Field and preclinical studies suggest that kratom (Mitragyna speciosa) may have therapeutic potential in moderating methamphetamine (METH) craving. However, there is a lack of clinical studies to affirm this claim. This study explored patterns and motivations of kratom use among people who used METH with and without a history of heroin use, and determined the associations of kratom use patterns with METH craving. A treatment sample of 403 male respondents who had used METH, with and without kratom and with and without a history of heroin use was recruited for this cross-sectional study. A semi-structured questionnaire including Kratom Dependence Scale (KDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Visual Analog Scale was administered. Our results showed that none of the assessed kratom use indicators were identified as risk factors for the presence of METH craving. Only heroin use history (aOR = 2.61, p = 0.014) and somatic/vegetative symptoms related to depression (aOR = 1.26, p = 0.023) were risk factors for the presence of METH craving. A significant association between the severity of METH craving and age at first kratom use (β = -0.19, p = 0.0497) was observed among people who used METH with a history of heroin use. Our findings suggest that kratom use patterns may influence METH craving among people who used METH with a history of heroin use. These findings further support the perceived self-therapeutic utility of kratom among people who use drugs (PWUDs).
This study examined the effectiveness of Emotionally Focused Couple Therapy (EFCT) in improving marital intimacy and marital functioning among Iranian couples affected by addiction. A quasi-experimental pretest-posttest design with a control group was used. The study population consisted of couples seeking services at counseling clinics in Tehran who reported difficulties in marital intimacy and marital functioning associated with addiction. Twenty couples were recruited through purposive convenience sampling and randomly assigned to either an experimental group (10 couples) or a control group (10 couples). Data were collected using the Marital Intimacy Scale and the Dyadic Adjustment Scale (DAS). Both groups completed the measures at baseline. The experimental group received eight 90-minute sessions of EFCT, while the control group received no intervention. One week after the intervention, both groups completed the posttest assessments. The results showed that EFCT significantly increased marital intimacy and improved marital functioning among couples affected by addiction compared with the control group. Overall, the findings indicate that EFCT is an effective intervention for enhancing relationship quality in this population. By strengthening emotional bonds, fostering secure attachment, improving emotional responsiveness, and restructuring maladaptive interaction patterns, EFCT contributes to greater marital intimacy and healthier marital functioning. Therefore, we recommend integrating EFCT into addiction treatment and family counseling services to enhance relationship quality, strengthen family functioning, and improve the psychological well-being of couples affected by addiction.
Social network scholars have long recognized the role that social connections play in the substance use behavior of adolescents as they rely less on their parents/caregivers and more on their school peers. In this article, we explore the role of social networks as they relate to the substance use patterns of American Indian youth, 9th and 10th grade students attending one of three schools on one large Great Plains reservation. Using social network information from eligible youth (egos), we explore how their connections to others (alters) are associated with substance use patterns of alcohol, marijuana, and tobacco use. We found that a higher proportion of family members in social networks was protective against alcohol use, while a high proportion of alters who used substances increased the likelihood of use across all substances. We also find that egos who have alters that actively discourage the use of specific substances are protective for some substances. These results underscore the complexity and interplay of alters' behaviors and influence on egos and the need for further exploration of positive peer influence, especially to address the vexing issue of persistent substance use for AI youth.
This systematic review and meta-analysis synthesized prevalence data from 21 studies conducted in Southeast Asia and the United States to provide the most comprehensive estimate to date of global kratom (Mitragyna speciosa) use. The pooled prevalence was 1.6% (95% CI: 0.6%-3.8%) for current use and 3.8% (95% CI: 1.8%-7.8%) for lifetime use. Prevalence varied substantially across countries and populations, with the highest estimates observed in Thailand and among high-risk and substance-using populations. These differences likely reflect variation in cultural practices, legal frameworks, and study methodologies. Although considerable between-study heterogeneity was identified, the findings indicate that kratom use remains relatively uncommon in the general population but is substantially more prevalent among substance-using populations, highlighting the need for standardized surveillance and targeted public health strategies.
Cigarette smoking is associated with adverse mental and sexual health outcomes, yet the effects of dual use of electronic and conventional cigarettes remain unclear, particularly in Southeast Asian populations. This study examined the association between dual nicotine use, mental health, and sexual functioning among Malaysian adults. In this cross-sectional study, 132 participants completed validated measures of nicotine dependence, depression, anxiety, stress, and sexual function. Convenience sampling was used due to the exploratory nature of the study and the difficulty of identifying dual users through probability-based sampling. This study was conducted within a multi-ethnic Malaysian context, allowing examination of substance use behavior within culturally diverse populations. Dual users demonstrated significantly higher sexual desire scores compared with cigarette-only smokers, while no significant differences were observed in psychological outcomes. These findings provide preliminary evidence that dual nicotine use may be associated with variations in sexual desire, although clinical significance remains uncertain. Further longitudinal and mechanistic studies are required to clarify neurobiological and sociocultural pathways linking nicotine exposure with psychological and sexual health outcomes.
Substance abuse among nursing professionals critically threatens patient safety and well-being, yet remains underexplored. This mini-review of 14 original research articles (2000-2024) aims to identify contexts and conditions increasing substance abuse risks among nurses. Findings reveal several contributing factors, including accountability issues within regulatory boards, -insufficient reporting mechanisms, occupational stressors, misperceptions of control, and workplace environment influences. Coordinated efforts are essential, including educational programs, improved working conditions, strengthened regulations, and fostering a supportive help-seeking culture. Collaboration among healthcare, educational, and government organizations is vital for effectively tackling this challenge and ensuring safer healthcare environments.
Abuse of anabolic-androgenic steroids (AAS) to enhance muscularity has become a global health problem. Gym participants may abuse AAS under the influence of performance goals, body image concerns, and ethnocultural masculinity norms. This study aimed to determine the prevalence of AAS-users among Turkish male gym participants and to compare their blood parameters with those of non-users. A retrospective cross-sectional analysis identified recreational male gym athletes aged 18-50 years who underwent measurement of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and total testosterone (TT) between 2015 and 2025. Athletes with gonadotropin (LH and FSH) suppression were defined as "AAS-users". A total of 161 athletes were included in the study, and 57 (35.4%) were AAS-users with severe gonadal suppression (median LH= 0.12 IU/L and FSH= 0.17 IU/L). AAS-users were predominantly young adults aged 18-25 years (54.5%). Compared with non-users, AAS-users had significantly higher levels of TT, vitamin-B12, creatinine, liver transaminases, red blood cells, hematocrit, hemoglobin, and platelets, and significantly lower levels of high-density lipoprotein (HDL). Vitamin-B12 showed the strongest inverse correlation with gonadotropin levels, whereas HDL showed the strongest positive correlation. The findings indicate that approximately one-third of Turkish gym participants were AAS-users. They exhibited AAS-related renal, hepatic, polycythemic, thrombocytic, and dyslipidemic alterations, along with a higher tendency to use vitamin supplements. The pursuit of a muscular physique is associated with substantial cardiometabolic risk among male AAS-users, particularly young adults. This underscores the need for targeted educational interventions to improve benefit-risk awareness.
BACKGROUND:Hookah smoking has increased in popularity, and acceptance in many countries in the world such as Arab American communities. AIM OF THE STUDY:To assess the frequency of hookah smoking and to recognize the knowledge and cultural identity of Arab Americans. MATERIALS AND METHODS:This cross-sectional questionnaire based on a descriptive study was conducted among 100 Arab American population (convenience sampling when the link distributed via social media, and community centers) during January 2024 to May 2025. RESULTS:A study included a total of 100 Arab American participants were included in this research. There was a significant difference regarding age (p ≤ 0.001), the majority were between 31 and 40 years old (54%), Males represented a higher proportion of the participants (67%) compared to females (33%) (p ≤ 0.001). Regarding smoking status, 36% were current smokers, 45% reported never smoking, and 19% were ex-smokers (p = 0.003). About 51% believed that hookah use was equally hazardous as cigars, whereas 49% believed it was less harmful (p = 0.777). Importantly, all participants (100%) agreed that hookah smoking affects multiple body systems, including the cardiovascular and respiratory systems, and is associated with cancer and transmission of infectious diseases such as COVID-19 virus. CONCLUSIONS:This study highlights adult dominance in hookah use, pervasive misconceptions, and cultural drivers among Arab American communities.
Loneliness and addiction are converging as a silent dual epidemic, with particularly profound implications for the wider Middle East. Drawing on epidemiological, demographic and neuroscientific evidence, this brief examines how rapid social change, population ageing and shifting family structures heighten vulnerability to both chronic isolation and substance use disorders. Chronic loneliness is shown to biologically embed itself through alterations in dopaminergic, oxytocinergic, serotonergic and opioid pathways, thereby intensifying addiction risk and undermining treatment and recovery trajectories. By integrating these neurobiological insights with a social‑structural understanding of marginalization and weakened community ties, the brief highlights an urgent need for policy responses that recognize loneliness as a measurable and modifiable public‑health determinant. Recommendations include routine loneliness screening in addiction services, expansion of culturally tailored social prescribing, and stronger cross‑sector coordination to strengthen social connectedness and mitigate this mutually reinforcing epidemic.
Parental substance use is widely recognized as a source of household instability with adverse consequences for children, yet limited research has examined how such harm is lived and interpreted within contexts of prolonged structural constraint. This qualitative study explores Palestinian mothers' narratives of childhood in households affected by paternal substance use in the occupied West Bank. Drawing on 30 first-person narratives shared on digital platforms, the analysis examines how fear, violence, emotional neglect, and stigma shape children's everyday lives over time. Using thematic analysis, five interrelated themes were identified: constant fear and unpredictability, exposure to violence and the normalization of harm, emotional neglect and premature responsibility, stigma and social isolation, and long-term psychological consequences coupled with fear of repetition. Mothers' accounts reveal childhood fear as anticipatory and cumulative, embedded in daily routines rather than confined to discrete events. The findings show how this behavior-related harm is intensified by political, economic, and social pressures that constrain protection and silence disclosure. By centering mothers as moral witnesses, the study reframes parental behavior as a sustained family condition that restructures childhood, identity formation, and future orientation.
Drug use affects a significant portion of the Brazilian population, which increases the likelihood of children being exposed to illicit drug environments, making them a particularly vulnerable group. This study describes the profile of illicit drug exposure in children up to 12 years in Rio Grande do Sul state, Brazil, based on emergency cases. Data were collected from suspected intoxication cases attended between 2018 and 2023 in children ≤12 years old. Urine samples were analyzed for cocaine and its metabolites, THC-COOH, and amphetamine-type stimulants using LC-MS/MS. Information about the cases was also collected. Of 286 suspected cases, 32.9% detected at least one illicit drug. Cocaine and its metabolites were the most common (24.8%), followed by THC-COOH (9.4%) and MDA/MDMA (2.1%). Among detected drug cases, 56.4% were male. The mean age was 3.4 ± 3.5 years, with the highest incidence in 1 to 4-year-olds (47.9%). Exposure circumstances included accidental (37.2%), mistreatment/violence (8.5%), and abuse (2.1%). Most exposures occurred at home (58.5%). A notable prevalence of illicit drugs, mainly cocaine, was found. These data show a worrying scenario of drug exposure, primarily involving children aged 1 to 4 years. Above all, it also demonstrates a high frequency of exposure to illicit drugs in their own homes. The findings provide a solid basis for toxicovigilance activities and the development of public health policies aimed at protecting the vulnerable pediatric population.
This study aims to determine high school student's knowledge levels and usage patterns concerning electronic cigarettes. This descriptive and cross-sectional study was conducted with 354 high school students studying in a district of Istanbul between September-December, 2025. Data were collected online using a Descriptive Information Form that inquired about individual characteristics and electronic cigarette use. The mean age of the students was 16.14 ± 1.21 years, and 64.4% were female. While 15% of the students reported smoking cigarettes, 59.6% had at least one parent who smoked. Additionally, 69.4% of the students began smoking between the ages of 13 and 15. Electronic cigarette usage was reported by 9.3% of the students, and 25.1% reported considering using e-cigarettes in the future. Only 38.6% of the students were aware of the harms of electronic cigarettes, with most information being obtained from friends, social media, and their environment. Compared to traditional cigarettes, 28% of students disagreed that electronic cigarettes are less harmful, 38.2% disagreed that they are less addictive, and 39% were undecided on whether electronic cigarettes are cheaper. Furthermore, 52.8% of students stated that electronic cigarettes are popular in social settings, while 62.4% believed they are completely harmless. It is recommended that awareness and educational programs related to cigarettes and electronic cigarettes be provided at an early age to raise awareness and inform young people on this issue.
Objective: To develop a program of psychotherapeutic rehabilitation for mental patients who abuse synthetic cannabinoids and to describe phenomenon of this comorbidity. Object of study: The total sample included 311 young men dependent on synthetic cannabinoids: 169 with specific and persistent personality disorders and 142 with paranoid schizophrenia. Methods: Follow-up, clinical-psychopathological, psychometric (ICD-10, CGI, GAF, SANS), statistical methods were used. Results and discussion: The developed psychotherapeutic rehabilitation program for people with drug addiction, replacing the need for drugs with the need to stay in socially acceptable addictive groups, allows to improve the quality and duration of remissions, reduce the frequency of drug addiction, improve their condition and functioning.
This study examines how Palestinian mothers living with addicted husbands navigate the moral and psychological dilemma between staying in marriage and pursuing divorce. Drawing on thematic analysis of 30 first-person narratives shared in digital peer-support spaces in the occupied West Bank, the study conceptualizes addiction not only as a behavioral condition but as a relational and moral rupture that reorganizes family life. Findings reveal that marital decision-making is profoundly shaped by stigma, gendered expectations, and intensive social surveillance that frame divorce as a socially punitive act while moralizing women's endurance as maternal virtue. Mothers describe prolonged psychological distress marked by fear, depression, emotional paralysis, and life lived in suspension, as they weigh personal survival against children's wellbeing and anticipated social judgment. Children emerge as the central ethical justification for both staying and leaving, producing deep moral ambivalence. While endurance is normalized as duty and sacrifice, leaving is narrated as an act of reclaimed agency and moral resistance. The study challenges individualistic models of choice and highlights how motherhood operates simultaneously as a source of meaning and a mechanism of social regulation in addiction-affected marriages.
Substance use disorders (SUDs) present persistent challenges for effective treatment and relapse prevention. Understanding the factors that support sustained recovery is therefore critical. Recovery capital, encompassing the internal and external resources that facilitate the initiation and maintenance of recovery, is recognized as a key determinant of long-term recovery outcomes. This study examines factors associated with recovery capital among individuals with SUDs across different treatment modalities in Iran. In this cross-sectional study, 332 individuals in recovery from SUDs were recruited in 2024 through cluster sampling from outpatient and community-based treatment settings. Guided by a socioecological framework, individual, social, and treatment-related factors were assessed. Data were collected using validated questionnaires measuring recovery capital, perceived social support, and perceived quality of life and satisfaction, along with demographic and substance use-related variables. Multiple linear regression analyses were conducted using SPSS. Recovery capital was significantly associated with gender (p = 0.005), marital status (p < 0.001), employment status (p < 0.001), predominant substance type (p < 0.001), stage of recovery (p = 0.004), relapse history (p = 0.034), and treatment modality (p < 0.001). Higher recovery capital was also strongly correlated with greater perceived social support (p < 0.001), perceived quality of life and satisfaction (p < 0.001), and engagement in meaningful activities (p < 0.001). In multivariable analysis, perceived social support, perceived quality of life and satisfaction, living arrangements, and treatment modality jointly explained 44% of the variance in recovery capital. Recovery capital appears to be shaped by modifiable social and contextual resources, in addition to demographic and treatment-related factors. The strong associations with social support and perceived well-being highlight the importance of integrating psychosocial and quality-of-life-focused strategies into routine SUD services to strengthen recovery resources across treatment settings.
Substance misuse among young adults is increasingly becoming a public health concern in Ghana's small-scale mining communities, especially among young miners, where socioeconomic vulnerabilities and limited access to support services intensify the issue. While there is evidence on the challenges that families face because of young adults' substance misuse, there is limited evidence on the strategies they use to cope with them. This study aims to explore the coping strategies used by single female parents of young adults misusing substances in small-scale mining communities of southwestern Ghana. Fourteen participants were purposively selected to take part in in-depth semi-structured interviews. The findings were analyzed thematically. The mean age of participants was 54.6 years. Findings revealed three main coping strategies that were used by the parents: parental monitoring, resorting to spirituality, and informal support networks. Study implications include having parent-support groups, providing psychoeducation to parents, and implementing anti stigma campaigns to enhance help seeking attitudes.
Cannabis use has long been linked to the emergence and worsening of psychotic disorders, particularly among adolescents and young adults. This study aimed to determine the prevalence of cannabis use and its psychiatric associations in youth and young adults enrolled in an Early Psychosis Intervention (EPI) program in Southeast Ontario. A retrospective cross-sectional analysis was conducted on 116 individuals aged 14-35 who were consecutively enrolled in the EPI program between 2016 and 2019. Data on demographic characteristics, psychiatric diagnoses, and self-reported cannabis use were extracted from clinical records. Statistical analyses were performed to examine associations between cannabis use and variables such as age, gender, educational background, and psychiatric comorbidities. Cannabis use was self-reported by 82.8% of participants. The majority of users were male, and use was most prevalent among individuals aged 18-25. A significant association was found between cannabis use and diagnoses of substance-induced psychosis (p < 0.001). Lower levels of formal education were more frequent among cannabis users compared to non-users (p = 0.004).This study identified a strikingly high rate of cannabis use among youth engaged in early psychosis care, particularly among males and young adults in their early twenties. The findings underscore the importance of routine screening, targeted psychoeducation, and harm reduction strategies within EPI programs. Given the strong association with substance-induced psychosis, early identification and integrated treatment approaches are essential to improve long-term outcomes in this population.
American Indian/Alaska Native (AI/AN) populations often experience higher rates of opioid use disorder (OUD) and opioid overdose deaths compared to other racial/ethnic groups. This study evaluates modifiable risk factors and protective clinical interventions for OUD and overdose prevention interventions among AI/AN patients to understand potential points of intervention. This retrospective cohort study utilized electronic health record data from the Oracle Cerner Real-World Database. The sample included AI/AN individuals aged ≥12 years with an index encounter for opioid prescription or a new OUD diagnosis between January 2006 - January 2021. Modifiable risk factors and protective clinical interventions or overdose prevention interventions included opioid and benzodiazepine co-occurrence, polysubstance use, and interventions such as medications for opioid use disorder (MOUD), safe substance use education, naloxone prescription, and urine drug testing. Adjusted hazard ratios (aHRs) were obtained via Cox Proportional-Hazard regressions. Individuals with a co-occurrence of opioids and benzodiazepines had a higher risk of developing OUD (aHR 1.32, 95% CI 1.19-1.45). Polysubstance use was significantly associated with an increased risk of OUD (aHR 1.85, 95% CI 1.58-2.17) and opioid overdose (aHR 1.47, 95% CI 1.04-2.09). Receiving safe substance use education was associated with a 19% lower risk of OUD (aHR 0.81, 95% CI 0.68-0.98). Prescriptions for naloxone (aHR 0.39, 95% CI 0.17-0.89) or MOUD (aHR 0.25, 95% CI 0.13-0.49) were associated with a lower risk for opioid overdose. The findings highlight key clinical practices and patient behaviors that may significantly affect the risk of OUD and overdose for AI/AN populations.
