Addiction [JOURNAL]
Sun
200 papers
Longitudinal association of switching to dual cigarette and e-cigarette use vs. continued exclusive cigarette smoking with tobacco-specific nitrosamine and nicotine intake.
Chen R, Stuart EA, Jones MR … +3 more , Shao Y, Davis MF, Rule AM
Addiction · 2026 Jul · PMID 42393000 · Publisher ↗
BACKGROUND AND AIMS: Dual use of cigarettes and e-cigarettes is often employed by smokers as a harm reduction strategy. This study evaluated the harm reduction potential of e-cigarettes by investigating changes in urinar...
BACKGROUND AND AIMS: Dual use of cigarettes and e-cigarettes is often employed by smokers as a harm reduction strategy. This study evaluated the harm reduction potential of e-cigarettes by investigating changes in urinary biomarker of exposure (BOE) to tobacco-specific nitrosamines (TSNAs) and nicotine among smokers transitioning to dual use. METHODS: Data from 8688 adult smokers in waves 1 to 5 of the Population Assessment of Tobacco and Health Study (United States) were analyzed. 'Transitioned dual users' were defined as those changing from exclusive cigarette smoking to dual use across two consecutive waves. BOE levels were assessed before and after this transition and compared with those who continued smoking cigarettes exclusively ('remained smokers') across the same time frame. Propensity score weighting was used to adjust for baseline confounders. Further analyses were stratified by baseline cigarette consumption, dichotomized at the cohort median into heavy and light smoking groups. RESULTS: Observational analysis revealed that transitioned dual users experienced a statistically significant reduction in TSNAs without a statistically significant change in nicotine. The regression analysis comparing transitioned dual users with 'remained smokers' showed that transitioning to dual use was statistically significantly associated with a 13% decrease in 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) [95% confidence interval (CI) = -20% to -6%] and a 10% decrease in N'-nitrosonornicotine (NNNT) (95% CI = -15% to -4%). In contrast, dual use was statistically significantly associated with a 17% increase in total nicotine equivalents-2 (95% CI = 12%-23%) and 8% increase in total nicotine equivalents-6 (95% CI = 5%-12%). Stratified analysis further showed that the association between dual use and TSNAs reduction was attenuated among the baseline heavy smoking group (>13 cigarettes/day), with one-fourth of the effect estimates and no statistical significance. CONCLUSIONS: Smokers transitioning to dual use alongside e-cigarettes appear to show reductions in tobacco-specific nitrosamines exposure, particularly among lighter smokers, but do not appear to show reductions in nicotine exposure.
Novel product, familiar challenges: Navigating uncertainty in oral nicotine pouch regulation.
Tonti L, Pesko MF
Addiction · 2026 Jul · PMID 42387888 · Publisher ↗
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Craving and personal functioning as mediators of extended-release buprenorphine efficacy: A four-way decomposition analysis from a randomised trial.
Marsden J, Kelleher M, Cowden F … +9 more , Day E, Dewhurst J, Evans R, Gilvarry E, Lowry N, Mitcheson L, Murray R, Quarshie S, Hoare Z
Addiction · 2026 Jul · PMID 42384966 · Publisher ↗
AIMS: To investigate whether the treatment effect of extended-release buprenorphine (BUP-XR) on opioid-free days in opioid use disorder (OUD) is mediated by reductions in opioid craving and improvements in personal funct...
AIMS: To investigate whether the treatment effect of extended-release buprenorphine (BUP-XR) on opioid-free days in opioid use disorder (OUD) is mediated by reductions in opioid craving and improvements in personal functioning. DESIGN AND SETTING: Exploratory causal mediation analysis using VanderWeele's four-way decomposition framework in a 24-week, multi-centre, open-label, superiority, randomised controlled trial comparing methadone or sublingual buprenorphine (MET/BUP-SL) with extended-release buprenorphine (BUP-XR). PARTICIPANTS: Adults with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition moderate to severe OUD (n = 314; 98% severe). Mean age was 42 years, 32% were female and 44% were using non-medical opioids, predominantly heroin, at study baseline. INTERVENTION AND COMPARATOR: MET/BUP-SL vs. BUP-XR (1:1 randomisation). MEASUREMENTS: The outcome was the number of opioid-free days (0-84) during weeks 13-24. Candidate mediators were visual analogue scale ratings of opioid 'need' and 'want' (VAS-N, VAS-W), craving imagery and intrusiveness [Craving Experiences Questionnaire - frequency version (CEQ-F)] and personal functioning impairment [Work and Social Adjustment Scale (WSAS)]. Craving measures were assessed at baseline and weeks 4, 8 and 12, then reduced to binary summaries indicating craving absent at all follow-up assessments vs. present at any assessment. WSAS was assessed at week 12 and retained as a continuous mediator. FINDINGS: During weeks 13-24, the adjusted mean number of opioid-free days was 48.9 in the MET/BUP-SL group and 58.5 in the BUP-XR group [incidence rate ratio (IRR) = 1.20, 95% confidence interval (CI) = 1.10-1.30; P-value <0.001]. Across the four mediator-specific models, BUP-XR was associated with more opioid-free days (total-effect IRRs = 1.10-1.18; all P-values <0.05). BUP-XR increased the odds of craving absence for VAS-N and VAS-W. VAS-N was the only mediator showing evidence of indirect mediation [pure indirect effect (PIE) = 1.05, 95% CI = 1.01-1.10; P-value = 0.015], indicating that reduced opioid 'need' contributed to the treatment effect. CEQ-F and VAS-W showed small, non-statistically significant indirect effects. BUP-XR improved personal functioning (WSAS mean difference -3.79; P-value = 0.014), although WSAS showed no clear evidence of mediation (PIE = 1.05; P-value = 0.085). Findings were broadly consistent across deterministic and multiple imputation sensitivity analyses, with VAS-N remaining the clearest candidate mediator. CONCLUSIONS: In a pre-registered exploratory secondary analysis of a randomised controlled trial, the beneficial effect of extended-release buprenorphine among people with opioid use disorder (OUD) on opioid-free days appeared to operate mainly through direct pathways, with additional evidence that reduced need-related craving contributed to benefit. Improved personal functioning occurred alongside, rather than clearly mediating, treatment benefit. Need-related craving may represent a useful proximal mechanistic endpoint in OUD pharmacotherapy trials.
Alcohol consumption and the risks of morbidity and mortality across 39 diseases and conditions: A population-based cohort study in Korea.
Bui TT, Kang HY, Lee J … +2 more , Kang E, Oh JK
Addiction · 2026 Jul · PMID 42384023 · Publisher ↗
BACKGROUND AND AIMS: Alcohol is embedded in social life; however, alcohol control policies remain insufficiently enforced in Korea. Comprehensive evidence linking alcohol intake to disease and mortality is limited. This...
BACKGROUND AND AIMS: Alcohol is embedded in social life; however, alcohol control policies remain insufficiently enforced in Korea. Comprehensive evidence linking alcohol intake to disease and mortality is limited. This study estimated associations between alcohol consumption in Korea and risks of morbidity and mortality for 39 diseases and conditions. DESIGN: Retrospective cohort study using National Health Insurance Service (NHIS) data linked with death records from Statistics Korea. SETTING: Population-based customized NHIS data, a mandatory single-payer system covering the entire Korean population, between 2006 and 2022. PARTICIPANTS: 6 214 569 participants (57.36% males) aged ≥20 years who underwent two general health examinations during 2006-2009 and were disease-free at baseline. MEASUREMENTS: Alcohol consumption was categorized by drinking status and daily pure alcohol intake (seven levels in 10 g/day increments), averaged across two measurements (2006-2007, 2008-2009). The reference group comprised current abstainers at both examinations. Outcomes included incident cases, all-cause and cause-specific deaths for 39 diseases, followed through 2022. Covariates included age, income, body mass index, smoking, physical activity and comorbidities. Hazard ratios and lifetime risks were estimated. FINDINGS: At baseline, 79.3% of men and 39.0% of women were current drinkers. For cancer (450 738 cases), alcohol consumption was statistically significantly associated with increased risks of seven cancers in men and four in women. On average, lifetime incidence rate of alcohol-related cancers was 9.96% [95% confidence interval (CI) = 9.83-10.09] among current drinkers and 7.88% (95% CI = 7.73-8.03) among current abstainers in men (2.1% difference). Among women, corresponding rates were 10.28% (95% CI = 10.07-10.50) vs. 9.89% (95% CI = 9.78-9.99) (0.4% difference). For diseases of the circulatory system (2 998 902 cases of ten subtypes), alcohol consumption was associated with increased risks of eight subtypes in men and two in women. In contrast, J- or U-shaped association was observed for ischemic heart diseases, heart failure (men) and cardiac arrhythmias (women), which was no longer evident in analyses using light drinking as the reference. Additionally, statistically significant positive association was exhibited in 14 other conditions among men and six among women. For mortality, alcohol consumption was associated with a lifetime incidence rate of death from any cause of 41.70% (95% CI = 41.40-42.01), compared with 39.06% (95% CI = 38.69-39.43) among current abstainers in men, a 2.6% difference. It was also associated with mortality from 15 diseases in men and nine in women. CONCLUSIONS: Alcohol consumption in Korea appears to be associated with numerous diseases and conditions, highlighting the need for strengthened national alcohol control policies. Protective effects of alcohol on cardiac health should be interpreted with caution.
A cross-sectional and prospective examination of alcohol use and misuse among adult twin and sibling pairs discordant for neighborhood socio-economic disadvantage.
Slutske WS, Baker TB, Piasecki TM
Addiction · 2026 Jun · PMID 42367156 · Publisher ↗
AIM: To determine whether the association between neighborhood disadvantage and alcohol use and misuse can be explained by a potentially causal effect of neighborhoods or by between-family genetic and environmental confo...
AIM: To determine whether the association between neighborhood disadvantage and alcohol use and misuse can be explained by a potentially causal effect of neighborhoods or by between-family genetic and environmental confounding. DESIGN: Cross-sectional and prospective discordant twin and sibling study. SETTING: United States national sample. PARTICIPANTS: 1477 adult twin and sibling pairs (217 monozygotic twin, 336 dizygotic twin and 924 full biological sibling pairs) from the National Longitudinal Study of Adolescent to Adult Health (mean age = 28.49 years, 53% female). Most twin and sibling pairs were discordant for the level of disadvantage in their neighborhood (70%). MEASUREMENTS: The predictor was wave 4 neighborhood disadvantage, along with wave 4 individual-, family- and neighborhood-level covariates. The outcomes were any alcohol use, quantity x frequency of alcohol use (alcohol QF) and frequency of binge drinking assessed at wave 4 in the cross-sectional models and at wave 5 in the prospective models. Neighborhood disadvantage for the two members of a twin/sibling pair was used to create two orthogonal within- and between-pair variables to be used to decompose the neighborhood/alcohol association into a within-pair (i.e. potentially causal) effect and a between-pair association (i.e. family level confounding). FINDINGS: In fully adjusted models including all covariates, only between-pair (not within-pair) neighborhood disadvantage was cross-sectionally [odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.88-0.98] and prospectively (OR = 0.92, 95% CI = 0.85-0.98) associated with lower odds of any alcohol use in the past year. Between-pair neighborhood disadvantage was cross-sectionally, but not prospectively, associated with increased alcohol QF in the past month among women [mean ratio (MR) = 1.09, 95% CI = 1.03-1.15], but not among men (MR = 1.01, 95% CI = 0.96-1.06). Within-pair disadvantage was also cross-sectionally, but not prospectively, associated with increased alcohol QF in the past month (MR = 1.04, 95% CI = 1.01-1.07). Neighborhood disadvantage was not significantly associated with binge drinking. CONCLUSIONS: Neighborhood disadvantage appears to be negatively, positively and not significantly associated with any alcohol use, quantity-frequency of use and binge drinking, respectively. Neighborhood disadvantage associations are more consistently explained by between-family confounds, that is, genetic and family environmental factors common to neighborhood disadvantage and to drinking occurrence and amount consumed. This may be due to differential selection by families into neighborhoods.
The Cannabis Research Image Database (CRESIDA): A standardized and validated image set for studying cannabis cue reactivity.
Cousijn J, Kroon E, Suo C … +4 more , Freeman TP, Hindocha C, Quinones-Valera M, Lorenzetti V
Addiction · 2026 Jun · PMID 42366532 · Publisher ↗
BACKGROUND AND AIMS: Cannabis cue reactivity paradigms are instrumental in studying the behavioral and neurocognitive mechanisms of cannabis use and cannabis use disorders; however, image sets used for cannabis cue react...
BACKGROUND AND AIMS: Cannabis cue reactivity paradigms are instrumental in studying the behavioral and neurocognitive mechanisms of cannabis use and cannabis use disorders; however, image sets used for cannabis cue reactivity paradigms vary between studies, and the lack of reliability and validity assessment hinders the quality of evidence they generate. The main aim of this study was to create a novel, open access, standardized and representative database of cannabis use-related images including control images matched by resolution, luminosity and complexity: The Cannabis Research Image Database (CRESIDA). The secondary aim was to examine whether subjective cannabis cue-induced craving was associated with cannabis use severity and whether this relationship was moderated by image type. As an illustrative example of how our open data can be used and how sample characteristics can shape cue reactivity, we also explored the role of cannabis-tobacco mixing by comparing cannabis cue induced cannabis and tobacco craving between individuals who did and did not mix the substances. DESIGN: An online survey was administered to participants recruited via online platforms, community advertisement and snowballing. SETTING: USA, the Netherlands and Australia. PARTICIPANTS/CASES: 689 participants who consumed cannabis monthly to daily (385 men, 298 women, 6 other) were recruited between January 2022 and May 2024. MEASUREMENTS: Out of 93 cannabis images and 93 matched neutral images, participants each rated 31 image pairs for cannabis craving (the primary outcome), arousal, valence and tobacco craving. Participants were characterized for socio-demographic data, level of cannabis use and related problems and mixing cannabis and tobacco. A subset of 78 images was selected for further analysis based on cannabis craving results. Image ratings were evaluated for internal consistency (α). Furthermore, we examined the association between cannabis cravings and cannabis use characteristics, and explored if cannabis craving ratings were affected by image type (i.e. product, paraphernalia and actions) and by using cannabis alone vs. mixing cannabis and tobacco. FINDINGS: The database showed excellent reliability (α = 0.995-0.965). Cannabis craving, valence and arousal discriminated cannabis and control images. More cannabis use days [unstandardized beta (β) = 0.162, P < 0.001] and cannabis use-related problems (β = 0.268, P < 0.001) were statistically significantly associated with higher image-related cannabis craving. Mixing cannabis with tobacco, compared with using cannabis alone, was associated with the presence of tobacco craving in relation to cannabis images, and with greater cannabis craving in relation to cannabis images (β = -0.457, P < 0.001). CONCLUSIONS: Images in the open access Cannabis Research Image Database (CRESIDA, https://osf.io/dc9nz/) appear to be reliable and valid for the scientific study of cue reactivity internationally, providing a broad range of free to use cannabis and control images.
Problems in comparing tobacco regulatory models and excise when only two countries are considered.
Chapman S, Egger S, Freeman B
Addiction · 2026 Jun · PMID 42363676 · Publisher ↗
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E-cigarette and cannabis use and co-use patterns and dependence trajectories among young adults in the United States.
Pokhrel P, Phillips KT, Phillips MM … +2 more , Kawamoto CT, Herzog TA
Addiction · 2026 Jun · PMID 42351352 · Publisher ↗
BACKGROUND AND AIMS: Co-use of cannabis and e-cigarettes for nicotine is increasing among younger adults in the United States (US). This study aimed to determine (1) the patterns of cannabis and e-cigarette use and co-us...
BACKGROUND AND AIMS: Co-use of cannabis and e-cigarettes for nicotine is increasing among younger adults in the United States (US). This study aimed to determine (1) the patterns of cannabis and e-cigarette use and co-use over time and (2) the trajectories of e-cigarette and cannabis dependence symptoms across latent classes representing different patterns of use and co-use. DESIGN: Prospective cohort study, with data collected every six months at six time points. SETTING: Hawaii, USA. PARTICIPANTS: N = 1305 individuals [mean age = 25.0 (standard deviation = 2.2); 52% women], who reported past-30-day cannabis and/or e-cigarette use at any of the six data collection time points between March 2021 and February 2024. MEASUREMENTS: For the repeated measures latent class analysis (RMLCA): past-30-day cannabis use, e-cigarette use and co-use (any past-30-day use of both cannabis and e-cigarettes for nicotine). RMLCA covariates: demographic variables and cigarette smoking. For the latent growth curve analyses: e-cigarette dependence [Penn State E-Cigarette Dependence Index (PSEDI), range: 0-20] and cannabis dependence symptoms [Cannabis Abuse Screening Test (CAST), range: 0-24]. FINDINGS: Four latent classes were identified: individuals who, across time points, consistently showed (1) low probabilities (≤ 0.17) of using e-cigarettes or cannabis, including co-use (44% of the sample); and (2) high probabilities (> 0.50) of primarily e-cigarettes-only use (18%); (3) primarily cannabis-only use (20%); and (4) primarily co-use (18%). For co-use class, the average trajectory for cannabis dependence remained flat [mean linear slope (LS) = 0.01 (standard error [SE] = 0.03), P > 0.05] whereas that for e-cigarette dependence increased over time [LS = 0.15 (0.03), P < 0.0001] before showing a slight decline [mean quadratic slope (QS) = -0.02 (0.007), P < 0.01]. For e-cigarette-only use class, e-cigarette dependence increased over time [LS = 0.91 (0.05), P < 0.0001], before showing a slight decline [QS = -0.02 (0.006), P < 0.0001]. The levels of e-cigarette dependence were higher for e-cigarette-only class than the co-use class across all time points. For cannabis-only class, the average trajectory of cannabis dependence symptoms did not change over time [LS = 0.03 (0.03), P > 0.05]. The levels of cannabis dependence symptoms were higher for the co-use class than the cannabis-only class across all time points. CONCLUSIONS: Among young adults who reported past-30-day cannabis and/or e-cigarette use, on average, e-cigarette dependence increased over time for both e-cigarette-only and co-use classes before showing slight declines. Compared with the co-use class, the e-cigarette-only class tended to show higher levels of e-cigarette dependence across all time points. Cannabis use dependence did not change statistically significantly for either co-use or cannabis-only classes.
The United Kingdom's Tobacco and Vapes Act 2026-A landmark in tobacco control, but a missed opportunity for product clarity.
Cox S, Notley C, West R
Addiction · 2026 Jun · PMID 42351334 · Publisher ↗
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Commentary on Zacher et al.: How cocaine memories may drive craving and drug instrumentalization.
Müller CP
Addiction · 2026 Jun · PMID 42351320 · Publisher ↗
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Toward a public health and prevention-oriented approach to stimulant-induced psychosis.
Bouthillier A, Sharafi H, Bisaga A … +1 more , Jutras-Aswad D
Addiction · 2026 Jun · PMID 42347686 · Publisher ↗
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Commentary on Friedman et al.: Inequitable improvements and data gaps-A call for better drug surveillance data.
Kiang MV
Addiction · 2026 Jun · PMID 42340138 · Publisher ↗
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Balancing harm prevention and liberty preservation when implementing financial risk assessments for gambling in the United Kingdom: Insights from open banking data.
Heirene RM, Newall P
Addiction · 2026 Jun · PMID 42339558 · Publisher ↗
BACKGROUND AND AIMS: The United Kingdom (UK) and Dutch governments have recently implemented mandatory financial risk (affordability) assessments for online gambling as a harm prevention measure. Assessments should trigg...
BACKGROUND AND AIMS: The United Kingdom (UK) and Dutch governments have recently implemented mandatory financial risk (affordability) assessments for online gambling as a harm prevention measure. Assessments should trigger at a level of gambling expenditure that strikes a balance between harm prevention (most at-risk consumers should surpass the threshold) and liberty preservation (most no-/lower-risk consumers should gamble below it), yet little empirical research exists to guide threshold setting. We aimed to demonstrate how research can inform the harm-prevention, liberty-preservation trade-off in this context and evaluate the UK's proposed implementation of financial risk assessments. DESIGN, SETTING AND PARTICIPANTS: We reanalysed a dataset that combines self-reported Problem Gambling Severity Index (PGSI) scores and open banking data from consumers who gamble (n = 424) to (1) simulate the impact of the UK's rolling 30-day £150 net-deposit (deposits minus withdrawals) threshold for financial risk assessments, and (2) identify optimal threshold values for these assessments under different circumstances. Participants were UK residents who had gambled in the past year, recruited via Prolific in April 2024. MEASUREMENTS: Participants completed a survey containing the PGSI and agreed to provide their past 12 months' banking records. FINDINGS: Over 12 months, two-thirds of at-risk (PGSI ≥1) and nearly half of no-/lower-risk participants crossed the UK's £150 threshold [area under the curve = 0.66, 95% confidence intervals (CIs) = 0.62-0.71], demonstrating a greater emphasis on harm prevention over liberty preservation. Increasing the value to £186.9 (95% CIs = £69.5-£401.7) slightly improved this balance, although £150 remained within the range of appropriate values. Optimising for harm prevention in our sample required lowering the threshold to £39.0 (95% CIs = £29.6-£58.8), while emphasising liberty preservation increased it to £716.5 (95% CIs = £508.5-£990.9). We found that using a more conservative definition of risk (≥2 PGSI harms) resulted in higher thresholds, and lower thresholds may be appropriate for younger adults (<30 years). Finally, our findings suggest that thresholds based on spending with all operators-rather than single operators as implemented in the UK-may be better able to differentiate at-risk from no-/lower-risk consumers, although the added benefit of this approach in our sample was marginal and further research is needed to confirm its value. CONCLUSIONS: The United Kingdom's £150 net-deposit threshold for financial risk assessments for online gambling may place more emphasis on harm prevention than liberty preservation. This study provides a methodological template for guiding the implementation of financial risk assessments for online gambling. Because our sample is not representative of the broader UK gambling population, our specific threshold estimates should be treated as provisional.
Beyond abstinence: Redefining success in cannabis use disorder treatment.
Atkin TB, Levin FR, Mariani J … +1 more , Brezing CA
Addiction · 2026 Jun · PMID 42331735 · Publisher ↗
BACKGROUND: Over two decades of pharmacotherapy research has yet to yield a consistently effective medication for cannabis use disorder (CUD), in part because clinical trials have frequently prioritized abstinence as a p...
BACKGROUND: Over two decades of pharmacotherapy research has yet to yield a consistently effective medication for cannabis use disorder (CUD), in part because clinical trials have frequently prioritized abstinence as a primary or key endpoint. Abstinence, however, is difficult for many patients to attain, may not align with their treatment goals, and can obscure meaningful clinical improvements. By contrast, the alcohol and tobacco fields have advanced through adoption of validated reduction-based frameworks that capture changes in harm, functioning, and quality of life. ARGUMENT/ANALYSIS: This paper (1) critiques the limitations of abstinence-focused endpoints in CUD trials, (2) outlines key methodological challenges, and (3) proposes a more comprehensive approach to outcome measurement. Most adult pharmacotherapy trials have been deemed negative when evaluated on abstinence, despite frequent reductions in cannabis use that are associated with improvements in psychiatric symptoms and functional outcomes. Studies evaluating non-abstinent outcomes are often difficult to interpret clinically without clearer links to mental, physical, and functional outcomes. Emerging CUD data and lessons from other substance use fields point to the need for standardized, reduction-based metrics that can more accurately detect treatment-related change. CONCLUSION: Reliance on abstinence as the primary endpoint has constrained progress in CUD treatment development. Incorporating consensus-driven, reduction-based outcomes, while continuing to measure abstinence as a secondary endpoint, may better align research with patient goals, enhance interpretability of trial findings, and improve the field's ability to identify promising interventions. Standardizing definitions for meaningful reductions is critical to advancing CUD care.
Cannabis consumer responses to the concept of standard THC units.
Pawson M, Vuolo M, Kelly BC
Addiction · 2026 Jun · PMID 42331728 · Publisher ↗
AIMS: Within a context of considerable cannabis market expansion and product diversification, cannabis consumers must manage their use across a range of potencies and modes of consumption. This study aimed to provide dee...
AIMS: Within a context of considerable cannabis market expansion and product diversification, cannabis consumers must manage their use across a range of potencies and modes of consumption. This study aimed to provide deeper understandings of how cannabis consumers would perceive the introduction of a standard THC (tetrahydrocannabinol) unit system. DESIGN: Qualitative study. SETTING: United States, 2023-2024. PARTICIPANTS: Adult cannabis consumers (n = 50) across criminalized and legalized cannabis states. MEASUREMENTS: Within a study focused on the experiences of dosing cannabis among adults in contexts of evolving cannabis markets with product diversification, subjects were provided with a description of a standard THC unit and with the analog of a standard drink. They were then asked about their perceptions of a standard THC unit. Interviewers probed for personal attitudes, practical utility and potential for reducing harm. FINDINGS: Broadly, cannabis consumers were enthusiastic about the introduction of a standard THC unit system, although a minority expressed some skepticism about how it would be implemented. Standard THC units were viewed as most beneficial for novices and infrequent consumers, although some experienced consumers indicated it would be valuable for tolerance management and avoiding dependence. It was also seen as valuable for avoiding risks related to driving under the influence and overconsumption. CONCLUSIONS: Standard metrics for cannabis consumption may be received with enthusiasm from cannabis consumers. Experienced consumers indicated they would have benefited from a standard THC (tetrahydrocannabinol) unit when initiating cannabis use and highly recommended it for novices. It was also viewed as an opportunity to manage risks. Successful implementation would require managing misunderstandings about the concept of a standard THC unit as well as how regular, experienced consumers would incorporate such a metric into established consumption routines.
Collaborative care intervention for risky opioid use among primary care patients: The STOP randomized clinical trial.
McNeely J, Subramaniam GA, Stone R … +16 more , Mazel S, Appleton N, Rostam-Abadi Y, Bunting AM, Shi Y, Lovejoy TI, Gelberg L, Beers D, Kline M, Zhang S, Kim T, Case A, McCormack J, Incze MA, Liebschutz JM, STOP trial site principal investigators
Addiction · 2026 Jun · PMID 42331724 · Publisher ↗
BACKGROUND AND AIMS: Individuals who engage in illicit or nonmedical opioid use may have elevated risk of health and social consequences, including progression to opioid use disorder (OUD). Preventive interventions to re...
BACKGROUND AND AIMS: Individuals who engage in illicit or nonmedical opioid use may have elevated risk of health and social consequences, including progression to opioid use disorder (OUD). Preventive interventions to reduce this risk are lacking. This trial tested the impact of a primary care-integrated collaborative care approach for reducing risky opioid use, defined as nonmedical use of prescription opioids or any use of illicit opioids. DESIGN: Cluster-randomized controlled trial randomized primary care providers (PCPs) and their patients into the Subthreshold Opioid Use Disorder Prevention (STOP) intervention or enhanced usual care (EUC). SETTING: Primary care clinics at 5 U.S. sites. PARTICIPANTS: PCPs and their patients were recruited January 2021-May 2023. A total of 119 PCP clusters (STOP = 48, EUC = 51) and 202 patients (STOP = 88, EUC = 114) enrolled. Eligible patients were adults (≥18 years) having current risky opioid use, without moderate-severe OUD. Patient participants were majority female (63.4%), white (70.8%) and non-Hispanic (96.5%), with a mean age of 55.7 [standard deviation (SD) = 12.7] years. At baseline, 63.4% of participants had moderate-severe pain (Brief Pain Inventory) and below average physical (79.2%) and mental (62.4%) health (SF-12). INTERVENTIONS: The STOP collaborative care intervention consisted of brief advice from the PCP about reducing risky opioid use, meetings with a clinic-embedded nurse care manager over 12 months and remote health coaching (2-6 sessions). Both groups received primary care treatment as usual and overdose risk reduction materials. MEASUREMENTS: The primary outcome was total days of risky opioid use, recorded from 6 monthly electronic surveys. A key secondary outcome was moderate-severe OUD at 6 and 12 months. FINDINGS: A total of 77 (87.5%) STOP and 107 (93.9%) EUC participants completed the 6-month assessment period. The primary outcome analysis used the Intention-to-Treat sample with multiple imputations of missing data. Mean days of risky opioid use at 180 days were lower in STOP than EUC [12.2 (SD = 27.73) vs. 15.5 (SD = 32.64)]; the difference between groups adjusted for baseline risky opioid use was not statistically significant (rate ratio 0.95, 95% confidence interval = 0.52-1.74). One STOP participant (1.1%) and 13 EUC participants (11.4%) developed moderate-severe OUD at 6 months, and 3 (3.4%) STOP and 6 (5.3%) EUC participants had moderate-severe OUD at 12 months (P < 0.001). CONCLUSIONS: This cluster-randomized controlled trial did not find evidence that the STOP intervention for reducing risky opioid use produced greater reductions over 6 months compared with enhanced usual care, though fewer intervention participants progressed to moderate-severe opioid use disorder. Patients had a high burden of pain and comorbidities that may present challenges to reducing opioid use.
Alcohol-free and low-alcohol beverage consumption and concurrent and subsequent alcohol outcomes among young adults.
Mann S, Siconolfi D, Rodriguez A … +4 more , Seelam R, Pedersen ER, Dunbar M, D'Amico EJ
Addiction · 2026 Jun · PMID 42321593 · Full text
BACKGROUND AND AIMS: Alcohol-Free and Low-Alcohol Beverages (AFLABs) have grown in popularity, yet predictors and longitudinal outcomes of their use remain unclear. We aimed to measure the association between AFLAB consu...
BACKGROUND AND AIMS: Alcohol-Free and Low-Alcohol Beverages (AFLABs) have grown in popularity, yet predictors and longitudinal outcomes of their use remain unclear. We aimed to measure the association between AFLAB consumption and (1) concurrent and (2) subsequent alcohol consumption, risk and change measures (e.g. consequences, quit attempts, abstention) and drinking motives among young adults. DESIGN: Observational study using two survey waves (W15 and W16; 2022-2024) from a longitudinal cohort study (STRATA). SETTING: California, USA (surveys fielded 2022-2024). PARTICIPANTS: Cross sectional analysis of young adults (n = 877 individuals, of which 849 were followed in W16) who report past-month alcohol consumption in W15 from a California-based cohort study, and analysis of those with past-month alcohol consumption at both W15 and W16 (n = 693). MEASUREMENTS: Individuals completed survey items on past-month AFLAB consumption, alcohol consumption (past-month heavy episodic drinking and past-year abstention), alcohol risk and change measures (alcohol-related consequences, indicators of a change effort and the alcohol contemplation ladder) and drinking motives (from the drinking motives questionnaire). FINDINGS: Twenty-four percent of participants reported past-month AFLAB use at baseline. Adjusted cross-sectional models using W15 data indicated that AFLAB use was associated with lower social drinking motives [coefficient = -0.005; 95% confidence interval (CI) = -0.011 to 0.0001] but was not statistically significantly associated with other alcohol consumption, risk or change measures. In adjusted prospective models, baseline AFLAB use was associated with a 5.1 percentage point (pp) higher probability of alcohol abstention at W16 (95% CI = 1.1-9.1) than lack of AFLAB use. In adjusted prospective models, baseline AFLAB use was not statistically significantly associated with heavy episodic drinking, alcohol-related consequences or most change-related measures, although there was suggestive evidence of a higher likelihood of reporting a quit attempt in the past 3 months. CONCLUSIONS: Use of alcohol-free and low-alcohol beverages appears to be common among young adults in California, USA, and appears to be concurrently associated with lower social drinking motives and prospectively associated with subsequent alcohol abstention.
Barriers and facilitators to detoxification from opioid substitution treatment: A mixed-methods systematic review.
Bagshaw A, Shah S, Olchefske I … +3 more , Paterson LM, Crawford MJ, Lingford-Hughes A
Addiction · 2026 Jun · PMID 42309510 · Publisher ↗
BACKGROUND AND AIMS: Despite the well-documented benefits of opioid substitution treatment (OST) in treating opioid dependence (OD), many people diagnosed with OD desire to live a drug-free life. The transition to abstin...
BACKGROUND AND AIMS: Despite the well-documented benefits of opioid substitution treatment (OST) in treating opioid dependence (OD), many people diagnosed with OD desire to live a drug-free life. The transition to abstinence involves detoxification: a gradual dose reduction of OST to zero milligrams. Despite these aspirations, only a minority of patients undertake detoxification, and successful completion remains limited. This mixed-methods systematic review aimed to identify the barriers and facilitators to detoxification from OST, to help provide a better understanding of what can be done to support patients and improve outcomes in OD. METHODS: Four databases were searched until 22 January 2025: PubMed, Embase, APA PsycINFO and CINAHL. Qualitative, quantitative and mixed methods studies of individuals with a diagnosis of OD undergoing detoxification from OST, or staff responsible for providing the treatment, were included. Studies of only pharmacological interventions were excluded. An integrated approach to data synthesis was used, transforming quantitative data into textual descriptions to integrate them with qualitative data and form one set of themes. Joanna Briggs Institute checklists were used to assess the quality of included papers. RESULTS: From 1999 studies identified, 41 papers were deemed eligible. Studies originated from the USA (22), UK (7), Sweden (6), Canada (1), Ireland (1), Norway (1), Switzerland (1), Australia (1) and China (1). The medications explored included methadone (28), buprenorphine (5), both forms (6) and unspecified OST (2). Studies were conducted in outpatient settings (29), inpatient settings (7), mixed settings (4) and a prison setting (1). Participants included patients (37), treatment providers (1) and mixed populations (3). Factors affecting detoxification were present at an individual and structural level, with overlap between influences at the initiation and completion phases. Eight themes emerged, comprising psychological and emotional factors (particularly around fear of detoxification), personal motivation, withdrawal symptoms, clinical and demographic factors, environmental factors, social factors, professional support and treatment models/interventions. 54% of included studies were rated high quality, and 37% of medium quality. CONCLUSION: Detoxification from opioid substitution treatment appears to be commonly hindered by fear, emotional resurgence, low confidence, environmental turbulence, negative social influences and insufficient professional/pharmacological support, while facilitators include psychological readiness, life stability, supportive relationships, psychological interventions, inpatient facilities and adjunctive medications.
Evaluating the immediate impacts of the repeal of the Northern Territory minimum unit price on off-premises alcohol pricing: Findings from an observational study of online alcohol retailers.
Miller M, Man N, Taylor N … +7 more , Livingston M, Clifford S, Kowalski M, Jiang H, Callinan S, Wright CJC, Peacock A
Addiction · 2026 Jun · PMID 42299053 · Publisher ↗
BACKGROUND AND AIMS: A minimum unit price (MUP) of AUD$1.30 per standard drink was implemented in 2018 in the Northern Territory (NT), Australia, to reduce the availability of cheap alcohol. Despite evidence of its effic...
BACKGROUND AND AIMS: A minimum unit price (MUP) of AUD$1.30 per standard drink was implemented in 2018 in the Northern Territory (NT), Australia, to reduce the availability of cheap alcohol. Despite evidence of its efficacy in decreasing alcohol consumption and harms, the MUP was repealed on 1 March 2025. This study aimed to determine the immediate impacts of the MUP repeal on the price of off-premises (i.e. takeaway) alcohol in Darwin, NT, assessing the proportion of products available <$1.30 per standard drink after the repeal in March 2025, identifying whether these products were pre-existing or new to market, and analysing any broader shifts in the price distribution across all alcoholic products that could be attributable to the repeal. DESIGN AND PARTICIPANTS: Observational study of all alcoholic products available from three large alcohol retailer websites. SETTING: Darwin, NT, between October 2024 and March 2025. MEASUREMENTS: Price per standard drink was estimated, and fixed-effects panel quantile regression was used to test for price differences. FINDINGS: Within one month of the repeal, no beer or spirits, 5.1% of all wine and 2.5% of all ciders were available <$1.30 per standard drink, including 67.6% of the 37 wine products in vessels ≥1 L. Of the products identified at <$1.30 per standard drink, most had been available in previous months (i.e. not new or restocked). Quantile regression results showed a downward shift in price across the market for all product types, including beer and spirits, which were priced substantially above the $1.30 threshold at all percentiles. The largest reductions were observed for cheaper spirits, beer, cider and wine ≥1 L, ranging from $0.08 at the 20th percentile for spirits to $0.48 for wine ≥1 L at the 10th percentile. CONCLUSIONS: The minimum unit price repeal in Northern Territory, Australia, in March 2025 resulted in an immediate increase in the availability of cheap alcohol products and a downward shift in the overall price of alcohol in the off-premises market, particularly for lower-priced products.
Factors associated with the percentage of individuals who initiate and discontinue naltrexone as a relapse prevention pharmacotherapy in opioid use disorder: A systematic review, meta-analysis and meta-regression.
Roberts E, Sanderson E, Santo T … +3 more , Hickman M, Farrell M, Degenhardt L
Addiction · 2026 Jun · PMID 42286437 · Publisher ↗
BACKGROUND AND AIMS: Naltrexone is a pharmacotherapeutic option for relapse prevention in opioid use disorder (OUD); however, studies highlight low rates of initiation and high rates of discontinuation as limiting its ef...
BACKGROUND AND AIMS: Naltrexone is a pharmacotherapeutic option for relapse prevention in opioid use disorder (OUD); however, studies highlight low rates of initiation and high rates of discontinuation as limiting its effectiveness. We aimed to (1) estimate the percentage of individuals with OUD who (having undergone withdrawal and wish to remain abstinent) initiate and discontinue naltrexone and (2) examine participant- and study-level factors that contribute to variation in initiation and discontinuation rates. METHODS: We undertook a systematic review, random-effects meta-analysis and meta-regression searching Medline, Embase, PsychINFO and CENTRAL from database inception to 19 February 2025 for studies of any design from any geographical region involving individuals with OUD eligible to receive naltrexone as a relapse prevention pharmacotherapy (i.e. those completing opioid withdrawal and wishing to remain abstinent). Measurements included the percentage of individuals who initiate or discontinue oral, long-acting injectable depot or implantable formulations of naltrexone at 1, 3 or 6 months. Certainty was assessed using the GRADE framework. RESULTS: Twenty-two studies, including 124 016 individuals, reported initiation and 95 studies, including 16 969 individuals, reported discontinuation. The pooled percentage initiating oral naltrexone among those eligible was 60.3% [95% confidence interval (CI) = 38.9%-80.0%, 2014 participants, 15 studies] and depot was 18.2% (95% CI = 2.7%-42.5%, 57 383 participants, 4 studies). The pooled percentage discontinuing oral was 50.0% (95% CI = 41.9%-58.1%, 7340 participants, 34 studies) at 1 month, 61.3% (95% CI = 50.9%-71.2%, 2347 participants, 29 studies) at 3 months and 71.0% (95% CI = 57.3%-83.0%, 1889 participants, 19 studies) at 6 months. The pooled percentage discontinuing depot was 26.1% (95% CI = 19.5%-33.3%, 3589 participants, 33 studies) at 1 month, 46.7% (95% CI = 38.4%-55.1%, 3302 participants, 33 studies) at 3 months and 60.0% (95% CI = 43.2%-75.8%, 3071 participants, 22 studies) at 6 months. Statistically significantly higher percentages initiated oral naltrexone if it was the only offered pharmacotherapy (meta-regression coefficient 33.6%, 95% CI = 8.1%-59.2%, P = 0.014) and statistically significantly lower percentages discontinued oral naltrexone at 3 and 6 months if administration was supervised (meta-regression coefficient -18.6%, 95% CI = -36.6% to -1.0%, P = 0.043 and -27.3%, 95% CI = -50.1% to -4.4%, P = 0.022, respectively). There was no clear evidence that study setting (i.e. if the study was conducted in routine clinical care or an investigational setting) substantially explained or contributed to the variation in any estimates. All outcomes were very low certainty. CONCLUSIONS: Very low certainty evidence suggests that, among people with opioid use disorder who have undergone withdrawal and wish to remain abstinent, a substantial percentage are willing to initiate naltrexone with marked early discontinuation.
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