Drug And Alcohol Dependence[JOURNAL]
Sun
200 papers
The evolving burden of drug use disorders in Mexico: Secondary data analysis from the global burden of disease study 2021.
Dávila-Cervantes CA
Drug Alcohol Depend · 2026 Mar · PMID 41638009 · Publisher ↗
OBJECTIVE: To analyze the burden of disease from drug use disorders (DUD) in Mexico by state from 1990 to 2021 and to assess the association of this burden of disease with the Healthcare Access and Quality Index (HAQI)....
OBJECTIVE: To analyze the burden of disease from drug use disorders (DUD) in Mexico by state from 1990 to 2021 and to assess the association of this burden of disease with the Healthcare Access and Quality Index (HAQI). METHODS: Secondary data analysis from the GBD-2021 study. The paper analyzes mortality, premature mortality, disability and disability-adjusted life years (DALYs). A log-linear segmented regression model to analyze trends in DUD DALYs over time was used. The information was disaggregated by age-groups and sub-causes, at the national and state levels. RESULTS: DUD mortality increased by 27.9 % over the last three decades. The DUD burden of disease remained stable with DALY rates of 85.8 per 100000 in 1990 and 86.9 in 2021. Males showed mortality rates over four times higher than females. In 2021, DUD premature mortality was higher for males (35.6 vs. 8.2 per 100000 among females), while disability rates were higher for females (70.7 vs. 59.7 among males). The highest DUD DALYs occurred among individuals aged 20-29, with cocaine and opioid use disorders as the leading contributors to the DUD DALYs, with notable differences between males and females. Regionally, the northern states, especially Baja California and Chihuahua, exhibited the highest DUD DALYs, whereas central states like Tlaxcala and the State of Mexico had the lowest. A complex relationship between DUD DALYs and the HAQI was observed. CONCLUSIONS: There is also an urgent need for age- and gender-responsive public health strategies, evidence-based harm reduction programs, and comprehensive policy interventions to lessen the impact of DUD in Mexico.
Cannabis legalization and cannabis and opioid use in a large, multistate sample of people who inject drugs: A staggered adoption difference-in-differences analysis.
Haley DF, Beane S, Beletsky L … +4 more , Yarbrough CR, Linton S, Ibragimov U, Cooper HL
Drug Alcohol Depend · 2026 Mar · PMID 41638008 · Full text
BACKGROUND: The role of cannabis reform in shaping North America's overdose and addiction crisis remains hotly contested. People who inject drugs (PWID) sometimes substitute cannabis for opioids. Yet, no research has exa...
BACKGROUND: The role of cannabis reform in shaping North America's overdose and addiction crisis remains hotly contested. People who inject drugs (PWID) sometimes substitute cannabis for opioids. Yet, no research has examined the effects of cannabis legalization on opioid use among PWID-- despite major potential for PWID to benefit from policy interventions reducing opioid-related harms. We examined whether legalizing cannabis for medical use (MCL) vs. both MCL and adult/recreational use (MCL+RCL) was associated with changes in substance use among PWID, overall and by sex and race/ethnicity. METHODS: This serial cross-sectional observational study used staggered adoption difference-in-differences models to analyze data (2012, 2015, 2018, 2022) from 28,069 PWID from 13 states. We examined associations between time-varying implementation of MCLs and MCL+RCLs and self-reported past 12-month daily use of cannabis and non-medical opioid use. RESULTS: Compared to MCL, MCL+RCL was associated with a 9-11 % decrease in the probability of daily opioid misuse (95 % CIs: [any opioids: -14.0, -4.0]; [injected opioids, -19.0, -2.0]). The probability of daily cannabis use increased from 15 % to 20 % for non-Latinx White PWID in states transitioning from no legalization to MCL (95 % CIs: 14.0, 17.0; 17.0, 23.0). CONCLUSIONS: Cannabis legalization may shape daily opioid consumption among PWID, potentially reducing drug-related harms. Differences in cannabis use following legalization may reflect disparate impact by race, due to structural racism or other factors. Future research examining whether policy attributable changes in substance use manifest health benefits among PWID is critical to developing evidence- based cannabis reform.
Illicit cannabis use among workers in Australia: A nationally representative cross-sectional analysis of prevalence, determinants, and associated absenteeism.
Di Censo G, Thompson K, Bowden J
Drug Alcohol Depend · 2026 Mar · PMID 41633211 · Publisher ↗
INTRODUCTION: Cannabis is the most used illicit substance among workers in Australia, yet the epidemiology of frequent use and risk of harm remains underexplored. This study investigated the prevalence and determinants o...
INTRODUCTION: Cannabis is the most used illicit substance among workers in Australia, yet the epidemiology of frequent use and risk of harm remains underexplored. This study investigated the prevalence and determinants of, as well as absenteeism associated with, weekly illicit cannabis use and risk of cannabis-related harm among Australian workers. METHOD: The study used data from the 2019 and 2022-23 National Drug Strategy Household Surveys (N = 24,954). RESULTS: Weekly cannabis use was reported by 5.0 % (SE = 0.2) of respondents, while 2.2 % (SE = 0.1) were classified as at risk of harm. Workers in construction and hospitality, as well as labourers and tradesmen, exhibited elevated rates of use and harm. Significant determinants of weekly illicit cannabis use identified in multivariate regression models include being male, younger (14-39 years), never married, born in Australia, smoking (current or former), and heavy episodic drinking (HED). Determinants of being at risk of harm were being male, never married, born in Australia, residing in a major city, experiencing psychological distress, smoking (current or former), and HED. Current smoking showed the strongest associations with both outcome measures. Weekly illicit cannabis use and being at risk of harm were associated with 2.8 and 6.9 additional days absent from work due to illness or injury, respectively. CONCLUSIONS: By identifying the determinants and consequences of frequent illicit cannabis use and being at risk of harm among employed individuals, these findings provide key insights necessary to develop targeted behavioural change and workplace substance use interventions.
Daily patterns of substance use among young adults who vape nicotine and cannabis: Latent class analysis of smartphone-based daily diary data.
Halliday DM, Lund L, Ling PM … +1 more , Nguyen N
Drug Alcohol Depend · 2026 Mar · PMID 41628576 · Full text
INTRODUCTION: Using multiple tobacco and cannabis products is common among young adults and raises concerns about addiction and health risks. Few studies address daily use patterns of multiple products on the same day. W...
INTRODUCTION: Using multiple tobacco and cannabis products is common among young adults and raises concerns about addiction and health risks. Few studies address daily use patterns of multiple products on the same day. We used daily diaries to identify patterns of substance use and associated factors among young adults who reported vaping nicotine and cannabis. METHODS: We collected smartphone-based daily diaries from 113 California young adults (mean age=23.8) who vaped nicotine or cannabis for 20 + days in the past month. For 30 consecutive days, participants reported their daily use of nicotine/tobacco, cannabis, alcohol, craving for nicotine and cannabis vaping, and mood. We used multilevel latent class analysis to identify daily substance use patterns and mixed-effects logistic regression to identify factors associated with these patterns, controlling for baseline covariates (e.g., demographics, nicotine/cannabis dependence). RESULTS: Three latent classes emerged: Class 1 - "Nicotine vaping days" (52.7 % of the assessments), Class 2 - "Nicotine and cannabis co-vaping days" (39.9 %), and Class 3 -"Combustible tobacco and cannabis use days" (7.4 %). Higher levels of feeling sad on a given day were associated with increased likelihood of that day belonging to Class 1 (adjusted OR = 1.11, 95%CI95 %CI = 1.01 - 1.23). Higher cravings for cannabis vaping on a given day were associated with increased likelihood of that day belonging to Class 2 (adjusted OR = 1.81, 95 % CI = 1.63 - 2.01). CONCLUSION: Interventions should be tailored to varying daily substance use patterns among young adults who vape. Efforts targeting vaping cessation may also address combustible product use.
Impulsivity as a dynamic mechanism linking young adult sleep and drinking behavior during naturally occurring drinking episodes.
Waddell JT, Wycoff AM, Miller MB
Drug Alcohol Depend · 2026 Mar · PMID 41621368 · Publisher ↗
BACKGROUND: Impulsivity is implicated in theories linking sleep and drinking behavior. While well-studied across individuals, research regarding sleep, impulsivity, and drinking in real-world contexts is lacking. This st...
BACKGROUND: Impulsivity is implicated in theories linking sleep and drinking behavior. While well-studied across individuals, research regarding sleep, impulsivity, and drinking in real-world contexts is lacking. This study tested a theoretical pathway wherein better-than-average sleep predicts decreased impulsivity while drinking, which then predicts lesser drinking and negative alcohol consequences experienced during drinking episodes. METHOD: Young adults (N = 131) completed 21 days of ecological momentary assessment, including morning reports, self-initiated drink reports after first drink, and follow-up drinking reports 60/120min later. Past-day drinking quantity, negative alcohol consequences, and sleep (duration, nighttime awakenings, and morning readiness to start day) were measured each morning. Impulsivity (urgency, lack of premeditation, lack of perseverance, and sensation seeking) was measured during drink initiation/follow-up reports. RESULTS: In two of the four multilevel mediation models (one for each facet of impulsivity), better sleep (higher morning readiness and longer sleep duration) predicted decreased state impulsivity (lack of premeditation and sensation seeking) while drinking, which indirectly predicted fewer negative consequences via lighter drinking quantity. Above and beyond state impulsivity while drinking, higher morning readiness indirectly predicted fewer negative consequences via lighter drinking quantity. Increased urgency also indirectly predicted negative consequences via heavier drinking quantity but was unrelated to sleep. Findings were unchanged when accounting for cumulative sleep debt, except relations between morning readiness and sensation seeking while drinking. CONCLUSIONS: Dampened state impulsivity while drinking may explain protective associations between good sleep health and less risky drinking. Sleep interventions may be effective at reducing impulsivity while drinking and alcohol-related harms.
Caregiver-reported evaluation for and diagnosis of fetal alcohol spectrum disorders in the United States.
Deputy NP, Kellerman AM, Dorsey AN … +6 more , Denny CH, Weber MK, Thomas SA, Jones J, Kim SY, Bertrand J
Drug Alcohol Depend · 2026 Mar · PMID 41610460 · Full text
BACKGROUND: In-person, active case ascertainment studies suggest the prevalence of children with fetal alcohol spectrum disorders (FASDs), lifelong disorders caused by prenatal alcohol exposure, in selected communities r...
BACKGROUND: In-person, active case ascertainment studies suggest the prevalence of children with fetal alcohol spectrum disorders (FASDs), lifelong disorders caused by prenatal alcohol exposure, in selected communities ranges from 11.3 to 71.4 per 1000 (including diagnosed and undiagnosed FASDs). National, population-based estimates of children with an FASD diagnosis and who are at different stages of a prototypical diagnostic process are limited. METHODS: Data are from the 2022-2024 National Survey of Children's Health (n = 160,640). We estimated the caregiver-reported prevalence of children who had ever been recommended for an FASD evaluation, received an FASD evaluation, and received an FASD diagnosis, overall and by demographic subgroups; Chi-square tests assessed differences by subgroup. RESULTS: Based on caregiver report, 2.4 per 1000 children were recommended for an FASD evaluation, 3.1 per 1000 received an evaluation, and 2.0 per 1000 received an FASD diagnosis. Prevalence varied by several characteristics; for example, the prevalence of children with an FASD diagnosis was higher among those cared for by grandparents or other relations (10.8 per 1000, 95 % confidence interval [CI]: 7.2-16.0) than those cared for by two parents (1.2 per 1000, 95 % CI: 0.9-1.6). Of the 4.6 per 1000 children either recommended for an FASD evaluation, received an evaluation, or diagnosed with an FASD, 20.0 % had all three experiences. CONCLUSIONS: These nationally representative, caregiver-reported estimates for children with an FASD diagnosis are lower than those from active case ascertainment studies, suggesting efforts are needed to improve the screening, evaluation, and diagnosis process for children suspected of an FASD.
Retreatment with nicotine replacement therapy: Predictors of re-enrolment in a cohort of people who smoke seeking treatment in ambulatory settings.
Man X, Selby P, Zawertailo L … +1 more , Veldhuizen S
Drug Alcohol Depend · 2026 Feb · PMID 41604753 · Publisher ↗
BACKGROUND: People who re-enrol in smoking cessation treatment repeatedly may benefit from more intensive or alternative interventions. We aimed to measure differences across participants in propensity to re-enrol in a l...
BACKGROUND: People who re-enrol in smoking cessation treatment repeatedly may benefit from more intensive or alternative interventions. We aimed to measure differences across participants in propensity to re-enrol in a large treatment program, to describe re-enrolment patterns, and to examine specific participant characteristics that predict re-enrolment. METHODS: We analyzed 172,050 enrolments into the Ontario-wide Smoking Treatment for Ontario Patients (STOP) program between 2014 and 2023. STOP provides up to 26 weeks of nicotine replacement therapy (NRT) and allows re-enrolment after one year. We used probabilistic deduplication to identify 128,481 unique individuals. To analyze re-enrolment, we fit a mixed-effects Cox proportional hazards survival model for recurrent events, with demographic, clinical, and contextual variables included as fixed effects. RESULTS: Of all enrolments, 25.3 % (43,569) were repeat entries. Participant-level variance was very high (σ2 =1.66, median hazard ratio = 3.4), indicating large residual individual-level differences in propensity to re-enrol. The strongest predictors of reenrolment were time to first cigarette after waking (p < 0.001), lifetime quit attempts (p < 0.001), type of NRT provided (p < 0.001) and total visits in previous enrolment (HR 1.10, 95 % CI 1.10-1.11), clinic type (p < 0.001), schizophrenia (HR 1.51, 95 % CI 1.41-1.60), and enrolment during the COVID-19 era (HR 1.31, 95 % CI 1.20-1.44). CONCLUSION: Propensity to re-enrol varied markedly across individuals, implying that there is a subgroup of treatment-seeking people who are less likely to achieve longterm abstinence. Alternative interventions or long-term nicotine replacement may be justified for these individuals.
Safety, tolerability, and drug-drug interactions of NYX-783 and oxycodone in persons using opioids recreationally: Preliminary results from a randomized, double-blind, placebo-controlled phase 1 study.
Harvanek ZM, Mignosa MM, Kitaneh R … +9 more , Oliva HNP, Borelli A, Dauginikas E, Fogelman N, Sakmar E, Taylor J, DiLeone R, Sinha R, Angarita GA
Drug Alcohol Depend · 2026 Feb · PMID 41604752 · Full text
BACKGROUND: Novel treatments are needed for opioid use disorder (OUD). NYX-783, an NMDA positive allosteric modulator, affects synaptic plasticity and learning, key processes in. Although prior preclinical and studies in...
BACKGROUND: Novel treatments are needed for opioid use disorder (OUD). NYX-783, an NMDA positive allosteric modulator, affects synaptic plasticity and learning, key processes in. Although prior preclinical and studies in healthy humans have established its safety and tolerability, studies are needed in the context of opioid use. METHODS: Nine men who used opioids recreationally and passed a safety session were enrolled in inpatient study. Participants received single doses of NYX-783 (50mg, 150mg) and placebo and in combination with two oxycodone doses (15mg, 30mg), across six inpatient drug-drug interaction (DDI) sessions in a randomized, double-blind, crossover design. The primary endpoints included cardiovascular and respiratory safety, tolerability, and pharmacokinetics. RESULTS: No severe nor serious adverse events were reported and 85 % of adverse events were mild. NYX-783 reduced oxycodone's calmative effects (p < .0005). There was no effect of NYX-783 on feeling drug effect and high, nor wanting, liking, or disliking the drug. For the DDI sessions, there was no significant timepoint-by-NYX-783-by-oxycodone interaction for pulse, systolic & diastolic blood pressure, temperature, pupillary dilation, subjective drug effects, nor electrocardiogram's segments. There was a significant timepoint-by-NYX-by-oxycodone interaction for plasma NYX plasma levels (F = 3.19; DF = 8; p = 0.003) in which NYX levels were significantly higher when combined with 30mg of oxycodone vs. 15mg of oxycodone (p < 0.0001). CONCLUSIONS: NYX-783's tolerability, safety, capacity to reduce oxycodone's calmative effects and benign DDI profile offers support for future, larger (i.e., Phase 1B/2A) trials specifically targeting its safety and therapeutic potential in OUD.
Randomized studies assessing the effect of flavor on pharmacokinetic and subjective parameters for dry and moist nicotine pouches.
Staaf M, Masser AE, Pramfalk C … +4 more , Pendrill R, Moses S, Lindholm J, Ljung T
Drug Alcohol Depend · 2026 Feb · PMID 41579531 · Publisher ↗
BACKGROUND: Nicotine pouches (NPs) have different formulations (e.g., dry or moist), and the vast majority are flavored. However, it is unclear if flavors exert any effect on nicotine pharmacology and subjective paramete...
BACKGROUND: Nicotine pouches (NPs) have different formulations (e.g., dry or moist), and the vast majority are flavored. However, it is unclear if flavors exert any effect on nicotine pharmacology and subjective parameters. METHODS: Data from two, open-label, randomized, nine-way cross-over, single-dose administration, pharmacokinetic and subjective effects studies were analyzed, evaluating dry 6-mg and moist 9-mg NPs, respectively. The studies included unflavored and flavored varieties (flavor characteristics: traditional [tobacco], cooling, minty, fruit, beverage). All participants were adults who currently used snus and/or NPs daily (n = 38 for moist, n = 39 for dry). RESULTS: Maximum plasma concentrations (C) of nicotine were observed at NP removal at ~60min (T), with overlapping geometric least squares mean (GLSM) values for the dry and moist products (12.08-15.07ng/mL). The total nicotine exposure (calculated as area under the curve from time point 0 to infinity, AUC) was 40.84-50.86h⁎ng/mL, with overlapping GLSM values for dry and moist varieties. Equivalence testing for AUC and C between unflavored and flavored varieties showed equivalence for all varieties except two of the moist minty NPs. For subjective parameters, the effect of flavor was more pronounced for moist NPs, with participants rating the flavored varieties higher for satisfaction, product liking, and intent to use again. CONCLUSIONS: For dry varieties, flavor had no effect on C and AUC, but two moist varieties were different from moist unflavored. Flavor did not affect T for dry or moist NPs. Considerable variation in participant preferences suggest a need for diverse varieties and product types.
"Not in my backyard": The impact of recovery residences on property values.
Ramphul R, McCurdy SA, Lee J … +7 more , Liu Y, Chen Y, Rodriguez SA, Gallardo KR, Akkala S, Theyra-Enias H, Wilkerson JM
Drug Alcohol Depend · 2026 Feb · PMID 41579530 · Publisher ↗
BACKGROUND: In 2023, an estimated 39.6 million adults aged ≥ 18 years had a substance use disorder (SUD) and 94.7 % did not seek treatment. Recovery residences provide essential support for individuals recovering from SU...
BACKGROUND: In 2023, an estimated 39.6 million adults aged ≥ 18 years had a substance use disorder (SUD) and 94.7 % did not seek treatment. Recovery residences provide essential support for individuals recovering from SUD, yet their presence in residential neighborhoods often raises concerns on potential decline in property values. Our study examines the relationship between presence of recovery residences and median home values at the census tract level in Texas. METHODS: We used publicly available tract-level data on area, total population, housing units, CDC/ATSDR Social Vulnerability Index (SVI), and median home values. Data on the recovery residences were obtained from a cross-sectional statewide survey of substance use service providers. Census tracts with and without recovery residences were matched using a k-nearest neighbors (KNN) algorithm. Logistic regression and permutation tests were used to assess differences in median home values between matched tracts. RESULTS: Results from comparison of 329 census tracts with recovery residences and 1161 matched controls showed no significant association between presence of recovery house and property values, after adjusting for population and the covariates that are used for KNN matching. Sensitivity analysis showed no significant association between median home value and the presence of recovery housing. CONCLUSIONS: Our findings suggest no significant association between the likelihood of a tract having recovery residence and home values. Policymakers should consider these findings when addressing zoning restrictions and community opposition to recovery housing.
Dyadic association between support persons' attitudes towards medication for opioid use disorder and patients' mental health outcomes.
Moon KJ, Burgette LF, Choi J … +4 more , Nameth K, Shah K, Watkins KE, Osilla KC
Drug Alcohol Depend · 2026 Feb · PMID 41576709 · Publisher ↗
INTRODUCTION: Nearly one in three adults with opioid use disorder (OUD) has co-occurring depression or anxiety. Pervasive stigma towards medication for OUD has been identified as a barrier to OUD treatment initiation and...
INTRODUCTION: Nearly one in three adults with opioid use disorder (OUD) has co-occurring depression or anxiety. Pervasive stigma towards medication for OUD has been identified as a barrier to OUD treatment initiation and retention, but whether stigma also complicates patient mental health outcomes remains unclear. METHODS: We analyzed longitudinal, dyadic data (n = 356 dyads) from a cohort of patients receiving buprenorphine from community health centers in California, who were accompanied by support persons (e.g., partner, family member, friend). We assessed how changes in support persons' stigmatizing attitudes towards buprenorphine were associated with patients' depressive and anxiety symptoms at 3-month follow-up using ordinary least squares regression models. To aid in clinical interpretability, we used logistic regression models to estimate the probability of clinically significant depressive and anxiety symptoms at 3-month follow-up. RESULTS: Support persons' changes in stigmatizing attitudes towards buprenorphine were significantly associated with patients' depressive (χ= 10.95, P = 0.012) and anxiety (χ = 14.40, P = 0.002) symptoms at follow-up, adjusted for patients' sociodemographic characteristics and baseline symptoms. Patients whose support person reported increased stigma towards buprenorphine had the highest estimated probability of clinically significant depressive (36.7 % [95 % CI: 21.2, 52.1]) and anxiety symptoms (33.3 % [95 % CI: 18.7, 47.9]). CONCLUSIONS: Stigmatizing attitudes towards buprenorphine held by patients' loved ones were associated with worse depression and anxiety outcomes. Interventions are needed to address the stigma towards MOUD among support persons; these interventions may also improve the mental health and wellbeing of patients with OUD.
Sustained effects of reduced nicotine cigarettes and co-use of non-combusted alternative nicotine delivery systems: A one-month follow-up to a randomized clinical trial.
Klemperer EM, Luo X, Cao Q … +7 more , Carroll DM, McClernon FJ, Benowitz NL, Strasser AA, Tidey JW, Donny EC, Hatsukami DK
Drug Alcohol Depend · 2026 Feb · PMID 41570485 · Full text
INTRODUCTION: The US FDA has proposed a nicotine-reducing standard for cigarettes. A recent trial found that, with access to alternative nicotine delivery systems (ANDS; i.e., e-cigarettes, nicotine medicines), participa...
INTRODUCTION: The US FDA has proposed a nicotine-reducing standard for cigarettes. A recent trial found that, with access to alternative nicotine delivery systems (ANDS; i.e., e-cigarettes, nicotine medicines), participants randomized to very low nicotine content (VLNC) vs normal nicotine content (NNC) cigarettes achieved greater smoking reduction. This secondary analysis compared effects of the VLNC+ANDS-access versus NNC+ANDS-access conditions on post-intervention cigarette smoking. METHODOLOGY: Adults who smoke were randomized to 12 weeks of an experimental marketplace with VLNC (0.4mg nicotine/gram tobacco) vs NNC (15.8mg/g) cigarettes. All participants had access to non-combusted ANDS. Multivariable regressions were used to examine effects of VLNC vs NNC condition and co-use of ANDS with cigarettes on smoking and cessation-related outcomes during follow-up, when no study products were provided (weeks 12-16). RESULTS: Among those who completed follow-up (n = 336), VLNC vs NNC participants achieved more 7-day point-prevalence smoking abstinence (VLNC=19.6 % vs NNC=11.0 %; p = 0.031), had more smokefree days (VLNC mean=9.7 vs NNC mean=4.9; p = 0.043), and smoked fewer cigarettes/day (VLNC mean=7.3 vs NNC mean=10.7; p < 0.001). Among participants smoking at week-12 (n = 281), co-use of ANDS vs exclusive smoking was associated with more quit attempts (25.5 % vs 13.0 %; p = 0.005) and fewer cigarette/day (mean=9.3 vs mean=12.4; p < 0.001) during follow-up. CONCLUSIONS: Switching to VLNC cigarettes with access to non-combusted ANDS produced sustained effects on smoking abstinence. Among those who continued smoking, co-use of ANDS was associated with fewer cigarettes/day and more attempts to quit. Findings provide further support for a nicotine-reducing standard for cigarettes in the context of a marketplace which includes ANDS.
Alcohol consumption in the Western Province of Sri Lanka: Prevalence, patterns, and health implications.
Katulanda P, Gamage S, Bandara T … +5 more , Nilaweera AI, Fernando DR, Katulanda GW, Wickramasinghe VP, Wijewickrama E
Drug Alcohol Depend · 2026 Feb · PMID 41570484 · Publisher ↗
INTRODUCTION: Alcohol contributes to global morbidity and mortality. This study aimed to describe the prevalence and patterns of alcohol use, its correlates with health related quality of life (HRQoL) and chronic medical...
INTRODUCTION: Alcohol contributes to global morbidity and mortality. This study aimed to describe the prevalence and patterns of alcohol use, its correlates with health related quality of life (HRQoL) and chronic medical conditions in the Western Province of Sri Lanka. METHODS: A cross-sectional study (2018-2020) was conducted in Western Province recruited 1800 adults (>20 years) via multi-stage stratified cluster sampling. Data collection included interviewer-administered questionnaires, physiological, anthropometric, and biochemical measurements. Alcohol consumption patterns were assessed with Alcohol Use Disorders Identification Test and CAGE tools, and HRQoL with RAND-36. RESULTS: A total of 1333 adults participated. Alcohol consumption at any point in their life was reported by 25.5 % of participants (95 %CI:18.9-32.1), and 21.3 % (95 %CI:16.8-25.7) had consumed alcohol in the past year. The prevalence was highest among males (56.8 %;95 %CI:46.2-67.4), those aged 40-49 (27.9 %;95 %CI:20.9-34.6), residents of Gampaha district (33.2 %;95 %CI:21.4-44.9), rural dwellers (27.9 %;95 %CI:18.3-37.6), and those earning $300-400 monthly (46.5 %;95 %CI:28.4-64.6). Daily consumption was 5.2 % (95 %CI:1.9-8.3), harmful alcohol use was 28.1 % (95 %CI:19.5-36.7), and clinical alcoholism was 26.6 % (95 %CI:19.5-33.8) among alcohol consumers. Those without clinical alcoholism had higher quality of life than those with the condition. Comorbidities among consumers included dyslipidemia (81.3 %, undiagnosed:58.5 %), hypertension (61.6 %, undiagnosed:33.9 %), diabetes (41.4 %, undiagnosed:11.3 %), and prediabetes (33.8 %). CONCLUSIONS: One-fourth of Western Province adults reported alcohol consumption, highest among middle-aged, middle-income, and residents in Gampaha district. Cardio-metabolic diseases were high among individuals who consume alcohol, many remaining undiagnosed. Non-communicable diseases programs should focus high-risk screening, alcohol control, and preventive community initiatives.
Sociodemographic, behavioral, and geospatial factors associated with syringe services program use in San Francisco, California.
Chung EO, Ray B, Humphrey JL … +4 more , Lindstrom M, Megerian CE, Lambdin BH, Kral AH
Drug Alcohol Depend · 2026 Feb · PMID 41564493 · Full text
BACKGROUND: Syringe services programs (SSPs) are a cornerstone of preventing infectious disease and overdose for people who use drugs. Given efforts to achieve universal access, we examined factors associated with SSP us...
BACKGROUND: Syringe services programs (SSPs) are a cornerstone of preventing infectious disease and overdose for people who use drugs. Given efforts to achieve universal access, we examined factors associated with SSP use, including proximity. METHODS: We used cross-sectional data from 713 people who use drugs across San Francisco, California (September 2023-September 2024). We assessed proximity to an SSP by calculating the walking time between where participants slept the night before and nearest SSP location. We conducted multivariable negative binomial models to explore factors associated with SSP use and assess whether the association between proximity and SSP use was modified by race-ethnicity. RESULTS: Almost 80 % of participants used an SSP at least once in the past 3 months. Age, race-ethnicity, mode of use, and proximity to SSP were negatively associated with SSP use. Participants who only smoked used SSPs less often than those who used in other ways (adjusted rate ratio [aRR]=0.77, 95 % CI: 0.61-0.97), as well as those more than a 20-minute walk to an SSP (aRR=0.54, 95 % CI: 0.36-0.83). The effect size between walking time to SSP and SSP use was substantially larger for Black participants than non-Black (Black: aRR=0.38, 95 % CI: 0.15-0.60 vs. non-Black: aRR=0.72, 95 % CI: 0.40-1.31). CONCLUSIONS: Geographic distance was a barrier to SSP use, especially for Black participants. SSPs may not reach people who only smoke drugs. SSPs should be added to areas with limited geographic access and include safer smoking supply distribution.
Explainable machine learning for predicting opioid-related aberrant behavior: A multimodal approach using clinical text and structured data.
Farooq M, Banka AA
Drug Alcohol Depend · 2026 Feb · PMID 41558200 · Publisher ↗
PURPOSE: The rising misuse of opioids, overdose deaths, and opioid use disorder (OUD) associated with chronic pain treatment present a significant public health challenge, continuing to fuel the opioid epidemic. Since op...
PURPOSE: The rising misuse of opioids, overdose deaths, and opioid use disorder (OUD) associated with chronic pain treatment present a significant public health challenge, continuing to fuel the opioid epidemic. Since opioid-related aberrant behaviours (ORABs) are early indicators of potential misuse, it is crucial to develop advanced predictive models for safe opioid management. METHODS: This study introduces an explainable machine learning framework to predict confirmed aberrant behaviours by integrating clinical text with structured data from the Opioid-Related Aberrant Behavior Detection Dataset (ODD). A multimodal, clinically applicable, and explainable predictive model is developed in this study. The study used GloVe (Global Vectors for Word Representation) embeddings and ClinicalBERT contextual embeddings for EHR text, applied Synthetic Minority Oversampling Technique (SMOTE) for data balancing, and trained various machine learning algorithms. RESULTS: The performance of models was assessed using multiple evaluation metrics. Additionally, SHAP (Shapley Additive exPlanations) was employed to address explainability concerns and to assess feature importance via an ablation study. Results demonstrated that Opioid Risk Ensemble achieved an AUROC of 96.0 % and an accuracy of 98.8 %, indicating that opioids, benzodiazepine prescriptions, and factors related to the central nervous system are significant predictors, as confirmed by SHAP analysis. Furthermore, the Opioid Risk Neural Network, applied with ClinicalBERT embeddings, achieved an AUROC of 98.75 % and an accuracy of 98.47 % on the held-out test set, with SHAP interpretation providing insights into the most influential clinical note terms. CONCLUSION: The multimodal, explainable AI approach will be valuable for modern healthcare decision-making, supporting risk prediction for ORABs.
Impact of a brief fentanyl educational intervention on demand for cocaine mixed with fentanyl.
Nunez C, Anighoro B, Yoon JH … +1 more , Wardle MC
Drug Alcohol Depend · 2026 Feb · PMID 41554235 · Publisher ↗
BACKGROUND: People who use cocaine are at increased risk of overdose related to fentanyl in the cocaine supply, yet few interventions address fentanyl risks among this population. Demand tasks use hypothetical decisions...
BACKGROUND: People who use cocaine are at increased risk of overdose related to fentanyl in the cocaine supply, yet few interventions address fentanyl risks among this population. Demand tasks use hypothetical decisions about drug purchases to quantify likely real-world behavior. Our cocaine demand task, the Adulterated Cocaine Purchasing Task, contrasts planned purchases of cocaine when there is 0 % probability (no chance) the cocaine is mixed with fentanyl vs. 10 % probability (in 10 chance) the cocaine is mixed with fentanyl. METHODS: Using a between-subjects design, participants who reported purchasing cocaine in the past year (N = 58) were randomly assigned to complete test measures either following (intervention group; n = 30) or before receiving (control group; n = 28) fentanyl education. Test measures consisted of the Adulterated Cocaine Purchasing Task, self-reported fentanyl knowledge, and harm reduction strategies. Demographics and substance use history were also assessed. RESULTS: Findings suggested providing brief fentanyl education significantly increased fentanyl knowledge. Results also indicated higher probability (1 in 10 chance) of fentanyl admixture was consistently related to decreased cocaine demand across multiple demand indices (e.g., reducing their consumption when cocaine is free). However, providing brief education did not lead to reduced demand for cocaine mixed with fentanyl relative to those in the control group. Results also showed fentanyl education did not affect endorsement of harm reduction behaviors. CONCLUSION: Our findings further suggest the urgent need to prioritize strategies aside from education to address overdose risk among people who use cocaine.
Rising and disparate trends in the private/for-profit acquisition of nonprofit substance use treatment facilities, US, 2019-2024.
Pro G, Cantor J, Gu M … +2 more , Weber K, Montgomery B
Drug Alcohol Depend · 2026 Feb · PMID 41548536 · Publisher ↗
BACKGROUND: Private acquisition of public and nonprofit healthcare facilities is increasing throughout the United States (US). While privatization can be beneficial, growing evidence has demonstrated higher costs, larger...
BACKGROUND: Private acquisition of public and nonprofit healthcare facilities is increasing throughout the United States (US). While privatization can be beneficial, growing evidence has demonstrated higher costs, larger patient volumes, and worsening outcomes. These trends are also apparent in substance use disorder (SUD) treatment facilities at a time when overdose and treatment demand are at an all time high. This study was designed to measure whether increases in private acquisitions of nonprofit substance use treatment facilities are happening faster in underrepresented and underresourced communities. METHODS: We used the Mental health and Addiction Treatment Tracking Repository (MATTR) to identify SUD treatment facilities that were nonprofit/public owned in 2019 (N = 2826 facilities). Our outcome was whether a facility became privatized and owned by a for-profit company by 2024. We linked MATTR to demographic census data and modeled privatization using a generalized estimating equation with a modified Poisson distribution, log link function, and robust standard errors. RESULTS: Twenty percent (n = 572) of public/nonprofit SUD treatment facilities were privatized between 2019 and 2024. Privatization of nonprofit/public facilities was more common in communities with lower household incomes (p < 0.01). CONCLUSION: Private acquisition of nonprofit/public SUD treatment facilities increased between 2019 and 2024. Acquisitions were disproportionately located in communities with higher rates of low-income households. Private acquisition can be beneficial for some facilities, but a growing evidence base is demonstrating how privatization is generally followed by worsening health outcomes in the process of restructuring and reselling at a profit. Treatment systems must not be extractive. Oversight and community involvement may help ensure mutual beneficence.
Identification of hazardous alcohol use in outpatient psychiatric care: A comparison of biomarker phosphatidylethanol (PEth) and self-report.
Lundholm L, Skånberg J, Wallhed-Finn S … +1 more , Lenhard F
Drug Alcohol Depend · 2026 Feb · PMID 41548535 · Publisher ↗
BACKGROUND: Phosphatidylethanol (PEth) is a reliable biomarker of recent hazardous alcohol use but is resource-intensive and not always feasible in routine mental health care. The Alcohol Use Disorders Identification Tes...
BACKGROUND: Phosphatidylethanol (PEth) is a reliable biomarker of recent hazardous alcohol use but is resource-intensive and not always feasible in routine mental health care. The Alcohol Use Disorders Identification Test (AUDIT-10) and its short form, AUDIT-C, are widely used self-report tools that may offer practical alternatives. This study examined whether AUDIT scores can serve as proxies for PEth and whether machine learning models enhance prediction. METHODS: Data were collected from 4063 psychiatric outpatients who completed both PEth testing and AUDIT assessments. Regression models evaluated associations between AUDIT scores and PEth concentrations. Receiver Operating Characteristic (ROC) analyses determined cut-offs for hazardous alcohol use (PEth ≥ 0.3 µmol/L). Logistic regression, random forest, and XGBoost models were trained using AUDIT-10/AUDIT-C scores, age, and gender. RESULTS: AUDIT-10 and AUDIT-C correlated strongly with PEth (pseudo-R² = 30-47 %). ROC analyses showed good discrimination for hazardous use: AUDIT-10 AUC = 0.80 (optimal cut-off ≥5) and AUDIT-C AUC = 0.83 (optimal cut-off ≥4). XGBoost models improved classification modestly, yielding AUCs of 0.90 (AUDIT-10) and 0.88 (AUDIT-C), with balanced accuracies of 79-83 %, outperforming logistic regression and random forest. CONCLUSIONS: AUDIT-10 and AUDIT-C are effective, accessible tools for identifying hazardous alcohol use in psychiatric populations, supporting their role as practical alternatives when PEth testing is unavailable. Machine learning methods offer incremental gains, but simple cut-off scores remain clinically useful. Findings highlight the value of integrating brief alcohol screening into psychiatric care to guide timely interventions, while considering PEth's biological variability.
Test-retest reliability of mgTHC consumption in the self-administered Cannabis Exposure Index (CEI).
Hasin DS, Borodovsky J, Wall M … +10 more , Habib MI, Murphy E, Liu J, Stohl M, Struble CA, Livne O, Greenstein E, Aharonovich E, Wisell CG, Budney AJ
Drug Alcohol Depend · 2026 Feb · PMID 41546987 · Full text
INTRODUCTION: Cannabis legalization and adult use are expanding across the U.S., requiring greater knowledge of cannabis risks and benefits. Cannabis use measures traditionally assessed frequency but omitted quantity, an...
INTRODUCTION: Cannabis legalization and adult use are expanding across the U.S., requiring greater knowledge of cannabis risks and benefits. Cannabis use measures traditionally assessed frequency but omitted quantity, an essential element of consumption that is complicated by increasingly varied cannabis products and use patterns. To address this, we developed the self-administered CEI (Cannabis Exposure Inventory) to determine milligrams of THC used per using day (mgTHC/using day). In this study, we examined the test-retest reliability of the CEI mgTHC measure and key component items (i.e., products, routes of administration). METHODS: Participants were recruited through social media (Facebook and Instagram ads) and Qualtrics Research panels. Eligible participants (n = 511) completed initial and retest CEI surveys. Chance-corrected agreement between initial and retest surveys on mean mgTHC/using day was indicated with Intraclass Correlation Coefficients (ICCs); kappa (k) indicated reliability of key dichotomous component variables. RESULTS: Overall, ICC for mean mgTHC/using day= 0.77, indicating substantial reliability. In demographic subgroups, ICCs were 0.54 ('other' race/ethnicity) to 0.86 (Hispanic). ICCs for mean mgTHC/using day among those who used for medical-only, recreational-only and medical-plus-recreational reasons were 0.72, 0.69 and 0.77, respectively; ICCs for those in non-legalized, medical-only and medical-plus-recreational states were 0.70, 0.92 and 0.75, respectively. Binary measures generally exhibited substantial reliability (mean k, last 30 days=0.74; last 7 days=0.73). CONCLUSION: Findings support the CEI mgTHC measure as a reliable instrument for quantifying cannabis use, addressing a critical gap in cannabis measurement. This measure offers a promising approach to provide urgently-needed information on potential harms and benefits of THC exposure.
Alcohol quantity mediates the association between daily alcohol and cannabis co-use and alcohol consequences.
Gunn RL, Sokolovsky AW, Howe LK … +6 more , Barnett NP, Jackson KM, Lipperman-Kreda S, Miranda R, Trull T, Metrik J
Drug Alcohol Depend · 2026 Feb · PMID 41546986 · Full text
BACKGROUND: Alcohol and cannabis are commonly used substances for young adults, and person-level co-use (i.e., concurrent or simultaneous use of both) is associated with increased likelihood of experiencing positive and...
BACKGROUND: Alcohol and cannabis are commonly used substances for young adults, and person-level co-use (i.e., concurrent or simultaneous use of both) is associated with increased likelihood of experiencing positive and negative alcohol-related consequences. However, findings regarding within-person effects (i.e.,day-level) co-use on consequences are mixed, possibly due to inconsistency in including alcohol quantity (i.e., total number of standard drinks consumed) when examining the association between co-use and consequences. In the present study, we examined whether the number of drinks mediates the association between co-use and positive or negative alcohol consequences at the day level. METHODS: Data from morning reports in a 28-day field-based study of young adults reporting frequent past 60-day alcohol and cannabis use (N = 115) were used to test multilevel mediation models. RESULTS: We found significant mediation for both positive and negative alcohol consequences; consuming more alcoholic drinks on co-use days, relative to alcohol-only days, was associated with a higher likelihood of experiencing negative consequences and a lower likelihood of positive consequences. These results suggest that daily number of drinks is a significant driver of the relationship between co-use and alcohol-related consequences at the day-level. CONCLUSIONS: In the context of increased cannabis use among young adults, this finding provides critical information for prevention and intervention efforts aimed at reducing the alcohol-related consequences associated with co-use days. Overall, reducing total alcohol consumption remains a prominent harm-reduction strategy among this population.
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