Drug And Alcohol Dependence[JOURNAL]
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200 papers
Effectiveness and clinical predictors of a virtual based combined cognitive behavioral and motivational enhancement group therapy for adults with cannabis use disorder.
Mehta DD, Goud R, Sanches M … +9 more , Buckley L, Sloan ME, Vandervoort J, Le Foll B, Beyraghi N, Kaduri P, Zawertailo L, Selby P, Tang VM
Drug Alcohol Depend · 2026 Feb · PMID 41546985 · Publisher ↗
BACKGROUND: Cannabis use has increased in recent years, while perceptions of harm have declined. Cognitive behavioural therapy (CBT), motivational enhancement therapy (MET), and their combinations (CBT-MET) are evidence-...
BACKGROUND: Cannabis use has increased in recent years, while perceptions of harm have declined. Cognitive behavioural therapy (CBT), motivational enhancement therapy (MET), and their combinations (CBT-MET) are evidence-based interventions for CUD, though their effectiveness when delivered virtually is underexplored. This study evaluated the clinical efficacy of a virtual 12-week group-based CBT-MET program in individuals with CUD and examined baseline predictors of treatment response. METHODS: A retrospective analysis was conducted on 116 adults enrolled in a virtual group-based CBT-MET program between 2020 and 2023. Participants completed weekly self-report assessments of cannabis use and biweekly assessments of depression (PHQ-9) and anxiety (GAD-7). Cannabis craving (MCQ) and a measure of problematic cannabis use (CUDIT) were assessed at baseline and post-treatment. Wilcoxon signed-rank tests evaluated changes among completers (≥ 75 % attendance), and linear mixed models identified baseline predictors of change over time. RESULTS: Of the 116 participants, 79 (68 %) completed the program, indicating high retention. Among completers, significant reductions were observed in cannabis use frequency (p < 0.01), quantity (p < 0.01), craving (p < 0.01), depression (p < 0.01), and anxiety (p = 0.02). Higher baseline cannabis use predicted greater reductions in cannabis frequency and quantity, while higher self-efficacy predicted lower cannabis use frequency across treatment. Individuals with co-occurring substance use disorders other than tobacco demonstrated smaller reductions in cannabis quantity. CONCLUSION: Virtual CBT-MET was feasible and led to significant reductions in cannabis use and psychiatric symptoms among individuals with CUD. Baseline cannabis use patterns and self-efficacy were key predictors of reduction in cannabis use, highlighting the need for personalized approaches in future interventions.
Impact of metabolic syndrome components on fibrosis severity and mortality in alcohol-related liver disease.
Abassa KK, Yu H, Tan S … +4 more , Li M, Zhong Z, Zhou H, Guo Y
Drug Alcohol Depend · 2026 Feb · PMID 41538924 · Publisher ↗
BACKGROUND/ AIM: The prognosis of concomitant chronic liver disease and metabolic syndrome (MetS) has been established. However, data on the impact of individual MetS components on mortality in patients with alcohol-rela...
BACKGROUND/ AIM: The prognosis of concomitant chronic liver disease and metabolic syndrome (MetS) has been established. However, data on the impact of individual MetS components on mortality in patients with alcohol-related liver cirrhosis (ALC) remain scarce. METHODS: A cross-sectional cohort of 120 patients with alcohol-related liver disease (ArLD) and a longitudinal cohort of 789 patients with ALC were retrospectively enrolled. Patients were categorized into three groups based on the number of MetS components present: Group 1 included patients with no MetS components; Group 2 included those with 1 or 2 components; and Group 3 included patients with ≥ 3 components. Kaplan-Meier and regression analyses were performed to assess the severity of fibrosis in patients with ArLD and to compare mortality outcomes among those with ALC. RESULTS: Patients with ArLD in group 3 had the highest odds of significant fibrosis [adjusted OR = 2.80 (95 % CI: 1.01-7.76)] and advanced fibrosis [adjusted OR = 17.1 (95 % CI: 3.58-81.9)]. Elevated glucose levels were the only independent factor associated with both significant and advanced fibrosis. Furthermore, the presence of ≥ 3 MetS components predicted higher all-cause mortality (adjusted HR = 5.91, 95 % CI: 2.98-11.75) and liver-related mortality (adjusted HR = 4.73, 95 % CI: 2.05-10.94) in patients with ALC, with glucose and triglycerides levels emerging as the most significant independent risk factors. The presence of diabetes further exacerbated mortality risk in patients with ≥ 3 MetS components. CONCLUSIONS: MetS, particularly abnormal fasting glucose, exacerbated liver fibrosis and significantly worsened mortality in patients with ArLD.
Gabapentin utilization and nontherapeutic use relative to select comparator drugs, United States 2013-2022.
Karami S, Yoo JW, Woods C … +4 more , Conrad SW, McAninch J, Meyer T, Mallama C
Drug Alcohol Depend · 2026 Feb · PMID 41538923 · Full text
BACKGROUND: Gabapentin prescribing has increased over the past decade, including as part of efforts to reduce opioid analgesic use. Data on trends and scope of harms from gabapentin nontherapeutic use (NTU) are needed. M...
BACKGROUND: Gabapentin prescribing has increased over the past decade, including as part of efforts to reduce opioid analgesic use. Data on trends and scope of harms from gabapentin nontherapeutic use (NTU) are needed. METHODS: For gabapentin and selected contextual comparator drugs (pregabalin, diazepam, oxycodone), we describe utilization using a dispensed prescriptions all-payer claims database (2013-2023) and adverse events for NTU exposure cases using Poison Center data (2013-2022). We then calculated utilization-adjusted NTU exposure case rates, based on prescription units dispensed, for each drug. RESULTS: From 2013-2023, the number of units (e.g., tablets) dispensed increased for gabapentin (4.4-7.7 billion [B]) and pregabalin (0.68-1.0B) and decreased for diazepam (0.7-0.3B) and oxycodone (4.2-2.5B). From 2013-2022, gabapentin NTU exposure cases (N = 8729) exceeded pregabalin (N = 1257) and diazepam (N = 2452) but not oxycodone (N = 17,808) NTU exposure cases. Gabapentin NTU exposure cases and utilization-adjusted NTU exposure case rates increased from 2013-2017, then decreased through 2022; trends were similar for pregabalin, decreased throughout for diazepam, and fluctuated for oxycodone. From 2013-2022, gabapentin annual utilization-adjusted NTU exposure case rates most closely resembled those of pregabalin (range: 0.09-0.16 versus 0.08-0.22 exposure cases per million units dispensed), while diazepam and oxycodone exhibited higher rates (range: 0.33-0.55 and 0.39-0.85 exposure cases per million units dispensed, respectively). Most gabapentin (68 %) and comparator (55-80 %) NTU exposure cases involved multiple substances, particularly opioids, resulting in more severe clinical outcomes than single-substance exposures. CONCLUSIONS: Our study highlights the harms from gabapentin NTU, particularly in combination with opioids.
Developmental windows of vulnerability: Substance-specific effects of prenatal exposure timing on child psychopathology.
Li Q, Pang Z, Lu Y … +3 more , Jiang L, Sun M, Xu J
Drug Alcohol Depend · 2026 Feb · PMID 41520412 · Publisher ↗
BACKGROUND: Prenatal alcohol, tobacco, and cannabis exposure are known risks for childhood psychopathology symptoms, but gaps persist in identifying substance-specific developmental vulnerability windows. Exposure timing...
BACKGROUND: Prenatal alcohol, tobacco, and cannabis exposure are known risks for childhood psychopathology symptoms, but gaps persist in identifying substance-specific developmental vulnerability windows. Exposure timing relative to maternal pregnancy awareness may alter outcomes, yet this temporal specificity remains unclarified, limiting targeted risk assessment and prevention. METHODS: Data from 7777 children in the Adolescent Brain Cognitive Development Study (enrolled 2016-2018) were analyzed. Prenatal substance exposure timing was categorized as pre-awareness (exposure before maternal awareness of pregnancy) and post-awareness (exposure after maternal awareness of pregnancy). Six domains of childhood psychopathology symptoms were assessed via the Child Behavior Checklist (CBCL). Linear mixed-effects models were applied to investigate the timing effects of prenatal substance exposure on childhood psychopathology symptoms, adjusting for covariates. RESULTS: The analysis revealed distinct temporal patterns of risk for each substance. Childhood psychopathology symptoms were specifically linked to pre-awareness exposure for alcohol and post-awareness exposure for cannabis. In contrast, post-awareness alcohol use and pre-awareness cannabis use showed no significant associations. Prenatal tobacco exposure conferred modest risks across all timings without temporal divergence. CONCLUSIONS: Prenatal substance exposure has substance-specific, timing-dependent effects on childhood psychopathology relative to maternal pregnancy awareness. Findings support distinct developmental vulnerability windows, highlighting the need to include substance type and timing in public health guidelines and clinical risk stratification.
β-Nicotyrine and e-cigarette abuse liability II: Behavioral economic demand and intracranial self-stimulation in rats.
Smethells JR, Wilde S, Muelken P … +2 more , Harris AC, LeSage MG
Drug Alcohol Depend · 2026 Feb · PMID 41520411 · Full text
BACKGROUND: Given the prominence of electronic nicotine delivery systems (ENDS), understanding the product characteristics that underlie ENDS abuse liabilty is a public health research priority. β-Nicotyrine (β-Nic) is a...
BACKGROUND: Given the prominence of electronic nicotine delivery systems (ENDS), understanding the product characteristics that underlie ENDS abuse liabilty is a public health research priority. β-Nicotyrine (β-Nic) is a uniquely prevalent constituent (up to 25 % of nicotine [Nic] levels) in ENDS aerosols that may contribute to ENDS abuse liability. Previously, we found clinically relevant concentration of β-Nic doubled the elimination half-life and prolong the interoceptive (discriminative stimulus) properties of Nic in rats, but that it had little or no psychoactive effects itself. The present study used i.v. self-administration (23 hrs/day) and intracranial self-stimulation (ICSS) paradigms to further evaluate if β-Nic alone has abuse liability or if it enhances the abuse liability of Nic. METHODS: We examined if β-Nic (> 25 % of Nic levels) substitutes for Nic (0.03mg/kg/inf) during drug self-administration, and whether combinations of Nic and β-Nic alter the acquisition and behavioral economic demand of i.v. Nic. Reinforcement-enhancing and aversive effects of β-Nic alone or in combination with Nic were also evaluated using ICSS. RESULTS: Moderately high β-Nic doses (0.03 & 0.10mg/kg/inf) increased demand for Nic (0.03mg/kg/inf). β-Nic alone did not maintain self-administration, affect ICSS, or influence the effects of Nic on ICSS. CONCLUSION: β-Nic itself does not have abuse potential in either i.v. self-administration or ICSS models, but it does increase the reinforcing efficacy of self-administered Nic. As such, β-Nic may play a role in the abuse liability of ENDS, which has important treatment and regulatory implications.
Effects of acute adolescent stress on the acquisition and maintenance of intravenous oxycodone self-administration in male and female rats.
Gallagher CA, Chandler DJ, Manvich DF
Drug Alcohol Depend · 2026 Feb · PMID 41519027 · Full text
BACKGROUND: The persistent threat of the opioid epidemic warrants investigation into risk factors that predispose individuals to opioid use disorder (OUD). Adolescent stress has been linked to enhanced risk for OUD in hu...
BACKGROUND: The persistent threat of the opioid epidemic warrants investigation into risk factors that predispose individuals to opioid use disorder (OUD). Adolescent stress has been linked to enhanced risk for OUD in humans, however, attempts to model this preclinically have yielded mixed results. Additionally, few studies have explored whether adolescent stress modulates the reinforcing effects of prescription opioids. Here we investigate the impact of acute adolescent stress on oxycodone self-administration in male and female rats. METHODS: Adolescent male and female rats underwent acute restraint stress during concurrent exposure to predator odor, or control handling. Approximately one week later, subjects were allowed to acquire IV oxycodone self-administration (0.03mg/kg/inf) over 10 sessions (2h/day) under a fixed-ratio 1 (FR1) schedule of reinforcement. Following three additional FR1 sessions and seven sessions under FR3, rats underwent two progressive-ratio tests (0.03mg/kg/inf and 0.06mg/kg/inf, respectively). Separate groups of adolescent rats underwent similar experimental manipulations but were trained on sucrose reinforcement. RESULTS: Adolescent stress did not affect the rate of acquisition of IV oxycodone self-administration. However, oxycodone self-administration escalated during post-acquisition FR1 sessions and remained elevated during FR3 sessions in stressed rats as compared to unstressed controls. Adolescent stress exposure did not affect responding during progressive-ratio tests, nor did it affect any measure of sucrose pellet reinforcement. CONCLUSIONS: The present results are the first to demonstrate adolescent stress-induced enhancement of oxycodone reinforcement in rats and provide a preclinical model for investigating the neurobiological mechanisms by which adolescent stress increases vulnerability for prescription opioid misuse.
Is cannabis legalization associated with treatment completion? A study of pregnant women admitted for cannabis use in substance use treatment facilities, 2020-2022.
Carandang RR, Rhee TG, Ha T … +1 more , Cunningham SD
Drug Alcohol Depend · 2026 Feb · PMID 41519026 · Publisher ↗
BACKGROUND: Cannabis is the most used illicit substance during pregnancy in the United States. While cannabis legislation is associated with prevalence and access to care, its relationship with treatment completion among...
BACKGROUND: Cannabis is the most used illicit substance during pregnancy in the United States. While cannabis legislation is associated with prevalence and access to care, its relationship with treatment completion among pregnant women is unclear. This study examined the association between cannabis legalization and treatment completion among pregnant women admitted for cannabis use from 2020 to 2022. METHODS: This retrospective cross-sectional analysis used data from the Treatment Episode Data Set-Discharge (TEDS-D) to analyze treatment completion among pregnant women aged 12 or older who were admitted for cannabis use (n = 13,088) across states with fully legalized, partially legalized (medical use only), or illegal cannabis policies. Multivariable-adjusted logistic regression was used to assess the association between legalization status and treatment completion, with subgroup analyses by treatment setting and referral source. RESULTS: Among pregnant women admitted for cannabis use, 28.3 % completed treatment. Compared to states where cannabis remained illegal, those in states with fully legalized cannabis had significantly lower odds of treatment completion (adjusted odds ratio [AOR], 0.33 [95 % confidence interval, 0.27-0.41]), with a similar trend in states with partial legalization (AOR, 0.33 [0.28-0.40]). The negative association between cannabis legislation and treatment completion was more pronounced in outpatient settings than in residential programs, and stronger among court/other referrals than among voluntary referrals. CONCLUSIONS: Cannabis legalization may be negatively associated with treatment completion among pregnant women admitted for cannabis use. Further research is needed to identify policy-related barriers and develop evidence-based interventions that improve treatment engagement and retention in this vulnerable population.
Population reach, feasibility and acceptability of digital therapeutics for smoking cessation among people living with HIV: Results of the Quitting Matters pilot trial.
Vilardaga R, McClernon FJ, Akingbule O … +9 more , Mannelli P, Thomas SM, Davis JM, Gray MF, Arnold C, Chow Kai Reyes I, Ashare R, Paukner M, Pacek LR
Drug Alcohol Depend · 2026 Feb · PMID 41512654 · Full text
INTRODUCTION: Tobacco use is disproportionately prevalent among people living with HIV (PWH) and is a significant contributor to morbidity and mortality in this population. Reaching communities of PWH to facilitate smoki...
INTRODUCTION: Tobacco use is disproportionately prevalent among people living with HIV (PWH) and is a significant contributor to morbidity and mortality in this population. Reaching communities of PWH to facilitate smoking cessation is challenging. Digital Therapeutics (DTx) can facilitate widespread implementation and adoption of smoking cessation treatments for PWH. METHODS: We compared the feasibility and acceptability (primary outcomes) and preliminary efficacy (secondary outcome) of a DTx tailored to PWH -- Learn to Quit-HIV (LTQ-H) -- versus a gold standard smoking cessation DTx (QuitGuide) in a remote pilot randomized controlled trial. All participants received nicotine replacement therapy and were assessed at weeks 4, 8, and 12. RESULTS: During a 13-month period, we remotely recruited a sample of PWH (n = 41) across the United States, with randomization leading to a higher proportion of LTQ-H users with high levels of cannabis use. Digital markers of DTx use indicated that compared to QuitGuide, assignment to LTQ-H led to significantly greater number of device interactions (3610 vs 2086; RR=93.14; 95 % CI: 14.70-590; p < 0.001), and a four-fold increase in mean interactions with active smoking cessation content (8.5 vs. 2.15; Cohen's d=0.91; p < 0.001). At week 12, in an adjusted model, LTQ-H resulted in numerically greater, but not statistically significant, biochemically verified 7-day point prevalence abstinence versus QuitGuide (18.2 % vs 15.8 %; aOR=6.97, 95 % CI: 0.65-74.33). CONCLUSIONS: While participants assigned to LTQ-H had proportionally more features known to predict low quit rates (e.g. cannabis use), LTQ-H showed promising population reach, device engagement, and smoking outcomes. A hybrid effectiveness-implementation trial will evaluate this novel DTx in a larger sample of PWH. IMPLICATIONS: The study highlights the potential of DTx to address the high prevalence of tobacco use among people with HIV. Compared to QuitGuide (gold standard DTx developed by NCI), LTQ-H showed promising participant engagement and smoking cessation outcomes. These findings suggest that LTQ-H could be a valuable tool for smoking cessation in people with HIV, warranting further investigation in larger trials to evaluate its effectiveness and implementation feasibility.
Leveraging a digital health intervention to improve recovery outcomes among people with substance misuse experiencing housing insecurity.
Eswaran V, Dong F, Li X … +5 more , Szlyk HS, Dell NA, Kasson E, Williams J, Cavazos-Rehg PA
Drug Alcohol Depend · 2026 Feb · PMID 41512653 · Full text
BACKGROUND: People with substance use disorders (PwSUD) who experience housing insecurity have disproportionate overdose deaths. Digital interventions may improve care among PwSUD, but evidence specifically for housing-i...
BACKGROUND: People with substance use disorders (PwSUD) who experience housing insecurity have disproportionate overdose deaths. Digital interventions may improve care among PwSUD, but evidence specifically for housing-insecure PwSUD, who face unique barriers, remains limited. METHODS: We examined the efficacy of a mHealth tool (uMAT-R) among people who have misused substances and reported current housing insecurity. Substance use, cravings, access to basic needs, social disconnection, and digital literacy were assessed at baseline and 1 month and compared by uMAT-R use. Generalized estimating equations were employed to assess the efficacy of the intervention. RESULTS: Participants who logged into uMAT-R were less likely to report other non-opioid illicit drug use (aOR (95 %CI): 0.49(0.29, 0.85)). Similarly, those who messaged the e-coach were less likely to report using opioids (aOR(95 %CI): 0.39(0.21, 0.73)) or other illicit drugs (aOR (95 % CI): 0.53(0.30, 0.92)) during past 30-days. Significant interaction effects were found in uMAT-R use by time in cravings (Coef (95 %CI): -2.11(-4.07, -0.17)) and perceived burdensomeness (Coef(95 %CI): -2.62 (-4.91, -0.36)). Messaging an e-coach by time was significantly associated with improved health literacy (Coef (95 %CI): 0.61(0.05, 1.18)) and decreased thwarted belongingness (Coef(95 %CI): -0.36 (-0.71, -0.02). CONCLUSION: Our preliminary findings suggest that people who have misused substances and experience housing insecurity may benefit from uMAT-R, which was associated with improved recovery outcomes. Future research is needed to examine the unique barriers experienced by this population and how mHealth tools can be used to provide tailored, equitable access to supportive resources to reduce barriers and promote long-term recovery.
Successful hepatitis C elimination through decentralized treatment in Dutch addiction care: A RE-AIM based evaluation.
Von den Hoff DW, Berden FAC, Noordeloos A … +3 more , Knuijver T, Schellekens AFA, Drenth JPH
Drug Alcohol Depend · 2026 Feb · PMID 41506033 · Publisher ↗
BACKGROUND: People who use drugs (PWUD) are an important population of focus for hepatitis C virus (HCV) elimination. Case-finding and treatment of these patients in outpatient specialist care is a challenge due to popul...
BACKGROUND: People who use drugs (PWUD) are an important population of focus for hepatitis C virus (HCV) elimination. Case-finding and treatment of these patients in outpatient specialist care is a challenge due to population specific barriers. Screening and treatment integrated in addiction care might overcome these barriers. With this study we aim to evaluate the implementation of a decentralized PWUD-HCV care model. METHODS: We conducted a multicenter prospective observational study in Dutch addiction care centers to assess a decentralized HCV care pathway for PWUD. Implementation of HCV-care within addiction care was evaluated using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework. Viral elimination, defined as the proportion of identified HCV-RNA positive PWUD achieving sustained virologic response (SVR), was the primary outcome. RESULTS: Reach: 870 anti-HCV tests were performed, 29 HCV-RNA positive PWUD were enrolled. EFFECTIVENESS: 23 patients initiated and completed on-site treatment, three patients were referred for treatment, two patients were lost to follow-up and one patient refused treatment. All patients tested for SVR achieved SVR, one patient was lost to follow-up before SVR test. The elimination rate was 86 % (25/29). Adoption: five out of eleven addiction care organizations (45 %) implemented decentralized HCV care within addiction care. Implementation fidelity was high. CONCLUSION: This study demonstrates that successfully implemented decentralized HCV care within addiction services is feasible and highly effective, achieving an elimination rate of 86 %. However, adoption of decentralized HCV care was limited, underscoring the need for targeted strategies to enhance implementation. Our findings support expanding of decentralized HCV care models in addiction settings to meet HCV elimination targets.
Use of gabapentin with or without a prescription in substance use treatment settings: A national analysis of urine drug testing data, 2016-2023.
Ellis MS, Whitley P, Passik SD
Drug Alcohol Depend · 2026 Feb · PMID 41500003 · Publisher ↗
BACKGROUND: Gabapentin prescriptions have increased due to off-label use, including managing withdrawal/comorbidities in substance use disorder (SUD) treatment, despite gaps in evidence bases and corresponding increases...
BACKGROUND: Gabapentin prescriptions have increased due to off-label use, including managing withdrawal/comorbidities in substance use disorder (SUD) treatment, despite gaps in evidence bases and corresponding increases in nonmedical use. This study sought to identify trends in gabapentin use with and without a prescription in SUD treatment settings. METHODS: This retrospective, serial cross-sectional study analyzed urine drug tests (UDT) (n = 206,161) ordered from 2053 SUD settings in all 50 U.S. states, from 2016 to 2023. Specimens were analyzed by liquid chromatography-tandem mass spectrometry to assess positivity for gabapentin and other prescription and illicit drugs, with prescribed medications documented in requisitions. Multivariable regression assessed characteristics/diagnoses associated with gabapentin use with and without a prescription. RESULTS: Gabapentin was prescribed to 5.9 % of the sample, increasing from 3.9 % in 2016-7.6 % in 2023. Use of gabapentin without a prescription was identified in 11.3 % of the sample, decreasing from 15.2 % to 9.9 %. Gabapentin prescribing was associated with anxiety/mood disorders, insomnia, pain, and sedative, alcohol, or stimulant SUDs. Use without a prescription was associated with anxiety/mood disorders, and sedative or opioid SUDs. Detection was higher across all illicit substances among those engaged in gabapentin use without a prescription. CONCLUSIONS: Gabapentin prescribing significantly increased in SUD treatment settings despite a lack of strong evidence bases for its utility. While rates of gabapentin use outside a prescription were nearly double than for prescribed use, this appears to be decreasing over time. Polysubstance use and potential gaps in multimorbidity care may contribute to the use of gabapentin without a prescription.
Are there differences in gradual versus abrupt smoking cessation quit attempts and success by social grade? A population study in England.
Cox S, Shahab L, Garnett C … +2 more , Lindson N, Jackson S
Drug Alcohol Depend · 2026 Feb · PMID 41494225 · Publisher ↗
BACKGROUND AND AIMS: Smoking rates remain higher among individuals from less advantaged social grades, who tend to be less successful when they try to quit. Abrupt quitting may be more successful than cutting down first,...
BACKGROUND AND AIMS: Smoking rates remain higher among individuals from less advantaged social grades, who tend to be less successful when they try to quit. Abrupt quitting may be more successful than cutting down first, though evidence is mixed. It is not clear whether the quit methods chosen, and their effects, differ by social grade. This study aimed to: (1) compare the prevalence of gradual versus abrupt quit attempts across social grades; (2) examine the association between quit method and quit success; and (3) assess whether social grade moderates this association. METHODS: We used data from 27,390 adults in England who reported a past-year quit attempt in the Smoking Toolkit Study (2006-2025). Quit method used (gradual vs. abrupt) and quitting success were self-reported. Logistic regression analyses examined the two-way interaction between quit method and social grade (ABC1 =more advantaged vs. C2DE=less advantaged) and success, adjusting for sociodemographic and smoking-related covariates. RESULTS: People from less advantaged social grades were less likely to attempt to quit abruptly (53.2 % [95 % CI: 52.3-54.0 %] vs. 57.4 % [56.4-58.4 %]). Abrupt quitting was associated with higher odds of success compared with gradual quitting (OR = 1.70; 95 % CI: 1.58-1.84) providing no clear evidence this was moderated by social grade (interaction OR = 1.13; 95 % CI: 0.97-1.33, p = 0.14). CONCLUSION: People who choose to quit abruptly are more likely to quit successfully than people who choose to quit gradually, irrespective of their social grade. However, people from less advantaged social grades are less likely to choose to quit abruptly.
Association of tobacco and other substance use with nicotine pouch awareness and use in US adolescents.
Han DH, Rahman T, Miech RA … +7 more , Harlow AF, Dai HD, Cho J, Sussman SY, Sanchez LM, Meza LR, Leventhal AM
Drug Alcohol Depend · 2026 Feb · PMID 41494224 · Full text
INTRODUCTION: Evidence on the association between tobacco/nicotine and other substance use (TOSU) and adolescent nicotine pouch (NP) awareness and use is lacking but vital for policy and prevention planning. METHODS: The...
INTRODUCTION: Evidence on the association between tobacco/nicotine and other substance use (TOSU) and adolescent nicotine pouch (NP) awareness and use is lacking but vital for policy and prevention planning. METHODS: The sample was drawn from the 2023 Monitoring the Future study, a nationally representative survey of U.S. adolescents (8th, 10th, 12th graders). One-third of participants were randomly selected to complete questions on NP awareness and use (lifetime, past 12-month, past 12-month frequency) and past 30-day TOSU measures (yes/no). We estimated risk ratios (RRs) and incident rate ratios (IRRs) to examine the associations between TOSU and NP awareness and use. RESULTS: Overall (n = 6958; 53.4 % female), 35.4 % reported NP awareness, 2.5 % reported lifetime use, and 1.8 % reported past 12-month use. Past 30-day use of tobacco/nicotine products was each positively associated with NP awareness (RRs:1.42-1.70), lifetime (RRs:7.14-20.40), and past 12-month (RRs:5.84-22.44) use, with the strong associations for youth with vs. without smokeless tobacco use. Cannabis, alcohol, and other drug past 30-day use were each associated with NP awareness (RRs:1.49-1.68), lifetime (RRs:3.47-10.49), and past 12-month (RRs:4.70-15.70) use. CONCLUSIONS: NP awareness and use prevalence were disproportionately high among adolescents with various forms of TOSU in 2023, especially smokeless tobacco. These findings suggest the importance of monitoring NP use among youth with TOSU while recognizing that awareness may also reflect broader marketing, product availability, or incidental exposure. Policy and prevention efforts should address NP use alongside TOSU with established health risks.
Inequities in blunt use across multiple socio-demographic intersections among US adults.
Glasser AM, Jensen JK, Sterling KL … +1 more , Villanti AC
Drug Alcohol Depend · 2026 Feb · PMID 41483495 · Full text
INTRODUCTION: Blunts (cigars with tobacco replaced or mixed with cannabis) incur health risks from exposure to tobacco and cannabis and are disproportionately used by young adults, people identifying as Black/African Ame...
INTRODUCTION: Blunts (cigars with tobacco replaced or mixed with cannabis) incur health risks from exposure to tobacco and cannabis and are disproportionately used by young adults, people identifying as Black/African American (B/AA), people with lower socioeconomic status (SES), and people with mental health issues. This study described patterns of blunt use among US adults with multiple identities or circumstances increasing risk for blunt use. METHODS: We used Wave 6 (2021) (US adults; N = 30,516) of the Population Assessment of Tobacco and Health Study to examine the association between current blunt use and race (B/AA vs. non-B/AA) + mental health (symptoms of internalizing/externalizing conditions) and socioeconomic status (SES; receipt of government assistance) using weighted multivariable logistic regression models, stratified by age (young adults [YAs] 18-34 vs. adults 35 + years). RESULTS: In 2021, 8.4 % of YAs and 1.4 % of adults 35 + currently used blunts. Compared to people with joint advantage (e.g., non-B/AA + high SES), those identifying as B/AA with low SES (aOR=5.10, 95 % CI=4.16-6.26), high internalizing (aOR=4.83, 95 % CI=3.70-6.32), or externalizing conditions (aOR=4.74, 95 % CI=3.47-6.48) had greater odds of using blunts. The magnitude of the association between identifying as B/AA and having low SES (alone and jointly) and blunt use was greater among adults 35 + years (vs. YAs). CONCLUSIONS: Blunt use was most prevalent among B/AA adults with low SES or those who experienced mental health conditions. The magnitude of some inequities was greater among adults 35 + . Social and structural interventions to reduce blunt use among US adults could improve health equity.
Reciprocal relationships among youth social media use, internalizing symptoms, and substance use.
Zheng X, Yang M, Li R … +3 more , Li W, Lis N, Lin HC
Drug Alcohol Depend · 2026 Jan · PMID 41478039 · Publisher ↗
OBJECTIVE: Mental health, substance use, and social media are three important, inter-related factors influencing youth development. This study examines the dynamic, reciprocal relationships among social media use, intern...
OBJECTIVE: Mental health, substance use, and social media are three important, inter-related factors influencing youth development. This study examines the dynamic, reciprocal relationships among social media use, internalizing mental health symptoms, and substance use (e-cigarette, alcohol, cigarette, and marijuana) among U.S. adolescents. METHODS: Data were from restricted Population Assessment of Tobacco and Health (PATH) Study, Waves 4, 4.5, and 5 (2016-2019). The sample included 7759U.S. adolescents (weighted N = 15,032,305) who completed all three waves. Weighted generalized structural equation models with lagged dependent variables were performed to examine the reciprocal relationships between youth's social media use frequency, internalizing symptoms, and use of substances. Each variable has a dual role as both a predictor and outcome across waves, with earlier waves predicting subsequent ones, to assess bidirectional influences over time. RESULTS: Higher social media use and internalizing symptoms were associated with higher odds of subsequent e-cigarette, alcohol, and marijuana use. Higher social media use predicted higher odds of e-cigarette use (AOR=1.33, p < 0.001) and alcohol use (AOR=1.19, p < 0.001). Internalizing symptoms predicted higher odds of cigarette use (AOR=1.71, 95 % CI=1.15-2.53). Social media use also predicted greater odds of experiencing internalizing symptoms (AORs=1.05, all ps < 0.01). We found both similarities and differences in the patterns of the reciprocal pathways overtime across the four substances. CONCLUSIONS: Our study reveals a complex and dynamic relationship among social media use, mental health, and substance use among youth. The findings support the need for integrative interventions that simultaneously address mental health, social media behaviors, and substance use risk.
Racial diversity in cannabis use disorder research: A systematic review.
Reid MR, Reynolds B, Cape J … +7 more , Ahmed Z, Ali H, Jaimes-Bautista E, Gott C, Barajas A, Müller F, Alshaarawy O
Drug Alcohol Depend · 2026 Jan · PMID 41456522 · Publisher ↗
BACKGROUND: Several groups of people of color have a higher prevalence and more severe cases of cannabis use disorder (CUD) compared to White people. They also endure unique issues like racial discrimination, which are l...
BACKGROUND: Several groups of people of color have a higher prevalence and more severe cases of cannabis use disorder (CUD) compared to White people. They also endure unique issues like racial discrimination, which are linked with an increased likelihood of CUD. We conducted a systematic review to identify the number of people of color in CUD behavioral health RCTs and whether researchers designed interventions to address people of color's unique challenges. METHODS: We systematically searched PubMed, PsycINFO, and ClinicalTrials.gov for CUD behavioral health RCTs implemented in the United States for adults. We identified 14 out of 966 from 1994 to 2025 for review (12 published, two in ClinicalTrials.gov, completed but not published). RESULTS: White people comprise ~64 % of all participants, and were included at rates 49 times greater than their share of CUD cases. Black people comprise ~19 %, Latiné people 5 %, multiracial/other 0.8 %, Asians 0.6 %, and Indigenous people 0.4 %. No studies were culturally adapted or were designed to address people of color's unique challenges (e.g., racial discrimination). Racial sample diversity has not improved over time. DISCUSSION: People of color are significantly underincluded in CUD RCTs despite their heightened prevalence and CUD severity. This limits research's generalizability and applicability to people of color. Further, the lack of research into people of color's unique challenges may hinder therapists from meeting the full range of people of color's needs. Finally, despite decades of calls to increase racial sample diversity in RCTs, people of color's inclusion has remained low in CUD RCTs.
The association between benzodiazepine proliferation in the unregulated drug supply and experiences of violence: A gender-based analysis.
Swaich A, Rufus-Sedgemore K, Choi J … +5 more , DeBeck K, Boyd J, Milloy MJ, Kerr T, Hayashi K
Drug Alcohol Depend · 2026 Jan · PMID 41447802 · Full text
BACKGROUND: Rising contamination of illicitly-manufactured benzodiazepines in unregulated opioids in Canada poses concern as their strong sedative effects may increase vulnerability to violence for people who use drugs (...
BACKGROUND: Rising contamination of illicitly-manufactured benzodiazepines in unregulated opioids in Canada poses concern as their strong sedative effects may increase vulnerability to violence for people who use drugs (PWUD), particularly women. The current study longitudinally examined the relationship between suspected exposure to benzodiazepines (SEB) and violent victimization, assessing for gender differences. METHODS: Data were drawn from 1049 participants (40.9 % women) from three harmonized prospective cohorts of community-recruited PWUD in Vancouver, Canada between 2021 and 2023. We conducted gender-stratified analyses, with a three-level exposure variable 1) primary SEB: through using unregulated benzodiazepines, 2) secondary SEB: only through using other unregulated drugs, and 3) no exposure (reference category). Patterns of unregulated opioid and stimulant use were examined as effect modifiers. FINDINGS: At baseline, 249 (58.0 %) women and 349 (56.3 %) men reported any SEB; 84 (19.6 %) women and 126 (20.3 %) men reported experiencing violence. For all participants, secondary SEB was significantly related to higher odds of violence (adjusted odds ratio [AOR]=1.48; 95 % confidence interval [CI]:1.14-1.92), however this association did not persist for primary SEB (AOR=1.26; 94 % CI:0.73-2.18). In gender-stratified analyses, the association between secondary SEB and violence was only significant for women (AOR=1.62; 95 % CI:1.10-2.38). Secondary SEB was also associated with higher odds of violence when participants reported daily stimulant and no daily opioid use (AOR=2.76; 95 % CI:1.58-4.82). CONCLUSIONS: Our findings suggest lack of agency over exposure to benzodiazepines, as created by drug supply unpredictability, may exacerbate risk of violence among women who use drugs and PWUD who do not frequently use opioids.
Comparing random forest and elastic net models to predict substance use disorder transitions in participants with cannabis and stimulant use: Evidence from the All of Us cohort.
Zamora G, Gunawan T, Zhao Q … +1 more , Meruelo AD
Drug Alcohol Depend · 2026 Jan · PMID 41442977 · Full text
BACKGROUND: Predicting progression from substance use to substance use disorder (SUD) is challenging, particularly for participants with cannabis and stimulant use who follow distinct risk trajectories. Machine learning...
BACKGROUND: Predicting progression from substance use to substance use disorder (SUD) is challenging, particularly for participants with cannabis and stimulant use who follow distinct risk trajectories. Machine learning enables integration of demographic, behavioral, wearable-derived, and social determinants of health (SDoH) data, yet few studies have compared linear and non-linear approaches in large, diverse populations. METHODS: Data came from the All of Us Research Program, a nationwide cohort integrating electronic health records, surveys, wearable metrics, and SDoH. Individuals with baseline cannabis or stimulant use were followed for incident SUD diagnoses. Predictors included demographics, wearable-derived activity and sleep, and SDoH domains (income, food insecurity, housing instability, transportation barriers). Elastic net (EN) logistic regression and random forest (RF) models were trained separately within cannabis and stimulant cohorts. Discrimination was evaluated on independent test sets using the area under the receiver operating characteristic curve (AUC) and compared with the DeLong test. RESULTS: For participants with cannabis use, EN and RF showed similar performance (AUC = 0.740 vs. 0.741; DeLong p = 0.764). For participants with stimulant use, RF achieved AUC = 0.732 vs. EN = 0.698; DeLong p = 0.219. Demographic variables were the strongest predictors across models. SDoH indicators-particularly income-contributed substantially to prediction, while wearable-derived metrics provided incremental explanatory value primarily in EN models, with limited independent contribution in RF. CONCLUSIONS: EN and RF models achieved moderate prediction of SUD transitions. Incorporating SDoH and wearable-derived data enhanced interpretability and risk stratification, particularly in linear models, underscoring substance-specific pathways and the utility of multimodal frameworks for developing precision prevention strategies.
Longitudinal study of smoking cessation among World Trade Center Health Registry enrollees, 2003-2021.
Sirbu L, Sisti JS, Cone JE
Drug Alcohol Depend · 2026 Jan · PMID 41442976 · Publisher ↗
BACKGROUND: Individuals with post-traumatic stress disorder (PTSD) are more likely to smoke and less likely to quit smoking than people without the condition. Building upon previous research, we examined associations bet...
BACKGROUND: Individuals with post-traumatic stress disorder (PTSD) are more likely to smoke and less likely to quit smoking than people without the condition. Building upon previous research, we examined associations between probable PTSD and smoking cessation among World Trade Center Health Registry (WTCHR) enrollees, who have a relatively high prevalence of PTSD. METHODS: We used five waves of survey data (2003-2021) from the WTCHR, a closed cohort of 9/11-exposed individuals, to examine longitudinal associations between probable PTSD and subsequent smoking cessation among enrollees who reported current smoking. Probable PTSD was assessed with the PTSD Checklist for DSM-IV (PCL-S). The outcome of smoking cessation was also assessed via survey responses at the subsequent wave. Multivariable-adjusted risk ratios (RRs) and 95 % confidence intervals (95 % CI) were estimated with generalized estimating equations. RESULTS: Overall, 31.3 % of enrollees quit smoking by the subsequent survey wave. Differences by probable PTSD status were observed, and in multivariable adjusted models, enrollees with probable PTSD were 8 % less likely to quit smoking compared to enrollees without probable PTSD (RR=0.92, 95 % CI: 0.87, 0.97). CONCLUSION: Although various smoking cessation programs have been implemented among the WTC-exposed population, differences in cessation by PTSD status persist. Additional efforts to promote cessation among this group should consider mental health conditions.
Outpatient initiation of direct-to-inject buprenorphine.
Rosenwohl-Mack S, Heeney M, Samuel L … +7 more , Anderson E, Herring AA, Sirey LR, Peterson D, Bazazi AR, Snyder H, Suen LW
Drug Alcohol Depend · 2026 Jan · PMID 41442975 · Full text
BACKGROUND: Fentanyl-involved overdose deaths have surged, yet buprenorphine remains underutilized for opioid use disorder (OUD) treatment, partly due to the risk of precipitated withdrawal during buprenorphine initiatio...
BACKGROUND: Fentanyl-involved overdose deaths have surged, yet buprenorphine remains underutilized for opioid use disorder (OUD) treatment, partly due to the risk of precipitated withdrawal during buprenorphine initiation. Direct-to-inject (DTI) buprenorphine using weekly long-acting injectable formulations may reduce this risk with a gradual and sustained rise in serum buprenorphine levels. OBJECTIVE: To evaluate 90-day treatment retention, withdrawal tolerability, and associated factors following DTI buprenorphine initiation across multiple outpatient safety-net settings. METHODS: We conducted a retrospective cohort study of 131 DTI initiations among 114 patients with OUD across San Francisco and Oakland safety-net clinics from March 2024 to May 2025. Patients were initiated on weekly long-acting buprenorphine. We assessed withdrawal severity in the first 24h and calculated continuous treatment retention at 7, 30, and 90 days using pharmacy and chart data. RESULTS: Mean age was 42 years; 79 % reported fentanyl use, and 67 % were unstably housed or unhoused. In the 24h after injection, 37 % experienced no withdrawal, 31 % experienced mild-moderate withdrawal, and 11 % experienced severe withdrawal, with 21 % missing data. Overall, 72 % continued buprenorphine beyond initial injection, with most transitioning to monthly formulations. Retention rates were 69 % at 7 days, 68 % at 30 days, and 43 % at 90 days. No demographic or clinical factors predicted 90-day retention. CONCLUSIONS: In this retrospective study, DTI buprenorphine initiation demonstrated favorable tolerability and retention in a high-risk population across diverse outpatient settings. This approach may offer a viable pathway to long-acting buprenorphine treatment for individuals using fentanyl who may not tolerate traditional initiation methods.
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