Addiction [JOURNAL]
Sun
200 papers
A systematic review and meta-analysis of self-reported exposure to cannabis advertising and its association with cannabis use and intentions.
McClure-Thomas C, Yimer T, Strong C … +5 more , Sun T, Hall WD, Chan GCK, Connor JP, Leung J
Addiction · 2026 Jun · PMID 41709693 · Publisher ↗
BACKGROUND AND AIMS: Global changes in cannabis legislation have raised concerns about the potential impact of cannabis advertising on cannabis use and intentions to use. This systematic review and meta-analysis evaluate...
BACKGROUND AND AIMS: Global changes in cannabis legislation have raised concerns about the potential impact of cannabis advertising on cannabis use and intentions to use. This systematic review and meta-analysis evaluated the relationship between self-reported exposure to cannabis advertising across various media platforms and self-reported cannabis use and use intentions. DESIGN: Systematic review and meta-analysis of eligible quantitative studies using random-effects models. SETTING: All included studies were conducted in the United States or Canada. PARTICIPANTS: Participants ranged in age from 11 to 65 + years across 21 included studies. MEASUREMENTS: Studies measured self-reported exposure to cannabis-related advertising and either cannabis use or intentions to use cannabis. Three types of exposure were examined: [1] general cannabis advertising (a composite measure including billboards, storefront/sidewalk, magazines, social media, and other types of advertising avenues), [2] internet/social media advertising, and [3] storefront/sidewalk advertising. FINDINGS: A total of 2588 records were identified through database searches (PubMed, Scopus, and PsycINFO; January 2024). After title and abstract screening, 45 underwent full text review; of these, 21 studies met inclusion criteria. Most were cross-sectional (86%, n = 18), and three were longitudinal. Ten cross-sectional studies were eligible for meta-analysis, which found a statistically significant association between cannabis advertising exposure and cannabis use (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI] [1.32, 2.30]). Statistically significant heterogeneity was found (Q [11] = 22.73, P < 0.05, I = 42.3%) and therefore, based on methodological comparability, three additional meta-analyses were conducted by exposure type. General cannabis advertising (3 studies) exposure was statistically significantly associated with cannabis use (aOR = 1.67, 95% CI [1.27, 2.21]); internet/social media advertising (5 studies) also showed a statistically significant association (aOR = 3.38, 95% CI [1.07, 10.66]); exposure to storefront/sidewalk advertising (3 studies) was not statistically significantly associated with cannabis use (aOR = 1.25, 95% CI [0.95, 1.66]). Across studies, methodological quality was mostly good (48%) or satisfactory (43%), with 10% rated as unsatisfactory. CONCLUSION: There appears to be a generally positive association between exposure to cannabis advertising and cannabis use, with a consistent positive relationship observed between advertising exposure and intentions to use.
The prevalence and correlates of prescription stimulant diversion in a large, multi-institutional, cross-sectional sample of US post-secondary students regularly taking prescription stimulants.
Aluri J, Mojtabai R
Addiction · 2026 Jul · PMID 41705516 · Publisher ↗
BACKGROUND AND AIMS: Prior studies on past year prescription stimulant diversion (PSD) have used small samples with limited representation and generated a wide range of estimates for PSD. This study aimed to estimate the...
BACKGROUND AND AIMS: Prior studies on past year prescription stimulant diversion (PSD) have used small samples with limited representation and generated a wide range of estimates for PSD. This study aimed to estimate the prevalence and identify correlates of PSD using a large, multi-institutional sample of post-secondary students in the United States. DESIGN AND SETTING: Secondary analysis of a cross-sectional survey administered to either random or census samples (i.e. a random subset or all students, respectively) across 196 post-secondary institutions in the United States during the 2023-2024 academic year. PARTICIPANTS: The non-representative sample included 4771 post-secondary students who (a) were aged 18-25, (b) reported taking a prescription stimulant regularly during the past year with or without a prescription and (c) answered a question about stimulant diversion. The mean age was 20.8 years (standard error = 0.05), and most students were female (60.7%), White (71.7%) and heterosexual (50.1%). MEASUREMENTS: The weighted prevalence of past-year PSD was calculated from a self-report question. Demographic, socioeconomic, educational, substance use and service characteristics were examined for association with PSD. FINDINGS: Of 4771 students, 207 reported PSD (4.3%). In the multivariate regression model, PSD was associated with prescription stimulant misuse versus no misuse [adjusted odds ratio (aOR) = 4.02, 95% confidence interval (CI) = 2.32-6.99], binge drinking in the past two weeks versus no binge drinking (aOR = 1.57, 95% CI = 1.02-2.43) and use of other substances in the past 30 days versus no use (aOR = 4.94, 95% CI = 2.58-9.45, Ref = no past 30 day substance use). Receiving the prescription from a campus clinic versus any other source was also associated with PSD (aOR = 1.94, 95% CI = 1.04-3.63). Age, sex at birth, sexual orientation, race, Grade Point Average (GPA), fraternity or sorority affiliation, degree level, housing and receiving the stimulant from a psychiatrist were not associated with PSD. CONCLUSIONS: The prevalence of prescription stimulant diversion in a multi-institutional sample of post-secondary students in the United States was 4.3%, lower than prior estimates. Certain substance use behaviors and obtaining the prescription from a campus clinic were associated with prescription stimulant diversion.
Challenges in establishing a link between THC exposure and cannabis use disorder.
Manthey J, Schranz A, Wardell JD
Addiction · 2026 Feb · PMID 41705441 · Publisher ↗
Abstract loading — click title to view on PubMed.
Cannabis dispensary exposure and smoked, vaped and edible cannabis use among young adults: Comparison of web-scraped and government-maintained registries.
Harlow AF, Williams MP, Pacula RL … +7 more , Leventhal AM, Pedersen ER, Cockburn MG, Thompson LK, Cho J, Barrington-Trimis JL, Haley DF
Addiction · 2026 Jul · PMID 41705440 · Full text
BACKGROUND AND AIMS: The impact of exposure to cannabis dispensaries on young adult cannabis use may depend on how exposures and outcomes are defined. We estimated associations of dispensary exposure with young adult can...
BACKGROUND AND AIMS: The impact of exposure to cannabis dispensaries on young adult cannabis use may depend on how exposures and outcomes are defined. We estimated associations of dispensary exposure with young adult cannabis use across: (a) a government-maintained licensed dispensaries registry versus a web-scraped list of licensed and unlicensed dispensaries; and (b) varying modes of cannabis modes (i.e. smoked, edible, vaped). METHODS: This study used three waves of data (2021-2023) from a prospective cohort of n = 2277 young adults (mean baseline age = 22 years) from California, USA. Generalized linear models estimated the contemporaneous association of number of dispensaries within 1 mile of participants' homes with repeated measures of past 6-month, past 30-day frequency and past 30-day daily/near-daily (≥ 20 days/month) smoked, edible and vaped cannabis use (separate models for each product type). We compared associations for dispensary exposure derived from a government-maintained registry versus a validated web-scraped dispensary list. RESULTS: For each additional dispensary located within 1 mile of home, young adults had 5-6% increased risk of past 6-month use of smoked, edible and vaped cannabis use using registry data and 3-4% increased risk using web-scraped dispensary data. Dispensary exposure was positively associated with past 30-day frequency of smoked [incidence rate ratio (IRR)(registry list) = 1.08, 95% confidence interval (CI) = 1.01-1.15; IRR(web-scraped) = 1.04, 95% CI = 1.00-1.08] and edible [IRR(registry list) = 1.07, 95% CI = 0.99-1.15; IRR(web-scraped) = 1.04, 95% CI = 0.99-1.08] cannabis use, but was not consistently associated with cannabis vaping frequency or daily/near-daily use of any product. Magnitude of associations was generally smaller when using dispensary data derived through web-scraping than the government-maintained registry of dispensary licenses, though conclusions were mostly similar between the two lists and confidence intervals consistently overlapped. CONCLUSIONS: Living near a greater number of cannabis dispensaries within 1 mile of home appears to be associated with an increased risk of cannabis use. Web-scraped dispensary sources and United States government-maintained registry lists produce similar conclusions regarding the association of living near a greater number of dispensaries with young adult cannabis use.
Smoking and drinking among the Gypsy and Traveller communities: A population study in England.
Taylor E, Tattan-Birch H, Oldham M … +3 more , East K, Walsh H, Jackson S
Addiction · 2026 May · PMID 41704033 · Full text
BACKGROUND AND AIMS: Gypsy and Traveller communities in the United Kingdom (UK) face substantial health challenges. Smoking tobacco and drinking alcohol likely contribute to health disparities, but there is little nation...
BACKGROUND AND AIMS: Gypsy and Traveller communities in the United Kingdom (UK) face substantial health challenges. Smoking tobacco and drinking alcohol likely contribute to health disparities, but there is little national data on the prevalence or heaviness of smoking and drinking among these communities. We aimed to estimate the prevalence and heaviness of smoking and drinking among the UK Gypsy and Traveller communities compared with people from other UK ethnic groups. DESIGN/SETTING: Observational study using data collected between 2013 and 2025 in a series of monthly cross-sectional surveys of representative samples of the adult population in England. PARTICIPANTS: Adults aged 18+, between 2013 and 2025 (total n = 226 339; Gypsy or Traveller n = 213). MEASUREMENTS: Marginal means were derived from regression models and used to estimate the prevalence of current smoking and drinking (both of which includes daily and non-daily), and the heaviness of smoking (cigarettes per day) and drinking [Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score, units per week and estimated weekly alcohol consumption] by ethnicity; adjusted for age, gender and survey year. FINDINGS: Current smoking prevalence was markedly higher among Gypsy and Travellers [33.0%, 95% confidence interval (CI) = 26.3-39.8%, n = 81] than among the "Other White" ethnic group (18.7%, 95% CI = 18.5-18.9%; P < 0.001), and exceeded estimates observed across other ethnic groups (range: 9.4-19.9%; all P < 0.001). Among those who smoked, Gypsy and Travellers reported smoking more cigarettes per day (geometric mean = 12.5, 95% CI = 8.9-17.6) than the "Other White" group (geometric mean = 9.0, 95% CI = 8.8-9.1; P = 0.59), with other ethnic groups ranging from 6.8-9.7, although not all comparisons reached significance. The proportion reporting any current alcohol consumption was lower among Gypsy and Travellers (61.5%, 95% CI = 53.8-69.2%, n = 126) than 'Other White' ethnicities (77.1%, 95% CI = 76.8-77.3%; P < 0.001). Prevalence of high risk drinking was similar among Gypsy and Travellers (11.3%, 95% CI = 6.7-15.8%) and "Other White" ethnic groups (10.7%, 95% CI = 10.5-10.9%; P = 0.808) but exceeded estimates observed across all other ethnic groups (range: 1.3-7.1%; all P < 0.05). Prevalence of possible dependence was higher among Gypsy and Travellers (3.5%, 95% CI = 0.4-6.6%) compared with the "Other White" (1.3%, 95% CI = 1.2-1.3%; P = 0.027) and all other ethnic groups (range: 0.3-0.8%; all P < 0.05). CONCLUSIONS: People from Gypsy and Traveller communities in the United Kingdom appear to be more likely to smoke compared with other UK ethnic groups, and those who smoke and/or drink do so at more harmful levels compared with other UK ethnic groups.
The association between gambling frequency and risk of harm: Analysis using health survey data from England and Scotland.
Moore E, Pryce R, Squires H … +1 more , Goyder E
Addiction · 2026 Jun · PMID 41700531 · Full text
BACKGROUND AND AIMS: Health economic models can be used to assess the effectiveness and cost-effectiveness of public health policies for gambling. To develop such a model, we must understand how gambling behaviour is ass...
BACKGROUND AND AIMS: Health economic models can be used to assess the effectiveness and cost-effectiveness of public health policies for gambling. To develop such a model, we must understand how gambling behaviour is associated with risk of experiencing gambling-related harms. This study aimed to: (1) assess the strength of association between gambling frequency and the risk of gambling-related harm and to examine how these associations differ when lottery-only players are excluded; (2) apply the study's findings in a hypothetical policy model aimed at reducing gambling frequency. DESIGN: Observational study using six waves of cross-sectional data from the Health Survey for England and the Scottish Health Survey. SETTING: Survey conducted in England in 2015, 2016 and 2018 and Scotland in 2015, 2016 and 2017. PARTICIPANTS: The sample included 16 648 adults (aged 18 and over) who reported gambling in the past year, generally representative of the populations of England and Scotland. MEASUREMENTS: Gambling frequency was measured using 6 categories which indicated frequency in the past 12 months: (a) 2 or more times a week; (b) once a week; (c) less than once a week, more than once a month; (d) once a month; (e) every 2-3 months; (f) once or twice a year. Risk of gambling-related harm was assessed using Problem Gambling Severity Index (PGSI) score (0-27) and its four categories: no-risk (0), low-risk (1-2), moderate-risk (3-7) and high-risk (≥8). Control variables included age, sex, deprivation, social grade, presence of mental disorder and frequency of drinking alcohol. FINDINGS: Using multinomial logistic regression and zero-inflated negative binomial models we found that gambling at least twice weekly was associated with a statistically significantly higher PGSI score than gambling once or twice a year (incidence rate ratio = 3.528, 95% confidence interval = 2.040-6.103, P value < 0.001). Reducing gambling to guideline levels for people gambling at least twice weekly moved 10% of the sub-sample from higher PGSI categories (low, medium and high risk) to the no-risk category and shifted the distribution of PGSI scores down. CONCLUSIONS: There appears to be a statistically significant association between gambling frequency and risk of gambling-related harm. Data derived from this and similar analyses can be used to model gambling policies which impact gambling frequency.
The psychoactive effects of repeated ketamine infusions and their mechanistic role in the treatment of alcohol use disorder: Secondary analysis of a randomised controlled trial.
Bloy C, Sarma A, Marsh B … +9 more , Hardy L, Grabski M, Mollaahmetoglu M, Shotton J, Bhaskaran S, Lingford-Hughes A, Curran HV, Morgan C, Lawn W
Addiction · 2026 Feb · PMID 41698392 · Publisher ↗
BACKGROUND AND AIMS: Ketamine assisted psychotherapy is a promising new treatment for alcohol use disorder (AUD). The psychoactive effects of repeated intravenous (IV) ketamine infusions in people with AUD and their mech...
BACKGROUND AND AIMS: Ketamine assisted psychotherapy is a promising new treatment for alcohol use disorder (AUD). The psychoactive effects of repeated intravenous (IV) ketamine infusions in people with AUD and their mechanistic role in treating AUD are largely unknown. This study aimed to (1) quantify the subjective, psychoactive effects of IV ketamine in people with AUD, (2) investigate how these effects change over three dosing sessions and (3) test whether these effects mediate ketamine's therapeutic benefits in reducing alcohol consumption. DESIGN: Secondary analysis of the randomised, parallel-arm, double-blind, placebo-controlled, phase 2 'KARE' clinical trial. SETTING: Two clinical research facilities in England. PARTICIPANTS: 96 adults (35 women) aged 18-64 years with moderate-to-severe AUD. INTERVENTION: Three weekly infusions of either ketamine (IV 0.8 mg/kg over 40 minutes) or placebo (saline solution). MEASUREMENTS: Psychoactive drug effects experienced were self-reported pre-, during- and post-infusion, every 20 minutes (eight times/infusion) on Likert scales (1-10), for: Effects of Drug, Liking of Drug, Altered Reality, Out of Body Experiences, Visual Distortion, Sound Distortion and Altered Time Perception. For each scale, we calculated area-under-the-curve (AUC) scores for each infusion and the AUC average across three infusions. The clinical outcome was percentage of days abstinent from alcohol in the 6 months after infusions. FINDINGS: Ketamine produced strong psychoactive effects on every scale, relative to placebo (all P values < 0.001). Ketamine's psychoactive effects were moderated by infusion number (infusion 2 vs. infusion 1) for: Liking of Drug (P = 0.001), Altered Reality (P = 0.030) and Out of Body Experiences (P = 0.033), with small-to-moderate effect sizes. The remaining four psychoactive effects were not statistically significantly changed by repeated dosing. No psychoactive effect statistically significantly mediated the relationship between drug treatment and percentage days abstinent (all P values = 0.075-0.935). CONCLUSIONS: People with alcohol use disorder experience alterations in consciousness from 0.8 mg/kg intravenous ketamine administration. Ketamine's effects appear to be broadly consistent across three repeated infusions. Ketamine-related reductions in alcohol consumption do not appear to be mediated by the acute psychoactive effects of ketamine.
The Polysubstance Assessment Tool: Reliability, acceptability and feasibility of a novel measure of polysubstance use.
Bunting AM, Cleland CM, Barratt SM … +5 more , Griffin B, Williams J, Oser CB, Lee JD, McNeely J
Addiction · 2026 Jun · PMID 41677773 · Full text
BACKGROUND AND AIMS: There are currently no brief quantitative assessments that capture the drug patterns of people who engage in use of more than one drug on the same day or simultaneously. The current study examined th...
BACKGROUND AND AIMS: There are currently no brief quantitative assessments that capture the drug patterns of people who engage in use of more than one drug on the same day or simultaneously. The current study examined the retest reliability, acceptability and feasibility of a new quantitative assessment to measure polysubstance use. DESIGN: A tool for assessing simultaneous and same-day polysubstance behaviors, the polysubstance assessment tool (PAT) was developed in interviewer-administered and electronic self-administered formats. Participants were allocated 1:1 to receive either version of the PAT and returned one to three days later to repeat the assessment. SETTING: New York City, New York, USA. PARTICIPANTS: Adults (18 + years, n = 115) who reported use of more than one drug per day in the last 30 days. MEASUREMENTS: Test-retest reliability estimates for dichotomous items were assessed using Cohen's kappa, Gwet's Agreement Coefficient 1 (AC1) and percent agreement. Continuous items were assessed with two-way mixed effects intraclass correlations. Bivariate analyses examined acceptability using nine Likert-type survey questions. Feasibility was examined via time to completion. FINDINGS: Overall reliability was moderate to excellent [Gwet's AC1 range 0.70-0.96; intraclass correlation (ICC) range 0.62-0.88]. Reliability was higher for simultaneous polysubstance use (Gwet's AC1 = 0.90) as compared with same-day (Gwet's AC1 = 0.70). Acceptability was high, with no statistically significant difference between the self- and interviewer-administered versions of the tool. Median time to completion was 7 minutes, and was statistically significantly lower for the self-administered tool (median = 5 minutes) compared with the interviewer-administered version (median = 8 minutes) (P < 0.001). CONCLUSIONS: A new polysubstance assessment tool appears to have good reliability and can be considered by researchers seeking a quantitative measure of polysubstance use behaviors given its simplicity, high acceptability and quick completion time.
Considering alcohol and other drug screening, brief intervention and referral to treatment in two safety-sensitive industries in Australia: An exploratory qualitative study.
Thompson K, Hart T, Bowden J
Addiction · 2026 Jun · PMID 41652817 · Full text
BACKGROUND AND AIMS: Workplaces offer a practical setting for alcohol and other drug interventions, especially in industries where impairment introduces substantial risk. Screening, brief intervention and referral to tre...
BACKGROUND AND AIMS: Workplaces offer a practical setting for alcohol and other drug interventions, especially in industries where impairment introduces substantial risk. Screening, brief intervention and referral to treatment has demonstrated effectiveness in health care settings and shows promise in workplace settings. However, low participation and high attrition in previous workplace studies indicate a need for deeper understanding of feasibility and acceptability. This exploratory qualitative study aimed to identify likely determinants for implementing alcohol and other drug screening, brief intervention and referral to treatment in two safety-sensitive industries in Australia. METHODS: Qualitative research design based on semi-structured online interviews, focussed on the construction and manufacturing industries. Participants included 23 professionals working in health and safety roles representing 21 organisations located across six Australian jurisdictions. Interview transcripts were coded against the five domains of the updated Consolidated Framework for Implementation Research. FINDINGS: Sixteen determinants were identified that were expected to act as barriers (n = 10) or enablers (n = 5) or have bidirectional impacts (n = 1) on the implementation of screening, brief intervention and referral to treatment in construction and manufacturing. Enabling factors included freely available tools, flexible delivery methods and delivery by trusted, external, peer-based organisations. Pervasive barriers included workers' mistrust of management, concerns about confidentiality and fear of consequences for disclosing substance use. CONCLUSIONS: Successful workplace implementation of screening, brief intervention and referral to treatment appears to depend on organisational cultures where workers trust management, are assured of confidentiality and are not afraid of retribution for disclosure.
Commentary on Lim et al.: Real-world e-cigarette use under prescription-only regulation.
Kale D, Jackson S
Addiction · 2026 May · PMID 41645432 · Publisher ↗
Abstract loading — click title to view on PubMed.
Modelling the economic effects of reducing the consumption of unhealthy commodities: An inter-sectoral input-output approach.
Morris D, Gillespie D, James M … +2 more , Breeze P, Brennan A
Addiction · 2026 Jun · PMID 41629751 · Full text
AIMS: Industry arguments against public health policies that reduce the consumption of unhealthy commodities often include the assertion that the policy will harm the economy by reducing production and costing jobs. Howe...
AIMS: Industry arguments against public health policies that reduce the consumption of unhealthy commodities often include the assertion that the policy will harm the economy by reducing production and costing jobs. However, this argument does not consider that consumers may spend money previously used for unhealthy commodity consumption on other products, benefiting other sectors and potentially offsetting those negative economic consequences. In this study we aimed to estimate the macroeconomic impacts of reducing consumption of alcohol, tobacco, confectionary and gambling, accounting for reallocation of spending from these commodities to alternatives. METHOD: We developed the open-source Commercial Determinants of Health Input-Output (CDOHIO) model version 1.1.0. CDOHIO models inter-sectoral linkages in the United Kingdom (UK) economy using published input-output tables to estimate the macroeconomic outcomes of changes in the total national consumer expenditure on selected unhealthy commodities and the reallocation of this expenditure to other consumption. We modelled a 10% decrease in total consumer expenditure on (1) alcohol, (2) tobacco, (3) confectionary and (4) gambling, assuming that the reduced expenditure was reallocated entirely to other products. The comparator in each case was no change in expenditure. We analysed six economic outcomes: (i) output (the total value of production in the economy), (ii) tax receipts from employees, (iii) tax receipts from employers, (iv) full-time equivalent employment, (v) total net earnings to individuals, and (vi) Gross Value Added (GVA), which is the primary outcome measure used as a proxy for national Gross Domestic Product. RESULTS: For tobacco, confectionary and gambling, reduced spending was estimated to yield positive effects across all six measures. The total effect of a 10% reduction in confectionary spending was an increase in GVA of £0.389 billion (0.02%), for reduced spending on tobacco, +£1.859 billion GVA (+0.09%) and for gambling +£1.250 billion GVA (+0.06%). For alcohol, a 10% reduction in spending led to a small negative effect on GVA (-£0.134 billion, -0.01%), which is the net effect of positive effects of reduced spending on off-trade alcohol (+£2.543 billion) and negative effects of reduced spending on on-trade alcohol (-£2.677 billion). CONCLUSIONS: The potential negative macroeconomic impacts of reducing spending on tobacco, confectionary and gambling in the United Kingdom could be more than mitigated when consumers reallocate money spent on these products to other consumption. This is also the case for off-trade alcohol consumption, but not for on-trade alcohol consumption.
Trends in gamma-hydroxybutyrate use, harms and treatment in Australia, 2013 to 2024.
Peacock A, Chrzanowska A, Man N … +12 more , Darke S, Brown J, Grigg J, Dietze P, Ezard N, Bruno R, Siefried KJ, Salom C, Freestone J, Akhurst J, Tierney L, Sutherland R
Addiction · 2026 May · PMID 41628267 · Publisher ↗
BACKGROUND AND AIMS: There is significant concern about potential rising harms from gamma-hydroxybutyrate (GHB) but an absence of studies internationally synthesising data across indicators to identify changes in harms a...
BACKGROUND AND AIMS: There is significant concern about potential rising harms from gamma-hydroxybutyrate (GHB) but an absence of studies internationally synthesising data across indicators to identify changes in harms and broader patterns of use. This paper contributes to addressing this gap by measuring national trends in GHB use, harms and treatment in Australia. DESIGN, SETTING, AND CASES: Triangulation of indicators (2013-2024) from Australian triennial population surveys; annual interviews with cross-sectional non-representative samples of people who use illicit stimulants or who inject drugs; and administrative data on GHB-related hospitalisations, GHB-related deaths, and treatment episodes where GHB was the principal drug of concern. MEASUREMENTS: Annual trend data were analysed using Joinpoint regression. Survey data were modelled as the annual percent change in the proportion reporting lifetime, past 12-month, and past 6-month use, depending on the survey. Administrative data were modelled as the annual percent change in crude rates per 100 000 population. FINDINGS: Lifetime and past 12-month GHB use in the general population remained below 1.2% and 0.2% respectively, but the latter increased from 0.07% in 2013 to 0.19% in 2022-2023 (annual percent change [APC] 9.3; 95% confidence interval [CI]: 5.2, 13.2). The percentage of people who use illicit stimulants reporting past 6-month use increased from 5.7% in 2013 to 7.3% in 2017 (APC 11.6; 95%CI: 0.2, 52.9) and from 5.4% in 2019 to 11.5% in 2024 (APC 17.8; 95%CI: 5.9, 41.1). The proportion of people who inject drugs reporting use varied between 7.2% and 17.5% over the short period studied (2020-2024). There were statistically significant increases in GHB-related hospitalisations from 5.3 in 2012-13 to 19.1 per 100 000 people in 2022-23 (APC 19.0; 95%CI: 11.9, 31.1) and GHB-related deaths from 0.02 in 2013 to 0.24 per 100 000 people in 2022 (APC 36.5; 95%CI: 27.2, 58.1). Treatment episodes also increased across the period, from 0.07 in 2012-13 to 6.0 episodes per 100 000 people in 2020-21 (APC 97.3; 95%CI: 83.5, 830.9), with no subsequent statistically significant change (8.4 per 100 000 people in 2022-23). CONCLUSIONS: Gamma-hydroxybutyrate use, harms and treatment engagement increased in Australia from 2013 to 2024. These findings highlight a need to implement acceptable, tailored prevention and harm reduction strategies for key populations, and implement stronger monitoring efforts nationally and internationally.
The need for a comprehensive opioid overdose prevention program in Iran.
Malekifar P, Rahimi-Movaghar A
Addiction · 2026 Apr · PMID 41622021 · Publisher ↗
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Bidirectional genetic and phenotypic links between smoking and striatal iron content involving dopaminergic and inflammatory pathways.
Trofimova O, Iuliani I, Bergmann S
Addiction · 2026 Jun · PMID 41619226 · Full text
BACKGROUND AND AIMS: Tobacco smoking is a major risk factor for cardiovascular and lung diseases. A better understanding of its neurobiological underpinnings will benefit the prevention of smoking-related illnesses and m...
BACKGROUND AND AIMS: Tobacco smoking is a major risk factor for cardiovascular and lung diseases. A better understanding of its neurobiological underpinnings will benefit the prevention of smoking-related illnesses and mortality. Previous studies link smoking to increased iron concentration in the striatum, a central component of the brain's reward system, and to reduced cognitive performance. This study aimed to investigate whether smoking and striatal iron share common biological pathways and to assess potential causal relationships between the two. METHODS: Using data from the UK Biobank, we investigated phenotypic and genetic correlations, and causal relationships between smoking initiation and magnetic resonance imaging (MRI)-derived markers of iron content (T2* and quantitative susceptibility mapping) in the bilateral putamen, caudate and accumbens nuclei. RESULTS: We found positive correlations between smoking and striatal iron (β ∈ [0.03, 0.40], P < 0.001), particularly when comparing current smokers with never smokers. Striatal iron was positively associated with pack-years (β ∈ [0.11, 0.13], P < 0.001) and inversely related to years since smoking cessation (β ∈ [0.06, 0.10], P < 0.001), suggesting iron levels may decrease after quitting. Genetic analysis confirmed phenotypic correlations, with shared genetic associations (P < 2.73 × 10, or 0.01 for candidate genes) in genes related to dopaminergic, glutamatergic and synaptic systems (DRD2, PPP1R1B, NCAM1, DLX5, GGACT, NAT16, PLEKHM1). Causality analysis revealed a relationship from smoking to striatal iron via genes involved in synaptogenesis and plasticity (BAI3, SEMA6D, TENM2), with evidence of reverse causality from iron to smoking through inflammatory and immune system-related genes (ING5, NLRP7). CONCLUSIONS: There appear to be links between smoking and striatal iron with complex causal mechanisms involving synaptic transmission and inflammatory circuits. Striatal iron content could serve as a biomarker for smoking-related neurobiological changes and a potential target for interventions aimed at mitigating cognitive decline related to striatal iron accumulation.
Hippocampal subfield differences in people with and without recreational ketamine use: Insights from multi-modal neuroimaging.
Liu YH, Hung CC, Potenza MN … +6 more , Chou KH, Lee PL, Huang CC, Li CR, Lee TS, Lin CP
Addiction · 2026 Jun · PMID 41612591 · Full text
BACKGROUND AND AIMS: Recreational ketamine use has increased globally and is associated with psychiatric and cognitive concerns. The hippocampus in preclinical models shows damage and working-memory disruption with repea...
BACKGROUND AND AIMS: Recreational ketamine use has increased globally and is associated with psychiatric and cognitive concerns. The hippocampus in preclinical models shows damage and working-memory disruption with repeated dosing. However, whether specific hippocampal subregions may differ in people with chronic ketamine use remains unclear. In Taiwan, ketamine is predominantly consumed by smoking ketamine mixed with tobacco, producing smoking-related behavioral profiles like non-ketamine tobacco use participants (TUs). We therefore examined individuals with urine-confirmed ketamine as the only detected substance who reported predominantly smoking-administered recreational use (KUs) and used TUs as controls. This study aimed to: (1) characterize ketamine-use patterns and psychiatric symptoms; (2) compare working-memory and affective-behavioral measures between KUs and TUs; (3) quantify group differences in hippocampal subregion volumes; and (4) assess group differences in functional connectivity (FC) of identified subregions and relationships with neurotransmitter receptor distributions. DESIGN: Cross-sectional case-control study with cognitive testing and neuroimaging. SETTING: Community-based recruitment in Taiwan. PARTICIPANTS: 58 KUs (44 males; mean age = 21.00 ± 4.57) and 73 TUs (52 males; mean age = 24.34 ± 5.86). MEASUREMENTS: Ketamine-use patterns (Addiction Severity Index), psychiatric symptoms [Symptom Checklist-90-Revised (SCL-90-R)], working-memory (N-back), affective-behavioral measures [Barratt Impulsiveness Scale (BIS-11), Buss and Perry Aggression Questionnaire (BPAQ), Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ)], hippocampal subfield volumes (FreeSurfer) and functional connectivity (FC) of identified subregions (seed-based analysis). Spatial correspondence with N-methyl-D-aspartate (NMDA) receptor density was evaluated using JuSpace. FINDINGS: Heavier ketamine use was associated with greater psychological distress [Global Severity Index (GSI) r = 0.343, P = 0.011], particularly anxiety (r = 0.457, P < 0.001) and hostility (r = 0.442, P < 0.001). Although self-reported impulsivity, aggression and reward/punishment sensitivity did not differ between groups, KUs showed reduced accuracy under higher working-memory load [2-back: F(1, 124) = 4.16, P = 0.04, partial η = 0.03; 1-back: F(1, 124) = 8.10, P = 0.005, η2 = 0.06]. KUs displayed reduced left hippocampal volume [F(1, 119) = 4.23, P = 0.04, η2 = 0.03], most marked in the hippocampal-amygdaloid-transition-area [HATA; F(1, 119) = 10.52, P = 0.002, η2 = 0.08]. KUs also showed increased FC between left HATA and frontal, cingulate, temporal, subcortical, insular and cerebellar regions (P < 0.05, AlphaSim corrected), which correlated with NMDA-receptor distributions (z = 0.30, P = 0.005, false discovery rate corrected). CONCLUSIONS: Recreational smoking-administered ketamine use appears to be associated with dose-dependent psychiatric symptoms, load-dependent working memory impairment, selective hippocampal subregion volumetric differences and altered network connectivity aligned with N-methyl-D-aspartate- (NMDA) receptor distribution.
Adolescent cannabis use and psychological distress from 2013 to 2023: A population-based study in Ontario, Canada.
McDonald AJ, Doggett A, Bondy SJ … +10 more , Colman I, Cook S, Hamilton HA, Kurdyak P, Leatherdale ST, Myran DT, Rehm J, Wickens CM, MacKillop J, Halladay J
Addiction · 2026 Jun · PMID 41603606 · Full text
BACKGROUND AND AIMS: Epidemiologic research suggests that adolescent cannabis use is associated with psychological distress (i.e. depression and anxiety symptoms); however, most studies have relied on 20th-century data,...
BACKGROUND AND AIMS: Epidemiologic research suggests that adolescent cannabis use is associated with psychological distress (i.e. depression and anxiety symptoms); however, most studies have relied on 20th-century data, when cannabis was significantly less potent than today. This study aimed to estimate the association between adolescent cannabis use and psychological distress using contemporary population-based data and examine the roles of time [as a proxy for increasing Δ9-tetrahydrocannabinol (THC) potency], sex and age of initiation. DESIGN: Representative cross-sectional survey conducted biennially from 2013 to 2023. SETTING: Ontario, Canada. PARTICIPANTS: 35 007 adolescents in grades 7 to 12. MEASUREMENTS: Past-year cannabis use was categorized as Never, 1-2 times, 3-9 times, 10-39 times or 40+ times. Psychological distress was measured with the Kessler-6 scale using a cut-off score of 13+ indicating anxiety/depression symptoms. Multivariable modified Poisson and least-squares models were used to estimate the association between past-year cannabis use and psychological distress. Survey year and sex were tested as effect modifiers on the multiplicative and additive scales. The association between school grade of cannabis use initiation and psychological distress was also estimated. FINDINGS: From 2013 to 2023, the prevalence of psychological distress increased from 10.7% to 27.4%, whereas cannabis use decreased from 23.1% to 17.6%. Survey year and sex were statistically significant effect modifiers for the association between cannabis use and psychological distress with associations consistent with a super-additive effect but not multiplicative synergy (additive interactions: P < 0.05; multiplicative interactions: P > 0.05). The association between cannabis use and psychological distress strengthened over time, particularly for those using 40+ times compared with abstinence (from 0% [95% confidence interval (CI) = -6% to 6%] adjusted prevalence difference in 2013 to 18% (95% CI = 11%-25%] adjusted prevalence difference in 2023). Independent of time, there was evidence of dose-response among females, but not males. A 5% (95% CI = 1%-10%) lower prevalence of psychological distress was observed per later school grade of cannabis use initiation. CONCLUSIONS: Psychological distress increased markedly among adolescents in Ontario, Canada, from 2013 to 2023. In that setting, adolescent cannabis use was statistically significantly associated with psychological distress, especially among females, and this association increased in magnitude over time, especially for those using most frequently. It is possible that adolescents are increasingly self-medicating psychological distress with cannabis and/or that rising cannabis potency is increasingly contributing to psychological distress. While causality cannot be established, based on the precautionary principle, policymakers should prioritize cannabis prevention strategies that aim to reduce frequency of use, limit potency and delay age of initiation, particularly among females.
A cost-benefit analysis of the implementation and scale-up of harm reduction interventions in the Australian Capital Territory.
Bowring AL, Tidhar T, Olsen A … +6 more , Bailie C, Burke K, Martin-Hughes R, Keane H, Dietze P, Scott N
Addiction · 2026 May · PMID 41592220 · Publisher ↗
BACKGROUND AND AIMS: Harm reduction interventions aim to reduce negative consequences of drug use. We aimed to estimate the cost, health impact and economic benefits of current, expanded and new harm reduction interventi...
BACKGROUND AND AIMS: Harm reduction interventions aim to reduce negative consequences of drug use. We aimed to estimate the cost, health impact and economic benefits of current, expanded and new harm reduction interventions for people who use drugs in the Australian Capital Territory. DESIGN: We conducted a cost-benefit analysis of existing and new harm reduction interventions in the Australian Capital Territory. Independent decision tree models captured health outcomes [opioid/non-opioid overdose; overdose-related deaths; injection-related skin/soft tissue/vascular infections (IRIs); hepatitis C incidence] for 2026-2030 according to intervention coverage. SETTING: Australian Capital Territory, Australia. PARTICIPANTS/CASES: People who use drugs through injecting (n = 1500) or non-injecting (n = 33 600) routes differentiated by drug class (opioid/non-opioid). INTERVENTIONS AND COMPARATOR: A baseline scenario (current intervention coverage maintained) was compared with a counterfactual no interventions scenario, as well as scenarios with interventions linearly scaled up to the assumed maximum proportion of the target population that could be reached given geographical, social and implementation constraints. Interventions included in the analysis were: drug consumption rooms, needle-syringe programs, take-home naloxone, opioid agonist treatment, safer opioid supply, drug checking services and technological interventions (i.e. overdose monitoring 'apps'/hotlines). MEASUREMENTS: Economic benefits were estimated from health costs averted (emergency response; shorter hospitalisation for IRI; hepatitis C treatment) and societal costs from years of life lost. Benefit-cost ratios were calculated compared to the baseline. A sensitivity analysis considered a changed illicit drug market with increased probability of overdose and overdose-related death. FINDINGS: Compared with no coverage, the current package of harm reduction interventions was estimated to cost $24.6 million over 2026-2030 and avert 454 (24%) opioid and 20 (0.2%) non-opioid overdoses, 70 (28%) overdose-related deaths, 215 (17%) emergency responses, 552 (117%) hepatitis C infections and 199 (9%) IRIs. This corresponds to $250.1 million in economic benefits [benefit-cost ratio = 10.1, 95% confidence interval (CI) = 7.9-12.4]. Benefit-cost ratios for scaling up take-home naloxone [16.4 (5.0-27.9)], opioid agonist treatment [10.2 (5.6-15.3)], technological interventions [3.5 (0.0-15.7)], drug consumption room/s using medialised [1.9 (0.6-3.9)] or nurse/peer-led model [2.7 (1.2-4.4)], safer opioid supply [1.5 (0.8-2.6)] and needle-syringe programs [1.4 (0.7-2.6)] were favourable. The benefit-cost ratio for drug checking was 0.3 (0.0-6.2) but increased to 14.0 (0.1-29.6) under changed drug market conditions. CONCLUSIONS: Modelled expanded and new harm reduction interventions for people who use drugs in the Australian Capital Territory appear to be likely to be cost saving from a societal perspective. If circulation of drugs with higher overdose risks was greater in this region, this would increase the impacts of interventions to prevent overdose and associated harms.
Comparing the accuracy of artificial intelligence models to detect alcohol in video images.
Pararath Salim S, He Z, Millward J … +2 more , Kuntsche E, Riordan B
Addiction · 2026 May · PMID 41588658 · Publisher ↗
BACKGROUND AND AIMS: Thanks to smart devices, social media and streaming platforms, watching videos, like movies or short social media clips, has become extremely popular. Alcohol portrayals are frequent in videos, yet t...
BACKGROUND AND AIMS: Thanks to smart devices, social media and streaming platforms, watching videos, like movies or short social media clips, has become extremely popular. Alcohol portrayals are frequent in videos, yet their prevalence is difficult to quantify using traditional methods such as manual coding. Artificial intelligence (AI) offers a scalable solution to analyse large volumes of video images. This study aimed to compare the accuracy of three AI models in detecting alcohol presence in video images. METHOD: Experimental evaluation of three models: one supervised deep learning model (ABIDLA2) and two zero-shot learning models (ZSL-CLIP and ZSL-LLaVA). The models were tested on datasets of video frames that had been annotated by researchers for whether they included alcohol or not. Three datasets of increasing complexity were used: (1) a Google/Bing image set of clearly visible alcohol and non-alcohol images; (2) a set of movie frames manually annotated as containing or not containing alcohol; and (3) a contextually challenging set of movie frames from alcohol-related settings (e.g. bars, parties) that may or may not include visible alcohol. Model performance was assessed using accuracy, unweighted average recall (UAR) and F1 score, representing the balance between precision and recall. Execution time per frame was also measured to evaluate computational efficiency. RESULTS: Across the three datasets, ABIDLA2, ZSL-CLIP and ZSL-LLaVA achieved percentage accuracies of 90%, 91% and 92% on the Google/Bing images; 70%, 65% and 95% on the diverse movie-scene dataset; and 67%, 63% and 94% on the most complex alcohol-related dataset, respectively. In terms of execution time, ABIDLA2 processed a single frame the fastest (0.21 seconds), followed by ZSL-LLaVA (0.45 seconds), while ZSL-CLIP was the slowest (0.58 seconds). CONCLUSION: Automated artificial intelligence (AI) models appear to be able to detect alcohol imagery in videos at large scale with high accuracy and in near real time. Of the three AI models tested, ZSL-LLaVA achieved the best balance between accuracy and speed. Offering a cost- and time-efficient alternative to labour-intensive manual coding, ZSL-LLaVA could be used to monitor alcohol-related visual content in videos across diverse media platforms.
Commentary on Mereish et al.: Supporting sexually diverse youth requires a full spectrum understanding of substance use.
London-Nadeau K, Rioux C
Addiction · 2026 May · PMID 41582664 · Full text
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Predictors of outpatient treatment engagement following a visit to a specialized emergency department for substance use: A cohort study using high-resolution electronic health records.
Romero D, Kåberg M, Berman AH … +3 more , Carlbring P, Franck J, Lindner P
Addiction · 2026 May · PMID 41582065 · Full text
BACKGROUND AND AIMS: Substance-related emergency department (ED) visits represent a critical opportunity to link individuals with sustained treatment for substance use disorders (SUD), yet few transition to post-acute tr...
BACKGROUND AND AIMS: Substance-related emergency department (ED) visits represent a critical opportunity to link individuals with sustained treatment for substance use disorders (SUD), yet few transition to post-acute treatment. Among emerging initiatives to integrate specialized SUD care into ED services, the Stockholm SUD-ED is an example of a fully integrated model that remains unmapped. This study aimed to systematically map care pathways and identify predictors of post-acute SUD treatment engagement among SUD-ED patients in Stockholm. DESIGN: Retrospective cohort study. Electronic health records data were linked with five registries covering, among other aspects, clinical history and healthcare consumption. SETTING: The Stockholm SUD-ED, Sweden. PARTICIPANTS: n = 9771 SUD-ED patients during a sixteen-month period (2018-2019). MEASUREMENTS: For care flow mapping, post-acute SUD treatment engagement was defined as ≥2 outpatient visits during a six-month follow-up. Four engagement levels (none, low, moderate, high) were derived using a quantile regression approach and regressed on 19 candidate predictors in multinomial logistic regression models. FINDINGS: Of all SUD-ED patients, one-third (33.2%; n = 3248) primarily engaged in post-acute outpatient SUD treatment, 16.9% (n = 1651) primarily engaged in non-SUD psychiatric services and 49.9% (n = 4872) did not engage in either. Police-initiated admissions had lower odds of moderate or high post-acute treatment engagement than ambulance-initiated admissions [high engagement: adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.53-0.95]. Prior needle and syringe program visits increased the odds of post-acute treatment engagement (aOR = 2.09, 95% CI = 1.59-2.75). Lack of prior SUD outpatient treatment was consistently associated with lower odds of post-acute engagement across all levels (e.g. moderate engagement: aOR = 0.3, 95% CI = 0.25-0.35). CONCLUSIONS: The Stockholm model for fully integrating specialized substance use disorder care into emergency departments appears to generate high post-acute treatment engagement and highlights the need for (1) targeted interventions for police-initiated admissions and (2) broad aftercare options to better attract treatment-naïve patients.
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