Background Equitable access to medications for opioid use disorder (MOUD) remains a global challenge. Little is known about community geographic, demographic, and socioeconomics characteristics associated with buprenorphine provider availability following removal of the X-waiver. This study examined these associations across U.S. Zip Code Tabulation Area (ZCTA) nationwide. Methods We analyzed 32,667 ZCTAs with complete data from SAMHSA, the U.S. Census, CDC WONDER, and the Missouri Census Data Center. Outcomes were provider availability (≥1 provider/ZCTA) and provider count. Independent variables included dichotomized measures of urban/rural, racial composition, median household income, educational attainment, unemployment, health insurance coverage, and continuous opioid overdose mortality. Multivariable logistic and negative binomial models were estimated. Results 30.2% of ZCTAs had at least one provider. Rural ZCTAs had lower provider availability (AOR=0.074, p<.001) and provider counts (IRR=0.070, p<.001). Majority non-White ZCTAs were not significantly associated with either provider availability (AOR=1.1, p=.17) or counts (IRR=1.1, p=.35). Communities with majority less than a bachelor’s degree had lower provider availability (AOR=0.50, p<.001) and counts (IRR=0.53, p<.001). Higher unemployment (AOR=1.5; IRR=1.4, both p<.001), lower health insurance coverage (AOR=1.3; IRR=1.2, p<.001), and higher opioid overdose mortality (AOR=1.3; IRR=1.3, both p<.001) were associated with greater provider availability and counts. Low median household income was not associated with provider availability (AOR=1.0, p=.42) but was associated with higher provider counts (IRR=1.2, p<.001). Conclusions Despite the removal of X-waiver, the availability of buprenorphine providers remains limited and uneven. Policies should prioritize equitable distribution of providers to better align treatment capacity with community need, particularly in rural areas.
Background Treatment motivation is a critical factor for ensuring continued engagement in substance use disorder (SUD) interventions. Because both internal and external factors influence motivation, this study investigated the impact of substance cravings, readiness to change, and perceived social support on treatment motivation among youths with amphetamine-type stimulant (ATS) use disorder.MethodologyThis cross-sectional study recruited youths (aged ≤ 25 years) from Malaysian public SUD treatment centers. Assessments included the ATS Cravings Questionnaire (ATS-CQ), Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Multidimensional Scale of Perceived Social Support (MSPSS), and Treatment Motivation Scale (TMS). Results Participants (N = 172; Mage = 22.12; 97.7% Malay) reported an average substance use duration of 82.1 months (SD = 32.5), most frequently using amphetamine pills (pil kuda). Bivariate analyses indicated all variables—except use duration and prior rehabilitation—correlated significantly with TMS domains. Multivariate analyses yielded significant models for the domains of Problem Recognition (adj. R² =.410, p <.001), Desire for Help (adj. R² =.362, p <.001), and Treatment Readiness (adj. R² =.241, p <.001). Across these models, key significant predictors involved varying combinations of problem recognition, plans to use ATS, age of substance initiation, and polysubstance use. Conclusion Interventions focusing on managing cravings, facilitating problem recognition, and addressing polysubstance use are essential to improve overall treatment motivation. Furthermore, because age of substance initiation emerged as a key predictor, early prevention programs targeting younger demographics are crucial. Comprehensively addressing these determinants will significantly enhance both preventative efforts and long-term rehabilitation outcomes.
Background We previously demonstrated that standardized kudzu extract (NPI-031) reduced drinking in a four-week trial among non-treatment-seeking men diagnosed with alcohol abuse or dependence. The present study assessed the safety and efficacy of eight weeks of kudzu among treatment-seeking men and women with alcohol use disorder (AUD). Methods In this double-blind placebo-controlled study, nineteen individuals (12M, 7F; 27–65 years old) with AUD took either kudzu extract (750mg isoflavones) or matched placebo daily, combined with weekly counseling for eight weeks. Twice weekly laboratory visits monitored alcohol consumption (via daily diaries and timeline follow-back), medication adherence (via urinary riboflavin), safety (via blood chemistry), and adverse events. Results There were no significant differences in drinking at baseline, with 4.2 ± 0.7 heavy drinking days (HDDs) per week reported by the kudzu group (N=9; 5M, 4F) and 4.7 ± 0.6 in the placebo group (N=10; 7M, 3F). Medication adherence was excellent (>96%) with no adverse events or safety concerns noted. After 4 weeks of treatment, both groups decreased the number of HDDs per week by ~40%. Across the full 8-week treatment, the average reduction was 30% for kudzu extract and 44% for placebo. Conclusions In contrast to results from prior studies among non-treatment-seeking young adult men, kudzu did not perform better than placebo in reducing drinking among a treatment-seeking sample of men and women with AUD. Taken together, these data suggest that kudzu may help to reduce binge drinking but may not provide additional benefits to individuals who are enrolled in an effective AUD treatment program.
This narrative review reconstructs the U.S. history of treating co-occurring opioid use disorder (OUD) and alcohol use disorder (AUD) from the rise of methadone maintenance in the 1960s through contemporary interest in immunometabolic mechanisms and repurposed therapies. Drawing on peer-reviewed literature and selected grey sources, we trace four eras including early single-substance paradigms and maintenance; federally regulated opioid treatment programs and the broader medicalization of addiction care; recognition of co-occurring disorders, parity and Affordable Care Act reforms, and uneven diffusion of medications for OUD and AUD; and a renewed metabolic framing, including preclinical, clinical, and real-world evaluation of glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonists. Across eras, regulation, reimbursement, and professional authority shaped access as much as evidence, producing persistent geographic and socioeconomic inequities. Emerging GLP-1-based therapies may offer a distinctive cross-disorder adjunct, but their value for OUD/AUD remains unproven. Population benefit will require rigorous trials and delivery reforms that expand equitable access to integrated care.
Background:Although clinical guidelines support long-term buprenorphine treatment for opioid use disorder (OUD), evidence guiding planned discontinuation is limited. Extended-release buprenorphine (BUP-XR) produces a slow decline in plasma concentrations that may function as a natural taper. This study examined clinical and qualitative outcomes following planned BUP-XR discontinuation. Methods:This observational study followed participants for 6 months after BUP-XR discontinuation and included qualitative interviews exploring perspectives on discontinuation. Eligibility: adults with ≥ 12 months BUP-XR treatment, controlled OUD and other substances, and joint provider-participant agreement on treatment discontinuation. Primary endpoint: successful treatment discontinuation at 6 months, defined as no consistent self-reported nonmedical opioid use (≥1 day/week for 4 consecutive weeks or 7 consecutive days) and not restarting long-term OUD treatment due to withdrawal symptoms or nonmedical opioid use. Results:Twelve participants enrolled; one excluded for ineligibility. Eleven completed 6-month follow-up; 10/11(90.1%) met successful discontinuation criteria. Withdrawal symptoms were generally mild, nonpersistent, and resolved by Month 6. Opioid craving remained low throughout. No deaths, pregnancies, overdoses, or withdrawal-related adverse events occurred. One participant experienced non-study-related adverse events: pneumonia/empyema with hospitalization and macrocytic anemia. At interviews (on average 12 months post-discontinuation), all participants remained off treatment without persistent opioid use; one reported a brief, time-limited return to opioid use. Participants described minimal opioid withdrawal, low craving, and stable functioning across domains. Conclusion:After long-term BUP-XR treatment, discontinuation was effective and well tolerated over 6 months. BUP-XR's pharmacokinetic profile may safely support a gradual taper when paired with patient-centered care, psychosocial support, and ongoing engagement.
People who inject drugs (PWID) are disproportionately impacted by viral hepatitis C (HCV). Among PWID, homelessness, poverty, and material insecurity elevate infectious disease risk. We hypothesized a positive association between material hardship (difficulty accessing basic needs) and lifetime diagnosis of HCV, and a negative association between cumulative risk (material hardship and years since first injection) and HCV treatment. From 2021-22, we conducted a survey among community-recruited PWID that included items on HCV outcomes, material hardship (a sum score of usually (4) to never (1) having difficulty finding food, clothing, shelter, restrooms, and showers in the past 3 months), and years since injection drug use initiation. We developed a latent variable, cumulative risk, by combining individual scores of material hardship indicators and years since first injection drug use. Among our sample of PWID (n = 471), 246 (53%) participants reported lifetime HCV diagnosis and 27% of those who tested positive for HCV reported ever or current treatment (n = 67). In modified-Poisson regression, a one-unit increase in material hardship score was associated with a 3% (OR: 1.03, 95% CI: 1.01%, 1.05%) increase in odds of HCV diagnosis. In latent modeling, among PWID testing positive for HCV, a one-unit increase in cumulative risk score was associated with a 0.28 (OR: -0.28, 95% CI: -0.50, -0.06), decrease in the Z-score odds of receiving HCV treatment. Findings emphasize structural interventions to strengthen material security and co-delivering basic needs with health services to improve HCV-related outcomes among PWID.
Dental opioid prescriptions remain one of the most common initial exposures to opioids worldwide. Although opioid prescribing in dentistry has declined, even limited exposure to opioids may be a significant risk factor for developing Opioid Use Disorder (OUD), particularly in younger populations. This review evaluates the existing literature on dental opioid prescriptions and the development of OUD, identifies procedural and patient-related risk factors, and assesses the effectiveness of existing intervention strategies. Following the PRISMA guidelines, a comprehensive literature search was conducted across MEDLINE, Embase, PsycINFO, Web of Science, and CENTRAL from January 2011 to July 2026. Eligible studies examined opioid prescribing in dental alveolar surgeries, related OUD/SUD outcomes, and preventative interventions. From an initial 1,008 identified records, 12 studies met the final inclusion criteria for qualitative synthesis. Observational studies showed that factors significantly associated with persistent opioid use or adverse outcomes included higher prescribed opioid doses, prior substance use disorder, public or Medicaid insurance, younger age, female sex, and complex chronic medical conditions. Notably, patients undergoing low-pain dental procedures who received opioids demonstrated the highest relative risk for short-term persistent use. Five studies evaluated interventions, finding that short behavioral counseling and opioid-sparing pharmacologic strategies, specifically liposomal bupivacaine and preemptive intravenous paracetamol, effectively reduced postoperative opioid consumption. However, none of the included intervention studies had sufficient follow-up to evaluate the direct prevention of clinical OUD. Future research should prioritize prospective longitudinal studies and randomized controlled trials to evaluate interventions that safely reduce opioid exposure and definitively prevent OUD following dental procedures.
Background: Substance use disorders (SUDs) are prevalent in individuals with mental illness who interact with criminal justice systems, and inpatient forensic hospital care presents a treatment opportunity. Despite recognition that addressing SUD should be a central feature in forensic hospital care, knowledge is limited regarding existing practices. This scoping review addressed the research question: “What is known about the screening, assessment, treatment, and management of SUD in inpatient forensic hospital settings?”. Methods: We conducted this review in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA extension for scoping reviews, searching MEDLINE, PsycINFO, PubMed, and Embase databases. Inclusion criteria comprised original, English language, peer-reviewed studies focusing on inpatient substance use practices and interventions in forensic hospitals internationally, and published from database inception to May 13, 2025. Results: Forty-nine articles were included. Most of this research has been conducted in Europe using observational study designs. SUDburden was high, with prevalence estimates varying depending on detection approach. Treatment evidence came mostly from uncontrolled evaluations with small sample sizes of group-based psychosocial interventions. These data show acceptability and improvements in intermediate outcomes, but mixed results on substance use-specific outcomes. Studies highlighted service fragmentation, workforce training gaps, and security-related issues that strained the therapeutic alliance. Conclusion: This review can inform the development of effective SUD treatment pathways and standardized models of care, improving health outcomes and quality of life, and reducing recidivism in this vulnerable population. This work establishes a foundational knowledge base essential for improving forensic hospital services.
Introduction:Acute alcohol intoxication impairs inhibitory control. Intermittent theta-burst stimulation (iTBS) of the dorsolateral prefrontal cortex may alter executive control, but little is known about whether accelerated iTBS can be combined with controlled alcohol administration. Methods:This double-blind, sham-controlled pilot study evaluated feasibility and preliminary behavioral effects of accelerated left prefrontal iTBS during acute alcohol intoxication in healthy young adults (N = 10). Participants completed a Cued Go/No-Go task at baseline and near peak breath alcohol concentration after active or sham iTBS delivered in two bouts separated by 30 min. Results:All participants in the analytic sample completed both stimulation conditions without serious adverse events or stimulation-related discontinuations. Alcohol increased inhibitory failures relative to baseline. Preliminary analyses suggested greater alcohol-induced increases in inhibition failures following active versus sham iTBS. Conclusion:Accelerated prefrontal iTBS can be implemented during controlled acute alcohol intoxication in a laboratory setting. Although the behavioral findings are not conclusive, they are hypothesis-generating and underscore the need to evaluate state-dependent neuromodulation effects in larger, balanced studies.
Background:Alcohol risk prevention strategies have recently incorporated temporary, short-term abstinence to reduce overall alcohol risk and health and social impacts on both individuals and society. However, experimental research in animals and humans has shown that, for some, short-term abstinence followed by reinstatement of drinking escalates, instead of reduces, subsequent alcohol use. The goal of this project was to conduct a proof-of-concept study using a novel precision approach to optimize assignment to short-term abstinence. Methods:The sample consisted of 48 healthy adults aged 21-35 (Median=24.5, Interquartile Range (IQR)= 6, 67% female, 83% White) who endorsed moderate-to-heavy alcohol use. Participants completed two counterbalanced intravenous alcohol self-administration sessions, one following a two-week period of alcohol abstinence and one during usual drinking. Crossover generalized outcome weighted learning was used to estimate an optimal individualized assignment rule for short-term abstinence, based on relevant psychopathology dimensions and other individual characteristics as prescriptive factors. Results:Findings showed that an estimated rule with higher granularity - higher-specificity traits and demographics - led to lower overall alcohol consumption compared to one-size-fits-all rules. The effect sizes of the difference were small-to-medium but did not reach statistical significance, likely due to the small sample size. Discussion:Results provide preliminary evidence that individualized assignment rules based on simple, accessible characteristics warrant further examination as an approach to identify individuals who could benefit from short-term alcohol abstinence. This line of research has significant long-term implications for tailoring interventions to individual needs, thereby enhancing outcomes. Further research steps are necessary to realize its full impact.
Background:Cardiovascular disease (CVD) risk prediction tools have not been developed or validated for adults who use nonmedical stimulants (cocaine or methamphetamine), despite substantially elevated event rates and pathophysiologically distinct risk profiles in this population. Accurate estimation of absolute risk is needed to support individualized clinical decision-making. Methods:We developed a 3-year CVD risk prediction model using a cohort of 6940 adults aged 18-79 with documented stimulant use, identified from electronic health record (EHR) data of a large academic hospital system spanning 2016-2024. Type of stimulants used was a candidate predictor, alongside demographic characteristics, cigarette smoking status, systolic blood pressure, and baseline cardiovascular medications. Variable selection used least absolute shrinkage and selection operator (LASSO) with 10-fold cross-validation, followed by unpenalized logistic regression on selected variables. Model performance was assessed using discrimination and calibration metrics; bootstrap internal validation estimated and corrected for optimism in apparent performance. Results:LASSO selected 8 predictors: age, sex, Black race, Hispanic ethnicity, current cigarette smoking, cocaine-only use, any cardiovascular medication use, and systolic blood pressure. Calibration was excellent. Observed and predicted 3-year event rates were 29.6% and 30.1%, respectively (observed/expected [O/E] ratio 0.985, calibration slope 1.000, integrated calibration index [ICI] 0.008). Performance was maintained after optimism correction: O/E ratio 0.988, calibration slope 0.992, ICI 0.010. The apparent C-statistic was 0.730 (95% CI 0.717-0.743); the optimism-corrected C-statistic was 0.728. For illustration, a 45-year-old Black adult with cocaine use, current cigarette smoking, and systolic blood pressure of 130 mmHg has an estimated 3-year CVD risk of approximately 27.7%; the same profile with methamphetamine use yields approximately 22.1%. Conclusions:A CVD risk prediction model tailored to individuals with stimulant use accurately estimated absolute 3-year CVD risk, with excellent calibration and clinically meaningful risk stratification. These findings establish proof of concept for a stimulant-specific CVD risk prediction tool. External validation and implementation studies are needed before clinical deployment.
Purpose: Screening for substance use disorders (SUDs) during pregnancy is essential but is hindered by barriers, including limited leadership engagement, financial sustainability concerns, and insufficient infrastructure. This study evaluated the implementation in a maternal health clinic of an electronic health record (EHR)-integrated Screening, Brief Intervention, and Referral to Treatment clinical decision support system (SBIRT-CDSS) that incorporated the 5Ps screening tool. We aimed to assess social workers’ perceptions of usability and integration, and to compare screening rates, missed referrals, and revenue generation of the SBIRT-CDSS to SBIRT without CDSS. Methods: Our mixed-methods assessments encompassed four phases: (1) pre-implementation acceptability assessment using Technology Acceptance Model (TAM) surveys and qualitative input from social workers; (2) cognitive walkthroughs with mock patients; (3) systems modeling comparing SBIRT-CDSS to SBIRT without CDSS; (4a) post-implementation feedback from social workers at 1 month and (4b) quantitative analysis of SBIRT-CDSS usage, CPT billing, and screen-positive rates after 18 months of deployment. Results: Social workers rated SBIRT-CDSS as easy to use and useful. Systems modeling projected SBIRT-CDSS adoption would increase screening rates, referral rates, and revenue—depending upon extent of CDSS usage. Among 1967 patients with an initial prenatal visit during the 18-month post-implementation period, 1721 (87.5%) had SBIRT screenings documented at that encounter. Among screened patients, 1331 (77.3%) had CPT codes entered and 422 (24.5%) screened positive. Conclusions: SBIRT-CDSS implementation facilitated screening, billing code entry, and substance use identification. Social workers reported high usability and workflow integration. Utilization is expected to enhance referral rates and financial sustainability.
Background: Syringe services programs (SSPs) decrease HIV and overdose incidence among people who use drugs (PWUD). In May 2024, Pueblo, Colorado, banned syringe distribution, citing public complaints about syringe litter. The ban was overturned in June 2024. The two SSPs in Pueblo halted syringe distribution during the threeweek ban but continued other services. The effect of short-term syringe bans on harm reduction services is unknown. Methods: We analyzed program data from one SSP in Pueblo, Colorado, and syringe litter pickup data from the Pueblo Department of Parks and Recreation from January to September 2024. We used Interrupted Time Series analysis to evaluate the association between the syringe distribution ban and four weekly outcomes: SSP visits, naloxone kits distributed, syringes distributed, and syringe litter collected. Results: The ban was associated, on average, with 31 fewer visits (95% CI: -48, -15), 23 fewer naloxone kits distributed (95% CI: -34, -12), and 2406 fewer syringes distributed (95% CI: -3308, -1504) every week. There was an immediate decrease of 120 syringe litter units collected (95% CI: -285, 46) weekly. After the ban was overturned, there was an immediate increase and increasing trend in visits, naloxone kits, and syringes distributed, and no changes in syringe litter. Naloxone distribution did not return to expected levels in the 16 weeks following the ban being overturned. Conclusion: Banning syringe distribution in Pueblo, Colorado was associated with sustained decreases in SSP usage and naloxone distribution. Eliminating funding for certain SSP activities could inadvertently decrease access to naloxone.
Adolescent substance use imposes lasting costs on education, mental health, and lifetime earnings, with early initiation strongly predicting adult dependence. Despite legal prohibition, approximately 21% of U.S. high school students report current alcohol use, 18% report current nicotine vaping, and 16% report current cannabis use. Social media plausibly contributes to these patterns, yet prior studies rely on broad screen time measures that conflate passive consumption with compulsive checking. We analyzed 2023 Youth Risk Behavior Survey (YRBS) data, the first standalone measure of social media frequency in the YRBS series, from 10,027 U.S. high school students. We estimated survey weighted Linear Probability Models with state fixed effects, adjusting for demographics, mental health, electronic bullying, sleep, and physical activity. Students checking social media more than once per hour show a 19 %age point (pp) higher probability of current alcohol use, a 16 pp higher probability of current nicotine vaping, and a 13 pp higher probability of current cannabis use relative to nonusers, following a dose response gradient. Applied to 17.1 million U.S. high school students, this associates with approximately 1 million additional students drinking alcohol, 870,000 additionally nicotine vaping, and 681,000 additionally using cannabis among the 5.4 million students checking social media more than once per hour. Associations concentrate in alcohol, cannabis, and nicotine vaping, which are prominently normalized online. These findings inform legislative debates over engagement maximizing design features targeting adolescents and support extending content restrictions on alcohol and cannabis influencer marketing. Background Adolescent substance use imposes lasting costs on educational attainment, mental health, and lifetime earnings, with initiation during adolescence strongly predicting adult dependence. Despite legal prohibition, approximately 21% of U.S. high school students report current alcohol use, 18% report current nicotine vaping, and 16% report current cannabis use. Social media plausibly contributes to these patterns, yet most prior studies rely on composite screen time measures that conflate passive consumption with compulsive social media checking, limiting inference about frequency-specific risk. Methods We analyzed 2023 Youth Risk Behavior Survey (YRBS) data, the first standalone measure of social media frequency in the YRBS series, comprising 10,027 U.S. high school students. We estimated survey-weighted Linear Probability Models with state fixed effects, adjusting for sociodemographic characteristics, mental health status, electronic bullying, sleep, and physical activity. Results Students checking social media more than once per hour show 19 %age point (pp) higher probability of current alcohol use, a 16 pp higher probability of current nicotine vaping, and a 13 pp higher probability of current cannabis use relative to students reporting no use of social media, each following a dose-response gradient. Applied to 17.1 million U.S. high school students, these estimates associate with approximately 1 million additional students currently drinking alcohol, 870,000 additionally nicotine vaping, and 681,000 additionally using cannabis among the 5.4 million students checking social media more than once per hour. Conclusions Associations between social media use frequency and substance use concentrate in alcohol, cannabis, and nicotine vaping, the three substances most prominently normalized in platform content, while lower for cigarettes which are subject to platform content bans and strong social stigma. These findings inform ongoing legislative debates over engagement-maximizing platform design features targeting adolescents and support extending content restrictions on alcohol and cannabis influencer marketing equivalent to those already applied to tobacco.
Background:Interpersonal mistreatment in everyday life and healthcare settings are social determinants of health linked to a range of outcomes. However, their associations with adult polysubstance use-particularly at the population level-remain less understood. Methods:We analyzed survey data from the All of Us Research Program (version 8) (n = 259,033) and operationalized the Everyday Discrimination Scale (EDS; range, 0-5) and Healthcare Discrimination Scale (HDS; range, 0-4) as continuous measures. Substance use patterns were defined as mutually exclusive use categories of exclusive (any one), dual (any two), and poly (all three) current tobacco/nicotine, alcohol, and cannabis use. We fit multivariable multinomial logistic regression models to estimate associations between both forms of discrimination and substance use patterns. Results:The average EDS and HDS scores were 0.85 (SD=0.87) and 0.59 (SD=0.66); the prevalence of exclusive, dual, and poly use was 47.4%, 8.4%, and 0.6%. In adjusted models, increasing EDS was associated with higher odds of exclusive use (AOR: 1.05, 95% CI: 1.04-1.07), dual use (AOR: 1.12, 95% CI: 1.10-1.15), and poly use (AOR: 1.21, 95% CI: 1.13-1.30). Increasing HDS was inversely associated with exclusive use (AOR: 0.91, 95% CI: 0.90-0.92) and dual use (AOR: 0.96, 95% CI: 0.93-0.98) and not associated with poly use. Conclusions:Interpersonal discrimination represents a clinically relevant and potentially modifiable social determinant of polysubstance use. Efforts to reduce everyday discrimination and improve patient experiences within healthcare settings may play an important role in preventing higher-risk substance use patterns and advancing equity in substance use-related outcomes.
Aims This study aimed to examine within and between effects of the relationship between depression, using the Beck Depression Inventory (BDI), and cocaine craving, using the visual analog craving scale (VAS), over time. Methods Data from the NIDA Clinical Trial Network Study Cocaine Use Reduction with Buprenorphine (CTN-0048) were used in a secondary analysis (CTN-0148). Random-effects regression modelling was used to examine relationships between participants' depressive symptoms and their cocaine craving over time. Results A total of 301 participants with past-year DSM-IV criteria for cocaine and opioid use disorder were analyzed (21.6% female, 10.3% Hispanic, 66.4% Black) being treated with placebo or buprenorphine + naloxone. Craving significantly decreased over time (B = -1.11, 95% CI [-1.21, -1.02], p < 0.001). Depression emerged as a significant within-person predictor of craving over time (B = 0.93, 95% CI [0.76, 1.09], p < 0.001), indicating that when a person's BDI score increased by one point from their own mean, their craving increased by 0.71 units. Between-person differences in average BDI did not have significant effects (p > 0.05), indicating that depression scores across participants did not significantly predict differences in craving. Conclusions These findings highlight depression as a dynamic, time-varying clinical marker of heightened craving risk and suggest that monitoring and addressing increases in depressive symptoms during treatment may help mitigate craving spikes and potentially reduce vulnerability in returning to use.
Background:Wearable biosensors enable real-time monitoring of physiological stress. While methadone maintenance treatment (MMT) is effective in opioid use disorder (OUD), inter-dose withdrawal and stress dysregulation remain challenges. We sought to identify wearable-derived digital biomarkers of stress in individuals with OUD receiving MMT. Methods:In this cross-sectional, laboratory-based study, 72 adults completed 76 sessions (14 OUD pre-methadone dose, 15 OUD post-dose, 47 healthy controls) of a standardized protocol of calm tasks (e.g., relaxing videos, positive memory recall) followed by stress-inducing tasks (e.g., horror video, mental arithmetic, negative memory recall). Physiological data were continuously recorded using the Empatica E4 wristband (heart rate, heart rate variability [HRV], electrodermal activity [EDA], skin temperature, accelerometry). Features were extracted using open-source toolkits. Linear mixed-effects models tested calm-stress differences and group effects; Random Forest classifiers evaluated calm versus stress classification. Results:Among 340 extracted features, 63 (18.5%) significantly differentiated calm from stress across all groups, with EDA- and accelerometry-derived features showing the most consistent stress sensitivity. Compared with controls, OUD participants demonstrated higher baseline arousal and altered stress reactivity, with the largest responses observed in the pre-dose group. Random Forest models performed best for cognitively demanding tasks (up to 98% accuracy) and more modestly for other tasks. Conclusions:Wearable sensors can detect multidimensional alterations in resting-state physiology and stress reactivity among individuals with OUD on methadone. Future studies should validate these candidate biomarkers and test whether integrating wearable-derived stress detection into treatment improves clinically meaningful outcomes, such as stress management, craving, risk of return to opioid use, and retention.
Background Craving, the desire to use substances, is a key diagnostic feature for substance use disorders (SUDs) that predicts substance use. Experiencing affective states, both positive (PA) and negative affect (NA), are also implicated in SUDs. Yet, their dynamic interrelationships with craving and substance use remain unclear, particularly at the within-person level of analysis. This study aimed to use ecological momentary assessment (EMA) in daily life to test whether craving mediates the association between PA/NA and subsequent substance use. Methods Adults with SUDs (N = 36), from outpatient addiction treatment centers, were included in an observational study using EMA over 14 days prior to randomization in a clinical trial. They completed EMA surveys three times daily [midday, afternoon, evening], reporting on PA, NA, craving, and substance use. Multilevel mediation models with bootstrapping were used to examine whether craving mediated within-person associations between affect (PA and NA) and subsequent substance use. Results Craving significantly mediated the association between affect and subsequent substance use. Higher PA was associated with lower craving at the same timepoint, which in turn led to reduced likelihood of substance use at the next timepoint (β=-0.04, p = 0.02). Conversely, higher NA was associated with higher craving, leading to greater likelihood of substance use at the next timepoint (β=0.08, p = 0.03). Conclusion At the within-person level, craving mediates the association between affective states and subsequent substance use in individuals with SUD. Targeting momentary affect and craving in daily life, such as through ecological momentary interventions, is a promising strategy for treating SUDs.
Background: In 2023, Luxembourg partially legalised cannabis, permitting home cultivation and private-domain use. The current study aimed to evaluate the short-term impacts of this reform on consumption patterns, market dynamics, product potency, and cannabis-related driving-under-the-influence cases (DUI). Methods: An interdisciplinary approach was applied, combining data from cannabis seizures, wastewater analysis, toxicological data from DUI cases, and a WEB-based survey among adults who indicated to have used cannabis in the past 12 months. Indicators were compared before and after the policy change. Results: Most indicators suggested a limited overall impact of partial legalisation in the year following the reform. Tetrahydrocannabinol (THC) concentrations in seized herbal and resin samples remained stable, as did THC metabolite loads in wastewater. Results of the WEB-based survey indicated little change in patterns of use, prices, or acquisition channels, with most survey respondents continuing to purchase from illicit sources. Only a minority of respondents reported personal or intended future cultivation. In contrast, cannabis-related DUI cases increased significantly. Although average THC concentrations in blood samples remained unchanged, elevated levels of THC metabolites suggested a potential increase in chronic use among some individuals. Conclusion: Partial cannabis legalisation in Luxembourg appears to have had only moderate impacts on market dynamics, patterns of use, and product potency during the first year, but was associated with an increase in cannabis-related DUI cases. Similar to findings in other countries, new initiation of cannabis consumption was limited, while people with an established pattern of frequent use may have intensified their use. These findings highlight the need for continued monitoring of impaired driving, cannabis consumption patterns, and emerging trends in self-cultivation, alongside public education on health risks.
Purpose: Epidemiologic survey studies suggest that people with disabilities are vulnerable to excessive alcohol use and alcohol use disorder (AUD), yet little is known about potential differences in clinical AUD diagnosis by disability status. Our objective was to examine trends in annual AUD diagnoses in the US from 2016 to 2023 among adults with commercial insurance, and to investigate potential differences by disability status/type, and by disability status/type and sex. Methods: Retrospective cross-sectional study using MarketScan commercial insurance claims from 2016 to 2023. Population-based sample of adults age 18-64 with commercial insurance across all 50 states. AUD diagnoses were identified with ICD-10 diagnosis codes. Age-adjusted annual AUD diagnosis rates per 10,000 population, stratified by disability status/type, and disability status/type and sex. Average annual percentage change of AUD rates over time. Results: The rate of AUD increased steadily from 85/10,000 persons in 2016 to 128/10,000 persons in 2023; average annual percentage change of 5.41% per year (CI 3.82% - 7.03%). Adults with disability had greater than threefold higher rates of AUD, and males and females with disabilities had a persistently higher rate of AUD compared to non-disabled males and females. Adults with serious mental illness and acquired brain injury were particularly likely to have AUD; rates were over 10 and 5 times higher than adults without these types of disabilities, respectively. Conclusions: Adults with disabilities had higher than three times the rate of AUD diagnoses compared to adults without disabilities. Interventions are needed inclusive of person-centered care for disabled people with comorbid AUD
