Background: Cannabis use is prevalent in young adults, and earlier onset and frequent use increase risk for problematic use. In Chile, the Cannabis Abuse Screening Test (CAST) is widely used, but evidence in higher education students remains limited.Objectives: To evaluate the psychometric properties of the CAST in a national sample of Chilean higher education students.Methods: Secondary analyses of the Third Study of Drug Use in Higher Education (EDES) included cannabis users (N = 6,521; 54.9% female). Confirmatory factor analysis (WLSMV) and McDonald's ω assessed structure and reliability; multigroup CFA tested invariance; structural equation modeling regressed the latent CAST factor on age of onset and past-year use frequency.Results: A revised one-factor model with a correlated residual between Items 1 and 2 fit well (CFI = .996, RMSEA = .033) and was reliable (ω = .843). Scalar invariance held across gender (partial residual invariance after freeing Item 6 residual variance), full residual invariance held across macrozones, and metric plus partial scalar invariance held across institution types after freeing the Item 6 intercept. Earlier onset (β = -.229, p < .001) and higher past-year use frequency (β = .221, p < .001) were associated with higher latent problematic use.Conclusion: The CAST showed a coherent unidimensional structure, adequate score reliability, and generally strong, although not uniform, measurement equivalence across relevant groups. These findings support its use for research and surveillance within Chilean higher education students.
Background: Previous research indicates that workplace culture influences employees' alcohol use. Given the unique environment of the restaurant industry, this study examined how cultural factors contribute to on-the-job alcohol use among food servers.Objective: The study aimed to contribute to the growing literature on alcohol use in restaurants by identifying, analyzing, and reporting themes explaining how workplace culture influences employee drinking behavior. Guided by three research questions, it examined the roles of organizational artifacts, espoused values, and basic assumptions on drinking behaviors in the workplace.Methods: A descriptive qualitative design was used to explore restaurant food servers' perceptions of workplace influences on alcohol use. Data was collected on 12 semi-structured Zoom interviews and questionnaires completed by 88 participants recruited through a Facebook restaurant worker group. Interview data were analyzed using iterative thematic analysis in NVivo, while questionnaire data were summarized using descriptive statistics.Results: Findings showed that workplace artifacts such as alcohol-related branding, advertising, and social cues reinforce norms that encourage alcohol use. Despite formal zero-tolerance policies, inconsistent enforcement, peer influence, and managerial practices often normalize drinking at work. Underlying assumptions, including managerial tolerance and unwritten expectations, further sustain a workplace culture in which on-the-job alcohol use is accepted.Conclusions: Alcohol-related behaviors appear embedded in restaurant culture, with formal policies frequently contradicted by informal norms. The results highlight perceived alcohol availability and the role of passive leadership in enabling misuse. Strengthening alcohol policies, improving staff training, and increasing leadership accountability may help promote safer and more productive workplaces.
Background: Harm reduction and recovery housing approaches are often thought to be in conflict, yet each share goals of reducing negative impacts of substance use.Objectives: Examining this, we surveyed substance use and medication policies and practices among a state-stratified, nationally representative sample of 838 residences (male = 479; female = 263; co-ed = 94; unknown = 2).Methods: Survey items assessed residence characteristics and practices as well as 12-step orientation and adherence to social model principles (valuing peer support, lived experience, and shared responsibility). We generated weighted estimates of policies and practices; logistic regression analyses tested differences by program orientation.Results: Nationally, nearly all (97%) residences require abstinence from alcohol and illegal drugs, implement drug testing (99%), evict residents who break substance use rules (94%), keep naloxone on site (98%), and have individuals trained to administer naloxone (94%). Fewer (56%) accept residents taking psychiatric medications. Primarily 12-step oriented residences (vs. not) were less likely to accept residents taking methadone (OR = 0.41, p = .003), psychiatric medications (OR = 0.52, p = .006), and medications for pain (OR = 0.37, p < .001) but more likely to keep naloxone on site (OR = 10.38, p = .010). Residences with greater social model adherence (vs. not) were more likely to accept residents taking medications for substance use (OR = 2.55, p = .015) and to provide naloxone training (OR = 2.55, p = .001).Conclusion: While largely abstinence-based, the majority of residences engage in harm reduction practices to safeguard against drug overdose. Efforts are needed to increase acceptance of residents on medications for substance use and other psychiatric conditions. Supporting social model principles may help in decreasing overdoses and increasing medication acceptance.
Background: The oral microbiome comprises the microbial communities inhabiting the oral cavity, whereas the oral metabolome reflects the small molecules generated by host and microbial metabolic activity. These systems may provide insight into substance-related physiological disruption, including altered inflammation, immune signaling, and host - microbial interactions. Although the individual effects of methamphetamine, alcohol, and smoking have been explored, their combined impact on these systems remains largely unexplored.Objectives: To investigate the metabolic and microbiome alterations associated with chronic methamphetamine use in individuals with alcohol and tobacco use.Methods: High-throughput metabolomic and microbiome datasets from methamphetamine users (Males:168, Females: 50), stratified by self-reported tobacco smoking and alcohol use, were analyzed using integrative bioinformatics approaches, including multivariate and pathway enrichment analyses, to identify dysregulated metabolic pathways and microbial alterations across defined subgroups.Results: The study revealed significant upregulation in metabolites like prostaglandin E2 (log-2-fold-change: 2.63, Cohen's D: |~0.881|, p-val: 7.1 × 10-10) and glutamylisoleucine (log-2-fold-change: 1.42, Cohen's D: |~0.88|, p-val: 2.5 × 10-2). Microbes such as Bacteroides (log-2-fold-change: -4.91, Cohen's D: |~1.95|, p-val: 1.3 × 10-4) and Brachymonas (log-2-fold-change: -2.47, Cohen's D: |~1.09|, p-val: 5.8 × 10-3) were significantly downregulated. This suggests that long-term concurrent methamphetamine use, alcohol consumption, and smoking are associated with alterations in microbial and metabolic pathways related to oxidative stress, glutathione metabolism, and neuroactive signaling.Conclusions: The oral microbiome and metabolomic profiles may serve as accessible indicators of substance-related biological disruption. They may also help identify clinically relevant targets for monitoring risk, guiding personalized interventions, and developing informed strategies to support recovery.
Background: Sober living houses (SLHs) typically enforce zero-tolerance use policies in an effort to maintain abstinent environments.Objective: This study examines whether lapses (any substance use) and relapses (return to regular use) have different risk and protective factors for SLH residents.Methods: Secondary analysis of 555 residents across 56 Los Angeles County SLHs using Fine-Gray competing risks models. Lapses were defined as any substance use without progression to regular use; relapses as substance use averaging three times or more weekly.Results: Participants were 64.3% male, racially diverse (51.0% non-White, 49.0% non-Hispanic White), mean age 40.0 years (SD = 12.7). At six months, 61.6% maintained abstinence, 24.3% experienced lapse-only episodes, and 14.1% relapsed. Post-secondary education was associated with increased lapse hazard (SHR = 1.62 (1.08-2.43), p < .05), while no length of stay (LOS) plan was associated with a lower hazard (SHR = 0.60 (0.40-0.92), p < .05). Sponsorship demonstrated differential effects, with marginal lapse hazard increase but strong relapse protection. For relapse, female gender (SHR = 0.37 (0.22-0.62), p < .001), older age (SHR = 0.98 per year (0.97-0.99), p < .01), and higher monthly fees (SHR = 0.96 per $100 (0.93-0.98), p < .01) were protective. Employment problems (SHR = 3.13 (1.13-8.68), p < .05) and prior alcohol treatments (SHR = 1.02 per treatment (1.01-1.03), p < .001) were associated with increased relapse hazard. Longer LOS was associated with lower hazards of both outcomes (lapse: SHR = 0.84, relapse: SHR = 0.77, both p < .001).Conclusions: Distinct risk profiles for lapse versus relapse support differentiated response policies. Protective effects of longer LOS and higher fees suggest resource-related disparities in outcomes.
Background: Studies have shown that chronic morphine exposure results in altered patterns of gene expression through epigenetic mechanisms, suggesting potential transgenerational effects on the offspring's epigenome.Objectives: This study investigated transgenerational consequences of maternal pre-pregnancy chronic morphine exposure on offspring anxiety-like behaviors and alterations in epigenetic-related genes miR-96, miR-137, MeCP2 and HDAC2.Methods: Adolescent female Wistar rats had access to morphine (0.4 mg/mL) in drinking water (controls: tap water) for 50 days before mating with morphine-naïve males. Offspring underwent the forced swim test (FST) and open field test (OFT) to assess anxiety-like behaviors. Gene expression was analyzed in hippocampus from offspring and ovarian tissue from dams.Results: Offspring from morphine-treated dams exhibited significant increases in floating time (F1, 20 = 43.5; p < .001) and spent time in the center area of the OFT (F1, 20 = 68.1; p < .001). MeCP2 and HDAC2 gene expressions were significantly increased in the ovarian tissue of morphine-treated dams (MeCP2: t10 = 4.3; p < .01; HDAC2 t10 = 8.6; p < .001). In offspring of morphine-treated dams, MeCP2 (F1, 20 = 37.5; p < .001) and HDAC2 (F1, 20 = 62.6; p < .001) expression in the hippocampus was significantly increased, whereas miR-137 (F1, 20 = 25.5; p < .001) and miR-96 (F1, 20 = 23.8; p < .001) expression was significantly decreased.Conclusions: These findings underscore that maternal preconception morphine exposure induces neurobehavioral deficits across generations, likely mediated by epigenetic memory in the maternal germline. This suggests preconception opioid exposure could affect offspring's mental health and stress phenotypes, underscoring the need to integrate screening, counseling, and harm reduction into reproductive and addiction care.
Background: Amphetamine use disorder (AUD) is a growing public health concern, yet comparative evidence on long-term trends and future burden in China and the United States remains limited due to differing drug policy and sociocultural contexts.Objectives: To compare sex-specific long-term trends and future burden of AUD in China and the United States.Methods: Data on incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2023 were obtained from the Global Burden of Disease 2023 study for males and females. Given known sex differences in substance use burden, analyses were stratified by sex. Joinpoint regression, age - period - cohort (APC) analysis, and autoregressive integrated moving average (ARIMA) models were applied to assess trends and project rates through 2038.Results: Males had consistently higher age-standardized incidence rate (ASIR) and age-standardized disability-adjusted life year rate (ASDR) than females in both countries. In 2023, ASDR among males and females were 51.92 and 30.73 per 100,000 in China, compared with 175.38 and 82.82 per 100,000 in the United States, respectively. China showed significant declining trends in ASIR and ASDR (average annual percent change [AAPC] -1.38% and -1.67%, both p < .05), whereas the United States showed increasing trends (AAPC 1.03% and 4.26%, both p < .05). APC analysis showed declining cohort effects in China but increasing risks among recent U.S. cohorts. Projections suggested continued increases among U.S. males.Conclusions: AUD burden declined in China but increased in the United States. Strengthening prevention and treatment strategies may help reduce future burden.
Background: While physiological dependence on kratom (indicating tolerance and withdrawal) has been differentiated from kratom use disorder (KUD) in the West, the emphasis in Malaysia remains on kratom dependence. This has implications for treatment approaches.Objectives: This study was initiated to assess the extent to which medical practitioners treat patients with kratom dependence, their fields of specialization, their knowledge of kratom, and the treatment protocols used.Methods: An online questionnaire was distributed to approximately 17,000 Malaysian Medical Association (MMA) members, yielding 148 responses (0.9% response rate).Results: Male respondents comprised 58% of the sample, and 62% of physicians worked in public hospitals. Fifty-nine percent had treated patients for kratom dependence, with the majority having a background in psychiatry. Those treating kratom dependence had higher odds of being in public service (OR: 3.3: 1.64-6.56; p < .018), and had shorter mean duration of service (15.6 years), relative to the group that had not treated kratom dependence (18.3 years). Nearly 68% percent of those treating kratom dependence believed kratom to have similar effects as opioids and therefore prescribed treatments for kratom withdrawal that were designed for opioid withdrawal.Conclusions: Our findings suggest that opioid agonists are commonly used for the treatment of kratom withdrawal. However, kratom's distinct pharmacology relative to classical opioids suggests that treatment approaches developed for opioid withdrawal may not fully address the clinical features of kratom withdrawal.
Background: Xylazine and medetomidine (each sometimes referred to as "Tranq") are animal tranquilizers commonly and sometimes unknowingly used with illegal drugs, primarily fentanyl. In the United States, xylazine appeared in the Northeast beginning in the late 2010s, preceding medetomidine beginning in 2022. Current trends in the Great Lakes region west of this origin have not been thoroughly investigated.Objectives: Identify drug use trends associated with xylazine and medetomidine specific to five states comprising the Great Lakes region.Methods: From March 2023 through May 2025, 86,093 oral fluid specimens were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS-MS) following a presumptive positive screen for illegal substances using enzyme-linked immunosorbent assays (ELISA). Samples primarily originated from child protective, court, and probation services. Results and geospatial metadata from samples were used for analysis and discrete heatmap generation.Results: In xylazine- or medetomidine-positive cases, fentanyl was present over 95% of the time. Multiple drug classes were frequently detected in these cases. Each adulterant increased in prevalence among fentanyl-positive cases over their respective periods of study, converging to around 32%. Heatmaps of xylazine and medetomidine positivity rates showed that the prevalence of xylazine diminished in most states, while all states increased in prevalence for medetomidine.Conclusions: Medetomidine has been rapidly adopted as an adulterant in drug markets among Great Lakes states and is now frequently used alongside xylazine. Understanding regional trends regarding these adulterants can inform health-care professionals and policymakers of the spread and adoption of emergent drug use practices to improve public health.
Background: Acute kidney disease (AKD) is associated with a high risk of adverse long-term kidney outcomes after hospital discharge. Alcohol use disorder (AUD) is prevalent and may adversely affect kidney function; however, its impact on outcomes after AKD remains unclear.Objectives: To evaluate the association between AUD and long-term kidney outcomes among adults who survived AKD.Methods: We conducted a retrospective cohort study using the TriNetX global federated health research network. Adults with AKD, defined by receipt of dialysis during the index hospitalization, were included. The index date was set at 90 days after discharge. Patients were classified based on a documented diagnosis of AUD prior to AKD hospitalization. After propensity score matching, outcomes were assessed over up to five years using Cox proportional hazards models. The primary outcome was major adverse kidney events (MAKE), defined as a composite of acute kidney injury (AKI), dialysis, or all-cause mortality.Results: After matching, 316,082 patients were included in each group (mean age 54.5 years; 31.2% female). The AUD group had a higher risk of MAKE (HR 1.25; 95% CI 1.23-1.27; p < .001). Risks of AKI (HR 1.50; 95% CI 1.48-1.53), dialysis (HR 1.21; 95% CI 1.17-1.26), and all-cause mortality (HR 1.03; 95% CI 1.02-1.05) were also increased.Conclusions: AUD was associated with increased risks of adverse kidney outcomes after AKD, suggesting its role as a clinically relevant risk marker during post-AKD recovery.
Background: Despite evidence linking polyvictimization (i.e. two or more violence types such as physical assault and at least one adverse childhood experience) to substance use and mental health issues among people who inject drugs (PWID), research on its association with mental health, substance use, and socio-demographic factors among PWID remains limited.Objectives: We examined socio-demographics, mental health, and substance use factors associated with lifetime polyvictimization among PWID, focusing mainly on violent victimization, irrespective of perpetration/offending.Methods: We utilized cross-sectional data of 350 adults (169 females; 181 males) that examined the socio-ecologic factors influencing syringe service programs (SSPs) adoption among PWID in rural Appalachian Kentucky. Participant recruitment was via respondent-driven sampling (RDS) supplemented with direct community outreach. Our multivariable multinomial logistic regression examined socio-demographic, mental health, and substance use factors associated with polyvictimization.Results: Our multivariable multinomial logistic model indicated that female PWIDs were more than seven times likely to experience lifetime polyvictimization than male PWIDs (relative risk ratio or RRR = 7.49; p < .001). Additionally, PWIDs with severe symptoms of mental health disorders (MHD) in the past year were close to six times more likely to report lifetime polyvictimization (RRR = 5.88; p = .022). Those with severe substance use disorders (SUD) symptoms in the past year (RRR = 2.40; p = .035), and lifetime fentanyl injection (RRR = 2.29; p = .028), were also twice as likely to report lifetime polyvictimization.Conclusions: Tailored interventions and policies addressing complex trauma from polyvictimization, as well as comprehensive trauma-informed and gender-sensitive harm-reduction approaches, may be necessary to effectively treat SUD and related comorbidities in vulnerable PWI in rural Appalachia.
Background: Young adults experiencing homelessness (YAEH) are especially vulnerable to binge drinking. YAEH experience traumatic experiences and ongoing stressors at higher rates than the general population.Objective: This study aimed to explore whether YAEH's active (e.g. problem-solving) and avoidant (e.g. avoid the stressor) coping strategies serve as an intervening mechanism through which traumatic experiences and perceived stress associate with their binge drinking risks. Understanding this will provide critical insights for future interventions.Method: This study is a secondary analysis using self-administered survey data via a tablet collected from YAEH (N = 1,426) aged between 18 and 26, and from seven major cities in the US. A path analysis model was conducted to investigate the study's aim.Results: Among this sample of YAEH, 59.4% were cisgender males, and 34% had engaged in binge drinking (N = 1,297). Avoidant coping was positively associated with increased binge drinking (β = 0.095, p < .001). Adverse Childhood Experiences (ACE) (β = 0.012, p < .001), street victimization (β = 0.081, p < .001), and perceived stress (β = 0.013, p < .001) all were found to have positive associations with YAEH's increased binge drinking through the mediator, avoidant coping. ACE, street victimization, and perceived stress all had positive associations with using active coping strategies. However, active coping did not mediate their relationships to binge drinking.Conclusions: This study identified that avoidant coping mediated the relationships between ACE, street victimization, and perceived stress and binge drinking, while active coping did not. Our findings suggest the need to reduce avoidant coping mechanisms and support replacement behaviors aiming to reduce drinking among YAEH.
Background: The primary psychoactive ingredient in cannabis interacts with the endocannabinoid system, which declines with age and may alter cannabis-related effects in older adults. Animal studies suggest age-related differences in cannabis responses, though findings are mixed. Importantly, biological sex modifies the endocannabinoid system, which complicates interpreting age-related effects.Objective: This study examined how age and sex jointly influence cannabis-related outcomes in middle-aged and older adults.Methods: Self-reported measures of cannabis use behaviors, memory, mental and physical health, cannabis use disorder (CUD) symptom severity, and sleep quality were collected from 107 adults (age range = 35-78, 54 females) who use cannabis. Partial correlations examined associations between age and outcomes controlling for years of use. Self-reported biological sex was assessed as a moderator.Results: Regression analyses revealed a significant age × sex interaction for both CUD symptoms and mental health scores. Among females, CUD symptom severity decreased with age (b = -0.20, p = .03), and mental health scores improved (b = 0.59, p = .04); these age-related effects were not observed in males. Sensitivity analyses suggested that participants reporting medical-only cannabis use may exhibit a steeper age-related decline in CUD symptom severity than those reporting recreational-only use (b = 1.31, 95% CrI: -1.99 to 4.54) or hybrid use (b = 0.62, 95% CrI: -2.76 to 3.98).Conclusions: These findings suggest that factors such as sex and reason for cannabis use may be important for understanding cannabis safety profiles in aging populations and may inform individualized clinical care.
Background: Alcohol-induced hypertension (HTN) is linked to a 2.3-fold increase in cardiovascular-related death.Objective: We aimed to identify temporal trends in alcohol-induced HTN mortality among United States (US) adults stratified by year, sex, age, race, and region.Methods: Data on alcohol-induced HTN mortality among adults (≥25 years) in the US from 1999 to 2020 were extracted from the CDC WONDER database, utilizing ICD-10 codes. Crude (CMRs) and age-adjusted mortality rates (AAMRs) were calculated. Temporal trends in AAMRs were assessed using Joinpoint regression. Mortality forecasts through 2030 were generated using the ARIMA model in STATA software (version 17.0).Results: From 1999 to 2020, 50,793 alcohol-induced HTN-related deaths were recorded in the US, with an overall AAMR of 0.858 per 100,000. The AAMR increased from 0.279 (95% CI: 0.257-0.302) in 1999 to 1.348 (95% CI: 1.305-1.390) in 2018, rising further to 2.014 (95% CI: 1.963-2.066) in 2020. Mortality was higher in males (AAMR 2.16) than in females (0.55). The highest burden occurred among American Indians/Alaska Natives (AAMR 2.392), while the lowest was observed in Asians/Pacific Islanders (0.206). The Western region had the highest AAMR (1.116). CMR peaked among individuals aged 55-64 years (2.416), with slightly higher rates in rural areas. Forecast analysis projected the overall AAMR to increase from 2.01 in 2020 to 4.18 by 2030.Conclusion: Rising mortality from alcohol-induced HTN highlights an urgent need for strengthened control policies for alcohol use, early identification of hazardous drinking, and integrated management of hypertension and alcohol use to reduce preventable cardiovascular mortality in the US.
Background: Emerging research suggests online racial discrimination may be related to alcohol use and smoking, though more studies are needed to clarify the associations in diverse populations.Objectives: To explore the associations between online racism and hazardous drinking, smoking status, and co-use among Black, Asian American/Native Hawaiian/Pacific Islander (AANHPI), and Multiracial "Generation Z" emerging adults.Methods: Emerging adults (2,801 Black American AANHPI and Multiracial; 49.3% female) were recruited via online quota-based sampling. Multivariable logistic regression models examined the association between online racism and substance use, adjusting for frequency of social media use, total internet use, and sociodemographic covariates. The Karlson - Holm - Breen method was used to examine the role of depression and anxiety.Results: Among Black emerging adults, online racism was associated with greater odds of substance use (OR = 1.04, p < .001) and current smoking (OR = 1.04, p = .001). A similar pattern emerged for AANHPI (hazardous drinking: OR = 1.05, p < .001), current smoking (OR = 1.06, p < .001), and co-use (OR = 1.07, p < .001), and multiracial (current smoking: OR = 1.06, p = .014; and co-use OR = 1.07, p = .003). Anxiety had more pronounced mediating associations for Black emerging adults, while depression had more pronounced mediating effects for AANHPI and multiracial emerging adults.Conclusion: The widespread and chronic nature of online racism may in aggregate negatively impact substance use at the population level. Addressing online racism may require coordinated action, with future directions including the development of accountability strategies, coping interventions, and affirming digital spaces.
Background: Stimulant use and overdose (known as overamping) are rising across the United States, placing strain on the healthcare system. Harm reduction strategies and behavioral interventions for overamping are more effectively implemented in ambulatory settings, which also prevents costly emergency room utilization for this vulnerable population. However, clinical guidance for ambulatory overamping management is lacking.Objective: To address this gap, we developed a protocol for patient-centered ambulatory care and present two cases demonstrating its implementation.Methods: The protocol was developed by substance use disorder clinician and pharmacy experts. We incorporated evidence for the management of acute stimulant intoxication, clinical expertise, and implementation considerations in protocol development. The protocol was reviewed by a third-party pharmacist with expertise in psychosis treatment and stimulant use disorders. We describe protocol implementation and outcomes for two cases.Results: The protocol was implemented in patients that presented with signs of overamping and consented to treatment. First-line treatment was behavioral intervention, including environmental modifications to reduce external stimuli, remaining present, addressing acute needs, and verbal de-escalation. Second-line treatment was pharmacotherapy, including benzodiazepines followed by antipsychotics. Two cases are presented, both treated initially with behavioral measures and later pharmacotherapy. Long-term follow-up demonstrates continued care and management of stimulant use.Conclusion: Protocol-driven ambulatory care of overamping has the potential to provide patient-centered compassionate care that ensures patient follow-up and promotes continued treatment.
Background: Black persons who smoke are a recognized tobacco disparities group in the United States. Although past research indicates racial/ethnic discrimination is important to smoking among this group, less attention has been focused on anticipatory stress characterized by race-related vigilance, which is heightened awareness and preparation for potential discriminatory encounters.Objectives: The current study examined the role of race-related vigilance on smoking cessation outcomes, including severity of problems when quitting, perceived barriers for smoking cessation, as well as smoking abstinence expectancies related to negative mood, somatic symptoms, harmful consequences, and positive consequences among Black adults who smoke combustible cigarettes.Methods: The present sample consisted of 498 Black adults who reported daily use of combustible cigarettes (Mage = 45.37, SD = 14.68, age range: 18-73 years; 51.4% female).Results: Race-related vigilance was associated with several smoking-related constructs, including severity of problems when trying to quit (b = .02, p = .01), perceived barriers for smoking cessation (b = .28, p = .009), and expectations concerning the effects of smoking abstinence (i.e. negative mood [b = .49, p < .001], positive consequences [b = .20, p = .021]) even after accounting for sociodemographic factors and perceived racial/ethnic discrimination.Conclusions: These results provide novel evidence that race-related vigilance represents an important, yet understudied element involved in smoking behavior among Black adults, warranting further examination regarding its application to minority stress models of smoking behavior. Addressing race-related vigilance may be a critical component in developing more effective, culturally responsive cessation interventions.
Background: Methadone administration for opioid use disorder (OUD) has historically been in liquid formulations.Objectives: Evaluate how persons with OUD experience methadone dispensed in tablet versus conventional liquid formulation for the treatment of OUD.Methods: Persons (N = 48) receiving methadone for OUD were transitioned from liquid to a tablet formulation. Within-subject quantitative and qualitative reports of experience following each formulation were compared and descriptively summarized, respectively.Results: Participants were significantly more likely to describe tablet methadone as equal or better than liquid methadone (85.4% vs. 69.8%, p = .048, φ = .20). More participants endorsed benefits from tablet versus liquid methadone (66.7% vs. 37.8%, p = .005, φ = .29), including improved taste of the tablet, convenience in transporting medication, lower feelings of stigma, improved sleep, reduced cravings for sweet foods, and improved energy. No significant differences in formulations were evident with regards to bowel movements/constipation, sedation, and withdrawal suppression, with 81.5% of participants noting tablet methadone was equal or better at managing withdrawal compared to liquid. Participants found tablet methadone satisfactory, with 91.7% willing to recommend tablet methadone to their family/friends and 91.7% willing to use it again.Conclusion: Most participants experienced tablet methadone as neutral or advantageous compared to liquid methadone. Several qualitative potential benefits of tablet versus liquid methadone were raised. Approximately 80% of participants felt their opioid withdrawal was as good or better managed with tablet versus liquid methadone. These data may be used by clinics to explore tablet methadone dosing strategy and support advancement in the use of methadone for OUD.
Background: Neurodegenerative diseases including Alzheimer's disease (AD), Parkinson's disease (PD), Amyotrophic lateral sclerosis (ALS), and Huntington's disease (HD) represent a significant global public health problem. Alcohol consumption is a common lifestyle factor that has been implicated as both a risk factor and potential modifier of disease progression.Objectives: This review integrates evidence from human and experimental studies to characterize the effects of alcohol consumption on the onset and progression of major neurodegenerative diseases.Methods: A narrative review was undertaken examining the pathophysiological effects of alcohol on the brain and its disease-specific effects on neurodegenerative disorders, integrating findings from human cohort studies and mechanistic investigations in preclinical models.Results: Experimental evidence indicates that chronic alcohol consumption exacerbates neurodegeneration through multiple converging mechanisms, including oxidative stress, mitochondrial dysfunction, lipid peroxidation, inflammatory signaling, disruption of neurotrophic pathways, impairment of dopaminergic neurotransmission, and alcohol-induced gut microbiota dysbiosis with blood-brain barrier compromise. Epidemiological data suggest dose-dependent and disease-specific associations, with heavy and sustained consumption more consistently linked to increased risk or accelerated progression of AD and PD, while evidence in ALS and HD remains inconsistent.Conclusion: Alcohol exerts a multifaceted and context-dependent influence on neurodegenerative diseases. Accumulating evidence supports that long-term heavy alcohol consumption is associated with enhanced neurodegeneration. Minimizing alcohol consumption may present a pragmatic opportunity to reduce neurodegenerative risk.
