OBJECTIVE The aim of this study was to determine the efficacy and acceptability of targeted use of kudzu, an herbal supplement, in adults with alcohol use disorder (AUD) who binge drink. METHODS In a double-blind placebo-controlled trial, 120 adults with AUD who binge drink were randomized in a 1:1 ratio to targeted (as-needed) use of oral kudzu extract (2 grams taken on days when binge drinking was anticipated) or matching placebo, plus weekly counseling for 12 weeks. The primary outcome was number of binge-drinking days in the past week. Prespecified secondary outcomes included number of self-reported binge-drinking weeks, number of drinks, and measurements of changes in alcohol use using biomarkers, including ethyl glucuronide (EtG) and phosphatidylethanol (PEth). RESULTS Retention was high: 88% completed the trial, and 86% of weekly follow-up visits were completed. In the primary intention-to-treat (ITT) analysis, assignment to kudzu versus placebo reduced number of binge-drinking days (incidence rate ratio [IRR]=0.73, 95% CI=0.54, 0.99); as-treated (taking medication ≥2.7 days per week) analysis estimated a stronger effect (IRR=0.58, 95% CI=0.38, 0.89). Secondary outcomes showed lower number of binge-drinking weeks in ITT analysis (relative risk [RR]=0.79, 95% CI=0.62, 0.99). In as-treated analyses, reductions in number of binge-drinking weeks (RR=0.68, 95% CI=0.47, 0.98) and PEth positivity (RR=0.82, 95% CI=0.67, 0.99) were also significant. The number of binge-drinking days showed significant sustained reductions at the 3-month posttreatment visit (RR=0.68, 95% CI=0.47, 0.97). The overall frequency of adverse events was similar between groups. No serious adverse events related to kudzu occurred during follow-up. CONCLUSIONS Targeted use of kudzu reduced self-reported binge-drinking outcomes among adults with AUD during treatment compared to placebo. Greater reductions in binge drinking and PEth were observed among those who took medication more frequently. Reductions in self-reported binge drinking persisted at the posttreatment visit. Kudzu may be a helpful pharmacologic treatment for binge drinking among people with AUD.
OBJECTIVE Age-related differences in alcohol and cannabis use are well established, yet age-specific trends in substance-related acute morbidity remain incompletely understood. The authors examined age-specific trends in alcohol- and cannabis-related emergency department and inpatient admissions from 2016 to 2023. METHODS This was a retrospective cohort study using Merative MarketScan Commercial and Multi-State Medicaid databases (January 2016-December 2023). The cohort included 1,355,161 individuals 16-64 years of age with at least one substance-related acute care encounter (ICD-10-CM codes F10-F19, excluding nicotine). Outcomes included the proportion of substance-related encounters involving alcohol or cannabis, stratified by six age groups (16-18, 19-24, 25-34, 35-44, 45-54, and 55-64 years). Secondary analyses examined primary substance diagnoses, severe alcohol-related morbidity, and cannabis-related encounters involving psychosis or vomiting (hyperemesis). Weighted linear regression estimated age-specific annual changes in encounter proportions, and Poisson models assessed trends in total encounter volume and substance involvement per encounter. RESULTS Among 5,190,680 substance-related encounters, alcohol and cannabis exhibited divergent age patterns. Alcohol accounted for 19%-26% of adolescent admissions, increasing to 73%-76% among adults ages 55-64 years, whereas cannabis involvement was highest among adolescents (70%-78%) and lowest among older adults (10%-11%). Alcohol-related admissions increased significantly among adults ages 25-34 years (1.80 percentage points annually, 95% CI=1.59, 2.00) and 35-44 years (1.19 points, 95% CI=0.99, 1.38). Cannabis-related admissions increased most rapidly among individuals ages 19-24 years (1.81 points annually, 95% CI=1.57, 2.04) and 16-18 years (0.83 points, 95% CI=0.61, 1.06), with notable increases in presentations involving psychosis and vomiting. When restricted to primary diagnoses, cannabis-related trends were attenuated, with adolescents showing annual declines (-1.46 points, 95% CI=-1.98, -0.94). CONCLUSIONS Alcohol- and cannabis-related acute care presentations follow divergent age-specific trajectories, with cannabis increasingly predominant among adolescents and young adults and alcohol predominant among older adults.
OBJECTIVE This study examines migration stigma as a manifestation of symbolic violence and its association with psychological distress and posttraumatic stress disorder symptoms among Asian, Black, and Latinx immigrant-origin adults in the United States. METHODS Using data from a demographically diverse, national quota sample (N=908), stigma was assessed at macro (perceptions of government and policy makers), interpersonal (social exclusion, discrimination, and threat of deportation), and intrapersonal (anticipating rejection, internalized embarrassment and shame, and perceived devaluation) levels. A series of ordinary least-squares regression models was used to isolate the unique and combined effects of demographic, immigration-related, and stigma-related predictors on two outcomes: psychological distress (using the Kessler 6-item Psychological Distress Scale) and posttraumatic stress disorder symptoms. RESULTS Racial-ethnic disparities in mental health outcomes were attenuated after accounting for immigration-related factors and stigma exposure. Interpersonal and intrapersonal stigma, specifically experiences of discrimination, social exclusion, shame, and devaluation, emerged as the most robust predictors of mental health outcomes. A cumulative stigma index demonstrated a dose-response relationship, with each additional exposure associated with significantly higher symptom levels, underscoring the compounding mental health burden of layered stigma. CONCLUSIONS The findings highlight the need for policies and clinical interventions that reduce exposure to symbolic violence and address the psychological toll of stigma on immigrant-origin populations. Integrating culturally responsive, trauma-informed approaches into mental health services is essential for mitigating disparities and supporting mental health well-being in increasingly restrictive immigration climates.
OBJECTIVE Catatonia is a transdiagnostic psychomotor syndrome cutting across mood disorders (MODs) and schizophrenia spectrum disorders (SSDs). However, its neurobiological profiles remain poorly characterized. The authors examined structural and resting-state functional normative deviations associated with catatonia across two independent clinical cohorts, using hierarchical Bayesian normative modeling. METHODS Structural and resting-state functional MRI data were analyzed from two independent deeply phenotyped cohorts of 280 patients with MODs and SSDs. The Mannheim (Germany) sample included 184 patients with MODs or SSDs (58 with ICD-11 catatonia), and the Bern (Switzerland) sample comprised 96 SSD patients (59 with ICD-11 catatonia). Individual deviations from normative models were estimated using the PCNToolkit, based on healthy reference datasets (N=57,000 structural; N=22,000 functional). RESULTS Catatonia diagnosis was associated with significant ventricular enlargement (third ventricle and left and right lateral ventricles; q<0.05) and cortical thinning in the left dorsal posterior cingulate and insular cortices (q<0.05) across both cohorts. Exploratory analyses identified a significant left orbitofrontal cortex (OFC) difference between MOD and SSD patients with catatonia. In the overall catatonia versus non-catatonia comparison, the OFC association survived false discovery rate correction only in models adjusted for demographic variables. Resting-state functional analyses showed reduced connectivity between sensorimotor, salience, limbic, and executive control networks at the nominal significance level, but did not survive correction for multiple comparisons. CONCLUSIONS In the combined sample, catatonia was characterized by ventricular enlargement and cingulo-insular cortical thinning, supporting a transdiagnostic model implicating distributed motor-salience integration circuits. These findings provide reproducible, individual-level evidence for distributed brain network involvement in catatonia and identify candidate regions for future mechanistic and neuromodulation studies.
