BACKGROUND AND OBJECTIVES:Gambling in older adults represents an emerging but still underrecognized mental health concern. Although gambling participation is increasingly observed in later life, the specific psychological, social, cognitive, and biological factors associated with gambling-related problems in older adults remain insufficiently characterized. METHODS:A systematic review was conducted in accordance with PRISMA guidelines. Empirical studies involving adults aged ≥55 years with Gambling were identified through searches of Web of Science, PubMed/MEDLINE, Scopus, PsycNET, ClinicalTrials.gov, and WHO ICTRP from January 15 to June 15, 2025. RESULTS:From 40,263 identified records, 35 studies met the inclusion criteria. The included studies, published between 2000 and 2025, primarily investigated gambling behaviors, severity, psychosocial correlates, and associated mental health outcomes in older adults. Commonly identified correlates to gambling-related problems included loneliness, reduced social support, financial difficulties, male gender, stressful life events, and early gambling initiation. Gambling was frequently reported as a recreational activity but could become maladaptive when used as a strategy to regulate negative emotions or cope with social isolation. Psychiatric comorbidity, particularly depression and anxiety, was frequently observed in clinical and high-risk samples. Evidence regarding psychological interventions remains limited but suggests potential benefits. DISCUSSION AND CONCLUSIONS:Current evidence highlights substantial gaps in age-specific assessment and targeted interventions. Future studies should prioritize tailored psychological interventions addressing loneliness, emotional regulation, cognitive distortions, and life transitions in later adulthood.
BACKGROUND AND OBJECTIVES:Poppy seed tea (PST) contains unpredictable opioid concentrations, destabilising tolerance and increasing overdose risk. Extended-release buprenorphine (BUP-XR) provides sustained coverage without daily dosing. METHODS:Eighteen-month follow-up of adults (N = 3) with opioid use disorder (OUD) involving PST in Australia. RESULTS:All had polysubstance use and transitioned to BUP-XR after 2 days to 6 months of sublingual buprenorphine. Posttransition urine drug screens were morphine-negative; one patient was intermittently tramadol-positive. All remained in treatment at 18 months. DISCUSSION AND CONCLUSIONS:BUP-XR assisted stability within multidisciplinary care. SCIENTIFIC SIGNIFICANCE:This series adds longer-term follow-up on PST-related OUD and suggests BUP-XR feasibility.
BACKGROUND AND OBJECTIVES:Alcohol exclusion provisions (AEPs) in the Uniform Accident and Sickness Policy Provision Law (UPPL) allow insurers to deny claims for alcohol-related injuries. Although many states have repealed AEPs, some enacted explicit prohibitions on intoxication-based claim denials while others did not. This review documents the evolution and current legal landscape of AEPs and evaluates how prior studies have classified these policies. METHODS:Data were obtained from the Alcohol Policy Information System (APIS) accessed in December 2025 and verified using Westlaw and Nexis Uni. Targeted reviews of the literature on AEPs were conducted. RESULTS:As of 2024, 21 states retain AEPs. Fourteen states and the District of Columbia explicitly prohibit intoxication-based claim denials, 13 states have no UPPL-related provisions, four states limit AEP applicability to disability insurance, and two states maintain policy-specific exceptions. Prior studies frequently overlook these distinctions. CONCLUSIONS:Legal heterogeneity remains substantial and may contribute to policy misclassification and biased estimates in empirical evaluations of AEPs. SCIENTIFIC SIGNIFICANCE:By providing a comprehensive legal mapping of AEP regimes and identifying common methodological shortcomings in the literature, this review offers a framework for improving future research on alcohol-related insurance policies, alcohol screening practices, treatment utilization, and related health outcomes.
BACKGROUND AND OBJECTIVES:Despite growing cannabis use rates among US rural-residing young adults, less research has examined associations of rural-urban residence with cannabis use influences (e.g., harm perceptions, peer use) or behaviors (e.g., use frequency, driving under the influence of cannabis [DUIC]). METHODS:Using 2023 online survey data from 1961 US young adults (aged 18-34) reporting past-month cannabis use (Mage = 26.86 [standard deviation = 4.61], 14.7% rural-residing, 38.2% racial/ethnic minority, 59.2% female), multivariable regressions controlling for sociodemographics and state non-medical cannabis legalization examined associations of (1) rural-urban residence with cannabis use influences (motives, perceptions, mental/physical health, parent/peer use, advertising exposure); and (2) rural-urban residence and use influences with use behaviors (past-month days of use, past 6-month DUIC, consequences). RESULTS:Rural (vs. urban) residence was associated with three use influences (i.e., greater coping motives, lower perceived harm of cannabis use, higher odds of a mental health diagnosis), more frequent cannabis use and DUIC, but fewer use consequences. All three influences were associated with more frequent use and having a mental health diagnosis was associated with more frequent DUIC. Greater coping motives and lower harm perceptions were associated with fewer consequences, and having a mental health diagnosis was associated with greater consequences. DISCUSSION AND CONCLUSIONS:Rural (vs. urban) young adults reported more frequent cannabis use and DUIC, which may be associated with low cannabis-related harm perceptions and using cannabis to cope with stress/mental health symptoms. SCIENTIFIC SIGNIFICANCE:Interventions targeting rural young adults that address mental health symptoms and risk perceptions, including DUIC-related risks, may be needed.
BACKGROUND AND OBJECTIVES:Motives for and contexts of cannabis use (CU) are typically examined as independent characteristics of CU events in ecological momentary assessment (EMA) studies. However, theories posit that some combinations of motives and contexts (e.g., using to cope in a solitary setting) may contribute to heavier substance use than others (e.g., using to cope in a social setting). The current study aimed to test whether these combinations are associated with heavier substance use at the event-level. We aimed to do so among a sample of young adult females given sex differences in cannabis risk processes, which oversampled sexual minority women and gender diverse individuals due to their high rates of CU. METHODS:We utilized EMA data from a study of young adult females who regularly used cannabis (n = 571; 77.6% sexual minority women and gender diverse individuals). RESULTS:Coping motives and solitary settings interacted such that coping motives for CU were associated with longer and higher subjective intoxication but only in solitary settings. Social and enhancement motives did not interact with social contexts; however, social and enhancement motives, as well as social contexts, were associated with longer intoxication and higher subjective intoxication. DISCUSSION AND CONCLUSIONS:Findings indicated that coping motives were only associated with CU when combined with solitary use. Social and enhancement motives and social contexts produced additive effects. SCIENTIFIC SIGNIFICANCE:Findings indicate that studies examining the effects of coping motives or solitary cannabis use in isolation may not accurately characterize these effects.
BACKGROUND AND OBJECTIVES:Once-daily methadone dosing for opioid use disorder (OUD) may leave periods of inadequate analgesia. We tested whether experimental pain sensitivity differs across the inter-dose interval. METHODS:Twenty-five adults (52% female, 43.12 years old) with OUD receiving stable once-daily methadone completed thermal quantitative sensory testing at early post-dose and pre-dose. RESULTS:Heat pain threshold (MD -3.75°C; g = -0.78; p < .001) and tolerance (MD -0.92°C; g = -0.49; p = .018) were lower at pre-dose. Temporal summation and conditioned pain modulation did not differ. DISCUSSION AND CONCLUSIONS:Pain sensitivity increased pre-dose, consistent with a hyperalgesic window. SCIENTIFIC SIGNIFICANCE:Preliminary experimental evidence that once-daily methadone may contribute to cyclical hyperalgesia in persons with OUD.
Background and Objectives This study examined the prevalence of alcohol mixed with energy drinks (AmED) among Spanish adolescents and young adults and analyzed its associations with sociodemographic factors, substance use, and mental health. The primary objective was to compare AmED users specifically against alcohol-only users to identify unique risk profiles.Methods A cross-sectional survey was administered to 6156 individuals aged 16-30 enrolled in educational programs. Participants completed self-report measures assessing substance use, emotional distress, schizotypal traits, and suicidal behavior. Bivariate analyses compared AmED users with alcohol-only users and non-drinkers. Logistic regression identified independent correlates of AmED use specifically within the alcohol-using population.Results Among alcohol users, 31.3% reported consuming AmED. AmED users were more likely to be younger and male, and they initiated alcohol use earlier. They showed a higher prevalence of tobacco, e-cigarette, and cannabis use, as well as a greater risk of problematic alcohol, nicotine, and cannabis consumption. AmED users also reported elevated emotional distress, suicide behavior, and the schizotypal traits dimensions of anhedonia and interpersonal disorganization. Logistic regression identified younger age, male sex, binge drinking, e-cigarette use, nicotine dependence, alcohol-related problems, cannabis abuse risk, suicidal behavior, and schizotypal traits as significant correlates of AmED use.Discussion and Conclusions AmED consumption is common among Spanish youth and is more strongly linked to polysubstance use and poor mental health than alcohol use alone.Scientific Significance Screening for AmED use may help identify youth at higher risk of polysubstance use and suicidal behavior, facilitating earlier detection and targeted prevention efforts.
BACKGROUND AND OBJECTIVES:To describe provider preparedness and experiences engaging families after a patient overdose death. METHODS:We used descriptive statistics to summarize responses to a national survey of interdisciplinary providers. RESULTS:Participants (n = 524; 47,937 invited) agreed that providers should communicate with a patient's family after an overdose death (78.2% agreed), yet few felt very well prepared to do so (22.6%). DISCUSSION AND CONCLUSIONS:Providers inconsistently contacted families despite believing these interactions are opportunities to improve family and provider coping. SCIENTIFIC SIGNIFICANCE:There is a potential need for interventions addressing this discrepancy between providers' desired behaviors and practice contacting families following a patient death.
BACKGROUND AND OBJECTIVES:Readmission to residential treatment increases healthcare costs, strains publicly funded systems, and may not adequately meet clients' needs. This study examined rates and predictors of readmission to residential treatment among clients transitioned from detoxification services. METHOD:Data from 4915 clients admitted between April 2015 and March 2022, encompassing 10,463 treatment admissions, were analyzed. Logistic regression was used to compare readmitted with nonreadmitted clients, focusing on sociodemographic characteristics, primary substance of concern, and program-related variables. RESULTS:Overall, 41.6% (n = 2046) of clients were readmitted, with a mean of 3.7 admissions, indicating that a small subgroup accounted for a disproportionate use of limited treatment capacity. Higher odds of treatment readmission were associated with opiate or alcohol use, unstable employment or marital status, detox noncompletion or repeated cycling between completion and noncompletion, transition delays exceeding 14 days, polysubstance use, urban-rural mobility, and use of multiple detox facilities. Lower odds of treatment readmission were observed in individuals using cocaine, those admitted to integrated facilities offering both detox and residential care, and clients with less frequent detox utilization. CONCLUSION AND SCIENTIFIC SIGNIFICANCE:Readmission to residential treatment is common and linked to both individual vulnerabilities and system-level factors. Strengthening protocols for alcohol and opioid use, enhancing coordination between detox and residential treatment, and targeting high-risk groups may reduce readmission. Interventions addressing non-completion of detox and delayed transitions could further reduce treatment readmission. This study uniquely examines readmission in relation to prior detoxification programs and clients' characteristics within a continuum-of-care framework.
BACKGROUND AND OBJECTIVES:Participation in physician health programs (PHPs) is associated with positive outcomes for healthcare professionals (HCPs) with potentially-impairing conditions, but more information is needed about PHP completer experiences. The present study explored program completers' perceptions of their involvement with one state PHP. METHODS:A PHP staff member with no monitoring role conducted exit interviews via telephone with all individuals who completed the program between January 2019 and September 2023 (n = 666). Deidentified interview responses were examined using quantitative descriptive analysis and thematic analysis. RESULTS:The HCPs who completed PHP participation were generally satisfied with the program. Three major themes emerged: (1) PHP offers valuable support; (2) Helpful components of the PHP; and (3) Challenges encountered during PHP monitoring. The HCPs generally expressed appreciation for the PHP, with many describing a bittersweet journey. Components of the program identified as helpful included peer support, availability and expertise of case managers, accountability, advocacy and support offered by the program, and mental healthcare. Key challenges faced by program completers included the financial burden, feeling overwhelmed by program requirements, and perceived stigma and negative treatment related to their PHP involvement. DISCUSSION AND CONCLUSIONS:Many PHP completers perceive PHP support as critical to improving their recovery outcomes. Additional resources may be needed to relieve the perceived financial burden of PHP participation, mitigate disruption to daily life/responsibilities, and reduce emotional distress following referral to PHP. SCIENTIFIC SIGNIFICANCE:This is a large qualitative study of the perspectives and experiences of PHP completers.
BACKGROUND AND OBJECTIVES:Veterans face disproportionate suicide and mortality risks driven by intersecting social determinants of health (SDH), including housing instability, unemployment, and justice involvement, and co-occurring substance use disorders (SUD). This study examined how these intersecting factors influence mortality and whether SUD treatment mitigated mortality risks among US veterans. METHODS:Using national Veterans Health Administration data (2014-2019), we identified 215,944 veterans with SUD and an indicator of one of three adverse SDH: housing instability, justice involvement, or unemployment. We tracked suicide and all-cause mortality for 1 year following SDH exposure. We used discrete-time survival models to assess associations between month-specific SUD treatment and mortality outcomes, controlling for demographic, clinical (i.e., mental health conditions, suicidal behavior), and contextual covariates. RESULTS:Nearly half of veterans (48%) received SUD treatment. Those who received treatment had lower all-cause mortality (2.1% vs. 4.3%; p < .001) but no significant difference in suicide mortality (0.14% vs. 0.15%; p = .75). [Correction added on 22 April 2026, after first online publication: The preceding sentence has been revised in this version.] SUD treatment was associated with a 24% (aOR = 1.24; 95% CI: 1.16-1.34) reduction in all-cause mortality, though its interaction with each adverse SDH was not statistically significant. Suicide deaths remained concentrated among White veterans, those aged 18-34, with no service connection, and with time-varying suicidal ideation or attempts (p < .001). DISCUSSION AND CONCLUSIONS:Engagement in SUD treatment reduces all-cause mortality among veterans facing compounded social adversity but does not independently mitigate suicide deaths. SCIENTIFIC SIGNIFICANCE:Integrated approaches that embed suicide prevention within addiction and SDH-focused care are essential to address the multifactorial drivers of veterans' suicidal mortality.
