Addiction [JOURNAL]
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200 papers
Psilocybin microdosing in the United States: Insights from a nationally representative survey.
Priest M, Kilmer B, Ramchand R … +1 more , Atshan S
Addiction · 2026 Mar · PMID 41795902 · Publisher ↗
BACKGROUND AND AIMS: There has been a resurgence of interest in using psilocybin to treat various mental health conditions. Although some adults in the United States (US) are using psilocybin, little is known about the e...
BACKGROUND AND AIMS: There has been a resurgence of interest in using psilocybin to treat various mental health conditions. Although some adults in the United States (US) are using psilocybin, little is known about the epidemiology of its use, especially for microdosing (i.e., taking a fraction of a regular dose). This study aimed to present nationally representative survey results about people who microdose psilocybin in the US. METHODS: A probability-based and nationally representative survey of individuals living in the US was fielded from December 2023 to January 2024. A population estimate of how many US adults have microdosed, recency of microdosing, and intentions for microdosing was calculated using sample weights designed to produce national estimates. Multinomial logit models were used to identify predictors of microdosing status across demographic characteristics. RESULTS: Of 4253 respondents who completed the screener, 554 reported using psilocybin in their lifetime. Among the 12.1% of US adults who used psilocybin in their lifetime, 26.5% (95% Confidence Interval [CI]: 21.5-32.1%) reported they microdosed the last time they used, 57.5% (95% CI: 51.5-63.2) reported they did not microdose, and 14.6% (95% CI: 10.8-19.5) did not know or were unsure. Among the 3.1% of adults who used psilocybin in the past year, 46.9% (95% CI: 35.3-58.8) reported they microdosed the last time they used, 45.6% (95% CI: 34.2-57.5) reported they did not microdose, and 6.1% (95% CI: 2.8-12.8) did not know or were unsure. Compared with those who did not microdose the last time they used psilocybin, those who did were 12 percentage points (p = 0.002) more likely to have used psilocybin for improved physical health and 25 percentage points (p < 0.001) more likely to have used for improved mental health (including to address substance use disorders). Those who microdosed were also 27 percentage points (p < 0.001) less likely to report using psilocybin for fun or pleasure than those who did not microdose at last use. Individuals who used psilocybin more recently (in the past year) were 25 percentage points (standard error: 0.07; p < 0.001) more likely to report microdosing than those who used more than a year ago. CONCLUSIONS: At least 8.4 million US adults have microdosed psilocybin in their lifetime. Those who have used psilocybin within the past year are more likely to report microdosing the last time they used than those who have used psilocybin more than one year ago; however, approximately 15% respondents who used psilocybin in their lifetime were unsure whether they microdosed the last time they used. Improving physical and mental health are the top motivations for self-reported microdosing among US adults.
Long-term effects of a peer-led Brief Alcohol Screening and Intervention for College Students (BASICS) intervention to reduce alcohol consumption among Spanish university students: A 12-month randomised controlled trial.
Lavilla-Gracia M, Pueyo-Garrigues M, Alfaro-Díaz C … +1 more , Canga-Armayor N
Addiction · 2026 Jul · PMID 41787594 · Full text
BACKGROUND AND AIMS: Harmful alcohol consumption remains widespread among university students and is associated with numerous academic, social and health-related consequences. Peer-led approaches offer a promising strate...
BACKGROUND AND AIMS: Harmful alcohol consumption remains widespread among university students and is associated with numerous academic, social and health-related consequences. Peer-led approaches offer a promising strategy to reduce risky drinking in this population. This study evaluated the long-term effects of a peer-led Brief Alcohol Screening and Intervention for College Students (BASICS) program. DESIGN: A parallel two-group randomised controlled trial with a follow-up period of 12 months was conducted. SETTING: The study took place at a university in Spain. PARTICIPANTS: A total of 308 undergraduate students who had engaged in at least one episode of heavy drinking in the previous month were randomly assigned to either the intervention group (n = 154) or the control group (n = 154). INTERVENTION: The intervention group received a single individual session of the peer-delivered BASICS program. The control group received no intervention during the study period. MEASUREMENTS: The primary outcome was the number of alcoholic drinks consumed during a typical week at the 12-month follow-up. Secondary outcomes included weekly drinking at one month, as well as weekend drinking, drinks on the heaviest occasion, binge drinking episodes, peak blood alcohol concentration during a typical week and on the heaviest occasion, alcohol-related consequences, motivation to reduce alcohol use and self-efficacy, all of which were assessed at both 1 and 12 months. FINDINGS: At the primary 12-month follow-up, statistically significant between-group differences were observed for all nine measured outcomes. For the primary outcome, the mean weekly alcohol consumption was 8.93 drinks [95% confidence interval (CI) = 7.7-10.2] in the intervention group and 12.35 drinks (95% CI = 11.1-13.6) in the control group. The between-group difference was 3.42 drinks (95% CI = 1.66-5.18), indicating lower consumption in the intervention group. Among the secondary outcomes, statistically significant differences were also observed for weekend drinking (3.08 drinks, 95% CI = 1.59-4.56), drinks on the heaviest occasion (3.27 drinks, 95% CI = 1.79-4.76), binge drinking frequency (0.93 episodes, 95% CI = 0.54-1.32) and alcohol-related consequences (3.28 points, 95% CI = 1.74-4.82). CONCLUSIONS: Among Spanish college students who had engaged in at least one episode of heavy drinking in the previous month, a single peer-led Brief Alcohol Screening and Intervention for College Students (BASICS) session produced sustained improvements in alcohol use, related consequences, and psychological mediators up to 12 months post-intervention.
Impact of enhanced practices on opioid overdose deaths: A community-based modeling approach.
Barbosa C, Chen Q, Sahinkoc M … +17 more , Zarkin GA, Dowd W, Villani J, Barocas JA, Cerdá M, Chatterjee A, Fareed N, Hyder A, Keyes KM, Larochelle MR, Linas BP, Roberts SM, Schackman BR, Seiber E, Wakeman SE, Knudsen AB, Chhatwal J
Addiction · 2026 Jul · PMID 41786317 · Full text
BACKGROUND AND AIMS: The opioid crisis is still a public health emergency in the United States, despite recent declines in opioid overdose deaths (OODs) and increased availability of evidence-based practices (EBPs) for o...
BACKGROUND AND AIMS: The opioid crisis is still a public health emergency in the United States, despite recent declines in opioid overdose deaths (OODs) and increased availability of evidence-based practices (EBPs) for opioid use disorder (OUD). The geographic variability in OODs drives the need for localized decision-making, where interventions are tailored to the unique needs of communities. This study aimed to develop and calibrate a simulation model that evaluates the impact of enhanced implementation of EBP on OODs at the community-level. DESIGN: We developed OPSiM (Opioid Policy Simulation Model), a community-level microsimulation model that simulates the course of opioid use, OUD, treatment, recovery and overdose-related events. The model was parameterized with data from the HEALing Communities Study and looked at six scenarios of EBPs implemented in 2025 with sustainment through 2030: (1) maintain 2024 EBP levels (status quo); (2) increase initiation of medications for opioid use disorder (MOUD); (3) increase MOUD retention; (4) increase MOUD initiation and retention; (5) increase distribution of naloxone; and (6) both scenarios 4 and 5. SETTING: Twenty-nine communities in Massachusetts, New York, and Ohio, USA. PARTICIPANTS: Simulated community residents with non-prescribed opioid use or OUD. MEASUREMENTS: Estimated number of OODs per 100 000 individuals between 2025 and 2030 in each community, averaged across the 26 communities. FINDINGS: Under the status quo, the model projected 158 OODs (range across communities: 39-468) per 100 000 individuals between 2025 and 2030. Increasing medications for the treatment of OUD (MOUD) retention alone reduced OODs by 6% (range: 3-15%), while increasing MOUD initiation alone reduced OODs by 9% (range: 8-12%). Increasing both MOUD initiation and retention had a synergistic effect, reducing OODs by 21% (range: 15-31%). Reduction in OODs in response to increased MOUD initiation and/or retention was similar across urban and rural communities. The effect of increasing naloxone distribution varied substantially across communities due to differing saturation levels; in some communities, additional naloxone kits provided only marginal benefits. Rural communities were further from saturation whereas most urban communities were at or close to saturation. CONCLUSIONS: A tailored, multi-pronged approach that scales up medications for opioid use disorder alongside widespread naloxone distribution, and that addresses community-specific needs and capacities, will be most effective at reducing opioid overdose deaths in the United States.
Theorizing causality: A qualitative study of xylazine-related wound diversity and perceived etiology among people who inject drugs.
German D, Villarroel K, Denney M … +7 more , Guta A, Evans J, Bienert J, Fidler A, Ashburn K, Kosinski Z, Genberg BL
Addiction · 2026 Jul · PMID 41786273 · Full text
BACKGROUND AND AIMS: Incidence and severity of opioid-associated skin and soft-tissue infections, often requiring intensive and costly medical care, have increased substantially since the emergence of xylazine in the US...
BACKGROUND AND AIMS: Incidence and severity of opioid-associated skin and soft-tissue infections, often requiring intensive and costly medical care, have increased substantially since the emergence of xylazine in the US drug supply. Although progress has been made in clinical and harm reduction recommendations for treating xylazine-related wounds and slowing their progression, the mechanisms remain insufficiently established. This study aimed to describe wound experiences among people navigating xylazine exposure and explore their perspectives on wound etiology to inform collaborative clinical and public health approaches. DESIGN: Qualitative research as part of a convergent parallel mixed methods rapid assessment. SETTING: Baltimore, Maryland, USA. PARTICIPANTS: Eligible participants were age 18 or over, Baltimore residents and reported injection drug use and xylazine and wound experience in the past year. Participants (n = 26) were evenly distributed by gender and race, mostly over 40, heterosexual, recently unhoused and most frequently injected "fentanyl, in combination with something" or speedball. MEASUREMENTS: Semi-structured qualitative interviews and participatory body mapping, verbatim transcription, iterative thematic analysis. FINDINGS: Participants classified their wounds from mild (35%) to severe (23%) and commonly reported multiple wounds with shifting severity. Some characteristics matched those typically attributed to xylazine exposure, while others had less clear origins but were still perceived as xylazine-related. A spectrum from pimples, bumps, blisters to deep and blackened ulcerations were considered likely to be xylazine-related and a range of vascular and systemic symptomatology were considered possibly related, as were nasal and throat wounds for those who sniffed or snorted drugs. Participant causal attribution theories related to injection preparation (dilution, contamination), point of contact (subcutaneous tissue, vascularized areas, pulse injection) and interactions with co-occurring health conditions affecting vascular or immune systems (e.g. hypertension, auto-immune disorders). These align with physiological pathways suggested by clinicians and other researchers and offer additional explanations generated among people who inject drugs, drawing on injection-related physiological expertise and lived experience in the absence of formal clinical information. This attribution framework suggests a complex interplay between injection practices, xylazine's physiological effects and individual health conditions on wound development. CONCLUSIONS: Participant causal attribution theories about their possibly xylazine-related wounds align with physiological pathways suggested by clinicians and other researchers and offer additional explanations for wound etiology generated among people who inject drugs.
Gatekeeping harm reduction in Canadian Federal Prisons: Perspectives on the threat risk assessment for the prison needle exchange program by prison administrative leadership.
Kronfli N, Popovic N, Weiss E … +7 more , Stoové M, Lafferty L, Price O, Madden LM, Hajarizadeh B, Lloyd AR, Altice FL
Addiction · 2026 Mar · PMID 41785914 · Publisher ↗
BACKGROUND AND AIMS: Prison needle exchange programs (PNEPs) are evidence-based, cost-effective interventions that prevent transmission of blood-borne viruses. PNEPs were introduced in a minority of Canadian federal pris...
BACKGROUND AND AIMS: Prison needle exchange programs (PNEPs) are evidence-based, cost-effective interventions that prevent transmission of blood-borne viruses. PNEPs were introduced in a minority of Canadian federal prisons in 2018; however, participation is contingent on a mandatory approval process known as a "Threat Risk Assessment" (TRA). Although the TRA seeks to protect institutional safety and staff well-being, it has delayed access and restricted program participation. We aimed to explore prison administrators' perceptions of the TRA, including its goals and potential alternatives, within the broader PNEP policy objective of facilitating access to clean needles/syringes for people who inject drugs in prison. DESIGN AND SETTING: Qualitative analysis using semi-structured interviews across nine Canadian federal prisons with PNEPs. PARTICIPANTS: Twenty-seven institutional heads, including Wardens, Assistant Wardens of Operations and Chiefs of Health Services. MEASUREMENTS: Matland's Ambiguity-Conflict model informed this analysis. FINDINGS: Institutional heads largely described the TRA as a security tool, a clear goal consistent with low ambiguity, but whose aims often conflicted with PNEP goals of low-threshold access, placing implementation in a high conflict-low ambiguity political implementation paradigm. In this paradigm, top-down decision making, underpinned by carceral logic and moral hazard framing, prioritizes institutional security over public health. Many also perceived the TRA's function as symbolic, primarily to appease labour partners and demonstrate due diligence to external bodies, an interpretation that increases ambiguity around the TRA's true purpose consistent with high conflict-high ambiguity implementation. Participants proposed two pragmatic alternatives to reduce conflict: re-assigning the TRA to Health through a more bottom-up decision making approach, characteristic of low conflict-high ambiguity experimentation implementation; and streamlining the current TRA process within Operations, consistent with a low conflict-low ambiguity administrative implementation paradigm. A minority advocated to eliminate the TRA and grant automatic PNEP enrolment, aligning with community norms and international practice. CONCLUSION: Within Canadian federal prisons, the "Threat Risk Assessment" (TRA) appears to be a structural process obstacle within the prison needle exchange program (PNEP) policy that fails to provide low threshold access to PNEPs due to the prioritization of institutional safety at the cost of public health. Alternative options to the current TRA process clarify actionable levels for policy refinement that preserve safety, improve access and better align with evidence and public health goals.
Temporal and geographical patterns of nitazene detections in drug samples and biospecimens in the United States, 2019-2024.
Zhu DT, Fitzgerald ND, Palamar JJ … +1 more , Krotulski AJ
Addiction · 2026 Mar · PMID 41785913 · Full text
BACKGROUND AND AIMS: Nitazenes are a novel subclass of synthetic opioids that have been increasingly implicated in the United States (US) overdose crisis. Despite their growing presence in the illicit drug supply, nation...
BACKGROUND AND AIMS: Nitazenes are a novel subclass of synthetic opioids that have been increasingly implicated in the United States (US) overdose crisis. Despite their growing presence in the illicit drug supply, national trends have not been systematically evaluated. This study aimed to describe temporal and geographic patterns in nitazene detections and assess substances co-involved in nitazene-positive biospecimens. DESIGN: Cross-sectional study using forensic data from two national sources: the US Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS) and the Center for Forensic Science Research & Education's (CFSRE) NPS Discovery Program. SETTING AND CASES: Nitazene detections in all 50 US states and the District of Columbia between 2019 and 2024. MEASUREMENTS: We quantified annual nitazene detections overall and by individual nitazene analog, US Census region and state. Temporal trends were modeled using piecewise linear regression with a Poisson distribution and log link, nationally and by region. NPS Discovery data were used to characterize substances co-involved with nitazene-positive biospecimens. FINDINGS: Between 2019 and 2024, 7117 nitazene analog reports were submitted to NFLIS, increasing from 43 in 2019 to 1905 in 2024. Counts rose sharply from 2019 to 2021 [count ratio = 7.32; 95% confidence interval (CI) = 2.22-24.20] but did not increase statistically significantly from 2021 to 2024 (count ratio = 1.08; 95% CI = 1.00-1.17). Early detections were predominated by isotonitazene (97.7% of NFLIS nitazene reports in 2019) but later shifted toward metonitazene and protonitazene (29.5% and 30.1%, respectively, in 2024). NPS Discovery identified 361 nitazene-positive biospecimens, increasing from 11 in 2019 to 113 in 2024, with counts increasing by approximately 45% per year (count ratio = 1.45; 95% CI = 1.23-1.71). Nearly all nitazene-positive biospecimens (98.3%) had at least one co-detected substance, most commonly fentanyl (54.6%). CONCLUSIONS: Nitazene detections increased sharply across the United States between 2019 and 2024, with shifting patterns in the prevalence of individual nitazenes and extensive polysubstance involvement. These findings highlight the need to strengthen drug testing capacity, expand epidemiological surveillance and implement targeted public health interventions to mitigate harms associated with this emerging class of synthetic opioids.
Associations between the national 'Swap to Stop' programme offering free vapes for smoking cessation and quit attempts in England: Results from a population-based survey.
Buss VH, Beard E, Shahab L … +4 more , Simonavičius E, Bauld L, Brown J, Brose L
Addiction · 2026 Jun · PMID 41785407 · Full text
BACKGROUND AND AIMS: Vapes are effective for smoking cessation. The UK Government launched the Swap to Stop initiative in England in December 2023, aiming to encourage people to quit smoking by providing free vape starte...
BACKGROUND AND AIMS: Vapes are effective for smoking cessation. The UK Government launched the Swap to Stop initiative in England in December 2023, aiming to encourage people to quit smoking by providing free vape starter kits alongside behavioural support. This study aimed to assess the association between the introduction of Swap to Stop and the proportion of people in England who tried to quit smoking using vapes in the past year. DESIGN: Data came from the Smoking Toolkit Study, a monthly cross-sectional population-based survey. The primary analysis used an interrupted time-series approach based on Autoregressive Integrated Moving Average (ARIMA) regression models. SETTING: Telephone interviews with people residing in private households in England between December 2021 and December 2024. PARTICIPANTS: People aged ≥16 years who smoked in the past year. MEASUREMENTS: The outcome was vape use during past-year quit attempts. The intervention effect was included as a step change in December 2023 to indicate the start of the Swap to Stop programme. The model also included a dummy variable to adjust for above-inflation tobacco tax increases. FINDINGS: The primary analysis indicated that the introduction of Swap to Stop in December 2023 was associated with a 1.5 absolute percentage point increase (adjusted B = 0.015, 95% confidence interval = 0.005-0.025) in the proportion of people in England using vapes in past-year quit attempts that persisted to December 2024. CONCLUSIONS: The introduction of Swap to Stop (which provides free vape starter kits with behavioural support to quit smoking) in England appears to be associated with a statistically significant increase in quit attempts using vapes.
Underage deaths associated with substance-related harm in Taiwan: A national 10-year study.
Wei SY, Hu HY, Pan CH
Addiction · 2026 Jul · PMID 41755806 · Publisher ↗
AIMS: The objective of this study was to investigate underage deaths of preschool-aged children involving substance detection. DESIGN: Retrospective study. SETTING: Data from 2013 to 2022 were retrieved from the Institut...
AIMS: The objective of this study was to investigate underage deaths of preschool-aged children involving substance detection. DESIGN: Retrospective study. SETTING: Data from 2013 to 2022 were retrieved from the Institute of Forensic Medicine, Taiwan. CASES: Forty-seven cases of of substance-related deaths among individuals aged ≤5 years. MEASUREMENTS: The primary outcome was the identification of detected substances and their concentrations. Secondary outcomes included the manner and cause of death. FINDINGS: Among the 47 preschool-aged cases, methamphetamine was detected in 66% of them. Drug intoxication (30%) was the most frequently reported primary cause of death, followed by inflicted injury (13%). Lung disease (34%), head trauma (15%), smothering (9%), stillbirth (6%), sudden infant death syndrome (6%), starvation (6%) and choking (6%) were identified as common causes of death. Notably, 66% of the cases involved infants younger than one year, and no deaths were observed among children aged 5 years during the study period. CONCLUSIONS: Between 2013 and 2022, the deaths of 47 preschool-aged children in Taiwan involved substance detection, of which methamphetamine was the most frequently detected substance and drug intoxication the most frequently reported primary cause of death.
Generative AI tools and fabricated references.
Brown J, Marsden J
Addiction · 2026 May · PMID 41755787 · Publisher ↗
Abstract loading — click title to view on PubMed.
Does the total consumption model apply to cannabis use?
Norström T, Leifman H
Addiction · 2026 Jul · PMID 41734810 · Full text
AIMS: To test whether the total consumption model and its extension, the theory of collectivity, apply to adolescent cannabis use. We estimated: (1) whether the distribution of cannabis use frequency was stable over time...
AIMS: To test whether the total consumption model and its extension, the theory of collectivity, apply to adolescent cannabis use. We estimated: (1) whether the distribution of cannabis use frequency was stable over time; (2) whether changes in average cannabis use were mirrored across consumption quantiles; and (3) whether higher average use corresponds with a higher prevalence of high-frequency users. DESIGN: Repeated cross-sectional study based on annual surveys. We analyzed trends in cannabis use frequency across consumption percentiles using Lorenz curves and Gini coefficients to assess distributional stability. We used ordinary least squares (OLS) regression to estimate the elasticities between overall mean frequency of use and mean frequency of use for five quantiles ranging from P25 to P95. The association between average use and the prevalence of high-frequency users was examined graphically and parametrically. SETTING: Sweden. PARTICIPANTS: Ninth-grade students (aged 15-16) surveyed annually between 1990 and 2023 (excluding 2013), with a total of 180 059 respondents, and 2nd-year high school students (aged 17-18) surveyed annually between 2004 and 2023 (excluding 2013 and 2020), totaling 80 925 respondents. Our analyses were limited to individuals who reported cannabis use, resulting in analytical samples of 10 139 9th-grade students and 11 160 2nd-year high school students. MEASUREMENT: Frequency of cannabis use was measured by a question on how many occasions the respondent has used hashish or marijuana. The seven response alternatives ranged from 0 to 50 times or more. FINDINGS: Mean frequency of cannabis use fluctuated statistically significantly across survey years among 9th-grade students (F-test = 7.647, P < 0.001) and marginally among 2nd-year students (F-test = 1.550, P = 0.068). Notwithstanding this variation in mean use, the distribution of frequency of cannabis use remained stable: Lorenz curves were consistent across years, and Gini coefficients showed no significant changes. Mean frequency in all five quantiles (25th-95th) were positively and statistically significantly associated with overall mean frequency, suggesting synchronized changes across user groups; e.g. the elasticity for P50 was estimated at 0.914 (P < 0.001) in 9th grade. Increases in mean frequency use were associated with a higher prevalence of high-frequency users. Thus, an increase in average frequency of cannabis use by 1 percentage point was associated with a 1.794 (standard error = 0.065, P < 0.001) percentage point increase in high-frequency users in 9th grade. CONCLUSIONS: Adolescent cannabis use in Sweden appears to conform to key predictions of the total consumption model and its extension, the theory of collectivity.
Historical trends in self-reported US heroin initiation.
Caulkins JP, Giri B
Addiction · 2026 Jun · PMID 41733494 · Full text
BACKGROUND AND AIMS: Illegal opioids create challenges for public health and safety. There is imperfect understanding of when use of illegally manufactured opioids increased. This paper examined data on self-reported yea...
BACKGROUND AND AIMS: Illegal opioids create challenges for public health and safety. There is imperfect understanding of when use of illegally manufactured opioids increased. This paper examined data on self-reported year of first heroin use in the United States. DESIGN: Secondary analysis of general population survey data. SETTING: United States. PARTICIPANTS: 1 708 720 across 38 surveys from 1979 to 2023. MEASUREMENTS: The U.S. National Survey on Drug Use and Health and its predecessors ask respondents about their year of first use for various substances. In any single survey, few report initiating heroin in a specific year, but combining multiple surveys improves precision, enabling the plotting of time trends. Those who initiate can be broken down by age and by whether they report having misused pain relievers before they first used heroin. FINDINGS: Self-reported heroin initiation appears to have been rare before the late 1960s, although data for those years are sparse. It rose sharply to a peak in 1972, fell by almost half, and remained stable from 1978 to 1994. It rose by about 75% in the late 1990s and a further 85% by the early 2010s. The proportion reporting misuse of prescription opioids before first using heroin increased from about one-third before 1990 to one-half by 2000 and 80% by 2010. The proportion who were over age 40 at the time of first heroin use increased from nearly 0 before 1990 to 10% in 2012 and about 40% in 2020-2021. CONCLUSIONS: In the United States, heroin initiation that is self-reported to have occurred after 2000 differs in magnitude and character from that from the late 1970s through mid-1990s. Changes began before dates commonly associated with restrictions on opioid prescribing. This appears consistent with a view that "trading down" from prescription opioid misuse to consumption of illegally manufactured opioids did not only occur after implementation of policies to reduce opioid prescribing.
The feasibility of integrating remote breath alcohol monitoring into ecological momentary assessment of intimate partner violence among young adults with a history of heavy drinking and aggression.
Brem MJ, McCarthy DM, Shorey RC … +4 more , Lin M, Lozano AJ, Sjafii E, Tobar-Santamaria A
Addiction · 2026 Jun · PMID 41725361 · Full text
AIMS: We examined the feasibility and acceptability of pairing portable breathalyzers to assess field alcohol use with mobile ecological momentary assessment (EMA) to assess intimate partner violence (IPV; psychological,...
AIMS: We examined the feasibility and acceptability of pairing portable breathalyzers to assess field alcohol use with mobile ecological momentary assessment (EMA) to assess intimate partner violence (IPV; psychological, cyber, physical and sexual aggression) perpetration and victimization among undergraduates who drink heavily and were recently aggressive. DESIGN, SETTING AND PARTICIPANTS: We assessed EMA/breathalyzer completion rates, drinking captured via breathalyzer versus self-report, number of IPV events captured, procedural acceptability and reactivity to assessment. Sex differences were examined. Undergraduates aged 18-25 (n = 103; M age = 21 years, SD = 2.0; 52% women; 80.6% heterosexual; 64.1% white; 93.2% non-Hispanic) recruited from a large Mid-Atlantic university in the United States completed a baseline survey then a 30-day EMA wherein they were prompted to complete one morning and three evening surveys (7 PM, 9 PM, 11 PM) daily. After each evening survey, participants were prompted to submit a breath alcohol content (BrAC) sample to a breathalyzer linked to surveys. Participants could self-initiate surveys after drinking or IPV outside of assessment periods. Afterward, participants completed an exit survey. MEASUREMENTS: Outcome variables were self-reported alcohol use and IPV assessed via EMA surveys, and BrAC assessed via breathalyzer. Self-reported procedural acceptability was assessed in the exit survey. Reactivity to assessment was assessed by analyzing daily trends in IPV and drinking by sex using generalized linear mixed effects models. FINDINGS: Participants completed 80% of surveys and responded to 91% of breathalyzer prompts. BrAC was captured in 89.4% of self-reported drinking events, 91.4% of self-reported non-drinking events and 95.8% of IPV events, with greater responsiveness to breathalyzer prompts as the evening progressed despite increasing intoxication. More IPV events were captured during evening and event triggered (358 combined total events) than morning surveys (245 events). Results were comparable across women and men. Each additional study day was associated with modest declines in odds of experiencing any IPV [odds ratio (OR) = 0.95, 95% confidence interval (CI) = 0.94-0.97, P < 0.001], IPV perpetration (OR = 0.94, 95% CI = 0.92-0.96, P < 0.001), IPV victimization (OR = 0.97, 95% CI = 0.96-0.99, P = 0.004), any drinking (OR = 0.99, 95% CI = 0.98-1.00, P = 0.01) and positive BrAC readings (OR = 0.99, 95% CI = 0.98-1.00, P = 0.052), suggesting minimal reactivity to assessment. Participants reported high overall satisfaction with study components. CONCLUSIONS: Pairing ecological momentary assessment with portable breathalyzers to capture data on drinking and intimate partner violence across 30 days among US undergraduates who were previously aggressive and who drink heavily appears to be both feasible and acceptable.
The prevalence of cannabidiol (CBD) use in North America and Europe: A meta-analysis.
Weidberg S, Iza-Fernández C, Alemán-Moussa L … +2 more , Krotter A, González-Roz A
Addiction · 2026 Jul · PMID 41724499 · Full text
BACKGROUND AND AIMS: The global cannabidiol (CBD) market has expanded in recent years. Several studies suggest CBD use, whether for medical or recreational purposes, is on the rise; however, no systematic assessments of...
BACKGROUND AND AIMS: The global cannabidiol (CBD) market has expanded in recent years. Several studies suggest CBD use, whether for medical or recreational purposes, is on the rise; however, no systematic assessments of its prevalence have been conducted so far. This meta-analysis aimed to estimate the prevalence of CBD use in North America and Europe independently. METHODS: Searches were conducted in PubMed, PsycINFO and Web of Science on 25 March 2025. A total of 43 studies (48 distinct samples; n = 388 447; 57.52% female) from North America (k = 30; n = 353 088) and Europe (k = 13; n = 35 359) were included in the analyses. The prevalence was estimated at five time periods (i.e. lifetime, past 12 months, past 30 days, past 7 days and daily use) separately for each continent region. Differences in prevalence estimates by sex, year of data collection and sample type (i.e. clinical versus community) were examined. Publication bias was estimated using several indicators, and the methodological quality of the studies was appraised using the Joana Brigg's Institute (JBI) checklist. RESULTS: In preliminary analyses of heterogeneity there was evidence of differences in prevalence between North America and Europe across all time periods (P-value range: < 0.001-0.057). Consequently, the pooled prevalence estimates were calculated for both continental regions separately. In Europe, the pooled lifetime prevalence of CBD use was 12.8% [95% confidence interval (CI) = 0.06-0.25], 17.6% (95% CI = 0.11-0.28) in the past 12 months, 7.2% (95% CI = 0.02-0.21) in the past month, 4.3% (95% CI = 0.01-0.13) in the past week and 2.1% (95% CI = 0.01-0.08) daily. In North America, lifetime pooled estimates were 28.9% (95% CI = 0.2-0.39), 19.5% in the past 12 months (95% CI = 0.11-0.32), 12% in the past month (95% CI = 0.07-0.2), 10.5% in the past week (95% CI = 0.01-0.47) and 6.4% daily (95% CI = 0.03-0.13). Of the moderators tested, sample type statistically significantly influenced the meta-analyses. In Europe, clinical samples (25.6%) reported higher past-year prevalence of CBD use in comparison with community samples (11.6%), whereas in North America there was higher past-year use of CBD among community samples (26.1%) compared with clinical samples (4.1%). CONCLUSIONS: Cannabidiol use appears to be more prevalent in North America compared with Europe.
Tissue-retained needles in people who inject drugs: A systematic review of case reports and series on clinical presentations, complications and management.
Laukkala H, Nevalainen A, Rinta-Kiikka I … +5 more , Heikkilä S, Kiuru S, Sumanen M, Arponen O, Nevalainen O
Addiction · 2026 Jun · PMID 41724496 · Full text
BACKGROUND AND AIMS: Tissue-retained needles from intravenous drug use can cause rare but severe complications, ranging from local to systemic infections to needle embolization. Due to the limited evidence and the lack o...
BACKGROUND AND AIMS: Tissue-retained needles from intravenous drug use can cause rare but severe complications, ranging from local to systemic infections to needle embolization. Due to the limited evidence and the lack of epidemiological studies on the issue, we systematically reviewed the literature focusing on case reports and case series on the clinical presentations, diagnostic approaches, and management of tissue-retained needle fragments. METHODS: A systematic review of English-language case reports and case series was conducted (PROSPERO ID: CRD42024517020) on 15 November 2024, using PubMed and Scopus. Two authors performed the search independently and in duplicate following the PRISMA flow diagram. Case reports were included when the retained needles among people who inject drugs were confirmed by imaging, surgery or autopsy. Data on clinical characteristics, presentation, complications and outcomes were extracted by two reviewers and summarized descriptively. RESULTS: From 1479 citations, we included 46 publications reporting 52 cases [47 (90%) patients and 5 (9.6%) autopsy cases]. Patients were mostly young adults with a median age of 35.0 (range: 22-55) years and predominantly male [n = 37/52 (71%)]. No deaths were reported among the patients presenting with needle fragments; in the autopsy cases, the needles were incidental findings and not the cause of death. Although injection sites were not systematically imaged in all cases, nearly one third [n = 15/52 (29%)] of cases involved multiple retained needles. Needles migrated via circulation were most often found in the heart [n = 23/52 (44%)] or the lungs [n = 13/52 (25%)]. One fifth [10/47 (21%)] of the patients received antibiotics without needle retrieval, and in 18/47 patients (38%) the needle was surgically removed. CONCLUSIONS: Retained needle fragments among people who inject drugs are found in a range of anatomical sites, are often multiple, are not associated with fatal outcomes and are often incidental findings in autopsies. Management varies substantially as some patients receive antibiotics alone while some have needles removed surgically.
Exploring the intersection of heavy alcohol use and masculine norms as risk factors for male-to-female intimate partner violence: Evidence from an Australian national survey.
Willoughby B, Smit K, Wilson IM … +2 more , Gilchrist G, Laslett AM
Addiction · 2026 Jun · PMID 41720613 · Full text
BACKGROUND AND AIMS: Endorsement of traditional masculine norms and male alcohol use are identified risk factors for male-to-female intimate partner violence (MFIPV) perpetration, yet their interaction remains unexplored...
BACKGROUND AND AIMS: Endorsement of traditional masculine norms and male alcohol use are identified risk factors for male-to-female intimate partner violence (MFIPV) perpetration, yet their interaction remains unexplored in Australia. This study aimed to estimate the associations between heavy male alcohol use, endorsement of traditional masculine norms and MFIPV perpetration, and test their interaction among Australian men. DESIGN AND SETTING: Cross-sectional analysis of nationally representative data from Wave 1 (2013-2014) of the Australian Longitudinal Study on Male Health (Ten to Men). PARTICIPANTS: Participants were 12 284 men who were Australian citizens or permanent residents aged 18 years or older who identified as heterosexual and answered any of the MFIPV items. MEASUREMENTS: The primary outcome was lifetime MFIPV perpetration assessed through three items on frightening, physically harming or forcing sex on a partner. Predictors included past-year heavy episodic drinking (HED) and endorsement of masculine norms. Sociodemographics, other drug use, depression, anxiety and sexual performance problems were included as covariates. Multivariable logistic regression models with 95% confidence intervals (CI) were used to examine associations between sociodemographics, specific masculine norms, HED, total masculinity scores and perpetrating MFIPV. An interaction between HED and masculinity on MFIPV was also tested. FINDINGS: Of the 12 284 men (M = 38.3 years), 2947 (23.8%, 95% CI = 22.7-25.0) reported lifetime perpetration of MFIPV, with men aged 30-49 years reporting the highest perpetration rate (26.8%, 95% CI = 24.5-29.1). Higher mean scores on playboy, risk-taking, self-reliance, power over women and violence norms were associated with increased odds of reporting MFIPV perpetration, whereas greater scores on emotional control, primacy of work and heterosexual presentation norms appeared protective. Past-year HED [odds ratio (OR) = 1.24, 95% CI = 1.05-1.48] and greater total masculinity scores (OR = 1.03, 95% CI = 1.01-1.04) were both independently associated with statistically significantly higher odds of reporting lifetime MFIPV perpetration. A statistically significant interaction effect revealed higher total masculinity scores were associated with increased odds of MFIPV perpetration among men with past-year HED, after adjusting for sociodemographic characteristics and covariates (OR = 1.03, 95% CI = 1.00-1.06, P = 0.035), but not among men who did not engage in HED. CONCLUSIONS: Among Australian men, heavy episodic drinking appears to modify the association between traditional norms of masculinity and reporting male-to-female intimate partner violence, with stronger endorsement of traditional masculine norms associated with higher odds of perpetration among men reporting past-year heavy episodic drinking.
Personalizing smoking cessation pharmacotherapy using neuroaffective reactivity profiles: A randomized controlled trial.
Versace F, Green CE, Cui Y … +7 more , Robinson JD, Deweese MM, Minnix JA, Kypriotakis G, Kim S, Karam-Hage M, Cinciripini PM
Addiction · 2026 Jul · PMID 41720599 · Full text
BACKGROUND AND AIMS: By assessing neuroaffective response to motivationally relevant cues before a quit attempt, we have shown that smokers who attribute greater incentive salience to cigarette-related cues than non-ciga...
BACKGROUND AND AIMS: By assessing neuroaffective response to motivationally relevant cues before a quit attempt, we have shown that smokers who attribute greater incentive salience to cigarette-related cues than non-cigarette-related rewards (Sign-trackers, ST) benefit more from varenicline compared with smokers with the opposite neuroaffective reactivity profile (Goal-trackers, GT). This proof-of-concept trial aimed to extend this work by testing whether the efficacy of varenicline relative to nicotine replacement treatment differs across the two neuroaffective reactivity profiles. DESIGN: A 2-group, double-blind, randomized controlled clinical trial with stratification on ST versus GT classification (based on baseline-assessed neuroaffective reactivity profiles) for adults seeking to quit smoking using varenicline or nicotine replacement therapy (NRT). SETTING: Hospital-based outpatient clinic specializing in smoking cessation treatment, located in Houston, Texas, USA. PARTICIPANTS: 158 community volunteers (78 randomized to varenicline and 80 to NRT): 18-75 years of age, smoking 5 or more cigarettes/day and without severe comorbid psychiatric disorders, uncontrolled medical illnesses or contraindications for pharmacotherapy. INTERVENTIONS AND COMPARATORS: Twelve weeks of varenicline or NRT combined with brief cessation counseling. MEASUREMENTS: Primary outcome: continuous smoking abstinence over the last 4 weeks of treatment. SECONDARY OUTCOMES: continuous abstinence at 3- and 6-month follow-ups. FINDINGS: Using a Bayesian approach, we estimated the probability that an interaction between treatment and neuroaffective profile exists. We pre-specified a probability above 80% as evidence for an interaction. Logistic regression indicated a 92.7% probability that an interaction between treatment and neuroaffective profile exists, exceeding the pre-specified threshold. Individuals with the ST profile responded better to varenicline than to NRT. At the end of treatment, the ST group showed a 35% Absolute Risk Difference (ARD) favoring varenicline over NRT (absolute cessation rates: 47% and 11%, respectively). In contrast, among individuals with the GT profile, the benefit of varenicline was smaller, with an ARD of 13% (absolute cessation rates of 29% for varenicline and 17% for NRT). The varenicline advantage for the ST group persisted at 3- and 6-month follow-ups. CONCLUSIONS: Smokers seeking to quit who attribute greater incentive salience to cigarette-related cues than non-cigarette-related rewards benefit more from varenicline than from nicotine replacement therapy. These findings support using neuroaffective biomarkers to inform personalized smoking cessation interventions.
Glucagon-like peptide-1 receptor agonists in alcohol use disorder: Multi-system effects, early clinical promise and uncertain long-term use.
Haass-Koffler CL
Addiction · 2026 May · PMID 41715992 · Publisher ↗
Abstract loading — click title to view on PubMed.
Availability of nitazenes via cryptomarkets and surface web shops: An observational study.
Man N, Barratt MJ, Sutherland R … +4 more , Bruno R, Graham C, Sadaphale V, Peacock A
Addiction · 2026 Jul · PMID 41715911 · Publisher ↗
AIMS: To identify: (i) availability of nitazenes for purchase on international cryptomarkets and surface web shops, (ii) country of origin and country of destination of advertised products and (iii) types and forms of ni...
AIMS: To identify: (i) availability of nitazenes for purchase on international cryptomarkets and surface web shops, (ii) country of origin and country of destination of advertised products and (iii) types and forms of nitazenes available. We also identified shifts in market characteristics over time where possible. METHODS: Observational study of cryptomarkets and surface web marketplaces selling drugs and specifically nitazenes. Data comprised: (i) all drug listings on 34 cryptomarkets, collected twice monthly from October 2021 to September 2024, and from which nitazene listings were identified and (ii) all nitazene listings on 10 surface web shops, identified in April 2024 via search query on purchasing nitazenes in Australia on a common search engine. The former were analysed using Joinpoint regression; the latter descriptively. RESULTS: While nitazene listings comprised a small proportion of total drug listings across the cryptomarkets (0.16%), the proportion of nitazene listings had a small and fluctuating increase over the 3 years [average monthly percent change (MPC) = 1.7%; 95% confidence interval (CI) = 0.4%, 2.4%]. Overall, 78.9% of listings were reported as available for delivery to Australia, decreasing from 90.4% in October 2022 to 67.7% in September 2024 (MPC = -2.1%; 95% CI = -2.8%, -1.6%). The proportion reported as originating from Asia decreased from August 2023 (52.8%) to September 2024 (12.1%) (MPC = -11.7%; 95% CI = -16.3%, -8.9%), while listings originating from North America increased from April 2023 (19.3%) to September 2024 (82.8%) (MPC = 9.0%; 95% CI = 7.3%, 11.2%). Isotonitazene, protonitazene and metonitazene were most frequently identified, with proportion of isotonitazene and protonitazene listings increasing over the 3 years (average MPC = 2.1%; 95% CI = 1.5%, 2.8% and average MPC = 4.1%; 95% CI = 2.8%, 5.4%) and metonitazene declining (average MPC = -3.5%; 95% CI = -4.2%, -2.7%). Powder was the predominant form (87.2%), although the proportion of pills statistically significantly increased between October 2021 (0.0%) and September 2024 (20.2%) (MPC = 11.8%; 95% CI = 7.7%, 16.5%). Seven out of 10 surface web shops sold nitazenes for Australian delivery. Ten types of nitazene were identified on surface web shops. Powder was also the main form listed, followed by nasal sprays. CONCLUSIONS: From October 2021 to September 2024, nitazenes were listed across a range of cryptomarkets and surface web shops, with shifts in the types available and their reported country of origin. These market insights show the importance of ongoing digital trace monitoring and reinforce the need for comprehensive harm reduction strategies and strong public health risk communication frameworks.
On the need and contents of a specific addiction recovery research agenda.
White WL, Kelly JF
Addiction · 2026 Jul · PMID 41714158 · Full text
BACKGROUND: For decades knowledge about the etiology, epidemiology, neurobiology, typology, and treatment of addiction in various populations has been well documented and widely disseminated. In more recent years, there...
BACKGROUND: For decades knowledge about the etiology, epidemiology, neurobiology, typology, and treatment of addiction in various populations has been well documented and widely disseminated. In more recent years, there has been a growing interest in investigating the prevalence, multiple pathways, and mechanisms that facilitate sustained remission and long-term stable recovery. Such an endeavor is predicated on the belief that discovery of not just more effective short-term stabilization and addiction treatment protocols, but also how people achieve long-term recovery will help ameliorate current addiction crises. Such experiential knowledge could inspire and inform the testing of new service strategies to meet the dynamic recovery needs of diverse populations-services that could be coordinated with, or supplant, existing ones toward the goals of engaging affected individuals and families earlier and better supporting them across the long-term stages of recovery. ARGUMENT/ANALYSIS: The "why", "what" and "how", involved in creating and pursuing a recovery research agenda is described, with detailed attention given to twelve significant research dimensions that promise to enhance understanding of the multiple recovery pathways and mechanisms and thereby improve the precision, nature, timing, and scope of services. The article also describes how best to engage with recovery communities cross-culturally to obtain the most accurate, informative, and beneficial results. CONCLUSIONS: A new science of addiction recovery promises to reinvigorate and vitally inform clinical and public health efforts in ameliorating endemic harms related to addiction.
Decline of phosphatidylethanol (B-PEth) during abstinence in patients with alcohol use disorder undergoing withdrawal treatment, and the correlation of B-PEth with self-reported alcohol intake.
de Bejczy A, Walther L, Nilsson-Wallmark C … +2 more , Askerup B, Isaksson A
Addiction · 2026 Jun · PMID 41710972 · Full text
BACKGROUND AND AIM: Accurately estimating alcohol consumption is crucial for clinical decision-making and monitoring treatment outcomes. Phosphatidylethanol in blood (B-PEth), a direct alcohol biomarker, is currently the...
BACKGROUND AND AIM: Accurately estimating alcohol consumption is crucial for clinical decision-making and monitoring treatment outcomes. Phosphatidylethanol in blood (B-PEth), a direct alcohol biomarker, is currently the most reliable indicator of alcohol intake, with a detection window of several weeks; however, the factors influencing the decline of B-PEth levels remain largely unknown. This study aimed to investigate the decline of B-PEth levels during abstinence in patients with alcohol use disorder (AUD) undergoing withdrawal treatment. METHOD: A total of 100 patients were recruited in withdrawal treatment and followed during three to four weeks of abstinence. Blood samples were collected at baseline and weekly during abstinence to measure B-PEth levels of two homologues (16:0/18:1 and 16:0/18:2). Self-reported alcohol consumption was documented using the Timeline Followback (TLFB) method for 30 days before abstinence and throughout the study period. RESULTS: B-PEth elimination followed first-order kinetics. The mean half-life was 7.24 days [95% confidence interval (CI) = 6.98-7.53] for 16:0/18:1 and 4.55 days (95% CI = 4.44-4.67) for 16:0/18:2. The rate of decline varied by week, with a longer half-life observed in week three compared with week one. No statistically significant sex differences were detected. The strongest correlation between B-PEth levels and self-reported alcohol consumption was found for data from two weeks prior to abstinence. CONCLUSION: Elimination of phosphatidylethanol in blood (B-Peth) follows first-order kinetics, with homologue 16:0/18:1 exhibiting a longer half-life than 16:0/18:2. The rate of decline is influenced by the week of alcohol abstinence and B-PEth levels are detectable even in the fourth week of abstinence. The strongest correlation between B-PEth and self-reported alcohol consumption is at two weeks prior to abstinence.
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