Addiction [JOURNAL]
Sun
200 papers
Ethical tensions in legally mandated substance use treatment: A scoping review of participant perspectives.
Taylor J, Jamakandi S, Saloner B
Addiction · 2026 Mar · PMID 41866236 · Publisher ↗
BACKGROUND AND AIMS: Mandating people charged with drug-related criminal offenses to participate in substance use disorder (SUD) treatment as an alternative to jail time is a policy with widespread political and public s...
BACKGROUND AND AIMS: Mandating people charged with drug-related criminal offenses to participate in substance use disorder (SUD) treatment as an alternative to jail time is a policy with widespread political and public support in the United States; however, mandated treatment programs present a tension between competing ethical values (e.g. autonomy versus protection from harm). To help ground the ethical discussion, this paper examined qualitative literature on mandated treatment programs that explores these ethical tensions from the perspective of program participants. METHODS: We undertook a review of studies reporting views of individual participants on their experiences in a mandated treatment program. Scope of search was limited to the United States, and only literature pertaining to substance use treatment mandated by the criminal legal system was considered. In total, 39 studies were included in the review. RESULTS: Participants' perspectives reported in the literature attest to the existence of the following five tension points: (1) choice about whether to participate in a program, (2) choice about what services are provided during mandated treatment, (3) perceived conflicts of interest among treatment providers, (4) involvement of judges or other criminal legal officials in treatment decisions, and (5) targeting of people who are not in need of treatment. People subjected to mandates often experience these same tensions, but their overall appraisal of their experience often depends on unique contextual factors that vary substantially based on the implementation of programs in real world conditions. Many participants felt that programs such as drug court provide a necessary nudge without overly restricting their autonomy, but others revealed more ambivalent or negative attitudes. CONCLUSIONS: The widely varying experiences of people in the United States participating in mandated substance use disorder treatment programs underscore the difficulty of rendering sweeping conclusions about the benefits and harms of mandated treatment and highlight the need to calibrate programs and policies to meet the specific needs and interests of different groups facing mandates.
Latent classes of sleep deficiency and correlates among patients receiving methadone treatment: A longitudinal study.
Hsaio C, Jeon S, DiMeola KA … +9 more , Walker K, Akhiwu O, Stein MD, Madden LM, Redeker NS, Scheinost D, Fiellin DA, Yaggi HK, Barry DT
Addiction · 2026 Mar · PMID 41852290 · Publisher ↗
BACKGROUND AND AIMS: Few studies have examined multiple domains of sleep deficiency among patients receiving methadone treatment (MT). This study investigated sleep deficiency classes and their associations with demograp...
BACKGROUND AND AIMS: Few studies have examined multiple domains of sleep deficiency among patients receiving methadone treatment (MT). This study investigated sleep deficiency classes and their associations with demographics, clinical characteristics and one-year treatment outcomes among patients receiving MT. DESIGN: Longitudinal study using patient-completed questionnaires on demographics, sleep, pain interference with sleep and psychological symptoms in August 2023. We used latent class analysis to group patients into sleep deficiency classes and employed multinomial logistic regression to investigate their demographic and clinical correlates. Treatment continuity and urine toxicology results over the subsequent year were analyzed in August 2024. SETTING: A not-for-profit federally certified opioid treatment program in Connecticut, USA. PARTICIPANTS: 1237 patients receiving MT. MEASUREMENTS: Sleep questionnaires included the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Brief Index of Sleep Control, STOP questionnaire and the first two items from the Cambridge-Hopkins Restless Legs Syndrome Questionnaire. Urine toxicology results and treatment continuity were extracted from the medical chart. FINDINGS: We identified four classes. Class I (28.0%): normal sleep/no sleep deficiency. Class II (24.8%): late sleep with increased risk for obstructive sleep apnea and restless legs syndrome. Class III (20.5%): poor sleep quality with short and late sleep. Class IV (26.6%): severe sleep deficiency. Compared with Class I, participants in Classes II-IV had statistically significantly higher odds of reporting psychological symptoms [Class II adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.10-1.81; Class III aOR = 1.58, 95% CI = 1.23-2.03; Class IV aOR = 2.21, 95% CI = 1.72-2.84] and pain interference with sleep (for three or more days per week: Class II aOR = 5.52, 95% CI = 2.93-10.38; Class III aOR = 5.04, 95% CI = 2.62-9.69; Class IV aOR = 13.16, 95% CI = 6.98-24.84). Over the subsequent year, compared with Class I, participants in Class III had statistically significantly higher rates of positive urine toxicology results for benzodiazepines, while participants in Class IV had statistically significantly higher rates of positive urine toxicology results for fentanyl and benzodiazepines. Treatment continuity did not differ across the four classes after one year following baseline. CONCLUSIONS: Varieties of sleep deficiency compared with normal sleep appear to be associated with more severe psychological symptoms and pain interference with sleep among patients receiving methadone treatment and may serve as risk factors for substance use.
Titration of nicotine intake in smokers switching to reduced nicotine content cigarettes with access to alternative nicotine systems: Secondary analysis of a randomized clinical trial.
Benowitz NL, Hu J, Luo X … +6 more , McClernon FJ, Tidey J, Strasser AA, Colby S, Donny EC, Hatsukami DK
Addiction · 2026 Jul · PMID 41852246 · Full text
BACKGROUND AND AIMS: Mandated reduction of the nicotine content of cigarettes to reduce addictiveness to minimal levels has the potential to substantially reduce combusted cigarette use and promote public health. This pa...
BACKGROUND AND AIMS: Mandated reduction of the nicotine content of cigarettes to reduce addictiveness to minimal levels has the potential to substantially reduce combusted cigarette use and promote public health. This paper examined the hypothesis that when people who smoke cigarettes are switched to very low nicotine content (VLNC) cigarettes and provided with access to non-combusted alternative nicotine delivery systems (ANDS), they will titrate nicotine to maintain baseline levels of nicotine intake with the use of ANDS. DESIGN: This is a secondary analysis of a recently published randomized clinical trial. Clinical trial number NCT03272685. SETTING: Multicenter clinical trial conducted in the United States. PARTICIPANTS: 438 individuals who smoked 5 to 40 cigarettes per day, mean age 44 (range 20-73). INTERVENTION: Smokers were randomized 1:1 for 12 weeks of smoking Spectrum brand research cigarettes containing VLNC (0.4 mg nicotine/g tobacco) or normal nicotine content (15.8 mg nicotine/g, NNC). Participants purchased tobacco products from an experimental marketplace containing non-combusted ANDS, including electronic cigarettes, nicotine replacement medications and oral nicotine products. MEASUREMENTS: Measures taken at baseline, 4, 8 and 12 weeks included cigarettes smoked per day (CPD) and measures of ANDS use, assessed using past 3-day daily diary data, which would roughly account for nicotine intake as measured by urine total nicotine equivalents (TNE). Based on self-report and biomarker data at weeks 4, 8 and 12, we characterized three product-using groups of participants as cigarette-only users, ANDS-only users and dual users. Nicotine titration was assessed as the ratio of urine TNE at various research cigarette study weeks compared with baseline (smoking their own cigarettes). Combusted product abstinence was examined using expired carbon monoxide (CO) and adherence to smoking VLNC by urine anatabine. FINDINGS: Median titration at 12 weeks in cigarette-only participants was 0.84 (interquartile range 0.68-1.18) in the NNC group and 0.05 (0.01-0.12) in the VLNC group. Median titration at 12 weeks in ANDS-only participants was 0.81 (0.69-1.16) in the NNC group and 0.89 (0.49-1.58) in the VLNC group. Median titration at 12 weeks in dual use participants was 1.0 (0.78-1.29) in the NNC group and 0.91 (0.61-1.25) in the VLNC group. CONCLUSIONS: Most adults who smoke, when switched to very low nicotine content cigarettes, will use available alternative nicotine delivery systems (ANDS) to supplement their intake of nicotine. Provision of ANDS appears to be associated with a high degree of nicotine titration. Making less harmful ANDS widely available may make a mandated nicotine reduction intervention more acceptable to people who smoke.
Low and no alcohol availability and sales in small retailers in Great Britain: A geographic longitudinal analysis from 2018 to 2022.
Valiente R, Tunstall H, Wilson LB … +3 more , Gillespie D, Pearce J, Shortt NK
Addiction · 2026 Jul · PMID 41852240 · Full text
BACKGROUND AND AIMS: The United Kingdom Government is committed to reducing alcohol consumption through increasing the availability of alcohol-free and low-alcohol (No/Lo) drinks; however, little is known about whether t...
BACKGROUND AND AIMS: The United Kingdom Government is committed to reducing alcohol consumption through increasing the availability of alcohol-free and low-alcohol (No/Lo) drinks; however, little is known about whether these products are equally available across different types of neighbourhoods, which may have implications for inequalities in potential health benefits or harms from exposure to No/Lo drinks. This study measured differences in the availability and sales of No/Lo products in small retailers across disparate types of neighbourhoods in Great Britain and over time. DESIGN: A longitudinal geographic design using retail transaction data collected over 20 weeks seasonally distributed between 2018 and 2022. SETTING: The study was conducted in Great Britain (England, Scotland and Wales). PARTICIPANTS/CASES: 11 278 479 alcohol transactions across 1432 small retailers in neighbourhoods with varying levels of socioeconomic deprivation and urbanicity. MEASUREMENTS: No/Lo products were defined as alcoholic-mimic beverages containing ≤1.2% alcohol by volume (ABV). Each week, we calculated retail-level outcomes measuring No/Lo product availability defined as product range and sales volume (standardised as the number of serving units). Zero-inflated Poisson regression models were used to assess differences in these outcomes by neighbourhood income deprivation and urbanicity over time. FINDINGS: No/Lo sales volume tripled over the study period yet accounted for only 0.25% of total alcohol sales by 2022. In 2018, 34% of retailers reported sales of No/Lo products, rising to 68% by 2022. Retailers in low-deprivation areas were more likely to sell No/Lo products and sold a wider product range compared with those in high-deprivation areas ([incidence rate ratio (IRR) = 2.30, 95% confidence interval (CI) = 1.60-3.30 in 2022). No/Lo alcohol sales volume was statistically significantly higher among retailers in the least deprived neighbourhoods (IRR = 1.33, 95% CI = 1.14-1.57 in 2022) and rural areas compared with high-deprivation and urban areas, but only in the most recent years. CONCLUSION: Alcohol-free and low alcohol (No/Lo) product availability and sales increased among small retailers in Great Britain between 2018 and 2022, but these gains have been uneven, with greater access and uptake in more affluent and rural areas. This suggests emerging geographic disparities in access to and sales of No/Lo alternatives and their potential benefits or harms.
Associations of cannabis use, tobacco use and co-use with brain volume: A systematic review and meta-analysis.
Sawyer K, Freeman TP, Skumlien M … +14 more , Walton E, Lancaster T, Treur JL, Lorenzetti V, Blackwell AKM, Burke C, Carr RJ, Constantinides C, Cox M, Dance S, Daryan S, Hamilton S, Jenkins T, Taylor GMJ
Addiction · 2026 Mar · PMID 41852160 · Publisher ↗
BACKGROUND AND AIMS: Cannabis is the most widely used illicit drug worldwide and is often co-used with tobacco, the leading cause of preventable death. Although cannabis and tobacco have distinct neurobiological actions,...
BACKGROUND AND AIMS: Cannabis is the most widely used illicit drug worldwide and is often co-used with tobacco, the leading cause of preventable death. Although cannabis and tobacco have distinct neurobiological actions, their associations with brain volumes are unclear. We aimed to review studies investigating cannabis use, tobacco use, their co-use and brain volume and triangulate evidence across different study designs. METHODS: A systematic review and meta-analysis preregistered on PROSPERO (CRD42022356982) and reported according to PRISMA 2020 guidelines. We searched SCOPUS, PubMed and PsycINFO up to 5 September 2024 for studies investigating cannabis use, tobacco use, co-use and brain volume. Cross-sectional, longitudinal and Mendelian randomisation studies were included. The outcome was brain volume of global, cortical and subcortical regions. We extracted adjusted and unadjusted estimates. Random effects meta-analyses were stratified by exposure and study design across 33 brain regions. Risk of bias was assessed using a modified version of the Newcastle-Ottawa scale. RESULTS: Searches yielded 103 studies: 57 investigated cannabis use, 45 investigated tobacco use and one investigated tobacco and cannabis co-use. Seventy-seven studies were included in meta-analysis (n = 72 798), 44 (n = 18 247) in the cross-sectional cannabis analysis, 30 (n = 51 194) for tobacco cross-sectional and four (n = 3357) in the tobacco longitudinal analysis. Meta-analysis of adjusted estimates from cross-sectional studies (k denotes the number of independent studies) indicated smaller amygdala volumes [k = 17, g = 0.13, 95% confidence interval (CI) = 0.03, 0.23)] in people who use cannabis compared with controls. Relative to controls, people who smoked tobacco had smaller volumes in the amygdala (k = 5, g = 0.17, 95% CI = 0.04, 0.31), insula (k = 5, g = 0.17, 95% CI = 0.06, 0.27), pallidum (k = 5, g = 0.17, 95% CI = 0.13, 0.21) and total grey matter volume (TGMV) (k = 7, g = 0.17, 95% CI = 0.04, 0.30). Longitudinal studies indicated a larger decrease in TGMV in people who smoke tobacco (k = 5, g = 0.05, 95% CI = 0.01, 0.10) relative to controls. CONCLUSIONS: Cannabis use appears to be associated with smaller volume in the amygdala. Tobacco use appears to be associated with smaller amygdala, insula, pallidum and total grey matter volume.
Diagnostic validity of Addictions Neuroclinical Assessment indices for alcohol use disorder: Findings from an observational case-control study.
Garber ML, McIntyre-Wood C, Elsayed M … +3 more , Amlung MT, Sweet LH, MacKillop J
Addiction · 2026 Jul · PMID 41852141 · Full text
BACKGROUND AND AIMS: The Addictions Neuroclinical Assessment (ANA) provides a framework for assessing alcohol use disorder (AUD) with indices that may be both mechanistically and diagnostically informative. This study ev...
BACKGROUND AND AIMS: The Addictions Neuroclinical Assessment (ANA) provides a framework for assessing alcohol use disorder (AUD) with indices that may be both mechanistically and diagnostically informative. This study evaluated an array of measures from the three ANA domains in relation to AUD diagnostic status. DESIGN: This cross-sectional case-control study used receiver operating characteristic (ROC) curves to evaluate diagnostic classification validity using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Exploratory multivariate models using logistic regression were also evaluated using the same metrics. SETTING AND PARTICIPANTS: Participants were 189 general community adults (52% AUD+, 57% female, M = 32) recruited in Hamilton, Ontario, Canada. MEASUREMENTS: Classifiers included measures that conceptually mapped on to the three ANA domains of incentive salience (e.g. alcohol cue reactivity), negative emotionality (e.g. anxiety symptoms, coping motives) and executive function (e.g. NIH-toolkit cognition battery). The clinical criterion (reference standard) was AUD diagnostic status per structured clinical interview. FINDINGS: Incentive salience indices had AUCs from 0.55-0.85; negative emotionality indices had AUCs from 0.67-0.89; and executive function indices had AUCs from 0.51-0.58. For incentive salience, cravings in the cue reactivity paradigm and enhancement motives identified AUD diagnosis above accepted benchmarks for clinical utility. For negative emotionality, coping motives exhibited high diagnostic validity, exceeding clinical utility benchmarks. Exploratory multivariate models combining these indices outperformed the single indicator models. CONCLUSIONS: This study broadly supports using the Addictions Neuroclinical Assessment (ANA) framework for assessing alcohol use disorder (AUD) - specifically the motivational indices from the incentive salience and negative emotionality domains - for the development of next generation diagnostic assessments of AUD using theoretically informed mechanisms. As such, it reflects a further step in moving ANA toward utilization in clinical research and practice.
Regional perspectives: Substance use related problems in Ethiopia.
Yimer TM, Fekadu W, Leung J … +2 more , Mihretu A, Teferra S
Addiction · 2026 Jul · PMID 41852138 · Full text
Ethiopia, with a population exceeding 130 million, presents a complex landscape for understanding substance use disorders. The country's diverse cultural heritage, varying regional practices, and evolving socioeconomic c...
Ethiopia, with a population exceeding 130 million, presents a complex landscape for understanding substance use disorders. The country's diverse cultural heritage, varying regional practices, and evolving socioeconomic conditions create unique factors of substance use that differ markedly from global trends. Traditional substances like khat and locally brewed alcohols exist alongside emerging threats from cannabis, injecting drug use, and other illicit substances. This paper describes the epidemiology, societal impact, and policy responses to alcohol, tobacco, khat, and other psychoactive substances in Ethiopia. The interplay between economic interests, cultural practices, and public health imperatives creates a complex drug policy environment requiring nuanced, evidence-based approaches that balance harm reduction with sociocultural realities.
Direct gambling marketing, direct harm: A randomised experiment.
Rockloff M, Browne M, Hing N … +3 more , Russell AMT, Rawat V, Newall P
Addiction · 2026 Jul · PMID 41850333 · Full text
BACKGROUND AND AIMS: Whether gambling marketing has a causal effect on harm is of regulatory interest. Direct marketing offers (emails, push notifications and text messages) are frequently received by people with active...
BACKGROUND AND AIMS: Whether gambling marketing has a causal effect on harm is of regulatory interest. Direct marketing offers (emails, push notifications and text messages) are frequently received by people with active gambling accounts, but they can opt out. This study aimed to test whether opting out of direct marketing reduces betting and short-term gambling harms in a real-world gambling environment. DESIGN: Stratified randomised field experiment with a between-participants design, embedded in a 14-day ecological momentary assessment (EMA). SETTING: Nationwide, Australia (July-August 2023). PARTICIPANTS: Participants (n = 227; 61.7% men; mean age = 45), 52.0% of whom scored in the moderate-risk or problem range on the Problem Gambling Severity Index (PGSI), were regular Australian sports and race bettors recruited from online panels who agreed in principle to opt out of receiving direct marketing from all wagering operators with whom they held accounts. INTERVENTION: Participants were stratified by PGSI risk category, age group and gender and then randomly allocated either to an opt-out condition (n = 96), in which they opted out of direct marketing from their wagering operators and provided proof, or to a control condition (n = 131) that continued to receive direct marketing as usual. MEASUREMENTS: Seven EMA surveys were administered every 48 hours over a 14-day period during a high-volume betting season. Outcomes were self-reported number of bets placed, gambling expenditure (in Australian dollars, AUD) and short-term gambling harms in the previous 48 hours, assessed with a 10-item adapted Short Gambling Harm Screen (SGHS). FINDINGS: The opt-out group placed 23% fewer bets [B = -0.11, 95% confidence interval (CI) = -0.20, -0.03, P = 0.011], spent 39% less money (B = -0.53, 95% CI = -0.84, -0.21, P = 0.001) and reported 67% fewer short-term gambling harms (B = -0.22, 95% CI = -0.36, -0.07, P = 0.004) compared with the controls. CONCLUSIONS: Opting out of receiving direct marketing from wagering operators appears to be associated with statistically significantly fewer bets made, amount spent gambling and short-term gambling harms.
Genetic overlap of chronic pain, musculoskeletal-specific pain, substance use disorders and substance use consumption: Common addiction and substance-specific effects.
Rader L, Zorina-Lichtenwalter K, Hatoum AS … +3 more , Stallings MC, Wager TD, Friedman NP
Addiction · 2026 Jul · PMID 41845861 · Publisher ↗
BACKGROUND AND AIMS: Chronic pain and substance use disorders frequently co-occur and may share general addiction-related and substance-specific genetic pathways. Additionally, substance consumption and problematic use m...
BACKGROUND AND AIMS: Chronic pain and substance use disorders frequently co-occur and may share general addiction-related and substance-specific genetic pathways. Additionally, substance consumption and problematic use may differ in their genetic associations with pain subtypes. We applied genomic structural equation modeling to assess shared genetic and neurological enrichment between general and musculoskeletal-specific chronic pain to general addiction liability, substance use disorder-specific risk and substance use. DESIGN: Cross-trait genomic structural equation modeling using genome-wide association study (GWAS) summary statistics from large-scale global consortia. SETTING: Data were aggregated from international research collaborations and biobanks in the United States and Europe. PARTICIPANTS: Participants were individuals (n = 63 982 to 2 428 851) with European-like ancestry from population-based and clinical cohorts. MEASUREMENTS: We analyzed a General Chronic Pain factor from 24 chronic pain GWASs and a Musculoskeletal-specific Pain factor from 11 overlapping conditions. We constructed an Addiction factor from GWASs of alcohol, tobacco, cannabis and opioid use disorders, and partitioned out substance-specific genetic risk. We used alcohol and smoking consumption GWASs to distinguish use from problematic use. We applied molecular neurological annotations to assess brain cell type enrichment in shared genetic effects. FINDINGS: The Addiction factor was genetically correlated with General Chronic Pain [genetic correlation (r) = 0.448, false discovery rate (FDR)-corrected P < 0.001, 95% confidence interval (95% CI) = 0.40, 0.49], but not with Musculoskeletal-specific Pain (r = 0.001, FDR-corrected P = 0.998, 95% CI = -0.07 to 0.07). Controlling for Addiction, General Pain had substance-specific associations: negative correlations with Problematic Alcohol Use (r = -0.155, FDR-corrected P = 0.049, 95% CI = -0.28 to -0.02) and Alcohol Frequency (r = -0.334, FDR-corrected P < 0.001, 95% CI = -0.46 to -0.21), and a positive correlation with Cigarette Frequency (r = 0.274, FDR-corrected P < 0.001, 95% CI = 0.21, 0.34). Musculoskeletal-specific Pain positively associated with Tobacco Use Disorder (r = 0.186, FDR-corrected P = 0.020, 95% CI = 0.05, 0.32) and Alcohol Frequency (r = 0.161, FDR-corrected P = 0.049, 95% CI = 0.02, 0.30). General Pain related to Cannabis Use Disorder and Opioid Use Disorder entirely through the Addiction factor. Shared genetic components were enriched in excitatory and inhibitory neurons, glia and endothelial cells. CONCLUSIONS: General chronic pain appears to share substantial genetic overlap and neuronal enrichment with addiction risk and shows distinct associations with problematic alcohol use, alcohol consumption and cigarette use, reflecting both a broad transdiagnostic mechanism as well as substance-specific paths. In contrast, musculoskeletal-specific pain appears to be more narrowly linked to tobacco use disorder and alcohol use frequency, but not to general addiction liability.
A call for action: Closing the evidence gap in management of stimulant-induced psychosis.
Bouthillier A, Sharafi H, Bisaga A … +1 more , Jutras-Aswad D
Addiction · 2026 Mar · PMID 41833512 · Publisher ↗
BACKGROUND: Stimulant-induced psychosis (StIP) is emerging as one of most pressing health challenges. Over the past two decades, stimulant-related harms and psychiatric care demands have risen sharply. Individuals with S...
BACKGROUND: Stimulant-induced psychosis (StIP) is emerging as one of most pressing health challenges. Over the past two decades, stimulant-related harms and psychiatric care demands have risen sharply. Individuals with StIP often present with severe agitation and high suicide risk, and up to half progress to chronic psychotic illness within two years. Despite this burden, clinical recommendations remain sparse and largely based on consensus rather than evidence. This article aims to critically appraise current conceptual and therapeutic approaches to StIP, highlight evidence gaps, and outline priorities for research and clinical practice. ARGUMENT: We propose a re-evaluation of StIP nosology, shifting away from DSM-5 distinctions that require symptom presence beyond abstinence and often fail in real-world settings. Management might require stage-specific approaches- acute (safety and short-term antipsychotics), subacute (stabilization and relapse prevention), and long-term (management of recurrent or persistent psychosis)- yet no validated staging models exist. Antipsychotic prescribing remains guided by expert opinion, with unresolved questions around choice of agent, treatment duration, and relapse prevention strategies. Evidence for psychosocial and behavioral interventions is very limited. Individualized care, supported by predictive tools, biomarkers, and longitudinal risk stratification, is essential to identify individuals at highest risk of progression and chronicity while minimizing unnecessary long-term pharmacotherapy. CONCLUSIONS: Stimulant-induced psychosis (StIP) exemplifies a widening evidence-practice gap. Addressing this requires a coordinated research agenda to address nosology and phenomenology, validate diagnostic algorithms, develop stage-specific management models, and test integrated pharmacological and behavioral strategies. Without such efforts, outcomes will remain poor, and StIP will continue to represent one of psychiatry's most consequential yet neglected syndromes.
The association between sleep disturbance and stimulant use: A cross-lagged examination.
Horigian VE, Schmidt RD, Feaster DJ … +10 more , Duan R, Gonzalez ST, Hefner K, Shmueli-Blumberg D, Vena A, Moran LM, DiCamillo CA, Shafazand S, Tross S, Feinberg J
Addiction · 2026 Mar · PMID 41833393 · Publisher ↗
BACKGROUND AND AIMS: Sleep disruptions increase the risk of substance misuse. Substance use-especially stimulants-can increase acute and chronic sleep dysfunction. This study aimed to estimate the associations between sl...
BACKGROUND AND AIMS: Sleep disruptions increase the risk of substance misuse. Substance use-especially stimulants-can increase acute and chronic sleep dysfunction. This study aimed to estimate the associations between sleep disturbance and stimulant use over time among participants with stimulant use disorder (StUD). DESIGN: In this secondary analysis, a Random Intercept Cross-Lagged Panel Model (RI-CLPM) was used to assess sleep disturbance and stimulant use over 8 weeks among participants with StUD. SETTING: United States of America. PARTICIPANTS: The analysis included 793 participants with StUD enrolled across 3 randomized controlled trials in the National Institute on Drug Abuse's Clinical Trials Network (CTN): CTN-0037, CTN-0048 and CTN-0068. MEASUREMENTS: Self-reported sleep disturbance was harmonized as a binary indicator across trial measures at each week. Stimulant use days per week were captured by Timeline Follow Back. Baseline covariates included age, sex, race/ethnicity, employment status, presence of depressive symptoms, any psychiatric history, treatment arm and trial. FINDINGS: Sleep disturbance was associated with a higher average number of stimulant use days the following week [β = 0.15, 95% confidence interval (CI) = 0.09, 0.22, P < 0.001], and greater stimulant use was linked to increased odds of subsequent sleep disturbance (odds ratio = 1.20, 95% CI = 1.14, 1.26, P < 0.001). CONCLUSIONS: Higher-than-usual stimulant use appears to be associated with increased likelihood of sleep disturbance the following week, and vice versa.
Prevalence differences in lifetime methamphetamine and heroin use among American Indian reservation youth from 2015 to 2024.
Morse JL, Gray BA, Emery NN … +3 more , Crabtree MA, Swaim RC, Prince MA
Addiction · 2026 Jul · PMID 41833366 · Full text
BACKGROUND AND AIMS: Early use of methamphetamine and heroin are associated with severe consequences. American Indian (AI) youth are often portrayed as the highest risk ethnic group in the United States for early use of...
BACKGROUND AND AIMS: Early use of methamphetamine and heroin are associated with severe consequences. American Indian (AI) youth are often portrayed as the highest risk ethnic group in the United States for early use of methamphetamine and heroin, but little empirical evidence supports this. We aimed to examine odds of lifetime methamphetamine and heroin use among the largest representative sample of reservation-area Indigenous youth in the United States, comparing males and females as well as mono-ethnic AI (AI-mono) youth with mono-ethnic non-AI (NAI-mono), multiethnic AI (AI-multi) and multiethnic non-AI (NAI-multi) youth pre- and post-COVID-19 pandemic. DESIGN: Annual cross-sectional epidemiological surveys were conducted from 2016 to 2024, and comparisons were made between successive cross-sectional samples. SETTING: 176 schools on or near AI reservations in the contiguous United States were sampled. PARTICIPANTS: The sample consisted of 28.6% NAI-mono, 38.0%, AI-mono, 24.4% AI-multi and 8.8% NAI-multi youth (n = 50 779; mean age = 14.77; 50.5% male). MEASUREMENTS: Lifetime use of methamphetamine and heroin were assessed via survey items regarding ever having used these substances. FINDINGS: Overall, 2.4% of participants reported lifetime methamphetamine use, and 1.8% reported lifetime heroin use. Prevalence of lifetime methamphetamine use was statistically significantly lower post-COVID-19 [pre-COVID-19 = 3.5%, post-COVID-19 = 1.1%; odds ratio (OR) = 4.13, 95% confidence interval (CI) = 2.72-6.27, P < 0.001]. Regression models revealed pre-COVID-19, males were 1.43 times (P < 0.001) more likely than females to have used methamphetamine and 1.56 times (P < 0.001) more likely to have used heroin. NAI-mono youth were statistically significantly less likely to have used methamphetamine compared with AI-mono youth (OR = 0.74, P = 0.02); however, AI-multi youth were statistically significantly more likely to have used methamphetamine (OR = 1.38, P = 0.01) and heroin (OR = 1.84, P < 0.001) compared with AI-mono youth pre-pandemic. Post-COVID-19, males were 1.77 times (P < 0.001) more likely to have used heroin than females, and AI-multi youth were significantly more likely to have used methamphetamine compared with AI-mono (OR = 2.34, P < 0.001) and NAI-mono (OR = 2.50, P < 0.001) youth as well as heroin compared with AI-mono (OR = 1.52, P = 0.03). CONCLUSIONS: Among United States reservation-area Indigenous youth, use of methamphetamine and heroin was lower after the COVID-19 pandemic than before it; however, multi-ethnic American Indian youth are statistically significantly more likely to have used methamphetamine and heroin than mono-ethnic American Indian youth and mono-ethnic non-American Indian youth. Male youth are also at greater risk for lifetime use, supporting the need for targeted interventions for male and multiethnic American Indian youth.
Changes over time in hallucinogen-related emergency department visits in Ontario, Canada.
Myran DT, MacDonald-Spracklin R, Levesque AR … +7 more , Pugliese M, Fiedorowicz JG, McDonald AJ, Rosenblat JD, Colman I, Zein J, Solmi M
Addiction · 2026 Jul · PMID 41821125 · Full text
BACKGROUND AND AIMS: Recent increasing interest in hallucinogens has underscored the critical gaps in our understanding of their adverse health effects and healthcare usage over time. The current study aimed to examine c...
BACKGROUND AND AIMS: Recent increasing interest in hallucinogens has underscored the critical gaps in our understanding of their adverse health effects and healthcare usage over time. The current study aimed to examine changes in emergency department (ED) visit rates involving hallucinogens, clinical outcomes of visits and the characteristics of individuals with ED visits involving hallucinogens. DESIGN: Repeated cross-sectional study using health administrative data. SETTING: Ontario, Canada. PARTICIPANTS: All individuals aged 10 years and older living in Ontario, Canada, from 2008 to 2023 (population of 13 492 974 in 2023). MEASUREMENTS: Annual rates of ED visits involving hallucinogens overall and by demographic and clinical subgroups. Linear regression was used to calculate the average annual percent change (AAPC) in rates of visits. FINDINGS: We identified 7735 individuals with an ED visit involving hallucinogens [median (interquartile range) age at the time of visit, 24 (19-33) years; 71.5% male] who incurred 8274 visits. Visits displayed high acuity, with 54% arriving by ambulance and 13.2% requiring hospitalization. In 42% of visits another substance or co-morbid mental health diagnosis was noted as contributing to the visit. Annual rates of ED visits involving hallucinogens increased by 97.9% between 2008 and 2023 (3.3 to 6.5 visits per 100 000 individuals) with visits increasing on average by 5.6% per year [AAPC = 5.6%; 95% confidence interval (CI) = 3.9%, 7.3%]. Relative increases between 2008 and 2023 were higher in those aged 25-44 (relative change (RC) 192.5%: AAPC = 8.5%; 95% CI = 6.0, 11.0] compared with other ages (age 45 + RC 125%: AAPC = 5.5%; 95% CI = 3.6, 7.3; age 19-24 RC 75.0%: AAPC = 5.3%; 95% CI = 3.4, 7.3). Visits increased more in individuals with anxiety disorders (RC 247%: AAPC = 7.5%; 95% CI = 5.2%, 9.9%) or prior diagnosis of schizophrenia (RC 401%: AAPC = 12.2; 95% CI = 8.2%, 16.4%) than those without any mental health disorder (RC 85.5%: AAPC = 4.9%; 95% CI = 3.1, 6.7). Comparable changes over time were observed in males (RC 101.1%: AAPC = 4.7; 95% CI = 2.9, 6.5) and females (RC 85.9%: AAPC = 6.0%; 95% CI = 4.2, 7.8) and for those in the richest (RC 124.0%: AAPC = 5.7%; 95% CI = 4.6%, 6.9%) or poorest neighbourhoods (RC 70.2%: AAPC = 5.2%; 95% CI = 3.7%, 6.7%). CONCLUSIONS: The 97.9% increase in emergency department visits involving hallucinogens in Ontario, Canada, from 2008 to 2023 may reflect rising hallucinogen use and the need for ongoing monitoring, particularly in adults aged 25-44 years and those with co-morbid mental health diagnoses.
Determining the impact of cannabis use on tobacco cessation: Results from a prospective non-randomized tobacco treatment trial.
McClure EA, Baker N, Tomko RL … +4 more , Walters KJ, Chapman E, Carpenter MJ, Gray KM
Addiction · 2026 Jul · PMID 41815093 · Full text
BACKGROUND AND AIMS: Tobacco-cannabis co-use is associated with increased psychosocial and health harms; however, the treatment literature assessing the impact of co-use has been mixed and suffers from critical limitatio...
BACKGROUND AND AIMS: Tobacco-cannabis co-use is associated with increased psychosocial and health harms; however, the treatment literature assessing the impact of co-use has been mixed and suffers from critical limitations. To date, no prospective studies have evaluated the degree to which cannabis co-use affects tobacco cessation, nor are there treatment recommendations for those who co-use. The goal of this study was to evaluate and quantify the impact of cannabis co-use on tobacco cessation through a 12-week prospective tobacco cessation trial. DESIGN: This was a multi-site, non-randomized trial. Inverse probability weighted modified Poisson regression models were used to assess the probability of tobacco abstinence between tobacco-only and tobacco-cannabis co-use cohorts. SETTING: Enrollment occurred at three sites across South Carolina, USA: The Medical University of South Carolina (MUSC) Charleston, Behavioral Health Services of Pickens County and MUSC Florence. PARTICIPANTS: Enrolled participants were adults (n = 181; ages 18-40) who (1) smoked tobacco cigarettes and used cannabis regularly (co-use cohort; oversampled) or (2) smoked tobacco cigarettes daily (tobacco-only cohort). Across 3 sites, 181 adults (110 co-using cannabis; 71 tobacco-only) were enrolled (49% female; 19% Black/African American; 6% Hispanic/LatinX). INTERVENTIONS: All participants received 12 weeks of first-line tobacco treatment (varenicline, incentives for tobacco abstinence, counseling), while cannabis use was not addressed as part of treatment. MEASUREMENTS: The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence (PPA) at end of treatment (EOT; Week 12 post-enrollment). FINDINGS: Average baseline reported cigarettes per day were not different between tobacco-only or cannabis co-use cohorts [14.9, (standard deviation, SD = 7.2) versus 13.4 (SD = 7.8); P = 0.25]. Among the co-use cohort, days of cannabis use in the past month at baseline was 23.7 (SD = 9.5). In imputed analyses, EOT 7-day PPA tobacco abstinence was achieved in 59% of tobacco-only participants and 33% of the cannabis co-use cohort [Imputed data: relative risk (RR) = 1.63, 95% confidence interval (CI) = 1.14-2.33]. Neither baseline daily cannabis use [adjusted relative risk (RR) = 1.05, 95% CI = 0.63-1.77] nor within-treatment cannabis use frequency (RR = 0.51, 95% CI = 0.25, 1.06) was associated with EOT PPA for tobacco in the cannabis co-use cohort. CONCLUSIONS: This is the first prospective study designed to compare tobacco cessation outcomes by cannabis co-use status. Regular cannabis co-use had a negative impact on tobacco abstinence among younger to middle-aged adults. Addressing cannabis use should be incorporated into standard tobacco treatment to improve cessation outcomes.
What anabolic-androgenic steroids reveal about the limits of current harm reduction models.
Piatkowski T, Nagata JM, Nielsen S
Addiction · 2026 Mar · PMID 41813613 · Publisher ↗
BACKGROUND: Harm reduction has largely been shaped by responses to psychoactive drug use where the most urgent harms are acute. These models focus on overdose, blood-borne viruses, and rapid-onset toxicity related harms....
BACKGROUND: Harm reduction has largely been shaped by responses to psychoactive drug use where the most urgent harms are acute. These models focus on overdose, blood-borne viruses, and rapid-onset toxicity related harms. When applied wholesale to anabolic-androgenic steroids (AAS), they obscure the distinctive pharmacology, consumer typologies, and slow-developing physiological risks that define people who use AAS. ARGUMENT: AAS use is often chronic, patterned, and long-term. Harms are often cumulative and organ-based rather than event-based. Routes of administration carry different risk profiles, with oral formulations being more hepatotoxic and commonly falsified through mislabelling or adulteration than injectable products. Despite this, most health services position injecting as inherently higher risk, applying paradigms developed for opioids and stimulants that have not been adapted for AAS use. Using evidence across pharmacology, delivery routes, dependence trajectories, and consumer types, this paper argues for expanding harm reduction models to consider the unique needs of different populations of people who use drugs, including AAS. We draw critically on lessons from other substances as well as multiple existing approaches including structured dosing frameworks, and supply-checking infrastructures, provide practical templates for expanding adaptation to AAS. CONCLUSIONS: To remain evidence-based, harm reduction must evolve to be contextually relevant. We have used AAS as an example of this evolution, attempting to highlight cross-substance learnings which integrate consumer-focused tools, workforce development, and peer-led support.
Measuring the psychoactive effects of ketamine in alcohol use disorder: When assessment shapes experience.
McAnulty C, Garel N
Addiction · 2026 Mar · PMID 41808555 · Publisher ↗
Abstract loading — click title to view on PubMed.
Cost-effectiveness of contingency management for methamphetamine use disorder: A model-based analysis.
Qian GL, Chen Y, Rawson RA … +2 more , Humphreys K, Brandeau ML
Addiction · 2026 Mar · PMID 41807076 · Publisher ↗
BACKGROUND AND AIMS: The United States (US) is experiencing a surge in methamphetamine use. Treatment options for methamphetamine use disorder (MethUD) focus on behavior change, particularly via contingency management (C...
BACKGROUND AND AIMS: The United States (US) is experiencing a surge in methamphetamine use. Treatment options for methamphetamine use disorder (MethUD) focus on behavior change, particularly via contingency management (CM), where individuals receive rewards for submitting drug-free urine samples or for other positive behaviors such as attending treatment sessions. Little is known about the cost-effectiveness of CM for treating MethUD, including the January 2025 decision by the US federal government to increase the maximum annual CM incentive ten-fold to $750 per patient. This study aimed to assess the cost-effectiveness of CM for individuals with MethUD in the US. DESIGN, SETTING AND PARTICIPANTS: We developed a microsimulation model of methamphetamine use behavior among individuals with MethUD to assess the effectiveness and cost-effectiveness of CM for treating MethUD. We modeled methamphetamine use states and psychiatric and cardiovascular comorbidities. We considered a 12-week and 24-week CM program, with a maximum $750 incentive. We simulated the model in weekly time steps over the lifetime of a cohort of 10 000 individuals with MethUD, under the status quo (no treatment) and with the CM program. MEASUREMENTS: Number of deaths over one year and lifetime per person healthcare costs (healthcare sector perspective) and quality-adjusted life years (QALYs) experienced. FINDINGS: With no treatment, 274 overdose deaths and 305 total deaths occurred in the cohort over 1 year. Individuals experienced 11.37 lifetime QALYs and incurred $216 320 in lifetime healthcare costs. With a 12-week CM program, an estimated 117 deaths were prevented over 1 year, with a net gain of 0.70 lifetime QALYs per person and incremental cost of $6850 compared with no treatment, yielding an incremental cost-effectiveness ratio (ICER) of $9830/QALY gained [95% credible interval (CR) = $8100-$11 400]. With a 24-week program, 153 deaths were prevented over 1 year, with a net gain of 0.81 lifetime QALYs per person and incremental cost of $10 000, yielding an ICER of $12 312/QALY gained (95% CR = $10 400-$14 100). Even under the pessimistic assumption of no lasting behavior change after CM program completion, the programs cost less than $130 000/QALY gained. Threshold analysis suggests that at a $50 000 willingness to pay, the 24-week program would be cost-effective even if the maximum incentive were $2491. CONCLUSIONS: Modelling shows that contingency management appears to be a highly cost-effective intervention for treating methamphetamine use disorder, even with conservative assumptions and a $750 incentive cap. When cost impacts in the criminal justice and child welfare systems are included, such programs are likely cost-saving.
Healthcare utilization and mortality after overdose prevention site closure: A linked cohort analysis using segmented difference-in-differences time series.
Day N, Kaufmann K, Devoe DJA … +8 more , Grubac V, DiMarzo A, Osmanli H, Norton V, Vik S, Mathew N, Tanguay RL, Bahji A
Addiction · 2026 Mar · PMID 41806310 · Publisher ↗
BACKGROUND AND AIMS: Evidence regarding the impacts of supervised drug consumption services (SDC) remains mixed, and few evaluations have used individual-level, linkable health data to examine service withdrawal. In Sept...
BACKGROUND AND AIMS: Evidence regarding the impacts of supervised drug consumption services (SDC) remains mixed, and few evaluations have used individual-level, linkable health data to examine service withdrawal. In September 2024, the Red Deer overdose prevention site (OPS) in Alberta, Canada, was scheduled for closure, with operations ceasing on 31 March 2025. This study examined: (1) changes in weekly opioid agonist therapy (OAT) dispensing among identifiable OPS clients associated with the closure announcement and subsequent service cessation; and (2) changes in acute healthcare utilization and mortality. DESIGN: Retrospective cohort study using linked provincial administrative health data from 30 June 2024 to 6 months after the Red Deer site closure (27 September 2025). A segmented difference-in-differences interrupted time-series (DID-ITS) design compared Red Deer OPS clients with clients from a continuously operating OPS in Lethbridge. Within-site interrupted time-series (ITS) models were applied for Red Deer-only analyses. SETTING: Two provincially regulated OPS programs in Alberta, Canada. The Red Deer OPS closure was publicly announced on 24 September 2024 and implemented on 31 March 2025. The Lethbridge OPS remained operational throughout. PARTICIPANTS: OPS clients with a linked personal health number (PHN) and at least one consumption event at the Red Deer (n = 381) and Lethbridge sites (n = 300). MEASUREMENTS: Primary outcome: weekly proportion of clients receiving ≥1 OAT dispensing. SECONDARY OUTCOMES: weekly emergency department (ED) visits, inpatient (IP) admissions, suspected opioid-related emergency medical services (EMS) events and mortality. FINDINGS: Prior to the closure announcement, baseline weekly OAT proportions were lower in Red Deer (9.9%) than in Lethbridge (12.0%), with broadly similar pre-announcement trends. After the closure, the proportion of clients on OAT in Red Deer exceeded those in Lethbridge (16.1% versus 14.4%, respectively; P < 0.021). After closure, there was no statistically significant difference in the number of ED visits or suspected opioid-related EMS events in both the Red Deer only ITS models or in the proportion of these outcomes in the DID-ITS model comparing Red Deer and Lethbridge. Mortality events were rare during the follow-up period, and no statistically detectable increase was observed over the available follow-up. CONCLUSIONS: The announcement and subsequent closure of the Red Deer overdose prevention site in Alberta, Canada, were associated with increased opioid agonist therapy dispensing among identifiable site users. Short-term effects on acute healthcare utilization and mortality appear stable but remain inconclusive due to the limited 26-week follow-up period and low event counts.
Medication effects on cue-induced craving in the human laboratory are associated with return to heavy drinking in randomized clinical trials for alcohol use disorder: A follow-up meta-analysis.
Nieto SJ, Du H, Meredith LR … +5 more , Donato S, Baskerville WA, McManus KR, Magill M, Ray LA
Addiction · 2026 Jul · PMID 41797424 · Publisher ↗
BACKGROUND AND AIMS: The alcohol cue-reactivity paradigm is widely used to test the initial efficacy of potential medications for alcohol use disorder (AUD); however, there is limited quantitative evidence demonstrating...
BACKGROUND AND AIMS: The alcohol cue-reactivity paradigm is widely used to test the initial efficacy of potential medications for alcohol use disorder (AUD); however, there is limited quantitative evidence demonstrating that medication effects on cue-induced craving are associated with efficacy in clinical trials. This meta-analysis examined whether medication effects on cue-induced alcohol craving are associated with medication effects in randomized clinical trials (RCTs). METHODS: Follow-up meta-analysis of RCTs. Participants included people who engaged in heavy drinking or have AUD. Medications were compared with a placebo control. We computed medication effect sizes (Cohen's d) for cue-induced craving (k = 36 studies; 15 medications) and for the following individual RCT endpoints (k = 139 studies; 19 medications): percent days abstinent, percent heavy drinking days, the percentage of participants who returned to any drinking, the percentage of participants who returned to heavy drinking, drinks per day and drinks per drinking day. We applied Williamson-York regression models to test the relationship between medication effects on cue-induced craving and the six individual RCT endpoints. One-sided P values were used to test directional hypotheses and two-sided P values were also reported to allow for exploratory interpretation. RESULTS: Medication effect sizes on cue-induced craving were positively associated with medication effect sizes on percent participants who returned to heavy drinking [ = 1.06, standard error (SE) = 0.63, one-sided P = 0.04, two-sided P = 0.09; k = 74; 7 medications] in RCTs but no other RCT endpoints tested. Specifically, medications that reduced cue-induced craving in the human laboratory also decreased the percentage of participants who returned to heavy drinking in RCTs. CONCLUSIONS: Medications that produce greater reductions in cue-induced alcohol craving appear to be associated with lower rates of return to heavy drinking, but not consistently with other drinking outcomes. This pattern indicates that the cue-reactivity paradigm has limited and outcome-specific translational validity rather than functioning as a universal indicator of clinical efficacy.
Understanding the relationship of social anxiety with alcohol use and alcohol-related problems in young people: A meta-analysis.
Fichtenmaier AJ, George AM
Addiction · 2026 Jun · PMID 41796042 · Full text
BACKGROUND AND AIMS: Social anxiety is associated with disparate alcohol-related outcomes among young people. This meta-analysis synthesised the literature to determine what factors (e.g. impulsivity) may account for var...
BACKGROUND AND AIMS: Social anxiety is associated with disparate alcohol-related outcomes among young people. This meta-analysis synthesised the literature to determine what factors (e.g. impulsivity) may account for variance in these outcomes. METHODS: Empirical studies reporting the correlation of social anxiety with alcohol use and/or alcohol-related problems (ARPs) among young people (aged 13-29 years) were identified through a systematic literature search. Five random-effects meta-analyses were performed for ARPs, problematic alcohol use, frequency, quantity and quantity by frequency index measures of alcohol use. Seventy studies were included with 233 effect sizes extracted. The average age was 20 years (n = 38 517; 66.2% female). RESULTS: Social anxiety was negatively associated with index alcohol use [number of studies (k) = 28, r = -0.05, 95% confidence interval (CI) = -0.08 to -0.03, t = -4.04, P < 0.001] but statistically non-significant with quantity (k = 21, r = 0.00, 95% CI = -0.04 to 0.05, t = 0.18, P = 0.86) or frequency (k = 18, r = -0.01, 95% CI = -0.06 to 0.05, t = -0.29, P = 0.78) of alcohol use. Social anxiety was statistically significantly positively associated with ARPs (k = 45, r = 0.13, 95% CI = 0.10-0.16, t = 9.93, P < 0.001) and problematic alcohol use (k = 23, r = 0.06, 95% CI = 0.01-0.11, t = 2.68, P = 0.01). Impulsivity was a statistically significant moderator, such that, as the correlation of impulsivity with social anxiety increased, the association of social anxiety with index alcohol use positively increased. Subgroup analyses for ARPs measure used were also statistically significant. CONCLUSION: Young people with elevated social anxiety appear to drink less alcohol than their peers, but report more problematic alcohol use and alcohol-related problems. Impulsivity may clarify unexpected patterns of lower alcohol consumption, although conclusions remain tentative due to methodological constraints.
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