions, particularly those using motivational interviewing, modestly reduce prenatal alcohol use. Preconception interventions also lower the risk of alcohol-exposed pregnancies. However, evidence for pharmacotherapies remains minimal, with no medication currently recommended as first-line treatment in pregnancy. Barriers include stigma, punitive policies, fragmented care, and social determinants of health. Facilitators include integrated, trauma-informed models, peer support, universal screening, and supportive legal and insurance policies. Effective care requires shifting from punitive approaches toward compassionate, evidence-based, and equity-focused models. Future research must prioritize rigorous evaluation of integrated interventions, improved implementation of screening and brief interventions, and safe pharmacologic options.
Chemsex is a sexual practice in which psychoactive substances such as methamphetamine, mephedrone, GHB/GBL and ketamine are used to prolong and enhance the sexual experience, mostly engaged in gay, bisexual and other men who have sex with men (GBMSM). Chemsex sessions involve risky practices such as sex with people with the same HIV-positive status, anal sex without a condom, receiving anal penetration with the fist, and using injecting drugs. These practices entail risks and health damage such as anal injuries, sexually transmitted infections, HIV, hepatitis C, and sleep and mood disturbances. The aim of this study was to identify and categorize the harm reduction practices mentioned in articles on chemsex among men who have sex with men. A narrative review (n = 16) was used to identify harm reduction practices and categorize them into three types of strategies. The first involves prevention, encompassing psychoeducation on chemsex, communication and agreements, physical preparation, sexual health care, and emergency preparedness. The second comprises protection regarding drug use, hygiene measures, sexual care, and rest. The third consists of recovery, including resting and subsequent sessions. Risk and harm reduction strategies in chemsex are focused on preventing and avoiding overdose, injury, sexually transmitted diseases, physical and mental exhaustion, as well as promoting rapid physical recovery after a chemsex session.
Pornography consumption has become increasingly prevalent in digital environments, with a subset of individuals developing problematic pornography use (PPU). Despite growing research interest, limited attention has been given to the role of empathy and interpersonal sensitivity in this context. This narrative review aims to synthesize the available evidence on the relationship between pornography use, PPU, and socio-emotional processes, particularly empathy and interpersonal sensitivity. Across seven empirical studies, convergent evidence from cross-sectional, longitudinal, and experimental studies suggests that pornography exposure, especially when involving violent content, is associated with reduced empathy and increased emotional desensitization. Experimental studies suggest that exposure to sexually violent pornographic material is associated with lower empathic responses and greater acceptance of rape myths, whereas correlational and clinical studies link lower empathy to higher exposure to violent pornographic content and greater likelihood of coercive sexual behaviors. Early exposure to pornography, particularly when combined with adverse developmental experiences, may be associated with more pronounced socio-emotional effects. Emerging neurobiological evidence also points to alterations in oxytocin–vasopressin systems among individuals with PPU, raising the possibility of biopsychosocial mechanisms that could be linked to lower empathic functioning. Overall, the available evidence indicates that pornography use may be associated with diminished empathy and increased objectification, particularly under conditions of high exposure to pornography or violent content. However, evidence specifically addressing interpersonal sensitivity remains limited and indirect. Nonetheless, methodological limitations, including the predominance of cross-sectional designs and heterogeneous measures, constrain causal interpretation. Future research should prioritize longitudinal and experimental designs, incorporate diverse samples, and integrate psychosocial and neurobiological measures. These findings also suggest that preventive and educational interventions focused on empathy and media literacy may mitigate potential adverse outcomes associated with pornography use and PPU.
Electronic cigarette (EC) use has increased markedly in recent years, raising concerns regarding its potential impact on mental health. While prior evidence has demonstrated a strong association between vaping and depression, suicidal ideation, and other psychiatric symptoms in adolescents, less is known about these associations in adults. This meta-analysis aimed to evaluate the odds of psychiatric symptoms among adult EC users compared with non-users. We systematically searched eight databases through December 2025 for studies comparing current EC use with no current use in adults and reporting at least one psychiatric outcome. Twenty-four studies (22 cross-sectional and two prospective cohort studies; n = 2,594,722; mean age 49.7 years; 44.8
We evaluate the contemporary societal belief that social media use causes mental health problems among adolescents, such as depressive and eating disorders, and suicide. We alternatively raise the more likely scenario that poor mental health is what can drive social media use/overuse. We summarize empirical evidence from longitudinal studies on relations between social media use/overuse and mental health among adolescents, demonstrating mixed findings and important methodological limitations that preclude our ability to state that social media use is a major cause of mental disorder. Nonetheless, we discuss the need for government regulation of social media companies, given that these companies have purposefully promoted excessive social media use in adolescents, and have inadequately protected against violent content and misinformation on their platforms. Social media use/overuse is not likely a major cause of mental disorder, but can nonetheless result in other harms.
Purpose of Review:College students' alcohol-related regretted sex is linked to adverse health outcomes. However, studies report inconsistent prevalence estimates and gender differences. Recent Findings:A search of five databases yielded 15 studies. Lifetime alcohol-related regretted sex prevalence ranged from 14%-48% for women and 38%-47% for men; past year ranged 18%-34% for women and 22%-28% for men; past six months was reported as 18% for women and 15% for men; past month was 12% for women and 11% for men. Two studies found men more likely to regret alcohol-related sex, one found women more likely, two reported mixed results, and 10 found no significant gender differences. Summary:Findings suggest alcohol-related regretted sex is not a consistently gendered phenomenon among college students which has implications for the development of universal vs. group-specific interventions. Longitudinal studies of types of regretted sex among diverse students are needed to examine changes over time and inform age-specific interventions. Supplementary Information:The online version contains supplementary material available at 10.1007/s40429-026-00764-w.
The rapid proliferation of synthetic opioids, particularly fentanyl and its analogues, has intensified the opioid crisis, highlighted the limitations of fragmented approaches to opioid use disorder (OUD), and heightened tensions between the United States and China. This narrative review compares public health policy responses in the United States and China across four key domains: demand reduction, harm reduction, supply control, and governance coordination, to evaluate how integrated governance can improve outcomes. In the United States, there has been substantial progress in expanding opioid agonist treatment, naloxone distribution, and low-threshold services. However, persistent fragmentation across healthcare, public health, criminal justice, and social services continues to limit long-term recovery. In China, sustained declines in registered drug users over seven consecutive years and improvements in community-based rehabilitation reflect a more coordinated system linking treatment, rehabilitation, and social reintegration, although new challenges have emerged from the rising non-medical use of prescription medicines, veterinary anesthetics, and new psychoactive substances. Regulatory control of supply chains, upstream targeted interdiction,expanded treatment access, and harm reduction strategies may contribute collectively to recent reductions in drug overdose deaths in the United States. An effective response to synthetic opioids requires aligning demand reduction, harm reduction, and supply control strategies within a unified public health framework. Public health can serve as a practical bridge across differing policy systems and provide a foundation for sustained international cooperation in the synthetic opioid era.
This narrative review synthesizes literature linking adverse childhood experiences (ACEs) and substance use among Latino, Black, Asian American, and American Indian/Alaska Native adolescents. A total of 31 peer-reviewed studies, published between 2020 and 2025, were included that included at least 50
This review explores the complex, bidirectional relationship between impulsivity and substance use disorders. We examine how impulsivity, a tendency to act without forethought, acts as both a vulnerability factor for addiction and a consequence of chronic substance exposure. We distinguish between different subdomains of impulsivity, such as impulsive action and impulsive choice, and highlight the unique ways various substances like alcohol, opioids, and stimulants impact specific brain regions and circuits. The ultimate goal is to synthesize current neurocognitive and behavioural findings to inform the development of more effective, personalized treatment strategies. Recent advancements in neuroimaging, computational modelling, and animal studies have greatly enhanced our understanding of the neural mechanisms underlying this relationship. Research demonstrates that substances uniquely impact fronto-striatal circuits and other brain regions, leading to specific patterns of impulsive behaviour. Neuroplastic changes in the prefrontal cortex and nucleus accumbens contribute to a self-perpetuating cycle of addiction by disrupting executive control and reward processing. The field is also exploring the evolutionary neurobiology of impulsivity, with a focus on structures like the habenula to identify novel therapeutic targets. Impulsivity and addiction are intertwined through a self-perpetuating neurobiological cycle. Chronic substance use exacerbates pre-existing impulsive tendencies by inducing significant neuroplastic changes in key brain circuits. By understanding these neurocognitive mechanisms, we can develop more targeted and effective interventions. A deeper comprehension of this bidirectional relationship provides a critical foundation for creating personalized treatment strategies, including pharmacological, behavioural, and neuromodulation techniques that address the core components of impulsivity in addiction.
Neuroscientific models of addiction have evolved over the past four decades from single-circuit dopamine frameworks to dual-process, tripartite, and multidimensional accounts. Despite these advances, existing models incompletely account for the lived experience of addiction and for developmental, social, and mental-health factors that contribute to heterogeneity in risk and outcome. This review synthesizes this progression and evaluates the need for more integrative frameworks. Recent work highlights addiction-related alterations in large-scale brain networks and demonstrates that psychosocial and contextual factors play a more central mechanistic role than previously acknowledged. Emerging interventions, including psychedelic-assisted therapies, further underscore the relevance of multilevel change across neurobiological, cognitive, and affective domains. Framing addiction as a multilevel, interactive process within a biopsychosocial framework provides a unifying perspective that accommodates heterogeneity in pathways and outcomes. Integrative models may better inform mechanistic research and guide the development of more precise, clinically meaningful interventions.
We capitalize on recent developments in the neuropsychology of alcohol use disorders to propose an expanded conceptualization of impulsivity. We principally underline the added value of an integrative perspective, encompassing its interactions with external and internal contexts. We review the emerging literature suggesting that impulsivity is not an isolated phenomenon, and that meaningful relations with social cognition and interoception processes exist. Acknowledging these relations holds promise for improving impulsivity conceptualization and measurement, as well as for providing treatment venues in alcohol use disorders. The current approach of conceptualizing and studying impulsivity in alcohol use disorders does not fully consider the context in which impulsive behaviors occur. Recent evolutions in alcohol research support the inclusion of social environment and inner bodily states in studies measuring alcohol-related impulsivity.
This review synthesizes research on trauma exposure and substance use disorder (SUD) among Hispanic mothers in the U.S., emphasizing culturally grounded strategies to address disparities in treatment access, engagement, and outcomes. Hispanic mothers face elevated trauma exposure, including adverse childhood experiences, intimate partner violence, and migration-related stress that increases SUD risk. Culturally responsive, trauma-informed interventions are needed using community-based models while integrating language and cultural adaptations. Advances in culturally valid measurement tools are also critical, as existing instruments often overlook culturally specific stressors and strengths. Emerging research highlights the need to tailor SUD interventions for Hispanic mothers by centering sociocultural context and trauma histories. Integrating culturally responsive care and precise evaluation methods is essential to improve outcomes, promote equity, and disrupt intergenerational cycles of trauma and substance use disorder.
