Drug And Alcohol Dependence[JOURNAL]
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200 papers
Associations between ZIP code-level alcohol outlet density and binge drinking among people who inject drugs in 22 US metropolitan areas.
Peddireddy SR, Beane S, Yarbrough C … +5 more , Ibragimov U, Cummings JR, Haley DF, Linton SL, Cooper HLF
Drug Alcohol Depend · 2026 Jun · PMID 41864110 · Full text
BACKGROUND: Although alcohol outlet density (AOD) is associated with drinking behaviors in the general population, little evidence exists about this relationship among people who inject drugs (PWID). Establishing this co...
BACKGROUND: Although alcohol outlet density (AOD) is associated with drinking behaviors in the general population, little evidence exists about this relationship among people who inject drugs (PWID). Establishing this connection is particularly important, as alcohol use exacerbates the risk of opioid overdose. This study investigated 1) the association between ZIP code-level AOD and binge drinking among PWID who use opioids, and 2) the potential moderating effect of race/ethnicity on the AOD-binge drinking relationship. METHODS: This analysis linked 2018 National HIV Behavioral Surveillance (NHBS) data and 2016 ZIP code-level AOD data from the ZIP Code Business Pattern survey. Hierarchical generalized linear models quantified the association between AOD and binge drinking, overall and by race/ethnicity. RESULTS: Of 9660 PWID, 27% reported recent binge drinking. For Hispanic/Latinx and White PWID, each increase of three outlets per square mile above the median AOD was associated with a 1% and 3% increase in the odds of binge drinking, respectively (p < 0.05); AOD was unrelated to binge drinking among Black PWID. However, when AOD was set to the median, binge drinking probability was highest among Black PWID (PP: 0.28, 95% CI: 0.24-0.33). CONCLUSIONS: Reducing AOD may decrease binge drinking among White and Latinx PWID. Our results suggest, however, that this strategy alone may not be effective among Black PWID. Holistic strategies targeting structural determinants of alcohol and opioid co-use among Black PWID are needed to address inequities in drug-related harms.
Foodie traps within facebook cannabis promotional posts: Deploying multimodal deep learning AIs to monitor audience engagement.
Lu L, Yu X, Xu Z … +7 more , Kwon H, Reddy AP, Xin H, Zhang S, Yang EF, Li Y, Yang S
Drug Alcohol Depend · 2026 Jun · PMID 41861608 · Publisher ↗
BACKGROUND: Cannabis marketing has flourished due to the legalization of recreational cannabis across multiple U.S. states, particularly on social media platforms that effectively reach adolescents and young adults. Unde...
BACKGROUND: Cannabis marketing has flourished due to the legalization of recreational cannabis across multiple U.S. states, particularly on social media platforms that effectively reach adolescents and young adults. Understanding how cannabis promotional content shape audience engagement is important for monitoring exposure and informing public health and regulatory discussions. METHODS: Leveraging advanced computational analysis, including the multimodal large language model LLaVA and GPT-4o, we analyzed a comprehensive dataset of Facebook posts from 2021 to 2022 to explore associations between visual tactics and online audience engagement (e.g., likes, shares, and comments). RESULTS: Unsupervised clustering identified ten distinct visual themes, with human and animal portrayals, food cues being the most prevalent. High-level visual features such as food cues were consistently associated with increased shares and comments. Also, low-level color characteristics, particularly red, yellow, and orange, predicted higher audience engagement. Nearly half of posts contained health benefit-oriented messaging, whereas explicit health risk or safety information was rare. DISCUSSION: Visually engaging strategies in cannabis advertising on social media are associated with higher audience engagement and may increase the visibility of cannabis-related content, raising public health concerns about widespread exposure and the normalization of cannabis use.
Associations of spirituality and craving among individuals in substance use disorder treatment: A latent change score modeling approach.
Rabinowitz JA, Masyn K, Thomas N … +8 more , Kahn G, Grimm KJ, Ellis J, Hochheimer M, Strickland JC, Ramdin C, Piccirillo ML, Huhn AS
Drug Alcohol Depend · 2026 Jun · PMID 41861607 · Publisher ↗
OBJECTIVE: Using a latent change score modeling approach, we tested the bidirectional relationships between spirituality and craving during the first month of substance use disorder (SUD) treatment. Specifically, we exam...
OBJECTIVE: Using a latent change score modeling approach, we tested the bidirectional relationships between spirituality and craving during the first month of substance use disorder (SUD) treatment. Specifically, we examined whether higher spirituality levels predicted greater reductions in craving over the first month of treatment and explored whether higher craving predicted smaller increases in spirituality. METHOD: Participants (N = 25,735) included patients admitted to one of 73 SUD treatment centers in 2021 (either inpatient, outpatient, or withdrawal management) in the United States. Craving was assessed using substance-specific questionnaires and spirituality was assessed via the modified Religious Background and Behavior scale, which participants completed weekly for the first four weeks of treatment. RESULTS: Spirituality levels increased and craving levels decreased during the first month of treatment. The proportional effects of change in these processes became stronger over time such that magnitude of change became smaller from week to week. Spirituality did not predict changes in craving, although higher levels of craving at week 1 predicted smaller increases in spirituality from week 1 to week 2. CONCLUSIONS: Findings highlight the first week of SUD treatment as a critical window of therapeutic recovery whereby patients may exhibit the greatest amount of change in spirituality and craving processes. However, overall, results from this study do not support modulation of craving through spirituality, suggesting spirituality-focused interventions may not be universally beneficial. However, further research is needed to explore whether such interventions may be helpful for specific patient subgroups or influence other treatment outcomes.
Relations between depression and cannabis use among college students in evolving state cannabis policy environments.
Bae H, Kerr DCR
Drug Alcohol Depend · 2026 Jun · PMID 41855891 · Full text
OBJECTIVES: Depression is a risk factor for cannabis use, an association that may change as state cannabis policies evolve. The present study uses individual-level data on college students and a continuous measure of sta...
OBJECTIVES: Depression is a risk factor for cannabis use, an association that may change as state cannabis policies evolve. The present study uses individual-level data on college students and a continuous measure of state cannabis policy restrictiveness to examine this question. METHODS: Undergraduates (n = 902,486) ages 18-24 years from 591 four-year institutions in 47 states completed a cross-sectional survey between 2008 and 2019, including items assessing significant 30-day depressive symptoms, 12-month depression diagnosis or treatment, and 30-day cannabis use and frequent (20 + days) use. Time-varying, state-level cannabis policy restrictiveness was measured with the Cannabis Policy Scale (CPS). RESULTS: From 2008-2019 prevalence increased for 30-day depressive symptoms (15.3-26.7%) and frequent cannabis use (3.3-5.2%). Depression measures were associated with cannabis use outcomes [odds ratios (OR) ranged from 1.54 to 2.13, p < 0.0001]. Effects were modestly but significantly weaker in less restrictive than in more restrictive state cannabis policy environments. For example, depressive symptoms were less associated with increased odds of 30-day cannabis use in the least restrictive states [OR (95% CI) = 1.47 (1.42-1.52), p < 0.0001] than in the most restrictive states [OR (95% CI) = 1.57 (1.54-1.59), p < 0.0001; interaction p = 0.0017]. There was no evidence that depression prevalence was higher among students exposed to less restrictive cannabis policies. CONCLUSIONS: Depression and frequent cannabis use co-occurred across restrictive and liberal state cannabis policy environments, and both conditions increased in prevalence across the study period. Depression was a somewhat weaker risk factor for cannabis use when and where cannabis was more legal and accessible.
The wake of addiction: Pharmacological strategies for sleep disturbances in stimulant use disorders, a systematic review.
Bourtin IG, Calvillo DJ, Badawi JC … +4 more , Schmitz JM, Lane SD, Yoon JH, Webber HE
Drug Alcohol Depend · 2026 Jun · PMID 41855890 · Full text
BACKGROUND: A systematic review was conducted following PRISMA guidelines to identify human studies investigating pharmacological interventions and reported sleep outcomes among individuals with CUD or MUD. METHODS: PubM...
BACKGROUND: A systematic review was conducted following PRISMA guidelines to identify human studies investigating pharmacological interventions and reported sleep outcomes among individuals with CUD or MUD. METHODS: PubMed and APA PsycInfo were searched from inception to January 2025 and risk of bias was assessed. Articles were included if they included human participants with either cocaine or methamphetamine dependence, administered a pharmacological treatment, and reported night-time sleep as an outcome using at least one rigorous measurement tool. Articles were excluded if they included animals, did not include pharmacological intervention (e.g., supplements or behavioral treatments), or only assessed baseline sleep or if sleep was only reported as a side effect rather than as a formal outcome. RESULTS: Eighteen studies (N = 678) met inclusion criteria, eleven in CUD and seven in MUD. The results of the risk-of-bias assessment indicated good-to-excellent interrater reliability (ICC range=0.85-0.90), and overall methodological quality across studies was moderate to high. For CUD, modafinil, buprenorphine, and suvorexant were preliminarily associated with improvements in sleep parameters, with modafinil linked to higher abstinence rates. Results for mirtazapine, lisuride, lorazepam, tiagabine, and cannabidiol were mixed. For MUD, mirtazapine and modafinil demonstrated modest initial benefits, while quetiapine and suvorexant showed preliminary promise in smaller studies. CONCLUSIONS: Overall, pharmacological interventions targeting sleep disturbances showed emerging but inconsistent benefits in CUD and MUD, which could be due to small sample sizes, short treatment durations, side effects, or comorbidities. Addressing sleep dysregulation may represent a novel and clinically meaningful pathway to improve recovery outcomes in stimulant use disorders.
Evidence for pharmacological versus sensory influences on puffing behavior and nicotine extraction during ENDS use: Implications for compensation and product regulation.
Talih S, Hanna E, El-Hourani M … +7 more , Karaoghlanian N, El-Hage R, Salman R, Baldassarri S, El-Hellani A, Eissenberg T, Shihadeh A
Drug Alcohol Depend · 2026 Jun · PMID 41850135 · Full text
BACKGROUND: Tobacco products designed to emit less nicotine can prompt longer and more frequent puffs, a compensatory response that may undermine nicotine reduction policies. Although this behavior is often attributed to...
BACKGROUND: Tobacco products designed to emit less nicotine can prompt longer and more frequent puffs, a compensatory response that may undermine nicotine reduction policies. Although this behavior is often attributed to central nervous system-mediated nicotine titration, immediate sensory cues from nicotine in the mouth and throat may also contribute. METHODS: We conducted a novel secondary analysis of puff topography data from two previously published laboratory studies of electronic nicotine delivery systems (ENDS). Across 129 participants, we examined minute-to-minute variations in puff duration and frequency during one-hour sessions under 11 conditions varying in nicotine concentration (0-30mg/mL), formulation (freebase vs. salt), and electrical power. Time-resolved estimates of extracted nicotine dose were computed within each session. RESULTS: First-puff duration differed significantly across conditions (p < .001), well before nicotine could reach the brain. These differences persisted throughout the 60-min sessions (p < .001): puff duration remained stable (p < .001), with no compensatory increases in low-flux or decreases in high-flux conditions. Extracted nicotine dose rose proportionally with flux (p < .001) and linearly over time (p < .001), showing no within-condition behavioral adjustments in response to accumulating nicotine dose. CONCLUSIONS: Together, these findings indicate open-loop sensory regulation, in which puffing is shaped by immediate sensory cues, rather than the closed-loop control, in which puffing would be dynamically titrated based on systemic nicotine feedback. Puffing behavior stability persisted across a wide range of nicotine dosing conditions. These results suggest that nicotine-reduction strategies that account for sensory features, in addition to nicotine content, may reduce reinforcing potential without eliciting compensatory puffing.
Mitragynine and naltrexone alone and in combination reduce alcohol self-administration in female Sprague Dawley rats.
Haile CN, Sangu M, Das J … +1 more , Kosten TA
Drug Alcohol Depend · 2026 Jun · PMID 41850134 · Publisher ↗
BACKGROUND: Mitragynine (MG), an alkaloid found in leaves of Mitragyna speciosa (kratom), is used for pain and opioid withdrawal. MG's effects are thought to be mediated through opioid receptors. The mu opioid antagonist...
BACKGROUND: Mitragynine (MG), an alkaloid found in leaves of Mitragyna speciosa (kratom), is used for pain and opioid withdrawal. MG's effects are thought to be mediated through opioid receptors. The mu opioid antagonist naltrexone (NTX), indicated for the treatment of alcohol use disorder (AUD), reduces alcohol self-administration in animals. MG also alters alcohol consumption and alleviates alcohol withdrawal. Therefore, we tested MG, NTX, and both combined on alcohol self-administration in rats. METHODS: MG (0.3-3.0 mg/kg, IP) and NTX (0.3-3.0 mg/kg, IP) alone and the combinations of equal drug doses were evaluated in female Sprague Dawley rats lever pressing for alcohol (10%, w/v) under a fixed ratio 2 schedule of reinforcement. Numbers of active and inactive lever presses and estimated alcohol consumed were analyzed. Locomotor activity was assessed in separate groups of rats following MG, NTX (3.0 mg/kg), or its combination and their brains processed to determine cFos expression using immunohistochemistry. RESULTS: Both MG and NTX decreased alcohol self-administration, yet the combination had a greater effect than either alone and did not depress locomotor activity. Similarly, MG and NTX combined enhanced cFos expression in several brain regions more than either drug alone. CONCLUSIONS: MG decreased alcohol reinforcement more than NTX but the combination of the two was more impactful than either alone and engendered no adverse effects suggesting decreases in alcohol self-administration were not due to non-specific depression of activity levels. These data suggest that MG has a complex pharmacology that may involve mechanisms other than the mu opioid system.
Spatiotemporal clustering of state-level opioid, opioid-stimulant, and opioid-benzodiazepine polysubstance deaths across the U.S.: Hierarchical agglomerative clustering analysis.
Cadet K, Brinzo P, Martins SS
Drug Alcohol Depend · 2026 Jun · PMID 41833088 · Publisher ↗
BACKGROUND: Polysubstance use continues to complicate the US overdose landscape, with over 107,000 lives lost to drug overdoses in 2022. The present study uses hierarchical agglomerative clustering to identify distinct s...
BACKGROUND: Polysubstance use continues to complicate the US overdose landscape, with over 107,000 lives lost to drug overdoses in 2022. The present study uses hierarchical agglomerative clustering to identify distinct spatiotemporal profiles of opioid-only, opioid-stimulant, and opioid-benzodiazepine overdose deaths. METHODS: We used de-identified data sourced from the CDC's WONDER Multiple Cause of Death file, covering the period from 2004 to 2022. Hierarchical Agglomerative Clustering was used to classify and assign age-adjusted mortality rate (AAMR) trends for opioid-only, opioid-stimulant, and opioid-benzodiazepine combinations into distinctive clusters based on their temporal and spatial similarities using the dynamic time warping (DTW) metric. RESULTS: The opioid-only, opioid-stimulant, and opioid-benzodiazepine clusters each yielded four clusters. The Opioid-only clusters were characterized by states with AAMRs showing the following trajectory patterns of change over time: lower-level, gradual increase (n = 22 states, 43.14%), delayed acceleration (post-2015) (n = 10 states, 19.61%), early rapid increase (n = 18 states, 35.29%), and a higher-level, accelerating trajectory containing only West Virginia. The Opioid-Stimulant clusters were characterized by states with lower-level, gradual increase (n = 33 states, 64.71%), delayed acceleration (post-2015) (n = 9 states, 17.65%), early rapid increase (n = 8 states, 15.69%), and West Virginia, which had a higher-level, accelerating trajectory. The Opioid-Benzodiazepine clusters were characterized as low-level, minimal change (n = 27 states, 52.94%), steady increase (n = 18; 35.29%), early rapid increase with a recent decline (n = 5, 9.80%), and West Virginia, which was characterized as having a higher-level, irregular trajectory denoting substantial variability. CONCLUSIONS: These findings reveal significant spatial and temporal variation, with West Virginia consistently emerging as an outlier with the highest AAMR. These findings further underscore the need for region-specific interventions to curb the growing opioid crisis.
The changing contribution of fentanyl use to non-fatal overdose among a cohort of people who inject drugs in San Diego, California: A longitudinal assessment.
Jegede OS, Abramovitz D, Eger WH … +7 more , Artamonova I, Bazzi AR, Martin NK, Werb D, Vera CF, Strathdee SA, Bórquez A
Drug Alcohol Depend · 2026 May · PMID 41832858 · Full text
BACKGROUND: Fentanyl has driven overdoses across the U.S. in heterogeneous ways, with local variation in non-fatal overdoses remaining under-described. We sought to estimate the contributions of fentanyl to non-fatal ove...
BACKGROUND: Fentanyl has driven overdoses across the U.S. in heterogeneous ways, with local variation in non-fatal overdoses remaining under-described. We sought to estimate the contributions of fentanyl to non-fatal overdose among people who inject drugs (PWID) in San Diego, CA, during a period of substantial drug supply evolution. METHODS: Using convenience sampling, we recruited PWID living in San Diego into a longitudinal cohort study involving biannual assessments of opioid use and non-fatal overdose from 10/2020-05/2024. Multivariable Poisson regression assessed longitudinal associations between past six-month fentanyl use and non-fatal overdose risk. We calculated the confounder-adjusted longitudinal population attributable fraction (LPAF) to quantify fentanyl's contribution to non-fatal overdoses over time. RESULTS: Among 204 participants, the median age was 40.5 years, 73.0% were male, and 68.1% experienced homelessness. Fentanyl use increased from 51.0%(104/204) at Visit 1(10/2020-10/2021) to 62.4%(68/109) at Visit 6(10/2023-05/2024) while non-fentanyl opioid use decreased from 39.7%(81/204) to 5.5%(6/109). Past six-month non-fatal overdose decreased from 22.5%(46/204) to 15.6%(17/109) overall, and from 38.5%(40/104) to 19.1%(13/68) among those using fentanyl. Significant associations between fentanyl use and non-fatal overdose risk were observed at Visits 1 (Adjusted Relative Risk (ARR) 5.97, 95%CI: 2.37-15.00) and 5 (ARR 4.19, 95%CI: 1.17-15.00). The percentage of non-fatal overdoses contributed by fentanyl use in this cohort (LPAF) was 35%(0.35, 95%CI: 0.17-0.52). CONCLUSION: The contribution of fentanyl to non-fatal overdoses varied over time in our cohort. Disentangling the role of contextual factors such as opioid tolerance, fentanyl potency, and behavioral changes will support intervention design amid increasingly toxic drug supplies.
Variation in quantity of puffs per day among U.S. adolescents and young adults using electronic nicotine delivery systems.
Mongilio JM, Kcomt L, Evans-Polce RJ
Drug Alcohol Depend · 2026 May · PMID 41832857 · Full text
PURPOSE: The present study examines an underutilized measure of electronic nicotine delivery system (ENDS) use quantity-the number of puffs taken per day (PPD)-and its associations with sociodemographic characteristics,...
PURPOSE: The present study examines an underutilized measure of electronic nicotine delivery system (ENDS) use quantity-the number of puffs taken per day (PPD)-and its associations with sociodemographic characteristics, device characteristics, and other tobacco/nicotine use behaviors. METHODS: The U.S. nationally representative Population Assessment of Tobacco and Health Study Wave 7 (2022-23) data were used. The sample was restricted to adolescents and young adults (AYAs; aged 12-30) who reported past-month ENDS use (N = 2606). Using linear regression models, differences by device characteristics (product type and flavor), nicotine use behaviors (other tobacco/nicotine use, nicotine dependence), and sociodemographics (age, sex, race, ethnicity) were examined as predictors of the average number of PPD. Predictors were examined for the full sample and stratified by age (12-20 and 21-20). RESULTS: AYAs reported picking up their ENDS device 26.1 times per day and took 3.9 puffs each time they picked up the ENDS device. The mean number of PPD was 66.9. Greater nicotine dependence (b=32.66; 95% CI=[20.48,35.84]) and use of a tank system (vs disposable devices; b=20.53, 95% CI=[7.39,33.67]) were associated with greater PPD. Average PPD did not vary by legal sales age or sex. CONCLUSIONS: On average, AYAs picked up their ENDS device more than once per hour each day and took multiple puffs each time. No differences were observed by sociodemographic characteristics. Other nicotine use behaviors are associated with more PPD among AYAs.
Problematic substance use among trans and non-binary people in Spain: An overlooked reality.
García-Marín C, Gonzalez-Recio P, Moreno-García S … +4 more , Romero-Panadero B, Donat M, Guerras JM, Belza MJ
Drug Alcohol Depend · 2026 May · PMID 41806543 · Publisher ↗
BACKGROUND AND AIMS: Trans and non-binary people (TNBP) are particularly vulnerable to problematic substance use (PSU) due to multiple structural factors such as discrimination. This study analyzes the prevalence and ass...
BACKGROUND AND AIMS: Trans and non-binary people (TNBP) are particularly vulnerable to problematic substance use (PSU) due to multiple structural factors such as discrimination. This study analyzes the prevalence and associated factors of PSU among TNBP in Spain. DESIGN: Cross-sectional study based on data collected through an online survey conducted between October 2023 and March 2024 using diversified sampling through social media, community organizations, and gender identity support centers. PARTICIPANTS: 1562 trans and non-binary individuals aged ≥ 15 years residing in Spain. MEASUREMENTS: PSU in the past year was assessed for 13 substances and a composite indicator for any of them, based on DSM-5-TR criteria for substance use disorder across various life domains. Prevalence estimates and 95% confidence intervals (95%CI) were calculated. To identify factors associated with PSU, a Poisson regression model with robust variance was fitted to obtain adjusted prevalence ratios. FINDINGS: In the past year, 18.6% (95% CI: 16.7-20.6) of TNBP reported PSU, most commonly cannabis (11.8%), non-prescribed tranquilizers (5.2%), and cocaine (2.4%). Independent factors significantly associated with PSU include ages 25-34, no university education, and in the past year, experiencing physical violence, anxiety or depression, engaging in sex work, regular use of any substance, cannabis use, and cocaine use. CONCLUSIONS: There is a high prevalence of PSU among TNBP in Spain, which is closely linked to social vulnerability and mental health factors. Public health interventions are urgently needed to address the specific needs of TNBP and eliminate health inequities in PSU rooted in systemic discrimination.
Substance use patterns among individuals who consume alcohol during pregnancy: Results from a US multi-site study.
Bakhireva LN, Ma X, Psaras C … +8 more , Brtek V, Sullivan EL, Bogdan R, Chaiyachati BH, Chambers CD, Bandoli G, Croff JM, HBCD Substance Exposure Working Group
Drug Alcohol Depend · 2026 May · PMID 41797178 · Full text
INTRODUCTION: Prenatal alcohol exposure (PAE) is common and associated with adverse outcomes, yet the impact of concurrent substance use remains poorly understood. Using HEALthy Brain and Child Development (HBCD) data (n...
INTRODUCTION: Prenatal alcohol exposure (PAE) is common and associated with adverse outcomes, yet the impact of concurrent substance use remains poorly understood. Using HEALthy Brain and Child Development (HBCD) data (n = 1426), we described alcohol use patterns-with and without other substances-and examined factors associated with alcohol use in pregnancy. METHODS: Data were obtained from the HBCD Study public release 1.0, a 27-site longitudinal cohort examining normative development and the effects of four primary substances (alcohol, cannabis, tobacco, and opioids). More-than-minimal PAE was assessed by self-report and ethanol biomarkers. Participants were classified into 3 study groups: a) Alcohol-Only; b) Alcohol-Plus (alcohol with ≥1 other substance); and c) Comparison (alcohol use below the threshold and negative ethanol biomarkers). Correlates of alcohol use were assessed via polychotomous logistic regression contrasting two alcohol-use categories relative to a common reference group. RESULTS: More-than-minimal alcohol use occurred in 12.7% of participants, with 37% of these also using other substances. The most common polysubstance use pattern was a combination of alcohol, cannabis, and/or nicotine, which occurred, in different combinations, among 28% of participants. Maternal mental health disorders were positively associated with both Alcohol-Only and Alcohol-Plus use. Higher socioeconomic status (SES) was associated with Alcohol-Only use, whereas lower SES was associated with Alcohol-Plus use. CONCLUSIONS: Over one-third of pregnant individuals who used alcohol also used at least one additional substance. Observed associations with maternal mental health and SES highlight opportunities for targeted policy, enhanced screening, and tailored interventions to support maternal and child health.
Trends in first-time psychedelic and other hallucinogen use in the United States: Results from the National Survey on Drug Use and Health.
Montoy JCC, Wang RC, Coker AR … +1 more , Anderson BT
Drug Alcohol Depend · 2026 May · PMID 41795251 · Publisher ↗
BACKGROUND AND AIMS: Psychedelic drug use is increasing due in part to local legislative reforms. Understanding the patterns of first-time psychedelic drug use is imperative for informing consumers, healthcare providers,...
BACKGROUND AND AIMS: Psychedelic drug use is increasing due in part to local legislative reforms. Understanding the patterns of first-time psychedelic drug use is imperative for informing consumers, healthcare providers, and policy makers. DESIGN SETTING AND PARTICIPANTS: The National Survey on Drug Use and Health (NSDUH) is a repeated cross-sectional nationally representative survey of civilians aged 12 and older. Use estimates are presented for 2002-2019 and 2021-2023; regression analyses did not span 2020 due to data incompatibility. MEASUREMENTS: Primary analysis variables were binary indicators for a) lifetime use of hallucinogens (LSD, psilocybin, and MDMA) and b) first-time use of hallucinogens in the past year. FINDINGS: Among 1,005,421 respondents from 2002 to 2019 the prevalence of first-time use of any hallucinogen in the past year was 0.71 %; among 173,808 respondents from 2021 to 2023 0.79 % reported new hallucinogen use. From 2002-2019, an average of 0.39 % of participants used MDMA for the first time; 0.28 % used psilocybin for the first time; and 0.18 % used LSD for the first time each year. First-time use of any hallucinogen increased from 2002 to 2019 at an average odds ratio (OR) 1.009 (95 % confidence interval (CI) 1.001-1.016). New use varied by age group, with the age cohort x year interaction showing a decrease among the 12-17 age cohort (OR 0.96 (95 %CI 0.96-0.97)) and an increase among the 65 + cohorts (OR 1.56 (95 %CI and 1.02 (95 %CI 1.01-1.03), respectively). New LSD use increased (OR per additional year 1.08, 95 % CI 1.07-1.09). Similar increases were not observed for psilocybin, MDMA, or hallucinogens overall. For 2021-2023, there was no change in new use of hallucinogens (OR 0.97 [95 %CI 0.86-1.08]). CONCLUSIONS: First-time psychedelic and hallucinogen increased only slightly over the period from 2002 to 2019 though there were notable age-group and substance-specific trends: new use generally decreased among adolescents and increased in among those aged 65 and older. Trends from 2021 to 2023 likewise did not suggest changes in overall new use, but continue to show changing patterns of use across substances and age groups.
Comparison of anticipated and detected drug contents in samples submitted to a statewide drug checking program in Maryland, USA.
Martin EM, Schneider KE, Sisco E … +4 more , Appley MG, Pyfrom EM, Rybak M, Sherman SG
Drug Alcohol Depend · 2026 May · PMID 41785534 · Publisher ↗
BACKGROUND: The unregulated drug supply in North America is volatile, with several adulterants emerging following the COVID-19 pandemic. These changes pose significant health risks, including wounds and overdose, to peop...
BACKGROUND: The unregulated drug supply in North America is volatile, with several adulterants emerging following the COVID-19 pandemic. These changes pose significant health risks, including wounds and overdose, to people who use drugs. Understanding discrepancies between perceptions and tested results of drug contents is vital in reducing overdose and other harms associated with the unregulated drug supply. METHODS: We analyzed data from Maryland's statewide drug checking program, Rapid Analysis of Drugs (RAD), from October 2021 to May 2024 (N = 792). Clients of participating RAD syringe service programs voluntarily provide drug samples and information about samples, including what they intended to buy. Samples were tested at the National Institute of Standards and Technology using DART-MS. We calculated prevalence of drug classes across different categories of what participants indicated they intended to use. RESULTS: Of 792 samples, 22.0 % were concordant. 278 (35.1 %) intended to contain heroin, but only 15 (1.9 %) overall tested positive for heroin. Contrastingly, xylazine appeared in 454 (57.3 %) samples but was only intended in 15 (1.9 %). 192 (24.2 %) samples were positive for cocaine, but some were detected in samples intended to solely contain opioids. Benzodiazepines (n = 13, 1.6 %) were detected in samples intended to solely contain opioids or stimulants. CONCLUSIONS: Discrepancies between substances participants intended to use and drug checking results demonstrate significant risks and unpredictability across Maryland's unregulated drug supply. Harm reduction efforts should be inclusive across drug classes, increase awareness of adulterants, and advocate for safer supply and overdose prevention sites.
Evaluating the trends and impact of COVID-19 on illicit drug and benzodiazepine use in drivers: A retrospective large-scale study based on oral fluid testing.
Blanco-Ces M, Lendoiro E, Cruz A … +3 more , Cobo-Golpe M, López-Rabuñal Á, de-Castro-Ríos A
Drug Alcohol Depend · 2026 May · PMID 41780480 · Publisher ↗
BACKGROUND: The COVID-19 pandemic disrupted global drug markets, but consumption soon returned to pre-pandemic levels. Continuous monitoring of drug use trends is essential for effective public health responses. METHODS:...
BACKGROUND: The COVID-19 pandemic disrupted global drug markets, but consumption soon returned to pre-pandemic levels. Continuous monitoring of drug use trends is essential for effective public health responses. METHODS: A total of 29,397 oral fluid specimens from roadside drug tests across Spain (January 2019-July 2024) were sent to the Toxicology Laboratory of the Institute of Forensic Sciences, University of Santiago de Compostela, for LC-MS/MS confirmation of on-site positives. Results were stratified into five periods to assess drug use trends and the impact of COVID-19. RESULTS: Over 90% of drivers were male, and 85% were under 45 years old. Overall, 69.9% of samples were positive for cannabis, 64.9% for cocaine, 13.7% for amphetamines, 10.6% for opiates, 6.5% for ketamine, 5.4% for methadone and 6.6% for benzodiazepines/zolpidem; 56.3% showed poly-drug use. Cannabis use was higher in men, while amphetamines and benzodiazepines were more frequent in women (p < 0.001). Due to regional variability in drug use patterns and sample distribution, trends were analyzed across five geographic regions. Globally, during the strict lockdown, cocaine, opiates, methadone and benzodiazepines peaked, while cannabis and amphetamines declined, and ketamine remained stable. In the final period, cannabis reached its highest levels, and ketamine showed a marked increase. Cocaine and amphetamines returned to pre-COVID levels, while opiates, methadone and benzodiazepines declined. Statistically significant differences across the studied periods were observed in the different regions. Specifically, in the Northwest for opiates, methadone, and benzodiazepines (p < 0.001), as well as for cannabis (p < 0.05); in the East for opiates, amphetamines, cocaine, and ketamine (p < 0.001); in the Center for cocaine (p < 0.001) and ketamine (p < 0.05); and in the South and Islands for cocaine (p < 0.05). CONCLUSIONS: Although a slight impact on drug use was observed during the strict lockdown, consumption increased again for all substances (particularly ketamine), except for opiates, methadone and benzodiazepines.
Development and psychometric evaluation of two substance use disorder knowledge scales.
Earnshaw VA, Mousavi M, Kelly B … +3 more , Zawislak K, Fox AB, Hulsey J
Drug Alcohol Depend · 2026 May · PMID 41780479 · Publisher ↗
PURPOSE: To develop and validate knowledge scales that span the continuum of substance use disorder (SUD) prevention, treatment, and recovery. Study 1 focused on ensuring the content validity of scale items, and study 2...
PURPOSE: To develop and validate knowledge scales that span the continuum of substance use disorder (SUD) prevention, treatment, and recovery. Study 1 focused on ensuring the content validity of scale items, and study 2 focused on evaluating the structural, convergent, and known groups validity as well as reliability of the scales. PROCEDURES: Study 1 included n = 15 experts in the SUD field. Study 2 included n = 5355 community members from throughout the U.S. Both studies were conducted online. FINDINGS: The SUD Prevention Knowledge Scale includes 16 items measuring age-related risk factors, other risk factors, and protective factors for SUD. The SUD Knowledge Scale includes 16 items measuring SUD-related characteristics, treatment and recovery, and medications. Supporting content validity, results of study 1 demonstrated that the scales include items with high item-level content validity indexes. Results of study 2 suggested that three-factor models are appropriate for both scales, supporting structural validity, and that the overall scales and subscales have acceptable reliability scores. Both scales and subscales were correlated with indicators of stigma, supporting convergent validity. Participants who were professionals working in the SUD field had the highest scores on the scales, supporting known groups validity. CONCLUSIONS: Results support the validity and reliability of two new measures of SUD-related knowledge. These scales may be appropriate for basic research to characterize levels of SUD knowledge within community settings as well as explore associations between knowledge and SUD-related health behaviors. They may also be useful for evaluating interventions that aim to promote SUD-related knowledge.
Exploratory analysis of the effect of a food security intervention on alcohol use among people with HIV in the Dominican Republic.
Celeste-Villalvir A, Then-Paulino A, Jimenez-Paulino G … +7 more , Sheira LA, Acevedo R, Armenta G, Becker N, Han B, Derose KP, Palar K
Drug Alcohol Depend · 2026 May · PMID 41764908 · Publisher ↗
BACKGROUND: Food insecurity is associated with increased alcohol consumption among people living with HIV (PLHIV). Few studies have explored whether interventions to reduce food insecurity might also mitigate alcohol use...
BACKGROUND: Food insecurity is associated with increased alcohol consumption among people living with HIV (PLHIV). Few studies have explored whether interventions to reduce food insecurity might also mitigate alcohol use. We examine whether a pilot urban gardens and peer nutritional counseling intervention ("ProMeSA") among PLHIV experiencing food insecurity in the Dominican Republic (DR) was associated with reduced alcohol consumption. METHODS: We recruited 109 participants from two HIV clinics: 1 intervention clinic (n = 46) and 1 control clinic (n = 63). The 12-month intervention included training, materials, and support to establish and maintain a garden; peer nutritional counseling sessions; and a garden-based nutrition and cooking workshop. Survey-based measures included a standard measure of alcohol use (AUDIT-C) and hazardous drinking derived from the AUDIT-C score. Intervention effects were analyzed using a differences-in-differences approach implemented via longitudinal multivariable regression accounting for serial cluster correlation. RESULTS: At baseline, the mean AUDIT score was 2.35, indicating low-risk for problematic drinking on average; however, one-third (34%) reported hazardous drinking. Between baseline and 6 months, AUDIT scores decreased by 0.6-points on average (p = 0.155; 95% CI: -1.45, 0.23) and the prevalence of hazardous drinking decreased by 11 % points (p = 0.146; 95% CI: -0.27, 0.04) in the intervention group compared to the control group. At 12 months, average alcohol use was lower for both intervention and control participants. CONCLUSIONS: Addressing food insecurity through urban gardening and peer nutritional counseling may decrease alcohol consumption among PLHIV. Larger trials are needed to confirm effects and examine if they are sustained across settings and timeframes.
Improving social cognition in individuals with substance use disorders through the E-motional training program: A pilot study.
Piñón-Blanco A, Vergara-Moragues E, López RV … +18 more , Calderón-Cruz B, Fernández-Palleiro P, Lage-López MT, Vázquez-González M, Carrera-Machado I, Lloves-Moratinos M, Viéitez-Fernández I, Cancelo-Martínez J, García-Torres A, Álvarez-Batista B, Carou-López M, Iglesias-Rejas L, Torrens M, Verdejo-García A, Otero-Lamas F, Olivares JM, García-Caballero A, Spuch C
Drug Alcohol Depend · 2026 May · PMID 41764907 · Publisher ↗
BACKGROUND: Individuals with Substance Use Disorders (SUD) may exhibit impairments in social cognition (SC), but few interventions are known to improve it. This study aimed to assess the efficacy of E-Motional Training (...
BACKGROUND: Individuals with Substance Use Disorders (SUD) may exhibit impairments in social cognition (SC), but few interventions are known to improve it. This study aimed to assess the efficacy of E-Motional Training (ET®), an online self-training program for SC, in a sample of individuals with SUD. METHODS: This randomized controlled trial included 47 outpatients diagnosed with SUD (22 in the control group and 25 in the experimental group). The experimental group underwent 12 sessions of ET® over 3 months, while the control group received treatment as usual. Outcome measures assessed two of the most studied SC domains: emotion recognition and Theory of Mind. RESULTS: Mixed ANOVAs showed significant group × time interactions (pre- vs post-treatment) for total emotion recognition [F(1,46) = 4.568, p = .038] with a moderate effect size (d = 0.495), and for recognition of the basic emotion fear [F(1,46) = 4.186, p = .047] with a small effect size (d = 0.341). Post hoc analyses revealed between-group differences after treatment in these same variables (total emotion recognition: [F(1,46) = 5.114, p = .029]; fear recognition: [F(1,46) = 4.283, p = .044]), as well as pre-post differences within the experimental group for total emotion recognition [F(1,46) = 4.707, p = .035]. CONCLUSIONS: The results of this pilot study suggest that the ET® intervention improves emotion recognition in individuals with SUD. CLINICAL TRIAL REGISTRATION DETAILS: Clinical Trial NCT06514937.
Buprenorphine utilization following removal of prior authorization requirements in the Kentucky Medicaid population.
Miracle DK, Hammerslag LR, Slavova S … +4 more , Lofwall MR, Walsh SL, Talbert J, Freeman PR
Drug Alcohol Depend · 2026 May · PMID 41764906 · Full text
PURPOSE: To evaluate changes in buprenorphine dispensing for treatment of opioid use disorder (OUD) among Kentucky Medicaid enrollees following the removal of prior authorization (PA) requirements for the transmucosal bu...
PURPOSE: To evaluate changes in buprenorphine dispensing for treatment of opioid use disorder (OUD) among Kentucky Medicaid enrollees following the removal of prior authorization (PA) requirements for the transmucosal buprenorphine combination product. METHODS: We analyzed Kentucky Medicaid claims from 1/1/2016 through 6/30/2023 to identify enrollees with OUD during each quarter (Q1/2017-Q2/2023), using a 12-month lookback window. Segmented regression analysis was used for statistical modeling of an interrupted time series (ITS) design to assess changes in the quarterly proportion of enrollees with OUD receiving buprenorphine for OUD treatment, focusing on the effect of PA removal. The effective date of the PA removal was February 22, 2019 and thus Q1/2019 was treated as a roll-in period for policy implementation. RESULTS: The quarterly proportion of enrollees with OUD receiving buprenorphine ranged from 0.29 to 0.44 across the study period. Prior to removal of PA requirements for transmucosal buprenorphine, this proportion was increasing at a modest rate (ITS pre-policy slope +0.009; 95% CI 0.008-0.011). The immediate estimated effect of the full PA removal implementation (Q4/2018 to Q2/2019) was a 4-percentage-point increase (level change +0.04; 95% CI 0.03-0.05) followed by a deceleration in growth (slope change -0.006; 95% CI -0.008- -0.005). CONCLUSIONS: Removal of transmucosal buprenorphine PA requirements for Kentucky Medicaid enrollees was associated with a significant immediate increase in buprenorphine dispensing for OUD treatment. Future research should evaluate how post-PA removal trends interact with the Kentucky Medicaid's coverage of methadone for OUD beginning in Q3/2019.
Increased salience network connectivity in college students who engage in binge drinking: A resting state EEG study.
Allegrini G, De Rossi E, Bersani FS … +5 more , Carbone GA, Ardito RB, Adenzato M, Farina B, Imperatori C
Drug Alcohol Depend · 2026 May · PMID 41747409 · Publisher ↗
BACKGROUND: Despite increasing awareness of the harmful consequences of binge drinking (BD), the underlying mechanisms, especially at the neurophysiological level, have yet to be fully elucidated. The main aim of the pre...
BACKGROUND: Despite increasing awareness of the harmful consequences of binge drinking (BD), the underlying mechanisms, especially at the neurophysiological level, have yet to be fully elucidated. The main aim of the present research was to investigate the functional dynamics of the salience network (SN) in individuals with BD during the resting state using electroencephalography (EEG). METHODS: Forty-seven college students who engage in BD and 71 controls were enrolled. EEG data were analyzed using exact Low-Resolution Electromagnetic Tomography (eLORETA) software. RESULTS: Compared to controls, individuals who engage in BD showed increased beta connectivity between the right insula and the left supramarginal gyrus (T = 3.927, p = 0.008). This connectivity pattern was also positively associated with BD severity (rho= 0.424, p < 0.001), even after controlling for potential confounding variables (i.e., age, sex, educational level, cannabis use severity, daily number of cigarettes, and general level of psychopathology). CONCLUSION: This neural configuration may reflect enhanced connectivity between interoceptive and attentional-control circuits, resulting in increased neural sensitivity to internal and external alcohol-related cues.
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