Addiction最新文献

Background and aims: Brief interventions delivered in healthcare settings represent a promising substance use prevention and early intervention strategy for youth in foster care, among whom early life adversity and resulting psychological sequalae increase risk for problematic substance use. Limited research has examined the effectiveness of brief interventions in this subpopulation. This study aimed to examine whether psychological diagnoses were associated with screening positive for problematic substance use, and whether psychological diagnoses impacted effectiveness of a brief intervention for substance use.

Design: Longitudinal observational study of adolescents (ages 10-20 years) seen for mandated health examinations in a foster care clinic. Youth who endorsed substance use and received a brief intervention were invited to complete baseline surveys and follow-ups at 30 days, 60 days and 6 months. Logistic regressions evaluated associations of mental health disorders with endorsing problematic substance use. Generalized linear mixed models examined associations of mental health disorders with trajectories of post-intervention change in substance use.

Setting: Midwest, United States.

Participants: Adolescents seen for mandated health examinations in a foster care clinic who completed a substance use screening measure [CRAFFT2.1 + N; n = 1656; mean age (SD) = 14.4 (2.6); 53.4% female; 58.4% Black, 31.6% white]. A second subsample included only those adolescents who received a brief intervention for substance use during their clinic visit [n = 287; mean age (SD) = 15.9 (2.1); 59.9% female; 53.7% Black, 35.5% white].

Measurements: Mental health diagnoses and CRAFFT2.1 + N were extracted from the electronic health record. Youth-reported count of past 30-day use of alcohol, cannabis and nicotine/tobacco at each wave.

Findings: A minority (12%) of youth in foster care endorsed problematic substance use. Youth with a mental health diagnosis had 58% to 161% higher odds of reporting problematic substance use [odds ratios (ORs) = 1.58-2.61; 95% confidence intervals (CIs) = (1.16-2.13) - (1.93-3.56)]. Following the intervention, youth who had been diagnosed with internalizing disorders (i.e. anxiety, depressive and trauma disorders), and those with co-occurring internalizing and externalizing disorders, reported smaller decreases or no decreases in their cannabis [ORs = 2.09, 7.03; 95% CIs = (1.17-3.71), (3.43-14.42)] and nicotine use [ORs = 1.95-7.68; 95% CIs = (1.08-3.53) - (4.12-14.32)]. Alcohol use did not vary as a function of mental health diagnoses [ORs = 0.31-13.10; 95% CIs = (0.00-19.37) - (0.19-915.80).

Conclusion: Foster youth in the United States, particularly those with mental health concerns, appear to be at high risk for problematic substance use.

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.

Background and aims: The market for new psychoactive substances (NPS) is highly dynamic, with hundreds of substances emerging on the European drug market in the last decade. 3-methylmethcathinone (3-MMC), a synthetic cathinone and isomer of mephedrone (4-MMC), gained popularity in the Netherlands due to its psychostimulant effects and initial legal status. The present study aimed to systematically examine developments in the Dutch 3-MMC market between 2012 and 2024, based on the Drugs Information and Monitoring System (DIMS) data, to describe trends in pricing, sources of purchase, chemical composition, user-reported effects and demographic and contextual use patterns.

Design and setting: Observational study using drug checking data collected from 2012 to 2024 through DIMS, a national network of 33 drug checking services operating throughout the Netherlands.

Cases: In total, 3437 samples sold as 3-MMC were submitted to DIMS for analysis and were included in the study. Of these, 2627 samples were chemically analysed.

Measurements: Number of samples sold as 3-MMC submitted for drug checking, price, source of purchase, drug composition, self-reported effects in relation to drug composition, and setting of use.

Findings: The number of samples sold as 3-MMC submitted to DIMS each year increased from n = 1 in 2012 to n = 1853 in 2024. Following the scheduling of 3-MMC in 2021, median prices doubled (from €10 during the period 2019-2021 to €20 in 2022) and the reported source of purchase shifted towards dealer (from approximately 50% of samples before scheduling to more than 90% after scheduling). Chemical composition of the analysed samples changed significantly (Cramér's V = 0.49, P < 0.01). Since 2022, samples sold as 3-MMC increasingly contained a variety of substances. By 2024, only 10% of samples still contained 3-MMC, compared with 85% in 2021, whereas substitutes such as 2-methylmethcathinone (2-MMC) and 3-chloromethcathinone (3-CMC), as well as more potent compounds including di(methyl)pentylone (DMP) and N-ethylnorpentedrone (NEP) became more prevalent. Self-reported effects (noted for 376 samples) were qualitatively similar for samples containing 2-MMC and 3-CMC compared with 3-MMC, whereas DMP and NEP were associated with more severe adverse reactions (e.g. anxiety, paranoia, cardiovascular disturbances, insomnia). Patterns of use shifted towards festivals and parties (around 50% and 25%, respectively), while home use (15%) remained notable in 2024.

Conclusions: The Dutch 3-methylmethcathinone (3-MMC) market changed substantially following scheduling in 2021, with more samples sold as 3-MMC submitted for drug checking. By 2024, only 10% of submitted samples contained 3-MMC and structurally related substitutes with greater health risks were increasingly detected.

Background and aims: Adolescent substance use is a significant public health concern, though the scope of the problem is difficult to ascertain given reliance on self-reported substance use information. Recent, large cohort studies in adolescents and young adults suggest underreporting of substance use. Analyses here aimed to determine concordance between self-reported substance use and biochemical verification through hair samples and to estimate prevalence of the three most reported substances used by adolescents.

Design: Observational cohort longitudinal study design. Liquid chromatography and gas chromatography tandem mass spectrometry (LC or GC/MS-MS) were used to test hair samples for biochemically verified substance use, with results compared with self-reported substance use. Multi-step weighting methods estimated prevalence trends of cannabis, alcohol and nicotine use over time, adjusting for discrepancies in sample representation due to recruitment demography, missed visits and hair sample testing.

Setting and participants: Data came from the United States nationwide Adolescent Brain Cognitive Development Study (n = 11 868; age 9-10 at baseline, age 15-16 at wave 6). Participants were followed annually, with data here from 2016 to 2024.

Measurements: Hair samples objectively detected at least several days of substance use in a subsample of participants (n_samples = 11 865; n = 6133 unique participants). Participants self-reported past 3-month substance use. Sociodemographic, individual and environmental-level factors were included in inverse propensity weights to estimate prevalence rates of cannabis, alcohol and nicotine use in teens.

Findings: Concordance between self-report and toxicological data improved with age (for cannabis, ages 11-12 = <1%; ages 15-16 = 45%). Weighted estimates of biochemically verified substance use indicated 7.1% [95% confidence interval (CI) = 6.0-8.3] of 15-16 year olds engaged in biochemically detected cannabis use, 0.2% (95% CI = 0.1-0.4) used alcohol and 4.7% (95% CI = 3.7-6.0) used nicotine.

Conclusions: In United States youth, the concordance between self-reported substance use patterns and biochemical verification improves with age. Biochemical verification reflects substantive cannabis and nicotine use by United States youth aged 15-16, supporting combining toxicological and self-report data to improve identification of substance use in youth when possible.

Aims: This study used Australian longitudinal data to examine the effect of being fired or made redundant on alcohol and tobacco use.

Design and setting: Fixed effect panel analyses of 19 waves of the Household Income and Labour Dynamics in Australia (HILDA) survey, a voluntary representative longitudinal survey of over 17 000 Australians.

Participants: 143 517 survey responses from 15 934 individuals, with the effective sample varying by analysis.

Measurements: Outcome variables were drinking status (drinker/non-drinker), drinking frequency (days per week/month), drinking amount (number of standard drinks), smoking status (smoker/non-smoker), tobacco consumption (packets per week). Covariates included age, sex, Indigenous status, marital status, country of birth (Australia vs. other country), remoteness of residence, year 12 completion, mental health [measured using the mental health component of the 36-Item Short Form Health Survey (SF36)], poor health, low socio-economic status, whether separated/divorced in the last 12 months, whether experienced a sudden loss of income in the last 12 months and survey year.

Findings: After adjusting for the effects of other factors, there is no statistically significant association between being fired and the risk that a non-drinker will initiate or return to drinking alcohol [odds ratio (OR) = 0.889, 95% confidence interval (CI) = 0.894-1.093]. Nor is there a statistically significant association between being fired and the frequency with which a drinker drinks [incidence rate ratio (IRR) = 1.008, 95% CI = 0.999-1.016)]. There is an association between being fired and the amount of alcohol consumed (IRR = 1.030, 95% CI = 1.018-1.093), but the association is weak. Being fired is associated with an increase in the likelihood of initiating or returning to tobacco use (OR = 1.276, 95% CI = 1.153-1.412) and with the quantity of tobacco smoked (IRR = 1.024, 95% CI = 1.003-1.046). In the latter case, however, the effect is small.

Conclusion: There appears to be limited evidence that being fired or made redundant in the past year increases alcohol and/or tobacco consumption among Australians.