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This data synthesis examined the effectiveness of behavioural and pharmacological approaches for cannabis treatment. We integrated findings from high level evidence studies and prioritised data from Europe when available. The synthesis found that only a relatively small number of published behavioural and pharmacological studies on cannabis interventions have been conducted in Europe. Applying both European and non-European data, it was found that Cognitive Behavioural Therapy (CBT) and/or Motivational Enhancement Therapy (MET) improved short-term outcomes in the frequency of cannabis use and dependency severity, although abstinence outcomes were less consistent. These improvements were typically not maintained nine months after treatment. CBT and MET (or combined CBT + MET) treatments that extend beyond four sessions were more effective than fewer sessions over a shorter duration. Combining CBT or MET (or combined CBT + MET) with adjunctive Contingency Management (CM) improved therapeutic outcomes. No pharmacotherapies have been approved for the management of cannabis use, cannabis use disorders or cannabis withdrawal. Despite only weak evidence to support the use of pharmacological agents, some are used 'off-label' to manage withdrawal symptoms outside clinical trials.
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BACKGROUND AND AIMS: Population-level alcohol use data are available from high-income countries, but limited research has been conducted in sub-Saharan Africa. This systematic review and meta-analysis aimed to summarize population-level alcohol use in sub-Saharan Africa. METHOD: Databases searched included PubMed, EMBASE, PsycINFO and AJOL, without language restrictions. Searches were also conducted in the Global Health Data Exchange (GHDx) and Google Scholar. Search terms encompassed 'substance' or 'substance-related disorders' and 'prevalence' and 'sub-Saharan Africa'. We included general population studies on alcohol use (including any use, high-risk alcohol use and alcohol use disorders) from 2018 onwards. Prevalence data for alcohol use among sub-Saharan African adolescents (10-17) and adults (18+) were extracted. Analyses included life-time and past 12- and 6-month alcohol use. RESULTS: We included 141 papers. Among adolescents, the life-time prevalence of alcohol use was 23.3% [95% confidence interval (CI) = 11.3-37.1%], 36.2% (CI = 18.4-56.1%) in the past year and 11.3% (CI = 4.5-20.4%) in the past 6 months. Among adolescents, 12-month prevalence of alcohol use disorder and alcohol dependence were 7.7% (CI = 0.0-27.8%) and 4.1% (CI = 1.4-7.9%), respectively. Among adults, the life-time prevalence of alcohol use was 34.9% (CI = 17.7-54.1%), 27.1% (CI = 5.0-56.4%) in the past year and 32.2% (CI = 19.8-46.0%) in the past 6 months. Among adults, the 12-month prevalence of alcohol use disorder and alcohol dependence were 9.5% (CI = 0.0-30.4%) and 4.3% (CI = 0.8-9.8%), respectively. The highest weighted life-time prevalence of alcohol use, 86.4%, was reported in Tanzania among adults. The highest weighted past 6-month prevalence of alcohol use, 80.6%, was found in Zambia among adolescents. CONCLUSION: Alcohol use patterns vary across countries and subregions within sub-Saharan Africa, and comprehensive population-level data on alcohol use remain scarce in numerous sub-Saharan African countries. The prevalence of alcohol use disorder is common among adolescents in sub-Saharan Africa.
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Consumo de Bebidas Alcohólicas , Trastornos Relacionados con Alcohol , Humanos , África del Sur del Sahara/epidemiología , Adolescente , Consumo de Bebidas Alcohólicas/epidemiología , Prevalencia , Trastornos Relacionados con Alcohol/epidemiología , Adulto , Niño , Adulto Joven , Masculino , Alcoholismo/epidemiología , FemeninoRESUMEN
PURPOSE OF REVIEW: This review describes the diagnoses related to problem gaming that are included in ICD-11, published by the WHO in 2022. It summarizes the recent literature on the prevalence of Gaming Disorder, its structure, antecedents and comorbidities, and explores whether the range of diagnoses currently available adequately covers the range of experiences seen with problem gaming. RECENT FINDINGS: Overall, between 3 and 6% of the population worldwide are reported to have a gaming disorder as defined by ICD-11 or DSM-5. However, most studies are constrained by methodological issues such as nonrepresentative samples and the use of brief questionnaires to determine prevalence. ICD-11 Gaming Disorder is a psychometrically sound diagnosis. There is no diagnosis that currently captures the experience of harm from gaming, where the requirements for the diagnosis of Gaming Disorder are not reached. SUMMARY: There is evidence in support of the proposed new entity of 'Harmful Gaming', which encompasses mental and physical harm/impairment due to a repeated pattern of gaming, but where requirements for the diagnosis of Gaming Disorder are not met. Such a diagnosis would complete the spectrum of diagnoses available for problem or unhealthy gaming, similar to those for unhealthy substance use, and would provide a framework for a public health approach to reducing the overall harm from unhealthy gaming.
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Clasificación Internacional de Enfermedades , Juegos de Video , Humanos , Juegos de Video/efectos adversos , Trastorno de Adicción a Internet/diagnóstico , Conducta Adictiva/diagnóstico , Conducta Adictiva/clasificación , Manual Diagnóstico y Estadístico de los Trastornos MentalesRESUMEN
Randomized controlled trials (RCTs) are considered the gold standard for causal inference. With a sufficient sample size, randomization removes confounding up to the time of randomization and allows the treatment effect to be isolated. However, RCTs may have limited generalizability and transportability and are often not feasible in addiction research due to ethical or logistical constraints. The importance of observational studies from real-world settings has been increasingly recognized in research on health. This paper provides an overview of modern approaches to designing observational studies that enable causal inference. It illustrates three key techniques, Directed Acyclic Graphs (DAGs), modified Disjunctive Cause Criterion and Target Trial Emulation, and discusses the strengths and limitations of their applications.
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Causalidad , Estudios Observacionales como Asunto , Proyectos de Investigación , Humanos , Conducta Adictiva/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos Relacionados con Sustancias/terapiaRESUMEN
BACKGROUND AND AIM: Social networking sites (SNS) are interactive internet-based social platforms that facilitate information sharing. A growing body of literature on exposure to, and self-posting of, alcohol-related content on SNS has examined the relationship between SNS use and alcohol consumption in young people. This study aims to synthesise the literature exploring the relationship between exposure (i.e. viewing or listening of alcohol-related media) and self-posting (i.e. uploading images or text of alcohol content) of alcohol-related media on SNS on alcohol consumption. METHODS: A pre-registered systematic review was conducted in June 2022 within PubMed, Scopus, PsycINFO and Web of Science. Original prospective and cross-sectional studies assessing youth and young adults (≤ 24 years of age) that measured exposure to alcohol-related media or posting of alcohol-related content on SNS and self-reported alcohol consumption outcomes were included. Meta-analyses were conducted on comparable methodologies. RESULTS: Thirty studies were included (n = 19,386). Meta-analyses of cross-sectional studies showed both greater exposure (five studies; pooled ß = 0.34, 95% confidence interval [CI] = 0.23, 0.44, i2 = 27.7%) and self-posting of alcohol-related content (six studies; pooled ß = 0.57, 95%CI = 0.25,0.88, i2 = 97.8%) was associated with greater alcohol consumption. Meta-analyses of three prospective studies also identified that greater exposure predicted greater future alcohol consumption (three studies; pooled ß = 0.13, 95%CI = 0.11,0.15, i2 = 0.0%). Narrative analyses of studies that could not be meta-analysed due to incompatible methodologies were also conducted. Most studies (all four prospective, one of two cross-sectional) identified positive associations between exposure to alcohol-related content and greater average consumption. Most studies (three of four prospective, four of six cross-sectional) reported a positive association between of alcohol-related self-posting and greater average alcohol consumption. CONCLUSIONS: Both exposure to, and self-posting of, alcohol-related content on social networking sites are positively associated with current average consumption, problem drinking, and drinking frequency.
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Medios de Comunicación Sociales , Consumo de Alcohol en Menores , Adolescente , Adulto Joven , Humanos , Estudios Prospectivos , Estudios Transversales , Consumo de Bebidas Alcohólicas/epidemiologíaRESUMEN
BACKGROUND: Anxiety, depression and pain catastrophizing are independently associated with risk of opioid misuse in patients with persistent pain but their relationship to current opioid misuse, when considered together, is poorly understood. This study will assess the relative contribution of these modifiable, and distinct psychological constructs to current opioid misuse in patients with persistent pain. METHODS: One hundred and twenty-seven patients referred to a specialized opioid management clinic for prescription opioid misuse within a tertiary pain service were recruited for this study. The Pain Catastrophizing Scale, Depression, Anxiety and Stress Scales and the Current Opioid Misuse Measure were administered pre-treatment. Pain severity and morphine equivalent dose based on independent registry data were also recorded. RESULTS: Higher levels of pain catastrophizing, depression, and anxiety were significantly associated with higher current opioid misuse (r = .475, 0.599, and 0.516 respectively, p < .01). Pain severity was significantly associated with pain catastrophizing (r = .301, p < .01). Catastrophizing, depression, and anxiety explained an additional 11.56% of the variance (R2 change = 0.34, p < .01) over and above age, gender, pain severity and morphine equivalent dose. Depression was the only significant variable at Step 2 (ß = 0.62, p < .01). CONCLUSION: Findings show that in a sample of people with persistent pain referred for treatment for opioid misuse, depression contributes over and above that of anxiety and pain catastrophizing. Theoretical and clinical practice implications are presented.
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Dolor Crónico , Trastornos Relacionados con Opioides , Humanos , Depresión/complicaciones , Depresión/psicología , Dolor Crónico/complicaciones , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/psicología , Ansiedad/psicología , Catastrofización/psicología , Trastornos Relacionados con Opioides/complicaciones , Analgésicos Opioides/uso terapéutico , Derivados de la Morfina/uso terapéuticoRESUMEN
INTRODUCTION: Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high-risk substance use. METHOD: This study is a cross-sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high-risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test-Lite (ASSIST-Lite) and current smokers. We measured self-reports of past 12-month engagement in a tobacco, alcohol or other drugs treatment program. RESULTS: Overall, 0.4% had high-risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high-risk alcohol use, and 14.0% currently smoked. Among high-risk users, past 12-month treatment access rates were 50.6% [22.3-78.9%] for opioids, 27.1% [8.1-46.1%] for meth/amphetamine, 14.5% [4.3-24.7%] for cannabis, 9.6% [8.1-11.0%] for alcohol and 11.7% [10.6-12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high-risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77-11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20-4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52-2.49], p ≤ 0.001). DISCUSSION AND CONCLUSIONS: The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted.
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Trastornos Relacionados con Sustancias , Humanos , Anfetamina , Analgésicos Opioides , Australia/epidemiología , Estudios Transversales , Alucinógenos , Metanfetamina , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/prevención & control , Consumo de Bebidas Alcohólicas/epidemiología , Asunción de RiesgosRESUMEN
AIMS: E-cigarette and tobacco-related content on social media continues to rise from lax restrictions on both personal and promotional posts. This content has been linked to various mechanisms of increased e-cigarette and tobacco use (i.e., lower risk perceptions and increased susceptibility). This study aimed to synthesis the association between exposure to e-cigarette and tobacco-related content and youth behaviours and attitudes. METHODS: A comprehensive search was conducted on PubMed, Scopus, PsycINFO and Web of Science. Studies published post-2004 reporting effect estimates for exposure or engagement with e-cigarette or tobacco content on social media and behaviour or attitude outcomes were included. RESULTS: Thirty-two studies (N = 274,283, aged 9 to 25 years) were included for synthesis. Meta-analyses revealed significant associations between engagement with tobacco content and use (OR 2.21; 95% CI = 1.27-3.82, p =.005; I2 = 96.4%), exposure to tobacco content and never users' lower risk perceptions (OR 0.68; 95% CI = 0.49-0.91; p =.011; I2 = 78.2%), and exposure to e-cigarette content and use (OR 1.37; 95% CI = 0.99-1.88; p = 0.058; I2 = 64.4%). There was no observed relationship between exposure to tobacco content and ever users' risk perceptions (OR 0.83; 95% CI = 0.61-1.13; p =.231; I2 = 83.5%). Qualitative synthesis found significant associations between tobacco exposure and increased current use and pro-tobacco attitudes; e-cigarette exposure and increased susceptibility and lower risk perceptions; tobacco engagement and increased susceptibility; e-cigarette engagement and increased use; dual exposure and increased susceptibility; and dual engagement and increased dual use. Mixed findings were identified for the influence of e-cigarette exposure on attitudes, tobacco exposure on susceptibility, dual exposure on dual use behaviours, and dual engagement on dual susceptibility. CONCLUSIONS: Findings suggest an association between exposure and engagement to e-cigarette or tobacco products on social media and use or pro-use attitudes among youth. Further substantive research in the area of youth-specific use and attitudes following exposure and engagement with e-cigarette and tobacco content is needed to quantify this association.
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Sistemas Electrónicos de Liberación de Nicotina , Medios de Comunicación Sociales , Vapeo , Adolescente , Humanos , ActitudRESUMEN
BACKGROUND AND AIM: E-cigarette marketing strategies are targeting and appealing to youth, particularly through social media. This study examined the longitudinal relationship between recalled exposure to e-cigarette advertisements on social media and across five traditional advertising mediums, and e-cigarette use, a year later. DESIGN: Weighted regression analyses of waves 4 (W4; 2017), 4.5 (W4.5; 2018) and 5 (W5; 2019) from the Population Assessment of Tobacco and Health Study. SETTING: United States. PARTICIPANTS: Youth aged 12-17 years at W4 or W4.5 (N = 16,671). MEASUREMENTS: We examined the association between past 30-day recalled exposure to six different e-cigarette advertisement mediums (gas stations/convenience stores, social media/websites, newspaper/magazines, radio, billboard, TV) in W4.5 and past 30-day and past 12-month e-cigarette use in W5, while controlling for W4 e-cigarette use and covariates such as sociodemographic variables, academic performance, peer cigarette/e-cigarette use and other substance use. Associations between recalled exposure (W4.5) and lifetime use (W5) among e-cigarette naïve youth at W4.5 (N = 8,914) were also assessed. FINDINGS: Past 12-month and past 30-day e-cigarette use was significantly associated with recalled exposure to e-cigarette advertisement on social media/websites (aOR = 1.65 [99.17 %CI = 1.36,1.99; aOR = 1.49 [99.17 %CI = 1.13, 1.97]) and gas stations/convenience stores (aOR = 1.33; [99.17 %CI = 1.11,1.58]; aOR = 1.27 [99.17 %CI = 1.03,1.58]). Exposure to e-cigarette advertisement on social media/websites (aOR = 1.35 [99.17 %CI = 1.04,1.74]) and gas stations/convenience stores (aOR = 1.67 [99.17 %CI = 1.31,2.13]) was significantly associated with lifetime e-cigarette use among baseline youth who were e-cigarette naïve. CONCLUSIONS: Exposure to e-cigarette advertisement on social media/websites and gas stations/convenience stores was associated with youth e-cigarette use a year later. Stricter restrictions on marketing in these mediums is needed to limit youth exposure to e-cigarette marketing messages if we are to reduce e-cigarette use.
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Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Vapeo , Humanos , Estados Unidos/epidemiología , Adolescente , Publicidad , Vapeo/epidemiología , MercadotecníaRESUMEN
PURPOSE OF REVIEW: This review provides an overview of recent developments in understanding polysubstance use patterns across the lifespan, and advances made in the prevention and treatment of harm arising from polysubstance use. RECENT FINDINGS: A comprehensive understanding of the patterns of polysubstance use is hampered by heterogeneity across study methods and types of drugs measured. Use of statistical techniques such as latent class analysis has aided in overcoming this limitation, identifying common patterns or classes of polysubstance use. These typically include, with decreasing prevalence, (1) Alcohol use only; (2) Alcohol and Tobacco; (3) Alcohol, Tobacco, and Cannabis; and finally (4) a low prevalence, Extended Range cluster that includes other illicit drugs, New Psychoactive Substances (NPS), and nonmedical prescription medications. SUMMARY: Across studies, there are commonalities present in clusters of substances used. Future work that integrates novel measures of polysubstance use and leverages advances in drug monitoring, statistical analysis and neuroimaging will improve our understanding of how and why drugs are combined, and more rapidly identify emerging trends in multiple substance use. Polysubstance use is prevalent but there is a paucity of research exploring effective treatments and interventions.
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Cannabis , Alucinógenos , Drogas Ilícitas , Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Sustancias/epidemiología , Consumo de Bebidas Alcohólicas/epidemiologíaRESUMEN
ISSUES: Established literature suggests that electronic cigarettes (EC) are more effective than traditional nicotine replacement therapies (NRT) as a smoking cessation aid, but the factors that mediate this difference remain poorly understood. We examine how adverse events (AE) associated with EC use relative to NRTs differ, with the view that differences in AEs experienced may drive differences in use and compliance. APPROACH: Papers for inclusion were identified via a three-tiered search strategy. Eligible articles involved healthy participants and compared nicotine ECs to non-nicotine ECs or NRTs and reported frequency of AE as an outcome. Random-effects meta-analyses were conducted to compare the likelihood for each of the AEs between nicotine ECs, non-nicotine placebo ECs and NRTs. KEY FINDINGS: A total of 3756 papers were identified, of which 18 were meta-analysed (10 cross-sectional and 8 randomised controlled trials). Meta-analytic results found no significant difference in the rates of reported AEs (i.e., cough, oral irritation, nausea) between nicotine ECs and NRTs, and between nicotine and non-nicotine placebo ECs. IMPLICATIONS: The variation in the incidence of AEs likely does not explain user preferences of ECs to NRTs. Incidence of common AEs reported because of EC and NRT use did not differ significantly. Future work will need to quantify both the adverse and favourable effects of ECs to understand the experiential mechanisms that drive the high uptake of nicotine ECs relative to established NRTs. CONCLUSIONS: There is inconclusive evidence on the incidence of AEs experience when using ECs compared to NRTs, possibly given the small sample size of studies.
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Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Humanos , Cese del Hábito de Fumar/métodos , Agonistas Nicotínicos/uso terapéutico , Estudios Transversales , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Nicotina/efectos adversosRESUMEN
BACKGROUND AND AIMS: Heated tobacco products (HTPs) are electronic devices that heat process tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on world-wide HTP use prevalence. This meta-analytic review estimated the prevalence of HTP use by country, World Health Organization (WHO) region, year, sex/gender and age. METHODS: Five databases (Web of Science, Scopus, Embase, PubMed and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post-modern HTP device market entry (2015). A random-effects meta-analysis was used to estimate overall prevalence for life-time, current and daily HTP use. RESULTS: Forty-five studies (n = 1 096 076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for life-time, current and daily HTP use was 4.87% [95% confidence interval (CI) = 4.16, 5.63], 1.53% (95% CI = 1.22, 1.87) and 0.79% (95% CI = 0.48, 1.18), respectively, across all years (2015-22). Life-time HTP use prevalence significantly increased by 3.39% for WPR [0.52% (95% CI = 0.25, 0.88) in 2015 to 3.91% (95% CI = 2.30, 5.92) in 2019] and 5.58% for EUR [1.13% (95% CI = 0.59, 1.97) in 2016 to 6.98% (95% CI = 5.69, 8.39) in 2020]. Current HTP use increased by 10.45% for WPR [0.12% (95% CI = 0, 0.37) in 2015 to 10.57% (95% CI = 5.59, 16.88) in 2020] and 1.15% for EUR [0% (95% CI = 0, 0.35) in 2016 to 1.15% (95% CI = 0.87, 1.47) in 2020]. Meta-regression revealed higher current HTP use in WPR [3.80% (95% CI = 2.88, 4.98)] compared with EUR [1.40% (95% CI = 1.09, 1.74)] and AMR [0.81% (95% CI = 0.46, 1.26)] and for males [3.45% (95% CI = 2.56, 4.47)] compared with females [1.82% (95% CI = 1.39, 2.29)]. Adolescents had higher life-time HTP use prevalence [5.25% (95% CI = 4.36, 6.21) than adults [2.45% (95% CI = 0.79, 4.97)]. Most studies scored a low risk of sampling bias due to their nationally representative sampling. CONCLUSION: The prevalence of HTPs use increased in the EUR and WPR between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period.
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Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Masculino , Adulto , Femenino , Adolescente , Humanos , Prevalencia , Nicotina , Organización Mundial de la Salud , Uso de TabacoRESUMEN
BACKGROUND AND AIMS: For most treatment-seeking patients with severe Alcohol Use Disorder (AUD), abstinence is the clinically indicated goal. Existing AUD motivation scales are non-specific about treatment consumption goals, which limit their effectiveness. Desires and mental imagery are relevant in the motivation for AUD treatment engagement. The Motivational Thought Frequency Scale for an abstinence goal (MTF-A) was adapted from the MTF for controlled drinking (MTF-CD). This study psychometrically evaluated the MTF-A in an alcohol-dependent sample engaged in treatment with a goal of abstinence. To enhance the clinical utility of the scale, a secondary aim was to evaluate a psychometrically equivalent short version of the MTF-A. METHOD: A sample N of 329 treatment-seeking patients with AUD (mean age of 44.44 years, SD = 11.89 years, 72% male) who were undertaking a cognitive behavioral treatment (CBT) program for abstinence completed the Motivational Thought Frequency Scale for Abstinence (MTF-A) and the Severity of Alcohol Dependence Questionnaire (SADQ). The MTF-A measured motivation for abstinence through four factors: intensity, self-efficacy imagery, incentives imagery, and availability. Confirmatory factor analyses (CFAs) were conducted to examine factor structure and model fit. Cronbach's alpha assessed internal consistency. Predictive validity was determined by logistic regression predicting first-session treatment non-attendance and alcohol consumption between baseline assessment and commencement of treatment, controlling for potential confounds. RESULTS: A four-factor structure provided the best fit for the MTF-A, compared with one- and three-factor models. A shortened 9-item MTF-A scale (S-MTF-A) provided better fit than the 13-item MTF-A scale. Both MTF-A and S-MTF-A displayed good internal consistency. Although both MTF-A and S-MTF-A successfully predicted first-session treatment non-attendance, neither predicted alcohol consumption between the baseline assessment and commencement of treatment. CONCLUSIONS: The model fit of the four-factor, 9-item S-MTF-A was superior to the original 13-item MTF-A. Both scales were predictive of participation of AUD treatment. Desires and mental imagery play an important role in AUD treatment motivation.
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Abstinencia de Alcohol , Alcoholismo , Humanos , Masculino , Adulto , Femenino , Abstinencia de Alcohol/psicología , Motivación , Consumo de Bebidas Alcohólicas/terapia , Consumo de Bebidas Alcohólicas/psicología , Autoeficacia , Análisis Factorial , Alcoholismo/diagnóstico , Alcoholismo/terapia , Alcoholismo/psicologíaRESUMEN
BACKGROUND: When treating patients with alcohol use disorder (AUD), best practice guidelines recommend the use of standardised assessment instruments to obtain reliable information about psychological symptoms and functioning to inform treatment. Due to time constraints and administrative burden, many mental health practitioners do not routinely use standardised assessments. To overcome these barriers, an instant assessment and feedback system (iAx) was developed that electronically administers standardised instruments. Responses are instantly scored and benchmarked against clinical norms for immediate interpretation. This allows for timely assessment and feedback. The aim of this study was to evaluate the implementation of the iAx system at a specialist alcohol and drug outpatient unit in a public hospital. METHODS: Baseline (pre-iAx implementation; paper-and-pencil assessments) and follow-up (post-iAx implementation) clinical audits collated records from 313 patients with AUD across 2,616 treatment sessions. Multilevel modelling was used to determine if use of standardised instruments increased post-iAx implementation. RESULTS: Post-iAx implementation, there was a significant increase in the probability of using standardised assessments during the initial assessment and throughout treatment (ps < 0.001). Specifically, the use of standardised assessments to inform initial assessment of patients increased from 51% to 89%, and progress monitoring of symptoms increased from 28% to 84%. A significant increase in treatment completion rates was also observed post-iAx implementation (from 15.6% to 32.4%). Psychologists and patients also provided feedback on iAx acceptability, appropriateness and feasibility. CONCLUSIONS: This study found support for the successful implementation of an electronic, theory-driven iAx system to improve assessment practices with patients with AUD in routine clinical settings.
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Alcoholismo , Consumo de Bebidas Alcohólicas , Alcoholismo/diagnóstico , Alcoholismo/terapia , Retroalimentación , Humanos , Pacientes AmbulatoriosRESUMEN
OBJECTIVE: To review evidence from longitudinal studies on the association between prescription opioid use and common mood and anxiety symptoms. DESIGN: We conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: We searched PubMed, Embase, and PsycINFO for search terms related to opioids AND (depression OR bipolar OR anxiety OR post-traumatic stress disorder [PTSD]). Findings were summarized narratively, and random-effects meta-analyses were used to pool effect sizes. RESULTS: We identified 10,290 records and found 10 articles that met our inclusion criteria. Incidence studies showed that people who used prescription opioids had an elevated risk of any mood outcome (adjusted effect size [aES] = 1.80 [95% confidence interval = 1.40-2.30]) and of an anxiety outcome (aES = 1.40 [1.20-1.80]) compared with those who did not use prescription opioids. Associations with depression were small and not significant after adjustment for potential confounders (aES = 1.18 [0.98-1.41]). However, some studies reported an increased risk of depressive symptoms after increased (aES = 1.58 [1.30-1.93]) or prolonged opioid use (aES = 1.49 [1.19-1.86]). CONCLUSIONS: Mental health should be considered when opioids are prescribed because some patients could be vulnerable to adverse mental health outcomes.
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Trastornos Relacionados con Opioides , Trastornos por Estrés Postraumático , Analgésicos Opioides/efectos adversos , Ansiedad/epidemiología , Humanos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiología , Prescripciones , Trastornos por Estrés Postraumático/psicologíaRESUMEN
AIM: There are concerns regarding what young people are exposed to on TikTok due to trending content promoting e-cigarette use through humour, marketing and lifestyle acceptability. Using baseline data from November 2020, we aimed to examine how much content from a sample of popular vaping videos remained accessible at 9- and 12-month follow-ups. We aimed to monitor changes in viewer engagement (using metadata) before and after the U.S. Congressional Hearing on youth protection measures on social media in October 2021. METHODS: Hashtag-based keywords were used to collect the most viewed publicly available e-cigarette related videos on TikTok (N = 802) from inception to November 2020 to form a baseline. Researchers conducted a longitudinal descriptive study using this data, with 9- and 12-month follow-ups to measure changes in viewer engagement (using metadata) and content availability. FINDINGS: Of the 802 videos from the baseline, 562 remained at the 9-month follow-up and 511 remained at the 12-month follow-up. At the 12-month follow-up, the majority of vaping-related hashtags were removed by TikTok after the Congressional Hearing. Between the baseline and 9-month follow up, views increased by 1.4% and likes increased by 4.4%. At 12-month follow-up, views had increased by 1.7% and likes by 4.2% compared to baseline data. Whilst 291 videos were no longer publicly accessible at 12-month follow-up, 39 of these were made inaccessible by the content creators. The most viewed and most liked vaping videos at baseline were still publicly available. CONCLUSIONS: Whilst the depiction type and thematic distribution of removed videos suggest that TikTok may be removing a small proportion of content that promotes the use of e-cigarettes, metadata of remaining videos indicate an increase in viewer engagement. TikTok's removal of explicit substance-related hashtags from the platform could be a step towards preventing adolescents from being exposed to harmful behaviours and substances online. However, the platform should consider enforcing effective age restrictions on content that promotes substance use in a positive light.
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COVID-19 , Sistemas Electrónicos de Liberación de Nicotina , Medios de Comunicación Sociales , Vapeo , Adolescente , Humanos , Estudios ProspectivosRESUMEN
INTRODUCTION: With over 1 billion monthly users globally, a third of whom are under 14 years, TikTok's popularity is indisputable. Publicly available cannabis-related content on this platform may influence perceptions of cannabis use. We aimed to examine how cannabis-related videos are portrayed on TikTok. METHODS: Data were collected from TikTok using hashtag-based keywords on cannabis-related videos (n = 1377). Seven researchers documented video metrics (i.e. views, likes, comments) and independently coded videos for sentiment and theme. RESULTS: After removing duplicates and non-related content, the final sample contained 881 videos. These videos had a median view count of 518 700 (SD = ±1 082 905), median likes count of 99 900 (SD = ±206 647) and median comment count of 931 (SD = ±2977). Many videos portrayed cannabis use positively (54.14%; collectively viewed 417 million times), with 15.84% of this subset actively depicting cannabis or administration products. The thematic analysis identified seven non-mutually exclusive themes. Content portraying cannabis use as entertaining or humorous accounted for 71.74% of videos, with a further 42.90% discussing personal cannabis use experiences and 24.63% promoting the social and cultural acceptability of cannabis use. DISCUSSION AND CONCLUSIONS: Our sample revealed over half of videos portrayed cannabis use positively and none were age restricted. All were publicly accessible through standard web and smartphone applications. With previous research demonstrating that exposure to cannabis-related content can influence adolescents' attitudes and problematic cannabis use, it is important more effective age restrictions and regulations are introduced to social media platforms.
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Cannabis , Medios de Comunicación Sociales , Adolescente , Analgésicos , Humanos , Grabación en VideoRESUMEN
BACKGROUND: Alcohol consumption is a leading preventable risk factor for morbidity and mortality in China. Understanding drinking patterns provides important data to inform public health policies in alcohol control, especially in specific groups like university students. This study aims to assess the alcohol consumption patterns and level of use in an urban population and a university town in a Chinese city using wastewater-based epidemiology (WBE). METHODS: Daily wastewater sample was collected from an urban catchment (n = 270) and every Wednesday's sample from a university town of 10 university campus (n = 43) in 2017-2018. Concentration of alcohol consumption biomarker in wastewater, ethyl sulfate, was measured by direct injection LC-MS/MS analysis. Per capita daily alcohol consumption was then back calculated for assessment purposes. RESULTS: Per capita daily alcohol consumption was 1.4 ± 0.6 mL/ person aged 15 + /day (EPD) (range: 0.2-4.9) in the urban catchment and 1.3 ± 0.6 EPD (range: 0.3-2.6) in the university town. Trends of alcohol consumption were stable in both catchments in 2017-2018. Alcohol consumption on weekends (1.5 EPD) and weekdays (1.4 EPD) were at a similar level. Additionally, no difference was observed between holidays (1.5 EPD) and non-holidays (1.4 EPD). CONCLUSION: There is a stable weekly drinking level in the studied urban population, which is different compared to studies conducted in Western countries. Our study suggested a similar consumption level between the urban population and university students. Drinking during weekdays could negatively affect China's economic productivity and future public health policies could be adapted to reflect this pattern of drinking.
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Universidades , Monitoreo Epidemiológico Basado en Aguas Residuales , Consumo de Bebidas Alcohólicas/epidemiología , China/epidemiología , Cromatografía Liquida , Humanos , Espectrometría de Masas en Tándem , Población UrbanaRESUMEN
BACKGROUND AND AIMS: Cannabis withdrawal is a well-characterized phenomenon that occurs in approximately half of regular and dependent cannabis users after abrupt cessation or significant reductions in cannabis products that contain Δ9 -tetrahydrocannabinol (THC). This review describes the diagnosis, prevalence, course and management of cannabis withdrawal and highlights opportunities for future clinical research. METHODS: Narrative review of literature. RESULTS: Symptom onset typically occurs 24-48 hours after cessation and most symptoms generally peak at days 2-6, with some symptoms lasting up to 3 weeks or more in heavy cannabis users. The most common features of cannabis withdrawal are anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite. Less common physical symptoms include chills, headaches, physical tension, sweating and stomach pain. Despite limited empirical evidence, supportive counselling and psychoeducation are the first-line approaches in the management of cannabis withdrawal. There are no medications currently approved specifically for medically assisted withdrawal (MAW). Medications have been used to manage short-term symptoms (e.g. anxiety, sleep, nausea). A number of promising pharmacological agents have been examined in controlled trials, but these have been underpowered and positive findings not reliably replicated. Some (e.g. cannabis agonists) are used 'off-label' in clinical practice. Inpatient admission for MAW may be clinically indicated for patients who have significant comorbid mental health disorders and polysubstance use to avoid severe complications. CONCLUSIONS: The clinical significance of cannabis withdrawal is that its symptoms may precipitate relapse to cannabis use. Complicated withdrawal may occur in people with concurrent mental health and polysubstance use.
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Cannabis , Alucinógenos , Abuso de Marihuana , Síndrome de Abstinencia a Sustancias , Analgésicos/uso terapéutico , Agonistas de Receptores de Cannabinoides , Dronabinol , Humanos , Abuso de Marihuana/complicaciones , Abuso de Marihuana/terapia , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/etiologíaRESUMEN
AIMS: E-cigarettes may benefit public health if they are effective for smoking cessation. Evidence suggests that the frequency of e-cigarette use is likely an important predicator of smoking cessation success, so we examined the associations between frequency of e-cigarette use and smoking reduction and cessation in an Australian population sample of past year adult smokers. METHODS: Data from the 2019 National Drug Strategy Household Survey were used (N = 22,015). The sample was restricted to 3868 adults who had smoked within the past year. The outcome was self-reported smoking status and smoking reduction, adjusted for key potential confounders. RESULTS: Compared with no current e-cigarette use, daily e-cigarette users reported an increased likelihood for smoking reduction among current daily smokers (RRR = 2.83; 95% CI = 1.53, 5.22) and were more likely to report quitting smoking among past year smokers (RRR = 2.16; 95% CI = 1.30, 3.58). Smoking reduction and cessation for occasional e-cigarette use were not significantly different from no e-cigarette use. CONCLUSIONS: Daily, but not occasional, e-cigarette users were more likely to quit or reduce smoking cigarettes than Australian smokers who did not use e-cigarettes.