The clinical course of comorbid substance use disorder and attention deficit/hyperactivity disorder: protocol and clinical characteristics of the INCAS study.

BACKGROUND: Substance use disorders (SUD) often co-occur with attention deficit hyperactivity disorder (ADHD). Although the short-term effects of some specific interventions have been investigated in randomized clinical trials, little is known about the long-term clinical course of treatment-seeking SUD patients with comorbid ADHD. AIMS: This paper presents the protocol and baseline clinical characteristics of the International Naturalistic Cohort Study of ADHD and SUD (INCAS) designed and conducted by the International Collaboration on ADHD and Substance Abuse (ICASA) foundation. The overall aim of INCAS is to investigate the treatment modalities provided to treatment-seeking SUD patients with comorbid ADHD, and to describe the clinical course and identify predictors for treatment outcomes. This ongoing study employs a multicentre observational prospective cohort design. Treatment-seeking adult SUD patients with comorbid ADHD are recruited, at 12 study sites in nine different countries. During the follow-up period of nine months, data is collected through patient files, interviews, and self-rating scales, targeting a broad range of cognitive and clinical symptom domains, at baseline, four weeks, three months and nine months. RESULTS: A clinically representative sample of 578 patients (137 females, 441 males) was enrolled during the recruitment period (June 2017-May 2021). At baseline, the sample had a mean age (SD) of 36.7 years (11.0); 47.5% were inpatients and 52.5% outpatients; The most prevalent SUDs were with alcohol 54.2%, stimulants 43.6%, cannabis 33.1%, and opioids 14.5%. Patients reported previous treatments for SUD in 71.1% and for ADHD in 56.9%. Other comorbid mental disorders were present in 61.4% of the sample: major depression 31.5%, post-traumatic stress disorder 12.1%, borderline personality disorder 10.2%. CONCLUSIONS: The first baseline results of this international cohort study speak to its feasibility. Data show that many SUD patients with comorbid ADHD had never received treatment for their ADHD prior to enrolment in the study. Future reports on this study will identify the course and potential predictors for successful pharmaceutical and psychological treatment outcomes. TRIAL REGISTRATION: ISRCTN15998989 20/12/2019.

[International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder]. / Internationale Konsenserklärung zu Screening, Diagnostik und Behandlung von Jugendlichen und Heranwachsenden mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und gleichzeitigen Störungen durch Substanzgebrauch.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Differential Diagnosis in Patients with Substance Use Disorder and/or Attention-Deficit/Hyperactivity Disorder Using Continuous Performance Test.

BACKGROUND: Although substance use disorders (SUD) and attention-deficit/hyperactivity disorder (ADHD) show significant symptomatic overlap, ADHD is often overlooked in SUD patients. OBJECTIVE: The aim of the present study was to characterize aspects of attention and inhibition (as assessed by a continuous performance test [CPT]) in SUD patients with and without a comorbid diagnosis of ADHD and in healthy controls, expecting the most severe deficits in patients with a combined diagnosis. METHODS: The MOXO-CPT version, which incorporates visual and auditory environmental distractors, was administered to 486 adults, including healthy controls (n = 172), ADHD (n = 56), SUD (n = 150), and combined SUD and ADHD (n = 108). RESULTS: CPT performance of healthy controls was better than that of individuals in each of the 3 clinical groups. The only exception was that the healthy control group did not differ from the ADHD group on the Timing index. The 3 clinical groups differed from each other in 2 indices: (a) patients with ADHD (with or without SUD) showed increased hyperactivity compared to patients with SUD only and (b) patients with ADHD showed more responses on correct timing as compared with the SUD groups (with or without ADHD). CONCLUSION: The CPT is sensitive to ADHD-related deficits, such as disinhibition, poor timing, and inattention, and is able to consistently differentiate healthy controls from patients with ADHD, SUD, or both. Our results are in line with previous research associating both ADHD and SUD with multiple disruptions across a broad set of cognitive domains such as planning, working memory, decision-making, inhibition control, and attention. The lack of consistent differences in cognitive performance between the 3 diagnostic groups might be attributed to various methodological aspects (e.g., heterogeneity in severity, type, and duration of substances use). Our results support the view that motor activity should be considered a significant marker of ADHD.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder.

BACKGROUND: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. OBJECTIVE: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. METHOD: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. RESULTS: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. CONCLUSION: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Voices of Temporary Sobriety - A Diary Study of an Alcohol-Free Month in Hungary.

Background: Temporary abstinence from alcohol as a challenge could support self-knowledge, self-care, and health consciousness in several ways. Objectives: The present study explored Dry November participants' personal experiences and coping strategies during a one-month abstinence period. The research is embedded in the Hungarian context of drinking habits, culture, society, and alcohol policy. Methods: This qualitative study comprised the thematic analysis of 23 participants' diaries, reported twice a week for 30 days (in November 2017), to identify and understand the common experiences of temporary sobriety. Results: Three main themes emerged from the analysis: challenge, community, and relationship toward alcohol and abstinence. Results showed that there are no categorical differences between successful and non-successful participants. Conclusions: The present research demonstrated that during the challenge, rather than simply saying 'no' to alcohol, participants utilized other refusal strategies to avoid social confrontation.

[Recommendations for the screening, diagnosis and treatment of patients with comorbid attention deficit hyperactivity- and substance use disorder].

Among patients with substance use disorders (SUD), adult attention deficit hyperactivity disorder (ADHD) is one of the most frequently co-occuring disorder. Those SUD patients with comorbid ADHD show earlier onset of substance use, more severe SUD and poor treatment outcomes. Therefore, early recognition of ADHD is highly rele - vant within this patient population. The results of available screening instruments may lay the foundation of timely ADHD diagnosis. Considering the integrated treatment of patients with a dual ADHD+SUD diagnosis, the applica tion of combined pharmaco- and psychotherapy is recommended. Based on the evidence-and consensus-based suggestions, prescription of long-acting methylphenidate, extended-release amphetamines and atomoxetine with up-titration might be the best choice in the treatment of patients who are either unresponsive to standard dose or characterized by therapy resistance. The main purpose of this manuscript is to establish a standing-ground for the effective screening, diagnosis and treatment of ADHD+SUD patients.

Utility of Web search query data in testing theoretical assumptions about mephedrone.

OBJECTIVE: With growing access to the Internet, people who use drugs and traffickers started to obtain information about novel psychoactive substances (NPS) via online platforms. This paper aims to analyze whether a decreasing Web interest in formerly banned substances-cocaine, heroin, and MDMA-and the legislative status of mephedrone predict Web interest about this NPS. METHODS: Google Trends was used to measure changes of Web interest on cocaine, heroin, MDMA, and mephedrone. Google search results for mephedrone within the same time frame were analyzed and categorized. RESULTS: Web interest about classic drugs found to be more persistent. Regarding geographical distribution, location of Web searches for heroin and cocaine was less centralized. Illicit status of mephedrone was a negative predictor of its Web search query rates. The connection between mephedrone-related Web search rates and legislative status of this substance was significantly mediated by ecstasy-related Web search queries, the number of documentaries, and forum/blog entries about mephedrone. CONCLUSIONS: The results might provide support for the hypothesis that mephedrone's popularity was highly correlated with its legal status as well as it functioned as a potential substitute for MDMA. Google Trends was found to be a useful tool for testing theoretical assumptions about NPS.

Novel psychoactive substance use among treatment-seeking opiate users: The role of life events and psychiatric symptoms.

OBJECTIVE: Over the past 5 years, a shift to the use of novel psychoactive substances (NPS) has been observed among opioid users. The aim of this study was to assess the potential reasons for NPS use among treatment-seeking patients receiving opiate substitution therapy. METHOD: A structured questionnaire was filled out by a sample of 198 opiate dependent patients of Hungary's National Institute of Psychiatry and Addiction. This questionnaire assessed demographics, treatment characteristics, lifetime substance use, potential reasons for NPS use, negative life events (Life Events Scale), and psychiatric symptoms (Brief Symptom Inventory). RESULTS: The most frequent reasons for NPS use were curiosity, replacing other drugs, and easy availability. The majority of the respondents used synthetic cathinones and chose practical reasons, not psychopharmacological preferences. A series of binary logistic regressions indicated that lifetime amphetamine use (OR = 4.64, 95% CI [2.16, 9.96]) and more severe psychiatric symptoms (OR = 1.89, 95% CI [1.18, 3.04]) may predict NPS use. Time spent in treatment was a minor protective factor (OR = 0.92, 95% CI [0.86, 0.99]). CONCLUSION: Synthetic cathinones might still substitute amphetamine-derivatives, although these NPS are no longer legal. There is a need for the regular screening of psychiatric symptoms and the use of family therapy among participants on opioid substitution programs.

Is there any difference in patterns of use and psychiatric symptom status between injectors and non-injectors of mephedrone?

OBJECTIVE: In recent years, increasing intravenous mephedrone use was reported in several countries. The aim of this study was to describe the characteristics of such a form of mephedrone use, while identifying the differences between injectors and non-injectors in patterns of mephedrone use and psychiatric symptom status. METHODS: One hundred and forty-five mephedrone users were surveyed on patterns of mephedrone use using a structured questionnaire as well as the Brief Symptom Inventory. RESULTS: Majority of users received mephedrone from acquaintances and used it in discos/parties settings regarding both first and current mephedrone use. Intranasal use was the most typical route of administration (84.4%). Injectors (11%) used the drug more frequently and in higher dosages. This group included a greater proportion of opiate users (37.5%) and showed more diffuse psychiatric symptoms. Regarding the predictors of being an injector, heroin use showed the highest odds ratio. CONCLUSIONS: Intravenous mephedrone use is associated with a higher risk of harmful drug use, elevated psychiatric symptom profile and increased possibility of mephedrone being considered as an addictive substance. These findings might be important in efficient treatment planning.

Enhancing sexual desire and experience: an investigation of the sexual correlates of gamma-hydroxybutyrate (GHB) use.

OBJECTIVE: Various studies have dealt with gamma-hydroxybutyrate's (GHB) potential role in sexual assaults, while the sexual correlates of intentional recreational GHB use have not well been highlighted. Our study aims to explore GHB's sexual effects, the patterns of choice of sexual partners, the frequency of experienced blackouts, and endured sexual or acquisitory crimes as a result of GHB use. METHODS: Sixty recreational GHB users filled out a questionnaire on experienced subjective, somatic, and sexual effects of GHB, the frequency of blackouts due to their GHB use, and items on their sexual experiences in relation to GHB use. RESULTS: Of the sample, 25.9% reported increased sexual arousal as well as more intense attraction towards their sexual partners and increased sexual openness when using GHB; 34.8% had sexual intercourse with strangers, or with others, but not with their partners when using GHB; and 8.6% were victims of acquisitory crimes, whereas 3.4% were victims of a sexual assault. Furthermore, 24.6% typically experienced blackouts when using GHB. CONCLUSION: Gamma-hydroxybutyrate seems to be a potential substitute for both stimulant and depressant substances. Increased sexual desire and disinhibition may lead to a more frequent and potentially more riskful sexual activity. Experienced blackouts need to be considered as risk factors for suffering sexual or acquisitory crimes.

Substitutional potential of mephedrone: an analysis of the subjective effects.

OBJECTIVE: In the past 25-30 years, a large number of synthetic and non-synthetic drugs have appeared on the recreational scene, but with the exception of 4-methylmethcathinone (mephedrone), none of these substances reached the popularity of ecstasy [3,4-methylenedioxy-N-methylamphetamine, (MDMA)]. Authors aimed to determine the subjective effects of mephedrone in order to understand how mephedrone can serve as a potential substitute for entactogens, such as MDMA. METHODS: One hundred forty-five mephedrone users--recruited by snowball method--filled out a questionnaire on their patterns of use and experienced subjective effects of mephedrone. RESULTS: Factor analysis revealed six factors of mephedrone-induced subjective effects: positive emotions, sensibility, adverse somatic effects, adverse psychological effects, stimulant effects, and psychedelic effects. A preference list of subjective effects indicates that mephedrone is popular primarily for its psychostimulant and entactogen effects. Latent class analysis identified two classes of mephedrone users, with closely parallel profiles. The two classes differed in severity of subjective experience in a way that was consistent across the six dimensions. CONCLUSIONS: By having similar subjective effects as MDMA and other entactogens, mephedrone seems able to substitute other enactogenic stimulants.

The Effects of a Cyberbullying Intervention Programme Among Primary School Students.

Background: With the increase of cyberbullying, several intervention programmes have been created that aim at reducing cyber-victimisation and perpetration. Objective: Our study presents the effects of the STAnD anti-cyberbullying programme with peer-education both on the short and the long run among lower and upper primary school students, with a focus on the participants' cyberbullying roles. Method: The sample comprised of 536 students who participated in the intervention programme, involving 36% lower and 64% upper primary school students. Participants were measured by a self-reported questionnaire before and right after the programme, then six months later. Results: The main effect of the STAnD programme was a positive change in the participants' willingness to engage in help-seeking and their active-defending reaction, although this effect decreased after six months. The changes were larger among lower primary school students compared to upper primary school participants. Conclusion: Our results imply that long-lasting and intensive health promotion programmes are necessary to reach a long-term intervention effect. Anti-cyberbullying programmes should take into consideration participants' involvement and roles in cyberbullying. As our study was a non-randomised uncontrolled study design, thus interpretation of the effectiveness of the programme is limited. Supplementary Information: The online version contains supplementary material available at 10.1007/s10566-022-09714-9.

Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus.

OBJECTIVE: This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. METHOD: A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. RESULTS: According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. CONCLUSION: The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. SCIENTIFIC SIGNIFICANCE: On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.

Time perception at resting state and during active motion: The role of anxiety and depression.

BACKGROUND: Time perception and motion intensity are interrelated factors that may influence symptom expression and severity in case of various psychiatric conditions, including anxiety and depression. AIMS: The present study aimed to 1) explore the associations between the intensity of physical activity, time perception, impulsivity, anxiety and depressive symptoms, and to 2) investigate the extent to which resting state motion intensity can be used to identify the assessed psychiatric conditions. METHODS: 20 healthy controls and 20 psychiatric patients (with either anxiety or depression-related diagnoses) were included in the study and filled out a questionnaire consisting of validated anxiety, depression and impulsivity measures. Time perception was measured by a computerized time production task, whereas motion intensity was analyzed by a motion capture and analysis software. Respondents were randomly assigned to an experimental (with active motion task) and non-experimental group (resting state conditions). Both subgroups were repeatedly assessed, in order to explore changes in motion intensity, time perception and psychiatric symptom levels. RESULTS: Random forest regression analysis identified the level of impulsivity, depression and anxiety as the strongest predictors of resting state motion intensity, while a path analysis model indicated that controls and psychiatric patients show different pathways regarding the connection between motion intensity changes, time production ratio alterations and symptom reduction. CONCLUSIONS: Our study implies the importance of distinguishing between clinical and subclinical severity of psychiatric symptoms when considering the association between motion intensity, time perception, anxiety and depression. Potential transdiagnostic relevance of resting state motion intensity is also addressed.

Efficacy of a complex smartphone application for reducing hazardous alcohol consumption: Study protocol for a randomized controlled trial with analysis of in-app user behavior in relation to outcome.

OBJECTIVE: The efficacy of alcohol reduction applications is variable, and the underlying factors are largely unknown. The aim of this study is threefold: evaluate the relationship between user engagement and intervention efficacy, investigate the efficacy of the different functions applied, and investigate the efficacy of the intervention application compared to control groups. METHODS: A randomized controlled trial will be conducted to determine the efficacy of a newly developed smartphone application compared to the controls in reducing alcohol consumption at a 30, 60, 90, 120, 150, and 180 days follow-up. Hazardous drinkers, aged 18 years or older, will be recruited through web articles and will be randomized (blinded to their allocation), to receive one of the two versions of the application (educational or control application) for 30 days, or will be allocated to a wait-list control group. Function usage times will be recorded on a single-user level to determine the association between application usage and efficacy. RESULTS: Data collection will be completed by July 2020, and follow-up will be completed by January 2021. CONCLUSIONS: The evaluation of intervention efficacy as a function of user behavior will hopefully contribute to the science of developing more efficient alcohol intervention applications in the future.

Predicting tick-borne encephalitis using Google Trends.

Data generated through public Internet searching offers a promising alternative source of information for monitoring and forecasting of infectious disease. Here future cases of tick-borne encephalitis (TBE) were predicted using traditional weekly case reports, both with and without Google Trends data (GTD). Data on the weekly number of acute, confirmed TBE cases in Germany were obtained from the Robert Koch Institute. Data relating to the volume of Internet searching on TBE was downloaded from the Google Trends website. Data were split into training and validation parts. A SARIMA (0,1,1) (1,1,1) [52] model was used to describe the weekly TBE case number time series. Google Trends Data was used as an external regressor in a second, as optimal identified SARIMA (4,1,1) (1,1,1) [52] model. Predictions for the number of future cases were made with both models and compared with the validation dataset. GTD showed a significant correlation with reported weekly case numbers of TBE (p < 0.0001). A comparison of forecasted values with reported ones resulted in an RMSE (residual mean squared error) of 0.71 for the model without Google search values, and an RMSE of 0.70 for the Google Trends values enhanced model. However, difference between predictive performances was not significant (Diebold Mariano test, p-value = 0.14).

Childhood Trauma, Cognitive Emotion Regulation and Motivation for Behavior Change Among Clients of Opioid Substitution Treatment With and Without Past Year Synthetic Cathinone Use During Therapy.

BACKGROUND: With a decrease in heroin's purity and availability in the European drug market, Hungarian opioid dependent patients started to substitute heroin with novel psychoactive substances (NPS) and especially with synthetic cathinones. GOAL: This study aims to assess whether clients of opioid substitution treatment (OST) with and without a history of synthetic cathinone use during therapy differ in (1) the rate and type of experienced childhood trauma, (2) the way they cope with negative life events, (3) their motivation to change substance use behavior, (4) the rate of treatment retention. METHODS: A total of 198 clients of an outpatient centers (Nyírõ Gyula National Institute of Psychiatry and Addictions, Budapest) OST were asked to provide information about their general substance use experiences, including the consumption of NPS during treatment, their childhood traumatic experiences (Childhood Trauma Questionnaire), cognitive emotion regulation strategies (Cognitive Emotion Regulation Questionnaire), their motivation to change substance use behavior (University of Rhode Island Change Assessment Scale) and current psychiatric symptoms (Brief Symptom Inventory). Baseline data was collected in the summer of 2015, while 4 years follow-up data on treatment retention was obtained in the summer of 2019. RESULTS: The majority of the clients were male (N = 141, 71.2%), receiving methadone as a substitute for opioids (N = 178, 89.9%), while mean age of the full sample was 39.7 (SD = 6.8). Based on a logistic regression model, the odds for past year synthetic cathinone use was higher among clients with more severe psychiatric symptoms (B = 0.8, OR = 2.2, p < 0.01) and among clients who were in treatment for a shorter period of time (B = 0.1, OR = 0.9, p < 0.05). Synthetic cathinone use during treatment was further associated with less adaptive strategies to cope with negative life events. Synthetic cathinone use was also a risk factor for reduced treatment retention (B = -0.8, OR = 0.4, p < 0.05) and was associated with lower odds of being member of a latent class with less severe psychopathological profile (B = -0.9, OR = 0.4, p < 0.05). CONCLUSION: Synthetic cathinone use during treatment is associated with poorer treatment outcomes and might be characterized by more severe psychiatric symptoms and amotivation to change substance use among opioid dependent clients.

The 21-item Barratt Impulsiveness Scale Revised (BIS-R-21): An alternative three-factor model.

BACKGROUND AND AIMS: Due to its important role in both healthy groups and those with physical, mental and behavioral disorders, impulsivity is a widely researched construct. Among various self-report questionnaires of impulsivity, the Barratt Impulsiveness Scale is arguably the most frequently used measure. Despite its international use, inconsistencies in the suggested factor structure of its latest version, the BIS-11, have been observed repeatedly in different samples. The goal of the present study was therefore to test the factor structure of the BIS-11 in several samples. METHODS: Exploratory and confirmatory factor analyses were conducted on two representative samples of Hungarian adults (N = 2,457; N = 2,040) and a college sample (N = 765). RESULTS: Analyses did not confirm the original model of the measure in any of the samples. Based on explorative factor analyses, an alternative three-factor model (cognitive impulsivity; behavioral impulsivity; and impatience/restlessness) of the Barratt Impulsiveness Scale is suggested. The pattern of the associations between the three factors and aggression, exercise, smoking, alcohol use, and psychological distress supports the construct validity of this new model. DISCUSSION: The new measurement model of impulsivity was confirmed in two independent samples. However, it requires further cross-cultural validation to clarify the content of self-reported impulsivity in both clinical and nonclinical samples.

Why do people use new psychoactive substances? Development of a new measurement tool in six European countries.

INTRODUCTION: New psychoactive substances (NPS) pose a public health threat. Many studies have tried to identify the reasons of NPS use; however, none of them have so far used any standardised measures. The aim of this study was (i) to develop and cross-culturally validate the New Psychoactive Substance Use Motives Measure (NPSMM) and (ii) to compare motives of NPS use across countries and user types. METHODS: Three subgroups (socially marginalised users, nightlife attendees and members of online communities) of NPS users (N = 3023) were recruited from six EU member countries. Demographics, motives and types of NPS used were assessed. NPS use motives were measured by adapting the extended six-factor version of the Marijuana Motives Measure. RESULTS: Exploratory and confirmatory factor analysis resulted in a similar five-factor solution across most of the countries: coping, enhancement, social, conformity and expansion motives. Marginalised users scored higher on coping and conformity motives, nightlife groups showed higher endorsement of social motive, whereas online community users showed higher scores on expansion motives. Various types of NPS were also associated with different motives. CONCLUSION: NPS use motives might be associated with both the groups of users and the specific types of NPS being consumed. Expansion (psychedelics) and enhancement (stimulants) motives seemed to be linked to the chosen NPS product type, while coping, social and conformity motives were rather associated with user groups. NPSMM was found to be a valid instrument to measure NPS motives.

Can Google Trends data improve forecasting of Lyme disease incidence?

BACKGROUND: Online activity-based epidemiological surveillance and forecasting is getting more and more attention. To date, Google search volumes have not been assessed for forecasting of tick-borne diseases. Thus, we performed an analysis of forecasting of the Lyme disease incidence based on the traditional data extended with Google Trends. METHODS: Data on the weekly incidence of Lyme disease in Germany from 16 June 2013 to 27 May 2018 were obtained from the database of the Robert Koch Institute. Data of Internet searches were obtained from Google Trends searching "Borreliose" in Germany for the "last 5 years" as a timespan category. Data were split into the training (from 16 June 2013 to 11 June 2017) and validation (from 12 June 2017, to 27 May 2018) data sets. A seasonal autoregressive moving average model, SARIMA (0,1,1) (0,1,1) [52] model was selected to describe the time series of the weekly Lyme incidence. After this, we added the Google Trends data as an external regressor and identified the SARIMA (0,1,1) (0,1,1) [52] model as optimal. We made predictions for the validation interval using these two models and compared predictions with the values of the validation data set. RESULTS: Forecasting for the validation timespan resulted in similar values for the models. Comparing the forecasted values with the reported ones resulted in an residual mean squared error (RMSE) of 0.3763; the mean absolute percentage error (MAPE) was 8.233 for the model without Google searches with an RMSE of 0.3732; and the MAPE was 8.17495 for the Google Trends values-expanded model. The difference between the predictive performances was insignificant (Diebold-Mariano Test, p-value = 0.4152). CONCLUSION: Google Trends data are a good correlate of the reported incidence of Lyme disease in Germany, but it failed to significantly improve the forecasting accuracy in models based on traditional data.