Drug And Alcohol Dependence[JOURNAL]
Sun
200 papers
Cannabis retail environment and treatment for cannabis use disorder.
Mennis J, Coatsworth JD, Zaharakis N … +4 more , Riggs NR, Brown A, Russell M, Mason MJ
Drug Alcohol Depend · 2026 May · PMID 41747408 · Full text
PURPOSE: This research investigates whether the efficacy of a digital cannabis use disorder (CUD) treatment for young adults (age 18-25) differs by exposure to cannabis retailers in the residential neighborhood and activ...
PURPOSE: This research investigates whether the efficacy of a digital cannabis use disorder (CUD) treatment for young adults (age 18-25) differs by exposure to cannabis retailers in the residential neighborhood and activity space (significant places visited throughout daily life). METHODS: This is a secondary analysis of data from a randomized clinical trial of the digital substance use disorder treatment Peer Network Counseling-txt (PNC-txt) for reducing cannabis use among young adults with CUD (n = 425). We hypothesize that the indirect effect of treatment on reducing cannabis use via the mediating mechanism readiness-to-change is moderated by exposure to cannabis retailers, due to the stronger effect of readiness-to-change on reducing cannabis use at lower levels of exposure. RESULTS: The indirect effect of PNC-txt on reducing cannabis use is significantly moderated by activity space exposure to cannabis retailers (β=0.104, 95 % CI: 0.010, 0.197), where the treatment effect is more than three times as strong at low, as compared to high, levels of exposure. We did not find significant moderating effects by residential exposure (β=0.059, 95 % CI: -0.020, 0.137). CONCLUSIONS: Findings indicate that greater exposure to cannabis retailers in a young adult's activity space is associated with reduced CUD treatment efficacy. This is likely due to easier access to cannabis, more tolerant cannabis attitudes, and environmental cues which can trigger craving among those with CUD. Regulations regarding locations and density of cannabis retailers may contribute to better CUD treatment outcomes.
Change in most commonly used vaping brands by young adults in Texas - 2023-2025.
North C, Harrell MB, Pasch KE … +3 more , Marti CN, Wilkinson AV, Loukas A
Drug Alcohol Depend · 2026 May · PMID 41747407 · Publisher ↗
INTRODUCTION: Surveillance of the most popular nicotine vaping brands among young adults is limited and needed to inform FDA regulatory efforts. We examined changes in the most commonly used nicotine vaping brands by Tex...
INTRODUCTION: Surveillance of the most popular nicotine vaping brands among young adults is limited and needed to inform FDA regulatory efforts. We examined changes in the most commonly used nicotine vaping brands by Texas college students across 2023, 2024 and 2025. METHODS: Participants were 6049 18-25-year-olds who vaped nicotine in the past 30-days (Mean age=20.6; 62.3% female). Data were from three repeated cross-sectional samples of Texas college students during spring 2023 (n = 2460), 2024 (n = 2144) and 2025 (n = 1445). Participants reported one nicotine vaping brand they currently use most often. Trends in vaping brands were analyzed using mixed effect growth models. RESULTS: The most used brands across all years were Esco Bar, Elf Bar, Vuse, JUUL, Puff Bar, Geek Bar/Vape, and Lost Mary. Linear mixed effect models indicated that from 2023 to 2025 use of Esco Bar, Elf Bar, JUUL, and Puff Bar decreased, while use of Geek Bar/Vape increased. Quadratic mixed effect models indicated that from 2023 to 2024 use of Vuse and Lost Mary increased; however from 2024 to 2025 Vuse decreased and Lost Mary did not significantly change. CONCLUSIONS: Findings indicate that the nicotine vaping brands that young adults in Texas use rapidly changed within a two-year period, which may reflect FDA's recent regulatory efforts targeting the distribution/sale of unauthorized brands like Esco Bar and Elf Bar. Additional surveillance research is needed for rapidly rising brands like Geek Bar/Vape, which are not authorized for marketing or sale by the FDA.
Applying decision curve analysis to evaluate a patient-centered opioid prescribing strategy among patients with laparoscopic cholecystectomy in the US.
Huang Y, Jacobson JS, Li G … +9 more , Mauro PM, Guschwan MT, Tergas AI, Hou JY, Xu X, Martins SS, Elkin EB, Hershman DL, Wright JD
Drug Alcohol Depend · 2026 Apr · PMID 41719776 · Publisher ↗
BACKGROUND: With evolving prescription policies, the clinical utility of patient-centered opioid prescribing remains unclear. We evaluated whether a patient-centered opioid prescribing approach improves outcomes compared...
BACKGROUND: With evolving prescription policies, the clinical utility of patient-centered opioid prescribing remains unclear. We evaluated whether a patient-centered opioid prescribing approach improves outcomes compared to default strategies: "treat all" (emulating opioid over-prescribing practices in the late 1990s and 2000s) or "treat none" (reflecting prescribing restrictions in Centers for Disease Control and Prevention 2016 guideline). METHODS: We conducted a decision curve analysis using electronic medical data from 1136 adult patients undergoing laparoscopic cholecystectomy for benign indications (October 2015 - December 2018) at an urban tertiary care center. Perioperative opioid needs were categorized as "none/low" or "medium/high" based on pain scores and opioid prescriptions/administrations from 30 days pre-operative to two weeks postoperative. RESULTS: Of 803 patients in the training dataset, 63.9 % required medium/high opioid levels. Key predictors included sex, preoperative medication use (opioids, acetaminophen, other nonsteroidal anti-inflammatory drug, antidepressants), emergent surgery, anesthesia type, and surgical indications. The prediction model's c-statistic was 0.65 (95 %CI: 0.58-0.71) and Brier score was 0.20 (95 % CI: 0.009-0.71) in the testing dataset. At an optimal threshold probability of 0.60, the prediction model correctly identified 16 more true positive cases per 100 patients needing medium/high opioid prescriptions than the "treat all" strategy, accounting for false positives. Across a threshold range of 0.18-0.91, the model-based strategy constantly outperformed both default strategies. CONCLUSION: Prediction-based, patient-centered opioid prescribing provides greater clinical utility across most thresholds.
Hidden nicotine: Cotinine levels among young adult Black men who smoke cannabis blunts.
D'Anna LH, Chang K, Owens J … +3 more , Wood JL, Pang R, Conner B
Drug Alcohol Depend · 2026 May · PMID 41719726 · Publisher ↗
INTRODUCTION: Young adult Black men who smoke cannabis blunts face increased risk for nicotine exposure and addiction. We assessed salivary cotinine levels (a nicotine derivative) associated with blunt use, explored blun...
INTRODUCTION: Young adult Black men who smoke cannabis blunts face increased risk for nicotine exposure and addiction. We assessed salivary cotinine levels (a nicotine derivative) associated with blunt use, explored blunt construction characteristics, and established congruence between self-reported tobacco exposures and salivary cotinine levels. METHODS: Data were collected between July 2023 and March 2024 from young adult Black men (ages 18-30) who reported 30-day blunt use but reported no tobacco/nicotine use. Data included a baseline survey, timeline follow-back, and saliva sample, followed 10h later by an additional survey and sample. Pearson correlations and independent t-tests assessed relationships between blunt use frequency, cravings, affect, risk perception, and cotinine levels. RESULTS: Of the 111 participants, 46 provided saliva sample; over half (54.3%) of the 46 had at least one saliva sample containing more than 10ng/mL cotinine. Higher cotinine concentrations were significantly associated with more blunts smoked (r(44) = .35, p = .017), self-constructed blunts (t(16.5) = 2.58, p = .02), quantity of cannabis (T1: r(43) = 0.33, p = 0.03, T2: r(43) = .426, p = .004), cannabis and blunt cravings (T1: r(44) = 0.36, p = 0.014) (T1: r(43) = 0.33, p = 0.03), cannabis dependence (r(43) = 0.31, p = 0.046), and affect (T1: r(44) = - 0.33, p = 0.023). DISCUSSION: Participants had considerable nicotine exposure exceeding that which is typical of secondhand smoke, despite not reporting other tobacco use. Thus, nicotine exposure may be unintentional and unaccounted for, highlighting the need for tobacco harm reduction interventions focused on blunt smoking.
Changing characteristics in the 2020s of fatal 'novel' benzodiazepine toxicity cases in Australia.
Darke S, Duflou J, Farrell M … +2 more , Lappin J, Peacock A
Drug Alcohol Depend · 2026 May · PMID 41719725 · Publisher ↗
BACKGROUND: Deaths due to poisoning involving novel benzodiazepines (NBZDs) are increasing. We aimed to determine: 1. The characteristics, toxicology and major autopsy findings of known cases of NBZD-related poisoning in...
BACKGROUND: Deaths due to poisoning involving novel benzodiazepines (NBZDs) are increasing. We aimed to determine: 1. The characteristics, toxicology and major autopsy findings of known cases of NBZD-related poisoning in Australia, 2000-2025; and 2. Changes in characteristics of known cases from 2020 onwards compared to earlier known cases. METHODS: Retrospective study of fatal NBDZ-related poisoning in Australia retrieved from the National Coronial Information System. RESULTS: 258 cases were identified, the first in 2013 (2013-2019: 33, 2020-2025: 225). The mean age was 31.9 years and 217 were male, which did not change. 2020s cases were more likely to have histories of injecting drug use (52.0v 21.2 %, OR 4.0) and mental health issues (55.1v 30.3 %, OR 2.8). Fifteen NBZDs were detected, nine first detected in the 2020s. The most frequent were etizolam (48.9 %) and bromazolam (38.0 %). Cases in the later period were more likely to have multiple NBZDs detected (39.6v 12.1 %, OR 4.7). The most common other drug classes were opioids (74.8 %) and registered hypnosedatives (62.4 %). There were no differences between cases in the later and earlier periods in the presence of depressants (94.7v 93.9 %), or psychostimulants (52.0v 39.4 %). Acute bronchopneumonia was less common in the later period (18.2v 40.0 %, OR 1.5). CONCLUSIONS: The 2020s saw a large increase in poisoning deaths related to NBZDs. As testing varied across time and jurisdiction and new NBZDs are constantly appearing the true extent of NBZD-related poisoning deaths is likely to be higher than those identified.
Neural reward sensitivity and longitudinal patterns of alcohol and cannabis use in college-aged youth.
Byrd KJ, Johnston BW, Culp S … +4 more , Kreutzer KA, Way BM, Phan KL, Gorka SM
Drug Alcohol Depend · 2026 Apr · PMID 41713074 · Publisher ↗
BACKGROUND: Alcohol and cannabis are commonly used substances among adolescents, yet the neurobiological mechanisms that confer risk for alcohol and cannabis use disorder remain poorly understood. Abnormalities in neural...
BACKGROUND: Alcohol and cannabis are commonly used substances among adolescents, yet the neurobiological mechanisms that confer risk for alcohol and cannabis use disorder remain poorly understood. Abnormalities in neural reward processing have been implicated in the etiology of substance use disorders, but their predictive utility is unclear. Identifying such risk factors is critical for developing prevention and intervention strategies for high-risk youth. METHOD: We examined whether deficits in neural reward processing predicted changes in problematic alcohol and cannabis use symptoms in youth (ages 16-19, n = 172) with minimal prior substance use. At baseline, the reward positivity (RewP), an event-related potential (ERP) measured via electroencephalography, was used to index deficits in neural reward processing. Every 3 months for 2 years, participants reported problematic cannabis and alcohol use symptoms. To examine changes in substance use problems, we conducted a series of linear mixed-effects models (LMMs). RewP amplitude was the key predictor and linear and quadratic terms for time were included as fixed effects. RESULTS: In our cannabis use model, we observed a significant linear time X RewP interaction. Lower RewP amplitude predicted increases in cannabis use problems over 24-months. At higher levels of RewP amplitude, there was no effect of time on cannabis use problems. We did observe a positive effect of time on alcohol use problems. We found no main/interactive effects of RewP on alcohol use problems. CONCLUSIONS: A blunted RewP is a robust predictor of risk for cannabis use problems, offering potential for early identification and targeted intervention in vulnerable youth.
Prevalence and correlates of drug use during incarceration among people with opioid use disorder: A focused decision tree analysis.
Jadkarim L, Wang EA, Cloud DH … +2 more , Rajeevan H, Brinkley-Rubinstein L
Drug Alcohol Depend · 2026 Apr · PMID 41707366 · Publisher ↗
INTRODUCTION: Substance use disorder is prevalent among incarcerated populations. However, gaps remain in the literature regarding the prevalence of incarcerated drug use and the factors associated with this behavior. Th...
INTRODUCTION: Substance use disorder is prevalent among incarcerated populations. However, gaps remain in the literature regarding the prevalence of incarcerated drug use and the factors associated with this behavior. This study explores the correlates of incarcerated drug use among individuals recently released from incarceration. METHODS: We used data from the multi-site TCN PATHS study, a hybrid type-1 trial, which recruited people with OUD just prior or immediately following release from incarceration. At baseline, participants reported incarcerated drug use, past criminal legal involvement, drug use behaviors, and medical history. We used bivariate analyses and a Classification and Regression Tree (CART) model to determine factors associated with drug use during incarceration. RESULTS: Approximately 17 % of the study population reported using drugs while incarcerated. The majority were male (89 %), White (45 %), straight (97 %), and had a high school education or equivalent (44 %). Participants who reported using drugs while incarcerated mostly used opioids and also reported experiencing withdrawal and social and work disruptions. We found that carceral context was a strong predictor for incarcerated drug use, specifically facilities with medium-to-high security levels and offering multiple types of MOUD were strong correlated of drug use during incarceration. DISCUSSION: Given that carceral context was a strong predictor of incarcerated drug use, efforts to improve MOUD access and tailor treatment plans within facilities may help mitigate risk. Understanding the correlates of drug use in carceral settings will guide implementation of programs and policies tailored that improve the health of people who use drugs during incarceration.
Identifying the 'gray zone': Developing scalable methods to detect opioid misuse in veterans on long-term opioid therapy for pain.
Macleod C, Logue C, Kumbier K … +8 more , Shaw MA, Henneman J, Kehne A, Jarzebowski M, Powell VD, Sussman J, Bohnert A, Lagisetty P
Drug Alcohol Depend · 2026 Apr · PMID 41702269 · Publisher ↗
BACKGROUND: Patients prescribed opioids who are at high risk for misuse but don't meet diagnostic criteria for opioid use disorder (OUD) fall into a clinical 'gray zone,' posing challenges for identification and interven...
BACKGROUND: Patients prescribed opioids who are at high risk for misuse but don't meet diagnostic criteria for opioid use disorder (OUD) fall into a clinical 'gray zone,' posing challenges for identification and intervention. Manual chart reviews are effective but resource intensive while electronic health records (EHR) are imprecise and lack specific codes to identify this high-risk group, limiting understanding of treatments and outcomes. METHODS: We conducted manual chart reviews of 741 US Veterans with long-term opioid prescriptions and at least two opioid-related ICD codes to identify 'gray zone' patients. Using this dataset we trained elastic net regression (ENR) models which then, using only structured EHR data (e.g., ICD codes, pharmacy claims), predicted gray zone status in a larger, unreviewed sample of Veterans creating a sample larger than using manual reviews and more reliable than using only structured data fields. RESULTS: Of 741 patients reviewed, 541 (73 %) met gray zone criteria. The primary ENR model supplemented gray zone identification with a minimum positive predictive (PPV) value of 84 %, 11 % over identification using structured data alone (73 %). The primary (PPV) model augmented sample identified 4047 additional individuals who fell within the "gray zone." Key model variables included age, proportion of no-show appointments, opioid-related ICD code type, non-opioid substance use disorders, and average opioid dose. CONCLUSIONS: Machine learning models can improve the identification of gray zone patients beyond what is possible through chart review using only structured EHR data. This approach may help facilitate population-level identification, enabling targeted research and clinical interventions.
Sleep disturbance is associated with greater subjective and neural negative emotionality in people with alcohol use disorder.
Grodin EN, Kirsch DE, Baskerville WA … +1 more , Ray LA
Drug Alcohol Depend · 2026 Apr · PMID 41691824 · Full text
BACKGROUND: Sleep disturbance is ubiquitous in alcohol use disorder (AUD). Sleep disturbance within AUD has been mapped onto the three-stage addiction cycle. The Addictions Neuroclinical Assessment (ANA) is a neuroscienc...
BACKGROUND: Sleep disturbance is ubiquitous in alcohol use disorder (AUD). Sleep disturbance within AUD has been mapped onto the three-stage addiction cycle. The Addictions Neuroclinical Assessment (ANA) is a neuroscience-based framework, which measures functional domains that correspond to the stages of the addiction cycle. The present study investigated the relationship between sleep disturbance and AUD neuroclinical phenomenology and underlying neurobiology. METHODS: In two independent studies, participants completed assessments of sleep disturbance through the Pittsburgh Sleep Quality Index (PSQI; n = 115) or the Insomnia Severity Index (ISI; n = 102). A subset of individuals (n = 52) completed a functional magnetic resonance imaging scan to assess the neurobiology of the incentive salience and negative emotionality domains. RESULTS: Both studies found that sleep disturbance was associated with negative emotionality (ps≤0.001), but not incentive salience (ps>0.14) or executive function (p = 0.62). Individuals with sleep disturbance had greater activation in the frontal pole, anterior cingulate, medial frontal cortex, and posterior cingulate cortex when viewing negative vs. neutral images, compared to those without sleep disturbance, indicating an underlying neural substrate for the heightened negative emotionality neuroclinical profile. CONCLUSIONS: These results suggest that sleep disturbances in AUD are associated with a neurofunctional profile of enhanced negative emotionality and identify a potential neurobiology underlying this association. These findings suggest that sleep disturbance may be a promising treatment target to improve negative emotionality in this group.
A pilot trial of using ecological momentary intervention to deliver tetris for alcohol craving among women.
Hahn CK, Brockdorf AN, Pavlacic JM … +6 more , Metts CL, Brady KT, Hoffman M, Guille C, Saladin ME, Back SE
Drug Alcohol Depend · 2026 Apr · PMID 41691823 · Publisher ↗
Innovative and accessible interventions are critical to address rising rates of alcohol misuse and low rates of alcohol treatment engagement among women. Ecological momentary interventions (EMI) that use technology to de...
Innovative and accessible interventions are critical to address rising rates of alcohol misuse and low rates of alcohol treatment engagement among women. Ecological momentary interventions (EMI) that use technology to deliver interventions in real-time may be a promising avenue to reduce barriers to alcohol interventions for women and ensure they receive intervention when they need it most. Craving is a key proximal predictor of alcohol use that may be beneficial to target using EMI. Tetris is a visuospatial task that may disrupt craving by placing competing demands on visual working memory. This study tested a Tetris EMI for craving and alcohol use among women who reported alcohol misuse. Forty women completed a two-week experimental EMA protocol involving a daily interval-contingent survey assessing past-day alcohol craving and consumption, as well as four daily signal-contingent surveys assessing momentary craving. Participants assigned to the intervention condition (n = 20) were prompted to complete Tetris for four minutes in response to momentary craving and those assigned to the control condition (n = 20) were prompted to wait four minutes before re-rating craving. Participants also completed baseline and post-experimental questionnaires. Results indicated that the Tetris EMI was highly acceptable and generally feasible. The EMI predicted average decreases in momentary craving for those who reported high levels of recognition of possible harms related to their drinking and readiness to change. However, the EMI did not lead to decreases in average daily craving or drinking. Findings suggest craving is a modifiable target for EMIs among women who are more ready for treatment.
The intersectionality of cannabis use and depression symptoms on functional brain topology in adults.
Liu C, Cousijn J, Kroon E … +1 more , Filbey FM
Drug Alcohol Depend · 2026 Apr · PMID 41691822 · Publisher ↗
BACKGROUND: Although behavioral and epidemiological studies demonstrate high co-morbidity between cannabis use and depression, the underlying neurobiological mechanisms of this relationship remain poorly understood. METH...
BACKGROUND: Although behavioral and epidemiological studies demonstrate high co-morbidity between cannabis use and depression, the underlying neurobiological mechanisms of this relationship remain poorly understood. METHODS: This study evaluated the interaction between cannabis use and depression on brain resting state functional connectivity using graph theory network properties in 223 individuals who currently use cannabis (26.8 ± 8.1 years, 61.9 % males) and 172 controls (25.0 ± 6.8 years, 48.3 % males). RESULTS: Graph theory analyses showed that the cannabis group relative to the control group had shorter characteristic path length, higher global efficiency and transitivity as well as increased local efficiency and clustering coefficient in salience, frontoparietal, and subcortical networks. Depression symptoms significantly moderated the effect of group on global measures, such that the effect of cannabis use status on characteristic path length, global efficiency and transitivity weakened in those with higher depression scores. Post-hoc analyses indicated a dose-response relationship such that the higher cannabis use frequency, the shorter characteristic path length, higher global efficiency, and transitivity; but no significant moderating effect of depression symptoms emerged on these associations. CONCLUSIONS: These findings suggest that the co-occurrence of depression symptoms and cannabis use, compared to cannabis use alone, may be associated with less efficient and less integrated brain network function. Among those who use cannabis, the effects of cannabis use frequency on these global measures do not vary with depression symptoms, suggesting that depression's moderating effect is conditional on cannabis use status, not dose. These findings underscore the complex interplay between cannabis use and depression in altering functional brain organization.
Suicidal ideation and driving under the influence of alcohol and marijuana among U.S. adults: Findings from the 2021-2023 National Survey on Drug Use and Health.
Grigsby TJ, Yockey RA, Rojas M … +2 more , Zhang X, Forster M
Drug Alcohol Depend · 2026 Apr · PMID 41691821 · Publisher ↗
INTRODUCTION: Individuals experiencing suicidal thoughts may exhibit reduced self-preservation, increased impulsivity, or a greater tendency toward risk-taking behaviors -factors that could plausibly elevate the likeliho...
INTRODUCTION: Individuals experiencing suicidal thoughts may exhibit reduced self-preservation, increased impulsivity, or a greater tendency toward risk-taking behaviors -factors that could plausibly elevate the likelihood of driving under the influence. Suicidal ideation has also been linked to diminished engagement in safety-promoting behaviors such as seatbelt use and reduced health-promoting attitudes and behaviors. The present study investigates the association between suicidal ideation with driving under the influence of alcohol (DUIA) and marijuana (DUIM) among US adults. METHOD: Data are responses (N = 173,808) from the 2021-2023 National Drug Use and Health survey. This study included adults 18 and older (unweighted N = 139,524). Multivariate logistic regression models assessed relationships between SI and alcohol or marijuana DUI, adjusting for past year major depressive episode, substance use frequency, tobacco use, age, sex, survey year, education, annual household income, and metro area. RESULTS: The majority of respondents (71 %) were 35 years old or older, 16 % were 26-34, 13 % were between 18 and 25, and about half (49 %) identified as male. Approximately 6 % reported past-year DUIA, and 5 % reported DUIM. Individuals with past-year SI had higher odds of DUIA (aOR=1.43, 95 % CI: 1.21-1.69) and DUIM (aOR=1.52, 95 % CI: 1.29-1.79) after adjusting for covariates. CONCLUSION: Our findings highlight that past-year SI is associated with higher odds of DUIA and DUIM. Implementing SI screening and interventions could indirectly address rates of DUI.
Achieving SVR is associated with long term reduced hazardous alcohol use for people who inject drugs receiving HCV treatment: The HERO study.
Waters E, Obeysekare J, Lopes S … +14 more , Pericot-Valverde I, Norton BL, Tsui JI, Mehta SH, Taylor LE, Lum PJ, Feinberg J, Kim AY, Page K, Anderson J, Murray-Krezan C, Heo M, Litwin AH, HERO Study Group
Drug Alcohol Depend · 2026 Apr · PMID 41690189 · Publisher ↗
BACKGROUND/AIMS: People who inject drugs (PWID) have high rates of HCV infection. Concurrent alcohol use is associated with higher rates of HCV and acceleration of HCV-related liver disease. This study analyzed alcohol u...
BACKGROUND/AIMS: People who inject drugs (PWID) have high rates of HCV infection. Concurrent alcohol use is associated with higher rates of HCV and acceleration of HCV-related liver disease. This study analyzed alcohol use among PWID both during and after treatment of HCV with direct-acting antivirals. APPROACH/RESULTS: We conducted a secondary analysis of the HERO study, a multisite pragmatic randomized trial, in which PWID with active drug use (n = 755) were assigned to either patient navigation or modified directly observed therapy models of HCV care. Alcohol use was measured using the modified Addiction Severity Index (ASI) and the Alcohol Use Disorders Identification Test-Concise (AUDIT-C). Linear mixed-effects models were used to analyze changes in alcohol use between baseline, treatment (weeks 4, 8, and 12), and after-treatment follow-up visits (weeks 24, 72, 120, 168). Overall, there were no significant differences in ASI or AUDIT-C scores by sustained virological response (SVR) or treatment arm. Among patients who achieved SVR, there was a significant reduction in AUDIT-C scores at all follow-up visits compared to baseline (all, p < 0.05). Among those with high AUDIT-C score at baseline, there were significant reductions in drinking at all visits compared to baseline in both treatment arms (all, p ≤ 0.001). CONCLUSIONS: Among PWID who achieved SVR or with high AUDIT-C scores at baseline, there was a significant reduction in AUDIT-C scores at all visits after baseline. The treatment period for HCV may represent a unique opportunity to address dual causes of liver disease, especially for individuals with hazardous alcohol use.
Long-term use of Benzodiazepines and Z-drugs: A register-based cohort study in Taiwan.
Chou MC, Lin YP, Pan CH … +4 more , Su SS, Tsai SY, Chen CC, Kuo CJ
Drug Alcohol Depend · 2026 Apr · PMID 41690188 · Publisher ↗
BACKGROUND: Benzodiazepines (BZDs) and Z-drugs are commonly prescribed for anxiety and insomnia, but their long-term use remains a public health concern. Evidence from Asia remains limited. This study investigated trajec...
BACKGROUND: Benzodiazepines (BZDs) and Z-drugs are commonly prescribed for anxiety and insomnia, but their long-term use remains a public health concern. Evidence from Asia remains limited. This study investigated trajectories and predictors of long-term use in Taiwan by using a population-based cohort. METHODS: We conducted a register-based cohort study by using a nationally representative sample from Taiwan's National Health Insurance Research Database (NHIRD), covering a 20-year period from January 1, 2000, to December 31, 2019 after a 1-year washout. Incident users were identified and followed to evaluate long-term use patterns on the basis of two discontinuation thresholds: 90 days and 365 days. Cox regression models were used to estimate adjusted hazard ratios (aHRs) for long-term use by demographic, physical, and psychiatric factors. RESULTS: Among 896,163 incident users, 3.8% progressed to long-term use under the 90-day definition, increasing to 14.7% under the 365-day definition. Under the 90-day definition, clonazepam and hypnotic BZDs showed the highest persistence (10.3% and 8.4%). More than 70% of initiations occurred in nonpsychiatric specialties. Long-term use was associated with male sex, older age, and higher Charlson Comorbidity Index; strong predictors included cancer, pneumonia, moderate-to-severe renal disease, alcohol- or drug-induced mental disorders, and personality disorders. CONCLUSION: In Taiwan, most BZD and Z-drug use is short-term, and their usage patterns are affected by both clinical and system-level factors. These findings highlight the need for risk-based monitoring, cross-specialty prescribing oversight, and further research into treatment substitution strategies.
Patterns of structural brain differences in cocaine use disorder: Integrating multilevel frequentist, Bayesian, and coordinate-based meta-analyses.
Bittencourt AML, Favero BP, Haas C … +5 more , Portolan ET, Gallardo E, Rothmann LM, Grassi-Oliveira R, Viola TW
Drug Alcohol Depend · 2026 Apr · PMID 41687382 · Publisher ↗
BACKGROUND: Cocaine Use Disorder (CUD) has been associated with differences in gray matter (GM) measures, but prior meta-analyses have yielded inconsistent results due to methodological variability, publication bias, and...
BACKGROUND: Cocaine Use Disorder (CUD) has been associated with differences in gray matter (GM) measures, but prior meta-analyses have yielded inconsistent results due to methodological variability, publication bias, and selective reporting. To address these gaps, this study integrates multilevel frequentist, Bayesian, and coordinate-based approaches to provide a comprehensive, anatomically resolved synthesis of structural neuroimaging findings in CUD. METHODS: Following PRISMA guidelines (PROSPERO: CRD42024585260), 47 studies were included that compared GM indices between individuals with CUD and healthy controls. Multilevel random-effects meta-analyses were conducted to quantify cortical and subcortical group differences while accounting for clinically relevant moderators. Bayesian hierarchical models were used to conduct sensitivity analyses addressing potential reporting bias, and a coordinate-based Activation Likelihood Estimation (ALE) analysis evaluated spatial convergence across voxel-based morphometry studies. RESULTS: The analyses indicated that CUD showed lower GM measures in prefrontal and temporal cortical regions, particularly the ITG and the rostral middle frontal gyrus. Subcortical analyses showed lower GM volume in the amygdala, hippocampus, thalamus, pallidum, nucleus accumbens, brainstem, and cerebellum. Longer duration of cocaine use and greater clinical severity were associated with larger negative effect-size estimates for cortical measures. Bayesian regularization yielded consistent cortical effect-size estimates across sensitivity analyses, whereas the coordinate-based ALE analysis identified no clusters surviving family-wise error correction. CONCLUSIONS: Together, results from this meta-analysis identify consistent patterns of GM differences across cortico-subcortical regions in individuals with CUD. These findings provide an integrated neuroanatomical reference framework that may inform future longitudinal studies and the evaluation of candidate neuroimaging biomarkers.
Association between the initiation of strong chū-hai consumption and the incidence of hazardous and harmful alcohol use in Japan: An online survey-based cohort study.
Yoshioka T, So R, Shinozaki T … +6 more , Rossheim M, Tsutsumi S, Funada S, Hanada A, Minami T, Tabuchi T
Drug Alcohol Depend · 2026 Apr · PMID 41655505 · Publisher ↗
OBJECTIVE: To investigate the association between the initiation of strong chū-hai-an inexpensive Japanese ready-to-drink beverage with high-alcohol-content-consumption and the newly incident hazardous and harmful alcoho...
OBJECTIVE: To investigate the association between the initiation of strong chū-hai-an inexpensive Japanese ready-to-drink beverage with high-alcohol-content-consumption and the newly incident hazardous and harmful alcohol use among individuals who consume alcohol. METHODS: This cohort study is based on a three-year longitudinal internet survey conducted in Japan from 2022 to 2024. Respondents who completed all three annual surveys, did not drink strong chū-hai in 2022, and consumed alcohol without presenting hazardous or harmful alcohol use in both 2022 and 2023, were included. The outcome was defined as having newly developed hazardous and harmful alcohol use in 2024, defined as a score of ≥ 8 on the Alcohol Use Identification Test. We fitted a multivariable logistic regression model to examine confounder-adjusted association between initiating strong chū-hai consumption and the incidence of hazardous and harmful alcohol use. RESULTS: Of 5358 respondents from 33,000 surveyed in 2022, approximately 10 % (n = 533) initiated strong chū-hai consumption in 2023. In 2024, the prevalence of hazardous and harmful alcohol use was higher for those who initiated strong chū-hai consumption (7.7 %) than those who did not (3.1 %). Multivariable analysis revealed that initiating strong chū-hai consumption was associated with higher odds of hazardous and harmful alcohol use the year following (adjusted odds ratio 1.90, 95 % confidence interval 1.19-3.06, p = 0.008). CONCLUSIONS: The initiation of strong chū-hai consumption was associated with the incidence of hazardous and harmful alcohol use. Considering the global increase in sales of ready-to-drink alcoholic beverages, our findings serve as an important caution for policymakers worldwide.
Perspectives on collaboration between drug courts and MOUD providers: Impact of interagency implementation strategies.
Pivovarova E, Taxman FS, Andraka-Christou B … +5 more , Boland A, Drawbridge D, Smelson D, Lemon SC, Friedmann PD
Drug Alcohol Depend · 2026 Mar · PMID 41650799 · Full text
BACKGROUND: Effective working relationships between drug courts and community providers are critical to improving access to medications for opioid use disorder (MOUD), but collaboration is often inadequate. We adapted an...
BACKGROUND: Effective working relationships between drug courts and community providers are critical to improving access to medications for opioid use disorder (MOUD), but collaboration is often inadequate. We adapted and piloted a package of implementation strategies (Clinical Organizations and Legal Agency Alliance Building; COLAAB) designed to enhance collaboration between recovery courts and MOUD agencies. COLAAB activities included structured interagency meetings, agency tours, academic liaison, and development of local resource guides. METHODS: After the implementation of COLAAB in three courts, we conducted semi-structured interviews (n = 24) with drug court and MOUD staff to assess the impact of COLAAB on collaboration, communication, and referrals. Data were analyzed using a modified iterative categorization approach. RESULTS: Drug court and MOUD agency staff perceived COLAAB as facilitating interagency relationships and referrals to MOUD, increasing MOUD agencies' understanding of drug courts, improving communication quality, strengthening understanding and trust in MOUD providers and drug courts, and reducing time to referrals to MOUD. COLAAB also increased the MOUD agency staff's awareness of other community providers and helped build their potential referral networks. COLAAB may have also enhanced drug court staff's willingness to speak with clients about MOUD and MOUD provider staff's willingness to discuss clients' criminal legal involvement. DISCUSSION: Our pilot study provides preliminary evidence that court-MOUD agency collaborations can be enhanced through active learning about one another's practices and services, participation in regularly scheduled meetings or activities, and the identification and use of resources that support efficient interagency referral processes.
Emotional arousal of graphic cigarette warning labels loses its beneficial effects on craving reduction after repeated exposure - A longitudinal neuroimaging study.
Ramos-Rolón AP, Langleben DD, Lynch KG … +2 more , Wiers CE, Shi Z
Drug Alcohol Depend · 2026 Mar · PMID 41650798 · Full text
BACKGROUND: Graphic warning labels (GWLs) on cigarette packaging have been implemented in many countries. In the U.S., however, GWLs have faced legal challenges based on concerns that their aversive imagery elicits exces...
BACKGROUND: Graphic warning labels (GWLs) on cigarette packaging have been implemented in many countries. In the U.S., however, GWLs have faced legal challenges based on concerns that their aversive imagery elicits excessive emotional arousal without sufficient data to support its beneficial impact. This longitudinal study examined how GWLs' level of arousal affects cigarette craving and neural responses related to emotional processing. METHODS: A total of 158 adults who smoked cigarettes were exposed to either high-arousal (n = 79) or low-arousal (n = 79) GWLs attached to their cigarette packs for 4 weeks. Cigarette craving and brain responses to GWLs were measured using functional magnetic resonance imaging before and after the exposure period. The amygdala, a key region involved in emotional processing, was the brain region of interest. RESULTS: At baseline, high-arousal GWLs elicited a greater reduction in craving and stronger amygdala activation than low-arousal GWLs. However, by week 4, the differences in craving reduction and amygdala response between groups were no longer significant. Amygdala activity mediated the effect of GWLs on craving reduction, with the mediation effect being more pronounced in the high-arousal group than the low-arousal group at baseline but not at week 4. CONCLUSIONS: The impact of GWL-induced arousal on cigarette craving appears to diminish over time, likely due to habituation in amygdala reactivity. High-arousal GWLs do not provide sustained advantages over low-arousal ones. Low-arousal GWLs may represent a more practical and legally defensible approach to tobacco control in the U.S.
Could the telescoping effect and comorbidity with substance use disorders account for sex differences in the processes and therapeutic outcomes? A latent-class moderation analysis.
Dacosta-Sánchez D, Mancheño-Velasco C, Narváez-Camargo M … +1 more , Lozano ÓM
Drug Alcohol Depend · 2026 Mar · PMID 41643328 · Publisher ↗
BACKGROUND: Sex differences in substance use disorder (SUD) treatment outcomes remain unclear; protocols focused on male prevalence may overlook female-specific needs. This study tested interactions among sex, the telesc...
BACKGROUND: Sex differences in substance use disorder (SUD) treatment outcomes remain unclear; protocols focused on male prevalence may overlook female-specific needs. This study tested interactions among sex, the telescoping effect, and comorbid profiles in outcomes. METHODS: Retrospective multisite electronic health record study (N = 4818) of patients with co-occurring disorders. Interaction regressions and latent class analysis tested sex moderation of links between years of substance use (telescoping) and outcomes within SUD and co-occurring diagnostic groups. RESULTS: Slower progression from substance use onset to diagnosis was associated with lower readmission likelihood at 3 years in males than females; similar patterns appeared at 18 and 24 months for alcohol dependence and at 18 months for co-occurring mood disorders. Six comorbid classes were identified (feature-based labels): behavioral dysregulation (Class 1), anxious distress (Class 2), adolescence-cannabis (Class 3), emotional-interpersonal dysregulation (Class 4), affective-alcohol (Class 5), and reality distortion (Class 6). Only Classes 2 and 4 showed the telescoping effect. Latent-class moderation revealed males in Classes 1 and 3 had higher readmission over 3 years, whereas females in Class 4 had lower adherence to scheduled appointments and higher predicted readmissions across all follow-ups. Females in Class 6 showed better appointment adherence than males. CONCLUSIONS: Telescoping and sex differences may contribute to higher readmission in females, particularly with alcohol dependence and mood or personality disorders. Males with impulse-control or childhood disorders may require more post-treatment care. Sex-specific interventions and moderation/latent class approaches may improve targeting.
Descriptive content analysis assessment of ChatGPT responses to substance use disorder treatment questions compared to National health guidelines.
Decker M, Kamm C, Burgoa S … +7 more , Rao M, Mejia M, Ramdin C, Dean A, Nasr M, Nelson LS, Sacca L
Drug Alcohol Depend · 2026 Mar · PMID 41643327 · Publisher ↗
BACKGROUND: Artificial intelligence (AI)-powered large language models like ChatGPT are increasingly used by the public to access health information. These platforms may be particularly appealing for high-risk conditions...
BACKGROUND: Artificial intelligence (AI)-powered large language models like ChatGPT are increasingly used by the public to access health information. These platforms may be particularly appealing for high-risk conditions such as substance use disorder (SUD), where anonymity and nonjudgmental responses are valued. Despite growing interest in AI-assisted health education, limited research has assessed the quality of ChatGPT's content when it comes to accuracy and completeness on complex behavioral health topics. This study evaluated the accuracy and clinical consistency of ChatGPT's responses to SUD-related questions compared to national health guidelines. METHODS: This descriptive study, using a content analysis approach, analyzed ChatGPT 3.5's and 5's responses to 14 clinically relevant SUD-related questions, drawn from over 200 FAQs sourced from six leading U.S. health organizations in comparison to the top SUD questions asked by US adults using ChatGPT. Each response was independently assessed by a multidisciplinary team for accuracy, clarity, and appropriateness using an evidence-informed rating system. Responses were categorized as excellent, satisfactory requiring minimal clarification, satisfactory requiring moderate clarification, or unsatisfactory. Discrepancies were resolved through consensus. RESULTS: Among the 14 responses, 3 were rated excellent, 9 were satisfactory requiring minimal clarification, and 2 were satisfactory requiring moderate clarification. None were rated unsatisfactory. ChatGPT responses were generally accurate for straightforward questions but lacked clinical nuance and specificity in more complex scenarios, particularly regarding individualized care recommendations, withdrawal management, and treatment planning. CONCLUSION: As AI becomes more integrated into health information-seeking behaviors, continued evaluation of its role and potential impact in addiction medicine is essential.
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