Most recent papers:

• The Polysubstance Assessment Tool: Reliability, acceptability and feasibility of a novel measure of polysubstance use.
  Amanda M. Bunting, Charles M. Cleland, S. Michaela Barratt, Brittany Griffin, Jaimee Williams, Carrie B. Oser, Joshua D. Lee, Jennifer McNeely.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1410-1420, June 2026. ", "\nAbstract\n\nBackground and aims\nThere are currently no brief quantitative assessments that capture the drug patterns of people who engage in use of more than one drug on the same day or simultaneously. The current study examined the retest reliability, acceptability and feasibility of a new quantitative assessment to measure polysubstance use.\n\n\nDesign\nA tool for assessing simultaneous and same‐day polysubstance behaviors, the polysubstance assessment tool (PAT) was developed in interviewer‐administered and electronic self‐administered formats. Participants were allocated 1:1 to receive either version of the PAT and returned one to three days later to repeat the assessment.\n\n\nSetting\nNew York City, New York, USA.\n\n\nParticipants\nAdults (18 + years, n = 115) who reported use of more than one drug per day in the last 30 days.\n\n\nMeasurements\nTest–retest reliability estimates for dichotomous items were assessed using Cohen's kappa, Gwet's Agreement Coefficient 1 (AC1) and percent agreement. Continuous items were assessed with two‐way mixed effects intraclass correlations. Bivariate analyses examined acceptability using nine Likert‐type survey questions. Feasibility was examined via time to completion.\n\n\nFindings\nOverall reliability was moderate to excellent [Gwet's AC1 range 0.70–0.96; intraclass correlation (ICC) range 0.62–0.88]. Reliability was higher for simultaneous polysubstance use (Gwet's AC1 = 0.90) as compared with same‐day (Gwet's AC1 = 0.70). Acceptability was high, with no statistically significant difference between the self‐ and interviewer‐administered versions of the tool. Median time to completion was 7 minutes, and was statistically significantly lower for the self‐administered tool (median = 5 minutes) compared with the interviewer‐administered version (median = 8 minutes) (P < 0.001).\n\n\nConclusions\nA new polysubstance assessment tool appears to have good reliability and can be considered by researchers seeking a quantitative measure of polysubstance use behaviors given its simplicity, high acceptability and quick completion time.\n\n"]

  May 08, 2026   doi: 10.1111/add.70349   open full text
• Considering alcohol and other drug screening, brief intervention and referral to treatment in two safety‐sensitive industries in Australia: An exploratory qualitative study.
  Kirrilly Thompson, Tina Hart, Jacqueline Bowden.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1434-1444, June 2026. ", "\nAbstract\n\nBackground and aims\nWorkplaces offer a practical setting for alcohol and other drug interventions, especially in industries where impairment introduces substantial risk. Screening, brief intervention and referral to treatment has demonstrated effectiveness in health care settings and shows promise in workplace settings. However, low participation and high attrition in previous workplace studies indicate a need for deeper understanding of feasibility and acceptability. This exploratory qualitative study aimed to identify likely determinants for implementing alcohol and other drug screening, brief intervention and referral to treatment in two safety‐sensitive industries in Australia.\n\n\nMethods\nQualitative research design based on semi‐structured online interviews, focussed on the construction and manufacturing industries. Participants included 23 professionals working in health and safety roles representing 21 organisations located across six Australian jurisdictions. Interview transcripts were coded against the five domains of the updated Consolidated Framework for Implementation Research.\n\n\nFindings\nSixteen determinants were identified that were expected to act as barriers (n = 10) or enablers (n = 5) or have bidirectional impacts (n = 1) on the implementation of screening, brief intervention and referral to treatment in construction and manufacturing. Enabling factors included freely available tools, flexible delivery methods and delivery by trusted, external, peer‐based organisations. Pervasive barriers included workers' mistrust of management, concerns about confidentiality and fear of consequences for disclosing substance use.\n\n\nConclusions\nSuccessful workplace implementation of screening, brief intervention and referral to treatment appears to depend on organisational cultures where workers trust management, are assured of confidentiality and are not afraid of retribution for disclosure.\n\n"]

  May 08, 2026   doi: 10.1111/add.70348   open full text
• Trends in fentanyl‐containing drug samples seized by law enforcement agencies across Canada.
  Shaleesa Ledlie, Ria Garg, Pamela Leece, Gillian Kolla, Elaine Hyshka, Mina Tadrous, Tara Gomes.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1530-1540, June 2026. ", "\nAbstract\n\nBackground and aims\nCanada's drug toxicity crisis has been largely attributed to a volatile fentanyl‐dominated unregulated drug supply with increasing reports of fentanyl detected in combination with benzodiazepines, stimulants and xylazine. Although rates of opioid‐related harms vary significantly by region, it remains unknown how the composition of the unregulated drug supply differs across Canada. Therefore, we sought to describe trends in Canadian fentanyl‐containing drug seizures nationally and compare trends by province/territory.\n\n\nDesign\nRepeated cross‐sectional analysis between February 2020 and December 2024.\n\n\nSetting and cases\nFentanyl‐containing drug samples seized by law enforcement agencies across Canada were analyzed by Health Canada's Drug Analysis Service, with test results made publicly available.\n\n\nMeasurements\nCounts and crude rates of fentanyl‐containing drug seizures, with the population of each province/territory used to calculate rates per 100 000. We described the number of notable drug classes (e.g. benzodiazepines, stimulants, non‐fentanyl opioids, etc.) and chemical substances identified within each drug seizure and used the Cochrane Armitage Test for Trend to look for significant changes over time. All analyses were conducted overall and stratified by province/territory.\n\n\nFindings\nWe identified 71 996 fentanyl‐containing drug seizures over the study period, with the quarterly number of seizures increasing by 24.4% (from 2640 in 2020 to 3284 in 2024) across Canada. This varied by province/territory, with the highest annual rates of fentanyl‐containing seizures in 2024 reported in British Columbia (60.4 per 100 000) and Alberta (52.3 per 100 000). Among fentanyl types, we observed statistically significant increases (P < 0.001) in the detection of para‐flurofentanyl (0.0% to 46.3%) and methylfentanyl (0.0% to 28.6%). Additionally, there was a notable rise in the annual proportion of seizures in which benzodiazepines (13.4% to 40.2%) or xylazine (1.5% to 18.9%) were detected. Approximately half of all seizures contained fentanyl in combination with at least one other drug class and over 95% contained fentanyl in combination with at least one other chemical substance.\n\n\nConclusions\nAcross Canada from 2020 to 2024, there has been a 24% increase in fentanyl‐containing drug seizures in which multiple substances are detected, most notably benzodiazepines, xylazine and potent fentanyl analogues within a single sample.\n\n"]

  May 08, 2026   doi: 10.1111/add.70314   open full text
• Navigating pregnancy and addiction recovery: Patient perspectives on perinatal care interventions for women with opioid use disorder in Kentucky, USA.
  Hilary L. Surratt, Olivia A. Davis, Elizabeth O. Nelson, Hayley Durr, Karen Fawcett, Jason Joy, Brandon L. Schanbacher, Marie Vice, John A. Bauer, Wendy F. Hansen.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1508-1519, June 2026. ", "\nAbstract\n\nBackground and aims\nThe state of Kentucky has been heavily impacted by the ongoing opioid crisis in the United States, with high overdose mortality, high prevalence of opioid use disorder (OUD), elevated maternal mortality and incidence of Neonatal Abstinence Syndrome. Evidence‐based care for pregnant people with OUD remains limited in many areas of the state, and patient perspectives are urgently needed to understand the acceptability of intervention approaches, and broader perspectives on prenatal and recovery care in their communities. This study aimed to understand women's experiences with prenatal care and substance use treatment in Kentucky throughout the perinatal period.\n\n\nDesign\nData were drawn from a recently completed Patient‐Centered Outcomes Research Institute (PCORI) funded comparative effectiveness trial known as PATHHome, whose overarching objective was to study the delivery of a pregnancy‐specific educational recovery curriculum for pregnant women treated for OUD in Kentucky. PATHHome was a pragmatic, non‐inferiority, cluster randomized trial testing group versus telemedicine interventions for delivering care. We conducted a qualitative study with trial completers.\n\n\nSetting\nPATHHome was conducted in 13 clinical sites across eastern and central Kentucky.\n\n\nParticipants\nEligible patient participants were: (1) between ages 18–55, (2) pregnant (between 6 and 32 weeks' gestation), (3) diagnosed with OUD, and (4) being treated with medications for opioid use disorder (MOUD). Thirty‐three participants across 10 clinical sites were ultimately interviewed.\n\n\nMeasurements\nParticipants were invited to complete an in‐depth qualitative interview at the time of their final 6‐month postpartum follow‐up visit. Interview coding was conducted using a hybrid inductive‐deductive approach and consensus coding techniques were used. Coding and analysis were conducted in NVivo.\n\n\nFindings\nSystematic analysis of patient experiences revealed four overarching themes: Theme 1. MOUD stigma diminishes the quality of perinatal care for women with OUD, highlighting the need for expanded integration of evidence‐based MOUD, prenatal and delivery care; Theme 2. Navigating siloed and inconsistent care system policies contributes to suboptimal delivery experiences and limits parenting opportunities; Theme 3. Maternal engagement in perinatal OUD interventions is enhanced by responsive and adaptable approaches that address patient beliefs, circumstances and histories; and Theme 4. A pregnancy‐specific educational recovery curriculum delivered by a supportive, nonjudgmental and multidisciplinary intervention team promotes high acceptability among women on MOUD.\n\n\nConclusions\nIn Kentucky, USA, there appears to be a high level of acceptability for a pregnancy‐specific opioid use disorder recovery education intervention among pregnant patients on medications for opioid use disorder (MOUD). Major recommendations include prioritizing the expansion of integrated prenatal and addiction care, including through the use of telehealth in communities with insufficient clinical capacity, and engaging the entire perinatal healthcare team in stigma training and foundational training on MOUD, which may reduce episodes of enacted stigma in the care setting.\n\n"]

  May 08, 2026   doi: 10.1111/add.70317   open full text
• Understanding the interplay between alcohol use, cannabis use and mental health across the lifespan: A network analysis.
  Inês Macedo, Emese Kroon, Karis Colyer‐Patel, René Freichel, Christophe Romein, Rita Pasion, Fernando Barbosa, Janna Cousijn.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1421-1433, June 2026. ", "\nAbstract\n\nAims\nThis study aimed to understand the interplay between alcohol use, cannabis use and mental health across the lifespan by addressing the following questions: (1) Do the structure and overall connectivity of mental health symptom networks differ between individuals who use alcohol and those who co‐use alcohol and cannabis?; (2) Within co‐users, what is the strength of the associations between characteristics of alcohol and cannabis use (quantity/frequency, severity of use‐related problems and age of onset) and mental health symptoms?; and (3) Does age moderate these associations among co‐users?\n\n\nDesign, setting and participants\nCross‐sectional observational study including 740 participants aged 16–81 years, of which 446 used alcohol (57.6% female) and 294 co‐used alcohol and cannabis (50.7% female). Data were collected online from English‐ and Dutch‐speaking participants across multiple countries.\n\n\nMeasurements\nMain outcome measures included self‐reported severity of mental health symptoms (DSM‐Level 1‐Cross‐Cutting Symptom Measure), quantity/frequency and problematic use of cannabis (Cannabis Use Disorder Identification Test ‐ Revised) and alcohol (Alcohol Use Disorder Identification Test). Using a network approach, interactions between mental health symptoms (12 nodes) were compared between alcohol users and alcohol and cannabis co‐users. In co‐users, we incorporated detailed measures of alcohol and cannabis use (6 nodes) in the network and assessed the moderating role of age.\n\n\nFindings\nThe alcohol and cannabis co‐use group was characterized by higher quantity/frequency of use, problematic use and severity for all mental health symptoms compared with the alcohol group (Ps ≤ 0.001). Still, the alcohol use and alcohol‐cannabis co‐use networks did not statistically significantly differ (network invariance test: maximum difference in edge weights = 0.167, P = 0.611, global strength invariance test: global strength difference statistic = 0.265, P = 0.470), with both showing strong connections between anxiety, personality functioning and depression. However, the centrality invariance test revealed a statistically significantly (P = 0.018) higher strength of somatic symptoms in co‐use (strength = 1.31) compared with alcohol use (strength = 0.17). When substance use outcomes were included in the co‐use network, distinct associations emerged: alcohol‐related problems were uniquely linked to anxiety, impaired personality functioning and suicidal ideation (partial cor. = 0.03, 0.01 and 0.01, respectively), while cannabis‐related problems were associated with mania and dissociation (partial cor. = 0.05 and 0.02). Age did not moderate these relationships.\n\n\nConclusions\nAlcohol use and alcohol‐cannabis co‐use appear to be associated with a range of mental health symptoms, including overlapping and distinct symptom patterns that are similar regardless of age.\n\n"]

  May 08, 2026   doi: 10.1111/add.70324   open full text
• Quitting trajectories of Hong Kong Chinese smokers receiving behavioral smoking cessation interventions: A post hoc analysis of eight randomized controlled trials.
  Yingpei Zeng, Yongda Socrates Wu, Tzu Tsun Luk, Sheng Zhi Zhao, Ziqiu Guo, Yajie Li, Henry Sau Chai Tong, Vienna Wai Yin Lai, Yee Tak Derek Cheung, Tai Hing Lam, Man Ping Wang.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1568-1579, June 2026. ", "\nAbstract\n\nBackground and aims\nCharacterizing distinct quitting trajectories may inform tailored behavioral smoking cessation interventions. We identified the quitting trajectories and associated characteristics in Hong Kong Chinese smokers.\n\n\nMethods\nData were from eight randomized controlled trials nested within the annual Smoking‐free Community Campaign (‘Quit‐to‐Win’ Contest) from 2014 to 2021. The trials were two‐ or three‐arm evaluating the effectiveness of behavioral smoking cessation interventions in 8300 adult daily smokers who were proactively recruited from communities across Hong Kong and followed‐up at 1, 2, 3 and 6 months. Daily cigarette consumption was collected at baseline and follow‐ups for identifying quitting trajectories by group‐based trajectory modeling based on relative changes in cigarette consumption (vs. baseline) over four follow‐up assessment points. Multinomial logistic regressions were used to yield relative risk ratios (RRRs) for the trajectories by baseline smoking‐related characteristics, adjusting for sex, age, economic status and education attainment.\n\n\nResults\nFour quitting trajectories were identified, including quitters (4.6%), relapsers (6.8%), reducers (54.8%) and persistent smokers (33.8%). Compared with persistent smokers, smokers in the other 3 trajectories were associated with having previous quit attempts, higher intention to quit and perceived higher importance and confidence in quitting (all P < 0.05). Quitters [adjusted RRR (aRRR) = 0.59, 95% confidence interval (CI) = 0.62–1.00] and relapsers (aRRR = 0.75, 95% CI = 0.61–0.91) reported lower nicotine dependence vs. persistent smokers, whereas reducers showed higher nicotine dependence (aRRR = 1.39, 95% CI = 1.25–1.55) at baseline. Relapsers and reducers perceived higher difficulty of quitting (all P < 0.05). When compared with quitters, relapsers had higher intention to quit within 7 days (aRRR = 2.32, 95% CI = 1.64–3.28) and perceived higher importance (aRRR = 1.17, 95% CI = 1.09–1.25) and confidence (aRRR = 1.10, 95% CI = 1.04–1.17) in quitting, while reducers showed lower intention to quit within 7 days (aRRR = 0.59, 95% CI = 0.45–0.77) and perceived lower confidence in quitting (aRRR = 0.91, 95% CI = 0.86–0.95). Subgroup analysis of different interventions showed similar trajectory shapes and group probabilities.\n\n\nConclusions\nChinese smokers who joined behavioral smoking cessation trials in Hong Kong appear to have four quitting trajectories, each with associated characteristics, which may help predict the potential quitting trajectories and inform future interventions.\n\n"]

  May 08, 2026   doi: 10.1111/add.70328   open full text
• The association between gambling frequency and risk of harm: Analysis using health survey data from England and Scotland.
  Esther Moore, Robert Pryce, Hazel Squires, Elizabeth Goyder.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1594-1610, June 2026. ", "\nAbstract\n\nBackground and aims\nHealth economic models can be used to assess the effectiveness and cost‐effectiveness of public health policies for gambling. To develop such a model, we must understand how gambling behaviour is associated with risk of experiencing gambling‐related harms. This study aimed to: (1) assess the strength of association between gambling frequency and the risk of gambling‐related harm and to examine how these associations differ when lottery‐only players are excluded; (2) apply the study's findings in a hypothetical policy model aimed at reducing gambling frequency.\n\n\nDesign\nObservational study using six waves of cross‐sectional data from the Health Survey for England and the Scottish Health Survey.\n\n\nSetting\nSurvey conducted in England in 2015, 2016 and 2018 and Scotland in 2015, 2016 and 2017.\n\n\nParticipants\nThe sample included 16 648 adults (aged 18 and over) who reported gambling in the past year, generally representative of the populations of England and Scotland.\n\n\nMeasurements\nGambling frequency was measured using 6 categories which indicated frequency in the past 12 months: (a) 2 or more times a week; (b) once a week; (c) less than once a week, more than once a month; (d) once a month; (e) every 2–3 months; (f) once or twice a year. Risk of gambling‐related harm was assessed using Problem Gambling Severity Index (PGSI) score (0–27) and its four categories: no‐risk (0), low‐risk (1–2), moderate‐risk (3–7) and high‐risk (≥8). Control variables included age, sex, deprivation, social grade, presence of mental disorder and frequency of drinking alcohol.\n\n\nFindings\nUsing multinomial logistic regression and zero‐inflated negative binomial models we found that gambling at least twice weekly was associated with a statistically significantly higher PGSI score than gambling once or twice a year (incidence rate ratio = 3.528, 95% confidence interval = 2.040–6.103, P value < 0.001). Reducing gambling to guideline levels for people gambling at least twice weekly moved 10% of the sub‐sample from higher PGSI categories (low, medium and high risk) to the no‐risk category and shifted the distribution of PGSI scores down.\n\n\nConclusions\nThere appears to be a statistically significant association between gambling frequency and risk of gambling‐related harm. Data derived from this and similar analyses can be used to model gambling policies which impact gambling frequency.\n\n"]

  May 08, 2026   doi: 10.1111/add.70344   open full text
• The feasibility of integrating remote breath alcohol monitoring into ecological momentary assessment of intimate partner violence among young adults with a history of heavy drinking and aggression.
  Meagan J. Brem, Denis M. McCarthy, Ryan C. Shorey, Muyao Lin, Alicia J. Lozano, Emily Sjafii, Allison Tobar‐Santamaria.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1458-1473, June 2026. ", "\nAbstract\n\nAims\nWe examined the feasibility and acceptability of pairing portable breathalyzers to assess field alcohol use with mobile ecological momentary assessment (EMA) to assess intimate partner violence (IPV; psychological, cyber, physical and sexual aggression) perpetration and victimization among undergraduates who drink heavily and were recently aggressive.\n\n\nDesign, setting and participants\nWe assessed EMA/breathalyzer completion rates, drinking captured via breathalyzer versus self‐report, number of IPV events captured, procedural acceptability and reactivity to assessment. Sex differences were examined. Undergraduates aged 18–25 (n = 103; M age = 21 years, SD = 2.0; 52% women; 80.6% heterosexual; 64.1% white; 93.2% non‐Hispanic) recruited from a large Mid‐Atlantic university in the United States completed a baseline survey then a 30‐day EMA wherein they were prompted to complete one morning and three evening surveys (7 PM, 9 PM, 11 PM) daily. After each evening survey, participants were prompted to submit a breath alcohol content (BrAC) sample to a breathalyzer linked to surveys. Participants could self‐initiate surveys after drinking or IPV outside of assessment periods. Afterward, participants completed an exit survey.\n\n\nMeasurements\nOutcome variables were self‐reported alcohol use and IPV assessed via EMA surveys, and BrAC assessed via breathalyzer. Self‐reported procedural acceptability was assessed in the exit survey. Reactivity to assessment was assessed by analyzing daily trends in IPV and drinking by sex using generalized linear mixed effects models.\n\n\nFindings\nParticipants completed 80% of surveys and responded to 91% of breathalyzer prompts. BrAC was captured in 89.4% of self‐reported drinking events, 91.4% of self‐reported non‐drinking events and 95.8% of IPV events, with greater responsiveness to breathalyzer prompts as the evening progressed despite increasing intoxication. More IPV events were captured during evening and event triggered (358 combined total events) than morning surveys (245 events). Results were comparable across women and men. Each additional study day was associated with modest declines in odds of experiencing any IPV [odds ratio (OR) = 0.95, 95% confidence interval (CI) = 0.94–0.97, P < 0.001], IPV perpetration (OR = 0.94, 95% CI = 0.92–0.96, P < 0.001), IPV victimization (OR = 0.97, 95% CI = 0.96–0.99, P = 0.004), any drinking (OR = 0.99, 95% CI = 0.98–1.00, P = 0.01) and positive BrAC readings (OR = 0.99, 95% CI = 0.98–1.00, P = 0.052), suggesting minimal reactivity to assessment. Participants reported high overall satisfaction with study components.\n\n\nConclusions\nPairing ecological momentary assessment with portable breathalyzers to capture data on drinking and intimate partner violence across 30 days among US undergraduates who were previously aggressive and who drink heavily appears to be both feasible and acceptable.\n\n"]

  May 08, 2026   doi: 10.1111/add.70357   open full text
• Exploring the intersection of heavy alcohol use and masculine norms as risk factors for male‐to‐female intimate partner violence: Evidence from an Australian national survey.
  Bree Willoughby, Koen Smit, Ingrid M. Wilson, Gail Gilchrist, Anne‐Marie Laslett.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1445-1457, June 2026. ", "\nAbstract\n\nBackground and aims\nEndorsement of traditional masculine norms and male alcohol use are identified risk factors for male‐to‐female intimate partner violence (MFIPV) perpetration, yet their interaction remains unexplored in Australia. This study aimed to estimate the associations between heavy male alcohol use, endorsement of traditional masculine norms and MFIPV perpetration, and test their interaction among Australian men.\n\n\nDesign and setting\nCross‐sectional analysis of nationally representative data from Wave 1 (2013–2014) of the Australian Longitudinal Study on Male Health (Ten to Men).\n\n\nParticipants\nParticipants were 12 284 men who were Australian citizens or permanent residents aged 18 years or older who identified as heterosexual and answered any of the MFIPV items.\n\n\nMeasurements\nThe primary outcome was lifetime MFIPV perpetration assessed through three items on frightening, physically harming or forcing sex on a partner. Predictors included past‐year heavy episodic drinking (HED) and endorsement of masculine norms. Sociodemographics, other drug use, depression, anxiety and sexual performance problems were included as covariates. Multivariable logistic regression models with 95% confidence intervals (CI) were used to examine associations between sociodemographics, specific masculine norms, HED, total masculinity scores and perpetrating MFIPV. An interaction between HED and masculinity on MFIPV was also tested.\n\n\nFindings\nOf the 12 284 men (Mage = 38.3 years), 2947 (23.8%, 95% CI = 22.7–25.0) reported lifetime perpetration of MFIPV, with men aged 30–49 years reporting the highest perpetration rate (26.8%, 95% CI = 24.5–29.1). Higher mean scores on playboy, risk‐taking, self‐reliance, power over women and violence norms were associated with increased odds of reporting MFIPV perpetration, whereas greater scores on emotional control, primacy of work and heterosexual presentation norms appeared protective. Past‐year HED [odds ratio (OR) = 1.24, 95% CI = 1.05–1.48] and greater total masculinity scores (OR = 1.03, 95% CI = 1.01–1.04) were both independently associated with statistically significantly higher odds of reporting lifetime MFIPV perpetration. A statistically significant interaction effect revealed higher total masculinity scores were associated with increased odds of MFIPV perpetration among men with past‐year HED, after adjusting for sociodemographic characteristics and covariates (OR = 1.03, 95% CI = 1.00–1.06, P = 0.035), but not among men who did not engage in HED.\n\n\nConclusions\nAmong Australian men, heavy episodic drinking appears to modify the association between traditional norms of masculinity and reporting male‐to‐female intimate partner violence, with stronger endorsement of traditional masculine norms associated with higher odds of perpetration among men reporting past‐year heavy episodic drinking.\n\n"]

  May 08, 2026   doi: 10.1111/add.70358   open full text
• Decline of phosphatidylethanol (B‐PEth) during abstinence in patients with alcohol use disorder undergoing withdrawal treatment, and the correlation of B‐PEth with self‐reported alcohol intake.
  Andrea de Bejczy, Lisa Walther, Cecilia Nilsson‐Wallmark, Barbro Askerup, Anders Isaksson.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1474-1482, June 2026. ", "\nAbstract\n\nBackground and aim\nAccurately estimating alcohol consumption is crucial for clinical decision‐making and monitoring treatment outcomes. Phosphatidylethanol in blood (B‐PEth), a direct alcohol biomarker, is currently the most reliable indicator of alcohol intake, with a detection window of several weeks; however, the factors influencing the decline of B‐PEth levels remain largely unknown. This study aimed to investigate the decline of B‐PEth levels during abstinence in patients with alcohol use disorder (AUD) undergoing withdrawal treatment.\n\n\nMethod\nA total of 100 patients were recruited in withdrawal treatment and followed during three to four weeks of abstinence. Blood samples were collected at baseline and weekly during abstinence to measure B‐PEth levels of two homologues (16:0/18:1 and 16:0/18:2). Self‐reported alcohol consumption was documented using the Timeline Followback (TLFB) method for 30 days before abstinence and throughout the study period.\n\n\nResults\nB‐PEth elimination followed first‐order kinetics. The mean half‐life was 7.24 days [95% confidence interval (CI) = 6.98–7.53] for 16:0/18:1 and 4.55 days (95% CI = 4.44–4.67) for 16:0/18:2. The rate of decline varied by week, with a longer half‐life observed in week three compared with week one. No statistically significant sex differences were detected. The strongest correlation between B‐PEth levels and self‐reported alcohol consumption was found for data from two weeks prior to abstinence.\n\n\nConclusion\nElimination of phosphatidylethanol in blood (B‐Peth) follows first‐order kinetics, with homologue 16:0/18:1 exhibiting a longer half‐life than 16:0/18:2. The rate of decline is influenced by the week of alcohol abstinence and B‐PEth levels are detectable even in the fourth week of abstinence. The strongest correlation between B‐PEth and self‐reported alcohol consumption is at two weeks prior to abstinence.\n\n"]

  May 08, 2026   doi: 10.1111/add.70359   open full text
• Retention in opioid agonist treatment during pregnancy and variations according to treatment and maternal characteristics.
  Bianca Varney, Nicola Jones, Chrianna Bharat, Jonathan Brett, Louisa Degenhardt, Ju‐Lee Oei, Sallie‐Anne Pearson, Alys Havard, Duong T. Tran.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1520-1529, June 2026. ", "\nAbstract\n\nBackground and aims\nTo measure the proportion of women in New South Wales, Australia, retained in opioid agonist treatment (OAT) for opioid dependence (OD) during pregnancy and examine how this varies according to treatment and maternal characteristics.\n\n\nDesign\nRetrospective cohort study using linked population‐based data, including OAT records, perinatal, hospital admissions, mental health outpatient services and criminal justice data.\n\n\nSetting\nNew South Wales, Australia, January 2004–December 2021.\n\n\nParticipants\nPregnancies resulting in childbirth among women receiving OAT during pregnancy. The cohort included 4472 pregnancies among 2821 women receiving OAT during pregnancy.\n\n\nMeasurements\nWe defined retention as continuous receipt of OAT from the date of OAT initiation during pregnancy or date of conception (whichever came last) until childbirth. We calculated the proportion of women retained in treatment and 95% confidence intervals (CI) overall, by timing of initiation (pre‐conception, first, second and third trimester) and medication type (methadone, buprenorphine) at initiation. We used logistic regression to assess retention variation according to maternal socio‐demographic and clinical factors, including morbidities commonly co‐occurring with OD, stratified by timing of initiation. Data on dosing, other substance use and psychopharmacological medications were unavailable.\n\n\nFindings\nOAT was initiated pre‐conception in 74.8% (3346) of pregnancies, during the first trimester in 11.1% (n = 497), second trimester in 8.8% (n = 394) and third trimester in 5.3% (n = 237). Overall, women were retained in OAT for 84.3% (3771) of all pregnancies. Retention was 87.4% (95% CI = 86.3–88.6) with pre‐conception initiation; 65.8% (95% CI = 61.6–70.0) in the first trimester; 80.5% (95% CI = 76.5–84.4) second trimester; and 85.2% (95% CI = 80.8–89.7) third trimester. Retention was 72.4% (95% CI = 69.5–75.3) with buprenorphine and 87.7% (95% CI = 86.6–88.9) with methadone. Pregnancies delivered during 2019–2021 were less likely to be retained in treatment compared with those delivered during 2004–2006, regardless of the timing of initiation [pre‐conception initiation odds ratio (OR) = 0.49, 95% CI = 0.30–0.79; first trimester initiation OR = 0.29, 95% CI = 0.08–1.07; second/third trimester initiation OR = 0.29, 95% CI = 0.10–0.91). Among women who initiated OAT pre‐conception, retention was lower among those whose first antenatal visit occurred after 20 gestational weeks (OR = 0.68, 95% CI = 0.53–0.86), those in their first (OR = 0.72, 95% CI = 0.54–0.97) or second pregnancy (OR = 0.73, 95% CI = 0.56–0.96) and those who initiated on buprenorphine (OR = 0.31, 95% CI = 0.24–0.40) or in a custodial setting (OR = 0.66, 95% CI = 0.44–1.01).\n\n\nConclusions\nIn New South Wales, Australia, from 2004 to 2021, over 84% of women receiving opioid agonist treatment during pregnancy were retained in treatment until childbirth; however, lower retention in later study years and among women initiating buprenorphine, coupled with recent guidelines recommending buprenorphine as first‐line therapy during pregnancy, highlights the need for ongoing monitoring and targeted support to improve retention among women who are at higher risk of discontinuation.\n\n"]

  May 08, 2026   doi: 10.1111/add.70325   open full text
• Associations between the national ‘Swap to Stop’ programme offering free vapes for smoking cessation and quit attempts in England: Results from a population‐based survey.
  Vera Helen Buss, Emma Beard, Lion Shahab, Erikas Simonavičius, Linda Bauld, Jamie Brown, Leonie Brose.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1557-1565, June 2026. ", "\nAbstract\n\nBackground and aims\nVapes are effective for smoking cessation. The UK Government launched the Swap to Stop initiative in England in December 2023, aiming to encourage people to quit smoking by providing free vape starter kits alongside behavioural support. This study aimed to assess the association between the introduction of Swap to Stop and the proportion of people in England who tried to quit smoking using vapes in the past year.\n\n\nDesign\nData came from the Smoking Toolkit Study, a monthly cross‐sectional population‐based survey. The primary analysis used an interrupted time‐series approach based on Autoregressive Integrated Moving Average (ARIMA) regression models.\n\n\nSetting\nTelephone interviews with people residing in private households in England between December 2021 and December 2024.\n\n\nParticipants\nPeople aged ≥16 years who smoked in the past year.\n\n\nMeasurements\nThe outcome was vape use during past‐year quit attempts. The intervention effect was included as a step change in December 2023 to indicate the start of the Swap to Stop programme. The model also included a dummy variable to adjust for above‐inflation tobacco tax increases.\n\n\nFindings\nThe primary analysis indicated that the introduction of Swap to Stop in December 2023 was associated with a 1.5 absolute percentage point increase (adjusted B = 0.015, 95% confidence interval = 0.005–0.025) in the proportion of people in England using vapes in past‐year quit attempts that persisted to December 2024.\n\n\nConclusions\nThe introduction of Swap to Stop (which provides free vape starter kits with behavioural support to quit smoking) in England appears to be associated with a statistically significant increase in quit attempts using vapes.\n\n"]

  May 08, 2026   doi: 10.1111/add.70332   open full text
• Bidirectional genetic and phenotypic links between smoking and striatal iron content involving dopaminergic and inflammatory pathways.
  Olga Trofimova, Ilaria Iuliani, Sven Bergmann.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1580-1593, June 2026. ", "\nAbstract\n\nBackground and aims\nTobacco smoking is a major risk factor for cardiovascular and lung diseases. A better understanding of its neurobiological underpinnings will benefit the prevention of smoking‐related illnesses and mortality. Previous studies link smoking to increased iron concentration in the striatum, a central component of the brain's reward system, and to reduced cognitive performance. This study aimed to investigate whether smoking and striatal iron share common biological pathways and to assess potential causal relationships between the two.\n\n\nMethods\nUsing data from the UK Biobank, we investigated phenotypic and genetic correlations, and causal relationships between smoking initiation and magnetic resonance imaging (MRI)‐derived markers of iron content (T2* and quantitative susceptibility mapping) in the bilateral putamen, caudate and accumbens nuclei.\n\n\nResults\nWe found positive correlations between smoking and striatal iron (β ∈ [0.03, 0.40], P < 0.001), particularly when comparing current smokers with never smokers. Striatal iron was positively associated with pack‐years (β ∈ [0.11, 0.13], P < 0.001) and inversely related to years since smoking cessation (β ∈ [0.06, 0.10], P < 0.001), suggesting iron levels may decrease after quitting. Genetic analysis confirmed phenotypic correlations, with shared genetic associations (P < 2.73 × 10−6, or 0.01 for candidate genes) in genes related to dopaminergic, glutamatergic and synaptic systems (DRD2, PPP1R1B, NCAM1, DLX5, GGACT, NAT16, PLEKHM1). Causality analysis revealed a relationship from smoking to striatal iron via genes involved in synaptogenesis and plasticity (BAI3, SEMA6D, TENM2), with evidence of reverse causality from iron to smoking through inflammatory and immune system‐related genes (ING5, NLRP7).\n\n\nConclusions\nThere appear to be links between smoking and striatal iron with complex causal mechanisms involving synaptic transmission and inflammatory circuits. Striatal iron content could serve as a biomarker for smoking‐related neurobiological changes and a potential target for interventions aimed at mitigating cognitive decline related to striatal iron accumulation.\n\n"]

  May 08, 2026   doi: 10.1111/add.70311   open full text
• Gender differences in the impact of psychological distress on methamphetamine use disorder outcomes and treatment effect.
  Masoumeh Amin‐Esmaeili, Himani Byregowda, Ryoko Susukida, Ramin Mojtabai, Rosa M. Crum.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1483-1494, June 2026. ", "\nAbstract\n\nBackground and aims\nMethamphetamine use disorder (MUD) is a major public health concern, often complicated by co‐occurring psychological distress (PD). Evidence suggests gender differences in both the prevalence of PD and its impact on treatment outcomes. This study examined impacts of PD on MUD treatment outcomes, focusing on gender differences.\n\n\nDesign\nSecondary analysis of pooled data from five randomized controlled trials of pharmacotherapy for MUD available on the NIDA DataShare site (accessed 19 October 2024). Individual participant data meta‐analysis methods were used, adjusting for sociodemographic factors and accounting for heterogeneity across trials. Regression analyses were conducted for total sample and stratified by gender.\n\n\nSetting\nTreatment facilities in the US.\n\n\nParticipants\nAdults seeking MUD treatment (n = 866).\n\n\nMeasurements\nPD was assessed using the Addiction Severity Index psychiatric domain (≥24.6 cutoff). Outcomes included reductions in methamphetamine use and positive urine tests for methamphetamine and other drugs.\n\n\nFindings\nPD was found in 39.9% of participants. PD was more common among women than men [odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.15–2.12], and among individuals who were younger (ages 35–45 vs. <35: OR = 0.72, 95% CI = 0.61–0.85; >45 vs. < 35: OR = 0.62, 95% CI = 0.44–0.88), had lower education (OR = 1.38, 95% CI = 1.16–1.65), chronic medical conditions (OR = 1.60, 95% CI = 1.16–2.20), history of injection drug use (OR = 1.47, 95% CI = 1.13–1.91) and prior treatment for alcohol use disorder (OR = 2.52, 95% CI = 1.64–3.84). PD was associated with lower odds of reduced use [adjusted OR (aOR) = 0.74, 95% CI = 0.66–0.82] and higher odds of positive methamphetamine urine tests (aOR = 1.27, 95% CI = 1.08–1.49). Stratified analyses revealed a stronger association among women between PD and lower odds of reduced use (aOR = 0.41, 95% CI = 0.23–0.75) and higher odds of positive urine tests for methamphetamine (aOR = 2.18, 95% CI = 1.25–3.81) and other drugs (aOR = 3.16, 95% CI = 1.53–6.47), whereas men showed no statistically significant impact of PD on treatment outcomes. A statistically significant interaction between treatment, gender and PD (P < 0.001) indicated that women without PD benefited more from treatment than those with PD, a pattern not mirrored in men.\n\n\nConclusion\nPsychological distress appears to negatively impact outcomes for MUD and the effects of MUD treatment, particularly among women. Integrated psychological interventions, tailored by gender, may enhance treatment efficacy for individuals with co‐occurring MUD and psychological distress.\n\n"]

  May 08, 2026   doi: 10.1111/add.70315   open full text
• Hippocampal subfield differences in people with and without recreational ketamine use: Insights from multi‐modal neuroimaging.
  Yi‐Hsuan Liu, Chia‐Chun Hung, Marc N. Potenza, Kun‐Hsien Chou, Pei‐Lin Lee, Chu‐Chung Huang, Chiang‐Shan R. Li, Tony Szu‐Hsien Lee, Ching‐Po Lin.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1541-1556, June 2026. ", "\nAbstract\n\nBackground and aims\nRecreational ketamine use has increased globally and is associated with psychiatric and cognitive concerns. The hippocampus in preclinical models shows damage and working‐memory disruption with repeated dosing. However, whether specific hippocampal subregions may differ in people with chronic ketamine use remains unclear. In Taiwan, ketamine is predominantly consumed by smoking ketamine mixed with tobacco, producing smoking‐related behavioral profiles like non‐ketamine tobacco use participants (TUs). We therefore examined individuals with urine‐confirmed ketamine as the only detected substance who reported predominantly smoking‐administered recreational use (KUs) and used TUs as controls. This study aimed to: (1) characterize ketamine‐use patterns and psychiatric symptoms; (2) compare working‐memory and affective‐behavioral measures between KUs and TUs; (3) quantify group differences in hippocampal subregion volumes; and (4) assess group differences in functional connectivity (FC) of identified subregions and relationships with neurotransmitter receptor distributions.\n\n\nDesign\nCross‐sectional case‐control study with cognitive testing and neuroimaging.\n\n\nSetting\nCommunity‐based recruitment in Taiwan.\n\n\nParticipants\n58 KUs (44 males; mean age = 21.00 ± 4.57) and 73 TUs (52 males; mean age = 24.34 ± 5.86).\n\n\nMeasurements\nKetamine‐use patterns (Addiction Severity Index), psychiatric symptoms [Symptom Checklist‐90‐Revised (SCL‐90‐R)], working‐memory (N‐back), affective‐behavioral measures [Barratt Impulsiveness Scale (BIS‐11), Buss and Perry Aggression Questionnaire (BPAQ), Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ)], hippocampal subfield volumes (FreeSurfer) and functional connectivity (FC) of identified subregions (seed‐based analysis). Spatial correspondence with N‐methyl‐D‐aspartate (NMDA) receptor density was evaluated using JuSpace.\n\n\nFindings\nHeavier ketamine use was associated with greater psychological distress [Global Severity Index (GSI) r = 0.343, P = 0.011], particularly anxiety (r = 0.457, P < 0.001) and hostility (r = 0.442, P < 0.001). Although self‐reported impulsivity, aggression and reward/punishment sensitivity did not differ between groups, KUs showed reduced accuracy under higher working‐memory load [2‐back: F(1, 124) = 4.16, P = 0.04, partial η2 = 0.03; 1‐back: F(1, 124) = 8.10, P = 0.005, η2 = 0.06]. KUs displayed reduced left hippocampal volume [F(1, 119) = 4.23, P = 0.04, η2 = 0.03], most marked in the hippocampal‐amygdaloid‐transition‐area [HATA; F(1, 119) = 10.52, P = 0.002, η2 = 0.08]. KUs also showed increased FC between left HATA and frontal, cingulate, temporal, subcortical, insular and cerebellar regions (P < 0.05, AlphaSim corrected), which correlated with NMDA‐receptor distributions (z = 0.30, P = 0.005, false discovery rate corrected).\n\n\nConclusions\nRecreational smoking‐administered ketamine use appears to be associated with dose‐dependent psychiatric symptoms, load‐dependent working memory impairment, selective hippocampal subregion volumetric differences and altered network connectivity aligned with N‐methyl‐D‐aspartate‐ (NMDA) receptor distribution.\n\n"]

  May 08, 2026   doi: 10.1111/add.70331   open full text
• Adolescent cannabis use and psychological distress from 2013 to 2023: A population‐based study in Ontario, Canada.
  André J. McDonald, Amanda Doggett, Susan J. Bondy, Ian Colman, Steven Cook, Hayley A. Hamilton, Paul Kurdyak, Scott T. Leatherdale, Daniel T. Myran, Jürgen Rehm, Christine M. Wickens, James MacKillop, Jillian Halladay.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1495-1507, June 2026. ", "\nAbstract\n\nBackground and aims\nEpidemiologic research suggests that adolescent cannabis use is associated with psychological distress (i.e. depression and anxiety symptoms); however, most studies have relied on 20th‐century data, when cannabis was significantly less potent than today. This study aimed to estimate the association between adolescent cannabis use and psychological distress using contemporary population‐based data and examine the roles of time [as a proxy for increasing Δ9‐tetrahydrocannabinol (THC) potency], sex and age of initiation.\n\n\nDesign\nRepresentative cross‐sectional survey conducted biennially from 2013 to 2023.\n\n\nSetting\nOntario, Canada.\n\n\nParticipants\n35 007 adolescents in grades 7 to 12.\n\n\nMeasurements\nPast‐year cannabis use was categorized as Never, 1–2 times, 3–9 times, 10–39 times or 40+ times. Psychological distress was measured with the Kessler‐6 scale using a cut‐off score of 13+ indicating anxiety/depression symptoms. Multivariable modified Poisson and least‐squares models were used to estimate the association between past‐year cannabis use and psychological distress. Survey year and sex were tested as effect modifiers on the multiplicative and additive scales. The association between school grade of cannabis use initiation and psychological distress was also estimated.\n\n\nFindings\nFrom 2013 to 2023, the prevalence of psychological distress increased from 10.7% to 27.4%, whereas cannabis use decreased from 23.1% to 17.6%. Survey year and sex were statistically significant effect modifiers for the association between cannabis use and psychological distress with associations consistent with a super‐additive effect but not multiplicative synergy (additive interactions: P < 0.05; multiplicative interactions: P > 0.05). The association between cannabis use and psychological distress strengthened over time, particularly for those using 40+ times compared with abstinence (from 0% [95% confidence interval (CI) = −6% to 6%] adjusted prevalence difference in 2013 to 18% (95% CI = 11%–25%] adjusted prevalence difference in 2023). Independent of time, there was evidence of dose–response among females, but not males. A 5% (95% CI = 1%–10%) lower prevalence of psychological distress was observed per later school grade of cannabis use initiation.\n\n\nConclusions\nPsychological distress increased markedly among adolescents in Ontario, Canada, from 2013 to 2023. In that setting, adolescent cannabis use was statistically significantly associated with psychological distress, especially among females, and this association increased in magnitude over time, especially for those using most frequently. It is possible that adolescents are increasingly self‐medicating psychological distress with cannabis and/or that rising cannabis potency is increasingly contributing to psychological distress. While causality cannot be established, based on the precautionary principle, policymakers should prioritize cannabis prevention strategies that aim to reduce frequency of use, limit potency and delay age of initiation, particularly among females.\n\n"]

  May 08, 2026   doi: 10.1111/add.70333   open full text
• Modelling the economic effects of reducing the consumption of unhealthy commodities: An inter‐sectoral input–output approach.
  Damon Morris, Duncan Gillespie, Megan James, Penny Breeze, Alan Brennan.
  Addiction. 2 days ago
  ["Addiction, Volume 121, Issue 6, Page 1398-1407, June 2026. ", "\nAbstract\n\nAims\nIndustry arguments against public health policies that reduce the consumption of unhealthy commodities often include the assertion that the policy will harm the economy by reducing production and costing jobs. However, this argument does not consider that consumers may spend money previously used for unhealthy commodity consumption on other products, benefiting other sectors and potentially offsetting those negative economic consequences. In this study we aimed to estimate the macroeconomic impacts of reducing consumption of alcohol, tobacco, confectionary and gambling, accounting for reallocation of spending from these commodities to alternatives.\n\n\nMethod\nWe developed the open‐source Commercial Determinants of Health Input–Output (CDOHIO) model version 1.1.0. CDOHIO models inter‐sectoral linkages in the United Kingdom (UK) economy using published input–output tables to estimate the macroeconomic outcomes of changes in the total national consumer expenditure on selected unhealthy commodities and the reallocation of this expenditure to other consumption. We modelled a 10% decrease in total consumer expenditure on (1) alcohol, (2) tobacco, (3) confectionary and (4) gambling, assuming that the reduced expenditure was reallocated entirely to other products. The comparator in each case was no change in expenditure. We analysed six economic outcomes: (i) output (the total value of production in the economy), (ii) tax receipts from employees, (iii) tax receipts from employers, (iv) full‐time equivalent employment, (v) total net earnings to individuals, and (vi) Gross Value Added (GVA), which is the primary outcome measure used as a proxy for national Gross Domestic Product.\n\n\nResults\nFor tobacco, confectionary and gambling, reduced spending was estimated to yield positive effects across all six measures. The total effect of a 10% reduction in confectionary spending was an increase in GVA of £0.389 billion (0.02%), for reduced spending on tobacco, +£1.859 billion GVA (+0.09%) and for gambling +£1.250 billion GVA (+0.06%). For alcohol, a 10% reduction in spending led to a small negative effect on GVA (−£0.134 billion, −0.01%), which is the net effect of positive effects of reduced spending on off‐trade alcohol (+£2.543 billion) and negative effects of reduced spending on on‐trade alcohol (−£2.677 billion).\n\n\nConclusions\nThe potential negative macroeconomic impacts of reducing spending on tobacco, confectionary and gambling in the United Kingdom could be more than mitigated when consumers reallocate money spent on these products to other consumption. This is also the case for off‐trade alcohol consumption, but not for on‐trade alcohol consumption.\n\n"]

  May 08, 2026   doi: 10.1111/add.70336   open full text
• Self‐harm in individuals with substance use disorders: Predictive factors and risk model.
  Rongqin Yu, Derek K. Tracy, Julia Sinclair, Isabell Brikell, Paul Lichtenstein, Henrik Larsson, Seena Fazel.
  Addiction. 3 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nSubstance use disorders are associated with an elevated risk of self‐harm. Currently, clinical and structured assessment of self‐harm risk typically relies on evidence from the general population samples. The aim of this study was to develop a risk model for self‐harm that incorporates predictors specific to individuals with substance use disorders.\n\n\nMethods\nUsing national registers, we identified a population‐based cohort of 449 720 individuals with substance use disorders in Sweden between 2006 and 2020. We tested independence and strength of a range of socio‐demographic and clinical factors, obtained through linkage of population‐based registers, with a Cox proportional hazards model, and estimated the risk of self‐harm. For the risk model, 361 120 individuals were allocated to the development sample and 88 600 to external validation based on different geographical regions. We assessed self‐harm risk over five predetermined follow‐up periods—within 7 days, 1 month, 3 months, 6 months and 12 months—following a healthcare contact for substance use disorders.\n\n\nResults\nIn the development sample, self‐harm rates ranged from 0.6% to 3.5%, and in the validation sample from 0.5% to 3.6%. Ten risk factors were retained in the final risk model. Strongest associations with subsequent self‐harm were for clinical factors: previous self‐harm [hazard ratio (HR) = 3.17, 95% confidence interval (CI) = 3.08–3.26] and comorbidity of mental disorders (HR = 2.63, 95% CI = 2.50–2.72). Recent psychotropic medication use, including antidepressant (HR = 1.29, 95% CI = 1.23–1.38) and antipsychotic treatments (HR = 1.34, 95% CI = 1.24–1.44), was associated with increased risk, even after adjusting for psychiatric comorbidity, likely reflecting greater clinical severity and complexity. Across follow‐up periods, performance was good in terms of discrimination, with area under the curve (AUCs) ranging from 0.73 (95% CI = 0.71–0.76) to 0.79 (95% CI = 0.78–0.80). In relation to calibration, expected‐to‐observed risk ratios were 1.00 to 1.04 and Brier scores 0.01 to 0.04 across follow‐up periods. We used the model to generate a simple web‐based risk calculator [Oxford Self‐hArM after substance use disorders (OxSAMS)].\n\n\nConclusions\nModifiable clinical factors appear to have the strongest associations with increased risk of self‐harm in people with substance use disorders. Structured tools, taking account of the different strengths of those factors, could inform clinical decision‐making and provide a baseline assessment for training and research\n\n"]

  May 07, 2026   doi: 10.1111/add.70465   open full text
• Cost‐effectiveness of in‐hospital motivational smoking cessation counselling and proactive referral to community‐based follow‐up.
  Karin Pleym, Ingrid Engebretsen, Elise Sverre, Toril Dammen, Einar Huseby, Mohpal Singh Kahlon, Marie Stugaard, Henrik Støvring, Ivar Sønbø Kristiansen, John Munkhaugen.
  Addiction. 3 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aim\nIn a randomised open‐label trial among hospitalised patients with atherosclerotic vascular disease, motivational smoking cessation counselling with proactive referral to community‐based follow‐up was more effective than brief cessation advice and written information, with 6‐month continuous abstinence rates of 49.5% vs. 24.5%. This study aimed to estimate the cost‐effectiveness of this intervention compared with brief cessation advice.\n\n\nDesign\nEconomic evaluation alongside a multicentre, randomised open‐label, blinded‐endpoint trial with 1:1 randomisation.\n\n\nSetting\nThree secondary care hospitals in Norway. Recruitment took place from November 2021 to October 2023.\n\n\nParticipants\nHospitalised patients aged 18 years or older with established atherosclerotic vascular disease who reported smoking at least one cigarette daily before admission were eligible for participation, regardless of whether admission was planned or unplanned. A total of 221 patients were randomised. One participant withdrew informed consent and was excluded from all analyses, leaving 220 participants in the economic evaluation. The cohort comprised 40% women and the mean age was 65.2 years.\n\n\nMeasurements\nIntervention costs included staff training, materials and personnel time. Hospital costs during the 16‐month follow‐up were estimated using Diagnosis‐Related Group cost weights. Survival beyond follow‐up was extrapolated using national mortality data adjusted for age, sex and atherosclerotic vascular disease. Lifetime costs were estimated using mean costs from the final six months of follow‐up. The primary economic outcome was net monetary benefit (NMB), calculated at a willingness‐to‐pay threshold of €38 346 per life‐year gained. The incremental cost‐effectiveness ratio was also estimated. Future costs and life‐years were discounted at 4%. Uncertainty estimates (UE) were obtained using bootstrapping.\n\n\nFindings\nDuring the 16‐month follow‐up, five patients (4.6%) died in the intervention group and nine (8.1%) in the control group. Discounted life expectancy from baseline was 13.54 years in the intervention group and 12.47 years in the control group, corresponding to an incremental gain of 1.06 life‐years (95% UE = −0.72 to 3.31). The incremental discounted lifetime cost was €3280 per patient (95% UE = –€19 457 to €26 436), resulting in an incremental cost‐effectiveness ratio of €3094 per life‐year gained. At a willingness‐to‐pay threshold of €38 346 per life‐year gained, the NMB was €37 475 (95% UE = –€15 868 to €107 797) and the probability of the intervention being cost‐effective was 90.5%.\n\n\nConclusion\nMotivational smoking cessation counselling delivered during hospitalisation with proactive referral to community‐based follow‐up had a high probability of being cost‐effective from a hospital perspective for patients with atherosclerotic vascular disease.\n\n"]

  May 07, 2026   doi: 10.1111/add.70460   open full text
• Are people who use methamphetamine at increased risk of physical violence? Results from a nationally representative sample.
  Christel Macdonald, Rebecca McKetin, Sergey Alexeev, Don Weatherburn.
  Addiction. 4 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nThe association between methamphetamine use and violent behaviour has received much attention in the research. The risk of violent victimisation among people who use methamphetamine is comparatively underexplored. People who use methamphetamine appear to be at a high risk of violent victimisation, but no studies have examined this association in a population‐based representative survey. The aim of the current study was to examine the association between methamphetamine use and violent victimisation using a nationally representative sample of Australians.\n\n\nDesign\nObservational study.\n\n\nSetting\nAustralia.\n\n\nParticipants\n18 805 individuals aged 15 years or over.\n\n\nMeasurements\nOutcome variable: whether a respondent reported having been a victim of violence in the past 12 months. Exposure variable: frequency of methamphetamine use in the past 12 months (no use, every few months, monthly or more often). Co‐variates: age, gender, financial stress, personal stress, long‐term health condition, social isolation, cocaine use, drinking consumption, remoteness of area and survey year. Analyses were exploratory.\n\n\nFindings\n1.27% of the sample reported violence victimisation in the past 12 months, and 1.33% reported methamphetamine use (0.71% every few months; 0.62% monthly or more often). After adjusting for covariates, the odds of being a victim of violence in the preceding 12 months were higher for those who used methamphetamine every few months [adjusted odds ratio (aOR) = 5.94; 95% confidence interval (CI) = 1.95–18.06], and once a month or more often (aOR = 9.04; 95% CI = 3.48–23.45) than for those who had not used methamphetamine in the past year. Predicted probabilities indicated an estimated 11 709 (95% CI = 9473–13 953) excess violent victimisations attributable to methamphetamine use.\n\n\nConclusions\nMethamphetamine use appears to be associated with an elevated risk of being a victim of violence. The population‐level effects of methamphetamine use on violence may be small but are likely to have substantial public health implications in communities experiencing high levels of methamphetamine use.\n\n"]

  May 06, 2026   doi: 10.1111/add.70455   open full text
• Cross‐sectional and longitudinal associations of cannabis use with cognitive functioning in individuals with a cannabis use disorder: The moderating role of nicotine.
  Emese Kroon, Nora de Bode, Karis Colyer‐Patel, Jia Hua Hsieh, Francesca Filbey, Janna Cousijn.
  Addiction. 4 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and Aims\nCannabis is among the most widely used psychoactive substances globally and is often consumed alongside tobacco. Cannabis use has been associated with impairments in attention, learning, and memory, whereas nicotine can acutely enhance, but chronically impair, certain cognitive functions. Most studies examine cannabis in isolation, leaving the cognitive impact of tobacco co‐use unclear. This study aimed to estimate differences in cognitive performance between individuals with cannabis use disorder (CUD) and healthy controls, to determine whether cognition relates to heaviness of cannabis use or CUD symptom severity, to test moderation by daily tobacco use, and to assess whether baseline cognition was associated with cannabis outcomes one year later.\n\n\nDesign\nCross‐sectional and one‐year longitudinal study.\n\n\nSetting\nThe Netherlands and Texas, USA.\n\n\nParticipants\nA total of 231 participants aged 18–30 participated: 130 with CUD (57.7% male) and 101 controls (43.6% male).\n\n\nMeasurements\nParticipants completed tasks assessing interference control, attentional bias, sustained attention, executive functions, emotion recognition, delayed recall memory, working memory, and intelligence quotient (IQ). Primary outcomes were cognitive task scores; predictors included heaviness of cannabis use, CUD symptom severity, and daily tobacco use.\n\n\nFindings\nCompared with controls, individuals with CUD performed worse on interference control (rank biserial correlation [rrank] = 0.080, p < 0.001), immediate recall memory (rrank = 0.089, p = 0.009), delayed recall memory (rrank = 0.090, p = 0.013), executive functions (rrank = 0.089, p = 0.016), and estimated IQ (rrank = 0.081, p < 0.001). Within the CUD group, cognitive performance was unrelated to heaviness of use or CUD severity. Before correction, daily tobacco use moderated the link between CUD severity and working memory (p = 0.011, unstandardized beta [B] = −1.83), with poorer performance observed only among non‐tobacco users. Lower attentional bias (p = 0.027, B = −1.78) and sustained attention (p = 0.023, B = −27.88) were modestly associated with greater CUD severity at one‐year follow‐up.\n\n\nConclusions\nCannabis use disorder (CUD) appears to be associated with deficits in several cognitive domains independent of use intensity or severity. Tobacco and cannabis co‐use appears to be related to relatively better working memory. Attention‐related cognition appears to have limited associations with later CUD outcomes.\n\n"]

  May 06, 2026   doi: 10.1111/add.70457   open full text
• Efficacy and safety of transcranial direct current stimulation in alcohol use disorder: A randomized controlled triple‐blind trial.
  Benoit Trojak, Anne Sauvaget, Wissam El Hage, Thomas Wallenhorst, Benjamin Rolland, Philippe Nubukpo, Ghina Harika‐Germaneau, David Szekely, Julie Giustiniani, Marc Auriacombe, Georges Brousse, Sébastien Guillaume, Maxime Bubrovszky, Benjamin Petit, Clémence Cabelguen, Hussein El Ayoubi, Suzanne Rankin, Agnès Soudry‐Faure, Karine Goueslard, Anastasia Demina.
  Addiction. 4 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nCurrent treatment options for alcohol use disorder are limited. Transcranial direct current stimulation has been proposed as a therapeutic approach, but evidence remains scarce. This study aimed to compare active vs. sham transcranial direct current stimulation to evaluate its efficacy and safety in reducing alcohol consumption in a large sample of individuals with alcohol use disorder.\n\n\nDesign\nREDSTIM is a triple‐blind, randomized, sham‐controlled trial that was conducted from October 2015 to January 2022. Participants were followed up every 4 weeks for 24 weeks.\n\n\nSetting\nFourteen sites in France and Monaco.\n\n\nParticipants\n356 adult outpatients with alcohol use disorder were assessed for eligibility, and 337 were enrolled and randomly assigned (1:1) to receive active or sham stimulation. At baseline, the randomized participants were primarily male (60.5%) with an average age of 51.3 ± 11.3 years.\n\n\nIntervention and comparator\nTwo daily stimulation sessions (anode F4, cathode F3, 2 mA) delivered over five consecutive days vs. sham stimulation. Direct currents were applied via a pair of 0.9% NaCl‐soaked surface sponge electrodes (25 cm2). In the sham stimulation group, the initial ramp‐up time of 15 s (also up to 2 mA) was immediately followed by a ramp down phase of 30 seconds.\n\n\nMeasurements\nThe co‐primary outcomes were the change in the number of heavy drinking days (HDD) and total alcohol consumption (TAC) over the follow‐up period. Exploratory secondary outcomes included alcohol craving, clinical and biological improvements, quality‐of‐life, mood, cognitive and safety assessments.\n\n\nFindings\nOver 24 weeks of follow‐up, vs. sham, the active stimulation group reported statistically significant reductions in the number of HDD [−2.45 HDD/4 weeks, 97.5% confidence interval (CI) = −4.86 to −0.05, P = 0.022]. The reduction in TAC was not statistically significant (−5.96 g/day, 97.5% CI = −15.18 to 3.26, P = 0.147). The interpretation of these findings should take into account the proportion of missing data related to alcohol diary completeness and losses to follow‐up.\nFor secondary outcomes at 24 weeks, vs. sham, craving assessments were lower in the stimulation group (−0.36 95% CI = −0.65 to −0.07, P = 0.016), as were carbohydrate deficient transferrin levels (−0.33 95% CI = −0.65 to −0.01, P = 0.045). In the active vs. sham stimulation group, 69 (41.1%) and 62 participants (36.7%) experienced one or more adverse effects, resulting in 6 dropouts.\n\n\nConclusions\nAmong adult outpatients with alcohol use disorder, active transcranial direct current stimulation resulted in a modest but sustained reduction in heavy drinking days over 24 weeks, while no statistically significant effect was observed for total alcohol consumption. The intervention was well tolerated.\n\n"]

  May 06, 2026   doi: 10.1111/add.70461   open full text
• Discrimination experiences are associated with same‐day and next‐day smoking among adults with low socio‐economic status trying to quit: A secondary analysis of data from a randomized clinical trial.
  Laili K. Boozary, Meng Chen, Summer G. Frank‐Pearce, Emily T. Hébert, Sixia Chen, Adam C. Alexander, Motolani E. Ogunsanya, Munjireen S. Sifat, Jason A. Oliver, Michael S. Businelle, Darla E. Kendzor.
  Addiction. 10 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nResearch indicates that experiencing discrimination may be associated with a return to smoking following a quit attempt. The current study aimed to characterize day‐to‐day relations between discrimination and smoking in the context of a smoking cessation trial for adults with socio‐economic disadvantage.\n\n\nDesign\nSecondary analysis of data from a randomized controlled trial, which used a parallel 2‐group design (unblinded). Eligible participants (adults with socio‐economic disadvantage) were randomly assigned to usual care (UC) for smoking cessation (counseling and pharmacotherapy) or UC plus financial incentives contingent on biochemically verified abstinence. All participants were asked to complete daily smartphone assessments over the first 28 days following a scheduled quit attempt.\n\n\nSetting\nThe smoking cessation trial (parent study) was conducted in a tobacco treatment clinic between 2017 and 2022 in Oklahoma City, Oklahoma, USA.\n\n\nParticipants\nParticipants (n = 256) were primarily female (64.8%) and 40.6% were racially/ethnically minoritized. The average age was 48.97 [standard deviation (SD) = 11.61] years. The average cigarettes smoked per day before quitting was 19.00 (SD = 10.51).\n\n\nMeasurements\nSmartphone assessments measured discrimination [“Do you believe you experienced discrimination yesterday?” (yes/no)] and self‐reported daily smoking [“How many cigarettes did you smoke yesterday?” (smoking [≥one puff]/abstinent)]. Biochemically verified past 7‐day smoking status was assessed at the 4, 8, 12 and 26 week post‐quit follow‐ups. Generalized linear mixed models analyzed the relations between (1) same‐day and next‐day discrimination and abstinence and (2) reporting any discrimination during the smartphone assessment period (SAP) and biochemically verified abstinence at follow‐ups.\n\n\nFindings\nOverall, 62 participants (22.4%) reported 212 instances of discrimination over the SAP. Discrimination was statistically significantly associated with lower odds of same‐day [β = 0.48, 95% confidence interval (CI) = 0.25–0.94] and next‐day (β = 0.47, 95% CI = 0.25–0.86) abstinence, and any discrimination during the SAP was statistically significantly associated with lower odds of abstinence across follow‐ups (β = 0.08, 95% CI = 0.02–0.30).\n\n\nConclusions\nExperience of discrimination appears to adversely impact smoking cessation among adults with socio‐economic disadvantage who are trying to quit smoking and warrants attention in cessation interventions.\nTrial Registration: The parent trial was registered at ClinicalTrials.gov (NCT02737566). The secondary analyses described in this manuscript were not pre‐registered.\n\n"]

  April 30, 2026   doi: 10.1111/add.70419   open full text
• The feasibility of mindfulness‐based relapse prevention for adults with substance use disorders (illicit drugs) in a Chinese population: A pilot randomized controlled trial.
  Ka Tsun Ting, Ivan Chun Him Leung, Dicken Cheong Chun Chan, Ken On Tai Yu, Wai Kwong Tang, Fu Chan, Alan Ka Lam Tang, Helen Shuk Wah Ma, Benjamin Hon Kei Yip, Daisy Dexing Zhang, Sarah Bowen, Samuel Yeung Shan Wong.
  Addiction. 10 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nMindfulness‐based relapse prevention (MBRP) has been shown to be beneficial to individuals with substance use disorder (SUD) in the West. The current pilot study aimed at testing the feasibility of MBRP in a Chinese population.\n\n\nDesign\nThis pilot study adopted a design of randomized controlled trial comparing MBRP with treatment‐as‐usual group (TAU).\n\n\nSetting\nParticipants were recruited from residential detox centers, community addiction counseling centers and substance abuse clinics specialized addiction treatment clinics in Hong Kong.\n\n\nParticipants\nA total of 81 adults (85.2% male) with SUD (illicit drugs only) were recruited.\n\n\nInterventions\nThe intervention group participants (n = 41) attended a 1‐hour orientation session followed by 2‐hour weekly MBRP sessions for 8 weeks, delivered by a qualified MBRP teacher. The TAU group participants (n = 40) continued their service received from their referral agency. (After completion of all study assessments they were offered the same 8‐week MBRP course.)\n\n\nMeasurements\nFeasibility was measured by attendance, course satisfaction and retention rate. Participants' change in substance use and other related outcomes were captured by self‐reported drug use, urine drug tests and a list of psychometric scales at baseline, immediately after MBRP and 3‐ and 6‐month follow‐up.\n\n\nFindings\nThe MBRP course satisfaction was high, and the attendance (57.4%) and retention rates (63.4%–85.4%) were comparable to previous trials. No statistically significant differences were observed between the MBRP and TAU groups for any outcomes, including craving, depression, anxiety, mindfulness and health‐related quality of life; however, improvement trends were noticed in the MBRP group in self‐efficacy in managing high‐risk situations at post intervention, as well as in addiction severity and psychological flexibility at the 6‐month follow‐up.\n\n\nConclusions\nMindfulness‐based relapse prevention was shown to be feasible for substance use disorder treatment in a Chinese population. In this small study there was only limited evidence of abstinence efficacy, and no evidence of a benefit on other secondary outcomes.\n\n"]

  April 30, 2026   doi: 10.1111/add.70441   open full text
• Age period cohort trends in alcohol treatment episodes across Australia from 2003 to 2022.
  Wing See Yuen, Mia Miller, Nicola Man, Michael Livingston, Agata Chrzanowska, Philip Clare, Jane Akhurst, Louise Tierney, Kristina Da Silva, Parker Blakey, Willow Bryant, Gary Chan, Janni Leung, Amy Peacock.
  Addiction. 11 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nAims\nTo measure trends in alcohol treatment episodes in Australia, disaggregated by age, period and birth cohort.\n\n\nDesign and setting\nAge, period, cohort modelling with restricted cubic splines, using Australian alcohol treatment administrative data from July 2002 to June 2022.\n\n\nParticipants\n1 253 548 closed treatment episodes where alcohol was the primary drug of concern from people aged 10 to 100 years who received treatment for their own substance use in publicly funded specialist alcohol and other drug treatment services.\n\n\nMeasurements\nCount of alcohol treatment episodes by age, period, birth cohort and sex.\n\n\nFindings\nAlcohol treatment episode rates increased over time, peaking in 2022 (330.11 per 100 000 population). Age trends first peaked at around 21 years of age [cross‐sectional prevalence = 444.30, 95% confidence interval (CI) = 440.82–447.80; longitudinal prevalence = 462.45, 95% CI = 458.06–466.89], followed by a lifetime peak between 37 and 44 years and declining with older age. Cohorts born from 1974 to 1979 had the highest alcohol treatment episode rates, and the oldest and youngest birth cohorts had the lowest alcohol treatment episode rates. Males were overall 1.8 times as likely as females to have an alcohol treatment episode, but this gap closed with more recent birth cohorts.\n\n\nConclusions\nAlcohol treatment episode rates increased in Australia between 2003 and 2022, and particularly from 2017. Young to middle‐aged adults and people born in the 1970s were most at risk, alongside a persistent but narrowing gap between males and females.\n\n"]

  April 29, 2026   doi: 10.1111/add.70450   open full text
• Context, mechanisms and outcomes of a social enterprise model of residential rehabilitation for problem substance use: A realist‐informed process evaluation.
  Martin Anderson, Lucy Pickering, Mark McCann.
  Addiction. 11 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nThis study evaluated a three‐year residential rehabilitation programme, which aimed to support recovery from problem substance use via peer support and social enterprise activities. The aims were to clarify programme mechanisms and identify contextual factors associated with variation in outcomes.\n\n\nMethods\nThe study took place within River Garden, a residential rehabilitation for problem substance use, based in South Ayrshire, Scotland. A mixed‐methods realist‐informed process evaluation was undertaken, using participant observation, repeated qualitative interviews and routinely collected admissions data. Fieldwork was conducted with residents, staff and trustees between April 2019 and November 2020. Nine (of ten) residents were recruited into the study. All residents were male, aged 20–47 years (median 35 years) and were White Scottish or English. Data collection and analysis was guided by Medical Research Council guidance on process evaluation and informed by selected principles from realist evaluation.\n\n\nResults\nThree key contextual factors and six key mechanisms were associated with variation in resident outcomes. The severity of residents' substance use problems, their physical and mental health and their socioeconomic backgrounds shaped whether they responded to the programme's instrumental and relational resources with trust, respect or motivation (constituting six mechanisms, e.g. instrumental‐respect, relational‐trust). The programme was most beneficial for residents for whom intended outcomes were less constrained by contextual moderators.\n\n\nConclusions\nIn residential rehabilitation for substance use disorders, residents with higher problem severity, worse physical and mental health and greater socioeconomic disadvantage appear to be less likely to respond to rehabilitation resources with trust, respect or motivation compared with the other residents. These findings may support the development of strategies to improve outcomes for residents with greater contextual barriers to change.\n\n"]

  April 29, 2026   doi: 10.1111/add.70459   open full text
• ‘If you've ever experienced it, you'd feel differently’: Exploring willingness and skepticism toward using higher dose naloxone products among people who use drugs in Maryland, United States.
  Laura N. Sisson, Richard S. Rousch, Lucas G. Hill, Claire M. Zagorski, Tricia Triece, Saba Rouhani, Jill Owczarzak, Susan G. Sherman, Kristin E. Schneider.
  Addiction. 11 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nHigher dose naloxone products (HDN) have recently been approved and marketed in the United States; however, evidence on the relative advantage of these products to standard 4 mg products has not been substantiated by prior research. People who use drugs are the primary beneficiaries and consumers of naloxone products. This study aimed to characterize their willingness to use HDN products and technical understanding of these products.\n\n\nDesign and measurements\nWe conducted in‐depth interviews with syringe service program clients following an interview guide. Interviews were recorded and transcribed before being analyzed using a hybrid deductive‐inductive qualitative approach.\n\n\nSetting\nInterviews were conducted in partnership with community‐based syringe service programs in three distinct regions of the state of Maryland, USA: a rural county, Baltimore city and a surrounding suburban community.\n\n\nParticipants\nTwenty‐two interviews were completed. All participants had used opioids and responded to an overdose using naloxone in the past 3 months. The majority of participants were men (73%), non‐Hispanic white (64%) and currently experiencing housing instability (59%).\n\n\nFindings\nParticipants demonstrated high willingness to use HDN, motivated by volatility in the local drug supply and perceived inefficiency of naloxone against potent synthetic opioids. Participants believed that the relative advantage of HDN was that it would reverse overdoses more quickly than existing products; however, many participants wanted increased control in overdose situations, including the ability to titrate and combine dosages to reduce the severity of precipitated withdrawal. Skepticism towards HDN products was rooted in general skepticism of pharmaceutical companies, as well as the belief that perceptions of lower dose naloxone being ineffective could be attributed to user error.\n\n\nConclusions\nDevelopment of novel overdose reversal products should be informed by the experiences of primary consumers and beneficiaries of these products. A high level of transparency is needed in the marketing of these products to promote consumer trust and confidence in their safety and utility.\n\n"]

  April 29, 2026   doi: 10.1111/add.70447   open full text
• Nation‐wide trends in prevalence and mortality of high‐risk drinking among adult men with and without disabilities in South Korea between 2009 and 2017.
  Bo Hui Park, So Young Kim, Kyoung Eun Yeob, Yeon Yong Kim, Jong Hyock Park.
  Addiction. 12 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nExcessive alcohol consumption contributes substantially to the global burden of disease, yet population‐level evidence on disparities in high‐risk drinking among people with disabilities remains limited. We aimed to estimate and compare trends in the prevalence of high‐risk drinking and all‐cause mortality associated with drinking behavior among men with disabilities and those without disabilities.\n\n\nDesign\nNation‐wide serial cross‐sectional study.\n\n\nSetting\nSouth Korea, using linked administrative national health check‐up and mortality databases.\n\n\nParticipants\nA total of 7 551 340 adult men who participated in the National Health Insurance Service health check‐up program in 2017, including 450 536 men with registered disabilities and 7 100 804 men without disabilities.\n\n\nMeasurements\nHigh‐risk drinking was defined as consumption of seven or more standard drinks per occasion at least twice per week, based on self‐reported health check‐up questionnaires. Age‐standardized prevalence of high‐risk drinking was estimated annually from 2009 to 2017. Associations between disability characteristics and high‐risk drinking were estimated using multivariable logistic regression in 2017. All‐cause mortality occurring within 2017 was ascertained through deterministic linkage to the national death registry using unique personal identifiers.\n\n\nFindings\nIn 2017, age‐standardized prevalence of high‐risk drinking was 17 141 per 100 000 among men with disabilities and 23 226 per 100 000 among men without disabilities. Among men aged 20–49 years, prevalence was 29 710 per 100 000 in those with mild disabilities and 26 332 per 100 000 in those without disabilities. In 2017, compared with men without disabilities, mild disability was associated with higher odds of high‐risk drinking [adjusted odds ratio (aOR) = 1.12, 95% confidence interval (CI) = 1.11–1.13], whereas brain injury was associated with lower odds (aOR = 0.61, 95% CI = 0.58–0.65). In 2017, age‐standardized mortality rates were 131.4 per 100 000 among non‐drinkers, 99.2 among high‐risk drinkers, 77.3 among moderate drinkers and 59.9 among low‐risk drinkers. Across drinking categories, several disability groups had adjusted odds ratios greater than 1.0 for all‐cause mortality compared with those for men without disabilities within the same drinking category.\n\n\nConclusion\nHigh‐risk drinking prevalence among South Korean men was lower among those with disabilities than among those without disabilities from 2009 to 2017, with declining trends in both groups. High‐risk drinking prevalence among South Korean men appears to differ by disability characteristics. Mortality odds ratios within drinking categories vary by disability type and severity when compared with men without disabilities in the same drinking category.\n\n"]

  April 28, 2026   doi: 10.1111/add.70423   open full text
• Substance‐related intrusive memories in cocaine use disorder are different from but associated with craving.
  Amelie Zacher, Lina Dietiker, Victoria Häffner, Francesco Bavato, Birgit Kleim, Boris B. Quednow.
  Addiction. 13 days ago
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nCocaine use disorder (CUD) is a significant global health concern, characterized by persistent craving despite severe consequences. Recent theories highlight maladaptive memory processes – such as intrusive, vivid recollections of past substance use that arise spontaneously in daily life – as key contributors to craving and relapse; however, empirical studies examining such substance‐related intrusions in naturalistic contexts remain scarce. This study therefore used ecological momentary assessment (EMA) to investigate the frequency, phenomenology and emotional and behavioural correlates of substance‐related memory intrusions in individuals with CUD, and how these relate to craving, cocaine use severity (CUS) and psychotherapy experience.\n\n\nDesign\nA 14‐day EMA study captured event‐based reports of intrusions, craving and related experiences in participants diagnosed with CUD.\n\n\nSetting\nThe study was conducted in Switzerland in a naturalistic setting, with data collected via individuals' smartphones.\n\n\nParticipants\nN = 43 participants (recruited in Switzerland, 16% female; 18–59 years old, median compliance rate 82.8%) with a current DSM‐5 diagnosis of CUD made a total of n = 360 event‐based reports that were analysed.\n\n\nMeasurements\nEMA reports included intrusion episode types (pure intrusions, intrusions with subsequent or simultaneous craving or pure craving), intrusion characteristics (vividness, intrusiveness, modalities), craving intensity, episode triggers and cognitive‐behavioural, emotional and physiological responses. CUS was assessed based on use quantity, duration and obsessive‐compulsive use symptoms.\n\n\nFindings\nParticipants recorded an average of 8.4 episodes (standard deviation = 5.8) across 14 days. Intrusions frequently occurred independently of craving (42.4%) but were statistically significantly associated with greater craving intensity when more vivid (unstandardized regression coefficient b = 0.53, P = 0.002) and intrusive (b = 0.48, P < 0.001). Episodes involving craving were characterized by greater distress (b = 1.52–2.17, all P < 0.001) and greater loss of control (b = 2.41–3.22, all P < 0.001) and were associated with higher odds of reporting obtaining cocaine (odds ratio = 19.90, P < 0.001). Higher CUS predicted more frequent intrusion episodes (unstandardized regression coefficient β = 0.52, P < 0.001), while psychotherapy experience was associated with lower vividness (b = −1.45, P = 0.008), intrusiveness (b = −1.33, P = 0.004) and craving intensity (b = −1.56, P = 0.010).\n\n\nConclusions\nSubstance‐related memory intrusions in people with cocaine use disorder are distinct cognitive‐affective events that often occur independently of craving but are closely linked to its intensity, particularly when experienced as vivid and emotionally charged. Targeting these features through behavioural or pharmacological interventions may help mitigate craving‐driven distress and impulsive use‐related behaviour.\n\n"]

  April 27, 2026   doi: 10.1111/add.70449   open full text
• High temporal resolution monitoring of illicit drug consumption across England via wastewater analysis.
  Helena Rapp‐Wright, Keng Tiong Ng, Derryn Grant, William Francis, Margarita White, Dimitris Evangelopoulos, Yuxing Liu, Konstantina Dimakopoulou, Sofia Zafeiratou, Dylan Wood, Chryshanthi Christy, Stav Friedman, Timothy W. Gant, Klea Katsouyanni, Leon P. Barron.
  Addiction. April 26, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nAim\nTo monitor community‐level consumption of 20 illicit drugs across urban areas of England using wastewater‐based epidemiology (WBE) surveillance at high temporal resolution.\n\n\nDesign, setting, cases\nThis study was conducted over a 12‐month period in 2022 sampling 24‐hour composite wastewater samples at 15 wastewater treatment plants (WWTPs) covering catchment population equivalents ranging from ~100 000 to >1 million. Analysis was conducted using rapid liquid chromatography–tandem mass spectrometry methods. The sampled WWTPs collectively covered 21% of the national population.\n\n\nMeasurements\nPrimary data outcomes were the population‐normalised daily loads (PNLs) entering the WWTP, estimated population‐normalised consumption (both in mg/1000 people/day) and total mass (g/day) of 20 targeted illicit drugs and total mass in each catchment, quantified using suitable drug target residue markers in 1746 wastewater samples. Covariables included temporal indicators (e.g. public holidays, events) and regional factors. Presence, quantity and correlation of WBE‐derived drug use data were used to infer drug use patterns.\n\n\nFindings\nOf the 20 illicit drugs investigated, 18 were detected in at least one sample. Cocaine exhibited the highest average daily PNL (2770 ± 829 mg/1000 people/day), followed by heroin (382 ± 248), ketamine (287 ± 183), amphetamine (272 ± 268), 3,4‐methylenedioxymethamphetamine (MDMA) (80 ± 57) and methamphetamine (60 ± 99) across 2022. When comparing PNLs to Sewage analysis CORe group—Europe (SCORE) and European Drugs Agency WBE data for 109 other WWTPs across Europe from March to May, 2022 cocaine and ketamine PNLs from sites in England were ranked statistically higher [cocaine: Wilcoxon rank‐sum test statistic (W) = 971, adjusted P = 0.000115; ketamine: W = 264, adjusted P = 0.0000389]. Importantly, seven English WWTPs recorded higher mean ketamine PNLs than any other European site over the same period in 2022. Temporal spikes in drug consumption aligned with public holidays and major events. A notable decrease in cocaine use coincided with a 3.7‐t UK seizure. Strong inter‐drug correlations were observed across catchments, particularly for benzoylecgonine/ketamine and benzoylecgonine/cocaethylene. Extrapolation to generate a representative national average consumption estimate is not recommended, as the WWTPs studied were mostly classified as urban areas and found not to be representative of the entire population of England.\n\n\nConclusions\nWastewater analysis revealed widespread and temporally variable illicit drug use across England in 2022, with ketamine use exceeding European levels at multiple sites. The findings highlight wastewater‐based epidemiology's capacity to monitor drug use trends and identify community‐level impacts of interventions and events.\n\n"]

  April 26, 2026   doi: 10.1111/add.70398   open full text
• ‘Emptiness filled with love’: A reflexive thematic analysis of chemsex trajectories among gay, bisexual and other men who have sex with men in Almaty, Kazakhstan, using a life course framework.
  Nikolay Lunchenkov, Nadezhda Cherchenko, Elena German, Susanna Rinne‐Wolf.
  Addiction. April 24, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nThe intentional use of psychoactive substances to enhance sexual experiences, known as chemsex, is associated with human immunodeficiency virus (HIV) transmission, psychological distress and social isolation among gay, bisexual and other men who have sex with men (GBMSM). While research has predominantly focused on high‐income countries, gaps remain in our understanding of the dynamics in Eastern Europe and Central Asia, where structural homophobia, restrictive drug policies and limited healthcare access uniquely shape chemsex‐related risks. There is limited research on how chemsex engagement evolves over time. This study aimed to identify the stages of chemsex engagement and examine how social, psychological and structural factors shape transitions between these stages among GBMSM in Kazakhstan.\n\n\nMethods\nThis study is a secondary analysis of data from a cross‐sectional qualitative study conducted in Almaty, Kazakhstan, between July and September 2023. Twenty‐one GBMSM who had engaged in chemsex within the past 12 months participated in semi‐structured interviews lasting between 60 and 90 minutes. All participants reported using mephedrone and/or alpha‐PHP (α‐Pyrrolidinohexiophenone). Deductive reflexive thematic analysis, guided by Life Course Theory, was used to reconstruct chemsex trajectories from retrospective participant accounts.\n\n\nResults\nFive distinct themes related to different trajectory stages were developed. Initiation occurred through trusted social networks in intimate settings, taking the form of unplanned encounters that fulfilled emotional needs for connection and belonging. Maintenance was characterised by self‐imposed temporal and dosage limits; however, participants reported a decline in satisfaction with sober sex. Escalation involved a breakdown of protective boundaries, an increased frequency and quantity of use and a deeper involvement in chemsex social networks, despite mounting physical and psychological consequences. Dependence was characterised by a narrowed agency under escalating constraints, with substance use shifting from enhancing pleasure to coping with withdrawal, resulting in substantial impairment across life domains. Disengagement attempts described recursive trajectories with diverse recovery goals ranging from cessation to managed use. Sustained abstinence was rare and dependent on affirming care and supportive resources. Throughout all stages, structural stigma constrained individual agency, while chemsex networks provided crucial emotional safety that was unavailable in mainstream environments.\n\n\nConclusions\nChemsex trajectories among gay, bisexual and other men who have sex with men in Kazakhstan represent dynamic processes shaped by the interaction between individual agency and structural constraints, in which substance use functions as an emotional regulation strategy and a social survival strategy in contexts of high stigma.\n\n"]

  April 24, 2026   doi: 10.1111/add.70454   open full text
• Drug sellers' use of a drug checking service amid the overdose crisis in British Columbia, Canada.
  Pablo Gonzalez‐Nieto, Bruce Wallace, Collin Kielty, Irene Shkolnikov, Ava Margolese, Jaime Arredondo Sanchez Lira, Chris Gill, Dennis Hore.
  Addiction. April 24, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nAims\nThis study examined the use of a drug checking service by drug sellers in British Columbia, Canada, to assess motivations for service use and substances intended for distribution, focusing on risks associated with an unstable illicit drug market.\n\n\nDesign\nA retrospective analysis was conducted using data from an anonymous intake survey and drug checking results. The survey captured frequency of service use, expected substances and reasons for service access.\n\n\nSetting\nThe study was set in Victoria, British Columbia, where participants accessed a free confidential drug checking service between January 2021 and December 2024.\n\n\nParticipants\nA total of 2332 drug sellers were included in the analysis, accounting for 16.2% of all service users. They submitted 5528 samples (21.6% of total samples), averaging 2.4 samples per visit, compared to 1.7 among non‐sellers.\n\n\nMeasurements\nThe primary outcomes measured included the frequency of drug check use, the expected and actual composition of the samples, pre‐ or post‐consumption analysis and the reasons for engaging with the service. Secondary outcomes focused on the reported potency and the presence of unexpected substances.\n\n\nFindings\nA statistically significant portion of sellers continuously used the service, particularly for opioid samples, which comprised 69.2% of seller submissions compared with 35.1% among non‐sellers [X2 (1, n = 20 864) = 2055.57, P < 0.001]. Sellers reported using the service to mitigate risks associated with the illicit drug market, including overdose, showing a proactive interest in ensuring the safety of their customers. Despite greater confidence in the composition of their products, sellers were less likely than non‐sellers to have their samples confirmed as “expected” [38.4% vs. 51.9%; X2 (1, n = 12 520) = 313.76, P < 0.001]; unexpected substances were detected in 44.8% of their samples. Notably, protective strategies employed by sellers were identified, demonstrating the role of drug checking as a supply‐focused harm reduction intervention.\n\n\nConclusions\nIn Victoria, British Columbia, drug sellers appear to be increasingly using drug checking services as a preventive measure, positioning them as potential partners in harm reduction efforts.\n\n"]

  April 24, 2026   doi: 10.1111/add.70429   open full text
• Profiles of youth initiating use of nicotine pouches, vapes and cigarettes: National findings from the Population Assessment of Tobacco and Health (PATH) study, 2022–2023.
  Olufemi Erinoso, Karin Kasza.
  Addiction. April 24, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nNicotine pouches have risen in appeal and use among United States (U.S.) youth and young adults. However, less is known about the initiation determinants of pouch use, and how they compare with those of e‐cigarettes or cigarettes. This study compared the demographic, behavioral, and exposure profiles of adolescents and young adults (AYAs) who initiated nicotine pouch‐use with those who initiated nicotine vaping and those who initiated smoking in a nationally representative U.S. cohort.\n\n\nDesign and settings\nWe used a longitudinal study design. The study setting was the United States (US) with data from the Population Assessment of Tobacco and Health (PATH) Study (Waves 7 and 7.5, 2022–2023).\n\n\nParticipants\nAYAs aged 12–22 (n = 14 326).\n\n\nMeasurements\nThe primary outcomes at follow‐up were initiation of nicotine pouches (never use [2022] to ever use [2023]), vaping, and cigarette smoking. Study predictors at baseline (2022) included demographics, substance and tobacco use, mental health, and social and behavioral exposures. As a secondary objective, susceptibility to vape or smoke at baseline was examined as a predictor of pouch initiation. Separate multi‐variable logistic regression models assessed factors associated with the initiation of each product.\n\n\nFindings\nThe study population comprised 50.6% males, and 45.4% were between the ages 18–22 years, 15–17 years (21.2%), and 12–14 years (33.4%). In 2023, initiation rates were 2.4% for pouch use, 6.2% for vaping, and 3.2% for smoking. Current smoking at baseline was associated with initiating pouch use (adjusted odds ratio [AOR] = 2.8, 95% confidence interval [95% CI]: 1.7–4.4) and initiating vaping (AOR = 5.3, 95% CI: 2.0–13.7) at follow‐up. Current vaping was associated with higher odds of pouch initiation (AOR = 7.9, 95% CI: 5.1–12.4), but current pouch use was not associated with vaping initiation (AOR = 2.4, 95% CI: 0.3–16.2) at follow‐up. Having important peers who use pouches (vs. none) was associated with pouch initiation (AOR = 2.2, 95% CI: 1.2–4.3), similarly for vaping but not for smoking at follow‐up. Among pouch initiators (n = 335), most vaped nicotine at follow‐up (37.9%), 19.7% vaped nicotine and smoked, and 5.2% smoked cigarettes and did not vape.\n\n\nConclusions\nCigarette smoking appears to be associated with both nicotine pouch initiation and vaping initiation among United States adolescents and young adults. Current vaping appears to be associated with pouch initiation, but current pouch use does not appear to be associated with vaping initiation. Important peers using pouches appear to be associated with pouch initiation and vaping initiation but not cigarette smoking. Most pouch initiators in this study concurrently vaped at one‐year follow‐up.\n\n"]

  April 24, 2026   doi: 10.1111/add.70436   open full text
• Characterizing public comments via Regulations.gov in response to proposed cannabis rescheduling in the United States.
  Vijay M. Tiyyala, Cerina Dubois, Clarissa Madar, Ryan Vandrey, Johannes Thrul, Mark Dredze, John W. Ayers.
  Addiction. April 24, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nAims\nThe United States Drug Enforcement Administration's (DEA) proposed rescheduling of cannabis from Schedule I to Schedule III under the Controlled Substances Act marks a significant shift in federal policy. Understanding public sentiment toward this policy is critical for guiding the current cannabis rescheduling effort as well as future reforms. The objective of this study is to characterize public comments submitted to Regulations.gov regarding the DEA's cannabis rescheduling proposal and identify underlying justifications for support or opposition.\n\n\nDesign\nA mixed‐methods analysis was conducted.\n\n\nSetting\nOnline public comments submitted to Regulations.gov regarding the DEA's cannabis rescheduling proposal.\n\n\nParticipants\n42 913 public comments submitted between 21 May and 22 July 2024.\n\n\nMeasurements\nComments were analyzed for sentiment towards the proposed rescheduling (support, oppose or insufficient rescheduling) and thematic justifications using manual and automated natural language processing techniques. A two‐stage annotation approach was employed: manual coding of 200 randomly sampled comments by multiple independent evaluators, followed by automated classification of all 42 913 comments using open source Large Language Model (LLM) validated against the manual annotations.\n\n\nFindings\nUsing LLM‐based classification validated against human annotations [88% agreement, F1 (harmonic mean of precision and recall) = 0.86], we found that among 42 913 comments, 28.85% [95% confidence interval (CI) = 28.44%–29.24%] supported rescheduling, 6.74% (95% CI = 6.50%–6.99%) opposed and 63.50% (95% CI = 63.06%–63.99%) deemed the proposal insufficient, favoring further rescheduling or complete de‐scheduling of cannabis. Among the 200 manually annotated comments, therapeutic benefits (56.7%, 95% CI = 46.7%–66.7%) and economic impacts (27.8%, 95% CI = 18.9%–37.8%) were the most common justifications among supporters. Public health risks (100.0%, 95% CI = 100.0%–100.0%), addictiveness concerns (71.4%, 95% CI = 42.9%–100.0%) and concerns about underage use (57.1%, 95% CI = 14.3%–85.7%) were predominant in opposing comments. Insufficient rescheduling comments cited therapeutic benefits (37.8%, 95% CI = 28.5%–48.0%), economic impacts (28.6%, 95% CI = 19.4%–37.8%) and criminal justice reform (26.5%, 95% CI = 18.4%–35.7%) as primary justifications.\n\n\nConclusions\nPublic sentiment on Regulations.gov supports the United States Drug Enforcement Administration's proposal for cannabis rescheduling, though the majority views the proposed Schedule III classification as inadequate and supports further rescheduling or complete de‐scheduling of cannabis.\n\n"]

  April 24, 2026   doi: 10.1111/add.70410   open full text
• Understanding purchasing patterns of alcoholic, alcohol‐free and low‐alcohol drinks: A latent profile analysis.
  Oscar Rousham, Abigail K. Stevely, John Holmes.
  Addiction. April 23, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aim\nAlcohol‐free and low‐alcohol (no/lo) drinks (≤1.2% ABV) are increasingly popular in high‐income countries. Their potential to reduce alcohol‐related harm depends on who buys them, in what quantity and their incorporation into overall drinking patterns. We aimed to (1) compare purchases containing only no/lo drinks, only alcoholic drinks or both, over time between 2018 and 2023; (2) identify subgroups with distinct purchasing patterns in 2023; and (3) describe sociodemographic differences between these subgroups.\n\n\nDesign\nLatent profile analysis of cross‐sectional household purchasing data.\n\n\nSetting\nGreat Britain, 2018 and 2023.\n\n\nParticipants\nNationally representative samples of 30 401 (2018) and 28 254 (2023) households. 4975 households purchasing no/lo drinks in 2023 were included in the latent profile analysis.\n\n\nMeasurements\nData included off‐trade (i.e. shop) purchasing occasions categorised into no/lo‐only, alcohol‐only or no/lo alongside alcohol. Household characteristics were purchasing frequency, standard servings of no/lo drinks per adult, alcohol risk levels based on weekly units of alcohol purchased per adult (non‐drinker: 0 units; low‐risk: ≤14 units; increasing risk: >14‐ ≤ 35 units; high‐risk: >35 units; 1 unit = 8 g alcohol), age, social class, region and ethnicity.\n\n\nFindings\nFrom 2018 to 2023, the proportion of purchasing occasions that were alcohol‐only fell from 97% [95% confidence interval (CI) = 97%–97%] to 95% (95% CI = 95%–95%), while no/lo‐only purchases rose from 1.4% (95% CI = 1.3%–1.4%) to 2.7% (95% CI = 2.7%–2.8%) and no/lo alongside alcohol purchases rose from 1.2% (95% CI = 1.2%–1.2%) to 1.9% (95% CI = 1.9%–2.0%). In 2023, no/lo‐only purchases were smaller (median = 6.9 no/lo servings) than no/lo alongside alcohol purchases (median = 6.5 plus 24.5 alcohol units) and alcohol‐only purchases (median = 24.6 units). No/lo‐only purchases occurred earlier in the week, no/lo alongside alcohol purchases peaked on Fridays and Saturdays.\nLatent profile analysis identified three classes: no/lo triers (53%) averaged 2.1 no/lo servings per adult annually with 95% purchasing no or low‐risk levels of alcohol; occasional purchasers (34%) averaged 7.5 servings with 20% purchasing alcohol at increasing or high‐risk levels; dual purchasers (13%) averaged 37.8 servings with 39% purchasing alcohol at increasing or high‐risk levels. Dual purchasers and occasional purchasers were more likely to be older [60% (P < 0.001) and 54% (P = 0.010) aged ≤55 years, respectively] and white [both 97% (P = 0.014 and P = 0.0074, respectively)] compared with no/lo triers (49% aged ≤55 years, 94% white).\n\n\nConclusions\nIn Great Britain, most households that purchase no/lo drinks appear to do so infrequently and purchase alcohol at low‐risk levels; however, a smaller group of older, higher‐risk households purchase no/lo drinks more frequently.\n\n"]

  April 23, 2026   doi: 10.1111/add.70445   open full text
• Longitudinal associations between substance use problem severity and relative harm perceptions of e‐cigarettes compared with cigarettes: Results from the United States Population Assessment of Tobacco and Health study (2013–2023).
  Olufemi Erinoso, Katherine East, Joanna Streck, Karin Kasza, Andrew Hyland.
  Addiction. April 22, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nAims\nThis study examines, among adults who smoke: (1) the association between the harm perception of e‐cigarettes relative to cigarettes and substance use problem (SUP) severity, (2) whether changes in SUP severity over time are associated with changes in harm perceptions of e‐cigarettes relative to cigarettes and (3) whether associations between harm perceptions and vaping initiation are moderated by SUP.\n\n\nDesign\nLongitudinal study.\n\n\nSetting\nThe study setting was the United States (US) with data from the Population Assessment of Tobacco and Health (PATH) study waves 1–7 collected between 2013 and 2023.\n\n\nParticipants\nThe study population comprised non‐institutionalized US adults (18+) who smoked cigarettes in the past month.\n\n\nMeasurements\nThe primary predictor for aims 1 and 2 was SUP severity. The outcomes at follow‐up were: (1) relative harm perception of vaping compared with cigarette smoking [less harmful (accurate) versus more/same harm (inaccurate)], (2) change in SUP status (from no/low at baseline wave to moderate or high severity at follow‐up) and change in relative harm perceptions (from inaccurate at baseline to accurate at follow‐up). For aim 3, the primary predictor was relative harm perception, the outcome was nicotine vaping initiation and SUP was examined as a moderator.\n\n\nFindings\nA higher proportion and odds of respondents with high SUP (versus no/low SUP) had accurate harm perceptions [32.1% versus 28.5%; adjusted odds ratio (aOR) = 1.20; 95% confidence interval (CI) = 1.07–1.33]. Among individuals with no/low SUP at baseline with inaccurate perceptions, transitioning to high SUP at follow‐up was associated with higher odds of developing accurate harm perceptions (aOR = 1.63; 95% CI = 1.19–2.25). Among those who smoked but had no prior history of vaping, at baseline transitioning from inaccurate to accurate harm perception at follow‐up was associated with higher odds of vaping initiation (aOR = 2.08; 95% CI = 1.33–3.25).\n\n\nConclusion\nPeople who smoke and have high substance use problem severity appear to perceive vaping as less harmful than cigarette smoking. Notably, among those who smoke but have never vaped, transitioning from inaccurate to accurate perceptions was associated with vaping initiation.\n\n"]

  April 22, 2026   doi: 10.1111/add.70426   open full text
• Association between state‐level kratom regulations and poison center‐reported severe medical outcomes and healthcare use: A United States national analysis.
  Grant Comstock, Anthony P. Gulotta, Lisa E. Rein, Ryan Feldman.
  Addiction. April 21, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nKratom use in the United States (US) has increased. Kratom is not federally scheduled; regulation is heterogenous and determined at the state level. Strategies include no regulation, bans and kratom consumer protection acts (KCPA) such as age limits, product purity or labeling requirements. Public health data informing these policies remain limited. This study aimed to compare rates of poison center (PC) reported kratom exposures, including those associated with severe medical outcomes and healthcare use, across US states with differing regulatory frameworks, and to characterize national trends in kratom exposures over time.\n\n\nDesign\nRetrospective observational study of kratom exposures reported to the National Poison Data System from 2010 to 2023.\n\n\nSetting\nAll 50 US states and the District of Columbia.\n\n\nParticipants\nA total of 8919 kratom‐related exposures were reported to PCs during the study period, including 5452 single‐substance exposures (61%). Most cases involved adult males (69%), aged ≥18 years (8133; 91%).\n\n\nMeasurements\nStates were classified by kratom regulatory status into four categories: unrestricted (no regulations), KCPA, local restrictions (KCPA in 1 or more county, but no state regulation) or banned (retail sale illegal). The primary outcome was the incidence of severe medical outcomes defined as exposures coded by America's Poison Centers criteria as major effect (life‐threatening or resulting in significant residual disability) or death. Secondary outcomes included rates of exposure, hospitalization and healthcare use (defined as hospital admission or evaluation in an emergency department, urgent care or primary care).\n\n\nFindings\nKratom exposures increased from 19 cases in 2010 to 1242 cases in 2023 [incidence rate ratio (IRR) = 69.0 compared with 2010; 95% confidence interval (CI) = 39.6–120; P < 0.001]. Severe medical outcomes increased from zero cases in 2010 to 158 cases in 2023; 2012 was the first year in which a severe outcome was reported (2023 IRR = 56.9 vs 2012; 95% CI = 14.7–221; P < 0.001). Overall, 13% of kratom exposures resulted in a severe medical outcome. Compared with states where kratom was banned, statistically significantly higher rates of exposures (IRR = 2.49; 95% CI = 1.89–3.28), severe medical outcomes (IRR = 3.19; 95% CI = 1.78–5.70), healthcare use (IRR = 2.44; 95% CI = 1.66–3.60) and hospitalization (IRR = 2.45; 95% CI = 1.81–3.30, P < 0.001) occurred (all P < 0.001). No statistically significant differences were identified between other regulatory categories.\n\n\nConclusion\nKratom exposures and severe medical outcomes reported to United States poison centers are increasing nationally, though states with bans in place have experienced less pronounced increases.\n\n"]

  April 21, 2026   doi: 10.1111/add.70416   open full text
• Analysing police diversion for simple possession as a policy idea.
  Alison Ritter, Paul Kelaita.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1306-1315, May 2026. ", "\nAbstract\n\nBackground and aims\nExtensive critique of the evidence‐based policy paradigm has led to new ways of considering the role of evidence; for example Katherine Smith suggests that “ideas” rather than evidence mediate “the relationship between research and policy”. In this paper, we used Smith's typology on “ideas” to explore how this can be applied to a case of Australian policy making: a police diversion scheme for simple possession of drugs. We aimed to analyse the idea's journey into policy in one Australian jurisdiction (New South Wales) and assess its fit with the four different types of ideas outlined by Smith.\n\n\nMethod\nQualitative case study analysis using data from New South Wales, Australia, over the period 2018 to 2024. Multiple data sources were used: interviews with stakeholders (n = 26), documents [reports, non‐governmental organization (NGO) advocacy documents], media and official reports of a Drug Summit. Each data source was searched for narration/text concerned with police diversion in addition to decriminalisation, extracted and analysed against Smith's typology.\n\n\nResults\nFeatures of ‘institutionalised ideas’ suggest that police diversion is not an institutionalised idea. It appears in this case to be a ‘chameleonic idea’ inasmuch as its characteristics change and are malleably deployed by different stakeholders with different interests. ‘Flexian policy actors’ (including police, government officials, advocates and researchers) are able to interpret, transform and shape the meaning of police diversion to suit their interests and commitments. Despite evidence synthesis and expert review recommending police diversion as a second‐best option to decriminalisation, it was taken up into policy. We suggest this is because of its chameleonic nature, serving simultaneously at the hands of different policy actors as a roadblock to decriminalisation and as a Trojan horse for decriminalisation reform whilst also obscuring tensions between police diversion and decriminalisation.\n\n\nConclusions\nApplying Katherine Smith's typology of ideas to an Australian police diversion scheme for simple possession of drugs shows that the scheme is not an institutionalised idea but rather a chameleonic idea. Smith's typology of ideas adds another layer to policy process frameworks, enhancing analysis seeking to understand the uptake of ideas into policy.\n\n"]

  April 17, 2026   doi: 10.1111/add.70300   open full text
• Clinical factors linked to xylazine exposure in emergency department patients with illicit opioid overdose.
  Jennifer S. Love, Carmen Vargas‐Torres, Kim Aldy, Jeffrey Brent, Paul Wax, Rachel Culbreth, Alex Krotulski, Sharan Campleman, Barry Logan, Stephanie Abston, Shao Li, Alex F. Manini, on behalf of the Fentalog Study Group, Adrienne Hughes, Rob Hendrickson, Alexandra Amaducci, Bryan Judge, Joseph Carpenter, Michael Levine, Evan Schwarz, Diane Calello, Christopher Meaden, Jennie Buchanan, Joshua Shulman.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1227-1236, May 2026. ", "\nAbstract\n\nBackground and aims\nXylazine, an alpha‐2 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated with xylazine in non‐fatal opioid overdose. This study aimed to determine the demographic and clinical factors associated with xylazine detection among emergency department (ED) patients with opioid overdose.\n\n\nDesign\nObservational study. The Toxicology Investigators Consortium (ToxIC) Fentalog Study is a multicenter, prospective cohort of adult patients with suspected opioid overdose. This analysis included patients enrolled from September 2020 to September 2023.\n\n\nSetting\nIn this multicenter study, participating sites included 10 institutions across 9 states in 4 regions of the United States (US): Northeast, Southeast, Midwest and West.\n\n\nParticipants\nPatients were eligible for Fentalog Study inclusion if they were at least 18 years old, had a suspected opioid overdose and had waste blood available for toxicologic analysis. Only patients with qualitative serum detection of illicit opioids and/or xylazine were included in the final cohort. Of 5554 patients screened, 1289 were eligible for Fentalog Study inclusion.\n\n\nMeasurements\nBased on results of liquid chromatography with a quadrupole time‐of‐flight mass spectrometer (LCQTOF‐MS) and/or liquid chromatography with a triple quadrupole mass spectrometer (LC‐QQQ‐MS), patients were categorized into those with xylazine detected (positive cases) and without xylazine detected (negative controls). To determine clinical variables associated with xylazine detection, the primary outcome of interest was qualitative detection of xylazine on serum sampling by LCQTOF‐MS.\n\n\nFindings\nXylazine was detected in 238 patients. Patients with xylazine were primarily male (78%), white (48%), non‐Hispanic (82%) and located in the Northeast US (75%). Bradycardia on initial ED vital signs was associated with higher likelihood of xylazine detection (adjusted odds ratio = 2.11, 95% confidence interval = 1.06–4.06).\n\n\nConclusions\nXylazine detection among emergency department opioid overdose patients appears to be more prevalent in the Northeast US and bradycardia appears to be a statistically significant clinical predictor.\n\n"]

  April 17, 2026   doi: 10.1111/add.70289   open full text
• A cost–benefit analysis of the implementation and scale‐up of harm reduction interventions in the Australian Capital Territory.
  Anna L. Bowring, Tom Tidhar, Anna Olsen, Christopher Bailie, Kelvin Burke, Rowan Martin‐Hughes, Helen Keane, Paul Dietze, Nick Scott.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1272-1289, May 2026. ", "\nAbstract\n\nBackground and aims\nHarm reduction interventions aim to reduce negative consequences of drug use. We aimed to estimate the cost, health impact and economic benefits of current, expanded and new harm reduction interventions for people who use drugs in the Australian Capital Territory.\n\n\nDesign\nWe conducted a cost–benefit analysis of existing and new harm reduction interventions in the Australian Capital Territory. Independent decision tree models captured health outcomes [opioid/non‐opioid overdose; overdose‐related deaths; injection‐related skin/soft tissue/vascular infections (IRIs); hepatitis C incidence] for 2026–2030 according to intervention coverage.\n\n\nSetting\nAustralian Capital Territory, Australia.\n\n\nParticipants/cases\nPeople who use drugs through injecting (n = 1500) or non‐injecting (n = 33 600) routes differentiated by drug class (opioid/non‐opioid).\n\n\nInterventions and comparator\nA baseline scenario (current intervention coverage maintained) was compared with a counterfactual no interventions scenario, as well as scenarios with interventions linearly scaled up to the assumed maximum proportion of the target population that could be reached given geographical, social and implementation constraints. Interventions included in the analysis were: drug consumption rooms, needle‐syringe programs, take‐home naloxone, opioid agonist treatment, safer opioid supply, drug checking services and technological interventions (i.e. overdose monitoring ‘apps’/hotlines).\n\n\nMeasurements\nEconomic benefits were estimated from health costs averted (emergency response; shorter hospitalisation for IRI; hepatitis C treatment) and societal costs from years of life lost. Benefit–cost ratios were calculated compared to the baseline. A sensitivity analysis considered a changed illicit drug market with increased probability of overdose and overdose‐related death.\n\n\nFindings\nCompared with no coverage, the current package of harm reduction interventions was estimated to cost $24.6 million over 2026–2030 and avert 454 (24%) opioid and 20 (0.2%) non‐opioid overdoses, 70 (28%) overdose‐related deaths, 215 (17%) emergency responses, 552 (117%) hepatitis C infections and 199 (9%) IRIs. This corresponds to $250.1 million in economic benefits [benefit–cost ratio = 10.1, 95% confidence interval (CI) = 7.9–12.4].\nBenefit–cost ratios for scaling up take‐home naloxone [16.4 (5.0–27.9)], opioid agonist treatment [10.2 (5.6–15.3)], technological interventions [3.5 (0.0–15.7)], drug consumption room/s using medialised [1.9 (0.6–3.9)] or nurse/peer‐led model [2.7 (1.2–4.4)], safer opioid supply [1.5 (0.8–2.6)] and needle‐syringe programs [1.4 (0.7–2.6)] were favourable. The benefit–cost ratio for drug checking was 0.3 (0.0–6.2) but increased to 14.0 (0.1–29.6) under changed drug market conditions.\n\n\nConclusions\nModelled expanded and new harm reduction interventions for people who use drugs in the Australian Capital Territory appear to be likely to be cost saving from a societal perspective. If circulation of drugs with higher overdose risks was greater in this region, this would increase the impacts of interventions to prevent overdose and associated harms.\n\n"]

  April 17, 2026   doi: 10.1111/add.70276   open full text
• Is toke cheap? Correspondence between cannabis demand and purchase in the laboratory.
  Elizabeth R. Aston, Benjamin L. Berey, Michael Amlung, Robert Swift, James MacKillop, Jane Metrik.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1249-1261, May 2026. ", "\nAbstract\n\nBackground and aims\nThe typical Marijuana Purchase Task (MPT) assesses hypothetical demand (i.e. relative reinforcing value) for cannabis across escalating prices. Cannabis demand has been related to use frequency, craving, cannabis use disorder symptoms and cue‐exposure response, among other outcomes. This study assessed MPT performance for hypothetical consumption in relation to in vivo behavior in the laboratory wherein rewards were actualized.\n\n\nMethods\nIndividuals endorsing cannabis use at least twice weekly (n = 92) participated in a laboratory cannabis self‐administration study. Participants completed MPTs for Hypothetical and Actual cannabis. One trial (i.e. amount purchased at specified price) was randomly selected from the Actual MPT and participants with non‐zero value trials (n = 81) were permitted to smoke up to that amount during a 1‐hour session in the laboratory.\n\n\nResults\nBivariate Pearson correlations demonstrated that cannabis consumption preferences were highly similar across the Hypothetical and Actual MPT at the price (rs = 0.45–0.81) and index (rs = 0.46–0.81) level. However, mean Omax (i.e. maximum expenditure), Pmax (i.e. price at maximum expenditure) and breakpoint (i.e. price suppressing consumption to zero), were statistically significantly higher (ds = 0.47–0.51), and elasticity (i.e. consumption decline rate relative to price increase) was statistically significantly lower (d = −0.58) for the Actual MPT compared with the Hypothetical MPT; this was also evident at certain price points. Self‐reported anticipated consumption was statistically significantly related to the amount of cannabis smoked during self‐administration (R2 = 0.66; P < 0.001) and was not moderated by price of the randomly selected trial.\n\n\nConclusions\nHigh correspondence between Hypothetical and Actual Marijuana Purchase Task (MPT) performance in a laboratory setting suggests that hypothetical versions of the MPT may be broadly valid measures of cannabis demand. The robust relationship between anticipated consumption and actual cannabis quantity smoked in the laboratory suggests individual self‐report accurately predicts subsequent self‐administration, further supporting the construct validity of hypothetical MPTs.\n\n"]

  April 17, 2026   doi: 10.1111/add.70282   open full text
• Appetitive responses toward smoking‐related stimuli in abstinence‐motivated, non‐deprived individuals with chronic tobacco dependence: A multi‐methodological investigation.
  Franziska Motka, Haoye Tan, Seth M. Levine, Sabine Vollstädt‐Klein, Sarah K. Danböck, Katja Bertsch, Markus H. Winkler, Charlotte E. Wittekind.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1140-1152, May 2026. ", "\nAbstract\n\nBackground and aims\nAppetitive responses, such as approach biases, are thought to play a crucial role in smoking. This study aimed to compare responses toward smoking‐related stimuli with responses in control conditions (e.g. non‐approach or neutral stimuli) using a multi‐method approach. By examining associations between response measures and with smoking‐related variables, the study sought to extend understanding of their role in abstinence‐motivated, non‐deprived individuals with chronic tobacco dependence.\n\n\nDesign and setting\nCross‐sectional study conducted at a university laboratory and magnetic resonance imaging (MRI) scanner in Munich, Germany.\n\n\nParticipants\n362 chronically smoking individuals (51.38% female; data collection: November 2019–March 2023) with moderate‐to‐severe tobacco dependence, enrolled in a smoking cessation study, allowed ad libitum smoking prior to assessment.\n\n\nMeasurements\nResponses toward smoking‐related stimuli were assessed using cognitive‐behavioral (reaction‐time‐based approach biases), psychophysiological (electromyography: corrugator supercilii, zygomaticus major and orbicularis oculi for acoustic startle reflex) and neural (functional MRI: regions relevant to smoking cue‐reactivity) measures. Smoking‐related variables were cigarettes per day, tobacco dependence severity and craving. Split‐half reliabilities were estimated for all measures.\n\n\nFindings\nParticipants exhibited a statistically significantly attenuated acoustic startle reflex toward smoking‐related versus neutral stimuli (P < 0.001, Rosenthal's r = 0.39), while no statistically significant differences emerged for other psychophysiological or cognitive‐behavioral measures. Neural measures showed statistically significantly heightened reactivity toward smoking‐related versus neutral stimuli in sensory and motor regions (e.g. precuneus; P < 0.001, Rosenthal's r = 0.44) but reduced activity in reward‐related regions (e.g. striatum; P = 0.021, Cohen's d = 0.22). Higher craving was statistically significantly associated with stronger appetitive responses on some measures from all assessment methods (Ps ≤ 0.041), whereas greater tobacco dependence and smoking behavior were linked to reduced neural reactivity toward smoking‐related stimuli (Ps ≤ 0.036). No statistically significant associations emerged between measures from different methods (factor loadings ≤ 0.145, Ps ≥ 0.076). Differences scores between conditions (rel. = −0.351 to 0.837) were generally less reliable than their individual components (rel. = 0.619 to 0.964; excluding one exception)\n\n\nConclusions\nAppetitive responses toward smoking‐related stimuli may play a limited role in abstinence‐motivated, non‐deprived individuals with chronic tobacco dependence, whereas habitual motor responses could be more crucial.\n\n"]

  April 17, 2026   doi: 10.1111/add.70283   open full text
• The correlation between sanction adjustments and drunk‐driving violations and related outcomes in Taiwan: A nationwide interrupted time series analysis.
  Ling‐Wei Kuo, Chien‐An Liao, Chi‐Tung Cheng, Chien‐Hung Liao, Chih‐Po Hsu, Chih‐Yuan Fu, Shih‐Ching Kang, Brett Olin, Chun‐Shiang Yang, Jen‐Fu Huang.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1166-1178, May 2026. ", "\nAbstract\n\nBackground and aims\nDrunk‐driving accounts for a significant portion of traffic crashes in Taiwan. From 2008 to 2013, both the Taiwan Legislative Yuan and the federal administrative agencies collaborated to increase drunk‐driving penalties. This study aimed to determine whether these sanction changes are associated with changes in the incidence of drunk‐driving and subsequent hospital admissions.\n\n\nDesign\nExploratory retrospective cohort study.\n\n\nSetting\nTaiwan.\n\n\nParticipants\nAll traffic crashes involving drunk‐driving violations and every involved individual from 2003 to 2019 in Taiwan.\n\n\nMeasurements\nInterrupted time series analysis (ITSA) method was used to examine the effects of the three policy interventions in January 2008, December 2011 and June 2013. The numbers of drunk‐driving crashes, drunk‐driving casualties, drunk‐driving‐related admissions, drunk‐driving‐related major traumas, drunk‐driving‐related deaths and drunk‐driving‐related medical expenses in different time segments were compared to evaluate the effect of each policy intervention. All three policy initiatives increased drunk‐driving penalties, and there were no intervening policy changes that reduced said penalties.\n\n\nFindings\nFrom January 2003 to January 2008, the numbers of all drunk‐driving‐related outcomes gradually increased. After the first penalty adjustment, the reported number of drunk‐driving crashes had a sudden decrease (1632 in January 2008 to 1374 crashes in February 2008, β2 = −0.146, P < 0.001), but the overall trend continued upward (β3 = −0.001, P = 0.111). However, after the second policy intervention, drunk‐driving crashes began trending downward rapidly (β5 = −0.021, P < 0.001). Finally, after the third adjustment, the trend of drunk‐driving crashes continued to decrease, but the slope became significantly milder (β7 = 0.009, P < 0.001). Most of the target outcomes followed a similar trend as the drunk‐driving crashes, except for the number of deaths caused by drunk‐driving, which demonstrated a statistically significant decline after the first adjustment (β3 = −0.006, P = 0.007).\n\n\nConclusions\nIncreasing the fine and maximum incarceration periods for drunk‐driving in Taiwan appears to be associated with a reduction of the number of drunk‐driving crashes and other related outcomes; however, the decrease in drunk‐driving crashes diminished over time, especially after the third sanction change in 2013.\n\n"]

  April 17, 2026   doi: 10.1111/add.70285   open full text
• Trends in gamma‐hydroxybutyrate use, harms and treatment in Australia, 2013 to 2024.
  Amy Peacock, Agata Chrzanowska, Nicola Man, Shane Darke, Jared Brown, Jodie Grigg, Paul Dietze, Nadine Ezard, Raimondo Bruno, Krista J. Siefried, Caroline Salom, Jack Freestone, Jane Akhurst, Louise Tierney, Rachel Sutherland.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1290-1305, May 2026. ", "\nAbstract\n\nBackground and Aims\nThere is significant concern about potential rising harms from gamma‐hydroxybutyrate (GHB) but an absence of studies internationally synthesising data across indicators to identify changes in harms and broader patterns of use. This paper contributes to addressing this gap by measuring national trends in GHB use, harms and treatment in Australia.\n\n\nDesign, setting, and cases\nTriangulation of indicators (2013–2024) from Australian triennial population surveys; annual interviews with cross‐sectional non‐representative samples of people who use illicit stimulants or who inject drugs; and administrative data on GHB‐related hospitalisations, GHB‐related deaths, and treatment episodes where GHB was the principal drug of concern.\n\n\nMeasurements\nAnnual trend data were analysed using Joinpoint regression. Survey data were modelled as the annual percent change in the proportion reporting lifetime, past 12‐month, and past 6‐month use, depending on the survey. Administrative data were modelled as the annual percent change in crude rates per 100 000 population.\n\n\nFindings\nLifetime and past 12‐month GHB use in the general population remained below 1.2% and 0.2% respectively, but the latter increased from 0.07% in 2013 to 0.19% in 2022–2023 (annual percent change [APC] 9.3; 95% confidence interval [CI]: 5.2, 13.2). The percentage of people who use illicit stimulants reporting past 6‐month use increased from 5.7% in 2013 to 7.3% in 2017 (APC 11.6; 95%CI: 0.2, 52.9) and from 5.4% in 2019 to 11.5% in 2024 (APC 17.8; 95%CI: 5.9, 41.1). The proportion of people who inject drugs reporting use varied between 7.2% and 17.5% over the short period studied (2020–2024). There were statistically significant increases in GHB‐related hospitalisations from 5.3 in 2012–13 to 19.1 per 100 000 people in 2022–23 (APC 19.0; 95%CI: 11.9, 31.1) and GHB‐related deaths from 0.02 in 2013 to 0.24 per 100 000 people in 2022 (APC 36.5; 95%CI: 27.2, 58.1). Treatment episodes also increased across the period, from 0.07 in 2012–13 to 6.0 episodes per 100 000 people in 2020–21 (APC 97.3; 95%CI: 83.5, 830.9), with no subsequent statistically significant change (8.4 per 100 000 people in 2022–23).\n\n\nConclusions\nGamma‐hydroxybutyrate use, harms and treatment engagement increased in Australia from 2013 to 2024. These findings highlight a need to implement acceptable, tailored prevention and harm reduction strategies for key populations, and implement stronger monitoring efforts nationally and internationally.\n\n"]

  April 17, 2026   doi: 10.1111/add.70308   open full text
• Authorization of storefront recreational cannabis retailers and cannabis‐related healthcare encounters: A local‐level spatial difference‐in‐differences analysis in California, United States.
  Bing Han, Christian Gunadi, Yuyan Shi.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1262-1271, May 2026. ", "\nAbstract\n\nBackground and aims\nWhile half of the states in the United States of America (USA) have approved statewide retail sales of cannabis, local governments retain the authority to opt in or out of authorizing storefront recreational cannabis retailers. This study aimed to examine local‐level associations between the authorization of storefront recreational cannabis retailers and cannabis‐related healthcare encounters in California, USA.\n\n\nDesign\nA secondary data analysis of cannabis‐related healthcare encounters across 482 cities in California from 2010 to 2020. A spatial difference‐in‐differences model was employed at the city‐quarter level to assess both intracity and intercity associations, controlling for time‐varying city‐level policies and sociodemographic factors while accounting for spatial influence over neighboring cities.\n\n\nSetting\nCalifornia, USA.\n\n\nParticipants\nAll California residents from 2010 to 2020.\n\n\nMeasurements\nThree cannabis‐related healthcare encounter outcomes were assessed: (1) population‐adjusted emergency department visits, (2) population‐adjusted inpatient discharges, and (3) a binary indicator of any calls to poison centers. The primary policy variable was whether a city authorized storefront recreational cannabis retailers.\n\n\nFindings\nNo statistically significant intracity association was found between the authorization of storefront recreational cannabis retailers and rate of emergency visits [−0.14 percentage points; 95% confidence interval (CI) = −18.24 to 17.97; P = 0.988], rate of inpatient discharges (−6.11 percentage points; 95% CI = −17.58 to 5.36; P = 0.297) or probability of any poison center calls (−2.58 percentage points; 95% CI = −6.18 to 1.02; P = 0.161). For intercity associations, authorizing storefront recreational cannabis retailers was associated with a 6.75 percentage point decrease (95% CI = −12.46 to −1.03; P = 0.021) in the probability of any poison center calls in neighboring cities, suggesting that local cannabis policies may have influence extending beyond their immediate jurisdictions.\n\n\nConclusions\nIn California, USA, the local authorization of storefront recreational cannabis retailers appears to be associated with a reduction in cannabis‐related poison center calls in neighboring cities rather than within the policy‐implementing cities.\n\n"]

  April 17, 2026   doi: 10.1111/add.70318   open full text
• Smoking and drinking among the Gypsy and Traveller communities: A population study in England.
  Eve Taylor, Harry Tattan‐Birch, Melissa Oldham, Katherine East, Hannah Walsh, Sarah Jackson.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1128-1139, May 2026. ", "\nAbstract\n\nBackground and aims\nGypsy and Traveller communities in the United Kingdom (UK) face substantial health challenges. Smoking tobacco and drinking alcohol likely contribute to health disparities, but there is little national data on the prevalence or heaviness of smoking and drinking among these communities. We aimed to estimate the prevalence and heaviness of smoking and drinking among the UK Gypsy and Traveller communities compared with people from other UK ethnic groups.\n\n\nDesign/setting\nObservational study using data collected between 2013 and 2025 in a series of monthly cross‐sectional surveys of representative samples of the adult population in England.\n\n\nParticipants\nAdults aged 18+, between 2013 and 2025 (total n = 226 339; Gypsy or Traveller n = 213).\n\n\nMeasurements\nMarginal means were derived from regression models and used to estimate the prevalence of current smoking and drinking (both of which includes daily and non‐daily), and the heaviness of smoking (cigarettes per day) and drinking [Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) score, units per week and estimated weekly alcohol consumption] by ethnicity; adjusted for age, gender and survey year.\n\n\nFindings\nCurrent smoking prevalence was markedly higher among Gypsy and Travellers [33.0%, 95% confidence interval (CI) = 26.3–39.8%, n = 81] than among the “Other White” ethnic group (18.7%, 95% CI = 18.5–18.9%; P < 0.001), and exceeded estimates observed across other ethnic groups (range: 9.4–19.9%; all P < 0.001). Among those who smoked, Gypsy and Travellers reported smoking more cigarettes per day (geometric mean = 12.5, 95% CI = 8.9–17.6) than the “Other White” group (geometric mean = 9.0, 95% CI = 8.8–9.1; P = 0.59), with other ethnic groups ranging from 6.8–9.7, although not all comparisons reached significance. The proportion reporting any current alcohol consumption was lower among Gypsy and Travellers (61.5%, 95% CI = 53.8–69.2%, n = 126) than ‘Other White’ ethnicities (77.1%, 95% CI = 76.8–77.3%; P < 0.001). Prevalence of high risk drinking was similar among Gypsy and Travellers (11.3%, 95% CI = 6.7–15.8%) and “Other White” ethnic groups (10.7%, 95% CI = 10.5–10.9%; P = 0.808) but exceeded estimates observed across all other ethnic groups (range: 1.3–7.1%; all P < 0.05). Prevalence of possible dependence was higher among Gypsy and Travellers (3.5%, 95% CI = 0.4–6.6%) compared with the “Other White” (1.3%, 95% CI = 1.2–1.3%; P = 0.027) and all other ethnic groups (range: 0.3–0.8%; all P < 0.05).\n\n\nConclusions\nPeople from Gypsy and Traveller communities in the United Kingdom appear to be more likely to smoke compared with other UK ethnic groups, and those who smoke and/or drink do so at more harmful levels compared with other UK ethnic groups.\n\n"]

  April 17, 2026   doi: 10.1111/add.70330   open full text
• Predictors of outpatient treatment engagement following a visit to a specialized emergency department for substance use: A cohort study using high‐resolution electronic health records.
  Danilo Romero, Martin Kåberg, Anne H. Berman, Per Carlbring, Johan Franck, Philip Lindner.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1237-1248, May 2026. ", "\nAbstract\n\nBackground and aims\nSubstance‐related emergency department (ED) visits represent a critical opportunity to link individuals with sustained treatment for substance use disorders (SUD), yet few transition to post‐acute treatment. Among emerging initiatives to integrate specialized SUD care into ED services, the Stockholm SUD‐ED is an example of a fully integrated model that remains unmapped. This study aimed to systematically map care pathways and identify predictors of post‐acute SUD treatment engagement among SUD‐ED patients in Stockholm.\n\n\nDesign\nRetrospective cohort study. Electronic health records data were linked with five registries covering, among other aspects, clinical history and healthcare consumption.\n\n\nSetting\nThe Stockholm SUD‐ED, Sweden.\n\n\nParticipants\nn = 9771 SUD‐ED patients during a sixteen‐month period (2018–2019).\n\n\nMeasurements\nFor care flow mapping, post‐acute SUD treatment engagement was defined as ≥2 outpatient visits during a six‐month follow‐up. Four engagement levels (none, low, moderate, high) were derived using a quantile regression approach and regressed on 19 candidate predictors in multinomial logistic regression models.\n\n\nFindings\nOf all SUD‐ED patients, one‐third (33.2%; n = 3248) primarily engaged in post‐acute outpatient SUD treatment, 16.9% (n = 1651) primarily engaged in non‐SUD psychiatric services and 49.9% (n = 4872) did not engage in either. Police‐initiated admissions had lower odds of moderate or high post‐acute treatment engagement than ambulance‐initiated admissions [high engagement: adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.53–0.95]. Prior needle and syringe program visits increased the odds of post‐acute treatment engagement (aOR = 2.09, 95% CI = 1.59–2.75). Lack of prior SUD outpatient treatment was consistently associated with lower odds of post‐acute engagement across all levels (e.g. moderate engagement: aOR = 0.3, 95% CI = 0.25–0.35).\n\n\nConclusions\nThe Stockholm model for fully integrating specialized substance use disorder care into emergency departments appears to generate high post‐acute treatment engagement and highlights the need for (1) targeted interventions for police‐initiated admissions and (2) broad aftercare options to better attract treatment‐naïve patients.\n\n"]

  April 17, 2026   doi: 10.1111/add.70335   open full text
• Patterns, reasons and characteristics of e‐cigarette use in Australia: Findings from the 2022–2023 National Drug Strategy Household Survey.
  Carmen C. W. Lim, Tianze Sun, Germaine Lai, Wayne Hall, Jason Connor, Yan Yee Lee, Ara Cho.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1100-1109, May 2026. ", "\nAbstract\n\nBackground and aims\nE‐cigarette use (vaping) has increased in Australia despite restrictive policies. Little is known about the profiles and reasons to vape in this tightly regulated setting. This study aimed to determine the distinct profiles of individuals who vape and the socio‐demographic, psychological and substance use related correlates of these profiles.\n\n\nDesign\nObservational study using cross‐sectional data from from the 2022–2023 National Drug Strategy Household Survey.\n\n\nSetting\nAustralia.\n\n\nParticipants\n21 500 respondents aged 14 years and older.\n\n\nMeasurements\nLatent class analysis was used to identify distinct subgroups based on smoking status, vaping status, use of nicotine vapes, prescription vapes, inability to stop or cut down on the use of vapes and motivations to vape. Multinomial logistic regression explored the sociodemographic, mental health and substance use correlates of each identified class.\n\n\nFindings\nA five‐class solution was identified among the 18.7% of survey participants who have ever vaped. Class 1 (Experimented with vapes to quit smoking, 4.1%) predominantly included individuals who smoked daily and had experimented with vapes, presumably in the context of smoking cessation. Class 2 (Experimented with vapes for curiosity, 9.2%) mostly included individuals who had never smoked but had tried vaping once or twice out of curiosity. Class 3 (Exclusive Vaping, 4.2%) was characterised by individuals who regularly vaped but had never smoked. Class 4 (Non‐use, 80.3%) comprised individuals who did not currently smoke or vape. Class 5 (Using vapes to quit smoking, 2.2%) featured individuals who smoked and used e‐cigarettes as a cessation aid. Using Class 4 (non‐use) as a reference group, respondents in other classes, especially those in Class 5 (using vapes to quit smoking) reported very high psychological distress [odds ratio (OR) = 4.0, 99.6% confidence interval (CI) = 2.3–6.9], hazardous alcohol consumption (OR = 2.1, 99.6% CI = 1.4–3.3) and use of illicit drugs in the past year (OR = 6.4, 99.6% CI = 4.6–9.0).\n\n\nConclusions\nAustralians who vape appear to be associated with younger age, lower educational attainment, higher psychological distress and higher recent use of other substances compared with Australians who do not vape.\n\n"]

  April 17, 2026   doi: 10.1111/add.70281   open full text
• Comparing the accuracy of artificial intelligence models to detect alcohol in video images.
  Samatha Pararath Salim, Zhen He, Joshua Millward, Emmanuel Kuntsche, Benjamin Riordan.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1199-1206, May 2026. ", "\nAbstract\n\nBackground and aims\nThanks to smart devices, social media and streaming platforms, watching videos, like movies or short social media clips, has become extremely popular. Alcohol portrayals are frequent in videos, yet their prevalence is difficult to quantify using traditional methods such as manual coding. Artificial intelligence (AI) offers a scalable solution to analyse large volumes of video images. This study aimed to compare the accuracy of three AI models in detecting alcohol presence in video images.\n\n\nMethod\nExperimental evaluation of three models: one supervised deep learning model (ABIDLA2) and two zero‐shot learning models (ZSL‐CLIP and ZSL‐LLaVA). The models were tested on datasets of video frames that had been annotated by researchers for whether they included alcohol or not. Three datasets of increasing complexity were used: (1) a Google/Bing image set of clearly visible alcohol and non‐alcohol images; (2) a set of movie frames manually annotated as containing or not containing alcohol; and (3) a contextually challenging set of movie frames from alcohol‐related settings (e.g. bars, parties) that may or may not include visible alcohol. Model performance was assessed using accuracy, unweighted average recall (UAR) and F1 score, representing the balance between precision and recall. Execution time per frame was also measured to evaluate computational efficiency.\n\n\nResults\nAcross the three datasets, ABIDLA2, ZSL‐CLIP and ZSL‐LLaVA achieved percentage accuracies of 90%, 91% and 92% on the Google/Bing images; 70%, 65% and 95% on the diverse movie‐scene dataset; and 67%, 63% and 94% on the most complex alcohol‐related dataset, respectively. In terms of execution time, ABIDLA2 processed a single frame the fastest (0.21 seconds), followed by ZSL‐LLaVA (0.45 seconds), while ZSL‐CLIP was the slowest (0.58 seconds).\n\n\nConclusion\nAutomated artificial intelligence (AI) models appear to be able to detect alcohol imagery in videos at large scale with high accuracy and in near real time. Of the three AI models tested, ZSL‐LLaVA achieved the best balance between accuracy and speed. Offering a cost‐ and time‐efficient alternative to labour‐intensive manual coding, ZSL‐LLaVA could be used to monitor alcohol‐related visual content in videos across diverse media platforms.\n\n"]

  April 17, 2026   doi: 10.1111/add.70337   open full text
• Pharmacological treatment strategies to manage precipitated withdrawal following the administration of buprenorphine in opioid use disorder: A systematic review.
  Emmert Roberts, Nicola Kalk, John Strang.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1083-1099, May 2026. ", "\nAbstract\n\nBackground and aims\nThere has been limited evidence synthesis examining the treatment of buprenorphine precipitated opioid withdrawal (BPOW). We aimed to conduct the first systematic review to assess the clinical utility of any pharmacological intervention in the management of BPOW.\n\n\nMethods\nSystematic review searching Medline, Embase, PsychINFO and CENTRAL from the date of database inception to 26 August 2025 for studies of any design reporting any pharmacological intervention in the management of BPOW compared with any or no other interventions, using adult participants aged 18 or over receiving buprenorphine and experiencing BPOW. We planned to combine outcomes using random‐effects meta‐analysis; where this was not possible results were reported narratively. We considered two outcomes and extracted (1) any reported measure or description of the change in opioid withdrawal symptoms (OWS) and (2) the number of individuals retained in buprenorphine treatment. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.\n\n\nResults\nForty‐three studies met inclusion criteria reporting on 137 participants. These comprised one pilot randomised controlled trial and 42 uncontrolled observational case series or case reports. Meta‐analysis was not possible, and all evidence was of low or very low quality. The currently available randomised evidence suggests that use of intravenous magnesium sulphate, in addition to symptomatic treatment with clonidine, paracetamol and diazepam, may statistically significantly reduce OWS when compared with symptomatic treatment alone. The currently available observational evidence suggests that treatment strategies which include additional doses of transmucosal buprenorphine may demonstrate higher rates of symptom control and treatment retention than strategies which do not include additional doses of transmucosal buprenorphine.\n\n\nConclusions\nThere is a paucity of research into pharmacological management of buprenorphine precipitated opioid withdrawal. The limited very low to low quality evidence suggests treatment regimens that include magnesium sulphate and additional doses of transmucosal buprenorphine are potentially the most salient current options and avenues for future research in the management of buprenorphine precipitated opioid withdrawal.\n\n"]

  April 17, 2026   doi: 10.1111/add.70334   open full text
• Alcohol use disorder and risk of incident COVID‐19 infection: A nested case–control study in Taiwan.
  Yung‐Feng Yen, Yun‐Ju Lai, Sheng‐Siang Su, Chian‐Jue Kuo.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1190-1198, May 2026. ", "\nAbstract\n\nBackground and Aims\nAlcohol use disorder (AUD) may induce angiotensin‐converting enzyme 2 (ACE2) overexpression, potentially increasing vulnerability to severe acute respiratory syndrome coronavirus‐2 infection. However, the relationship between AUD and the risk of coronavirus disease 2019 (COVID‐19) infection remains unclear. This study aimed to measure the association between AUD and the incidence of COVID‐19 infection.\n\n\nDesign\nWe identified 247 000 individuals with AUD between 2001 and 2019 from the Taiwan National Health Insurance Research Database. Another 2 470 000 age‐ and sex‐matched controls without AUD were randomly selected for comparison. All study participants were followed up until the occurrence of new‐onset COVID‐19 infection, death, or December 31, 2021.\n\n\nSetting\nTaiwan National Health Insurance Research Database.\n\n\nParticipants\nA total of 247 000 individuals with AUD and 2 470 000 controls without AUD.\n\n\nMeasurements\nA new diagnosis of COVID‐19 was determined by a positive real‐time reverse transcriptase‐polymerase chain reaction test. We employed a Cox regression model, considering death as a competing risk, to assess the impact of AUD on the risk of COVID‐19 infection.\n\n\nFindings\nAmong 2 717 000 participants, 2374 developed incident COVID‐19 during an average follow‐up of 1.98 years, including 415 (0.17%) individuals with AUD and 1959 (0.08%) controls. After adjusting for age, sex, urbanization, COVID‐19 vaccination status, anxiety disorder, and the Charlson Comorbidity Index, AUD was statistically significantly associated with a higher risk of incident COVID‐19 infection (adjusted hazard ratio [AHR]:1.19; 95% confidence interval [CI]:1.06–1.34). Subgroup analyses, stratified by age, sex, and COVID‐19 vaccination status, revealed that AUD was linked to the risk of incident COVID‐19 infection across all subgroups, except for individuals aged 18–49 years, men, and those who were unvaccinated.\n\n\nConclusions\nAlcohol use disorder appears to be an independent risk factor for incident COVID‐19 infection. These findings highlight the importance of prioritizing individuals with AUD as a key target population for COVID‐19 prevention efforts.\n\n"]

  April 17, 2026   doi: 10.1111/add.70309   open full text
• The impact of opioid, cannabis and cocaine use disorder on the risk of diabetic retinopathy in patients with type 2 diabetes mellitus.
  Ming‐Pei Yueh, Yu‐Ting Yu, Cyuan‐Yi Yeh, Kai‐Wen Cheng, Shih‐Kai Kao.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1207-1216, May 2026. ", "\nAbstract\n\nBackground and aims\nOpioid use disorder (OUD), cannabis use disorder (CUD) and cocaine use disorder have been associated with a range of adverse health outcomes, including certain ocular manifestations; however, their impact on diabetic retinopathy (DR) remains insufficiently explored. This study aimed to measure the association between OUD, CUD and cocaine use disorder and the risk of DR among patients with type 2 diabetes mellitus (T2DM).\n\n\nDesign\nPropensity‐score‐matched retrospective cohort study.\n\n\nSetting\nThis study used the TriNetX US Collaborative Network to access electronic health records (EHRs), including data on demographics, diagnoses, medication use and laboratory results.\n\n\nParticipants/cases\nA total of 131 088 adult patients with T2DM and comorbid OUD, CUD or cocaine use disorder, and 131 088 adult patients with T2DM without these conditions, were identified following propensity score matching.\n\n\nMeasurements\nThe primary outcome was the risk of DR evaluated over a 5‐year follow‐up period. The risks of various DR subtypes and diabetic macular edema (DME) were also assessed. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated.\n\n\nFindings\nOver a 5‐year follow‐up period, patients with T2DM comorbid with OUD, CUD or cocaine use disorder had a statistically significantly higher risk of developing DR [HR (95% CI) = 2.90 (2.55–3.30), P < 0.00] compared with those without any drug use disorder. Drug use disorders were also associated with elevated risks of vision‐threatening diabetic retinopathy (VTDR) [HR (95% CI) = 2.78 (2.24–3.46), P < 0.00], non‐proliferative diabetic retinopathy (NPDR) [HR (95% CI) = 3.10 (2.61–3.68), P < 0.00], proliferative diabetic retinopathy (PDR) [HR (95% CI) = 3.17 (2.26–4.45), P < 0.00] and DME [HR (95% CI) = 2.64 (2.04–3.42), P < 0.00] among patients with T2DM.\n\n\nConclusions\nOpioid use disorder, cannabis use disorder and cocaine use disorder appear to be associated with an elevated risk of diabetic retinopathy among patients with type 2 diabetes mellitus.\n\n"]

  April 17, 2026   doi: 10.1111/add.70275   open full text
• Effectiveness of smoking cessation pharmacotherapies during pregnancy: A multi‐national population‐based study.
  Annelies L. Robijn, Sarah Donald, Jacqueline M. Cohen, Duong T. Tran, Carolyn E. Cesta, Kari Furu, Lianne Parkin, Sallie‐Anne Pearson, Johan Reutfors, Helga Zoega, Nicholas Zwar, Alys Havard.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1112-1127, May 2026. ", "\nAbstract\n\nAims\nAs clinical trial evidence on the effectiveness of smoking cessation pharmacotherapies during pregnancy is inconclusive, we conducted a large cohort study examining their effectiveness and comparative effectiveness during pregnancy.\n\n\nDesign\nPopulation‐based cohort study. We used propensity score matching and conditional Poisson regression to compare pharmacotherapy‐exposed with unexposed pregnancies, and to compare varenicline‐exposed with nicotine replacement therapy (NRT) ‐exposed pregnancies.\n\n\nSetting\nBirth records (2005–2020) from New South Wales (NSW) Australia, New Zealand (NZ) and Norway/Sweden linked to pharmacotherapy dispensing records.\n\n\nParticipants/cases\nWomen with a birth record indicating smoking in early pregnancy [during first 20 weeks' gestation (NSW), at lead maternity registration (NZ) or during the first trimester (Norway/Sweden)]. Participants were dispensed prescription NRT, varenicline or bupropion in the first 18 weeks of gestation (NSW, Norway/Sweden) or between the first antenatal visit and childbirth (NZ).\n\n\nMeasurements\nWe defined smoking cessation as not smoking after gestational week 20 (NSW), at gestational week 32–36 (Norway/Sweden) and at two weeks postpartum (NZ), identified via self‐report and documented in the birth record.\n\n\nFindings\nOur NRT analyses included 623, 7074 and 70 exposed and 6026, 68 161 and 700 propensity‐score‐matched unexposed pregnancies from NSW, NZ and Norway/Sweden, respectively. The associations between NRT and smoking cessation were mixed but tended toward reduced cessation compared with no pharmacotherapy. In NSW, NRT was associated with a reduction in cessation [relative risk (RR) = 0.68, 95% confidence interval (CI) = 0.48–0.97], while in NZ, the effect was smaller (RR = 0.93, 95% CI = 0.89–0.98) but inconclusive in Norway/Sweden (RR = 0.91, 95% CI = 0.61–1.35). Smoking cessation was also equally or less common among varenicline‐exposed pregnancies (NSW: 308 exposed vs 3077 matched unexposed, RR = 0.89, 95% CI = 0.72–1.09, Norway/Sweden: 196 exposed vs 1960 matched unexposed, RR = 0.49, 95% CI = 0.34–0.70). Our comparison of varenicline‐exposed with NRT‐exposed pregnancies indicated increased smoking cessation among varenicline‐exposed pregnancies (NSW: 108 vs 154 exposed, RR = 1.91, 95% CI = 1.10–3.22). There were too few bupropion‐exposed pregnancies to support interpretation.\n\n\nConclusions\nVarenicline appears to be more effective at smoking cessation than nicotine replacement therapy during pregnancy. The uncertainty about the real‐world effectiveness of nicotine replacement therapy and bupropion remains as this study's analyses were impacted by non‐adherence and biased by unmeasured confounding.\n\n"]

  April 17, 2026   doi: 10.1111/add.70290   open full text
• Trajectories of genetic risk across dimensions of alcohol use behaviors.
  Jeanne E. Savage, Fazil Aliev, Peter B. Barr, Maia Choi, Gabin Drouard, Megan E. Cooke, Sally I. Kuo, Mallory Stephenson, Sarah J. Brislin, Zoe E. Neale, Spit for Science Working Group, Karen Chartier, Ananda Amstadter, Danielle M. Dick, Emily Lilley, Renolda Gelzinis, Anne Morris, Katie Bountress, Amy E. Adkins, Nathaniel Thomas, Zoe Neale, Kimberly Pedersen, Thomas Bannard, Seung B. Cho, Peter Barr, Holly Byers, Erin C. Berenz, Erin Caraway, James S. Clifford, Megan Cooke, Elizabeth Do, Alexis C. Edwards, Neeru Goyal, Laura M. Hack, Lisa J. Halberstadt, Sage Hawn, Sally Kuo, Emily Lasko, Jennifer Lend, Mackenzie Lind, Elizabeth Long, Alexandra Martelli, Jacquelyn L. Meyers, Kerry Mitchell, Ashlee Moore, Arden Moscati, Aashir Nasim, Jill Opalesky, Cassie Overstreet, A. Christian Pais, Tarah Raldiris, Jessica Salvatore, Jeanne Savage, Rebecca Smith, David Sosnowski, Jinni Su, Chloe Walker, Marcie Walsh, Teresa Willoughby, Madison Woodroof, Jia Yan, Cuie Sun, Brandon Wormley, Brien Riley, Fazil Aliev, Roseann Peterson, Bradley T. Webb, COGA Investigators, Bernice Porjesz, Victor Hesselbrock, Arpana Agrawal, Danielle Dick, Howard J. Edenberg, Tatiana Foroud, Yunlong Liu, Martin H. Plawecki, Samuel Kuperman, Allan Anderson, Jacquelyn Meyers, Laura Bierut, Sarah Hartz, Marc Schuckit, Ronald Hart, Jay Tischfield, Laura Almasy, Alison Goate, Paul Slesinger, Denise Scott, Cathryn Holzhauer, Michie Hesselbrock, Dongbing Lai, John Nurnberger Jr., Leah Wetherill, Xiaoling Xuei, Sean O'Connor, John Kramer, Grace Chan, Chella Kamarajan, Ashwini Pandey, David B. Chorlian, Sivan Kinreich, Gayathri Pandey, Chris Chatzinakos, Jian Zhang, Stacey Saenz deViteri, Christian Richard, Arjun Bingly, Gita Pathak, Andrey Anokhin, Kathleen Bucholz, Fanghong Dong, Alexander Hatoum, Emma Johnson, Vivia McCutcheon, John Rice, Scott Saccone, Zhiping Pang, Sarah Brislin, Jennifer Moore, Alison Merikangas, Miri Gitik, Antti Latvala, Richard J. Rose, Jaakko Kaprio, Danielle M. Dick, Jacquelyn Meyers, Jessica E. Salvatore, Danielle Posthuma.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1153-1165, May 2026. ", "\nAbstract\n\nBackground and aims\nAlcohol use behaviors (AUBs) manifest in a variety of normative and problematic ways across the life course, all of which are heritable. Twin studies show that genetic influences on AUBs change across development, but this is usually not considered in research identifying and investigating the genes linked to AUBs. Understanding the dynamics of how genes shape AUBs could point to critical periods in which interventions may be most effective and provide insight into the mechanisms behind AUB‐related genes. In this project, we estimated how genetic influences on AUBs unfold across development using longitudinal modelling of polygenic scores (PGSs).\n\n\nDesign\nUsing results from genome‐wide association studies (GWASs), we created PGSs to index individual‐level genetic risk for multiple AUB‐related dimensions: Consumption, Problems, a temporally variable pattern of drinking associated with a preference for beer (BeerPref) and externalizing behavior (EXT). We created latent growth curve models and tested PGSs as predictors of latent growth factors (intercept, slope, quadratic) underlying trajectories of AUBs.\n\n\nSetting\nPGSs were derived in six longitudinal epidemiological cohorts from the United States, United Kingdom and Finland.\n\n\nParticipants\nParticipant data were obtained from the longitudinal studies AddHealth, ALSPAC, COGA, FinnTwin12, the older Finnish Twin Cohort and Spit for Science (total n = 19 194). These cohorts included individuals aged 14 to 67, with repeated measures collected over a span of 4 to 36 years.\n\n\nMeasurements\nPrimary measures included monthly frequency of typical alcohol consumption (CON) and heavy episodic drinking (HED).\n\n\nFindings\nWhen drinking behaviors were averaged across time, higher Consumption, Problems and EXT PGSs were robustly associated with higher levels of CON and HED (βs ranged from 0.105 to 0.333, P < 3.09E‐04) and higher BeerPref PGSs with higher HED (β = 0.064, P = 3.65E‐05). However, these PGSs were largely not associated with drinking trajectories in the latent growth curve models. In the meta‐analysis, only PGSs for chronic alcohol Problems consistently predicted a steeper slope (increasing trajectory) of CON across time (B = 0.470, P = 4.20E‐06). Other PGSs were associated with latent growth factors in some individual cohorts, but there was a large degree of heterogeneity.\n\n\nConclusions\nGenetic associations appear to differ not only between alcohol use behaviors, but also across developmental time points and across cohorts, highlighting the need for genetic studies to take such heterogeneity into account. Individual‐level genetic profiles may be useful to point to personalized intervention timelines, particularly for individuals with high genetic risk scores for alcohol problems.\n\n"]

  April 17, 2026   doi: 10.1111/add.70292   open full text
• Endocannabinoid system gene expression in mesocorticolimbic brain regions of individuals with alcohol use disorder: A descriptive study.
  María Salud García‐Gutiérrez, Abraham Bailén Torregrosa, Francisco Navarrete, Auxiliadora Aracil‐Fernández, Gabriel Rubio, Jorge Manzanares.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1179-1189, May 2026. ", "\nAbstract\n\nAims\nTo describe differences in the expression of genes encoding cannabinoid receptors (CNR1, CNR2), the associated receptor GRP55 and the enzymes fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MGLL) between individuals with alcohol use disorder (AUD) and controls in key mesocorticolimbic brain regions.\n\n\nDesign\nCase‐control, observational postmortem study comparing gene expression in brain tissue from individuals diagnosed with AUD and matched controls. The study was not pre‐registered and should therefore be considered exploratory.\n\n\nSetting\nBrain collection from the New South Wales Tissue Resource Centre (NSWTRC) at the University of Sydney, Australia.\n\n\nParticipants/cases\nBrain samples were obtained from 18 patients with AUD (mean alcohol use = 35.5 ± 8.7 drinking years) and 18 controls (C). Groups were matched for age (AUD: 55.8 ± 9; C: 56.3 ± 9.4) and postmortem interval (AUD: 39.7 ± 16.9 h; C: 31.8 ± 13.2 h).\n\n\nMeasurements\nRelative gene expression of CNR1, CNR2, GPR55, FAAH and MGLL was quantified using real‐time polymerase chain reaction (qPCR) in the prefrontal cortex (PFC) and nucleus accumbens (NAc).\n\n\nFindings\nCompared with controls, individuals with AUD showed higher CNR1 in the PFC (+125%) and NAc (+78%) and lower CNR2 expression in both regions (PFC: −50%; NAc: −49%). GPR55 was higher in the PFC (+19%) and lower in the NAc (−51%). FAAH expression was lower in the PFC (−15%) and higher in the NAc (+24%), whereas MGLL expression did not differ in the PFC and was lower in the NAc (−15%).\n\n\nConclusions\nThis descriptive postmortem study identifying region‐specific differences in endocannabinoid system gene expression between individuals with alcohol use disorder (AUD) and controls supports an involvement of the endocannabinoid system in the neuropathological features associated with AUD, although causal relationships cannot be inferred.\n\n"]

  April 17, 2026   doi: 10.1111/add.70293   open full text
• The association of methadone use with physical function and frailty among persons who inject drugs.
  Grace L. Kulik, Hsing‐Yu Hsu, Jacqueline Rudolph, Yutong Jiang, Kristine M. Erlandson, Damani A. Piggott, Shruti Mehta, Jeremy D. Walston, Gregory Kirk, Todd T. Brown, Jing Sun.
  Addiction. April 17, 2026
  ["Addiction, Volume 121, Issue 5, Page 1217-1226, May 2026. ", "\nAbstract\n\nBackground and Aims\nPersons who inject drugs (PWID) experience a high burden of early‐onset frailty, primarily due to multifactorial causes such as infections (human immunodeficiency virus [HIV], hepatitis C virus [HCV]), substance use, and polypharmacy. Methadone, although an effective treatment for opioid use disorder, has demonstrated toxicity across several body systems that may impact or accelerate the aging process. Therefore, the purpose of this analysis was to determine the association of methadone use with frailty and physical function among PWID.\n\n\nDesign\nThis study performed a retrospective analysis from the AIDS Linked to IntraVenous Experience (ALIVE) longitudinal cohort between 2005 and 2020, using multivariable mixed effect logistic regression, adjusting for demographics, body mass index, substance use, HIV, and comorbidities.\n\n\nSetting\nBaltimore, Maryland, United States.\n\n\nParticipants\nAdult participants (≥18 years) were recruited into the ALIVE cohort if they reported a history of or current injection drug use. Our study included 2153 participants with 13 909 person‐years of follow‐up.\n\n\nMeasurements\nMethadone usage, whether prescribed or non‐medical, was self‐reported by participants during study follow‐up. The primary outcome measurement was frailty as defined by the Fried frailty phenotype. Physical function was measured using grip strength and 4‐m gait speed.\n\n\nFindings\nAt baseline, 883 were currently using methadone. Median age was 48 (interquartile range: 42, 53) years; 81% were Black, 34% female, 80% had incomes <$5000, and 31% were living with HIV. Methadone use was associated with 25% higher odds of frailty (95% confidence interval [CI]: 1.09, 1.43). This difference suggested that the odds of frailty among individuals using methadone at age 50 were comparable to those not using methadone at age 54. Methadone use was associated with lower average grip strength [−0.71 kg (95% CI: −0.94, −0.48)], but not slower gait speed.\n\n\nConclusions\nAmong persons who inject drugs, those using methadone appear to be more likely to experience frailty at an earlier age compared with those not using methadone. Early screening for frailty and other geriatric conditions may be warranted among individuals with active methadone use in this population.\n\n"]

  April 17, 2026   doi: 10.1111/add.70306   open full text
• A population‐based study exploring racial and gender inequities in polysubstance‐related deaths across the United States from 2004 to 2022.
  Kechna Cadet, Paige Brinzo, Silvia S. Martins.
  Addiction. April 15, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aim\nRecent studies have shown that Black men and women have been disproportionately impacted by overdose deaths within recent years, with their mortality rates rising sharply compared with their White counterparts. As the United States is in the fourth wave of the polysubstance use overdose crisis, it is unclear if polysubstance use is contributing to these disparate patterns of overdose mortality across race and gender. This study aimed to measure gender‐specific racial disparities in opioid related polysubstance use drug mortality in the United States from 2004 to 2022.\n\n\nDesign, setting and participants\nIn this population‐level study of all deaths occurring in the United States, we obtained finalized death records of overdose fatalities identified using codes in the International Classification of Diseases, Tenth Revision (ICD‐10) from Centers for Disease Control (CDC) and Prevention's Wide‐Ranging Online Database for Epidemiologic Research (WONDER) Multiple Cause of Death file, from 2004 to 2022. Annual Percent Change (APC) and Annual Average Percent Change (AAPC) in age‐adjusted mortality rates (AAMR) for White men, White women, Black men, Black women, Hispanic men and Hispanic women were determined using joinpoint regression in this cross‐sectional study.\n\n\nMeasurements\nJoinpoint regression was used to examine mortality rates for opioid‐only, opioids with a stimulant, opioids with benzodiazepines, among racial/gender groups to measure temporal trends in age‐adjusted overdose mortality due to polysubstance‐related overdose.\n\n\nFindings\nThe final analytic sample included n = 627 793 opioid‐only deaths, n = 196 001 opioid‐stimulant and n = 117 322 opioid‐benzodiazepine overdose deaths. Opioid‐involved deaths increased across all groups, with the highest absolute rate change experienced by non‐Hispanic Black men (53.55 per 100 000, AAPC: 17.3%) and pronounced increases shown to occur between 2011 and 2022 (APC: 29.0%). Opioid‐stimulant polysubstance use deaths had the largest increases among non‐Hispanic Black men and women, with a 39.5% APC (2011–2022) for men and 36.2% APC (2012–2022) for women. Among Hispanic men, the rates accelerated 33.8% per year (2012–2022). For opioid‐benzodiazepine polysubstance use deaths, non‐Hispanic White men and women experienced the highest absolute rate change of 3.39 and 2.41 per 100 000, respectively.\n\n\nConclusions\nIn the United States from 2004 to 2022, overdose deaths from polysubstance use escalated sharply across all racial and ethnic groups, with disproportionate increases across non‐Hispanic Black and Hispanic individuals, particularly in opioid‐stimulant and opioid‐only profiles.\n\n"]

  April 15, 2026   doi: 10.1111/add.70409   open full text
• The Opioid Safety Toolkit: An interactive prescription opioid safety toolkit to increase opioid safety literacy and behaviours among people prescribed opioids for pain—a randomised controlled trial.
  Suzanne Nielsen, Frederick Fox, Tina Lam, Alex Waddell, Monica Jung, Bosco Rowland, Jessica Watterson, Dhruv Basur, Chris Prawira, Joshua Paolo Seguin, Patrick Olivier, Jarrod McMaugh, Paul Dietze, Louisa Picco.
  Addiction. April 14, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nPrescription opioid‐related harm remains a significant public health concern. This study aimed to evaluate the efficacy of the Opioid Safety Toolkit, a co‐designed, interactive online resource, in increasing naloxone uptake and healthcare provider discussions among adults prescribed opioids for pain.\n\n\nDesign\nParallel‐group, open‐label, randomised controlled trial.\n\n\nSetting\nCommunity‐based, online recruitment across Australia.\n\n\nParticipants\nAdults (n = 314) prescribed opioids for non‐cancer pain.\n\n\nInterventions\nParticipants were randomised to receive either the Opioid Safety Toolkit (intervention, n = 152), which included interactive and tailored educational content on opioid safety, or an active control website presenting evidence‐based opioid safety information (n = 162). Both groups were followed for four weeks.\n\n\nMeasurements\nThe primary outcome was self‐reported naloxone requests four weeks post‐intervention. Other outcomes were intentions to access naloxone immediately post‐intervention, and healthcare provider discussions about opioid safety at four weeks, opioid safety knowledge (immediately after the intervention and at four weeks), satisfaction with resources and naloxone possession at four weeks.\n\n\nFindings\nParticipants in the intervention group were more likely to have requested naloxone at four weeks compared with controls [21.7% vs 9.9%, odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.3, 4.8; P = 0.005], and more likely to report intentions to access naloxone immediately post‐intervention compared with controls (41.4% vs 15.4%, OR = 3.9, 95% CI = 2.3, 6.6; P < 0.001). Participants in the intervention group were not more likely to have healthcare provider discussions at four weeks compared with controls (OR = 1.1, 95% CI = 0.7, 1.8; P = 0.620). Post‐intervention opioid overdose knowledge was statistically significantly higher in the intervention group compared with control group (Mean score 16.6, 95% CI = 15.5, 17.7 vs control mean score 13.3, 95% CI = 12.3, 14.3). Satisfaction with the resource was higher in the intervention group compared with control group (Mean = 20.0, 95% CI = 18.7, 21.3 vs Mean = 18.0, 95% CI = 16.7, 19.3, P = 0.035).\n\n\nConclusions\nWe found good evidence that, compared with a gold‐standard opioid information website, the Opioid Safety Toolkit increased naloxone requests among Australian adults prescribed opioids for non‐cancer pain. We also observed consistent effects across secondary outcomes, with the Toolkit increasing intentions to access naloxone, enhancing opioid overdose knowledge and yielding higher satisfaction ratings, although it did not increase healthcare provider discussions at four weeks.\n\n"]

  April 14, 2026   doi: 10.1111/add.70412   open full text
• Excess mortality following discharge from substance use disorder treatment in Chile.
  Andrés González‐Santa Cruz, Alvaro Castillo‐Carniglia, Jay S. Kaufman.
  Addiction. April 10, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nPeople with substance‐use disorders (SUDs) have increased mortality risk, yet Chilean estimates of SUD‐based mortality are scarce. This study aimed to quantify all‐cause and cause‐specific mortality following SUD treatment in Chile compared with the general population and assess variation across key clinical and demographic subgroups.\n\n\nDesign\nNational‐level registry‐based retrospective data linkage cohort study.\n\n\nSetting\nPublicly funded SUD psychosocial treatments offered by the Chilean National Drug Agency, linked with official national mortality records from 2010 to 2020.\n\n\nParticipants\n70064 adults aged 18–64 years (24% women, median age 35 at treatment entry) were followed after their first treatment episode until death or 31 December 2020.\n\n\nMeasurements\nPrimary outcome was all‐cause mortality. Secondary outcomes were cause‐specific mortality by the International Classification of Diseases, 10th revision, underlying and external causes. We estimated age–sex–calendar year directly standardized rates (DSR), and standardized mortality ratios (SMR) compared with the expected rate for the (sub)population. We also stratified rates and ratios by sex (men/women), attained age (18–29, 30–44, 45–59, 60+), setting (ambulatory/residential), primary substance (alcohol; illicit: predominantly cocaine paste base, marijuana and cocaine hydrochloride) and treatment compliance (not completed/completed). Additionally, we estimated rates and SMRs for underlying and external causes of mortality.\n\n\nFindings\nOver a median 4.9‐year follow‐up (353 826 person‐years), 2996 deaths occurred [DSR = 10.6, 95% confidence interval (CI) = 8.6–13.1]. Overall SMR was 3.65 (95% CI = 3.52–3.79). Excess risk was particularly pronounced for women (SMR = 5.57, 95% CI = 5.14–6.03), patients admitted due to alcohol use disorder (SMR = 4.59, 95% CI = 4.33–4.86), in residential care (SMR = 4.91, 95% CI = 4.45–5.42) and treatment noncompletion (SMR = 4.04, 95% CI = 3.85–4.24). Cause‐specific mortality revealed elevated external‐cause excess risk for SUD patients, including intentional self‐harm (SMR = 6.67, 95% CI = 6.05–7.36), unintentional injuries (SMR = 5.37, 95% CI = 4.79–6.02) and assaults (SMR = 4.98, 95% CI = 4.16–5.96). Notable excess risk was also observed for non‐external mortality causes: digestive system (SMR = 8.20, 95% CI = 7.62–8.83), symptoms and signs (SMR = 5.18, 95% CI = 4.29–6.26) and respiratory diseases (SMR = 5.18, 95% CI = 4.47–5.99) were greater than expected.\n\n\nConclusions\nIn Chile, patients with a history of publicly funded substance‐use disorder treatment appear to have an all‐cause mortality up to 3.7 times higher than the general population, driven predominantly by digestive and respiratory causes, as well as self‐harm, unintentional injuries and assaults.\n\n"]

  April 10, 2026   doi: 10.1111/add.70420   open full text
• A genetically informed cross‐lagged twin study of the longitudinal association between addiction‐related behaviors and obesity.
  Baiyu Qi, Heather M. Highland, Mariaelisa Graff, Cynthia M. Bulik, Soo Hyun Rhee, Michael C. Stallings, John K. Hewitt, Daniel E. Gustavson, Chandra A. Reynolds, Kari E. North, Melissa A. Munn‐Chernoff.
  Addiction. April 09, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nAddiction‐related behaviors, such as loss of control eating (LOC), cigarette smoking and alcohol consumption, have been associated with high body mass index (BMI). This study aimed to assess genetic and environmental contributions to these associations over time.\n\n\nDesign\nA longitudinal twin study using data from waves 2 and 3 of the Center on Antisocial Drug Dependence study, employing additive genetic (A), shared environmental (C), nonshared environmental (E) influences and cross‐lagged models.\n\n\nSetting\nColorado, USA.\n\n\nParticipants\nThe sample included 764 male and 997 female same‐sex twins.\n\n\nMeasurements\nBMI was calculated using self‐reported height and weight. LOC was self‐reported. Cigarettes smoked per day (CPD) and drinks per week (DPW) were assessed during interviews.\n\n\nFindings\nWe conducted three cross‐lagged models: LOC and BMI in males, LOC and BMI in females and CPD and BMI in females, after excluding small phenotypic correlations (|r| < 0.10). Trait stability over time was largely attributable to genetic factors, accounting for 62% of the variance in BMI (both sexes), 11% in LOC (males), 18% in LOC (females) and 56% in CPD (females) at wave 3. Residual effects were mostly from nonshared environmental factors, accounting for 38% of the variance in BMI (both sexes), 76% of LOC (females), 71% of LOC (males) and 44% of CPD (females) at wave 3. A small but statistically significant cross‐lagged effect occurred from wave 2 BMI to wave 3 LOC, explaining 12% (males) and 3% (females) of the variance in wave 3 LOC, with genetic factors accounting for most of this effect. No cross‐lagged effects emerged from LOC or CPD to BMI.\n\n\nConclusions\nGenetic factors contributing to higher body mass index at an earlier age may also increase the risk of developing loss of control eating later in life, highlighting the importance of early weight‐related interventions to prevent the onset of disordered eating behaviors.\n\n"]

  April 09, 2026   doi: 10.1111/add.70407   open full text
• Which personality traits are necessary conditions for problematic alcohol use? Insights from a 23‐year longitudinal study.
  Angela Giugovaz, Peter Prinzie, Miranda C. Lutz, Ingmar H. A. Franken, Igor Marchetti.
  Addiction. April 07, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nPersonality traits have been consistently linked to alcohol use. High neuroticism and extraversion and low agreeableness and conscientiousness are known risk factors for both alcohol use frequency and problematic use across the lifespan. These associations have mostly been studied in the sufficient causality domain (“if X, then probably Y”), whereas little is known about these relationships in the necessary causality one (“if not X, then not Y”). Knowing that a variable is a necessary cause for an outcome helps identify who will be at risk for the outcome and who will be virtually immune. The aim of this study was to test whether personality traits in childhood, adolescence and emerging adulthood might serve as necessary conditions for problematic alcohol use in adulthood.\n\n\nDesign\nThe study is part of the “Flemish Study on Parenting, Personality, and Development”, and it is a 23‐year longitudinal study across four time points [childhood (T1), adolescence (T2), emerging adulthood (T3), adulthood (T4)].\n\n\nSetting\nFlanders (Belgium).\n\n\nParticipants\nAt T1, the total sample consisted of 306 participants (age = 7.8 ± 1.13 years, and 59.15% females), at T2 of 289 participants (age = 15.78 ± 1.16 years, 59.86% females), at T3 of 290 participants (age = 21.78 ± 1.15 years, 59.66% females) and at T4 of 306 participants (age = 30.08 ± 1.13 years, 59.15% females).\n\n\nMeasurements\nPersonality traits were assessed in childhood, adolescence and emerging adulthood using the Hierarchical Personality Inventory for Children (HiPIC) and were related to problematic alcohol use, measured through the Alcohol Use Disorders Identification Test (AUDIT), in adulthood. Necessary Condition Analysis (NCA) was used to test whether specific traits were necessary for the outcome, and to what extent.\n\n\nFindings\nConscientiousness emerged as a developmentally stable necessary condition for problematic alcohol use in adulthood (childhood: d = 0.31, P = 0.050; adolescence: d = 0.33, P = 0.052; emerging adulthood: d = 0.33, P = 0.023; all large effects). No other personality traits reached statistical significance.\n\n\nConclusions\nIt is possible to identify, already in childhood and through the lifespan, personality characteristics that distinguish individuals vulnerable to developing problematic alcohol use in adulthood from those who are not. Specifically, lower levels of conscientiousness appear to be necessary to be at risk of potentially developing problematic alcohol use in adulthood, whereas high levels of conscientiousness appear to lead to virtual immunity.\n\n"]

  April 07, 2026   doi: 10.1111/add.70417   open full text
• Comparative effectiveness of social‐contextual treatments for improving substance‐related problems among Black adults: An individual‐level data synthesis.
  Adriana Espinosa, Angela M. Haeny, Lesia M. Ruglass, Caravella McCuistian, Ashley Vena, Christopher Roundtree, Joel Lopez, Antonio A. Morgan‐López, A. Kathleen Burlew.
  Addiction. April 02, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nDespite similar substance use levels, Black adults experience greater family, legal, employment and other social‐contextual challenges related to recovery than other groups. Substance use treatments that address both substance use and social‐contextual factors are uniquely positioned to address these substance‐related problems and produce more sustainable improvements in social functioning than treatment as usual (TAU) or behavioral controls (Control). The aim of this study was to evaluate changes in substance‐related problems among Black adults, focusing on the comparative effectiveness between social‐contextual treatments and TAU/Control.\n\n\nDesign\nIndividual‐level data synthesis based on secondary analysis of Black adults enrolled in the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN).\n\n\nSetting\nAll data were collected in the primary studies between 2001 and 2008 at clinics across the United States.\n\n\nParticipants\nBlack adults who reported cocaine and/or opioid use across nine studies within the NIDA CTN. The sample used herein consisted of individuals from five of these studies who provided data on substance‐related problems (n = 532; mean age = 39.34; standard deviation = 9.6).\n\n\nMeasurements\nThere were two treatment conditions: Social‐contextual (e.g. Motivational Interviewing, Seeking Safety, STAGE 12) and TAU/Control. Moderated nonlinear factor analysis estimated latent scores for substance‐related problems, using subscales from the Addiction Severity Index, while accounting for measurement noninvariance across studies, time and covariates. Linear mixed models estimated latent score differences over time between social‐contextual treatments and TAU/Control during treatment and from the end of treatment through 12‐month follow‐up.\n\n\nFindings\nBoth treatment groups improved across substance‐related problem areas from baseline to the end‐of‐treatment (Cohen's d = −0.10 to d = −0.47), with effects maintained at 12‐month follow‐up. Although social‐contextual treatments did not statistically significantly outperform TAU/Control from baseline to end‐of‐treatment, they showed greater effects from end of treatment to 12‐month follow‐up in family/social [Cohen's d difference (Δd) = −0.47, 95% confidence interval (CI) = −0.57 to −0.38], legal (Δd = −0.20, 95% CI = −0.31 to −0.10) and psychiatric problems (Δd = 0.29, 95% CI = −0.38 to −0.20) than TAU/Control. Sensitivity analyses indicated that Seeking Safety and STAGE 12 predominantly drove post‐treatment improvements in family/social problems.\n\n\nConclusions\nSubstance use treatment may yield broader, delayed benefits beyond substance use reduction among Black adults in the United States. Compared with treatment‐as‐usual, social‐contextual treatments can yield more sustainable effects in legal, family and psychiatric areas among Black adults, with interventions such as Seeking Safety and STAGE 12 showing particular benefits in addressing family‐related challenges.\n\n"]

  April 02, 2026   doi: 10.1111/add.70405   open full text
• Unlocking ‘stuckness’ and catalysing change: A qualitative study of clinician and service leader perspectives on psychedelic‐assisted therapy for substance use and mental health problems.
  Sarah J. Catchlove, Katrin Oliver, Michael Savic, Shalini Arunogiri.
  Addiction. March 30, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nAustralia recently down‐scheduled and authorised psychedelic‐assisted therapies, including psilocybin, for certain mental health conditions. Evidence is emerging for potential application in substance use disorder treatment. However, regulatory developments have outpaced implementation readiness. While service leaders and clinicians are crucial to implementation, little research examines their perspectives on what psilocybin‐assisted therapy is, how it works, and for whom. This study explored how these stakeholders conceptualise psychedelic‐assisted therapy within their own professional setting, in the context of a broader implementation trial of psilocybin‐assisted therapy for co‐occurring depression and alcohol use disorder (AUD) in a routine alcohol and other drug (AOD) clinic.\n\n\nDesign\nA qualitative approach informed by the evidence‐making intervention approach.\n\n\nSetting\nVictoria, Australia, prior to the implementation of psilocybin‐assisted therapy in routine clinical services.\n\n\nParticipants\nTwo focus groups were conducted: one with clinicians (n = 9; nursing, psychology, psychiatry, pharmacy, and peer support professionals) and one with health service leaders (n = 9).\n\n\nMeasurements\nFocus groups used a semi‐structured guide, consisting of open‐ended questions about understandings and perspectives on psilocybin‐assisted therapy for co‐occurring substance use and mental health problems. Verbatim transcripts underwent inductive thematic analysis, informed by the evidence‐making intervention approach.\n\n\nFindings\nThree enactments of psilocybin‐assisted therapy emerged: (1) treatment of last resort for treatment‐resistant conditions, which was emphasised by service leaders and aligned with regulatory frameworks; (2) tool to “unlock stuckness” in ongoing relational care when conventional therapies plateau, which was prominent among clinicians; and (3) catalyst for rapid progress applicable at any treatment stage. Clinicians emphasised the need for careful integration, robust support, and aftercare, alongside concerns about access and eligibility. Service leaders highlighted operational and ethical tensions within regulatory requirements. Both groups understood psilocybin‐assisted therapy as a complex intervention dependent on interplay between medication, therapist skill, client readiness, and care context.\n\n\nConclusions\nPsilocybin‐assisted therapy in Victoria, Australia is constituted through local implementation rather than existing as a singular intervention. Implementation approaches must be reflexive and adaptive, with attention to clinical and managerial dialogue, equity considerations, and contextual practice factors.\n\n"]

  March 30, 2026   doi: 10.1111/add.70403   open full text
• All‐cause and cause‐specific mortality in gambling disorder: Evidence from a nation‐wide matched and sibling cohort study in Taiwan.
  Yang‐Chieh Brian Chen, Chih‐Wei Hsu, Liang‐Jen Wang, Mu‐Hong Chen, Yao‐Hsu Yang, Chih‐Sung Liang, Edward Chia‐Cheng Lai.
  Addiction. March 23, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nGambling disorder (GD) has been linked to suicidal ideation and suicide deaths; however, evidence on all‐cause and cause‐specific mortality—particularly in Asian populations—remains limited. Using a retrospective cohort study based on nationwide matched and sibling cohort, we investigated all‐cause and cause‐specific mortality risk in patients with GD.\n\n\nDesign, setting and participants\nA retrospective cohort study was conducted using 2000–2022 data from Taiwan’s National Health Insurance Research Database. A cohort of 961 individuals diagnosed with GD was identified. An age‐ and sex‐matched control cohort (n = 3,844) and an unaffected sibling cohort (n = 675) were constructed. Cumulative survival was illustrated using Kaplan‐Meier curves.\n\n\nMeasurements\nCox regression models estimated crude and adjusted hazard ratios (AHR) for all‐cause, natural‐cause and unnatural‐cause (accidents and suicides) mortality risks. Covariates for adjustment included sociodemographic factors, physical and psychiatric comorbidities and familial confounding.\n\n\nFindings\nOver a mean follow‐up of 8 years, GD was associated with elevated all‐cause mortality risk [AHR 1.20, 95% confidence interval (CI) = 0.90–1.61] driven by statistically significantly elevated risk of unnatural mortality (AHR 6.15, 95% CI = 3.44–10.98) and especially suicide mortality (AHR 10.03, 95% CI = 4.71–21.33). Risk of natural mortality was statistically significantly lower in GD patients (AHR 0.66, 95% CI = 0.45–0.96). Sibling cohort analysis revealed a similar trend (all‐cause mortality: AHR 1.70, 95% CI = 0.67–4.28; unnatural cause mortality: AHR 8.65, 95% CI = 1.62–46.22; suicide mortality: AHR 7.24, 95% CI = 0.74–70.59; natural cause mortality: AHR 0.48, 95% CI = 0.13–1.73). Results remained consistent after adjustment for individual psychiatric comorbidities.\n\n\nConclusions\nGambling disorder patients in Taiwan appear to have a statistically significantly increased risk of unnatural‐cause mortality and especially suicide mortality compared with matched controls. Policies and clinical interventions for treating GD patients should focus on suicide prevention to reduce mortality in this population.\n\n"]

  March 23, 2026   doi: 10.1111/add.70397   open full text
• Latent classes of sleep deficiency and correlates among patients receiving methadone treatment: A longitudinal study.
  Connie Hsaio, Sangchoon Jeon, Kimberly A. DiMeola, Kelly Walker, Ofure Akhiwu, Michael D. Stein, Lynn M. Madden, Nancy S. Redeker, Dustin Scheinost, David A. Fiellin, Henry K. Yaggi, Declan T. Barry.
  Addiction. March 19, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nFew studies have examined multiple domains of sleep deficiency among patients receiving methadone treatment (MT). This study investigated sleep deficiency classes and their associations with demographics, clinical characteristics and one‐year treatment outcomes among patients receiving MT.\n\n\nDesign\nLongitudinal study using patient‐completed questionnaires on demographics, sleep, pain interference with sleep and psychological symptoms in August 2023. We used latent class analysis to group patients into sleep deficiency classes and employed multinomial logistic regression to investigate their demographic and clinical correlates. Treatment continuity and urine toxicology results over the subsequent year were analyzed in August 2024.\n\n\nSetting\nA not‐for‐profit federally certified opioid treatment program in Connecticut, USA.\n\n\nParticipants\n1237 patients receiving MT.\n\n\nMeasurements\nSleep questionnaires included the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Brief Index of Sleep Control, STOP questionnaire and the first two items from the Cambridge‐Hopkins Restless Legs Syndrome Questionnaire. Urine toxicology results and treatment continuity were extracted from the medical chart.\n\n\nFindings\nWe identified four classes. Class I (28.0%): normal sleep/no sleep deficiency. Class II (24.8%): late sleep with increased risk for obstructive sleep apnea and restless legs syndrome. Class III (20.5%): poor sleep quality with short and late sleep. Class IV (26.6%): severe sleep deficiency. Compared with Class I, participants in Classes II–IV had statistically significantly higher odds of reporting psychological symptoms [Class II adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.10–1.81; Class III aOR = 1.58, 95% CI = 1.23–2.03; Class IV aOR = 2.21, 95% CI = 1.72–2.84] and pain interference with sleep (for three or more days per week: Class II aOR = 5.52, 95% CI = 2.93–10.38; Class III aOR = 5.04, 95% CI = 2.62–9.69; Class IV aOR = 13.16, 95% CI = 6.98–24.84). Over the subsequent year, compared with Class I, participants in Class III had statistically significantly higher rates of positive urine toxicology results for benzodiazepines, while participants in Class IV had statistically significantly higher rates of positive urine toxicology results for fentanyl and benzodiazepines. Treatment continuity did not differ across the four classes after one year following baseline.\n\n\nConclusions\nVarieties of sleep deficiency compared with normal sleep appear to be associated with more severe psychological symptoms and pain interference with sleep among patients receiving methadone treatment and may serve as risk factors for substance use.\n\n"]

  March 19, 2026   doi: 10.1111/add.70384   open full text
• Titration of nicotine intake in smokers switching to reduced nicotine content cigarettes with access to alternative nicotine systems: Secondary analysis of a randomized clinical trial.
  Neal L. Benowitz, Jiayi Hu, Xianghua Luo, F. Joseph McClernon, Jennifer Tidey, Andrew A. Strasser, Suzanne Colby, Eric C. Donny, Dorothy K. Hatsukami.
  Addiction. March 19, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nMandated reduction of the nicotine content of cigarettes to reduce addictiveness to minimal levels has the potential to substantially reduce combusted cigarette use and promote public health. This paper examined the hypothesis that when people who smoke cigarettes are switched to very low nicotine content (VLNC) cigarettes and provided with access to non‐combusted alternative nicotine delivery systems (ANDS), they will titrate nicotine to maintain baseline levels of nicotine intake with the use of ANDS.\n\n\nDesign\nThis is a secondary analysis of a recently published randomized clinical trial. Clinical trial number NCT03272685.\n\n\nSetting\nMulticenter clinical trial conducted in the United States.\n\n\nParticipants\n438 individuals who smoked 5 to 40 cigarettes per day, mean age 44 (range 20–73).\n\n\nIntervention\nSmokers were randomized 1:1 for 12 weeks of smoking Spectrum brand research cigarettes containing VLNC (0.4 mg nicotine/g tobacco) or normal nicotine content (15.8 mg nicotine/g, NNC). Participants purchased tobacco products from an experimental marketplace containing non‐combusted ANDS, including electronic cigarettes, nicotine replacement medications and oral nicotine products.\n\n\nMeasurements\nMeasures taken at baseline, 4, 8 and 12 weeks included cigarettes smoked per day (CPD) and measures of ANDS use, assessed using past 3‐day daily diary data, which would roughly account for nicotine intake as measured by urine total nicotine equivalents (TNE). Based on self‐report and biomarker data at weeks 4, 8 and 12, we characterized three product‐using groups of participants as cigarette‐only users, ANDS‐only users and dual users. Nicotine titration was assessed as the ratio of urine TNE at various research cigarette study weeks compared with baseline (smoking their own cigarettes). Combusted product abstinence was examined using expired carbon monoxide (CO) and adherence to smoking VLNC by urine anatabine.\n\n\nFindings\nMedian titration at 12 weeks in cigarette‐only participants was 0.84 (interquartile range 0.68–1.18) in the NNC group and 0.05 (0.01–0.12) in the VLNC group. Median titration at 12 weeks in ANDS‐only participants was 0.81 (0.69–1.16) in the NNC group and 0.89 (0.49–1.58) in the VLNC group. Median titration at 12 weeks in dual use participants was 1.0 (0.78–1.29) in the NNC group and 0.91 (0.61–1.25) in the VLNC group.\n\n\nConclusions\nMost adults who smoke, when switched to very low nicotine content cigarettes, will use available alternative nicotine delivery systems (ANDS) to supplement their intake of nicotine. Provision of ANDS appears to be associated with a high degree of nicotine titration. Making less harmful ANDS widely available may make a mandated nicotine reduction intervention more acceptable to people who smoke.\nClinical Trial Registration Details: NCT03272685.\n\n"]

  March 19, 2026   doi: 10.1111/add.70385   open full text
• Low and no alcohol availability and sales in small retailers in Great Britain: A geographic longitudinal analysis from 2018 to 2022.
  Roberto Valiente, Helena Tunstall, Luke B. Wilson, Duncan Gillespie, Jamie Pearce, Niamh K. Shortt.
  Addiction. March 19, 2026
  ["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nThe United Kingdom Government is committed to reducing alcohol consumption through increasing the availability of alcohol‐free and low‐alcohol (No/Lo) drinks; however, little is known about whether these products are equally available across different types of neighbourhoods, which may have implications for inequalities in potential health benefits or harms from exposure to No/Lo drinks. This study measured differences in the availability and sales of No/Lo products in small retailers across disparate types of neighbourhoods in Great Britain and over time.\n\n\nDesign\nA longitudinal geographic design using retail transaction data collected over 20 weeks seasonally distributed between 2018 and 2022.\n\n\nSetting\nThe study was conducted in Great Britain (England, Scotland and Wales).\n\n\nParticipants/cases\n11 278 479 alcohol transactions across 1432 small retailers in neighbourhoods with varying levels of socioeconomic deprivation and urbanicity.\n\n\nMeasurements\nNo/Lo products were defined as alcoholic‐mimic beverages containing ≤1.2% alcohol by volume (ABV). Each week, we calculated retail‐level outcomes measuring No/Lo product availability defined as product range and sales volume (standardised as the number of serving units). Zero‐inflated Poisson regression models were used to assess differences in these outcomes by neighbourhood income deprivation and urbanicity over time.\n\n\nFindings\nNo/Lo sales volume tripled over the study period yet accounted for only 0.25% of total alcohol sales by 2022. In 2018, 34% of retailers reported sales of No/Lo products, rising to 68% by 2022. Retailers in low‐deprivation areas were more likely to sell No/Lo products and sold a wider product range compared with those in high‐deprivation areas ([incidence rate ratio (IRR) = 2.30, 95% confidence interval (CI) = 1.60–3.30 in 2022). No/Lo alcohol sales volume was statistically significantly higher among retailers in the least deprived neighbourhoods (IRR = 1.33, 95% CI = 1.14–1.57 in 2022) and rural areas compared with high‐deprivation and urban areas, but only in the most recent years.\n\n\nConclusion\nAlcohol‐free and low alcohol (No/Lo) product availability and sales increased among small retailers in Great Britain between 2018 and 2022, but these gains have been uneven, with greater access and uptake in more affluent and rural areas. This suggests emerging geographic disparities in access to and sales of No/Lo alternatives and their potential benefits or harms.\n\n"]

  March 19, 2026   doi: 10.1111/add.70391   open full text
• Using cognitive modelling to investigate the psychological processes of the Go/NoGo discrimination task in male abstinent heroin misusers.
  Chi‐Wen Liang, Roy Yi‐Xiu Zhong, Yun‐Chen Chung, Chun‐Hung Pan, Muh‐Yong Yen, Chung‐Ping Cheng, Wen‐Yau Hsu.
  Addiction. May 29, 2014
  Aims To use cognitive modelling to investigate psychological processes underlying decision‐making in male abstinent heroin misusers (AHMs). Design A case–control study design. Setting A drug misuse treatment centre in Taiwan. Participants Eighty‐eight male AHMs and 48 male controls. Measurements Four parameters representing the attention to wins, learning rate, response sensitivity and incentive of heroin‐related stimuli from the modified Go/NoGo discrimination task. Findings A modified cue‐dependent learning (CD) model with four parameters representing attention to wins, learning rate, response sensitivity and incentive of heroin‐related stimuli had a lower value of the sum of Bayesian information criterion (showing a better fit) than the original CD model (9555.50 versus 11 192.22, P < 0.001). The AHM group had a higher value of the heroin‐incentive parameter than the control group (0.26 versus −1.66, P < 0.05). The attention to wins and heroin‐incentive parameters were associated positively with total commission rate and negatively with total omission rate in the AHM group (P < 0.001). Conclusions Male abstinent heroin misusers appear to be more influenced by heroin‐related stimuli during decision‐making than males with no history of heroin misuse.

  May 29, 2014   doi: 10.1111/add.12591   open full text
• Varenicline efficacy and safety among methadone maintained smokers: A randomized placebo‐controlled trial.
  Shadi Nahvi, Yuming Ning, Kate S. Segal, Kimber P. Richter, Julia H. Arnsten.
  Addiction. May 27, 2014
  Aims To test the efficacy and safety of varenicline as an aid to smoking cessation in methadone maintained smokers. Design Multicenter, randomized, double‐blind, placebo‐controlled trial with random assignment to 12 weeks of varenicline 1 mg twice daily (n=57) or matched placebo (n=55), with in‐person and telephone counseling. Setting Urban methadone programmes in the Bronx, New York City, New York, USA. Participants Methadone maintenance patients, smoking ≥5 cigarettes/day, interested in quitting, stable in methadone treatment, without current axis I psychiatric disorders, suicidal ideation, or recent suicide attempts. Measurements Seven‐day point prevalence abstinence verified by expired carbon monoxide (CO) < 8 p.p.m at week 12 (primary outcome); CO‐verified abstinence, cigarettes/day, incident axis I psychiatric illness, suicidal ideation or serious adverse events (SAEs) at weeks 2, 4, 8, 12 or 24 (secondary outcomes). Findings Baseline demographic, smoking and clinical factors were similar between groups. Retention at 24 weeks was 90%. Subjects receiving varenicline were more likely than those receiving placebo to achieve abstinence (10.5% v 0%, p = .03; effect size 10.5%, 95% CI 4.4 – 19.3%) and to reduce smoking (median 5 v 2 cigarettes/day, p<.001) at 12 weeks. These effects were not maintained after drug treatment ceased. Incident psychiatric illness (OR = 0.84, 95% CI 0.16, 4.4) and suicidality (OR = 0.88, 95% CI 0.2, 5.2) were not different between groups. There were no psychiatric or cardiac SAEs. Conclusions Varenicline can aid short‐term smoking abstinence in methadone maintained smokers.

  May 27, 2014   doi: 10.1111/add.12631   open full text
• Does Every US Smoker Bear the Same Cigarette Tax?
  Xin Xu, Ann Malarcher, Alissa O′Halloran, Judy Kruger.
  Addiction. May 27, 2014
  Aims To evaluate state cigarette excise tax pass‐through rates for selected price‐minimizing strategies. Design Multivariate regression analysis of current smokers from a stratified, national, dual‐frame telephone survey. Setting United States. Participants A total of 16,542 adult current smokers aged 18 years or older. Measurements Cigarette per pack prices paid with and without coupons were obtained for pack versus carton purchase, use of generic brands versus premium brands, and purchase from Indian reservations versus outside Indian reservations. Findings The average per pack prices paid differed substantially by price‐minimizing strategy. Smokers who used any type of price‐minimizing strategies paid substantially less than those who did not use these strategies (p<0.05). Premium brand users who purchased by pack in places outside Indian reservations paid the entire amount of the excise tax together with an additional premium of 7–10 cents per pack for every $1 increase in excise tax (pass‐through rate of 1.07–1.10, p<0.05). In contrast, carton purchasers, generic brand users, or those who were likely to made their purchases on Indian reservations paid only 30–83 cents per pack for every $1 tax increase (pass‐through rate of 0.30–0.83, p<0.05). Conclusions Many smokers in the US are able to avoid the full impact of state excise tax on cost of smoking by buying cartons, using generic brands and buying from Indian reservations.

  May 27, 2014   doi: 10.1111/add.12630   open full text
• Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis.
  Christoph Ort, Alexander L. N. Nuijs, Jean‐Daniel Berset, Lubertus Bijlsma, Sara Castiglioni, Adrian Covaci, Pim Voogt, Erik Emke, Despo Fatta‐Kassinos, Paul Griffiths, Félix Hernández, Iria González‐Mariño, Roman Grabic, Barbara Kasprzyk‐Hordern, Nicola Mastroianni, Axel Meierjohann, Thomas Nefau, Marcus Östman, Yolanda Pico, Ines Racamonde, Malcolm Reid, Jaroslav Slobodnik, Senka Terzic, Nikolaos Thomaidis, Kevin V. Thomas.
  Addiction. May 27, 2014
  Aims To perform wastewater analyses to assess spatial differences and temporal changes of illicit drug use in a large European population. Design Analyses of raw wastewater over a 1‐week period in 2012 and 2013. Setting and Participants Catchment areas of wastewater treatment plants (WWTPs) across Europe, as follows: 2012: 25 WWTPs in 11 countries (23 cities, total population 11.50 million); 2013: 47 WWTPs in 21 countries (42 cities, total population 24.74 million). Measurements Excretion products of five illicit drugs (cocaine, amphetamine, ecstasy, methamphetamine, cannabis) were quantified in wastewater samples using methods based on liquid chromatography coupled to mass spectrometry. Findings Spatial differences were assessed and confirmed to vary greatly across European metropolitan areas. In general, results were in agreement with traditional surveillance data, where available. While temporal changes were substantial in individual cities and years (P ranging from insignificant to <10−3), overall means were relatively stable. The overall mean of methamphetamine was an exception (apparent decline in 2012), as it was influenced mainly by four cities. Conclusions Wastewater analysis performed across Europe provides complementary evidence on illicit drug consumption and generally concurs with traditional surveillance data. Wastewater analysis can measure total illicit drug use more quickly and regularly than is the current norm for national surveys, and creates estimates where such data does not exist.

  May 27, 2014   doi: 10.1111/add.12570   open full text
• Effects of depressive symptoms on antecedents of lapses during a smoking cessation attempt: an ecological momentary assessment study.
  Jeannette Brodbeck, Monica S. Bachmann, Anna Brown, Hans Joerg Znoj.
  Addiction. May 22, 2014
  Aims To investigate pathways through which momentary negative affect and depressive symptoms affect risk of lapse during smoking cessation attempts. Design Ecological momentary assessment was carried out during 2 weeks after an unassisted smoking cessation attempt. A 3‐month follow‐up measured smoking frequency. Setting Data were collected via mobile devices in German‐speaking Switzerland. Participants A total of 242 individuals (age 20–40, 67% men) reported 7112 observations. Measurements Online surveys assessed baseline depressive symptoms and nicotine dependence. Real‐time data on negative affect, physical withdrawal symptoms, urge to smoke, abstinence‐related self‐efficacy and lapses. Findings A two‐level structural equation model suggested that on the situational level, negative affect increased the urge to smoke and decreased self‐efficacy (β = 0.20; β = −0.12, respectively), but had no direct effect on lapse risk. A higher urge to smoke (β = 0.09) and lower self‐efficacy (β = −0.11) were confirmed as situational antecedents of lapses. Depressive symptoms at baseline were a strong predictor of a person's average negative affect (β = 0.35, all P < 0.001). However, the baseline characteristics influenced smoking frequency 3 months later only indirectly, through influences of average states on the number of lapses during the quit attempt. Conclusions Controlling for nicotine dependence, higher depressive symptoms at baseline were associated strongly with a worse longer‐term outcome. Negative affect experienced during the quit attempt was the only pathway through which the baseline depressive symptoms were associated with a reduced self‐efficacy and increased urges to smoke, all leading to the increased probability of lapses.

  May 22, 2014   doi: 10.1111/add.12563   open full text
• Youth tobacco use type and associations with substance use disorders.
  Patricia A. Cavazos‐Rehg, Melissa J. Krauss, Edward L. Spitznagel, Richard A. Grucza, Laura Jean Bierut.
  Addiction. May 22, 2014
  Aims To examine the associations between youth poly‐tobacco use and substance use disorders. Design Analysis of data from the 2007–11 US National Survey on Drug Use and Health. Setting Randomly selected, household‐dwelling adolescents from the non‐institutionalized, civilian population of the United States. Participants A total of 91 152 adolescents (aged 12–17 years). Methods Logistic regression models were used to examine the associations between type of tobacco user (non‐user, users of alternative tobacco products only, users of cigarettes only and users of cigarettes plus alternative tobacco products) with past year alcohol, marijuana or other illicit drug use disorders, adjusting for demographic and social variables. Findings Compared with non‐users of tobacco, the greatest risk for substance use disorders was among users of cigarettes plus alternative tobacco products [alcohol disorder adjusted odds ratio (aOR) = 18.3, 95% confidence interval (CI) = 16.2–20.6; marijuana disorder aOR = 37.2, 95% CI = 32.5–42.7; other drug disorder aOR = 18.4, 95% CI = 15.4–21.8], followed by users of cigarettes only (alcohol disorder aOR = 9.6, 95% CI = 8.8–10.6; marijuana disorder aOR = 20.4, 95% CI = 18.1–23.0; other drug disorder aOR = 9.4, 95% CI = 7.8–11.4), then users of alternative tobacco products only (alcohol disorder aOR = 8.1, 95% CI = 6.7–9.6; marijuana disorder aOR = 9.2, 95% CI = 7.5–11.4; other drug disorder aOR = 3.2, 95% CI = 2.4–4.3). Conclusions Tobacco use in adolescence is associated with higher rates of substance use disorders across all tobacco users, especially among those who use cigarettes plus other tobacco products.

  May 22, 2014   doi: 10.1111/add.12567   open full text
• Real‐world effectiveness of e‐cigarettes when used to aid smoking cessation: a cross‐sectional population study.
  Jamie Brown, Emma Beard, Daniel Kotz, Susan Michie, Robert West.
  Addiction. May 20, 2014
  Background And Aims Electronic cigarettes (e‐cigarettes) are rapidly increasing in popularity. Two randomised controlled trials have suggested that e‐cigarettes can aid smoking cessation but there are many factors that could influence their real‐world effectiveness. This study aimed to assess, using an established methodology, the effectiveness of e‐cigarettes when used to aid smoking cessation compared with nicotine replacement therapy (NRT) bought over‐the‐counter and with unaided quitting in the general population. Design And Setting A large cross‐sectional survey of a representative sample of the English population. Participants The study included 5863 adults who had smoked within the previous 12 months and made at least one quit attempt during that period with either an e‐cigarette only (n=464), NRT bought over‐the‐counter only (n=1922) or no aid in their most recent quit attempt (n=3477). Measurements The primary outcome was self‐reported abstinence up to the time of the survey, adjusted for key potential confounders including nicotine dependence. Findings E‐cigarette users were more likely to report abstinence than either those who used NRT bought over‐the‐counter (odds ratio 2.23, 95% confidence interval 1.70 to 2.93, 20.0% vs. 10.1%) or no aid (odds ratio 1.38, 95% confidence interval 1.08 to 1.76, 20.0% vs. 15.4%). The adjusted odds of non‐smoking in users of e‐cigarettes were 1.63 (95% confidence interval 1.17 to 2.27) times higher compared with users of NRT bought over‐the‐counter and 1.61 (95% confidence interval 1.19 to 2.18) times higher compared with those using no aid. Conclusions Among smokers who have attempted to stop without professional support, those who use e‐cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over‐the‐counter or no aid to cessation. This difference persists after adjusting for a range of smoker characteristics such as nicotine dependence.

  May 20, 2014   doi: 10.1111/add.12623   open full text
• Future Orientation and Smoking Cessation: Secondary Analysis of Data from A Smoking Cessation Trial.
  Jane Beenstock, Nicola Lindson‐Hawley, Paul Aveyard, Jean Adams.
  Addiction. May 20, 2014
  Aims To examine the association between future orientation (how individuals consider and value outcomes in the future) and smoking cessation at four weeks and six months post quit‐date in individuals enrolled in a smoking cessation study. Design Cohort analysis of randomised controlled trial data. Setting UK primary care. Participants Adults aged ≥18 years smoking ≥15 cigarettes daily, prepared to quit in the next two weeks. Measurements Future orientation was measured prior to quitting and at four weeks post‐quitting using the Consideration of Future Consequences Scale. Smoking cessation at four weeks and six months was confirmed biochemically. Those lost to follow up were assumed to not be abstinent. Potential confounders adjusted for were: age, gender, educational attainment, nicotine dependence and longest previous period quit. Findings 697 participants provided data at baseline. 422 provided information on future orientation at four weeks. There was no evidence of an association between future orientation at baseline and abstinence at four weeks (adjusted odds ratio (95% confidence intervals): 1.05 (0.89 to 1.38) or six months (0.85 (0.60 to 1.20). There was no change in future orientation from baseline to four weeks and no evidence that the change differed between those who were and were not quit at four weeks (adjusted regression coefficient (95% confidence intervals): ‐0.04 (‐0.16 to 0.08). Conclusions In smokers who are prepared to quit in the next two weeks, extent of future orientation is unlikely to be a strong predictor of quitting over four weeks or six months and any increase in future orientation following quitting is likely to be small.

  May 20, 2014   doi: 10.1111/add.12621   open full text
• Early age of alcohol initiation is not the cause of alcohol use disorders in adulthood, but is a major indicator of genetic risk. A population‐based twin study.
  Eivind Ystrom, Kenneth S. Kendler, Ted Reichborn‐Kjennerud.
  Addiction. May 20, 2014
  Background and aims An early age of alcohol initiation (AAI) is associated with and has been hypothesized to be a cause of alcohol use disorders (AUD) in adulthood. Results from twin studies, however, indicate that AAI is an indicator of risk for AUD. We aimed to test a causal hypothesis vs. a risk indicator hypothesis for the relationship between early AAI and AUD. Design A population‐based twin study using biometric twin modelling. Setting Norway. Participants A population‐based sample of 1336 Norwegian twins. Measurements Lifetime DSM‐IV AUDs were assessed by structured clinical interview, and AAI by questionnaire. Findings The risk indicator model in which the association between AAI and AUD was explained by common vulnerability was the best fit to the data. The heritability was 37% (95%CI 21%, 53%) for AAI and 62% (95%CI 51%, 73%) for AUD. Genetic risk for AAI accounted for 44% (95%CI 17%, 71%) of the total genetic risk for AUD, and the correlation between genetic factors for AAI and AUD was −0.66 (95%CI −0.87, −0.46). Individual‐specific environmental risk for AAI explained only 1% (95%CI 0%, 3%) of the risk for AUD. Shared environmental factors did not influence AUD, but accounted for 25% (95%CI 7%, 35%) of the variance in AAI. Conclusions The association between early age of alcohol initiation and alcohol use disorders in later life does not reflect a causal relationship, but is almost entirely due to common genetic risk factors.

  May 20, 2014   doi: 10.1111/add.12620   open full text
• Reciprocal Associations Between Cigarette Consumption and DSM‐IV Nicotine Dependence Criteria in Adolescent Smokers.
  Mei‐Chen Hu, Pamela C. Griesler, Melanie M. Wall, Denise B. Kandel.
  Addiction. May 20, 2014
  Aims To examine the interrelationships between cigarette consumption and DSM‐IV nicotine dependence (ND) criteria from smoking onset in adolescence up to seven years later, adjusting for alcohol consumption and DSM‐IV alcohol dependence (AD) criteria. Design A cohort drawn from grades 6‐10 in an urban school system was interviewed five times at 6‐month intervals (Waves 1‐5) and 4.5 years later (Wave 6). A parent was interviewed three times. Setting Chicago, Illinois. Participants Recent smokers (n=409). Measurements Structured household interviews ascertained number of cigarettes smoked, DSM‐IV ND symptoms, drinks consumed, DSM‐IV AD symptoms, and selected covariates. Analysis Reciprocal prospective associations between number of cigarettes smoked and ND criteria, controlling for time‐varying alcohol consumption and dependence criteria, were examined with cross‐lagged models. Findings Reciprocal associations between number of cigarettes smoked and ND criteria were both significant. Cigarette consumption had stronger associations with later ND (β=0.25, 95% CI=0.17‐0.32) than dependence had with later cigarette consumption (β=0.09, 95% CI=0.01‐0.16). Alcohol and cigarette consumption influenced each other; AD scores were associated with later ND scores but not the reverse. Reports of pleasant initial experiences from smoking were positively associated with cigarette consumption and ND the first year after smoking onset; later smoking onset was negatively associated with cigarette consumption the seventh year after onset; parental ND predicted cigarette consumption and ND throughout. Conclusions In adolescent smokers, higher cigarette consumption predicts later severity of DSM‐IV nicotine dependence more than the reverse. Smoking and drinking also influence each other mutually over time.

  May 20, 2014   doi: 10.1111/add.12619   open full text
• Who under‐reports their alcohol consumption in telephone surveys and by how much? An application of the Yesterday Method in a national Canadian substance use survey.
  Tim Stockwell, Jinhui Zhao, Scott Macdonald.
  Addiction. May 13, 2014
  Background and aim Adjustments for under‐reporting in alcohol surveys have been used in epidemiological and policy studies which assume that all drinkers underestimate their consumption equally. This study aims to describe a method of estimating how under‐reporting of alcohol consumption might vary by age, gender and consumption level. Method The Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) 2008 to 2010 (N= 43,371) asks about beverage specific ‘yesterday’ consumption (BSY) and Quantity‐Frequency (QF). Observed drinking frequencies for different age and gender groups were calculated from BSY and used to correct values of F in QF. Beverage‐specific correction factors for quantity (Q) were calculated by comparing consumption estimated from BSY with sales data. Results Drinking frequency was underestimated by males (Z=24.62, p<0.001) and females (Z=17.46, p<0.001) in the QF as assessed by comparing with frequency and quantity of Yesterday drinking. Spirits consumption was underestimated by 65.94% compared with sales data, wine by 38.35% and beer by 49.02%. After adjusting Q and F values accordingly, regression analysis found alcohol consumption to be under‐estimated significantly more by younger drinkers (e.g.82.9 ±1.19% for underage drinkers vs 70.38 ±1.54% for those 65+, p<0.001) and by low risk more than high risk drinkers (76.25 ±0.34% vs 49.22 ±3.01%, p<0.001). Under‐reporting did not differ by gender. Conclusions Alcohol consumption surveys can use the Beverage‐Specific Yesterday method to correct for underreporting of consumption among sub‐groups. Alcohol consumption among Canadians appears to be under‐reported to an equal degree by men and women. Younger drinkers underreport alcohol consumption to a greater degree than do older, while low risk drinkers underestimate more than do medium and high‐risk.

  May 13, 2014   doi: 10.1111/add.12609   open full text
• Sustained‐Release Methylphenidate in a Randomized Trial of Treatment of Methamphetamine Use Disorder.
  Walter Ling, Linda Chang, Maureen Hillhouse, Alfonso Ang, Joan Striebel, Jessica Jenkins, Jasmin Hernandez, Mary Olaer, Larissa Mooney, Susan Reed, Erin Fukaya, Shannon Kogachi, Daniel Alicata, Nataliya Holmes, Asher Esagoff.
  Addiction. May 13, 2014
  Background and aims No effective pharmacotherapy for methamphetamine (MA) use disorder has yet been found. This study evaluated sustained‐release methylphenidate (MPH‐SR) compared with placebo (PLA) for treatment of MA use disorder in people also undergoing behavioural support and motivational incentives. Design This was a randomized, double‐blind, placebo‐controlled design with MPH‐SR or PLA provided for 10 weeks (active phase) followed by 4 weeks of single‐blind PLA. Twice‐weekly clinic visits, weekly group counseling (CBT), and motivational incentives (MI) for MA‐negative urine drug screens (UDS) were included. Setting Treatment sites were in Los Angeles, California (LA) and Honolulu, Hawaii (HH), USA. Participants 110 MA‐dependent (via DSM‐IV) participants (LA = 90; HH = 20). Measurements The primary outcome measure is self‐reported days of MA use during the last 30 days of the active phase. Included in the current analyses are drug use (UDS and self‐report), retention, craving, compliance (dosing, CBT, MI), adverse events, and treatment satisfaction. Findings No difference was found between treatment groups in self‐reported days of MA use during the last 30 days of the active phase (p=0.22). In planned secondary outcomes analyses, however, the MPH group had fewer self‐reported MA use days from baseline through the active phase compared with the PLA group (p=0.05). The MPH group also had lower craving scores and fewer marijuana‐positive UDS than the PLA group in the last 30 days of the active phase. The two groups had similar retention, other drug use, adverse events, and treatment satisfaction. Conclusions Methylphenidate may lead to a marginal reduction in concurrent methamphetamine use when provided as treatment for patients undergoing behavioural support for moderate to severe methamphetamine use disorder but this requires confirmation.

  May 13, 2014   doi: 10.1111/add.12608   open full text
• Alcohol industry sponsorship and hazardous drinking in UK university students who play sport.
  Kerry S. O'Brien, Jason Ferris, Ian Greenlees, Sophia Jowett, Daniel Rhind, Penny Cook, Kypros Kypri.
  Addiction. May 13, 2014
  Aim To examine whether receipt of alcohol industry sponsorship is associated with problematic drinking in UK university students who play sport. Methods University students (n=2450) participating in sports were invited to complete a pen‐and‐paper questionnaire by research staff approaching them at sporting facilities and in university settings. Respondents were asked whether they personally, their team, and/or their club were currently in receipt of sponsorship (e.g., money, free or subsidised travel, or sporting products), from an alcohol‐related industry (e.g., bars, liquor stores, wholesalers), and whether they had solicited the sponsorship. Drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Results Questionnaires were completed by 2048 of those approached (response rate=83%). Alcohol industry sponsorship was reported by 36% of the sample. After accounting for confounders (age, gender, disposable income, and location) in multivariable models, receipt of alcohol sponsorship by a team (adjusted βadj=.41, p=.013), club (βadj=.73, p=.017), team and club (βadj=.79, p=0.002), and combinations of individual and team or club sponsorships (βadj=1.27, p<0.002), were each associated with significantly higher AUDIT‐Consumption substance scores. Receipt of sponsorship by team and club (aOR=2.04; 95% CI: 1.04‐3.99) and combinations of individual and team or club sponsorships (aOR=4.12; 95% CI: 1.29‐13.15) were each associated with increased odds of being classified a hazardous drinker (AUDIT score >8). Respondents who sought out sponsorship were not at greater risk than respondents who had, or whose teams or clubs had, been approached by the alcohol industry. Conclusions University students in the United Kingdom who play sport and who personally receive alcohol industry sponsorship or whose club or team receives alcohol industry sponsorship appear to have more problematic drinking behaviour than UK university students who play sport and receive no alcohol industry sponsorship. Policy to reduce or cease such sponsorship should be considered.

  May 13, 2014   doi: 10.1111/add.12604   open full text
• Drinking in social groups. Does ‘groupdrink’ provide safety in numbers when deciding about risk?
  Tim Hopthrow, Georgina Randsley de Moura, Rose Meleady, Dominic Abrams, Hannah J. Swift.
  Addiction. May 05, 2014
  Aims To investigate the impact of alcohol consumption on risk decisions taken both individually and while part of a four‐ to six‐person ad‐hoc group. Design A 2 (alcohol: consuming versus not consuming alcohol) × 2 (decision: individual, group) mixed‐model design; decision was a repeated measure. The dependent variable was risk preference, measured using choice dilemmas. Setting Opportunity sampling in campus bars and a music event at a campus‐based university in the United Kingdom. Participants A total of 101 individuals were recruited from groups of four to six people who either were or were not consuming alcohol. Measurements Participants privately opted for a level of risk in response to a choice dilemma and then, as a group, responded to a second choice dilemma. The choice dilemmas asked participants the level of accident risk at which they would recommend someone could drive while intoxicated. Findings Five three‐level multi‐level models were specified in the software program HLM 7. Decisions made in groups were less risky than those made individually (B = −0.73, P < 0.001). Individual alcohol consumers opted for higher risk than non‐consumers (B = 1.27, P = 0.025). A significant alcohol × decision interaction (B = −2.79, P = 0.001) showed that individual consumers privately opted for higher risk than non‐consumers, whereas risk judgements made in groups of either consumers or non‐consumers were lower. Decisions made by groups of consumers were less risky than those made by groups of non‐consumers (B = 1.23, P < 0.001). Conclusions Moderate alcohol consumption appears to produce a propensity among individuals towards increased risk‐taking in deciding to drive while intoxicated, which can be mitigated by group monitoring processes within small (four‐ to six‐person) groups.

  May 05, 2014   doi: 10.1111/add.12496   open full text
• Change in physical activity after smoking cessation: the Coronary Artery Risk Development in Young Adults (CARDIA) study.
  Reto Auer, Eric Vittinghoff, Catarina Kiefe, Jared P. Reis, Nicolas Rodondi, Yulia A. Khodneva, Stefan G. Kertesz, Jacques Cornuz, Mark J. Pletcher.
  Addiction. May 04, 2014
  Aims To estimate physical activity trajectories for people who quit smoking, and compare them to what would have been expected had smoking continued. Design, Setting and Participants A total of 5115 participants in the Coronary Artery Risk Development in Young Adults Study (CARDIA) study, a population‐based study of African American and European American people recruited at age 18–30 years in 1985/6 and followed over 25 years. Measurements Physical activity was self‐reported during clinical examinations at baseline (1985/6) and at years 2, 5, 7, 10, 15, 20 and 25 (2010/11); smoking status was reported each year (at examinations or by telephone, and imputed where missing). We used mixed linear models to estimate trajectories of physical activity under varying smoking conditions, with adjustment for participant characteristics and secular trends. Findings We found significant interactions by race/sex (P = 0.02 for the interaction with cumulative years of smoking), hence we investigated the subgroups separately. Increasing years of smoking were associated with a decline in physical activity in black and white women and black men [e.g. coefficient for 10 years of smoking: −0.14; 95% confidence interval (CI) = −0.20 to −0.07, P < 0.001 for white women]. An increase in physical activity was associated with years since smoking cessation in white men (coefficient 0.06; 95% CI = 0 to 0.13, P = 0.05). The physical activity trajectory for people who quit diverged progressively towards higher physical activity from the expected trajectory had smoking continued. For example, physical activity was 34% higher (95% CI = 18 to 52%; P < 0.001) for white women 10 years after stopping compared with continuing smoking for those 10 years (P = 0.21 for race/sex differences). Conclusions Smokers who quit have progressively higher levels of physical activity in the years after quitting compared with continuing smokers.

  May 04, 2014   doi: 10.1111/add.12561   open full text
• Association between stricter alcohol advertising regulations and lower hazardous drinking across European countries.
  Marina Bosque‐Prous, Albert Espelt, Anna M. Guitart, Montserrat Bartroli, Joan R. Villalbí, M. Teresa Brugal.
  Addiction. May 04, 2014
  Aims To analyse the association between alcohol advertising restrictions and the prevalence of hazardous drinking among people aged 50–64 years in 16 European countries, taking into account both individual and contextual‐level factors (alcohol taxation, availability, etc.). Design Cross‐sectional study based on SHARE project surveys. Setting and Participants A total of 27 773 subjects, aged 50–64 years, from 16 European countries who participated in wave 4 of the SHARE (Survey of Health, Ageing and Retirement in Europe) project. Measurements We estimated the prevalence of hazardous drinking (through adaptation of the SHARE questions to the scheme used by the Alcohol Use Disorders Identification Test Consumption (AUDIT‐C) for each country. To determine whether the degree of advertising restrictions was associated with prevalence of hazardous drinking, we fitted robust variance multi‐level Poisson models, adjusting for various individual and contextual variables. Prevalence ratios (PR) and their 95% confidence intervals (95% CI) were obtained. Findings The observed prevalence of hazardous drinking was 24.1%, varying by sex and country. Countries with greater advertising restrictions had lower prevalence of hazardous drinking: 30.6% (95% CI = 29.3–31.8) in countries with no restrictions, 20.3% (95% CI = 19.3–21.2) in countries with some restrictions and 14.4% (95% CI = 11.9–16.8) in those with greatest restrictions. The PR found (with respect to countries with greatest restrictions) were 1.36 (95% CI = 0.90–2.06) for countries with some restrictions and 1.95 (95% CI = 1.31–2.91) for those with no advertising restrictions. Conclusions The extent of advertising restrictions in European countries is associated inversely with prevalence of hazardous drinking in people aged 50–64 years.

  May 04, 2014   doi: 10.1111/add.12562   open full text
• The impact of alcohol on clinical outcomes in established psychosis: a longitudinal study.
  Christine Barrowclough, Emily Eisner, Sandra Bucci, Richard Emsley, Til Wykes.
  Addiction. April 28, 2014
  Background and aims Alcohol use disorders are common among people with psychosis and are associated with poorer prognoses. In psychosis patients, there are inconsistent findings regarding the link between alcohol disorders and clinical symptomatic outcomes. This study examined the relationships between alcohol consumption and specific clinical outcomes, including affective symptoms, in psychosis. Methods Participants were recruited from secondary care services in the UK. Two hundred and ten participants whose substance use met inclusion for an alcohol disorder were compared with other substance users (n=117) on baseline demographic, clinical, and substance use variables. The alcohol sub‐group was assessed at three time points, with repeated measures of psychopathology and alcohol use over a 2 year period. Generalised Estimating Equations (GEE) models were used to examine whether change in alcohol use was associated with change in clinical outcomes. We controlled for a wide range of potential confounds, including other substance use. Results A small but specific effect was evident for change in the quantity of alcohol consumed on change in depression (adjusted coefficient for 10 total units over 90 days: 0.0015, p=0.047). Alcohol consumption was not associated with subsequent severity of psychotic symptoms (adjusted coefficient for Positive and Negative Syndrome Scale general for 10 average daily units 0.2492, p=0.420) or severity of anxiety symptoms (adjusted coefficient for 10 average daily units 0.0534, p=0.473). Conclusions For people with psychosis, the most detrimental effect of alcohol consumption appears to be its effect on mood. Some of this effect seems to be reversible, with drinking reduction associated with subsequent mood improvement.

  April 28, 2014   doi: 10.1111/add.12599   open full text
• Gambling expenditure predicts harm: Evidence from a venue‐level study.
  Francis Markham, Martin Young, Bruce Doran.
  Addiction. April 28, 2014
  Background and Aims The Total Consumption Theory of gambling suggests that gambling expenditure is positively associated with gambling‐related harm. We test the hypothesis that electronic gaming machine (EGM) expenditure predicts gambling‐related harm at the level of the EGM venue. Design Cross‐sectional analysis of survey and administrative data. Setting General urban adult population of the Northern Territory of Australia. Participants Sample consisted of 7049 respondents to a mail‐survey about venue visitation and gambling behaviour across 62 EGM venues. Measurements Gambling‐related harm was defined as the endorsement of two or more items on the Problem Gambling Severity Index. We obtained venue‐level EGM expenditure data from the local licensing authority for all venues in the study area. We compared the prevalence of gambling‐related harm among patrons aggregated at the venue level with the estimated mean EGM expenditure for each adult resident in the venue's service area using a Huff model, correlation analysis and multivariate binomial regression. Findings Aggregated to the venue level (n = 62), per capita EGM expenditure was significantly correlated with rates of gambling‐related harm [r = 0.27, n = 62, p = 0.03]. After adjusting for venue type and number of EGMs, an increase in mean per capita monthly EGM expenditure from AUD10 to AUD150 was associated with a doubling in the prevalence of gambling‐related harm from 9% (95% CI 6% ‐ 12%) to 18% (95% CI 13% ‐ 23%). Conclusions As suggested by the Total Consumption Theory of gambling, aggregate patron electronic gaming machine expenditure predicts the prevalence of gambling‐related harm at the venue level.

  April 28, 2014   doi: 10.1111/add.12595   open full text
• An Early Evaluation of Implementation of Brief Intervention for Unhealthy Alcohol Use in the U.S. Veterans Health Administration.
  Emily C. Williams, Anna D. Rubinsky, Laura J. Chavez, Gwen T. Lapham, Stacey E. Rittmueller, Carol E. Achtmeyer, Katharine A. Bradley.
  Addiction. April 28, 2014
  Aims The U.S. Veterans Health Administration (VA) used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation. Design Observational, retrospective cohort study using secondary clinical and administrative data. Setting 30 VA facilities. Participants Outpatients who screened positive for unhealthy alcohol use (AUDIT‐C ≥ 5) in the 6 months after the brief intervention performance measure (n=22,214) and had follow‐up screening 9‐15 months later (n=6,210; 28%). Measurements Multilevel logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow‐up AUDIT‐C <5 with ≥ 2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking). Findings Among 6,210 patients with follow‐up alcohol screening, 1,751 (28%) had brief intervention and 2,922 (47%) resolved unhealthy alcohol use at follow‐up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health, and more severe unhealthy alcohol use than those without (p‐values <0.05). Adjusted prevalences of resolution were 47% (95% Confidence Interval (CI) 42% ‐ 52%) and 48% (95% CI 42% ‐ 54%) for patients with and without documented brief intervention, respectively (p=0.50). Conclusions During early implementation of brief intervention in the U.S. Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.

  April 28, 2014   doi: 10.1111/add.12600   open full text
• Randomized controlled trial to assess the short‐term effectiveness of tailored web‐ and text‐based facilitation of smoking cessation in primary care (iQuit in Practice).
  Felix Naughton, James Jamison, Sue Boase, Melanie Sloan, Hazel Gilbert, A. Toby Prevost, Dan Mason, Susan Smith, James Brimicombe, Robert Evans, Stephen Sutton.
  Addiction. April 24, 2014
  Aims To estimate the short‐term effectiveness, feasibility and acceptability of a smoking cessation intervention (the iQuit system) that consists of tailored printed and Short Message Service (SMS) text message self‐help delivered as an adjunct to cessation support in primary care to inform the design of a definitive trial. Design A stratified two parallel‐group randomized controlled trial comparing usual care (control) with usual care plus the iQuit system (intervention), delivered by primary care nurses/healthcare assistants who were blinded to the allocation sequence. Setting Thirty‐two general practice (GP) surgeries in England, UK. Participants A total of 602 smokers initiating smoking cessation support from their local GP surgery were randomized (control n = 303, intervention n = 299). Measurements Primary outcome was self‐reported 2‐week point prevalence abstinence at 8 weeks follow‐up. Secondary smoking outcomes and feasibility and acceptability measures were collected at 4 weeks after quit date, 8 weeks and 6 months follow‐up. Findings There were no significant between‐group differences in the primary outcome [control 40.3%, iQuit 45.2%; odds ratio (OR) = 1.22, 95% confidence interval (CI) = 0.88–1.69] or in secondary short‐term smoking outcomes. Six‐month prolonged abstinence was significantly higher in the iQuit arm (control 8.9%, iQuit 15.1%; OR = 1.81, 95% CI = 1.09–3.01). iQuit support took on average 7.7 minutes (standard deviation = 4.0) to deliver and 18.9% (95% CI = 14.8–23.7%) of intervention participants discontinued the text message support during the programme. Conclusions Tailored printed and text message self‐help delivered alongside routine smoking cessation support in primary care does not significantly increase short‐term abstinence, but may increase long‐term abstinence and demonstrated feasibility and acceptability compared with routine cessation support alone.

  April 24, 2014   doi: 10.1111/add.12556   open full text
• The global epidemiology and burden of opioid dependence: results from the global burden of disease 2010 study.
  Louisa Degenhardt, Fiona Charlson, Bradley Mathers, Wayne D. Hall, Abraham D. Flaxman, Nicole Johns, Theo Vos.
  Addiction. April 24, 2014
  Aims To estimate the prevalence and burden of disease attributable to opioid dependence globally, regionally and at country level. Methods Multiple search strategies: (i) peer‐reviewed literature searches; (ii) systematic searches of online databases; (iii) internet searches; (iv) consultation and feedback from experts. Culling and data extraction followed protocols. DisMod‐MR, the latest version of the generic disease modelling system, a Bayesian meta‐regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. Disability weight for opioid dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs). Opioid dependence premature mortality was computed as years of life lost (YLLs) and summed with YLDs to calculate disability‐adjusted life years (DALYs). Results There were 15.5 million opioid‐dependent people globally in 2010 [0.22%, 95% uncertainty interval (UI) = 0.20–0.25%]. Age‐standardized prevalence was higher in males (0.30%, 95% UI = 0.27–0.35%) than females (0.14%, 95% UI = 0.12–0.16%), and peaked at 25–29 years. Prevalence was higher than the global pooled prevalence in Australasia (0.46%, 95% UI = 0.41–0.53%), western Europe (0.35%, 95% UI = 0.32–0.39) and North America (0.30%, 95% UI = 0.25–0.36). Opioid dependence was estimated to account for 9.2 million DALYs globally (0.37% of global DALYs) in 2010, a 73% increase on DALYs estimated in 1990. Regions with the highest opioid dependence DALY rates were North America (292.1 per 100 000), eastern Europe (288.4 per 100 000), Australasia (278.6 per 100 000) and southern sub‐Saharan Africa (263.5 per 100 000). The contribution of YLLs to opioid dependence burden was particularly high in North America, eastern Europe and southern sub‐Saharan Africa. Conclusion Opioid dependence is a substantial contributor to the global disease burden; its contribution to premature mortality (relative to prevalence) varies geographically, with North America, eastern Europe and southern sub‐Saharan Africa most strongly affected.

  April 24, 2014   doi: 10.1111/add.12551   open full text
• Sexual orientation and alcohol problem use among UK adolescents: an indirect link through depressed mood.
  Francesca Pesola, Katherine H. Shelton, Marianne B. M. Bree.
  Addiction. April 17, 2014
  Background and Aims Sexual minority adolescents are more likely to engage in alcohol use than their heterosexual counterparts; however, the underlying reasons remain unclear and longitudinal research is limited. Owing to evidence that this group also experiences greater depressive symptoms than their peers, we aimed to (i) assess to what extent depressed mood explains the increased likelihood of engaging in alcohol use among sexual minority adolescents, and (ii) explore potential gender‐specific patterns. Design Structural equation modelling was used to test the indirect relationship between sexual orientation and alcohol use through depressed mood, with heterosexuals as the reference group. Settings and Participants A total of 3710 adolescents (12% sexual minority), from the Avon Longitudinal Study of Parents and Children (ALSPAC) study, assessed between the ages of 15 and 18 years. Measurements Sexual orientation was assessed at age 15, while alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) at age 18. Depressed mood was indexed by the Short Mood and Feelings Questionnaire (SMFQ) at age 16. Findings Sexual minority adolescents were more likely to engage in alcohol problem use compared to their heterosexual counterparts [Btotal = 0.12, 95%confidence interval (CI) = 0.04–0.20, P = 0.003]. Depressed mood explained 21% of the link between sexual orientation and alcohol use after adjustment for covariates and earlier measures (Z = 3.2, P = 0.001). No gender differences were observed. Conclusions A higher prevalence of alcohol problem use in adolescents who are gay, lesbian or bisexual is partly explained by increased rates of depression in this group.

  April 17, 2014   doi: 10.1111/add.12528   open full text
• The impact of opioid substitution therapy on mortality post‐release from prison: retrospective data linkage study.
  Louisa Degenhardt, Sarah Larney, Jo Kimber, Natasa Gisev, Michael Farrell, Timothy Dobbins, Don J. Weatherburn, Amy Gibson, Richard Mattick, Tony Butler, Lucy Burns.
  Addiction. April 14, 2014
  Aims Release from prison is a high‐risk period for mortality. We examined the impact of opioid substitution therapy (OST), for opioid dependence during and after incarceration, upon mortality post‐release. Design A cohort was formed of all opioid‐dependent people who entered OST between 1985 and 2010 and who, following first OST entry, were released from prison at least once between 2000 and 2012. We linked data on OST history, court and prison records and deaths. Setting New South Wales (NSW), Australia. Participants A total of 16 453 people released from prison 60 161 times. Measurements Crude mortality rates (CMRs) were calculated according to OST retention; multivariable Cox regressions for post‐release periods were undertaken to examine the association between OST exposure (a time‐dependent variable) and mortality post‐release, for which covariates were updated per‐release. Findings There were 100 978 person‐years (PY) post‐release; 1050 deaths occurred. Most received OST while incarcerated (76.5%); individuals were receiving OST in 51% of releases. Lowest post‐release mortality was among those continuously retained in OST post‐release CMR 4 weeks post‐release = 6.4 per 1000 PY; 95% confidence interval (CI) = 5.2, 7.8, highest among those with no OST (CMR = 36.7 per 1000 PY; 95% CI = 28.8, 45.9). Multi‐factorial models showed OST exposure in the 4 weeks post‐release reduced hazard of death by 75% (adjusted hazard ratio 0.25; 95% CI = 0.12, 0.53); OST receipt in prison had a short‐term protective effect that decayed quickly across time. Conclusion In New South Wales, Australia, opioid substitution therapy in prison and post‐release appears to reduce mortality risk in the immediate post‐release period.

  April 14, 2014   doi: 10.1111/add.12536   open full text
• Betel‐quid dependence domains and syndrome associated with betel‐quid ingredients among chewers: an Asian multi‐country evidence.
  Chien‐Hung Lee, Shang‐Lun Chiang, Albert Min‐Shan Ko, Chun‐Hung Hua, Ming‐Hsui Tsai, Saman Warnakulasuriya, Salah Osman Ibrahim, Sunarjo, Rosnah Binti Zain, Tian‐You Ling, Chieh‐Liang Huang, Hsien‐Yuan Lane, Cheng‐Chieh Lin, Ying‐Chin Ko.
  Addiction. April 14, 2014
  Aims Betel‐quid (BQ) contains biologically psychoactive ingredients; however, data are limited concerning the symptoms and syndrome of BQ dependence among chewers. The aims of this study were to evaluate the ingredients‐associated BQ dependence syndrome and country‐specific chewing features and behaviour for BQ dependence among chewers from six Asian communities. Design An intercountry Asian Betel‐quid Consortium study. Setting Six Asian general communities in Taiwan, Mainland China, Indonesia, Malaysia, Sri Lanka and Nepal. Participants Six multi‐stage random samples of BQ chewers in the Asian Betel‐quid Consortium study (n = 2078). Measurements All chewers were evaluated for BQ dependence using the DSM‐IV and ICD‐10 criteria. Findings The 12‐month BQ dependence rate was 12.5–92.6% and 47.9–99.3% (P = 0.023) among tobacco‐free and tobacco‐added BQ chewers across the six Asian communities, with a higher dependence rate in chewers who used tobacco‐free BQ with lime added than without (23.3–95.6% versus 4.0%, P ≤ 0.001). Taiwanese and Hunanese BQ chewers both notably endorsed the dependency domain of ‘time spent chewing’. ‘Tolerance’ and ‘withdrawal’ were the major dependence domains associated with the Nepalese and Indonesian chewers, with high BQ dependence rates. Malaysian and Sri Lankan chewers formed a BQ dependence cluster linked closely to ‘craving’. In Sri Lanka, the quantity consumed explained 90.5% (P < 0.001) of the excess dependence risk for tobacco‐added use, and could be a mediator between tobacco‐derived psychoactive effect and BQ dependence development. Conclusions DSM‐IV criteria for dependence apply to a significant proportion of betel quid users in Asian communities, more so if they use it with tobacco or lime.

  April 14, 2014   doi: 10.1111/add.12530   open full text
• Trends in non‐drinking among Australian adolescents.
  Michael Livingston.
  Addiction. April 10, 2014
  Background and Aims Recent evidence suggests that there has been a sharp increase in non‐drinking among Australian adolescents. This study aimed to explore the socio‐demographic patterns of this increase to identify the potential causal factors. Design Two waves (2001 and 2010) of cross‐sectional data from the National Drug Strategy Household Survey, a large‐scale population survey. Logistic regression analyses were used to identify significant changes over time, with interaction terms used to test whether trends varied by respondent characteristics. Setting Australia. Participants Respondents aged 14–17 years (n = 1477 in 2001 and 1075 in 2010). Measurements The key outcome measure was 12‐month abstention from alcohol. Socio‐demographic variables including sex, age, income, socio‐economic status, state and rurality were examined. Findings Rates of abstention increased overall from 32.9% [95% confidence interval (CI) = 30.0–35.7%) to 50.2% (95% CI = 46.7–53.6%) (P < 0.01). Abstention increased significantly across all population subgroups examined. Conclusions A broad change in drinking behaviour has occurred among Australian adolescents in the last decade, with rates of abstention among 14–17‐year‐olds increasing markedly. Increases in abstention have occurred consistently across a wide range of population subgroups defined by demographic, socio‐economic and regional factors.

  April 10, 2014   doi: 10.1111/add.12524   open full text
• Alcohol Consumption and Cognitive Performance: a Mendelian Randomisation Study.
  Meena Kumari, Michael V Holmes, Caroline E Dale, Jaroslav Hubacek, Tom M Palmer, Hynek Pikhart, Anne Peasey, Annie Britton, Pia Horvat, Ruzena Kubinova, Sofia Malyutina, Andrzej Pajak, Abdonas Tamosiunas, Aparna Shanka, Archana Singh‐Manoux, Mikhail Voevoda, Mika Kivimaki, Aroon D Hingorani, Michael G Marmot, Juan P Casas, Martin Bobak.
  Addiction. April 09, 2014
  Aims To use Mendelian randomisation to assess whether any versus no alcohol intake causes either increased or reduced cognitive function. Design Mendelian randomization using a genetic variant related to alcohol intake (ADH1B rs1229984) was used to obtain unbiased estimates of the association between any alcohol intake and either higher or lower cognitive performance. Setting Europe Participants More than 34,000 adults. Measurements Any versus no alcohol intake in the previous week was measured by questionnaire. Cognitive function was assessed in terms of immediate and delayed word recall, verbal fluency and processing speed. Findings Having consumed any vs no alcohol was associated with higher scores by 0.17 standard deviations (SD) (95% confidence interval [CI] 0.15, 0.20) for immediate recall, 0.17 SD (95%CI 0.14, 0.19) for delayed recall, 0.17 SD (95%CI 0.14, 0.19) for verbal fluency and 0.12 SD (95%CI 0.09, 0.15) for processing speed. The minor allele of rs1229984 was associated with reduced odds of consuming any alcohol (odds ratio 0.87; 95% CI 0.80, 0.95; P=0.001; R2=0.1%; F‐statistic=47). In Mendelian randomisation analysis, the minor allele was not associated with any cognitive test score, and instrumental variable analysis suggested no causal association between alcohol consumption and cognition: ‐0.74 SD (95%CI ‐1.88, 0.41) for immediate recall, ‐1.09 SD (95%CI ‐2.38, 0.21) for delayed recall, ‐0.63 SD (95%CI ‐1.78, 0.53) for verbal fluency and ‐0.16 SD (95%CI ‐1.29, 0.97) for processing speed. Conclusions Consuming alcohol in some quantity does not appear to affect cognitive ability.

  April 09, 2014   doi: 10.1111/add.12568   open full text
• Are Alcohol Policies Associated with Alcohol Consumption in Low‐and Middle‐Income Countries?
  Won Kim Cook, Jason Bond, Thomas K. Greenfield.
  Addiction. April 09, 2014
  Aims To examine the associations between alcohol control policies in four regulatory domains with alcohol consumption in low‐ and middle‐income countries (LAMICs), controlling for country‐level living standards and drinking patterns. Design Cross‐sectional analyses of individual‐level alcohol consumption survey data and country‐level alcohol policies using multi‐level modeling Setting Data from 15 LAMICs collected in the Gender, Alcohol, and Culture: an International Study (GENACIS) Participants Persons aged 18‐65 Measurements Alcohol policy data compiled by the World Health Organization; individual‐level current drinking status, usual quantity and frequency of drinking, binge drinking frequency, and total drinking volume; Gross Domestic Product based on purchasing power parity (GDP‐PPP) per capita; detrimental drinking pattern scale; and age and gender as individual‐level covariates Findings Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a licensing system for off‐premises alcohol retail sales, as well as minimum legal drinking age, were the most consistent predictors of alcohol consumption. Aggregate relative alcohol price levels were inversely associated with all drinking variables (p<.05) except drinking volume. Greater restrictions on alcohol advertising, particularly beer advertising, were inversely associated with alcohol consumption (p<.05). Policies that set legal blood alcohol concentration (BAC) limits for drivers and random breath testing to enforce BAC limits were not significantly associated with alcohol consumption. Conclusions Alcohol policies that regulate the physical availability of alcohol are associated with lower alcohol consumption in low‐ and middle‐income countries.

  April 09, 2014   doi: 10.1111/add.12571   open full text
• The declining trend in Swedish youth drinking: collectivity or polarization?
  Thor Norström, Johan Svensson.
  Addiction. March 28, 2014
  Aims Alcohol consumption among youth in Sweden has declined markedly during the last decade. This study aims to tackle the following research questions: (i) how is the decrease in drinking distributed across consumption categories; and (ii) is the pattern of change in consumption consistent with Skog's theory of the collectivity of drinking behaviour? Design, Setting, Participants and Measurements We analysed data from the nationally representative annual school survey of alcohol and drug habits among Swedish 9th‐grade students (aged 15–16 years) covering the period 2000–12 (n ≈ 5000/year). Respondents were divided into seven drinking groups based on their relative ranking on consumption, which was measured by beverage‐specific quantity and frequency items summarized into a measure of overall drinking in litres of 100% alcohol per year. In addition, the mean number of heavy episodic drinking occasions (HED) was computed for each drinking group. Findings The decline in consumption among Swedish youth was mirrored in all seven drinking groups, although the relative decrease was smaller for heavy drinkers (top 5%) than for light drinkers (below the median). Among the top 5%, the average annual decrease was 2% (P = 0.027), while the corresponding figure for light drinkers was 28.9% (P < 0.001). The reverse pattern was true when looking at the absolute decrease. The decrease among the top 5% accounted for 26.1% of the decrease in mean consumption during the study period, whereas the light drinkers accounted for 2.9%. There was a marked relation between overall consumption, on one hand, and mean consumption and HED, on the other hand, in each of the seven drinking groups. Conclusion The marked decrease in youth drinking in Sweden that occurred during the period 2000–12 was manifest at all consumption levels. The findings are consistent with Skog's theory of the collectivity of drinking behaviour.

  March 28, 2014   doi: 10.1111/add.12510   open full text
• The collectivity of changes in alcohol consumption revisited.
  Ingeborg Rossow, Pia Mäkelä, William Kerr.
  Addiction. March 28, 2014
  Aims Within‐country temporal changes in alcohol consumption in the United States, Finland and Norway were examined to assess (i) whether a change in mean alcohol consumption is accompanied by a change in the prevalence of heavy drinkers, (ii) whether this mean change reflects a collective displacement in the whole distribution of consumption and (iii) whether collective displacement is found for both an upward and a downward shift in mean consumption. Methods We applied repeated cross‐sectional survey data on distribution measures for estimated annual alcohol consumption from national population sample surveys covering 30–40‐year periods in two countries with increasing trends in mean consumption (Finland and Norway) and one country with decreasing trends (the United States). Results There was a strong positive association (P < 0.001) between changes in mean consumption and changes in the prevalence of heavy drinkers in all three countries. Moreover, a change in mean consumption was accompanied by a consumption change in the same direction in all consumer categories in all three countries, i.e. a collective displacement. The regression coefficients were approximately 1. Conclusions Drinkers at all levels of consumption appear to move in concert, both up and down the consumption scale, in Finland, Norway and the United States, as predicted by Skog's theory of the collectivity of drinking cultures.

  March 28, 2014   doi: 10.1111/add.12520   open full text
• Effectiveness of the ‘Healthy School and Drugs’ prevention programme on adolescents' substance use: a randomized clustered trial.
  Monique Malmberg, Marloes Kleinjan, Geertjan Overbeek, Ad Vermulst, Karin Monshouwer, Jeroen Lammers, Wilma A. M. Vollebergh, Rutger C. M. E. Engels.
  Addiction. March 25, 2014
  Aim To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design Randomized clustered trial with two intervention conditions (i.e. e‐learning and integral). Setting General population of 11–15‐year‐old adolescents in the Netherlands. Participants A total of 3784 students of 23 Dutch secondary schools. Measurements Structured digital questionnaires were administered pre‐intervention and at 32 months follow‐up. The primary outcome measures were new incidences of alcohol (life‐time and 1‐month prevalence), tobacco (life‐time and 1‐month prevalence) and marijuana use (life‐time prevalence). Findings Main effect analyses showed no programme effects on incidences of alcohol consumption (life‐time prevalence: e‐learning condition: B = 0.102, P = 0.549; integral condition: B = −0.157, P = 0.351; 1‐month prevalence: e‐learning condition: B = 0.191, P = 0.288; integral condition: B = −0.140, P = 0.445), tobacco consumption (life‐time prevalence: e‐learning condition: B = 0.164, P = 0.444; integral condition: B = 0.160, P = 0.119; 1‐month prevalence: e‐learning condition: B = 0.088, P = 0.746; integral condition: B = 0.261, P = 0.093), or marijuana consumption (life‐time prevalence: e‐learning condition: B = 0.070, P = 0.732; integral condition: B = 0.186, P = 0.214). Conclusion The non‐significant impact of the Healthy School and Drugs programme (a Dutch school‐based prevention programme for early adolescents) on incidences of alcohol, tobacco and marijuana use indicates that the programme is either ineffective or implemented inadequately.

  March 25, 2014   doi: 10.1111/add.12526   open full text
• Ex‐smokers are happier than current smokers among Chinese adults in Hong Kong.
  Man Ping Wang, Xin Wang, Tai Hing Lam, Kasisomayajula Viswanath, Sophia S. Chan.
  Addiction. March 25, 2014
  Aim To investigate the cross‐sectional association between smoking and happiness in Chinese adults in Hong Kong. Design, Setting and Participants Telephone surveys were conducted between 2009 and 2012, with 4553 randomly sampled Chinese adults (male 54%, mean age 58.3 years) in Hong Kong. Measurements Happiness was measured using the four‐item Subjective Happiness Scale (SHS) and single‐item Global Happiness Item (GHI). Smoking status was categorized as current smokers (7.7%%), ex‐smokers (6.5%, 93% quit for >6 months) and never smokers (85.8%). Linear and ordinal logistic regressions were used to calculate adjusted β‐coefficients for SHS and proportional adjusted odds ratios (aOR) for GHI in relation to smoking. Findings Compared with current smokers, ex‐smokers enjoyed greater happiness according to both SHS (adjusted β = 0.16, P < 0.05) and GHI (aOR = 1.52, P < 0.05) measurements, but current and never smokers were similar. Among current smokers, the number of cigarettes smoked was not associated with happiness, but the lack of any attempt to quit was associated significantly with greater happiness (adjusted β = 0.31 for SHS, aOR = 1.82 for GHI) compared with smokers who had tried to quit but not succeeded. Smokers not intending to quit in the next 6 months had higher odds of happiness (GHI) than those wanting to quit within 6 months (aOR = 1.86, P < 0.05). Conclusions Ex‐smokers in Hong Kong are happier than current smokers and never smokers, whose happiness measurements are similar. Causal associations have yet to be established.

  March 25, 2014   doi: 10.1111/add.12531   open full text
• Heavy episodic drinking and deliberate self‐harm in young people: a longitudinal cohort study.
  Ingeborg Rossow, Thor Norström.
  Addiction. March 25, 2014
  Aim To assess the association between heavy episodic drinking (HED) and deliberate self‐harm (DSH) in young people in Norway. Design, setting, participants and measurements We analysed data on past‐year HED and DSH from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (cumulative response rate: 68.1%, n = 2647). Associations between HED and DSH were obtained as odds ratios and population‐attributable fractions (PAF) applying fixed‐effects modelling, which eliminates the effects of time‐invariant confounders. Findings An increase in HED was associated with an increase in risk of DSH (OR = 1.64, P = 0.013), after controlling for time‐varying confounders. The estimated PAF was 28% from fixed‐effects modelling and 51% from conventional modelling. Conclusion Data on Norwegian youths show a statistically significant association between heavy episodic drinking and deliberate self‐harm.

  March 25, 2014   doi: 10.1111/add.12527   open full text
• The association between smoking and depression from adolescence to adulthood.
  Tore Tjora, Jørn Hetland, Leif Edvard Aarø, Bente Wold, Nora Wiium, Simon Øverland.
  Addiction. March 25, 2014
  Background and Aims The association between depression and smoking is firmly established, but how the association develops remains unclear. The aim of this study was to examine development of the smoking–depression association from early adolescence to adulthood. Design Cross‐sectional and longitudinal analyses of the smoking–depression association from adolescence to adulthood. Setting Hordaland, Norway. Participants A cohort of adolescents (initially, 924 pupils) in the Norwegian Longitudinal Health Behaviour Study (NLHB) was followed over nine data collection waves from ages 13 to 30 years. Measurements Daily smoking and depressed mood were measured in each wave. Findings In the cross‐sectional analyses, daily smoking and depression were significantly associated (P‐value range from P < 0.01 to 0.04) in eight of nine waves. In the final longitudinal model, after controlling for the time‐invariant effects of smoking and depression and of tertiary factors, the only significant paths were early adolescent smoking prediction of early adolescent depression (waves 1–2: β = 0.07, P < 0.05; waves 2–3: β = 0.12, P < 0.05) and vice versa (waves 1–2: β = 0.10, P < 0.05; waves 2–3: β = 0.08, P < 0.05). Conclusions The inter‐relationship between depression and smoking seems to be due to the reciprocal causal effects between smoking and depression that are established in early adolescence and maintained into adulthood.

  March 25, 2014   doi: 10.1111/add.12522   open full text
• Time to first cigarette predicts 4‐(methylnitrosamino)‐1‐(3‐pyridyl)‐1‐butanol (NNAL) in adolescent regular and intermittent smokers, National Health and Nutrition and Examination Survey (NHANES) 2007–10.
  Steven A. Branstetter, Melissa Mercincavage, Joshua E. Muscat.
  Addiction. March 19, 2014
  Background and Aims The time to first cigarette (TTFC) of the day is an indicator of nicotine intake in adults and adolescents. However, the relation between TTFC and biological markers of nicotine addiction and health risk in youths has not been well described. The current study examined whether an earlier TTFC predicts higher levels of a tobacco‐specific carcinogen, 4‐(methylnitrosamino)‐1‐(3‐pyridal)‐1 (NNAL), in regular and intermittent adolescent smokers and if this relation is mediated by nicotine intake (measured by cotinine) or cigarettes per day (CPD). Design A cross‐sectional analysis of a nationally representative subsample of adolescents. Setting A general community sample from the 2007–08 and 2009–10 National Health and Nutrition and Examination Survey. Participants A total of 215 adolescents in the United States between the ages of 12 and 19 years who reported smoking at least once in the 5 days prior to data collection. Measurements The primary outcome measure was urinary levels of NNAL. Findings In both regular and intermittent smokers, earlier TTFC was associated dose‐dependently with higher levels of NNAL (P < 0.03 in both cases). TTFC had an indirect effect on NNAL, mediated by nicotine intake (cotinine) in both regular [β = −0.08, standard error (SE) = 0.03, 95% confidence interval (CI) = −0.15, −0.03] and intermittent (β = −0.02, SE = 0.01, 95% CI = −0.05, −0.002) smokers. CPD was not found to be an important mediator of the relation between TTFC and NNAL. Conclusions Time between waking and the first cigarette of the day is correlated in daily and non‐daily adolescent smokers with overall nicotine and therefore carcinogen intake.

  March 19, 2014   doi: 10.1111/add.12515   open full text
• Polygenic risk scores for smoking: predictors for alcohol and cannabis use?
  Jacqueline M. Vink, Jouke Jan Hottenga, Eco J. C. Geus, Gonneke Willemsen, Michael C. Neale, Helena Furberg, Dorret I. Boomsma.
  Addiction. March 18, 2014
  Background and Aims A strong correlation exists between smoking and the use of alcohol and cannabis. This paper uses polygenic risk scores to explore the possibility of overlapping genetic factors. Those scores reflect a combined effect of selected risk alleles for smoking. Methods Summary‐level P‐values were available for smoking initiation, age at onset of smoking, cigarettes per day and smoking cessation from the Tobacco and Genetics Consortium (n between 22 000 and 70 000 subjects). Using different P‐value thresholds (0.1, 0.2 and 0.5) from the meta‐analysis, sets of ‘risk alleles’ were defined and used to generate a polygenic risk score (weighted sum of the alleles) for each subject in an independent target sample from the Netherlands Twin Register (n = 1583). The association between polygenic smoking scores and alcohol/cannabis use was investigated with regression analysis. Results The polygenic scores for ‘cigarettes per day’ were associated significantly with the number of glasses alcohol per week (P = 0.005, R2 = 0.4–0.5%) and cannabis initiation (P = 0.004, R2 = 0.6–0.9%). The polygenic scores for ‘age at onset of smoking’ were associated significantly with ‘age at regular drinking’ (P = 0.001, R2 = 1.1–1.5%), while the scores for ‘smoking initiation’ and ‘smoking cessation’ did not significantly predict alcohol or cannabis use. Conclusions Smoking, alcohol and cannabis use are influenced by aggregated genetic risk factors shared between these substances. The many common genetic variants each have a very small individual effect size.

  March 18, 2014   doi: 10.1111/add.12491   open full text
• Predictors of change in cocaine use in a street‐recruited cohort of young cocaine users.
  José Pulido, Gemma Molist, Antonia Domingo‐Salvany, M. Teresa Brugal, Albert Sanchez‐Niubò, Gregorio Barrio, Luis Fuente,.
  Addiction. March 17, 2014
  Aim To determine predictors of changes in amount of cocaine use among regular users outside treatment services. Design Longitudinal study—we estimated the proportion of subjects who increased or decreased cocaine use and assessed possible predictors related to these changes among a street‐recruited cohort of young regular cocaine users (RCU). Setting Three Spanish cities: Barcelona, Madrid and Seville Participants A total of 720 RCU aged 18–30 years not regularly using heroin were recruited in the community during 2004–06 (Itinere Project). Follow‐up interviews (n = 501) were carried out at 12–24 months. Measurements The average amount of cocaine used weekly was calculated taking into account the number of days of use and the usual quantity (g/day). A multinomial logistic regression approach was used to investigate the association between changes in amount of cocaine use (i.e. difference exceeded 33.3% of baseline level) after 12–24 months, and baseline socio‐demographic characteristics, nightlife, patterns of cocaine use and use of alcohol and other psychoactive drugs. Findings Cocaine use baseline average level was 2.14 g/week [95% confidence interval (CI) = 2.02–2.42]. It decreased in 71.5% of subjects and increased in 14.1%. In multinomial analysis, negative associations were found between decreasing cocaine use and high levels of alcohol consumption and using an increasing number of psychoactive drugs. Moreover, low education level, having used cocaine frequently in houses and reporting cocaine binges were associated with increasing cocaine use. Conclusions A street‐recruited cohort of cocaine users in Spain showed a significant reduction in cocaine use over a period of 12–24 months. High consumption of alcohol and increasing use of other psychoactive drugs decreased the probability of reducing cocaine use.

  March 17, 2014   doi: 10.1111/add.12503   open full text
• Clinical features of methamphetamine‐induced paranoia and preliminary genetic association with DBH‐1021C→T in a Thai treatment cohort.
  Rasmon Kalayasiri, Viroj Verachai, Joel Gelernter, Apiwat Mutirangura, Robert T. Malison.
  Addiction. March 16, 2014
  Aims To explore the clinical features of methamphetamine‐induced paranoia (MIP) and associations between MIP and a genetic polymorphism in dopamine β‐hydroxylase (DBH‐1021C→T). Design Retrospective analysis of clinical presentation and genetic association by χ2 test and logistic regression analysis. Setting A Thai substance abuse treatment center. Participants A total of 727 methamphetamine‐dependent (MD) individuals. Measurements Clinical: Semi‐Structured Assessment for Drug Dependence and Alcoholism (SSADDA) and the Methamphetamine Experience Questionnaire (MEQ). Genetic: DBH‐1021C→T. Findings Forty per cent of individuals (289 of 727; 39.8%) with MD had MIP. Within‐binge latency to MIP onset occurred more rapidly in the most recent compared with initial MIP episode (P = 0.02), despite unchanging intake (P = 0.89). Individuals with MIP were significantly less likely to carry lower (TT/CT) compared with higher (CC) activity genotypes (34.3 versus 43.3%; χ21 = 5, P = 0.03). DBH effects were confirmed [odds ratio (OR) = 0.7, P = 0.04] after controlling for associated clinical variables (MD severity, OR = 3.4, P < 0.001; antisocial personality disorder, OR = 2.2, P < 0.001; alcohol dependence, OR = 1.4, P = 0.05; and nicotine dependence, OR = 1.4, P = 0.06). TT/CT carriers were more likely to initiate cigarette smoking (OR = 3.9, P = 0.003) and probably less likely to be dependent on alcohol (OR = 0.6, P = 0.05). Conclusions Among methamphetamine‐dependent individuals, paranoia appears to occur increasingly rapidly in the course of a session of methamphetamine use. Severity of methamphetamine dependence and antisocial personality disorder predicts methamphetamine‐induced paranoia. The genetic polymorphism in dopamine β‐hydroxylase is associated with methamphetamine‐induced paranoia and influences smoking initiation.

  March 16, 2014   doi: 10.1111/add.12512   open full text
• Maternal smoking during pregnancy and offspring smoking initiation: assessing the role of intrauterine exposure.
  Amy E. Taylor, Laura D. Howe, Jon E. Heron, Jennifer J. Ware, Matthew Hickman, Marcus R. Munafò.
  Addiction. March 16, 2014
  Aims To assess whether associations between maternal smoking during pregnancy and offspring smoking initiation are due to intrauterine mechanisms. Design Comparison of associations of maternal and partner smoking behaviour during pregnancy with offspring smoking initiation using partner smoking as a negative control (n = 6484) and a Mendelian randomization analysis (n = 1020), using a genetic variant in the mothers as a proxy for smoking cessation during pregnancy. Setting A longitudinal birth cohort in South West England. Participants Participants of the Avon Longitudinal Study of Parents and Children (ALSPAC). Measurements Smoking status during pregnancy was self‐reported by mother and partner in questionnaires administered at pregnancy. Latent classes of offspring smoking initiation (non‐smokers, experimenters, late‐onset regular smokers and early‐onset regular smokers) were previously developed from questionnaires administered at 14–16 years. A genetic variant, rs1051730, was genotyped in the mothers. Findings Both mother and partner smoking were similarly positively associated with offspring smoking initiation classes, even after adjustment for confounders. Odds ratios (OR) [95% confidence interval (CI)] for class membership compared with non‐smokers were: experimenters: mother OR = 1.33 (95% CI = 1.06, 1.67), partner OR = 1.28 (95% CI = 1.06, 1.55), late‐onset regular smokers: mother OR = 1.80 (95% CI = 1.43, 2.26), partner OR = 1.86 (95% CI = 1.52, 2.28) and early‐onset regular smokers: mother OR = 2.89 (95% CI = 2.12, 3.94), partner OR = 2.50 (95% CI = 1.85, 3.37). There was no clear evidence for a dose–response effect of either mother or partner smoking heaviness on class membership. Maternal rs1051730 genotype was not clearly associated with offspring smoking initiation class in pre‐pregnancy smokers (P = 0.35). Conclusion The association between smoking during pregnancy and offspring smoking initiation does not appear to operate through intrauterine mechanisms.

  March 16, 2014   doi: 10.1111/add.12514   open full text
• Unexpected adverse childhood experiences and subsequent drug use disorder: a Swedish population study (1995‐2011).
  Giuseppe N. Giordano, Henrik Ohlsson, Kenneth S. Kendler, Kristina Sundquist, Jan Sundquist.
  Addiction. March 11, 2014
  Aims Exposure to extraordinary traumatic experience is one acknowledged risk factor for drug use. We aim to analyse the influence of potentially life‐changing childhood stressors, experienced second‐hand, on later drug use disorder in a national population of Swedish adolescent and young adults (aged 15‐26 years). Design We performed Cox Proportional Hazard regression analyses, complemented with co‐relative pair comparisons. Setting Sweden Participants All individuals in the Swedish population born 1984 to 1995, who were registered in Sweden at the end of the calendar year they turned 14 years of age. Our follow‐up time (Mean: 6.2 years; Range 11 years) started at the year they turned 15 and continued to December 2011 (N=1,409,218). Measurements Our outcome variable was drug use disorder, identified from medical, legal and pharmacy registry records. Childhood stressors, as per DSM‐IV stressor criteria, include death of an immediate family member and second‐hand experience of diagnoses of malignant cancer, serious accidental injury, and victim of assault. Other covariates include parental divorce, familial psychological well‐being, and familial drug and alcohol use disorders. Findings After adjustment for all considered confounders, individuals exposed to childhood stressors ‘parental death’ or ‘parental assault’ had over twice the risk of drug use disorder than those who were not (HR = 2.63 (2.23‐3.09) and 2.39 (2.06‐2.79), respectively). Conclusions Children under 15 who experience second‐hand an extraordinary traumatic event (such as a parent or sibling being assaulted, diagnosed with cancer, or dying) appear to have approximately twice the risk of developing a drug use disorder than those who do not.

  March 11, 2014   doi: 10.1111/add.12537   open full text
• Increasing public support for supervised injection facilities in Ontario, Canada.
  Carol Strike, Jennifer A. Jairam, Gillian Kolla, Peggy Millson, Susan Shepherd, Benedikt Fischer, Tara Marie Watson, Ahmed M. Bayoumi.
  Addiction. March 10, 2014
  Aim To determine the level and changes in public opinion between 2003 and 2009 among adult Canadians about implementation of supervised injection facilities (SIFs) in Canada. Design Population‐based, telephone survey data collected in 2003 and 2009 were analysed to identify strong, weak, and intermediate support for SIFs. Setting Ontario, Canada Participants Representative samples of adults aged 18 years and over. Measurements Analyses of the agreement with implementation of SIFs in relation to four individual SIF goals and a composite measure. Findings The final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Between 2003 and 2009, there were increases in the proportion of participants who strongly agreed with implementing SIFs to: reduce neighbourhood problems (0.309 versus 0.556, respectively); increase contact of people who use drugs with health and social workers (0.257 versus 0.479, respectively); reduce overdose deaths or infectious disease among people who use drugs (0.269 versus 0.482, respectively); and encourage safer drug injection (0.213 versus 0.310, respectively). Analyses using a composite measure of agreement across goals showed that 0.776 of participants had mixed opinions about SIFs in 2003, compared with only 0.616 in 2009. There was little change among those who strongly disagreed with all SIF goals (0.091 versus 0.113 in 2003 and 2009, respectively). Conclusions Support for implementation of supervised injection facilities in Ontario, Canada increased between 2003 and 2009, but at both time‐points a majority still held mixed opinions.

  March 10, 2014   doi: 10.1111/add.12506   open full text
• Effectiveness of tobacco control television advertising in changing tobacco use in England: a population‐based cross‐sectional study.
  Michelle Sims, Ruth Salway, Tessa Langley, Sarah Lewis, Ann McNeill, Lisa Szatkowski, Anna B. Gilmore.
  Addiction. March 10, 2014
  Aim To examine whether government‐funded tobacco control television advertising shown in England between 2002 and 2010 reduced adult smoking prevalence and cigarette consumption. Design Analysis of monthly cross‐sectional surveys using generalised additive models. Setting England. Participants More than 80 000 adults aged 18 years or over living in England and interviewed in the Opinions and Lifestyle Survey. Measurements Current smoking status, smokers' daily cigarette consumption, tobacco control gross rating points (GRPs—a measure of per capita advertising exposure combining reach and frequency), cigarette costliness, tobacco control activity, socio‐demographic variables. Findings After adjusting for other tobacco control policies, cigarette costliness and individual characteristics, we found that a 400‐point increase in tobacco control GRPs per month, equivalent to all adults in the population seeing four advertisements per month (although actual individual‐level exposure varies according to TV exposure), was associated with 3% lower odds of smoking 2 months later [odds ratio (OR) = 0.97, 95% confidence interval (CI) = 0.95, 0.999] and accounted for 13.5% of the decline in smoking prevalence seen over this period. In smokers, a 400‐point increase in GRPs was associated with a 1.80% (95%CI = 0.47, 3.11) reduction in average cigarette consumption in the following month and accounted for 11.2% of the total decline in consumption over the period 2002–09. Conclusion Government‐funded tobacco control television advertising shown in England between 2002 and 2010 was associated with reductions in smoking prevalence and smokers' cigarette consumption.

  March 10, 2014   doi: 10.1111/add.12501   open full text
• Heterogeneous population effects of an alcohol excise tax increase on sexually transmitted infections morbidity.
  Stephanie A. S. Staras, Melvin D. Livingston, Alana M. Christou, David H. Jernigan, Alexander C. Wagenaar.
  Addiction. March 03, 2014
  Background and Aims Alcohol taxes reduce population‐level excessive alcohol use and alcohol‐related morbidity and mortality, yet little is known about the distribution of the effects of alcohol taxation across race/ethnicity and age subgroups. We examined the race/ethnicity‐ and age group‐specific effects of an excise alcohol tax increase on a common and routinely collected alcohol‐related morbidity indicator, sexually transmitted infections. Methods We used an interrupted time series design to examine the effect of a 2009 alcohol tax increase in Illinois, USA on new cases of two common sexually transmitted infections (chlamydia and gonorrhea) reported to the US National Notifiable Disease Surveillance System from January 2003 to December 2011 (n = 108 repeated monthly observations). We estimated the effects of the tax increase on infection rates in the general population and within specific race/ethnicity and age subgroups using mixed models accounting for temporal trends and median income. Results Following the Illinois alcohol tax increase, state‐wide rates of gonorrhea decreased 21% [95% confidence Interval (CI) = −25.7, −16.7] and chlamydia decreased 11% [95% CI = −17.8, −4.4], resulting in an estimated 3506 fewer gonorrhea infections and 5844 fewer chlamydia infections annually. The null hypothesis of homogenous effects by race/ethnicity and age was rejected (P < 0.0001). Significant reductions were observed among non‐Hispanic blacks: gonorrhea rates decreased 25.6% (95% CI = −30.0, −21.0) and chlamydia rates decreased 14.7% (95% CI = −20.9, −8.0). Among non‐Hispanics, point estimates suggest decreases were highest among 25–29‐year‐olds. Conclusions Increased alcohol taxes appear to reduce sexually transmitted infections, especially among subpopulations with high disease burdens, such as non‐Hispanic blacks.

  March 03, 2014   doi: 10.1111/add.12493   open full text
• Patterns of cannabis use and prospective associations with health issues among young males.
  Stéphanie Baggio, Alexandra A. N'Goran, Stéphane Deline, Joseph Studer, Marc Dupuis, Yves Henchoz, Meichun Mohler‐Kuo, Jean‐Bernard Daeppen, Gerhard Gmel.
  Addiction. February 28, 2014
  Background and Aims To test prospective associations between cannabis disorder symptoms/frequency of cannabis use and health issues and to investigate stability versus transience in cannabis use trajectories. Design Two waves of data collection from the longitudinal Cohort Study on Substance Use Risk Factors (C‐SURF). Setting A representative sample of young Swiss men in their early 20s from the general population. Participants A total of 5084 young men (mean age 19.98 ± 1.19 years at time 1). Measurements Cannabis use (life‐time use, frequency of use, cannabis disorder symptoms) and self‐reported measures of health issues (depression, mental/physical health, health consequences) were assessed. Significant changes in cannabis use were tested using t‐test/Wilcoxon's rank test for paired data. Cross‐lagged panel models provided evidence regarding longitudinal associations between cannabis use and health issues. Findings Most of the participants (84.5%) remained in the same use category and cannabis use kept to similar levels at times 1 and 2 (P = 0.114 and P = 0.755; average of 15 ± 2.8 months between times 1 and 2). Cross‐lagged panel models showed that cannabis disorder symptoms predicted later health issues (e.g. depression, β = 0.087, P < 0.001; health consequences, β = 0.045, P < 0.05). The reverse paths from health issues to cannabis disorder symptoms and the cross‐lagged panel model between frequency of cannabis use and health issues were non‐significant. Conclusions Patterns of cannabis use showed substantial continuity among young Swiss men in their early 20s. The number of symptoms of cannabis use disorder, rather than the frequency of cannabis use, is a clinically important measure of cannabis use among young Swiss men.

  February 28, 2014   doi: 10.1111/add.12490   open full text
• The freeze on mass media campaigns in England: a natural experiment of the impact of tobacco control campaigns on quitting behaviour.
  Tessa Langley, Lisa Szatkowski, Sarah Lewis, Ann McNeill, Anna B. Gilmore, Ruth Salway, Michelle Sims.
  Addiction. January 16, 2014
  Aims To measure the impact of the suspension of tobacco control mass media campaigns in England in April 2010 on measures of smoking cessation behaviour. Design Interrupted time series design using routinely collected population‐level data. Analysis of use of a range of types of smoking cessation support using segmented negative binomial regression. Setting England. Measurements Use of non‐intensive support: monthly calls to the National Health Service (NHS) quitline (April 2005–September 2011), text requests for quit support packs (December 2007–10) and web hits on the national smoking cessation website (January 2009–March 2011). Use of intensive cessation support: quarterly data on the number of people setting a quit date and 4‐week quitters at the NHS Stop Smoking Services (SSS) (quarter 1, 2001 and quarter 3, 2011). Findings During the suspension of tobacco control mass media spending, literature requests fell by 98% [95% confidence interval (CI) = 96–99], and quitline calls and web hits fell by 65% (95% CI = 43–79) and 34% (95% CI: 11–50), respectively. The number of people setting a quit date and 4‐week quitters at the SSS increased throughout the study period. Conclusions The suspension of tobacco control mass media campaigns in England in 2012 appeared to markedly reduce the use of smoking cessation literature, quitline calls and hits on the national smoking cessation website, but did not affect attendance at the Stop Smoking Services. Within a comprehensive tobacco control programme, mass media campaigns can play an important role in maximizing quitting activity.

  January 16, 2014   doi: 10.1111/add.12448   open full text
• Parental monitoring trajectories and gambling among a longitudinal cohort of urban youth.
  Grace P. Lee, Elizabeth A. Stuart, Nicholas S. Ialongo, Silvia S. Martins.
  Addiction. December 10, 2013
  Aim To test the strength of the association between parental monitoring trajectories throughout early adolescence (ages 11–14) and gambling behaviours by young adulthood (age 22). Design Longitudinal cohort design. Setting Baltimore, Maryland. Participants The sample of 514 participants with gambling data between ages 16–22 and parental monitoring data between ages 11–14 were predominantly African American and received subsidized lunches at age 6. Measurements The South Oaks Gambling Screen and South Oaks Gambling Screen–Revised for Adolescents collected self‐reports on annual gambling and gambling problems between ages 16–22. The Parental Monitoring Subscale of the Structured Interview of Parent Management Skills and Practices–Youth Version collected self‐reports on annual parental monitoring between ages 11–14. Findings General growth mixture modelling identified two parental monitoring trajectories: (i) ‘stable’ class (84.9%) began with a high level of parental monitoring at age 11 that remained steady to age 14; (ii) ‘declining’ class (15.1%) began with a significantly lower level of parental monitoring at age 11 and experienced a significant to through age 14. The declining class had increased significantly unadjusted (OR = 1.91; 95% CI = 1.59, 2.23; P ≤ 0.001) and adjusted (aOR = 1.57; 95% CI = 1.24, 1.99; P = 0.01) odds of problem gambling compared with non‐gambling. Conclusion Low and/or declining parental monitoring of children between the ages of 11 and 14 is associated significantly with problem gambling when those children reach young adulthood.

  December 10, 2013   doi: 10.1111/add.12399   open full text