Addiction [JOURNAL]

BACKGROUND AND AIMS: With expanding cannabis legalization, normalization, and diversifying products and delivery methods in the United States (US), cannabis use disorder (CUD) prevalence is rising. Various modes of canna... BACKGROUND AND AIMS: With expanding cannabis legalization, normalization, and diversifying products and delivery methods in the United States (US), cannabis use disorder (CUD) prevalence is rising. Various modes of cannabis use may influence pharmacokinetics, usage patterns, and harm, affecting CUD risk. We measured associations between modes of cannabis use, including multi-modal patterns, and CUD prevalence and severity. DESIGN AND SETTING: This cross-sectional study analyzed data from a nationally representative sample of US adults using the 2022-2023 National Survey on Drug Use and Health (NSDUH) data. Multivariable logistic regression analyses were employed to estimate the association between modes of cannabis use and past-year CUD, adjusting for potential confounders and covariates. Analyses were stratified by sex, age, and cannabis use frequency. Among multi-modal users, common combinations and their associations with CUD were further examined. PARTICIPANTS/CASES: Respondents 18 years or older who reported past-year cannabis use (unweighted n = 25 549; weighted N = 58 850 309). MEASUREMENTS: Exposure of interest was the mode of cannabis use, primarily categorized as smoke-only, vape-only, oral/mucosal-only, dab-only, topicals-only, and multi-modal (≥ two modes). The outcome variable was CUD in the past year, and CUD severity, based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Covariates included age, sex, race/ethnicity, income, education, state cannabis law status, age of cannabis initiation, cannabis use motive, frequency of use, perceived risk of smoking cannabis, illicit drug use, past year mental illness, nicotine dependence, and alcohol use disorder. FINDINGS: Of the total past-year cannabis users, 53.9% reported multi-modal cannabis use. Overall, CUD prevalence was 30.3%, ranging from 4.4% among oral/mucosal-only to 40.5% among multi-modal, and 28.9% among dab-only users (p < 0.0001). Moderate-to-severe CUD affected 13.2% of all users and was concentrated among multi-modal and dab-only users. In multivariable regression, multi-modal users had fourfold higher odds of CUD (adjusted odds ratio [AOR] = 4.14; 95% confidence interval [CI]: 2.91-5.90). Elevated odds were also observed among smoke-only (AOR = 2.98; 95% CI: 2.02-4.39) and vape/dab-only users (AOR = 1.89; 95% CI: 1.09-3.29), compared with oral/mucosal-only users. Analyses of multi-modal combinations showed the highest CUD odds among those using smoke + vape + oral/mucosal + dab (AOR = 19.74; 95% CI: 9.11-42.75), compared with oral/mucosal + topicals users. CONCLUSIONS: In the United States, modes of cannabis use appear to be statistically significantly associated with prevalence and severity of cannabis use disorder, with multi-modal and inhaled routes conferring the greatest risk. Findings underscore the importance of considering mode of use alongside frequency and potency in clinical assessment, prevention, and policy strategies aimed at reducing cannabis-related harms.

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Predictive validity of Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) for register-based alcohol-attributable events among general-population men and women of different ages.

Mäkelä P, Reinikainen J, Callinan S … +5 more , Jääskeläinen M, Kuurne K, Lintonen T, Niemelä S, Levola J

Addiction · 2026 May · PMID 42185086 · Publisher ↗

BACKGROUND AND AIMS: Originally developed for clinical screening for hazardous alcohol use, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) is also widely used in epidemiological research and monitor... BACKGROUND AND AIMS: Originally developed for clinical screening for hazardous alcohol use, the Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) is also widely used in epidemiological research and monitoring. However, its cutoff values may not suit all purposes, and evidence on its predictive validity is limited. We examined how AUDIT-C scores relate to subsequent register-based alcohol-attributable events across age and sex and identified optimal thresholds for predicting these outcomes. DESIGN: Five general population surveys conducted in 2011-2017, linked to nationwide registers with follow-up until the end of 2023 (total follow-up 879 964 person-years). SETTING: Nationwide, Finland. PARTICIPANTS: Adults aged ≥20 years (n = 103 567). MEASUREMENTS: AUDIT-C to assess exposure. OUTCOME: incident alcohol-attributable events in any of the registers capturing care, deaths and prescription medicines (n = 1444). FINDINGS: The hazard of register-based alcohol-attributable events increased approximately exponentially with increasing AUDIT-C score. It rose more strongly among women than men [hazard ratio (HR) = 1.61, 95% confidence interval (CI) = 1.55-1.67 for women; HR = 1.45, 95% CI = 1.40-1.49 for men; P < 0.001 for the sex × AUDIT-C interaction]. The risk of alcohol-attributable events was statistically significantly raised at 2 points among women and 3 points among men with 1 point as a reference level. The suggested optimal cutoff values were 2 points for women aged ≥80, 3 points for women aged 65-79 and men aged ≥80, 5 points for women aged 20-64 and men aged 65-79 and 6 points for men aged 20-64. CONCLUSIONS: Using Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) scores, optimal cutoff values for predicting alcohol-attributable harm may differ by age and sex, with lower cutoffs for older individuals and women. The ≥65 age group appears to be heterogeneous with regard to vulnerability to alcohol-attributable harm, which should be considered when establishing cutoffs or guidelines for alcohol use.

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The effect of higher versus lower wattage e-cigarettes on smoking: A randomized controlled trial.

Cho YJ, Hinton A, Nshimiyimana J … +6 more , Mehta T, Queimado L, Stepanov I, Case S, Beebe LA, Wagener TL

Addiction · 2026 May · PMID 42167788 · Publisher ↗

AIMS: To assess whether higher wattage e-cigarettes (HWe), with improved nicotine delivery, enhance complete substitution compared with lower wattage e-cigarettes (LWe) and whether complete switching lowers exposure to a... AIMS: To assess whether higher wattage e-cigarettes (HWe), with improved nicotine delivery, enhance complete substitution compared with lower wattage e-cigarettes (LWe) and whether complete switching lowers exposure to a cigarette-derived lung carcinogen, using urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) as a biomarker. DESIGN: A 3-arm randomized controlled trial with a 12-week treatment period and follow-ups at 26 and 52 weeks. Participants were enrolled from June 2017 to December 2022, with all visits completed by March 2023. SETTING: Academic medical centers in the United States. PARTICIPANTS: 372 adults who smoked and were not interested in quitting [mean age = 40 years; standard deviation (SD) = 11.0; 63% female; mean cigarettes per day = 17; SD = 8.9] were randomized and comprised the analytic sample. INTERVENTION: A 12-week supply of HWe, LWe or usual brand cigarettes (UBC). MEASUREMENTS: The primary outcome was between-group differences in complete substitution rates at week 12, defined as self-reported smoking of 1 or fewer cigarettes in the past 7 days [confirmed by exhaled carbon monoxide (eCO) < 4 ppm], with missing data imputed as smoking, and self-reported use of e-cigarettes during the 7-day period. Additional outcomes included urinary NNAL through week 12. FINDINGS: At 12 weeks, complete substitution rates were 6.0% (8 of 134) with HWe and 9.0% (12 of 133) with LWe, with no statistically significant between-group difference. Complete substitution rates were 3.7% (HWe) vs. 9.0% (LWe) at 26 weeks, and 4.5% vs. 5.3% at 52 weeks, with no statistically significant between-group differences. Among those who completely switched, mean NNAL levels decreased over 12 weeks with both LWe [mean decrease: 2.4 pmol/mg creatinine; 95% confidence interval (CI) = 1.2-3.7; P = 0.002] and HWe (mean decrease: 2.3 pmol/mg creatinine; 95% CI = 1.1-3.6; P = 0.002). CONCLUSIONS: Provision of higher and lower wattage e-cigarettes to adults who smoked and were not interested in quitting resulted in comparable substitution rates. Complete switching from cigarettes to higher and lower wattage e-cigarettes reduced urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. TRIAL REGISTRATION: NCT03113136 (ClinicalTrials.gov).

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Response to Crockford et al.: Healthcare utilization and mortality after overdose prevention site closure: A linked cohort analysis using segmented difference-in-differences time series.

Day N, Vik S, Tanguay R … +2 more , Mathew N, Bahji A

Addiction · 2026 May · PMID 42167768 · Publisher ↗

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Change of substance-related hospitalisation in adolescents after cannabis legalisation in Thailand in 2022.

Puetpaiboon S, Rajborirug S, Nakhonsri V … +5 more , Ngamphiw C, Khunkham P, Tongsima S, Janpoung W, Chongsuvivatwong V

Addiction · 2026 May · PMID 42167765 · Publisher ↗

BACKGROUND AND AIMS: On 9 June 2022, Thailand changed its cannabis legislation, expanding access to individuals aged >18 years. Evidence suggests that such changes could increase the risk of cannabis use and related harm... BACKGROUND AND AIMS: On 9 June 2022, Thailand changed its cannabis legislation, expanding access to individuals aged >18 years. Evidence suggests that such changes could increase the risk of cannabis use and related harms, and could influence patterns of use of other substances among adolescents. This study measured the potential impact of these legislative changes on adolescent substance-related hospital admissions. DESIGN: An interrupted time-series study to assess the impact of cannabis legalisation on substance-related hospitalisations using anonymised admission records from the Thai Health Information Portal. SETTING: Nationwide study in Thailand spanning from 1 October 2016 to 30 September 2023, with 9 June 2022 marking cannabis legalisation. PARTICIPANTS/CASES: Adolescents aged 10-19 years in Thailand. MEASUREMENTS: Based on International Classification of Diseases, 10th Revision diagnostic codes, hospitalisation records were classified as relevant or irrelevant to each of eight predefined substance categories: stimulants (excluding cocaine), alcohol, cannabis, sedatives (including opioids and narcotics), volatile solvents, nicotine, hallucinogens and cocaine. FINDINGS: There were an additional 25.5 weekly cannabis-related hospitalisations (95% prediction interval = 23.5-27.2) compared with counterfactual predictions, resulting in 1762 excess cases over the 68-week post-legalisation period. Statistically significant excess admissions were also observed for stimulants, nicotine, volatile solvents and hallucinogens, corresponding to additional admissions of 9.1, 1.4, 0.5 and 0.5 per week, respectively (95% prediction intervals = 0.3-15.4, 0.4-2.1, 0.3-0.7 and 0.2-0.7, respectively). No statistically significant changes were observed for alcohol-, sedative- or cocaine-related hospitalisations. CONCLUSIONS: Cannabis legalisation in Thailand was followed by a marked rise in adolescent hospitalisations related to cannabis, alongside an increase in stimulant-, nicotine-, volatile solvent- and hallucinogen-related hospitalizations. These findings highlight the potential unintended consequences of cannabis legalisation in Thailand and underscore the need for preventive strategies to reduce adolescent exposure and related harm.

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Commentary on Zhu et al.: Nitazenes-Tracking a moving target from linked United States databases.

Stove CP, Vandeputte MM

Addiction · 2026 May · PMID 42163835 · Publisher ↗

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Predictive value of real-time memory tests in identifying alcohol-induced blackouts in situ.

Miller MB, Shoemaker SD, Freeman LK … +3 more , Curtis AF, Merrill JE, Merkle EC

Addiction · 2026 May · PMID 42159425 · Publisher ↗

BACKGROUND AND AIMS: Memory loss from alcohol use ('blackout') is a prevalent and costly indicator of substance-related harm. While alcohol-induced blackouts can be assessed retrospectively via self-report, no tool exist... BACKGROUND AND AIMS: Memory loss from alcohol use ('blackout') is a prevalent and costly indicator of substance-related harm. While alcohol-induced blackouts can be assessed retrospectively via self-report, no tool exists to identify blackouts objectively in real time, hindering progress in research as well as intervention efforts. This study tested the feasibility and diagnostic accuracy of real-time memory tasks in identifying alcohol-induced blackouts in situ. DESIGN: Prospective diagnostic study. SETTING: United States. PARTICIPANTS: Young adults (18-30 years of age; n = 63) reporting recurrent memory loss as a result of alcohol use were recruited from across the United States between December 2022 and January 2024. MEASUREMENTS: Participants completed a baseline survey and orientation interview, followed by 30 days of ecological momentary assessments (EMA). EMA included recall and recognition tests for visual stimuli during drinking events (index tests) and subsequent self-reports of blackout (reference standard). At the end of the protocol, participants also completed a Timeline Followback interview of blackout events during the assessment period. Primary outcomes, which were specified prior to data collection, were (a) feasibility of memory task completion during drinking events and (b) diagnostic accuracy of memory tasks in identifying blackout at the event level. Data were analyzed using Bayesian logistic multilevel models. FINDINGS: Of the 63 participants included [mean age = 23.2, standard deviation (SD) = 3.3; 78% female, 51% White], 38 (60%) self-reported a blackout during the assessment protocol. On average, participants completed 85% of memory tests prompted (SD = 16.42). Within days, both greater-than-average number of drinks [odds ratio (OR) = 1.74; 95% confidence interval (CI) = 1.41-2.19] and failure of 1 + recall memory test (OR = 15.53; 95% CI = 5.96-36.27) were associated with increased odds of blackout. In model-predicted probabilities, blackout probability was ~0.01 if a person consumed their average number of drinks, ~0.21 if they had five more drinks than average and ~0.34 if they failed 1 + recall test. Participants self-reported blackout on 39% of the days that they failed 1 + recall memory test (positive predictive value; 95% CI = 30-49); however, they reported not having a blackout on 92% of days that they correctly recalled all memory tests (negative predictive value; 95% CI = 89-95). CONCLUSIONS: Objective measures of alcohol-induced blackout can be implemented in real-life contexts. Failing a visual memory test while intoxicated is not necessarily indicative of blackout; however, correct recall indicates that blackout is highly unlikely.

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Effects of nicotine concentration and pH on nicotine pouch appeal and sensory experience: A randomized experimental study.

Han DH, Martines PW, Duran C … +14 more , Skinner S, Kamassah D, Venkatesha M, Bayer S, Pope M, Tackett AP, Pang RD, Wagener TL, Cahn R, Cho J, Kirkpatrick MG, Page MK, Goniewicz ML, Leventhal AM

Addiction · 2026 May · PMID 42159066 · Full text

BACKGROUND AND AIMS: Understanding key product characteristics of oral nicotine pouches (ONPs), an emerging nicotine product category, is essential to developing evidence-based regulations that address ONP use among youn... BACKGROUND AND AIMS: Understanding key product characteristics of oral nicotine pouches (ONPs), an emerging nicotine product category, is essential to developing evidence-based regulations that address ONP use among young populations. This experimental trial assessed the effects of variations in nicotine concentration and pH in NPs on two behavioral outcomes of regulatory interest: sensory attributes and appeal. DESIGN AND INTERVENTION: We conducted an in-person, double-blind, within-subject randomized experiment involving standardized self-administration of 4 commercially available NPs (drawn from a pool of 20 ZYN and on! products) varying in nicotine strength (high: 6-8 mg vs. low: 3-4 mg) and pH (high: 8.5-9.3 vs. low: 7.6-8.0). Experimental conditions were not mutually exclusive (i.e., NP with a high pH could either have high or low nicotine concentration, or vice versa), and NPs were randomly assigned without replacement to ensure participants did not receive the same product more than once in each condition. SETTING: Los Angeles metropolitan area in California, United States (U.S.). PARTICIPANTS: Seventy-three young adults (21-35 years, mean[standard deviation] = 23.7[3.1] years; 87.7% males, 49.3% White) who currently use NPs were recruited between October 2024 and July 2025. MEASUREMENTS: Participant rated ONP appeal and sensory attributes (sweetness, smoothness, bitterness, harshness) on 0 ('not at all') to 100 ('extremely') scales. Repeated-measures random-intercept models assessed the effects of nicotine concentration and pH on the appeal and sensory attributes. FINDINGS: In the sample, high (vs. low) nicotine strength produced statistically significant lower ratings of appeal (b = -8.75, 95% confidence interval [CI] = -15.41, -2.08) and smoothness (b = -7.72, 95% CI = -14.01, -1.44) and higher harshness ratings (b = 7.21, 95% CI = 1.07, 13.36). No statistically significant linear effects of pH on appeal and sensory attributes were observed. Quadratic analyses revealed non-linear associations whereby ONP appeal and sweetness declined at both tails of the pH distribution (inverted U-shape). Statistically significant interactions between nicotine concentration and quadratic pH were observed for appeal and bitterness with stronger quadratic pH effects in high (vs. low) ONPs. In addition, statistically significant pH-sex interactions showed stronger quadratic effects in females (vs. males) for appeal and bitterness. CONCLUSIONS: In this double-blind randomized experiment among young adult oral nicotine pouch (NP) users in the United States, exposure to NPs with [1] higher vs. lower nicotine concentrations produced lower appeal and smoothness and greater harshness; [2] varying pH produced non-linear effects, such that appeal and palatability rose at moderate pH levels and then declined at high pH levels, particularly for high-nicotine NPs and among females.

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Day-level associations between protective behavioral strategies and alcohol consequences among young adults enrolled vs. not enrolled in college.

Shoemaker SD, DiBello AM, Freeman L … +4 more , Merrill JE, Carey KB, Curtis AF, Miller MB

Addiction · 2026 May · PMID 42141530 · Publisher ↗

BACKGROUND AND AIMS: Protective behavioral strategies (PBS) are designed to minimize negative alcohol-related consequences. They include limiting/stopping, manner-of-drinking (e.g. avoiding shots or drinking games) and s... BACKGROUND AND AIMS: Protective behavioral strategies (PBS) are designed to minimize negative alcohol-related consequences. They include limiting/stopping, manner-of-drinking (e.g. avoiding shots or drinking games) and serious harm reduction strategies. This secondary analysis measured day-level, within-person associations between PBS and alcohol-related consequences (including alcohol-induced blackout) among young adults enrolled and not enrolled in college. DESIGN: Observational study using ambulatory assessments each morning for 30 days. SETTING: United States. PARTICIPANTS: Young adults (n = 153, 35% male, 58% White, mean age = 22 y) with a history of alcohol-induced blackout. Fifty-nine participants (39%) were enrolled in college. MEASUREMENTS: Participants completed an orientation interview, baseline self-report measures and 30 days of prospective morning reports. Multilevel logistic regression was used to analyze data. FINDINGS: Within persons, participants had lower odds of experiencing any same-day alcohol-related consequence [odds ratio (OR) = 0.36; 95% confidence interval (CI) = 0.25-0.53], including blackout (OR = 0.24; 95% CI = 0.14-0.42) on days they used manner-of-drinking strategies compared with days they did not. Conversely, experiencing an alcohol-related consequence was not associated with use of manner-of-drinking (OR = 1.06; 95% CI = 0.76-1.48) or limiting/stopping (OR = 1.06; 95% CI = 0.76-1.49) strategies on the next drinking day. College enrollment did not moderate any of the associations. CONCLUSIONS: Manner-of-drinking strategies appear to reduce the odds of alcohol-related harm at the event level among young adults in the United States, whether or not they are enrolled in college. We speculate that limiting strategies (e.g. counting drinks) appear less effective because they are more difficult to implement in real-life drinking contexts.

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Stimulant-induced psychosis requires the same clinical priority as other psychotic disorders.

Niemelä S

Addiction · 2026 May · PMID 42136014 · Publisher ↗

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Characteristics of deaths due to drug-related causes among individuals recently released from prison in the United Kingdom, 1997-2025.

Roberts E, Strang J, Copeland C

Addiction · 2026 May · PMID 42135928 · Publisher ↗

BACKGROUND AND AIMS: There has been an extensive literature describing the elevated risk of drug-related death following an individual's release from prison; however, few previous studies have reported nationally represe... BACKGROUND AND AIMS: There has been an extensive literature describing the elevated risk of drug-related death following an individual's release from prison; however, few previous studies have reported nationally representative samples or provided granular detail as to which individual drugs were deemed implicated in death. We aimed to determine the (1) case characteristics, (2) circumstances of death and (3) type of implicated drugs among individuals recently released from prison and dying due to drug-related causes, stratified by the length of time an individual had been released prior to death. We additionally aimed to determine any changes in the number of deaths and the percentage of deaths in which individual drugs were implicated over time. DESIGN: Retrospective cohort study. SETTING: Coronial records submitted voluntarily to the observational cohort National Programme on Substance Use Mortality (NPSUM) in the United Kingdom (UK), 1997-2025. CASES: Decedents who were recently released from prison up to one month prior to their death due to a drug-related cause. MEASUREMENTS: Information was available on decedent sociodemographics, characteristics of death and drugs implicated in death. FINDINGS: A total of 597 decedents were found to have died due to a drug-related cause following recent release from prison. Where records reported the exact timeframe between prison release and death (n = 309), 140 were reported to have died within two days of release, 81 between two days and one week and 88 between one week and one month. There was a statistically significant average annual percentage decrease of -3.9% [95% confidence interval (CI) = -6.6% to -1.0%, P = 0.006] of deaths following recent prison release within the NPSUM population over the studied timeframe. Overall, decedents were predominantly male (n = 547, 91.6%), of White ethnicity (n = 410, 68.7%) and had a mean age of 34.2 years (standard deviation 8.8; range 16-71). Accidental poisoning was the most common direct cause of death (n = 433, 72.5%), with opioids the most common class of implicated drug, involved in more than 90% of fatalities (n = 545, 91.3%). CONCLUSIONS: Over the past three decades relative to the overall UK National Programme on Substance Use Mortality cohort of deaths due to drug-related causes, there have been substantial and reducing numbers of drug-related fatalities among individuals recently released from prison. Accidental poisoning was the direct cause of death in almost three quarters of cases from 1997 to 2025, and opioids were consistently implicated in over 90% of fatalities.

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A review of the relationship between dimensions of alcohol consumption and the burden of disease: 2026 update including Mendelian randomisation studies.

Carr S, Espinosa Dice AL, Gmel GE … +3 more , Hassan AS, Shield KD, Rehm J

Addiction · 2026 May · PMID 42129601 · Publisher ↗

BACKGROUND AND AIMS: Evidence on the causal impact and corresponding risk relationships between dimensions of alcohol consumption and health outcomes continues to evolve, with some contradictory findings across study des... BACKGROUND AND AIMS: Evidence on the causal impact and corresponding risk relationships between dimensions of alcohol consumption and health outcomes continues to evolve, with some contradictory findings across study designs. This review aimed to update current knowledge on causality and risk relationships to inform global and national comparative risk assessments for alcohol. METHODS: Fully alcohol-attributable conditions were identified using International Classification of Diseases (ICD) 10th and 11th revision codes. We conducted a scoping review of meta-analyses of cohort studies on average consumption and health outcomes (56 reviews), a systematic review of Mendelian randomisation (MR) studies on alcohol and ischaemic heart disease (IHD; 20 studies), and narrative syntheses on injuries, biological pathways, and reversibility of effects. RESULTS: ICD-11 provides more detailed categories, defining 62 fully alcohol-attributable conditions compared with 48 in ICD-10. Meta-analyses support monotonic increasing dose-response relationships between average consumption and most attributable health outcomes within infectious diseases, cardiovascular diseases, cancers, and digestive diseases. Relationships are J-shaped for IHD, ischaemic stroke, and type 2 diabetes, with lower risk at low-to-moderate consumption (generally only without heavy episodic drinking). For dementia, heavy drinking is harmful and, among non-heavy drinkers, relationships are age-specific. MR evidence for IHD largely suggested null or harmful relationships, but only three studies tested non-linear effects. In our view, the overall synthesis indicates that current MR evidence is insufficient to refute a J-shaped relationship for IHD. Injury risk is driven primarily by acute intoxication and includes substantial harm to others. Acute risks are reversible with reductions in drinking or abstention, whereas many chronic disease processes are only partly reversible. CONCLUSIONS: Epidemiological evidence to inform comparative risk assessments for alcohol is comprehensive, but prone to major limitations. Triangulation, alongside biological plausibility, can strengthen synthesis across cohort and Mendelian randomisation studies, and the target trial framework can help future studies avoid design-induced biases. Comparative risk assessments with ischaemic heart disease should, at this point, prioritise evidence from cohort studies.

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Health and economic impact of universal screening and management of alcohol use disorders in India: An economic modelling study.

Purohit N, Singh S, Ambekar A … +6 more , Duseja A, Mishra AK, Rao GN, Soundappan K, Kotwal A, Prinja S

Addiction · 2026 May · PMID 42126126 · Publisher ↗

AIM: The study assessed the health and economic implications as well as the cost-utility of implementing universal alcohol use disorder (AUD) screening in 15-74 years population at the primary healthcare level compared w... AIM: The study assessed the health and economic implications as well as the cost-utility of implementing universal alcohol use disorder (AUD) screening in 15-74 years population at the primary healthcare level compared with the current practice of diagnosis and management of symptomatic AUD patients seeking formal healthcare. DESIGN: Model-based cost-utility analysis using a hybrid model comprising a decision tree and lifetime age- and gender-specific Markov models for alcohol attributable conditions, including road traffic accident injuries, alcohol-related liver disease and head and neck cancers. The analysis was undertaken from both an abridged societal (consideration of direct cost of care) and a societal (consideration of direct and indirect costs) perspective. SETTING: India (national and sub-national level analysis). PARTICIPANTS: 15-74 years population segregated by gender. INTERVENTIONS AND COMPARATORS: The intervention was 10-year annual population-based screening for alcohol use disorders using alcohol use disorder identification test by community health workers at primary care facilities. The comparator was 'usual care' scenario of diagnosis and management of symptomatic AUD patients, considering care seeking patterns in India. MEASUREMENTS: Differences in life years, quality-adjusted life years (QALYs), alcohol attributable deaths and morbidities, direct costs and indirect costs in the comparative scenarios, along with incremental cost-utility ratio (ICUR), benefit-cost ratio and net monetary benefit. ICUR was evaluated using the per-capita gross domestic product (GDP) threshold of ₹171 498 (US$2182), as per Indian economic evaluation guidelines. Probabilistic and deterministic sensitivity analysis was conducted to identify the parameters that are likely to have an impact on efficiency of the screening programme. FINDINGS: The AUD universal screening programme was associated with a gain of 71.16 million QALYs at population level, with approximately one-fourth reduction in the incidence of alcohol-attributable conditions. The ICUR value indicated that the programme is likely to be cost-effective from an abridged societal perspective. The intervention is projected to generate a gain of ₹8.21 (US$1.03) trillion, equivalent to per year gain of 0.59% of GDP, based on the abridged societal perspective. The deterministic sensitivity analysis indicated that reductions in diagnostic accuracy of the screening method, prevalence of AUD and treatment coverage had an inverse impact on the ICURs and could impact efficiency of the programme. CONCLUSION: There is good health and economic evidence to support the integration of alcohol use disorder screening and management within routine primary care. It would be essential to deploy measures for effectiveness of the screening tool and continuity of care to enhance efficiency of the programme.

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Stop calling it self-medication: Tobacco smoking is not medicine.

Vermeulen JM, Treur JL, Wootton RE … +1 more , Taylor G

Addiction · 2026 May · PMID 42114844 · Publisher ↗

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Commentary on German et al.: Qualitative inquiry reduces lags in scientific discovery-to-practice by recognizing the living expertise of people who use drugs.

Reed MK

Addiction · 2026 Jul · PMID 42114832 · Full text

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Early insights from a national scheme providing vaping devices for smoking cessation: A preliminary evaluation to inform future return-on-investment modelling in England.

Moore E, Gillespie D, Simonavičius E … +1 more , Brose L

Addiction · 2026 May · PMID 42107391 · Publisher ↗

BACKGROUND AND AIMS: Swap to Stop is a government scheme to promote smoking cessation. Local authorities in England were given e-cigarette (vape) starter kits to provide alongside behavioural support in a wide range of s... BACKGROUND AND AIMS: Swap to Stop is a government scheme to promote smoking cessation. Local authorities in England were given e-cigarette (vape) starter kits to provide alongside behavioural support in a wide range of settings. This study evaluated (i) scheme uptake by region of England, (ii) proposed delivery settings and the type and length of support, (iii) proposed targeting of priority populations and (iv) product-cost per 4-week quit. DESIGN, SETTING AND PARTICIPANTS: From October 2023 to October 2024, local authorities submitted 218 expressions of interest (EOIs) to participate in Swap to Stop. We analysed a sample of 115 (53%) EOIs and associated cost information provided by the Department of Health and Social Care. NHS Quarterly Returns data (April 2024-September 2024) provided 4-week quit rates. MEASUREMENTS: Outcomes were the number of kits requested per adult who smokes in each region of England, the proposed delivery settings and the type and length of support and proposed targeting of priority populations categorised as 'specific' (exclusive to certain populations) or 'targeted' (accessible to all but targeting particular groups). Product-cost per 4-week quit was estimated from the 4-week quit rates and product cost. FINDINGS: Regional uptake varied, from 39 kits per 100 people who smoke in the Southwest to 5 per 100 in the Midlands. Most EOIs (75.7%) proposed supplying kits via existing local government funded stop smoking services, followed by physical health care settings (37.4%). A proposed duration of supply of 4 weeks was the most common (48.7%). Thirty-two percent of the EOIs described specific services, including services exclusively for pregnant women (14.8%) and people experiencing deprivation (13.9%). Frequently targeted were socioeconomically less advantaged groups (e.g. routine/manual workers, 57.4% of EOIs) and people with mental health conditions (36.5% of EOIs). The self-reported 4-week quit rate for those who received a kit was 34.3% and the average kit cost was £38.78 (the maximum cost was £40), giving an estimated product-cost per 4-week quit of £113.17, not including additional costs incurred by service providers. CONCLUSIONS: Swap to Stop in England, a government scheme to promote smoking cessation through provision of free e-cigarette starter kits, demonstrated variation in both uptake and the types of services offering free vapes, yet the early quit rates, and consequently the product-cost per quit, were comparable to those observed in similar smoking cessation schemes. There is potential for further targeting of priority populations with increased investment to ensure people have the best chance of quitting.

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Self-harm in individuals with substance use disorders: Predictive factors and risk model.

Yu R, Tracy DK, Sinclair J … +4 more , Brikell I, Lichtenstein P, Larsson H, Fazel S

Addiction · 2026 May · PMID 42098952 · Publisher ↗

BACKGROUND AND AIMS: Substance use disorders are associated with an elevated risk of self-harm. Currently, clinical and structured assessment of self-harm risk typically relies on evidence from the general population sam... BACKGROUND AND AIMS: Substance use disorders are associated with an elevated risk of self-harm. Currently, clinical and structured assessment of self-harm risk typically relies on evidence from the general population samples. The aim of this study was to develop a risk model for self-harm that incorporates predictors specific to individuals with substance use disorders. METHODS: Using national registers, we identified a population-based cohort of 449 720 individuals with substance use disorders in Sweden between 2006 and 2020. We tested independence and strength of a range of socio-demographic and clinical factors, obtained through linkage of population-based registers, with a Cox proportional hazards model, and estimated the risk of self-harm. For the risk model, 361 120 individuals were allocated to the development sample and 88 600 to external validation based on different geographical regions. We assessed self-harm risk over five predetermined follow-up periods-within 7 days, 1 month, 3 months, 6 months and 12 months-following a healthcare contact for substance use disorders. RESULTS: In the development sample, self-harm rates ranged from 0.6% to 3.5%, and in the validation sample from 0.5% to 3.6%. Ten risk factors were retained in the final risk model. Strongest associations with subsequent self-harm were for clinical factors: previous self-harm [hazard ratio (HR) = 3.17, 95% confidence interval (CI) = 3.08-3.26] and comorbidity of mental disorders (HR = 2.63, 95% CI = 2.50-2.72). Recent psychotropic medication use, including antidepressant (HR = 1.29, 95% CI = 1.23-1.38) and antipsychotic treatments (HR = 1.34, 95% CI = 1.24-1.44), was associated with increased risk, even after adjusting for psychiatric comorbidity, likely reflecting greater clinical severity and complexity. Across follow-up periods, performance was good in terms of discrimination, with area under the curve (AUCs) ranging from 0.73 (95% CI = 0.71-0.76) to 0.79 (95% CI = 0.78-0.80). In relation to calibration, expected-to-observed risk ratios were 1.00 to 1.04 and Brier scores 0.01 to 0.04 across follow-up periods. We used the model to generate a simple web-based risk calculator [Oxford Self-hArM after substance use disorders (OxSAMS)]. CONCLUSIONS: Modifiable clinical factors appear to have the strongest associations with increased risk of self-harm in people with substance use disorders. Structured tools, taking account of the different strengths of those factors, could inform clinical decision-making and provide a baseline assessment for training and research.

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Addiction [JOURNAL]

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