Cannabis use, depression, and attachment insecurities (anxiety, avoidance) have been previously linked, though typically examined using bivariate methods. This study tested cross-sectional and longitudinal associations among these constructs, assessing whether problematic cannabis use contributes to depression, and whether attachment insecurities exacerbate this effect. Data were collected from 1,745 Jewish Israeli adults at two timepoints (2024 = T1; 2025 = T2) of whom 412 reported lifetime cannabis use. Problematic cannabis use, depression, and attachments insecurities were assessed with the ASSIST, PHQ-9 and ECR ,respectively. Analyses in the full sample examined the full range of cannabis involvement, including no use, and in the lifetime-user subsample the impact of problematic use severity. Cross-sectional models at T1 and T2 tested whether depressive symptoms were predicted by problematic cannabis use and moderated by attachment anxiety and avoidance. A longitudinal model examined whether problematic cannabis use and attachment insecurities at T1 predicted changes in depression from T1 to T2. At both timepoints, attachment anxiety significantly moderated the cannabis-depression association (p = 0.013 at T1, p = 0.002 at T2), with a stronger link at higher anxiety levels. Similar patterns appeared in the lifetime-user subsample. Longitudinally, a significant three-way interaction (p = 0.014) indicated that increases in depression were greatest among individuals high in both anxiety and avoidance, while avoidance buffered this effect among users. Attachment insecurities are key vulnerability factors that intensify the depressive impact of problematic cannabis use. These findings underscore the importance of developing clinical interventions targeting both substance use and attachment-related vulnerabilities and emotional dysregulation.

Traumatic events, such as terror attacks and war, are expected to impact mental health. These potential effects can be explored by assessing the mental health of the general population of Israel, from before the events of October 7, 2023 and over the course of the Swords of Iron war. General population data were collected from Jewish adults in Israel before October 7 (April 2022), after October 7 (December 2023), and over the course of the ongoing war (March 2024, June 2024, February 2025), in a series of repeated cross-sectional samples with longitudinal data on a subset of the respondents. Among a subset of the sample including individuals who were surveyed in April 2022 and at least one follow-up time point (N=1,368), we used regression analysis to model trajectories over time in prevalence of problematic non-medical use of alcohol, tobacco, cannabis, sedatives, prescription stimulants, and prescription opioid painkillers; problematic use of internet, social media, electronic gaming, gambling, pornography, and compulsive sexual behavior; and post-traumatic stress disorder (PTSD), depression, and anxiety. Trajectories were modeled overall and moderation analysis was used to determine if trajectories differed by gender or age. Different patterns were observed by outcome. Different trajectories were observed before and after December 2023, suggesting that the events of October 7 th and the early war may have been a key transition point, for problematic use of alcohol, tobacco, sedatives, opioid painkillers, gambling, sexual behaviors, internet and PTSD. Smooth changes over time were observed for problematic use of gaming and social media, and anxiety and depression. No changes over time were observed for problematic use of cannabis, stimulants, and pornography. Many outcomes showed different trajectories by gender and age. Findings suggest possible effects of ongoing trauma and war and suggest that outcome-specific and group-specific strategies may be warranted. Monitoring the prevalence of addictions and other common mental health issues in the general population during and after nationally traumatic events is important to understand the evolving mental health of the population and provide information and resources for potential interventions. Awareness of the potentially harmful effects of such life events, as well as the consequences of maladaptive coping styles on health and well-being, should be increased.

War-related evacuation is a stressful event that may cause mental health problems, which, in turn, might lead to increases in substance and behavioural addictions. We used data collected online during the Swords of Iron to examine associations between being evacuated during the war, mental health, problematic substance use, and behavioural addictions. Study 1 surveyed young adults (ages 18-26) from various areas of Israel. Measures included self-reported anxiety, depression, problematic consumption of alcohol, cannabis, and prescription drugs, and problematic gambling, gaming, and pornography. Evacuees (n = 111) reported higher levels of anxiety, depression, problematic alcohol consumption, and problem gambling than non-evacuees (n = 973), with increased depression, problematic alcohol consumption and problem gambling among men. In Study 2, we used data from a quasi-representative sample of Jewish Israelis (ages 18-70), that included the same measures, in addition to problematic social media and internet usage. Findings replicated and extended those of Study 1: evacuees (n = 158) had higher rates of problematic use of all the assessed outcomes, compared to those not evacuated (n = 2485), with increased problematic use of alcohol, prescription drug, and gambling among men. In both Studies, the results held when controlling for exposure to war stressors and feelings of danger during the war, indicating that evacuation had a unique effect beyond the primary trauma of war. We discuss the limitations of the current research and consider its implications to addiction theory and gender differences in addictions and offer directions for future research and clinical considerations.

INTRODUCTION:Mental health disorders are leading causes of morbidity worldwide and often co-occur with substance use and other addictive behaviors. However, many individuals in mental healthcare settings are not screened for addictions. General psychopathology measures, such as the Brief Symptom Inventory (BSI), may offer valuable insights into addiction risk. This study explores whether machine learning models can utilize BSI responses to predict problematic substance use (alcohol, drugs) and addictive behaviors (gambling, gaming, hypersexual behavior, and pornography use). METHODS:A population sample of Jewish adults in Israel (N = 2,451) was assessed for mental health, including the BSI, problematic substance use (alcohol, drugs), and potentially addictive behaviors: gambling, gaming, compulsive sexual behavior, and pornography use. Machine learning models - including decision trees, random forest, boosting, LASSO, subset selection, and elastic net regression - were employed to predict addiction outcomes based on BSI responses. RESULTS:The BSI demonstrated varying degrees of predictive ability across different addictions and models. Test set explained variance (R2) on the continuous track ranged from 1% (gambling, decision tree) to 25% (compulsive sexual behavior, random forest); area under the precision-recall curve (AUPRC) ranged from 0.04 (pornography, LASSO) to 0.36 (gaming, decision tree), in each case exceeding the prevalence baseline. Behavioral addictions generally showed descriptively higher predictability than substance use disorders. CONCLUSIONS:The BSI contains substantial information on addiction risk, providing preliminary, proof-of-principle evidence that an existing general psychopathology measure carries item-level signal relevant to comorbid addiction screening, with the strongest signal for behavioral addictions. These findings serve as proof of principle for the notion that existing psychopathology measures can be leveraged to inform about potential comorbidity. Being able to efficiently identify which mental health patients must be screened for addictions will help to determine the most appropriate interventions.

This study investigated the complex relationships between adverse childhood experiences (ACE), post-traumatic stress symptoms (PTSS), and substance use disorder (SUD) following a large-scale collective trauma in Israel. We utilized a longitudinal design with a quasi-representative sample of 1,343 Jewish Israeli adults, measuring PTSS and SUD both before (April 2022) and after (December 2023) the October 7th attack. Using regression analysis and structural equation modeling, we tested the sensitization and self-medication hypotheses, and the direct effect of ACE on SUD beyond PTSS. Results demonstrate that higher ACE scores significantly predicted greater elevations in PTSS following the trauma, supporting the sensitization hypothesis. Pre-trauma PTSS significantly predicted increases in SUD, consistent with the self-medication hypothesis. Critically, ACE directly predicted an elevation in SUD even when controlling for PTSS. SEM analysis provided evidence for a direct contribution of ACE to changes in SUD after the collective trauma. This provides new evidence suggesting that early adversity confers a distinct, independent risk for SUD that is not solely mediated by post-traumatic stress. These findings underscore the profound and multifaceted impact of childhood experiences on long-term well-being and highlight the need for trauma-informed interventions that address both immediate stress reactions and the enduring consequences of early adversity.

Religiosity has been linked to favorable and unfavorable mental health outcomes. This study explored how religiosity relates to shared vulnerability for problematic substance use, behavioral addictions, and mental health symptoms, in the context of religion-related variations in meaning in life, social media use, and exposure to harmful online content in a quasi-representative cross-sectional sample of Israeli Jewish adults (N = 2907). Religious participants reported lower problematic substance use, behavioral addictions, and common mental health symptoms, higher meaning in life, lower social media use, and lower exposure to harmful content than other participants. All three outcome domains showed inverse associations with meaning in life and positive associations with social media use and harmful content exposure. After accounting for meaning in life and digital variables, religiosity remained inversely associated with problematic substance use, showed no significant association with mental health symptoms, and was positively associated with behavioral addictions. These findings suggest that meaning in life and digital engagement are broadly associated with shared vulnerability across substance use, addictive behaviors, and mental health symptoms, and they may account for some of religiosity’s relevance to outcomes. Meaning-related and digital factors could be considered when addressing population-level patterns of addiction and mental health.

Research suggests that Problem Gambling (PG) may result from maladaptive emotional regulation strategies aimed at escaping emotions and stress caused by negative life events and trauma. The current study, aimed to examine the effect of exposure to the mass trauma of October 7, 2023 terror attack and the consequent Swords of Iron war in Israel, and difficulties in emotional regulation on PG. We utilized longitudinal data of self-reports in the Problem Gambling Severity Index collected before the terror attack (April 2022) and during the Swords of Iron war (December 2023, March 2024, June 2024; N = 899) from a large sample of adult Jewish Israelis. Participants also completed the Difficulties in Emotional Regulation Scale before the war (April 2022). Results indicated that for non-problem gamblers, among men, high difficulties in emotion regulation scores were associated with increased PG scores from the time before to the times during the war (bs > 0.53, p-values < 0.003) but not for women or men with low difficulties in emotion regulation scores (bs < 0.36, p-values > 0.167). Among participants at moderate risk for PG and problem gamblers, there was a decrease in PG scores, especially among participants low in difficulties in emotion regulation, beyond gender. Findings highlight the important role of collective traumatic events and difficulties in emotion regulations as predictors of problem gambling. We discuss the study limitations, including the relatively small number of participants at risk for PG and the specificity of the sample, and offer directions for future research.

Post-traumatic stress disorder (PTSD) after traumatic events is prevalent and can lead to negative consequences. While social media use has been associated with PTSD, little is known about the specific association of online hate speech on social media networks and PTSD, and whether such association is stronger among those with difficulties in emotion regulation, who may have a harder time coping with hate speech. In a general population sample of Jewish adults (aged 18-70) in Israel (N = 3,998), assessed about two months after the wide-scale terror attacks of October 7, 2023, regression analysis was used to explore the association of online hate speech and self-reported PTSD symptomology. Difficulties in emotion regulation (DER) was explored as a moderator of the association. Greater frequency of hate speech was significantly associated with increased PTSD symptomology, adjusting for problematic use of technology, terror and war exposure, and prior mental health issues. The association differed significantly by DER; as difficulties increased, the association was stronger. Public health campaigns could educate about the potential harms of hate speech to help individuals make informed choices, and clinicians could discuss possible hate speech effects with patients more vulnerable to PTSD, for example, those with emotion dysregulation.

Background:Opioid use disorder (OUD) can be associated with cognitive impairment. However, little is known about how patients with OUD self-perceive any cognitive impairments, particularly in attention, executive function, and memory. No studies have addressed this issue in patients with OUD and self-reported adherence to office-based medication-assisted treatment (MAT). Methods:This was an observational, multisite, cross-sectional survey study to evaluate self-reported cognitive function in adults with OUD, enrolled at 7 sites in the U.S., who had received ⩾3 months of office-based MAT. A cognitive self-report survey was administered to a clinical sample of adults with OUD (N = 255) adherent to buprenorphine (BUP; N = 139) or extended-release naltrexone (XR-NTX; N = 116). Impairments in attention, executive function, and memory were assessed with relevant items of the Executive Function Index (EFI) and Prospective Retrospective Memory Questionnaire (PRMQ). Factor analysis explored item factor structure; item scores were summed to generate scales, and association was estimated by linear regression. Results:Approximately one-third of participants reported head injury and nearly one-half reported psychiatric comorbidities, particularly anxiety and depression. Most participants reported difficulties in ⩾1 cognitive item: 80.8% (206/255) for EFI and 49.0% (125/255) for PMRQ. Factor analysis suggested 3 cognitive scales (attention, executive, memory). Differences between the XR-NTX and the BUP groups on memory, executive function, and attention either were not found or lost significance after adjustment for neurological history. seizure). All scales were associated with a range of demographic and clinical variables. Conclusions:Most adults receiving office-based MAT for OUD reported self-perceived cognitive impairment, but neurological comorbidities may also play a role in these perceptions.

BackgroundAt-risk substance use is a leading cause of preventable morbidity and mortality worldwide. The Alcohol, Smoking and Substance Involvement Screening Test 3.1 (ASSIST) is widely used to screen for such use.ObjectivesUsing network analysis to reframe risky substance use as a web of interacting ASSIST symptoms to provide important suggestions about potential mechanisms underlying risky use.MethodsCross-sectional data on the ASSIST was collected via an online survey from a general population sample of Jewish adults in Israel (N=4,002; 50.4% women). Network analysis was carried out for ASSIST symptoms for non-medical use of alcohol, tobacco, cannabis, prescription sedatives, prescription stimulants, and prescription opioids. First, networks were modeled for each substance, to explore the following research questions: which symptoms were most strongly related? and what are the key symptoms that compose the networks? Second, networks were compared to determine if symptom relationships differed between substances.ResultsBasic similarities were observed across substances, e.g., strongest direct associations between frequency of use and craving, and frequency of substance related problems and role interference. Role interference and craving appeared to play important roles in the networks. Differences were observed between substances in strength of associations between symptoms.ConclusionNetwork structures were similar across substances, suggesting that similar intervention approaches may be appropriate, with substance-specific strategies as warranted. Among those who use substances, addressing the effects of role interference and craving in risky substance use may help reduce substance-related harms and limit progression to full blown disorder.

Importance:Research has shown evidence of increased substance use (ISU) in populations affected by mass terrorism; however, less is known regarding how psychosocial factors interact to estimate ISU following such events. Objective:To examine which factors are associated with reporting ISU, test whether psychological distress (PD) mediated the association between exposure to trauma and reporting ISU, and whether the mediation effect differed among those with prior mental health (MH) difficulties and those without. Design, Setting, and Participants:A partially representative cross-sectional survey of the adult Jewish population in Israel (aged 18-70 years) was conducted 4 weeks after October 7, 2023 (October 31 to November 5, 2023). A national Web panel using quotas based on national distributions was used. Randomly chosen adult Jewish members were invited to participate until a predetermined sample size was reached. Main Outcomes and Measures:The study measures included reporting ISU (outcome), PD (mediator), exposure to terror events and sociodemographic characteristics (variables), and prior MH difficulties (moderator). Hypotheses regarding outcome and variables were formulated before data collection. Results:A total of 7000 invitations were distributed, 2679 individuals consented, 1432 were excluded owing to quota limits, 74 failed attention tests, and 205 opted out, resulting in 968 participants (490 women [50.6%]; mean [SD] age, 41.5 [14.6] years). Hierarchical regression analysis revealed that participants were significantly more likely to report ISU if they had experienced direct exposure (odds ratio [OR], 5.75; 95% CI, 2.53 to 13.05), indirect exposure (OR, 1.84; 95% CI, 1.27 to 2.67), media exposure (OR, 1.22; 95% CI, 1.09 to 1.36), PD (OR, 1.80; 95% CI, 1.44 to 2.25), or previous MH difficulties (OR, 2.76; 95% CI, 1.86 to 4.09). PD partially mediated the association between indirect exposure (b = 0.20; 95% CI, 0.11 to 0.31) and media exposure (b = 0.14; 95% CI, 0.10 to 0.19) and reporting ISU. No evidence was found to support previous MH difficulties as a moderator of these indirect effects (indirect exposure, b = -0.003; 95% CI, -0.28 to 0.28; media exposure, b = 0.01; 95% CI, -0.06 to 0.08). Conclusions and Relevance:This study contributes to the research on the association of mass terrorism with ISU while shedding important light on the role it may play in the self-medication of PD following exposure, even in those who might have no previous MH difficulties. These insights are crucial for planning essential health services and preventive measures.

Background: Cannabis use is increasing among middle-aged and older US adults, populations that are particularly vulnerable to the adverse effects of cannabis. Risks for adverse effects differ by cannabis use patterns, which have become increasingly heterogeneous. Nevertheless, little is known about age differences in such patterns.Objective: To investigate age differences in cannabis use patterns, comparing younger (age 18-49), middle-aged (age 50-64), and older adults (age ≥65).Methods: A total of 4,151 US adults with past 7-day cannabis consumption completed an online survey (35.1% male; 60.1% female; 4.8% identified as "other"). Regression models examined age differences in cannabis use patterns.Results: Compared to younger adults, middle-aged and older adults were more likely to consume cannabis during evening hours (50-64: adjusted odds ratio [aOR] = 2.98, 95% CI 2.24-3.96; ≥65: aOR = 4.23, 95 CI 2.82-6.35); by only one method (50-64: aOR = 1.67, 95% CI 1.34-2.09; ≥65: aOR = 3.38, 95 CI 2.24-5.09); primarily by smoking as the only method (50-64: aOR = 1.52, 95% CI 1.29-1.78; ≥65: aOR = 2.12, 95 CI 1.64-2.74); but less likely to consume concentrated cannabis products (concentrates) with extremely high %THC (50-64: aOR = 0.71, 95% CI 0.54-0.93; ≥65: aOR = 0.30, 95 CI 0.16-0.55). Age differences in cannabis use patterns were also observed between middle-aged and older adults.Conclusion: Findings suggest that middle-aged and older adults may engage in less risky cannabis use patterns compared to younger groups (e.g. lower likelihood of consuming highly potent concentrates). However, findings also underscore the importance of recognizing risks unique to these older demographics, such as smoking-related health events. Consequently, prevention strategies targeting such use patterns are needed.

Background.Among those with common mental health disorders (e.g. mood, anxiety, andstress disorders), comorbidity of substance and other addictive disorders is prevalent. To sim-plify the seemingly complex relationships underlying such comorbidity, methods that includemultiple measures to distill which specific addictions are uniquely associated with specificmental health disorders rather than due to the co-occurrence of other related addictions ormental health disorders can be used. Methods.In a general population sample of Jewish adults in Israel (N= 4002), network ana-lysis methods were used to create partial correlation networks of continuous measures ofproblematic substance (non-medical use of alcohol, tobacco, cannabis, and prescription seda-tives, stimulants, and opioid painkillers) and behavioral (gambling, electronic gaming, sexualbehavior, pornography, internet, social media, and smartphone) addictions and commonmental health problems (depression, anxiety, and post-traumatic stress disorder [PTSD]),adjusted for all variables in the model. Results.Strongest associations were observed within these clusters: (1) PTSD, anxiety, anddepression; (2) problematic substance use and gambling; (3) technology-based addictive beha-viors; and (4) problematic sexual behavior and pornography. In terms of comorbidity, thestrongest unique associations were observed for PTSD and problematic technology-basedbehaviors (social media, smartphone), and sedatives and stimulants use; depression and prob-lematic technology-based behaviors (gaming, internet) and sedatives and cannabis use; andanxiety and problematic smartphone use. Conclusions.Network analysis isolated unique relationships underlying the observedcomorbidity between common mental health problems and addictions, such as associationsbetween mental health problems and technology-based behaviors, which is informative formore focused interventions.

IMPORTANCE Renewed interest in the clinical potential of hallucinogens may lead people with depression to a generally more positive view of the use of lysergic acid diethylamide (LSD). Therefore, past-year LSD use among people with depression may be increasing in prevalence. OBJECTIVE To assess time trends in the prevalence of past-year nonmedical LSD use by past-year major depression status and the variation in this association by sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This survey study used pooled publicly available data from 478 492 adults aged 18 years or older who were administered the National Survey on Drug Use and Health from 2008 through 2019. Statistical analysis was conducted from December 2022 to June 2023. MAIN OUTCOME AND MEASURES Past-year major depression diagnoses per criteria from the DSM-IV were analyzed. Logistic regression models examined whether time trends in past-year nonmedical LSD use differed between adults with vs without past-year depression, adjusting for sociodemographic characteristics. Secondary analyses examined whether the trends in LSD use by depression status differed between sociodemographic subgroups. RESULTS The analytic sample included 478 492 adults, of whom 51.8% were female, 56.1% were younger than 50 years, 11.7% were Black, 15.1% were Hispanic, 65.8% were White, and 7.5% were another race. Weighted interview response rates ranged from 64.9% to 75.6% during the study time frame. From 2008 to 2019, past-year use of LSD increased significantly more among adults with major depression (2008 prevalence, 0.5%; 2019 prevalence, 1.8%; prevalence difference [PD], 1.3%[95% CI, 1.0%-1.6%]) compared with adults without major depression (2008 prevalence, 0.2%; 2019 prevalence, 0.8%; PD, 0.6%[95% CI, 0.5%-0.7%]) (difference in difference, 0.8%[95% CI, 0.5%-1.1%]). This difference was particularly pronounced among young adults aged 34 years or younger (PD among those aged 18-25 years with depression, 3.3%[95% CI, 2.5%-4.2%]; PD among those aged 26-34 years with depression, 2.7%[95% CI, 1.6%-3.8%]) and individuals with incomes less than $75 000 per year (PD among those with income <$20 000, 1.9%[95% CI, 1.3%-2.6%]; PD among those with income $20 000-$49 999, 1.5%[95% CI, 1.0%-2.1%]; PD among those with income $50 000-$74 999, 1.3%[95% CI, 0.7%-2.0%]). CONCLUSIONS AND RELEVANCE This study suggests that, from 2008 to 2019, there was a disproportionate increase in the prevalence of past-year LSD use among US adults with past-year depression. Among those with depression, this increase was particularly strong among younger adults and those with lower household incomes. Among individuals with depression who also report LSD use, clinicians should discuss potential strategies for mitigating harm and maximizing benefits in medically unsupervised settings.

Objective: Underreporting of substance use is a frequent concern about studies based on self -report, but few robust studies have examined the agreement between different methods for capturing self-reported substance use. The current study therefore used repeated measures to compare self-reported substance use using (a) clinician interviewers and (b) self-administered computerized surveys in a sample that included both inpatients and community residents. Method: Adults age 18 years and older with problematic substance use were recruited from the community or an inpatient addiction treatment facility. At baseline ( N = 588), 3-month ( n = 469), and 6-month ( n = 476) interviews, participants were asked whether they used alcohol, cannabis, cocaine, heroin, and prescription painkillers by two methods: semi-structured, clinician-administered interview, and computerized self-administered questionnaire. Agreement between these two methods was investigated using Cohen's kappa coefficient. Multivariable logistic regression assessed differences in the odds of discordance between the two measures by recruitment source, gender, age, race/ethnicity, employment status, marital status, and level of education. Results: There was moderate-tostrong agreement between clinician-administered and self-administered surveys for alcohol (kappa = .70-.88), cannabis (kappa = .87-.92), cocaine (kappa = .81-.89), and heroin (kappa = .90-.92). However, there was only weak-to-moderate agreement for nonmedical use of prescription painkillers (kappa = .55-.71), with the self-administered questionnaire capturing a higher prevalence of use (percent difference = 2.4%). Conclusions: Clinician interviewers and self-administered surveys were shown to capture similar rates of self-reported use of alcohol, cannabis, cocaine, and heroin. Surveys assessing nonmedical prescription opioid use may benefit from using self-administered questionnaires.