Addiction [JOURNAL]
Sun
200 papers
Preventing lower-level gambling harms: Shifting from individual- to system-frame approaches.
Heirene RM
Addiction · 2026 May · PMID 42098928 · Publisher ↗
BACKGROUND: Gambling-related harm is not concentrated solely among individuals meeting criteria for problematic or disordered gambling. Tackling harm at a population level is essential to reducing the total burden of har...
BACKGROUND: Gambling-related harm is not concentrated solely among individuals meeting criteria for problematic or disordered gambling. Tackling harm at a population level is essential to reducing the total burden of harm and preventing escalation to more severe harms. The public health approach to gambling recognises this and the need to address both individual and systemic factors that shape people's risk of harm. Despite this, research and policy in the field remain largely focused on interventions that target individual responsibility, such as educational messages, warnings, and voluntary tools. ARGUMENT: Chater and Loewenstein's i-frame (individual-frame) and s-frame (system-frame) distinction provides a compelling basis for reorienting gambling harm prevention efforts. I-frame interventions target individual decision-making and self-regulation, while s-frame interventions seek systemic changes through restrictions and structural reforms. This paper argues that s-frame approaches are better suited to preventing gambling harms, particularly lower-level harms at the population level, because they [1] do not rely on individuals to recognise and effectively navigate the complex mathematical properties and potentially misleading features inherent in many gambling products, [2] apply universally without requiring individual engagement, and [3] can counter commercial interests without depending on consumer self-restraint. Reframing gambling harm prevention through the i-/s-frame lens offers conceptual clarity, highlights the opportunity costs of an overreliance on individual-focused interventions, and exposes incentives that perpetuate the status quo. This paper explains why i-frame approaches have dominated to date and how we can make the shift towards the s-frame. CONCLUSIONS: Rather than abandoning i-frame approaches, research priorities should be rebalanced toward understanding, implementing, and evaluating systemic solutions. While i-frame interventions remain valuable for individuals seeking help, preventing population-level harms requires proportionate investment in structural solutions that make gambling products safer by design.
Cost-effectiveness of in-hospital motivational smoking cessation counselling and proactive referral to community-based follow-up.
Pleym K, Engebretsen I, Sverre E … +7 more , Dammen T, Huseby E, Kahlon MS, Stugaard M, Støvring H, Kristiansen IS, Munkhaugen J
Addiction · 2026 May · PMID 42098913 · Publisher ↗
BACKGROUND AND AIM: In a randomised open-label trial among hospitalised patients with atherosclerotic vascular disease, motivational smoking cessation counselling with proactive referral to community-based follow-up was...
BACKGROUND AND AIM: In a randomised open-label trial among hospitalised patients with atherosclerotic vascular disease, motivational smoking cessation counselling with proactive referral to community-based follow-up was more effective than brief cessation advice and written information, with 6-month continuous abstinence rates of 49.5% vs. 24.5%. This study aimed to estimate the cost-effectiveness of this intervention compared with brief cessation advice. DESIGN: Economic evaluation alongside a multicentre, randomised open-label, blinded-endpoint trial with 1:1 randomisation. SETTING: Three secondary care hospitals in Norway. Recruitment took place from November 2021 to October 2023. PARTICIPANTS: Hospitalised patients aged 18 years or older with established atherosclerotic vascular disease who reported smoking at least one cigarette daily before admission were eligible for participation, regardless of whether admission was planned or unplanned. A total of 221 patients were randomised. One participant withdrew informed consent and was excluded from all analyses, leaving 220 participants in the economic evaluation. The cohort comprised 40% women and the mean age was 65.2 years. MEASUREMENTS: Intervention costs included staff training, materials and personnel time. Hospital costs during the 16-month follow-up were estimated using Diagnosis-Related Group cost weights. Survival beyond follow-up was extrapolated using national mortality data adjusted for age, sex and atherosclerotic vascular disease. Lifetime costs were estimated using mean costs from the final six months of follow-up. The primary economic outcome was net monetary benefit (NMB), calculated at a willingness-to-pay threshold of €38 346 per life-year gained. The incremental cost-effectiveness ratio was also estimated. Future costs and life-years were discounted at 4%. Uncertainty estimates (UE) were obtained using bootstrapping. FINDINGS: During the 16-month follow-up, five patients (4.6%) died in the intervention group and nine (8.1%) in the control group. Discounted life expectancy from baseline was 13.54 years in the intervention group and 12.47 years in the control group, corresponding to an incremental gain of 1.06 life-years (95% UE = -0.72 to 3.31). The incremental discounted lifetime cost was €3280 per patient (95% UE = -€19 457 to €26 436), resulting in an incremental cost-effectiveness ratio of €3094 per life-year gained. At a willingness-to-pay threshold of €38 346 per life-year gained, the NMB was €37 475 (95% UE = -€15 868 to €107 797) and the probability of the intervention being cost-effective was 90.5%. CONCLUSION: Motivational smoking cessation counselling delivered during hospitalisation with proactive referral to community-based follow-up had a high probability of being cost-effective from a hospital perspective for patients with atherosclerotic vascular disease.
Academic detailing is effective at altering clinician practice and patient outcomes for opioid use disorder.
Zhang J, Trafton J, Bounthavong M … +1 more , Christopher M
Addiction · 2026 May · PMID 42098898 · Publisher ↗
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Are people who use methamphetamine at increased risk of physical violence? Results from a nationally representative sample.
Macdonald C, McKetin R, Alexeev S … +1 more , Weatherburn D
Addiction · 2026 May · PMID 42092299 · Publisher ↗
BACKGROUND AND AIMS: The association between methamphetamine use and violent behaviour has received much attention in the research. The risk of violent victimisation among people who use methamphetamine is comparatively...
BACKGROUND AND AIMS: The association between methamphetamine use and violent behaviour has received much attention in the research. The risk of violent victimisation among people who use methamphetamine is comparatively underexplored. People who use methamphetamine appear to be at a high risk of violent victimisation, but no studies have examined this association in a population-based representative survey. The aim of the current study was to examine the association between methamphetamine use and violent victimisation using a nationally representative sample of Australians. DESIGN: Observational study. SETTING: Australia. PARTICIPANTS: 18 805 individuals aged 15 years or over. MEASUREMENTS: Outcome variable: whether a respondent reported having been a victim of violence in the past 12 months. Exposure variable: frequency of methamphetamine use in the past 12 months (no use, every few months, monthly or more often). Co-variates: age, gender, financial stress, personal stress, long-term health condition, social isolation, cocaine use, drinking consumption, remoteness of area and survey year. Analyses were exploratory. FINDINGS: 1.27% of the sample reported violence victimisation in the past 12 months, and 1.33% reported methamphetamine use (0.71% every few months; 0.62% monthly or more often). After adjusting for covariates, the odds of being a victim of violence in the preceding 12 months were higher for those who used methamphetamine every few months [adjusted odds ratio (aOR) = 5.94; 95% confidence interval (CI) = 1.95-18.06], and once a month or more often (aOR = 9.04; 95% CI = 3.48-23.45) than for those who had not used methamphetamine in the past year. Predicted probabilities indicated an estimated 11 709 (95% CI = 9473-13 953) excess violent victimisations attributable to methamphetamine use. CONCLUSIONS: Methamphetamine use appears to be associated with an elevated risk of being a victim of violence. The population-level effects of methamphetamine use on violence may be small but are likely to have substantial public health implications in communities experiencing high levels of methamphetamine use.
Cross-sectional and longitudinal associations of cannabis use with cognitive functioning in individuals with a cannabis use disorder: The moderating role of nicotine.
Kroon E, de Bode N, Colyer-Patel K … +3 more , Hsieh JH, Filbey F, Cousijn J
Addiction · 2026 May · PMID 42091089 · Publisher ↗
BACKGROUND AND AIMS: Cannabis is among the most widely used psychoactive substances globally and is often consumed alongside tobacco. Cannabis use has been associated with impairments in attention, learning, and memory,...
BACKGROUND AND AIMS: Cannabis is among the most widely used psychoactive substances globally and is often consumed alongside tobacco. Cannabis use has been associated with impairments in attention, learning, and memory, whereas nicotine can acutely enhance, but chronically impair, certain cognitive functions. Most studies examine cannabis in isolation, leaving the cognitive impact of tobacco co-use unclear. This study aimed to estimate differences in cognitive performance between individuals with cannabis use disorder (CUD) and healthy controls, to determine whether cognition relates to heaviness of cannabis use or CUD symptom severity, to test moderation by daily tobacco use, and to assess whether baseline cognition was associated with cannabis outcomes one year later. DESIGN: Cross-sectional and one-year longitudinal study. SETTING: The Netherlands and Texas, USA. PARTICIPANTS: A total of 231 participants aged 18-30 participated: 130 with CUD (57.7% male) and 101 controls (43.6% male). MEASUREMENTS: Participants completed tasks assessing interference control, attentional bias, sustained attention, executive functions, emotion recognition, delayed recall memory, working memory, and intelligence quotient (IQ). Primary outcomes were cognitive task scores; predictors included heaviness of cannabis use, CUD symptom severity, and daily tobacco use. FINDINGS: Compared with controls, individuals with CUD performed worse on interference control (rank biserial correlation [r] = 0.080, p < 0.001), immediate recall memory (r = 0.089, p = 0.009), delayed recall memory (r = 0.090, p = 0.013), executive functions (r = 0.089, p = 0.016), and estimated IQ (r = 0.081, p < 0.001). Within the CUD group, cognitive performance was unrelated to heaviness of use or CUD severity. Before correction, daily tobacco use moderated the link between CUD severity and working memory (p = 0.011, unstandardized beta [B] = -1.83), with poorer performance observed only among non-tobacco users. Lower attentional bias (p = 0.027, B = -1.78) and sustained attention (p = 0.023, B = -27.88) were modestly associated with greater CUD severity at one-year follow-up. CONCLUSIONS: Cannabis use disorder (CUD) appears to be associated with deficits in several cognitive domains independent of use intensity or severity. Tobacco and cannabis co-use appears to be related to relatively better working memory. Attention-related cognition appears to have limited associations with later CUD outcomes.
Efficacy and safety of transcranial direct current stimulation in alcohol use disorder: A randomized controlled triple-blind trial.
Trojak B, Sauvaget A, El Hage W … +17 more , Wallenhorst T, Rolland B, Nubukpo P, Harika-Germaneau G, Szekely D, Giustiniani J, Auriacombe M, Brousse G, Guillaume S, Bubrovszky M, Petit B, Cabelguen C, El Ayoubi H, Rankin S, Soudry-Faure A, Goueslard K, Demina A
Addiction · 2026 May · PMID 42091052 · Publisher ↗
BACKGROUND AND AIMS: Current treatment options for alcohol use disorder are limited. Transcranial direct current stimulation has been proposed as a therapeutic approach, but evidence remains scarce. This study aimed to c...
BACKGROUND AND AIMS: Current treatment options for alcohol use disorder are limited. Transcranial direct current stimulation has been proposed as a therapeutic approach, but evidence remains scarce. This study aimed to compare active vs. sham transcranial direct current stimulation to evaluate its efficacy and safety in reducing alcohol consumption in a large sample of individuals with alcohol use disorder. DESIGN: REDSTIM is a triple-blind, randomized, sham-controlled trial that was conducted from October 2015 to January 2022. Participants were followed up every 4 weeks for 24 weeks. SETTING: Fourteen sites in France and Monaco. PARTICIPANTS: 356 adult outpatients with alcohol use disorder were assessed for eligibility, and 337 were enrolled and randomly assigned (1:1) to receive active or sham stimulation. At baseline, the randomized participants were primarily male (60.5%) with an average age of 51.3 ± 11.3 years. INTERVENTION AND COMPARATOR: Two daily stimulation sessions (anode F4, cathode F3, 2 mA) delivered over five consecutive days vs. sham stimulation. Direct currents were applied via a pair of 0.9% NaCl-soaked surface sponge electrodes (25 cm). In the sham stimulation group, the initial ramp-up time of 15 s (also up to 2 mA) was immediately followed by a ramp down phase of 30 seconds. MEASUREMENTS: The co-primary outcomes were the change in the number of heavy drinking days (HDD) and total alcohol consumption (TAC) over the follow-up period. Exploratory secondary outcomes included alcohol craving, clinical and biological improvements, quality-of-life, mood, cognitive and safety assessments. FINDINGS: Over 24 weeks of follow-up, vs. sham, the active stimulation group reported statistically significant reductions in the number of HDD [-2.45 HDD/4 weeks, 97.5% confidence interval (CI) = -4.86 to -0.05, P = 0.022]. The reduction in TAC was not statistically significant (-5.96 g/day, 97.5% CI = -15.18 to 3.26, P = 0.147). The interpretation of these findings should take into account the proportion of missing data related to alcohol diary completeness and losses to follow-up. For secondary outcomes at 24 weeks, vs. sham, craving assessments were lower in the stimulation group (-0.36 95% CI = -0.65 to -0.07, P = 0.016), as were carbohydrate deficient transferrin levels (-0.33 95% CI = -0.65 to -0.01, P = 0.045). In the active vs. sham stimulation group, 69 (41.1%) and 62 participants (36.7%) experienced one or more adverse effects, resulting in 6 dropouts. CONCLUSIONS: Among adult outpatients with alcohol use disorder, active transcranial direct current stimulation resulted in a modest but sustained reduction in heavy drinking days over 24 weeks, while no statistically significant effect was observed for total alcohol consumption. The intervention was well tolerated.
The feasibility of mindfulness-based relapse prevention for adults with substance use disorders (illicit drugs) in a Chinese population: A pilot randomized controlled trial.
Ting KT, Leung ICH, Chan DCC … +9 more , Yu KOT, Tang WK, Chan F, Tang AKL, Ma HSW, Yip BHK, Zhang DD, Bowen S, Wong SYS
Addiction · 2026 Apr · PMID 42057693 · Publisher ↗
BACKGROUND AND AIMS: Mindfulness-based relapse prevention (MBRP) has been shown to be beneficial to individuals with substance use disorder (SUD) in the West. The current pilot study aimed at testing the feasibility of M...
BACKGROUND AND AIMS: Mindfulness-based relapse prevention (MBRP) has been shown to be beneficial to individuals with substance use disorder (SUD) in the West. The current pilot study aimed at testing the feasibility of MBRP in a Chinese population. DESIGN: This pilot study adopted a design of randomized controlled trial comparing MBRP with treatment-as-usual group (TAU). SETTING: Participants were recruited from residential detox centers, community addiction counseling centers and substance abuse clinics specialized addiction treatment clinics in Hong Kong. PARTICIPANTS: A total of 81 adults (85.2% male) with SUD (illicit drugs only) were recruited. INTERVENTIONS: The intervention group participants (n = 41) attended a 1-hour orientation session followed by 2-hour weekly MBRP sessions for 8 weeks, delivered by a qualified MBRP teacher. The TAU group participants (n = 40) continued their service received from their referral agency. (After completion of all study assessments they were offered the same 8-week MBRP course.) MEASUREMENTS: Feasibility was measured by attendance, course satisfaction and retention rate. Participants' change in substance use and other related outcomes were captured by self-reported drug use, urine drug tests and a list of psychometric scales at baseline, immediately after MBRP and 3- and 6-month follow-up. FINDINGS: The MBRP course satisfaction was high, and the attendance (57.4%) and retention rates (63.4%-85.4%) were comparable to previous trials. No statistically significant differences were observed between the MBRP and TAU groups for any outcomes, including craving, depression, anxiety, mindfulness and health-related quality of life; however, improvement trends were noticed in the MBRP group in self-efficacy in managing high-risk situations at post intervention, as well as in addiction severity and psychological flexibility at the 6-month follow-up. CONCLUSIONS: Mindfulness-based relapse prevention was shown to be feasible for substance use disorder treatment in a Chinese population. In this small study there was only limited evidence of abstinence efficacy, and no evidence of a benefit on other secondary outcomes.
Lower risk drinking guidelines and the 'no safe level' message: Finding a balance in risk communication.
Burton R, Nicholls J
Addiction · 2026 Jul · PMID 42057692 · Publisher ↗
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Discrimination experiences are associated with same-day and next-day smoking among adults with low socio-economic status trying to quit: A secondary analysis of data from a randomized clinical trial.
Boozary LK, Chen M, Frank-Pearce SG … +8 more , Hébert ET, Chen S, Alexander AC, Ogunsanya ME, Sifat MS, Oliver JA, Businelle MS, Kendzor DE
Addiction · 2026 Apr · PMID 42057652 · Publisher ↗
BACKGROUND AND AIMS: Research indicates that experiencing discrimination may be associated with a return to smoking following a quit attempt. The current study aimed to characterize day-to-day relations between discrimin...
BACKGROUND AND AIMS: Research indicates that experiencing discrimination may be associated with a return to smoking following a quit attempt. The current study aimed to characterize day-to-day relations between discrimination and smoking in the context of a smoking cessation trial for adults with socio-economic disadvantage. DESIGN: Secondary analysis of data from a randomized controlled trial, which used a parallel 2-group design (unblinded). Eligible participants (adults with socio-economic disadvantage) were randomly assigned to usual care (UC) for smoking cessation (counseling and pharmacotherapy) or UC plus financial incentives contingent on biochemically verified abstinence. All participants were asked to complete daily smartphone assessments over the first 28 days following a scheduled quit attempt. SETTING: The smoking cessation trial (parent study) was conducted in a tobacco treatment clinic between 2017 and 2022 in Oklahoma City, Oklahoma, USA. PARTICIPANTS: Participants (n = 256) were primarily female (64.8%) and 40.6% were racially/ethnically minoritized. The average age was 48.97 [standard deviation (SD) = 11.61] years. The average cigarettes smoked per day before quitting was 19.00 (SD = 10.51). MEASUREMENTS: Smartphone assessments measured discrimination ["Do you believe you experienced discrimination yesterday?" (yes/no)] and self-reported daily smoking ["How many cigarettes did you smoke yesterday?" (smoking [≥one puff]/abstinent)]. Biochemically verified past 7-day smoking status was assessed at the 4, 8, 12 and 26 week post-quit follow-ups. Generalized linear mixed models analyzed the relations between (1) same-day and next-day discrimination and abstinence and (2) reporting any discrimination during the smartphone assessment period (SAP) and biochemically verified abstinence at follow-ups. FINDINGS: Overall, 62 participants (22.4%) reported 212 instances of discrimination over the SAP. Discrimination was statistically significantly associated with lower odds of same-day [β = 0.48, 95% confidence interval (CI) = 0.25-0.94] and next-day (β = 0.47, 95% CI = 0.25-0.86) abstinence, and any discrimination during the SAP was statistically significantly associated with lower odds of abstinence across follow-ups (β = 0.08, 95% CI = 0.02-0.30). CONCLUSIONS: Experience of discrimination appears to adversely impact smoking cessation among adults with socio-economic disadvantage who are trying to quit smoking and warrants attention in cessation interventions. TRIAL REGISTRATION: The parent trial was registered at ClinicalTrials.gov (NCT02737566). The secondary analyses described in this manuscript were not pre-registered.
Age period cohort trends in alcohol treatment episodes across Australia from 2003 to 2022.
Yuen WS, Miller M, Man N … +11 more , Livingston M, Chrzanowska A, Clare P, Akhurst J, Tierney L, Da Silva K, Blakey P, Bryant W, Chan G, Leung J, Peacock A
Addiction · 2026 Apr · PMID 42057501 · Publisher ↗
AIMS: To measure trends in alcohol treatment episodes in Australia, disaggregated by age, period and birth cohort. DESIGN AND SETTING: Age, period, cohort modelling with restricted cubic splines, using Australian alcohol...
AIMS: To measure trends in alcohol treatment episodes in Australia, disaggregated by age, period and birth cohort. DESIGN AND SETTING: Age, period, cohort modelling with restricted cubic splines, using Australian alcohol treatment administrative data from July 2002 to June 2022. PARTICIPANTS: 1 253 548 closed treatment episodes where alcohol was the primary drug of concern from people aged 10 to 100 years who received treatment for their own substance use in publicly funded specialist alcohol and other drug treatment services. MEASUREMENTS: Count of alcohol treatment episodes by age, period, birth cohort and sex. FINDINGS: Alcohol treatment episode rates increased over time, peaking in 2022 (330.11 per 100 000 population). Age trends first peaked at around 21 years of age [cross-sectional prevalence = 444.30, 95% confidence interval (CI) = 440.82-447.80; longitudinal prevalence = 462.45, 95% CI = 458.06-466.89], followed by a lifetime peak between 37 and 44 years and declining with older age. Cohorts born from 1974 to 1979 had the highest alcohol treatment episode rates, and the oldest and youngest birth cohorts had the lowest alcohol treatment episode rates. Males were overall 1.8 times as likely as females to have an alcohol treatment episode, but this gap closed with more recent birth cohorts. CONCLUSIONS: Alcohol treatment episode rates increased in Australia between 2003 and 2022, and particularly from 2017. Young to middle-aged adults and people born in the 1970s were most at risk, alongside a persistent but narrowing gap between males and females.
Context, mechanisms and outcomes of a social enterprise model of residential rehabilitation for problem substance use: A realist-informed process evaluation.
Anderson M, Pickering L, McCann M
Addiction · 2026 Apr · PMID 42057467 · Publisher ↗
BACKGROUND AND AIMS: This study evaluated a three-year residential rehabilitation programme, which aimed to support recovery from problem substance use via peer support and social enterprise activities. The aims were to...
BACKGROUND AND AIMS: This study evaluated a three-year residential rehabilitation programme, which aimed to support recovery from problem substance use via peer support and social enterprise activities. The aims were to clarify programme mechanisms and identify contextual factors associated with variation in outcomes. METHODS: The study took place within River Garden, a residential rehabilitation for problem substance use, based in South Ayrshire, Scotland. A mixed-methods realist-informed process evaluation was undertaken, using participant observation, repeated qualitative interviews and routinely collected admissions data. Fieldwork was conducted with residents, staff and trustees between April 2019 and November 2020. Nine (of ten) residents were recruited into the study. All residents were male, aged 20-47 years (median 35 years) and were White Scottish or English. Data collection and analysis was guided by Medical Research Council guidance on process evaluation and informed by selected principles from realist evaluation. RESULTS: Three key contextual factors and six key mechanisms were associated with variation in resident outcomes. The severity of residents' substance use problems, their physical and mental health and their socioeconomic backgrounds shaped whether they responded to the programme's instrumental and relational resources with trust, respect or motivation (constituting six mechanisms, e.g. instrumental-respect, relational-trust). The programme was most beneficial for residents for whom intended outcomes were less constrained by contextual moderators. CONCLUSIONS: In residential rehabilitation for substance use disorders, residents with higher problem severity, worse physical and mental health and greater socioeconomic disadvantage appear to be less likely to respond to rehabilitation resources with trust, respect or motivation compared with the other residents. These findings may support the development of strategies to improve outcomes for residents with greater contextual barriers to change.
'If you've ever experienced it, you'd feel differently': Exploring willingness and skepticism toward using higher dose naloxone products among people who use drugs in Maryland, United States.
Sisson LN, Rousch RS, Hill LG … +6 more , Zagorski CM, Triece T, Rouhani S, Owczarzak J, Sherman SG, Schneider KE
Addiction · 2026 Apr · PMID 42053203 · Publisher ↗
BACKGROUND AND AIMS: Higher dose naloxone products (HDN) have recently been approved and marketed in the United States; however, evidence on the relative advantage of these products to standard 4 mg products has not been...
BACKGROUND AND AIMS: Higher dose naloxone products (HDN) have recently been approved and marketed in the United States; however, evidence on the relative advantage of these products to standard 4 mg products has not been substantiated by prior research. People who use drugs are the primary beneficiaries and consumers of naloxone products. This study aimed to characterize their willingness to use HDN products and technical understanding of these products. DESIGN AND MEASUREMENTS: We conducted in-depth interviews with syringe service program clients following an interview guide. Interviews were recorded and transcribed before being analyzed using a hybrid deductive-inductive qualitative approach. SETTING: Interviews were conducted in partnership with community-based syringe service programs in three distinct regions of the state of Maryland, USA: a rural county, Baltimore city and a surrounding suburban community. PARTICIPANTS: Twenty-two interviews were completed. All participants had used opioids and responded to an overdose using naloxone in the past 3 months. The majority of participants were men (73%), non-Hispanic white (64%) and currently experiencing housing instability (59%). FINDINGS: Participants demonstrated high willingness to use HDN, motivated by volatility in the local drug supply and perceived inefficiency of naloxone against potent synthetic opioids. Participants believed that the relative advantage of HDN was that it would reverse overdoses more quickly than existing products; however, many participants wanted increased control in overdose situations, including the ability to titrate and combine dosages to reduce the severity of precipitated withdrawal. Skepticism towards HDN products was rooted in general skepticism of pharmaceutical companies, as well as the belief that perceptions of lower dose naloxone being ineffective could be attributed to user error. CONCLUSIONS: Development of novel overdose reversal products should be informed by the experiences of primary consumers and beneficiaries of these products. A high level of transparency is needed in the marketing of these products to promote consumer trust and confidence in their safety and utility.
Nation-wide trends in prevalence and mortality of high-risk drinking among adult men with and without disabilities in South Korea between 2009 and 2017.
Park BH, Kim SY, Yeob KE … +2 more , Kim YY, Park JH
Addiction · 2026 Jul · PMID 42047229 · Full text
BACKGROUND AND AIMS: Excessive alcohol consumption contributes substantially to the global burden of disease, yet population-level evidence on disparities in high-risk drinking among people with disabilities remains limi...
BACKGROUND AND AIMS: Excessive alcohol consumption contributes substantially to the global burden of disease, yet population-level evidence on disparities in high-risk drinking among people with disabilities remains limited. We aimed to estimate and compare trends in the prevalence of high-risk drinking and all-cause mortality associated with drinking behavior among men with disabilities and those without disabilities. DESIGN: Nation-wide serial cross-sectional study. SETTING: South Korea, using linked administrative national health check-up and mortality databases. PARTICIPANTS: A total of 7 551 340 adult men who participated in the National Health Insurance Service health check-up program in 2017, including 450 536 men with registered disabilities and 7 100 804 men without disabilities. MEASUREMENTS: High-risk drinking was defined as consumption of seven or more standard drinks per occasion at least twice per week, based on self-reported health check-up questionnaires. Age-standardized prevalence of high-risk drinking was estimated annually from 2009 to 2017. Associations between disability characteristics and high-risk drinking were estimated using multivariable logistic regression in 2017. All-cause mortality occurring within 2017 was ascertained through deterministic linkage to the national death registry using unique personal identifiers. FINDINGS: In 2017, age-standardized prevalence of high-risk drinking was 17 141 per 100 000 among men with disabilities and 23 226 per 100 000 among men without disabilities. Among men aged 20-49 years, prevalence was 29 710 per 100 000 in those with mild disabilities and 26 332 per 100 000 in those without disabilities. In 2017, compared with men without disabilities, mild disability was associated with higher odds of high-risk drinking [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 1.11-1.13], whereas brain injury was associated with lower odds (aOR = 0.61, 95% CI = 0.58-0.65). In 2017, age-standardized mortality rates were 131.4 per 100 000 among non-drinkers, 99.2 among high-risk drinkers, 77.3 among moderate drinkers and 59.9 among low-risk drinkers. Across drinking categories, several disability groups had adjusted odds ratios greater than 1.0 for all-cause mortality compared with those for men without disabilities within the same drinking category. CONCLUSION: High-risk drinking prevalence among South Korean men was lower among those with disabilities than among those without disabilities from 2009 to 2017, with declining trends in both groups. High-risk drinking prevalence among South Korean men appears to differ by disability characteristics. Mortality odds ratios within drinking categories vary by disability type and severity when compared with men without disabilities in the same drinking category.
The psychometric properties of validated tools to assess cannabis use disorder: A systematic review and meta-analysis.
Leung J, Stjepanovic D, Fong S … +6 more , Dawson D, Vu G, Yimer T, McClure-Thomas C, Hall WD, Chan GCK
Addiction · 2026 Apr · PMID 42046882 · Publisher ↗
AIMS: To systematically review the evidence on the psychometric performance and accuracy of screening or diagnostic tools for cannabis use disorder. METHOD: Systematic review and meta-analysis which included studies cond...
AIMS: To systematically review the evidence on the psychometric performance and accuracy of screening or diagnostic tools for cannabis use disorder. METHOD: Systematic review and meta-analysis which included studies conducted in clinical settings, schools, universities, community settings and population-based surveys in multiple countries and regions. Participants were adolescents, young adults, general adult populations, people who used cannabis, psychiatric and substance use treatment attendees, and specialised groups such as justice involved youth and military personnel. The tools assessed included The Cannabis Abuse Screening Test (CAST), the Cannabis Use Disorders Identification Test-Revised (CUDIT-R), the Severity of Dependence Scale (SDS), the Cannabis Problems Questionnaire (CPQ), the Cannabis Problems Questionnaire for Adolescents (CPQ-A), the Cannabis Use Problems Identification Test (CUPIT), the Tobacco, Alcohol, Prescription medication, and other Substance use tool (TAPS), the Marijuana Screening Inventory-X (MSI-X), the DSM-Guided Cannabis Screen, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), the Marijuana Problem Index (MAPI), the Toronto Cannabis Risk Screening Tool (TCRUST), the Nigerian Cannabis Use Disorder Scale, and the Problematic Use of Marijuana measure (PUM). These were assessed for internal consistency, test-retest reliability, as well as diagnostic accuracy using measures of sensitivity, specificity and area under the curve (AUC). RESULTS: Forty studies met inclusion criteria (2000-2025), including data from N = 23 175 participants. Methodological quality was generally moderate to high, though some studies relied on self-reported symptom checklists rather than structured diagnostic interviews. The most frequently studied tools were the CAST (k = 13 studies), CUDIT-R (k = 8), SDS (k = 5), CPQ and CPQ-A (k = 4), and CUPIT (k = 2). Across instruments, internal consistency was generally acceptable to excellent (α = 0.66-0.92), with fair to excellent discriminative validity (AUC = 0.71-0.96) for detecting cannabis use disorder or dependence. Optimal cut-offs varied statistically significantly by population and setting. In clinical samples, the tools generally performed stronger with the use of standard or higher cut-offs to prioritize specificity and avoid misclassifying non-cases. In general population samples, particularly youth, the tools had better performance with lower cut-offs to prioritize sensitivity. CONCLUSIONS: There is a lack of sufficient studies on screening or diagnostic tools for cannabis use disorder for clear evidence. Based on this limited current evidence, several brief screening or diagnostic tools are useful in identifying disorder or problem cannabis use in diverse settings, including the CAST, CUDIT-R, and SDS. Variation in optimal thresholds by age, clinical status and cultural context suggest that the utility of these screening or diagnostic tools depends on the population.
Evaluating comparative effect of non-pharmacological interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analysis.
Lv B, Zhang YX, Tao QF … +4 more , Lin L, Li XY, Chen BZ, Zheng H
Addiction · 2026 Apr · PMID 42046533 · Publisher ↗
BACKGROUND AND AIMS: Non-pharmacological therapies are critical for disease management, particularly when pharmacological approaches are limited. Investigating their role as adjuncts to pharmacotherapy to improve outcome...
BACKGROUND AND AIMS: Non-pharmacological therapies are critical for disease management, particularly when pharmacological approaches are limited. Investigating their role as adjuncts to pharmacotherapy to improve outcomes in opioid use disorder (OUD) is of substantial clinical importance. This study aimed to evaluate the efficacy of non-pharmacological therapies as adjuncts to opioid agonist therapy (OAT) management for OUD. METHODS: We systematically searched PubMed, Cochrane Controlled Register of Trials, Embase and Web of Science from inception to 8 February 2025 for randomized controlled trials (RCTs) comparing OAT alone versus OAT combined with non-pharmacological interventions in OUD. Outcomes of interest included treatment retention [assessed via odds ratios (ORs)], negative urine test results (specimen and the longest duration of continuous drug abstinence) and opioid craving scores [both evaluated via standard mean differences (SMDs)]. Bayesian network meta-analysis (NMA) using a random-effects consistency model was conducted to compare the relative effects of all non-pharmacological interventions. Local inconsistency was evaluated through node-splitting analysis, and global inconsistency was assessed using the non-consistency model. The certainty of the evidence was assessed using the GRADE framework (Grading of Recommendations, Assessment, Development and Evaluation) for network meta-analysis. RESULTS: Forty-two RCTs involving 5113 participants were included. For treatment retention, contingency management (CM) combined with OAT likely results in an increase [low-certainty evidence; OR = 1.64, 95% credible interval (CrI) = 1.03-2.57], while the combination of OAT with contingency management plus cognitive behavioral therapy (CBT + CM; very low-certainty evidence; OR = 2.47, 95% CrI = 1.10-5.67) or with enhanced methadone services (EMS; very low-certainty evidence; OR = 5.48, 95% CrI = 1.47-22.61) may result in an increase, compared with OAT alone. No intervention statistically significantly improved opioid-negative urine tests over OAT alone (very low certainty). For craving, acupuncture (very low certainty; SMD = -2.13, 95% CrI = - 3.09 to -1.15) and sham acupuncture (low certainty; SMD = -1.49, 95% CrI = - 2.69 to -0.31) combined with OAT may reduce craving scores. CONCLUSION: Contingency management, as adjunctive therapies for opioid agonist therapy (OAT), may improve treatment retention in patients with opioid use disorder compared with traditional OAT. Enhanced methadone services and contingency management plus cognitive behavioral therapy may improve treatment retention too but the evidence is very uncertain. Compared with OAT, sham acupuncture as an adjunct therapy may help reduce opioid cravings; acupuncture may reduce cravings too but evidence is very uncertain.
Substance-related intrusive memories in cocaine use disorder are different from but associated with craving.
Zacher A, Dietiker L, Häffner V … +3 more , Bavato F, Kleim B, Quednow BB
Addiction · 2026 Apr · PMID 42044882 · Publisher ↗
BACKGROUND AND AIMS: Cocaine use disorder (CUD) is a significant global health concern, characterized by persistent craving despite severe consequences. Recent theories highlight maladaptive memory processes - such as in...
BACKGROUND AND AIMS: Cocaine use disorder (CUD) is a significant global health concern, characterized by persistent craving despite severe consequences. Recent theories highlight maladaptive memory processes - such as intrusive, vivid recollections of past substance use that arise spontaneously in daily life - as key contributors to craving and relapse; however, empirical studies examining such substance-related intrusions in naturalistic contexts remain scarce. This study therefore used ecological momentary assessment (EMA) to investigate the frequency, phenomenology and emotional and behavioural correlates of substance-related memory intrusions in individuals with CUD, and how these relate to craving, cocaine use severity (CUS) and psychotherapy experience. DESIGN: A 14-day EMA study captured event-based reports of intrusions, craving and related experiences in participants diagnosed with CUD. SETTING: The study was conducted in Switzerland in a naturalistic setting, with data collected via individuals' smartphones. PARTICIPANTS: N = 43 participants (recruited in Switzerland, 16% female; 18-59 years old, median compliance rate 82.8%) with a current DSM-5 diagnosis of CUD made a total of n = 360 event-based reports that were analysed. MEASUREMENTS: EMA reports included intrusion episode types (pure intrusions, intrusions with subsequent or simultaneous craving or pure craving), intrusion characteristics (vividness, intrusiveness, modalities), craving intensity, episode triggers and cognitive-behavioural, emotional and physiological responses. CUS was assessed based on use quantity, duration and obsessive-compulsive use symptoms. FINDINGS: Participants recorded an average of 8.4 episodes (standard deviation = 5.8) across 14 days. Intrusions frequently occurred independently of craving (42.4%) but were statistically significantly associated with greater craving intensity when more vivid (unstandardized regression coefficient b = 0.53, P = 0.002) and intrusive (b = 0.48, P < 0.001). Episodes involving craving were characterized by greater distress (b = 1.52-2.17, all P < 0.001) and greater loss of control (b = 2.41-3.22, all P < 0.001) and were associated with higher odds of reporting obtaining cocaine (odds ratio = 19.90, P < 0.001). Higher CUS predicted more frequent intrusion episodes (unstandardized regression coefficient β = 0.52, P < 0.001), while psychotherapy experience was associated with lower vividness (b = -1.45, P = 0.008), intrusiveness (b = -1.33, P = 0.004) and craving intensity (b = -1.56, P = 0.010). CONCLUSIONS: Substance-related memory intrusions in people with cocaine use disorder are distinct cognitive-affective events that often occur independently of craving but are closely linked to its intensity, particularly when experienced as vivid and emotionally charged. Targeting these features through behavioural or pharmacological interventions may help mitigate craving-driven distress and impulsive use-related behaviour.
High temporal resolution monitoring of illicit drug consumption across England via wastewater analysis.
Rapp-Wright H, Ng KT, Grant D … +12 more , Francis W, White M, Evangelopoulos D, Liu Y, Dimakopoulou K, Zafeiratou S, Wood D, Christy C, Friedman S, Gant TW, Katsouyanni K, Barron LP
Addiction · 2026 Apr · PMID 42035788 · Publisher ↗
AIM: To monitor community-level consumption of 20 illicit drugs across urban areas of England using wastewater-based epidemiology (WBE) surveillance at high temporal resolution. DESIGN, SETTING, CASES: This study was con...
AIM: To monitor community-level consumption of 20 illicit drugs across urban areas of England using wastewater-based epidemiology (WBE) surveillance at high temporal resolution. DESIGN, SETTING, CASES: This study was conducted over a 12-month period in 2022 sampling 24-hour composite wastewater samples at 15 wastewater treatment plants (WWTPs) covering catchment population equivalents ranging from ~100 000 to >1 million. Analysis was conducted using rapid liquid chromatography-tandem mass spectrometry methods. The sampled WWTPs collectively covered 21% of the national population. MEASUREMENTS: Primary data outcomes were the population-normalised daily loads (PNLs) entering the WWTP, estimated population-normalised consumption (both in mg/1000 people/day) and total mass (g/day) of 20 targeted illicit drugs and total mass in each catchment, quantified using suitable drug target residue markers in 1746 wastewater samples. Covariables included temporal indicators (e.g. public holidays, events) and regional factors. Presence, quantity and correlation of WBE-derived drug use data were used to infer drug use patterns. FINDINGS: Of the 20 illicit drugs investigated, 18 were detected in at least one sample. Cocaine exhibited the highest average daily PNL (2770 ± 829 mg/1000 people/day), followed by heroin (382 ± 248), ketamine (287 ± 183), amphetamine (272 ± 268), 3,4-methylenedioxymethamphetamine (MDMA) (80 ± 57) and methamphetamine (60 ± 99) across 2022. When comparing PNLs to Sewage analysis CORe group-Europe (SCORE) and European Drugs Agency WBE data for 109 other WWTPs across Europe from March to May, 2022 cocaine and ketamine PNLs from sites in England were ranked statistically higher [cocaine: Wilcoxon rank-sum test statistic (W) = 971, adjusted P = 0.000115; ketamine: W = 264, adjusted P = 0.0000389]. Importantly, seven English WWTPs recorded higher mean ketamine PNLs than any other European site over the same period in 2022. Temporal spikes in drug consumption aligned with public holidays and major events. A notable decrease in cocaine use coincided with a 3.7-t UK seizure. Strong inter-drug correlations were observed across catchments, particularly for benzoylecgonine/ketamine and benzoylecgonine/cocaethylene. Extrapolation to generate a representative national average consumption estimate is not recommended, as the WWTPs studied were mostly classified as urban areas and found not to be representative of the entire population of England. CONCLUSIONS: Wastewater analysis revealed widespread and temporally variable illicit drug use across England in 2022, with ketamine use exceeding European levels at multiple sites. The findings highlight wastewater-based epidemiology's capacity to monitor drug use trends and identify community-level impacts of interventions and events.
Working with, learning from and giving back: Principles for collaborative research with people who use drugs.
Harris M
Addiction · 2026 Apr · PMID 42029146 · Publisher ↗
Abstract loading — click title to view on PubMed.
'Emptiness filled with love': A reflexive thematic analysis of chemsex trajectories among gay, bisexual and other men who have sex with men in Almaty, Kazakhstan, using a life course framework.
Lunchenkov N, Cherchenko N, German E … +1 more , Rinne-Wolf S
Addiction · 2026 Apr · PMID 42029125 · Publisher ↗
BACKGROUND AND AIMS: The intentional use of psychoactive substances to enhance sexual experiences, known as chemsex, is associated with human immunodeficiency virus (HIV) transmission, psychological distress and social i...
BACKGROUND AND AIMS: The intentional use of psychoactive substances to enhance sexual experiences, known as chemsex, is associated with human immunodeficiency virus (HIV) transmission, psychological distress and social isolation among gay, bisexual and other men who have sex with men (GBMSM). While research has predominantly focused on high-income countries, gaps remain in our understanding of the dynamics in Eastern Europe and Central Asia, where structural homophobia, restrictive drug policies and limited healthcare access uniquely shape chemsex-related risks. There is limited research on how chemsex engagement evolves over time. This study aimed to identify the stages of chemsex engagement and examine how social, psychological and structural factors shape transitions between these stages among GBMSM in Kazakhstan. METHODS: This study is a secondary analysis of data from a cross-sectional qualitative study conducted in Almaty, Kazakhstan, between July and September 2023. Twenty-one GBMSM who had engaged in chemsex within the past 12 months participated in semi-structured interviews lasting between 60 and 90 minutes. All participants reported using mephedrone and/or alpha-PHP (α-Pyrrolidinohexiophenone). Deductive reflexive thematic analysis, guided by Life Course Theory, was used to reconstruct chemsex trajectories from retrospective participant accounts. RESULTS: Five distinct themes related to different trajectory stages were developed. Initiation occurred through trusted social networks in intimate settings, taking the form of unplanned encounters that fulfilled emotional needs for connection and belonging. Maintenance was characterised by self-imposed temporal and dosage limits; however, participants reported a decline in satisfaction with sober sex. Escalation involved a breakdown of protective boundaries, an increased frequency and quantity of use and a deeper involvement in chemsex social networks, despite mounting physical and psychological consequences. Dependence was characterised by a narrowed agency under escalating constraints, with substance use shifting from enhancing pleasure to coping with withdrawal, resulting in substantial impairment across life domains. Disengagement attempts described recursive trajectories with diverse recovery goals ranging from cessation to managed use. Sustained abstinence was rare and dependent on affirming care and supportive resources. Throughout all stages, structural stigma constrained individual agency, while chemsex networks provided crucial emotional safety that was unavailable in mainstream environments. CONCLUSIONS: Chemsex trajectories among gay, bisexual and other men who have sex with men in Kazakhstan represent dynamic processes shaped by the interaction between individual agency and structural constraints, in which substance use functions as an emotional regulation strategy and a social survival strategy in contexts of high stigma.
Drug sellers' use of a drug checking service amid the overdose crisis in British Columbia, Canada.
Gonzalez-Nieto P, Wallace B, Kielty C … +5 more , Shkolnikov I, Margolese A, Arredondo Sanchez Lira J, Gill C, Hore D
Addiction · 2026 Apr · PMID 42029063 · Publisher ↗
AIMS: This study examined the use of a drug checking service by drug sellers in British Columbia, Canada, to assess motivations for service use and substances intended for distribution, focusing on risks associated with...
AIMS: This study examined the use of a drug checking service by drug sellers in British Columbia, Canada, to assess motivations for service use and substances intended for distribution, focusing on risks associated with an unstable illicit drug market. DESIGN: A retrospective analysis was conducted using data from an anonymous intake survey and drug checking results. The survey captured frequency of service use, expected substances and reasons for service access. SETTING: The study was set in Victoria, British Columbia, where participants accessed a free confidential drug checking service between January 2021 and December 2024. PARTICIPANTS: A total of 2332 drug sellers were included in the analysis, accounting for 16.2% of all service users. They submitted 5528 samples (21.6% of total samples), averaging 2.4 samples per visit, compared to 1.7 among non-sellers. MEASUREMENTS: The primary outcomes measured included the frequency of drug check use, the expected and actual composition of the samples, pre- or post-consumption analysis and the reasons for engaging with the service. Secondary outcomes focused on the reported potency and the presence of unexpected substances. FINDINGS: A statistically significant portion of sellers continuously used the service, particularly for opioid samples, which comprised 69.2% of seller submissions compared with 35.1% among non-sellers [X (1, n = 20 864) = 2055.57, P < 0.001]. Sellers reported using the service to mitigate risks associated with the illicit drug market, including overdose, showing a proactive interest in ensuring the safety of their customers. Despite greater confidence in the composition of their products, sellers were less likely than non-sellers to have their samples confirmed as "expected" [38.4% vs. 51.9%; X (1, n = 12 520) = 313.76, P < 0.001]; unexpected substances were detected in 44.8% of their samples. Notably, protective strategies employed by sellers were identified, demonstrating the role of drug checking as a supply-focused harm reduction intervention. CONCLUSIONS: In Victoria, British Columbia, drug sellers appear to be increasingly using drug checking services as a preventive measure, positioning them as potential partners in harm reduction efforts.
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