Background: Substance use disorders (SUDs) are an increasing public health concern in low- and middle-income countries, where treatment services often encounter individuals with heterogeneous and complex substance use that challenge treatment approaches organized around single substances. Empirical evidence describing such patterns among treatment-seeking populations in sub-Saharan Africa remains limited. This study identified distinct substance use patterns among individuals seeking SUD treatment in Uganda and examined their correlates. Methods: We conducted a cross-sectional analysis of baseline data from a longitudinal cohort of 445 individuals seeking SUD treatment at three treatment facilities in Uganda. Latent Class Analysis (LCA) identified distinct substance use patterns based on self-reported psychoactive substance use. Model fit was assessed using information criteria, entropy, and posterior classification probabilities. Multinomial regression was used to examine associations between participant characteristics and latent class membership, with the alcohol-dominant class as the reference group. Ridge-penalized regression was conducted as a sensitivity analysis. Results: A four-class model best characterized substance use patterns in the sample. The alcohol-dominant class (51.3%) was characterized by older age, rural residence, and formal employment. The cannabis–alcohol class (29.4%) comprised predominantly younger adults with housing instability, unemployment, urban residence, and elevated acute psychosis risk. The prescription drug class (10.8%) was marked by legal opioid, sedative-hypnotic, and anticholinergic misuse with strong association with injection drug use and acute psychosis risk. The high-risk illicit class (8.5%) showed near-universal illegal opioid (88.8%) and cocaine/crack cocaine (89.1%) use with the strongest association with injection drug use. Conclusion: Individuals seeking treatment for SUD in Uganda present with four clinically distinct patterns of substance use that differ substantially in severity, clinical complexity, psychosocial adversity, and broader structural vulnerabilities. These findings challenge the single-substance framing of existing treatment services and provide an empirical basis for differentiated, person-centred care including integrated mental health support, harm reduction and context-specific treatment approaches for high risk groups in Uganda and resource-limited settings.

This study explores substitute addictions - the immediate or gradual replacement of an addiction or set of addictions that have been stopped or reduced by engaging with another addictive behavior - as a central concern in treatment-assisted recovery. Questionnaires were administered to 85 substance use disorder treatment professionals across 20 U.S. states, with qualitative items eliciting their views on why another addiction might replace the substance use disorder being treated; whether and how the facility educates service users about substitute addictions; how substitute addictions may help or hurt service users' recovery efforts, and assessed general recommendations for addressing substitute addictions. Thematic analysis yielded three themes: (i) substitutes supporting recovery, (ii) substitutes precipitating relapse or worse quality of life, and (iii) treatment of substitute addictions. Given the high rates of post-treatment relapse, we make important strides in addressing treatment professionals' rarely examined first-hand experiences, to inform service delivery.

Treatment is regarded as a core resource to initiate recovery and build recovery capital. In this chapter, we assess the role of treatment and support services in building recovery capital and explore how recovery capital is related to a range of treatment outcomes. Based on a comprehensive literature review, we provide an overview of quantitative and qualitative studies of recovery capital in treatment populations, its impact on outcomes and treatment participation, and related service provider and service user perspectives. Overall, studies in in- and outpatient settings show considerable growth of recovery capital during and after treatment, which is closely related to improved substance use outcomes. Treatment retention and completion are central to building recovery capital. According to service users’ and providers’ perspectives, social support and recovery supportive environments are crucial for building recovery capital, as well as more personalized and strengths-based approaches.

People with substance use disorders (SUD) have multiple associated health and social conditions that may lead to unmet needs, even among those receiving professional support. Furthermore, the fragmented nature of care provision may also contribute to unmet needs. Therefore, we assessed the needs of service users with SUD and identified their need profiles and their determinants. We aimed to identify possible gaps in care that were likely to hamper recovery pathways and to examine whether the care supply was tailored to users’ needs. A convenience sample of 562 service users with SUD drawn from diverse mental health services in Belgium, including specialised services for SUD, were assessed using the Camberwell Assessment of Needs– Short Appraisal Schedule (Patient version). Additional indicators, including social integration, substance use behaviours, service utilisation, and well-being, were also collected. A Latent Class Analysis was performed to identify need profiles. Three classes of need profiles were identified. The largest class comprised 40

Substance use disorders (SUDs) are increasingly recognized as a significant public health concern in Africa, placing considerable strain on the economy, healthcare system, and society at large. Given the dual disease burden of both infectious and non-communicable diseases, African countries may not prioritize addressing the emerging epidemic of SUDs. There is a paucity of scientific literature on SUD treatment outcomes following their management across the African continent. Therefore, this systematic review aimed to address this gap. We conducted an electronic search of Web of Science, CINAHL, Embase, Medline (PubMed interface), Scopus, and PsycArticles. We included studies with participants who were diagnosed and treated for SUDs following internationally recognized diagnostic criteria in the African region as defined by geographical boundaries and had at least one treatment outcome measured and reported. Studies were assessed for risk of bias using the Joanna Briggs Institute critical appraisal tool. This systematic review was registered in the PROSPERO database (CRD42022362926). Thirteen research studies were included across four African countries (South Africa − 8, Uganda − 2, Zambia − 2, and the Democratic Republic of Congo − 1). The treatment completion rates across all treatment modalities averaged 71.4

Background: Most studies that have examined the association of addiction with cardiovascular diseases (CVDs) have been completed regarding substances. However, behavioral addictions may indirectly or directly negatively impact one’s health. We engaged in a scoping review on the associations of behavioral addictions (i.e., sex, exercise, love, Internet, shopping, gambling, and work) with cardiovascular health. We aimed to explore (1) the addictive behaviors addressed in the literature, (2) the study samples and country contexts, (3) the methods used, and (4) the associations found with CVD or its precursors. Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist and following Arksey and O’Malley’s (2005) methodological framework, a search across the Web of Science, PubMed, 13 ProQuest databases, and Google Scholar yielded 59 primary research articles. Results: The majority of these studies inferred cardiovascular consequences emerging from engaging in these addictions, based on stresses induced, sedentary behavior involved, or proximal physiological data such as heart rate variability or electrocardiogram reactivity. However, the literature is quite weak in indicating that behavioral addictions lead to later cardiovascular events. Studies are also confounded by other variables (e.g., substance use disorders). No love addiction or shopping addiction-cardiovascular event studies were located, nor were the potential confounding effects of substitute addictions. Conclusions: Future longitudinal research and qualitative studies among older adults are needed to better discern the impact of behavioral addictions on cardiovascular health. For example, in studies that find cardiovascular effects such as high blood pressure, there is a need to try to discern whether the effects followed from addiction or preceded the addiction. In addition, studies are needed to discern whether behavioral addictions primarily impact cardiovascular health through social and reactivity consequences of engaging in the behaviors or merely indirectly through engagement in sedentary lifestyles.

Comments on the article by J. B. Grubbs and C. L. Boness (see record 2025-66167-001). We read the correspondence with interest and agree that the label "behavioral addictions" (BA) should be applied with care to avoid trivializing genuine addictions. However, in arguing that we should move past substance use disorder (SUD) paradigms the authors highlight known concerns that BA researchers appreciate, and we contend there are at least seven flaws in their viewpoint article. First, we are unaware of BA researchers claiming that the frequency of engagement in a behavior equates with dysfunction. Second, SUDs also vary in "boundaries" of when the use is a "passion" versus when it is an "addiction." Third, one might note that SUDs involve both a substance component and a behavioral component (preparation to engage in substance intake), both of which may alter neurobiological function. Fourth, researchers do engage in qualitative work eliciting self-reports and lived experiences of BA. Fifth, the authors do not discuss the neurobiological underpinnings of BAs. Sixth, the authors fail to note statements made expanding the concept of SUD beyond physiological tolerance and withdrawal (e.g., Leshner, 1997). Finally, the criteria now used to apply to substances are acknowledged to apply to behaviors (American Psychiatric Association, 2013). While insurance companies may not want to pay for treatment for BAs due to the increased prevalence of disordered behavior needing assistance, that does not mean that negatively consequential addictive behaviors do not exist or that they cannot be treated in the absence of established diagnostic criteria (Sussman & Sinclair, 2023). Frankly, the evidence for the existence of BAs is overwhelming at this point. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.

Globally little is known regarding substance use service providers’ perceptions of substitute behaviours and this significant gap could hinder service provision and recovery outcomes. Semi-structured focus group discussions (including 22 service providers across five sites) were conducted in residential treatment facilities in the Western Cape, South Africa. Service providers recognised substances (e.g. cigarettes and caffeine) and behaviours (e.g. gambling, eating, love, sex, shopping, exercise, and gaming) as potential substitutes. Identified substitute motives included managing cravings; self-medication; filling the experiential void of the primary substance, and time-spending. Concurrent behaviours and addictions were believed to be a key mechanism underlying substitution however, service providers did not uniformly screen for co-occurring behavioural addictions. Substitute behaviours were primarily considered a pathway to relapse and service providers emphasised prevention, detection and family education. To suitably intervene, screening for co-occurring behaviours should be an integral part of the assessment of those presenting for substance use treatment.

IntroductionPersons with substance use disorders (SUD) make up a considerable proportion of mental health care service users worldwide. Since 2010, Belgian mental health care has undergone a nationwide reform (‘Title 107’) aiming to realize a mental health care system that fosters more intensive collaboration, strengthens the cohesion and integration across and between different services, and is more responsive to the support needs of all service users. Although persons with SUD were named as a prioritized target group, how this reform impacted the lives and recovery journeys of persons with SUD remains understudied. This study aims to investigate how persons with SUD, regardless of whether they have co-occurring mental health issues, experience the accessibility of mental health care in light of the ‘Title 107’ reform.MethodsData were collected by means of in-depth interviews with a heterogeneous sample of persons with SUD (n=52), recruited from five regional mental health networks in Belgium. In-depth interviews focused on experiences regarding (history of) substance use, accessibility of services and support needs, and were analyzed thematically.ResultsFive dynamic themes came to the fore: fragmentation of care and support, the importance of “really listening”, balancing between treatment-driven and person-centered support, the ambivalent role of peers, and the impact of stigma.DiscussionDespite the ‘Title 107’ reform, persons with SUD still experience mental health care services as ‘islands in the stream’, pointing to several pressing priorities for future policy and practice development: breaking the vicious cycles of waiting times, organizing relational case management, tackling stigma and centralizing lived experiences, and fostering recovery-promoting collaboration.

The concept of recovery has emerged as a prominent paradigm to understand processes of change in individuals with substance use problems. To date, most studies have focused on personal recovery as the key driving force of recovery journeys, generally individualizing the often-disabling social realities that persons in recovery face. To counterbalance this bias, this paper focuses on the contextual dynamics at stake during recovery processes, based on the lived experiences of 30 persons in drug addiction recovery in Flanders (Belgium). A Lifeline Interview Method was applied to elicit recovery narratives, which were thematically analysed. We found that interpersonal relationships, enabling and disabling places, and socio-economic factors facilitate or impede recovery in meaningful ways. The findings also show how these diverse contextual dimensions are interrelated and ambiguous. Researchers, policymakers, and treatment providers should acknowledge the relational nature of recovery and the invalidating impact of stigma across the three identified contextual levels.

Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15–19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15–19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, P = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, P = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.

BACKGROUND:Specialised addiction treatment centers (SAC) and general mental health centers (GMHC) both offer care to people with substance use disorders (SUD) in Belgium, but these sectors often operate in parallel, with little collaboration. This fragmented system may lead to inefficiencies, particularly in the treatment of individuals with dual diagnoses. Despite the recognized challenges, there is limited understanding of the factors that influence whether patients with SUD are treated in SAC or GMHC. OBJECTIVES:This observational study has two main objectives: METHODS: The study used routinely collected data from treatment centers in Belgium from 2019 (Belgian Treatment Demand Indicator). Logistic regression evaluated the weight of drug use and sociodemographic variables for people entering treatment for SUD for the first time (n = 8322). A random forest algorithm was used to study all patients' orientation toward both sectors, across all treatment episodes (n = 29,658). RESULTS:The study found that the primary substance significantly influences sector choice. Patients using illicit substances like cannabis, opiates, cocaine, and stimulants are 6-12 times more likely to be treated in an SAC than those using alcohol. Factors such as income source and referral source (e.g. self-referral, general practitioner, etc) also significantly impact patient orientation. CONCLUSION:These findings highlight the need for better integration between SAC and GMHC to adequately address the complex needs of people with SUD, especially with dual diagnosis.

"Substitute addiction" refers to the process of achieving abstinence or resolution of one addictive behavior and subsequently engaging in one or more additional addictive behaviors in its place. Substitute addiction, a concept in the abstinence-based recovery field for decades, is viewed as a cause for concern because resolving one addictive behavior might not fully remove harm or ensure recovery. Conversely, "harm-reduction treatment" refers to a counseling orientation that focuses on helping service users reduce substance-related harm and improve their quality of life without necessarily requiring abstinence or use reduction. Harm-reduction treatment assesses a constellation of addictive behaviors in the larger context of a person's life to holistically reduce harm in that constellation. In this commentary, we define and compare both constructs and point out their implications for addictions treatment.

BackgroundRecovery-supportive interventions and strategies for people with substance use disorders are a cornerstone of the emergent recovery paradigm. As compared to other services, such approaches have been shown to be holistically focused and improve outcomes (e.g. substance use, supportive relationships, social functioning, and well-being). Even so, a comprehensive overview of the nature, extent, and range of research on the topic is lacking.MethodsA scoping review of the literature was conducted to characterize the main topics on recovery-supportive interventions. A systematic search was conducted in three databases: Scopus, Web of Science, and PubMed from January 2000 to July 2023 using the PRISMA-ScR. Twenty-five studies published between 2005–2022 met the inclusion criteria.ResultsMost studies emanated from the United States, and we found a peak in publication frequency between 2018–2022 (n = 13) relative to other years. The most prominent lines of inquiry appear to concern recovery-oriented policies; principles of recovery-oriented services (challenges encountered when implementing recovery-oriented practices, relationships with service providers characterized by trust, and service user-service provider collaboration), and recovery capital (particularly recovery-supportive networks, employment, and housing). Seventeen studies addressed co-occurring disorders, and eight addressed substance use recovery.ConclusionTo advance the field, more context-specific studies are required on supporting peer professionals, (including enabling cooperation with service users, and hiring experts by experience as staff), and training of professionals (e.g., nurses, psychologists, social workers, physicians) in the principles of recovery.

Behavioral addictions are highly comorbid with substance use disorders, presenting in as many as 54% of service users receiving substance use treatment. Few studies have examined whether treatment centers are attentive to such other addictions, which may undermine treatment. This study examined the mention and treatment of behavioral addictions on United States treatment center websites. The 2021 Newsweek America's Best Addiction Treatment Centers website was utilized to examine the mention and treatment of behavioral addictions in 300 leading treatment centers across 25 states in the United States. Of 289 active websites, only 61 (21.1%) treatment centers mentioned anything about behavioral addictions. The highest prevalence was for gambling (n = 38), sex (n = 22), food/eating (n = 21), and internet gaming (n = 12). A total of 49 treatment centers reported treating those addictions. The most prevalent treatments involved 12-step programming (n = 18), cognitive behavioral therapy (CBT; n = 16), individual counseling (n = 16), and group therapy (n = 15). Little formalized importance via websites was provided regarding the mention or treatment of behavioral addictions at treatment centers. A greater emphasis on concurrent and substitute behavioral addictions is needed to improve the quality of life and lower the possibility of relapse among those persons in addictions treatment.

Purpose of Review Although gaming disorder (GD) is prevalent during adolescence and group-based interventions (GBIs) prove highly beneficial for substance use disorders, much remains unknown regarding their utility for addressing problematic gaming (PG) and GD. This systematic review thus explores the potential value of GBIs for adolescents with PG/GD.Recent Findings With the inclusion of PG/GD as a potential diagnosis by the American Psychiatric Association in 2013 and the acceptance of GD as a psychological disorder by the World Health Organization in 2019, research on this topic has proliferated. Although reviews to date have accorded attention to cognitive behavioral therapy, technology-based interventions, or focused on broader conditions such as "Internet addiction," none has exclusively focused on GBIs or adolescent populations.Summary The findings from the eight retained studies suggest a positive impact of GBIs on adolescent PG/GD. Nonetheless, the particular benefits of "the group" as a modality remained largely unaddressed. Future research should adopt more rigorous designs to understand its underlying mechanisms.

BackgroundMuch remains unknown about the dynamics of substitute behaviors during addiction recovery among persons attending recovery support groups. Insight into the nature, motives for, and course of substitute behaviors could help to shape recovery support and harm reduction services.MethodsTwenty-three semi-structured in-depth interviews (n = 14 males and n = 9 females) were conducted with a convenience sample of Narcotics Anonymous attendees from a number of groups in the Western Cape, South Africa. Participants ranged in age from 22-55 years (M = 39.3, SD = 9.35).ResultsThematic analysis yielded four themes: (i) substance-to-substance substitution; (ii) substance-to-behavior substitution; (iii) substitute behaviors and harm (reduction) and (iv) support needs to manage and resolve substitute behaviors. According to the study, participants' substitute behaviors developed across recovery stages; were temporary or long-term replacements for substance use disorders and were engaged for distraction, isolation from others, calming, assuaging boredom, keeping occupied, filling a perceived experiential void, modifying mood and to self-medicate. While substitutes were utilized for harm reduction or relapse prevention, the potential for ostensibly healthy behaviors to threaten recovery and lead to relapse was also recognized.ConclusionsSelf-monitoring, ongoing vigilance, and awareness of when substitutes become genuine addictions are critical for timely, suitable interventions.