Drug And Alcohol Dependence[JOURNAL]
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200 papers
Pilot randomized study of three digital models to train opioid use disorder counselors in community reinforcement and family training.
Macky J, Handley C, Kirby KC … +8 more , Fitzpatrick B, Kishpaugh J, West C, Meyers RJ, Bearnot B, Herrera AE, Whitmarsh EH, McCarthy JM
Drug Alcohol Depend · 2026 Aug · PMID 42284931 · Full text
INTRODUCTION: Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that promotes family skills to encourage people with substance use disorders to seek treatment. To enhance scalable CRAFT im...
INTRODUCTION: Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that promotes family skills to encourage people with substance use disorders to seek treatment. To enhance scalable CRAFT implementation, we assessed three digital counselor training models for fidelity, feasibility/acceptability, and implementation potential. METHOD: Participants (47 counselors) were randomized to one of three digital training programs. Tutorial (T): two-week CRAFT modules. Tutorial + Self Study Materials (TM): two-week tutorial plus 13 modules of training materials (e.g., session videos/checklists) released over 10 weeks after the tutorial. Tutorial + Self Study Materials + Coaching (TMC): two-week tutorial, 10 weeks of additional materials, plus feedback and coaching on ≥one recorded CRAFT sessions. Participants completed assessments at baseline, two weeks, and 12-weeks. The primary outcome was CRAFT fidelity. Secondary outcomes included CRAFT knowledge, feasibility, acceptability, and implementation potential. RESULTS: TMC participants demonstrated the highest CRAFT fidelity and knowledge with 83% of counselors achieving proficiency (T:0%; TM:67%). Feasibility was highest for completing the tutorial (73-100% of participants), then the CRAFT session recording and coaching (79%), and the self-study materials (56-75%). 93% of participants were satisfied with their training program. Implementation potential scores were high across all training groups. CONCLUSIONS: The TMC training yielded the best balance of CRAFT fidelity, feasibility/acceptability and implementation potential. TM had the next highest fidelity, and its significantly lower cost/effort may aid implementation in resource-limited settings. T alone was not sufficient to facilitate CRAFT fidelity. Digital training has promise for expanding CRAFT implementation and potentially addressing clinical workforce gaps. CLINICALTRIALS: gov:NCT05875142.
Efficacy signals in a 12-week trial of clavulanic acid to decrease cocaine use.
Maser J, Callans L, Yu D … +9 more , Kampman K, McRae-Clark A, Cunningham R, Walters MI, Tabi S, Lu X, Lapeyra O, Kakar R, Morrison MF
Drug Alcohol Depend · 2026 Aug · PMID 42284930 · Publisher ↗
BACKGROUND: There is urgent need for effective medication to treat cocaine use disorder (CUD). Clavulanic acid (CLAV) is a clinical stage medication that has potential for treating CUD. METHODS: Sixty-four participants w...
BACKGROUND: There is urgent need for effective medication to treat cocaine use disorder (CUD). Clavulanic acid (CLAV) is a clinical stage medication that has potential for treating CUD. METHODS: Sixty-four participants with CUD were randomized and received either 500mg/day CLAV or matched placebo in a 12-week outpatient study, with dose escalation to 750mg/day in week 5 with continued use. RESULTS: There was no statistically significant improvement in the CLAV treatment group compared to the placebo group. However, women taking CLAV reduced use. Starting at week 4, women reported significantly more days without cocaine use relative to baseline than women taking placebo. During the last 3 weeks of the study, women taking CLAV had a median of 4.0 more days without cocaine per week relative to baseline compared to 0.6 days in the placebo group. CLAV treatment also reduced cocaine withdrawal symptoms in women relative to baseline compared to the placebo over the first 3 weeks of the study. No such trends were identifiable in men. CONCLUSION: At the 500-750mg/day dose there is a signal that CLAV is associated with a reduction in the number of days of cocaine use in women with CUD. Men with CUD did not benefit from CLAV treatment at these doses. CLAV for 12 weeks was safe and reasonably well tolerated in people with CUD. Future studies should refine a therapeutic dose for men with CUD and further elucidate the effect of CLAV on the observed effects in women.
Real-world evidence from a prospective longitudinal cohort study assessing changes in smoking behavior among adults using NJOY ACE tobacco and menthol ENDS products.
Vergara K, Pope DA, Sarkar M
Drug Alcohol Depend · 2026 Aug · PMID 42275902 · Publisher ↗
BACKGROUND: Switching from cigarettes to electronic nicotine delivery systems (ENDS) has the potential to reduce smoking-related harm among adults who smoke (AS). Actual use behavior under real-world conditions can infor...
BACKGROUND: Switching from cigarettes to electronic nicotine delivery systems (ENDS) has the potential to reduce smoking-related harm among adults who smoke (AS). Actual use behavior under real-world conditions can inform the substitution potential of ENDS products. The objective of this study was to assess the transition patterns from combustible cigarettes to use of NJOY ACE® ENDS products. METHODS: We conducted a prospective longitudinal cohort study (LCS) in a national, purposive sample of 8002 US adults, identity- and age-verified 21 + years, who first used NJOY ACE within the 12-month period prior to Baseline. Participants completed online surveys at Baseline and at 1-, 2-, 3- and 6-month follow-ups. Survey items included demographic characteristics, tobacco product use, and other outcome measures. Adjusted logistic regressions (controlling for relevant covariates) were applied to multiple analytic cohorts - per-protocol (PP) and intent-to-treat (ITT) - to comprehensively determine the association between tobacco and menthol-flavored NJOY ACE use and the association between flavor and past 30-day point prevalence smoking abstinence (30dPPA). RESULTS: Overall PP/ITT switching rates (30dPPA) among participants who used tobacco or menthol flavored product at the 3- and 6-month time points were 22.0%/15.1% and 36.2%/23.6%, respectively. Menthol-flavored product use was associated with significantly higher switching rates than tobacco-flavored use across the different analytic cohorts (1.12-1.55x higher). Covariate-adjusted logistic regressions demonstrated consistently higher odds of 3-month 30dPPA (Odds Ratio = 1.33-1.50) for menthol- compared to tobacco-flavored products. CONCLUSIONS: Real-world data demonstrated that availability of NJOY ACE results in robust switching from cigarettes and therefore can manifest a public health benefit.
"So what's gonna happen when I get out of here?" Qualitative barriers and facilitators to MOUD continuity post-release from jail.
Stopka TJ, Rottapel RE, Ruggiro M … +4 more , Santelices C, Friedmann PD, Pivovarova E, Evans EA
Drug Alcohol Depend · 2026 Aug · PMID 42275901 · Publisher ↗
BACKGROUND: Medication for opioid use disorder (MOUD) treatment is increasingly available within jails, but little is known about patient experiences regarding treatment continuity post-release. METHODS: Between 2021 and...
BACKGROUND: Medication for opioid use disorder (MOUD) treatment is increasingly available within jails, but little is known about patient experiences regarding treatment continuity post-release. METHODS: Between 2021 and 2022, we interviewed 38 recently-released people who received MOUD in Massachusetts county jails. We asked participants about their experiences with reentry and MOUD continuity post-release. Thematic analyses were framed by the social-ecological model. RESULTS: At the individual-interpersonal level, participants reported the importance of self-advocacy during incarceration to plan for post-release MOUD treatment continuity. They cited increasing awareness of diminished opioid tolerance as a risk factor for post-release overdose. Participants reported hopelessness about recovery when returning to communities saturated with substance use-related triggers. Participants recognized social support systems as crucial. At the organizational level, participants reported variation by facility in reentry assistance. Detail-oriented reentry teams, active outreach, follow through, clear communication, caring attitudes, and early initiation of reentry planning were key to filling gaps in treatment post-release. Community-level themes emphasized the importance of communication between jail staff and community providers to schedule appointments and provide transportation. At the policy level, advanced reentry planning is needed to avoid treatment lapses, including assistance with health insurance reactivation and bridge prescriptions during the transition from jail-based to community-based MOUD. CONCLUSION: Participants recognized the high risk of MOUD treatment lapses during transitions from jail to community reentry, and valued MOUD continuity services initiated during incarceration and continued post-release. Variation in patient-reported quality of reentry planning services underscored the need for more standardized investment in re-entry and treatment continuity services.
Pharmacokinetics of xylazine and fentanyl in patients presenting to the emergency department after non-fatal opioid overdose.
Krotulski AJ, Baumann MH, Chapman BP … +12 more , Martinez PME, Broach JP, Nguyen J, Olabisi D, Polackal J, Walton SE, Stang BN, Reyes AG, Logan BK, Hampson AJ, Merchant RC, Babu KM
Drug Alcohol Depend · 2026 Aug · PMID 42251817 · Full text
BACKGROUND: Xylazine is an alpha-2 agonist found as an adulterant in illicitly-manufactured fentanyl. Little information is available about its pharmacokinetics in humans. We conducted a naturalistic study with thirteen...
BACKGROUND: Xylazine is an alpha-2 agonist found as an adulterant in illicitly-manufactured fentanyl. Little information is available about its pharmacokinetics in humans. We conducted a naturalistic study with thirteen adult patients presenting to two urban, tertiary care emergency departments for suspected opioid overdose and concomitant xylazine exposure. METHODS: This study was conducted at two US emergency departments in Worcester, MA. Serial blood specimens were collected over 4h at 30-60min intervals for pharmacokinetic analyses. We developed a quantitative analytical method to measure the blood concentration of xylazine and its metabolites, fentanyl and its metabolite, and medetomidine and its metabolite. RESULTS: All thirteen participants had detectable concentrations of xylazine and fentanyl in their blood; five participants also had medetomidine present. Initial blood concentrations (mean±SD, ng/mL) were 47 ± 53 for xylazine, 14 ± 15 for fentanyl, 23 ± 19 for norfentanyl, and 25 ± 24 for medetomidine. Data from a subset of eight participants were used to calculate drug half-lives (t) (mean±SD, min): 345 ± 145 for xylazine and 537 ± 451 for fentanyl. CONCLUSION: The elimination t of xylazine in these opioid overdose participants was considerably longer than predicted from veterinary data. The fentanyl t values were within the upper range reported in the literature. Understanding the pharmacokinetics of xylazine is vital for projecting outcomes of xylazine exposed patients and could allow for improved interpretation in forensic analyses. The quantitative assay we developed for xylazine and its metabolites is suitable for clinical research.
Attentional bias toward emotional and cigarette cues: Insights from a computer mouse-tracking task in adults who smoke and adults who do not smoke.
Kang JU, Baldizon A, Salvador J … +2 more , Taylor BA, Versace F
Drug Alcohol Depend · 2026 Aug · PMID 42251816 · Publisher ↗
INTRODUCTION: Attentional bias to drug-related cues is widely considered a core feature of addiction, yet its empirical assessment is highly sensitive to task design and stimulus selection. We used a computer mouse-track...
INTRODUCTION: Attentional bias to drug-related cues is widely considered a core feature of addiction, yet its empirical assessment is highly sensitive to task design and stimulus selection. We used a computer mouse-tracking paradigm to examine attentional bias toward cigarette-related, pleasant, unpleasant, and neutral images. METHODS: Ninety-six participants (49 adults who smoke, 47 adults who did not smoke) completed the task. Trajectory deviation, measured via maximum absolute deviation (MAD), served as index of attentional bias. To examine individual differences in cue reactivity among participants who smoked, we applied k-means clustering to the MAD data and replicated the findings in an independent sample of 85 individuals who smoked cigarettes. RESULTS: Both groups showed stronger bias for emotionally salient distractors, especially pleasant images, highlighting how the inclusion of emotionally matched control stimuli could reveal overlooked confounds in addiction research. Contrary to expectations, individuals who smoked did not show greater attentional bias to cigarette cues than nonsmokers. K-means clustering revealed two subgroups among individuals who smoked: one selectively biased toward cigarette cues, and another more reactive to pleasant stimuli. We replicated these results in an independent sample of 85 individuals who smoked cigarettes. CONCLUSIONS: The identification of different attentional bias profiles among individuals who smoke aligns with prior neuroimaging findings and suggests that the mouse-tracking paradigm may serve as a scalable, cost-effective tool for detecting individual differences in reactivity to drug-related and non-drug-related pleasant stimuli.
Exploring tobacco, cannabis, and pain-related sleep disturbance among people with and without HIV enrolled in a tobacco smoking cessation trial.
Hubbard AN, Weinberger AH, Levy S … +2 more , Greene B, Ashare RL
Drug Alcohol Depend · 2026 Aug · PMID 42251815 · Publisher ↗
OBJECTIVE: Few studies have evaluated the influence of cannabis use and pain-related sleep disturbance on tobacco smoking outcomes despite a greater prevalence of smoking among people with pain and cannabis use to manage...
OBJECTIVE: Few studies have evaluated the influence of cannabis use and pain-related sleep disturbance on tobacco smoking outcomes despite a greater prevalence of smoking among people with pain and cannabis use to manage pain. This study examined cannabis use and pain-related sleep disturbance in relation to end of treatment (EOT) tobacco smoking abstinence. METHODS: Participants (N = 175; 42.3% HIV+; 57.7% HIV-) were treatment-seeking adults who completed a pre-quit laboratory phase assessing smoking related factors, then an 8-week cessation treatment. Cannabis use was measured via urine drug screen. Pain was measured with a single item (pain interference with sleep). Logistic regression models were used to test whether pain-related sleep disturbance and cannabis co-use predicted abstinence. Covariates included baseline pain, baseline cannabis use, and HIV status. RESULTS: EOT pain-related sleep disturbance was associated with lower odds of abstinence (OR=0.57, 95%CI: 0.37-0.89, p = 0.012). The cannabis use by pain-related sleep disturbance interaction was significant (OR=1.72, 95%CI: 0.29-3.15, p = 0.018), suggesting that pain-related sleep disturbance was associated with lower odds of abstinence among those not using cannabis (p = 0.012). This relationship was not significant among those using cannabis (p = 0.6). DISCUSSION: Pain-related sleep disturbance and cannabis use may be risk factors for return to use as pain-related sleep disturbance during a quit attempt was related to abstinence, and the additive effect of EOT cannabis use and pain-related sleep disturbance was associated with the highest odds of abstinence. Further evaluations of pain-related sleep disturbance and cannabis use are needed to understand individual and additive influences on smoking abstinence.
Does opioid replacement therapy for infants with prenatal opioid exposure modify the risk of ADHD in childhood? A matched cohort analysis.
Pimentel SD, Sun LS, Campbell CI … +10 more , Li S, Edelman D, Walsh EM, Croen LA, Comer SD, Hedderson M, Ames JL, Salorio CF, Barzilay R, Kuzniewicz MW
Drug Alcohol Depend · 2026 Aug · PMID 42248035 · Publisher ↗
IMPORTANCE: Prenatal opioid exposure (POE) in infants has been associated with increased risk for attention-deficit/hyperactivity disorder (ADHD). Does opioid replacement therapy (ORT) in infants after delivery amplify a...
IMPORTANCE: Prenatal opioid exposure (POE) in infants has been associated with increased risk for attention-deficit/hyperactivity disorder (ADHD). Does opioid replacement therapy (ORT) in infants after delivery amplify adverse impact of POE? If so, this should inform clinical decision-making about ORT. OBJECTIVE: Assess how ORT modifies effects of POE on ADHD risk. DESIGN: Matched cohort study in a birth cohort (2010-2019). Each POE child is matched to 5 unexposed controls, balancing covariates within ORT and non-ORT POE subgroups. SETTING: A large integrated Northern California health system. PARTICIPANTS: Child/mother dyads with children born at 35 weeks or later without congenital anomalies. EXPOSURE(S): POE was determined by dispensed opioid prescriptions from pharmacy records, urine drug screens, and chart review. ORT was determined using electronic administration records. MAIN OUTCOME(S) AND MEASURE(S): ADHD, defined as the combination of an ICD-9/ICD-10 diagnosis code and two dispenses of ADHD medication. RESULTS: Overall ADHD incidence was 1.0% (median event age 7 years, median follow-up time 5.9 years). 280 matched sets comparing infants with ORT to matched controls (without POE) exhibited a 0.1% risk difference for ADHD. 2986 matched sets comparing infants with POE but not ORT to matched controls exhibited a 0.7% risk difference. The difference between these effects was not significant (95% confidence interval: -1.9%,0.8%). CONCLUSIONS AND RELEVANCE: Our analysis reveals no evidence that ORT modifies detrimental impacts of POE on ADHD susceptibility, although short follow-up times limited outcome ascertainment. These findings suggested cautious optimism in response to concerns about whether ORT may exacerbate effects of POE.
Increasing housing instability and changing spatial distribution of people who inject drugs in Montreal, Canada, 2011-2024.
Vakili F, Minoyan N, Bruneau J … +1 more , Larney S
Drug Alcohol Depend · 2026 Aug · PMID 42248034 · Publisher ↗
BACKGROUND: Housing instability contributes to poor health outcomes among people who inject drugs (PWID). Housing affordability in Montreal has declined since 2020. We described changes in the prevalence and spatial dist...
BACKGROUND: Housing instability contributes to poor health outcomes among people who inject drugs (PWID). Housing affordability in Montreal has declined since 2020. We described changes in the prevalence and spatial distribution of unstable housing among PWID. METHODS: We analyzed data from the HEPatitis COhort (HEPCO) of PWID in Montreal across three time frames: 2011-2014, 2015-2019, and 2020-2024. Housing was categorized as stable, precariously housed, or unsheltered based on the Canadian Observatory on Homelessness definition. Postal codes of primary residence over the past month were geocoded using the ggmap package in R. A threshold (median+2*median absolute deviation) was used to identify boroughs with increasing concentration of unstably housed PWID in 2020-2024 compared to 2015-2019. RESULTS: Among 1607 study visits (2011-2014: 552, 2015-2019: 547, and 2020-2024: 508), the proportion of unsheltered PWID increased to 41.3% in 2020-2024, vs. 26.1% in 2015-2019 and 27.4% in 2011-2014. In 2020-2024, 43.5% of PWID were stably housed vs. 51.4% in 2015-2019 and 53.8% in 2011-2014. Unsheltered PWID were mostly centralized in the downtown area, but precariously housed participants were more dispersed in their locations. We identified six boroughs with increasing concentrations of unstably housed (including precariously housed and unsheltered) PWID, mainly in downtown and adjacent boroughs. CONCLUSION: In the context of declining housing affordability, an increased proportion of PWID are reporting being unsheltered. Further work is needed to examine transitions from stable and precarious housing to being unsheltered. Services supporting precariously housed people may need to diversify their geographic locations, given this population's more dispersed residential profile.
U.S. Poison Center exposure cases involving marijuana and selected comparator substances.
Karami S, Radin RG, Greene CR … +4 more , Harris A, Lee HS, Dal Pan G, Meyer T
Drug Alcohol Depend · 2026 Aug · PMID 42248033 · Publisher ↗
BACKGROUND: With increasing number of U.S. states legalizing marijuana use, nearly half now allow adult use. Consequently, harms from marijuana exposures are increasing. We describe recent levels, characteristics, and tr...
BACKGROUND: With increasing number of U.S. states legalizing marijuana use, nearly half now allow adult use. Consequently, harms from marijuana exposures are increasing. We describe recent levels, characteristics, and trajectory of harms associated with intentional and unintentional marijuana use compared to other drugs. METHODS: We examined exposure characteristics, medical outcomes, and utilization-adjusted rates (per million people with past-year nonmedical use from National Survey on Drug Use and Health) for U.S. Poison Center cases (2013-2021) involving marijuana recreational use (RU) and unintentional exposure compared to selected licit (alcohol, zolpidem, benzodiazepines, ketamine, tramadol, hydrocodone, oxycodone) and illicit (cocaine, heroin) comparators. RESULTS: Marijuana RU exposure cases (n = 22,731) exceeded comparator cases (n = 832-15,196), except for alcohol (n = 56,143), benzodiazepines (n = 33,688), and heroin (n = 34,083). Marijuana RU cases commonly involved adolescents (46%). Marijuana single-substance RU exposure cases less commonly resulted in major effects (3%) or death (0.04%) than comparator drugs (3-40%, and 0.1-2.5%, respectively), except zolpidem (deaths 0%). Marijuana utilization-adjusted RU case rates increased over time but remained lower than comparators' rates, except alcohol. Marijuana unintentional exposure cases (n = 15,301) increased 10-fold over the time-period and primarily involved children < 6 years (70%) and edibles (51%). Although observed pediatric marijuana unintentional exposure cases were non-fatal, serious outcomes were more common than for licit comparators. CONCLUSIONS: We found increasing frequency of marijuana harms from RU, generally less severe outcomes for marijuana cases versus several comparator drugs, and increasing unintentional marijuana exposure cases, suggesting the need for safe storage and public education for marijuana poisoning prevention, particularly in children and adolescents.
Profiles of stress and their associations with substance use among adults of color.
Lee R, Unger JB, Arpawong TE … +6 more , Oh H, Bluthenthal R, Sami M, Pagador A, Blevins B, Huh J
Drug Alcohol Depend · 2026 Aug · PMID 42235276 · Publisher ↗
INTRODUCTION: People of Color (POC) in the United States experience a variety of stressors stemming from multiple contextual domains; coping with such stressors has been linked to various substance use behaviors. However...
INTRODUCTION: People of Color (POC) in the United States experience a variety of stressors stemming from multiple contextual domains; coping with such stressors has been linked to various substance use behaviors. However, person-centered studies identifying the distinct and related patterns of stress among POC are lacking and thus limiting for informing substance use intervention approaches. METHODS: Latent profile analysis was performed to identify latent subgroups of stress profiles among racial/ethnic minority US adults who report current substance use (N = 964). We examined the associations between demographic characteristics and profile membership and simultaneously the associations between profile membership and substance use. RESULTS: Four distinct stress profiles were identified: "Low Stress," "Normative Stress," "Racialized Stress," and "Multi-Domain High Stress". Mean levels of substance use were significantly higher among "Racialized Stress," "Normative Stress," and "Multi-Domain High Stress" compared to the "Low Stress" group. CONCLUSION: POC in the US experience a constellation of stressors rooted in systemic social inequities. The Racialized Stress profile, characterized by racial discrimination and cultural stress, represents a high-risk group for substance use despite not necessarily experiencing the highest levels of overall stress, suggesting that the type and combination of stressors (and not just their intensity) matters. Understanding these unique latent stress profiles and their associations with substance use is important to better characterize the lived experiences of POC and implement targeted interventions to help POC cope with and navigate these stressors.
Mystery shopper assessments of cannabis retailer practices and regulatory compliance in five U.S. states, 2025.
Berg CJ, LoParco CR, Rossheim ME … +8 more , McCready DM, Langan L, Platt E, Romm KF, Johnson M, Speer MB, Burris S, Cavazos-Rehg PA
Drug Alcohol Depend · 2026 Aug · PMID 42224931 · Full text
OBJECTIVE: This study used mystery shoppers to assess cannabis retail practices in 5 US states regulating legal nonmedical cannabis retail. METHODS: This mystery shopper study assessed 130 cannabis retailers in 5 cities...
OBJECTIVE: This study used mystery shoppers to assess cannabis retail practices in 5 US states regulating legal nonmedical cannabis retail. METHODS: This mystery shopper study assessed 130 cannabis retailers in 5 cities (Los Angeles [LA], California; Las Vegas [LV], Nevada; Denver, Colorado; Portland, Oregon; Seattle, Washington) in summer 2025. Researchers recorded: 1) age verification; and 2) retail staff responses to inquiries about: a) use for anxiety, sleep, pregnancy-related nausea, etc.; b) use-related risks/cautions; c) interstate cannabis transport; and d) availability of derived intoxicating cannabis products (DICPs) and 'mushrooms' (psilocybin). RESULTS: Mystery shoppers were asked for ID at 87.7% of retailers. When asked, most (>88%) retail staff responded that cannabis helps with anxiety and insomnia. While 40.8% warned against use for pregnancy-related nausea, 36.2% suggested it helps and 24.6% said it depends on the person/situation. Over half (58.5%) warned against driving post-use, but 50.0% said it depends (on person/situation). When asked about interstate transport, several indicated not to (42.3%) and/or it was illegal (39.2%); however, 44.6% indicated ways to pack cannabis to be undetectable, and 27.7% said not to worry about getting caught. Retail staff generally indicated DICPs are not as safe as delta-9 THC (27.7%) or are illegal (20.0%). The majority said mushrooms were illegal (67.7%), but 53.8% indicated they were easy to obtain, and 29.2% suggested their mental health benefits. CONCLUSIONS: Cannabis retailer frequently made prohibited health claims and minimized risks, reinforcing public health concerns and the need for ongoing cannabis retail surveillance and stronger regulatory oversight and enforcement.
A random intercept cross-lagged panel analysis of the relationships between substance use, depressive symptoms, and suicidal behavior.
Ni H, Han D, Chen X … +2 more , Zhu Y, Shi X
Drug Alcohol Depend · 2026 Aug · PMID 42208470 · Publisher ↗
OBJECTIVE: Although the association among substance use, depressive symptoms, and suicidal behavior has been investigated, the longitudinal bidirectional relation remains poorly understood, particularly with respect to d...
OBJECTIVE: Although the association among substance use, depressive symptoms, and suicidal behavior has been investigated, the longitudinal bidirectional relation remains poorly understood, particularly with respect to distinguishing between-person and within-person effects, this study aimed to investigate the within-person longitudinal relationships between substance use, depressive symptoms, and suicidal behavior. METHODS: This study used a longitudinal design to explore these associations among 5608 college students from two universities in a city in southern China (aged 17-22 years; M = 18.63 years, SD = 0.89; 48.2% females). Substance use was assessed using the Substance Use Questionnaire, depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9), and suicidal behaviors were assessed using the Suicide Behavior Questionnaire-Revised (SBQ-R). The participants were assessed five times in a six-month interval over three years. Random intercept cross-lagged panel models (RI-CLPMs) were used to examine the within-person longitudinal relationships between substance use, depressive symptoms, and suicidal behavior. RESULTS: The results of RI-CLPMs indicated that at the within-person level, suicidal behavior can positively predict subsequent depressive symptoms and substance use, significantly positively predicted subsequent depressive symptoms among females, but not substance use. CONCLUSION: These results indicate that it is crucial to identify and address suicidal behavior among college students, as it can help prevent subsequent substance use and depressive symptoms.
Ecological momentary assessment of racial discrimination and same-day and next-day alcohol use among Black college students.
Peoples JE, Pfund GN
Drug Alcohol Depend · 2026 Aug · PMID 42202544 · Publisher ↗
BACKGROUND: Black college students experience elevated minority stress, particularly racial discrimination, which has been linked to greater alcohol use and related harms. Yet, research on this disparity overwhelmingly r...
BACKGROUND: Black college students experience elevated minority stress, particularly racial discrimination, which has been linked to greater alcohol use and related harms. Yet, research on this disparity overwhelmingly relies on cross-sectional or retrospective designs that fail to capture the dynamic nature of racial discrimination and its real-time influence on alcohol use risk. This study used ecological momentary assessment (EMA) to examine daily associations between racial discrimination and alcohol use in this population. METHODS: Black undergraduate and graduate students (N = 97;76% women) attending four predominantly White institutions completed 14 days of EMAs (five random daily prompts plus a morning survey capturing overnight experiences). Daily racial discrimination (any vs. none) and alcohol use (any use, quantity) were aggregated and modeled with multilevel generalized linear models testing between-person, within-person concurrent, and lagged effects, controlling for demographic covariates. RESULTS: Participants reported an average of 6.77 racial discrimination incidents across 14 days. After accounting for between-person differences in discrimination frequency, within-person analyses showed that on days when students experienced racial discrimination, they consumed more alcohol that same day (p = .020). Experiencing racial discrimination on one day was also associated with greater alcohol consumption the following day (p < .001) and 1.69 × higher odds of next-day drinking initiation (p = .015). Notably, higher average racial discrimination (between-person) was not associated with alcohol use once lagged effects were considered. CONCLUSIONS: Findings underscore the need for culturally responsive, real-time interventions addressing the episodic and temporally persistent nature of discrimination-related alcohol risk among Black college students, including both drinking initiation and escalation.
Association between ENDS device and liquid characteristics and cigarette smoking, quitting and smoking reduction behaviors among U.S. adults who frequently use ENDS.
Nian Q, Cohen JE, Hardesty JJ … +2 more , Crespi E, Kennedy RD
Drug Alcohol Depend · 2026 Aug · PMID 42202543 · Full text
INTRODUCTION: Electronic nicotine delivery systems (ENDS) may support cigarette cessation. We examine whether ENDS device and liquid characteristics are associated with cigarette smoking cessation and reduction. METHODS:...
INTRODUCTION: Electronic nicotine delivery systems (ENDS) may support cigarette cessation. We examine whether ENDS device and liquid characteristics are associated with cigarette smoking cessation and reduction. METHODS: Data are from U.S. adults (21 +) who used ENDS ≥ 5 days/week of a longitudinal study. Participants included 202 adults who completed Wave 3 (September-November 2021) and 4 (July-September 2022) and smoked in Wave 3; and 196 adults who completed Wave 4 and 5 (February-April 2023) and smoked in Wave 4. Cigarette quitting was defined as smoking at the prior wave and not smoking at follow-up. Cigarette reduction was defined as reducing daily cigarette consumption by ≥ 50% at follow-up. Rao-Scott Chi-Square tests and mixed-effects models were conducted. RESULTS: 32.2% of participants (n = 128) reported not smoking at a subsequent wave. Fewer years of smoking cigarettes, fewer cigarettes smoked/day, lower cigarette dependence, and lower likelihood of using any additional tobacco product were significantly associated with quitting (p < 0.05); however, device type, wattage, nicotine concentration, nicotine formulation, and flavor were not significantly associated with quitting. Participants who used non-tobacco flavored ENDS and smoked more cigarettes/day were more likely to report smoking reduction at follow-up in bivariate analyses (p < 0.05), but not in adjusted models. CONCLUSIONS: Among U.S. adults using ENDS ≥ 5 days/week alongside cigarette smoking, device and liquid characteristics were not associated with quitting behaviors or smoking reduction 6-12 months later in adjusted models. The study's limitations underscore the need for larger longitudinal and randomized studies tracking diverse ENDS characteristics, cigarette cessation, and reduction over time.
A retrospective comparison of two state-funded smartphone-based contingency management programs with different incentives.
Cardoso Sao Mateus C, Fletcher J, Rash C … +1 more , DeFulio A
Drug Alcohol Depend · 2026 Aug · PMID 42184588 · Publisher ↗
BACKGROUND: Contingency management, an incentive-based intervention for substance use disorders, has strong empirical support but limited availability. In the United States, this is partly attributable to policies that l...
BACKGROUND: Contingency management, an incentive-based intervention for substance use disorders, has strong empirical support but limited availability. In the United States, this is partly attributable to policies that limit the amount of incentives that can be used in these interventions when funded by some agencies. The recent completion of two pilot programs of a smartphone-based contingency management intervention provided the opportunity for a natural comparison of programs that differed in their incentive values and behavioral targets. METHODS: This retrospective study included participants (n = 262) in outpatient treatment who met the DSM-5 criteria for stimulant use disorder. Patients in the low-value program (n = 169) could earn up to $75 over 16 weeks for app engagement and completion of salivary drug tests. Patients in the moderate-value program (n = 93) could earn up to $599 over 26 weeks for app engagement and negative drug test results. The primary outcome was engagement with program activities (e.g., surveys, therapy modules). The secondary outcome was the rate at which participants submitted tests demonstrating abstinence from substance use. RESULTS: Beta regression controlling for demographic differences showed that patients in the moderate-value incentive program completed surveys and therapy modules at significantly higher rates compared to patients in the low-value incentive programs. Similarly, moderate-value program patients submitted tests demonstrating abstinence at a significantly higher rate. CONCLUSIONS: Larger financial incentives, abstinence-targeted rewards, and longer intervention duration were jointly associated with better engagement and abstinence outcomes. Policies should support evidence-based contingency management design features.
Longitudinal craving profiles in cannabis use disorder: A latent class growth analysis of the achieving cannabis cessation: Evaluating N-Acetylcysteine Treatment (ACCENT) (CTN-0053) trial.
Alias-Ferri M, Flesaker M, Gray K … +7 more , Tomko R, McPherson S, Korthuis PT, Humphreys K, Moran L, Timko C, Vest N
Drug Alcohol Depend · 2026 Aug · PMID 42184587 · Full text
BACKGROUND: Craving is a core clinical feature of cannabis use disorder (CUD) and a predictor of treatment outcomes, yet its temporal course during treatment is not well characterized. This study aimed to identify latent...
BACKGROUND: Craving is a core clinical feature of cannabis use disorder (CUD) and a predictor of treatment outcomes, yet its temporal course during treatment is not well characterized. This study aimed to identify latent classes of cannabis craving trajectories among adults with CUD and examine associated baseline predictors and cannabis use outcomes. METHODS: This was a secondary analysis of the National Drug Abuse Treatment Clinical Trials Network's CTN-0053 trial, a 12-week, multisite randomized controlled trial of N-acetylcysteine versus placebo for adults with CUD (N = 302). Cannabis craving was measured using the Marijuana Craving Questionnaire-Short Form at six treatment timepoints (weeks 1-5, 9 and 12) and one 5-week post-treatment follow-up (week 17). Urine cannabinoid tests were conducted twice weekly throughout treatment and follow-up. Latent class growth analysis identified craving trajectories. The present study aimed to identify latent classes of cannabis craving over 12 weeks of treatment and examine baseline predictors of class membership. RESULTS: A four-class solution provided the best fit: low craving (41%), moderate-decreasing craving (38%), moderate-stable craving (11%), and high craving (10%). Participants in higher craving classes exhibited greater baseline anxiety, depression, and obsessive-compulsive symptoms related to cannabis use. The high craving class had the greatest proportion of cannabis positive urine tests (96%) and the lowest urine test completion rate. CONCLUSIONS: Craving follows heterogeneous trajectories during CUD treatment and is associated with co-occurring mental health symptoms and poorer outcomes. Dynamic craving assessment may support personalized treatment and strategies to prevent return to use.
Tianeptine misuse and addiction: A systematic review of withdrawal, toxicity, and clinical management.
Anand A, Alessi MR, Toussi RA … +5 more , Tian J, Raffoul JJ, Pratt N, Nero N, Weleff J
Drug Alcohol Depend · 2026 Aug · PMID 42177839 · Publisher ↗
BACKGROUND: Tianeptine is an atypical tricyclic antidepressant with mu-opioid receptor agonist activity. Although marketed as an unregulated "nootropic" in the United States, its use has been increasingly associated with...
BACKGROUND: Tianeptine is an atypical tricyclic antidepressant with mu-opioid receptor agonist activity. Although marketed as an unregulated "nootropic" in the United States, its use has been increasingly associated with misuse, dependence, and toxicity. METHODS: We conducted a systematic review following PRISMA 2020 guidelines. MEDLINE, Embase, Cochrane, PsycInfo, and Scopus were searched from inception through July 2025 for human studies describing tianeptine misuse, toxicity, withdrawal, or overdose. Eligible designs included randomized controlled trials, observational studies, and case reports. Data were extracted on clinical presentation and management. Study quality was assessed using Joanna Briggs Institute tools, and findings were narratively synthesized. RESULTS: Fifty-three publications met inclusion criteria (48 case reports and 5 retrospective series; N = 1055). Among individual cases (n = 52), 26/52 (50%) presented with withdrawal and 23/52 (44%) with overdose. Long-term treatment for withdrawal included buprenorphine 5/26 (19%) and methadone 1/26 (4%). Overdose presentations commonly involved central nervous system depression, respiratory failure, and rhabdomyolysis; among overdose cases with detailed data (n = 22), naloxone was administered in 6/22 (27%), and fatalities occurred in 7/22 (32%). Retrospective studies (n = 1007) described mixed toxicity and withdrawal presentations; 227/1007 (22%) requiring intensive care. CONCLUSION: Tianeptine misuse is associated with opioid-like dependence, withdrawal, and toxicity. Continued clinical and epidemiological observation is warranted.
Predicting transitions in alcohol use among adolescents and young adults by nicotine and tobacco products used.
Ruleman AM, Mantey DS, Sokolovsky AW … +3 more , Chen B, Clendennen SL, Harrell MB
Drug Alcohol Depend · 2026 Aug · PMID 42176389 · Publisher ↗
OBJECTIVE: To characterize transitions in alcohol consumption behaviors by nicotine and tobacco products (NTPs) used across a diverse cohort of adolescents and young adults. METHODS: A three-state Markov model was applie...
OBJECTIVE: To characterize transitions in alcohol consumption behaviors by nicotine and tobacco products (NTPs) used across a diverse cohort of adolescents and young adults. METHODS: A three-state Markov model was applied to six waves of data (2019-2021) collected biannually for 2608 (N=14,152) participants in the Texas Adolescent Tobacco and Marketing Surveillance System 2.0. We examined nine possible transitions across three exclusive states of alcohol use (none, past 30-day drinking, and past 14-day binge drinking). We estimated the probability of transitioning between alcohol use behaviors by NTPs used (none, exclusive e-cigarette, exclusive combustible tobacco, dual use), controlling for age, race/ethnicity, sex, depression symptoms, and current cannabis use. Results were additionally stratified by sex. RESULTS: Any NTP use resulted in a significantly greater risk of transitioning from non-drinking to binge drinking. Combustible tobacco and dual use predicted a lower risk of transitioning from binge drinking to current drinking. Dual use among females predicted onset of current or binge drinking from non-drinking. In contrast, female dual use also predicted discontinuation of binge drinking to non-drinking. Among males, the rapid onset of binge drinking from non-drinking was predicted by exclusive combustible or e-cigarette use. CONCLUSIONS: Given findings that combustible tobacco use diminishes the probability of alcohol de-escalation among young adults, interventions should address both substances. Further research is needed to understand the moderating effect of sex on the relationship between NTP use and alcohol consumption.
Fentanyl overdose death rates are associated with regional differences in urine drug testing results.
Huhn AS, Dunn KE, Ciccarone D … +2 more , Whitley P, Marks C
Drug Alcohol Depend · 2026 Aug · PMID 42176388 · Publisher ↗
BACKGROUND: Identifying methods to quickly surveil drug use trends is key for responding to constant changes in the illicit opioid supply. This study evaluated whether changes in the concentration and prevalence of fenta...
BACKGROUND: Identifying methods to quickly surveil drug use trends is key for responding to constant changes in the illicit opioid supply. This study evaluated whether changes in the concentration and prevalence of fentanyl in urine drug tests (UDT) predict synthetic opioid-involved overdose mortality across U.S. geographic regions. METHODS: UDT samples were analyzed via liquid chromatography tandem mass spectrometry for fentanyl concentration and prevalence (detection rate). UDT measures were evaluated as predictors of monthly regional (Northeast, Southern, Midwestern, Western) synthetic opioid-related overdose deaths using correlation, linear regression and time-series analysis. RESULTS: Patients (N = 575,570) submitted a total of 2,172,218 UDT specimens for substance use testing between January 2019 and December 2025. A 333% increase in fentanyl concentration and a 104% increase in fentanyl prevalence were identified nationally between 2019 and 2023, followed by decreases of 33% for concentration and 27% for prevalence through 2025. Results varied by region, with the West reporting the highest overall fentanyl concentration (123.3ng/mg) and prevalence (19.2%) in 2025. UDT concentration was most highly correlated with overdose in the West (Spearman r = 0.87), whereas prevalence was more highly correlated in the South (r = 0.8), Midwest (r = 0.76) and Northeast (r = 0.75). Regional time-series models trained on the preceding 12-months of UDT and overdose data were able to predict the following month within 8.8% of the observed overdose deaths on average. CONCLUSION: UDT results likely reflect fentanyl supply and consumption trends that change the risk of fatal overdose. Understanding changes in drug exposure may help local health departments and providers respond to overdose risk in their communities.
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