Assessing the prevalence and knowledge of anabolic steroid use in male athletes in Al Madina Al Munawara, Saudi Arabia.

OBJECTIVES: To assess the prevalence of anabolic steroid use and the level of knowledge on anabolic steroids among the male athletes in Al Madina Al Munawara, Saudi Arabia. METHODS: A cross-sectional study was conducted on male athletes randomly selected from the private athletic centers in Al Madina Al Munawara over 5 months. Data were collected from all participants using a self-administered anonymous questionnaire with 33 questions. The questionnaire covered the socio-demographic characteristics of the participants, and their knowledge, attitudes, and use of anabolic steroids. RESULTS: Of the 150 male athletes surveyed, 121 completed the questionnaire (response rate: 80.6%). Over half were aged between 18 and 23 years (56.2%) and were single (79.3%). Thirty-two percent reported using anabolic steroids, mainly to increase muscle mass, following coaches' advice (46.1%). Key sources included the internet (30.7%), coaches (30%), and friends (27.9%), and non-healthcare professionals. The top motivations were price, coach's/physician's advice, and availability. The perceived benefits included increased muscle mass, strength, and endurance, while the perceived adverse effects included kidney/liver damage and sexual problems. CONCLUSION: One-third of the male athletes surveyed used anabolic steroids, influenced by accessibility and social contact, rather than healthcare guidance. This highlights the need for greater awareness of the long-term health risks, ideally through education provided by sports medicine specialists.

Beyond therapeutic potential: a systematic investigation of ketamine misuse in patients with depressive disorders.

Ketamine, a pharmacological agent that acts as an antagonist of the N-methyl-D-aspartate (NMDA) receptor, has garnered considerable interest because of its notable and expeditious antidepressant properties observed in individuals diagnosed with major depressive disorder (MDD) who exhibit resistance to conventional therapeutic interventions. A comprehensive and rigorous systematic review was undertaken to evaluate the prevalence of ketamine abuse undergoing ketamine treatment for depressive disorders. A comprehensive search was conducted across the electronic databases to identify pertinent studies published between 2021 and 2023. The present investigation incorporated a comprehensive range of studies encompassing the abuse or misuse of ketamine, including case reports, observational studies, and clinical trials. Data extraction and quality assessment were conducted in accordance with predetermined criteria. The findings of this systematic review demonstrate the importance of monitoring and addressing ketamine abuse in patients receiving ketamine treatment for depressive disorders like MDD. The wide range of reported prevalence rates highlights the need for standardized criteria and measures for defining and assessing ketamine abuse. This study presents a significant contribution to the field by introducing a novel screening questionnaire and assessment algorithm designed to identify and evaluate ketamine misuse among major depressive disorder (MDD) patients undergoing ketamine treatment. This innovative tool holds the potential to enhance clinical practice by providing healthcare professionals with a standardized approach to promptly detect and address ketamine misuse. The integration of this screening tool into routine care protocols can facilitate more effective monitoring and management of ketamine misuse in this population, ultimately leading to improved patient outcomes and safety.

Multidisciplinary rehabilitation following recreational nitrous oxide (N2O) misuse: evaluating service provision and rehabilitation outcomes in a cohort with serious disability.

Purpose: Recreational nitrous oxide (N2O) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature characterising rehabilitation is limited. This study aimed to evaluate rehabilitation service provision for impairments resulting from N2O misuse. Methods: A retrospective audit of hospitalised patients referred for rehabilitation for N2O toxicity was conducted between 2015 and 2022 at a single metropolitan hospital. Data were collected via medical record audit and analysed via descriptive and non-parametric statistics. Results: 16 eligible cases were identified, aged 18-43 years (50% female/male), with increasing case frequency. 12 cases received inpatient rehabilitation episodes for multifactorial sensorimotor, cognitive and psychosocial impairments. Cases articulated diverse rehabilitation goals and received intervention from a median of 6 clinical disciplines. All cases required assistance to mobilise or perform self-care activities on admission. Functional Independence Measure (FIM) scores significantly improved with rehabilitation (median FIM 84[75-93] to 117[112-123], p < .001). Despite gains in independence, all cases required referral for ongoing rehabilitation post-discharge. Conclusions: Demand for inpatient rehabilitation for disabling N2O toxicity appears to be increasing. In this series, cases were young, exhibited serious impairments, and had multidisciplinary rehabilitation needs. Inpatient rehabilitation led to significant functional improvements, though ongoing disability was evident post-discharge.

There appears to be rising demand for multidisciplinary rehabilitation to manage neurological disabilities from recreational Nitrous Oxide (N₂O) misuse.Heavy N₂O misuse can cause serious impairments and activity limitations across sensorimotor, cognitive and psychosocial domains.Intensive, multidisciplinary rehabilitation can improve functional independence for people with disabling N₂O toxicity; specialist rehabilitation services should be involved in optimising care of this population.Ongoing disability and the need for longer-term rehabilitation and support following hospital discharge were evident in severe cases of N₂O toxicity.

Insights from genetically stratified analyses comparing subtypes of alcohol misuse.

In a recent publication, we applied a novel model to address phenotypic heterogeneity in genetic research on alcohol misuse by stratifying individuals based on their patterns of alcohol use behaviours and comorbid psychopathology. In this Commentary, we provide further descriptions of the subtypes of alcohol misuse that emerged from the empirical mixture modelling approach and present new results comparing these groups on sociodemographic characteristics and additional alcohol use outcomes. We take a broad perspective to discuss how these results fit with existing typologies of alcohol misuse and how the results inform future genetic research. Our findings add further evidence that conceptualisations of a binary distinction between 'internalising' (relief-seeking) versus 'externalising' (reward-seeking) subtypes does not fully capture the complexity of alcohol misuse. However, accounting for individual differences in these dimensions is a promising means to reduce heterogeneity and thereby improve power for gene discovery and, eventually, personalised medicine applications. We argue that more detailed, person-specific assessment of alcohol misuse measures, particularly with attention to longitudinal trajectories, is needed to further advance this important line of research.

Psychological distress and alcohol use disorder in college students of color: Social support's moderating properties.

Alcohol use is prevalent among college students. Research has found that psychological distress in the form of depression, anxiety, or loneliness has been consistently associated with greater alcohol use. Because Students of Color (SoC) disproportionately experience greater psychological distress than White students, it is critical to determine buffers against psychological distress and subsequent alcohol use consequences. Previous literature found that social support can protect against the effects of psychological distress and weaken its link with alcohol use. This study aimed to determine the moderating effect of social support in the relation between psychological distress and alcohol use among SoC. College Students of Color from across the U.S. (n = 211, Mage = 27.51, SD = 9.63) were recruited via Prolific to answer an online survey through Qualtrics. Linear regression analyses showed that psychological distress variables (i.e., depression, anxiety, and loneliness) were positively associated with alcohol use. However, moderation analysis did not find any form of social support to moderate the relation between psychological distress variables and alcohol use. Future research needs to identify other protective factors against alcohol use to support SoC in their academic journey.

Prescription Painkiller Misuse in Hispanic and non-Hispanic Adults Ages 50 and Older: Trends and Correlates in a National Sample, 2015-2019.

Background: Older adults, an increasingly diverse segment of the United States population, are a priority population for prescription painkiller misuse. This study documents trends and correlates of prescription painkiller misuse among Hispanic and non-Hispanic adults ages 50 and older. Methods: A secondary analysis of adults 50 years and older across 5 cohorts using the 2015-2019 National Survey on Drug Use and Health (unweighted n = 16,181, 8.5% Hispanic, and 54% female). Logistic regression modeling with complex survey design was used to examine trends in prescription painkiller misuse. Results: Over time, the prevalence of past year painkiller misuse significantly decreased for Hispanic respondents (56.1% relative decrease, p = 0.02); elevated proportions were observed across strata of demographic characteristics. Conclusions: Variability in the prevalence of painkiller misuse may be explained by demographic characteristics. Further, these results emphasize the importance of addressing comorbid recreational marijuana use when designing interventions to address painkiller misuse for older adults.

How could proton pump inhibitors de-prescription be managed in geriatric long-term care?

BACKGROUND: Evaluate the misuse of proton pump inhibitors (PPIs) in geriatric long-term care (LTC) patients and improve caregiving by de-prescribing non-relevant PPIs in this population. AIM: This study was conducted in the long-term care department of the geriatric hospital Pierre-Garraud in Lyon. All patients receiving PPI for more than 8 weeks were included. A reassessment form was filled to evaluate the treatment benefit/risk ratio during a collegial consultation between the patient's referring physicians and pharmacists. During these consultations, the following possible decisions were taken: continuation, dose adjustment or gradual discontinuation of treatment. Patients' monitoring were performed one month and three months after discontinuation to detect any relapses and causes. RESULTS: Among the 113 patients included, 97 patients had their treatment re-evaluated by collegial consultation. Forty-four (45.4%) patients were treated in accordance with recommendations. For 24 of them, the indication was symptomatic recurrent gastroesophageal reflux disease. The treatment of more than half of the re-evaluated patients (54.6%) was gradually stopped. After the 3-month follow-up post-discontinuation, excluding patients who died during this period, 80.9% of the discontinuations were well-tolerated and only nine were resumed (19.1%). CONCLUSION: This study allowed a re-evaluation of PPI treatments in a high-risk population and offered a decision support tool focused on the benefit/risk balance of PPIs; 55% of treatments were considered irrelevant and could be stopped with 80% of good tolerance.

Buprenorphine deaths confirmed by toxicology reveal a low proportion of opioid agonist treatment before death in Finland.

We studied opioid agonist treatment (OAT) status before buprenorphine-related death in Finland, where buprenorphine is the principal OAT medicine and also the most misused opioid, through a retrospective population-based study using medico-legal cause-of-death investigation and OAT patient records. The study included all death cases (N = 570) between 2018 and 2020 with a buprenorphine or norbuprenorphine finding in post-mortem toxicology and with known drug misuse history or concomitant findings of illicit drugs. Of the deceased, 10% had received OAT in the year before death. Less than 1% of individuals < 25 years had received OAT, whereas the proportion in individuals ≥ 25 years was 13% (p < 0.001). There were significantly more females and more fatal poisonings (p < 0.001) among those < 25 years than among those ≥ 25 years. OAT medication at the time of death was sublingual buprenorphine-naloxone in 74% and subcutaneous buprenorphine in 23%. Except for significantly fewer benzodiazepine findings among those receiving OAT, minimal differences were found in terms of age, gender, cause and manner of death, or concomitant substance use between the deceased in and outside of OAT. Concomitant misuse of benzodiazepines, psychostimulants, alcohol, and gabapentinoids was frequent both in and outside of OAT and likely contributed to the death. These results suggest that access to OAT especially for young people and treatment of multiple addictions should be improved. Comprehensive information from medico-legal cause-of-death investigation as a starting point, combined with subsequent ante-mortem patient records, proved to be a successful approach to shed light on the Finnish scene of buprenorphine mortality.

The elephant in the room: Metaphors in women's accounts of life with a family member with problematic substance use.

Background: Research has shown that a family member's problematic substance use has significant deleterious mental and physical health impacts on other members of the family. Women are more often affected than men. These negative health effects persist as the person with problematic substance use ages, and they vary according to the relationship status. Aim: The aim of this study was to gain a deeper understanding of how women experience and are affected by their family member's substance use problems. Method: A metaphorical analysis of narrative interviews with 11 daughters and five wives of older adults (>65 years) with problematic substance use. Results: We identified four areas of signification in which metaphors were employed: (1) experiences (chaos and crash and walking on eggshells); (2) strategies (complicity and silencing); (3) dilemmas (deceit or a disease and open or closed dilemmas); and (4) consequences (obtaining or retaining an identity, health and different types of help). Conclusion: Family life with a parent or spouse with a substance use problem was described as chaotic, unsafe, uncertain and with no prospects of change. The study illustrates how metaphors are used to mediate experiences and worldviews pertaining to existential matters founded in deep negative emotions, deceit, shame and stigma. Metaphors make up a crucial material for communicating emotions and themes that are difficult to convey due to shame and stigma.

Resilience in children of parents with mental illness, alcohol or substance misuse-An integrative review.

AIM: The aim of this integrative review was to investigate how resilience has been researched and explore experiences of resilience, in children of parents with mental illness or alcohol or substance misuse. DESIGN: An integrative review. METHOD: The search included three major electronic databases, PubMed, Scopus and PsycINFO with the aim of identifying peer-reviewed studies where the concept of resilience was explored as resilience, coping, adaptation or protective factors. RESULTS: Out of 4016 studies, 14 were included after meeting predetermined criteria and methodological quality evaluation. The findings are presented in five categories: characteristics of the studies, operationalization and interpretation of resilience, individual resources, family resources and resources outside the family. PATIENT OR PUBLIC CONTRIBUTION: Resilience in children of parents with mental illness or substance misuse refers to coping strategies, protective factors and absence of symptoms or risk behaviour despite being exposed to risk. We suggest a three-level approach for mapping of resilience resources in the target group: the individual level, family level and outside of the family that includes both non-professionals and professionals. The use of disengagement or avoidance strategies implies poor resilience but may be necessary in absence of support, as acts of self-preservation during chaotic periods or harmful situations.

Generational and Gender Patterns of Prescription Opioid Misuse Among Black Adults.

INTRODUCTION: Opioid-related overdose mortality disproportionally affects Black adults in Kentucky, particularly overdoses associated with prescription opioid misuse (POM). Black adults also face other consequences of POM, such as disparate health and legal outcomes. While several factors effect POM, such as generational factors and gender, these risk factors are understudied among Black adults with a history of POM. Current literature primarily focuses on White individuals who use opioids. METHOD: The present study qualitatively examined reasons for POM, prescription opioids misused, how prescription opioids are obtained, and initiation of POM among Black adults using thematic analysis. Participants included a sample (n = 39) of Black adults from a southern state, stratified by gender and age across four cohorts: born (1) 1995-2001, (2) 1980-1994, (3) 1970-1979, and (4) 1955-1969. RESULTS: Results revealed similarities and differences in these themes across age cohorts and gender. CONCLUSIONS: Implications for findings include the importance of culturally responsive interventions that utilize dual diagnosis treatment and idiographic approaches due to heterogeneous experiences with POM among Black adults.

The misuse of codeine containing medicines: Perceptions and behaviours of qualified pharmacy professionals.

BACKGROUND:  Pharmacy professionals working in community pharmacies frequently provide pharmacist-initiated therapy, including codeine-containing medicines. Codeine is an opioid with great potential for misuse, adding to the global opioid epidemic burden. Professional pharmacy personnel are the first intervention point in relation to management of codeine use. This study highlights the importance of pharmacy professionals' perceptions and behaviours in combatting the opioid epidemic. METHODS:  A descriptive cross-sectional study was conducted. Simple random sampling included pharmacy professionals in the metropolitan city of Johannesburg. An electronic questionnaire was distributed via e-mail and data analysed descriptively. RESULTS:  Findings indicate that pharmacy personnel routinely ask patients about codeine use (n = 48; 53.9%), avoid dispensing over-the-counter (OTC) codeine as an initial treatment (n = 61; 69%) and express confidence to identify and manage codeine misuse (n = 69; 77.5%). Despite this, increased patient demands for OTC codeine (n = 69; 77.5%) were concerning, highlighting the ease of availability from internet sources (n = 76; 85.4%) and multiple pharmacies (n = 84; 94.4%). Apprehension about the lack of patient awareness on adverse health consequences (n = 66; 74.2%) and the risk of codeine dependence (n = 79; 88.8%) was expressed. CONCLUSION:  Growing concern regarding availability and accessibility of codeine-containing medicines within the community pharmacy sector is highlighted. Adverse health consequences of codeine misuse and dependence are not understood by customers and the ineffective information provided by pharmacy personnel was highlighted as a concern.Contribution: The results of this study give insight to the influence of dispensing personnel's attitude towards the growing challenges with respect to codeine containing medication abuse.

Rethinking Mental Automatism: De Clérambault's Theory in the Age of Novel Psychoactive Drugs: Psychotropic Effects and Synthetic Psychosis.

The widespread use of novel psychoactive substances (NPSs)-defined as new narcotic or psychotropic agents not classified under the Single Convention on Narcotic Drugs of 1961 or the Convention on Psychotropic Substances of 1971-poses a significant challenge to contemporary mental health paradigms due to their impact on psychiatric disorders. This study revisits and expands upon the theory of mental automatism as proposed by Gaëtan Gatian de Clérambault, aiming to elucidate the psychopathological mechanisms underlying substance-induced psychoses (SIP) and their distinction from non-induced psychoses (schizophrenia and related disorders). Through a phenomenological and clinical investigation, we explore the relevance of mental automatism in the development of toxic psychoses, drawing upon the historical and contemporary literature. This research highlights the psychopathological distinctions between induced and non-induced psychoses and the transition mechanisms from acute to chronic psychosis states. De Clérambault's theory, supplemented by Janet, Jackson, and Bonhoeffer's contributions, provides a foundational framework for understanding the genesis of SIP. Our findings suggest that NPS consumption, particularly among adolescents and psychiatric patients, significantly correlates with increased risks of SIP, marked by a transition to chronicity influenced by biological lesions triggered by substance use. Furthermore, we propose a comprehensive framework for SIP, integrating mental automatism, psychopathological distinctions, and transition mechanisms. This framework aims to refine diagnostic criteria and therapeutic approaches, addressing gaps in clinical practice and research. The study underscores the need for a nuanced understanding of SIP, advocating for a paradigm shift in psychiatric assessment and treatment approaches to better address the complexities of substance-induced mental health disorders.

Empowering Pharmacists: Strategies for Addressing the Opioid Crisis through a Public Health Lens.

BACKGROUND: The opioid crisis in the US is a severe public health issue, prompting pharmacists to adopt various strategies for prevention, harm reduction, treatment, and recovery. Despite progress, barriers persist. RESULTS: This commentary examines five determinants of public health in relation to pharmacist-led interventions for the opioid crisis: individual behavior, social factors, policymaking, health service accessibility, and biological/genetic considerations. Pharmacists can influence individual behavior through education and support, address social determinants like stigma, advocate for policy changes, ensure health service accessibility, and personalize opioid prescriptions based on biological factors. CONCLUSION: Pharmacists play a crucial role in addressing the opioid crisis by navigating these determinants. Pharmacists' engagement is essential for reducing opioid-related harms and improving public health outcomes through advocacy, service provision, and education.

Health behavior and psychological treatment utilization in adults with avoidant/restrictive food intake disorder symptoms.

BACKGROUND: Avoidant/restrictive food intake disorder (ARFID), an eating disorder not associated with weight and shape concerns, results in nutrient or energy deficiencies related with further health consequences and a pronounced need for specialized treatment. These interventions need to be tailored to individual health behavior. However, research about health behavior and treatment utilization in ARFID is scarce, particularly in adults, as ARFID is more common in children despite occurring across the lifespan. One important aspect of health behavior is the individual's health regulatory focus (i.e., health prevention and health promotion). Additionally, symptoms of eating disorders have generally been associated with various health risk behaviors, such as smoking, drinking, or unhealthy physical (in)activity. Therefore, the present study aimed to investigate health behavior and psychological treatment utilization in adults with symptoms of ARFID. METHODS: A representative adult population sample (N = 2415) completed several self-report questionnaires assessing symptoms of eating disorders and health behavior. Differences between groups (symptoms of ARFID vs. no symptoms of ARFID) were tested with analysis of variance, Mann-Whitney-U-tests, and binary logistic regression. RESULTS: Individuals with symptoms of ARFID (n = 20) did not differ in their health regulatory focus, smoking status, physical activity or psychological treatment utilization from individuals without symptoms of ARFID (n = 2395). However, they reported higher alcohol misuse than individuals without symptoms of ARFID. CONCLUSION: The findings suggest a relevance of further exploration of the relationship between alcohol misuse and ARFID, given the preliminary nature of these results. This exploration could inform treatment strategies for addressing potential comorbid substance misuse. Furthermore, the low psychological treatment utilization in adults with symptoms of ARFID suggest a need for more specialized psychological treatment services, public education about ARFID being an indication for psychological treatment, and further research about treatment barriers.

Avoidant/restrictive food intake disorder (ARFID), an eating disorder not associated with body image or weight concerns, results in nutrient or energy deficiencies related with further health consequences. It is most common in children, but can occur across the lifespan, although there is little research in adults. Therefore, the study investigated if adults with symptoms of ARFID differ from adults without symptoms of ARFID in health behaviors. A total of 2415 adults from a German national population sample completed questionnaires assessing symptoms of ARFID, health regulatory focus (health promotion focus with the aim of improving one's health and health prevention focus aiming to avoid any deterioration in health), alcohol misuse, smoking behavior, physical activity and psychological treatment utilization. Adults with symptoms of ARFID did not differ from those without symptoms of ARFID in treatment utilization or any of the assessed health behaviors except reporting higher alcohol misuse. We, therefore, suggest to further explore potential alcohol misuse in individuals with ARFID. Furthermore, more research about treatment barriers in ARFID and more specialized psychological treatment services as well as public education about ARFID being an indication for psychological treatment, are needed to address the low psychological treatment utilization.

Incitement to misuse of corticosteroids by Arab YouTubers in a local context.

BACKGROUND: The ubiquity of social media has ushered in an era where uncontrolled content sharing extends to all subjects, including sensitive topics such as medication consumption. OBJECTIVE: To quantify the prevalence of YouTube videos providing information on glucocorticoids and to underscore the risks associated with inaccurate information, which might inadvertently promote inappropriate use of these medications. METHODS: The YouTube videos were selected using predefined keywords from February 20 to March 4, 2023. The videos were categorized into two groups. Category 1 promotes the misuse of corticosteroids, while Category 2 raises awareness about the risks associated with these drugs. RESULTS: In total, 843 YouTube videos were included. Approximately 76% of the creators were women. Of these, category 1 videos (69.63%) predominated over Category 2 videos (30.37%). Regarding Category 1, dexamethasone was mentioned in 41.53% of cases, followed by hydrocortisone (17.30%). According to these YouTubers, these products/medications are mainly obtained from community pharmacies (58.09%), online shops (20.01%), and through illicit markets and the black market (13.46%). Weight gain was the most common objective, according to 32.62% of the YouTubers. CONCLUSION: This study highlights the prevalence of YouTube videos regarding the misuse of corticosteroids. The common focus on weight gain as an objective underscores the importance of educating content creators and viewers about responsible corticosteroid use. Targeted interventions are needed to promote safe and informed medication practices within this online environment.

Unraveling the Hippocampal Molecular and Cellular Alterations behind Tramadol and Tapentadol Neurobehavioral Toxicity.

Tramadol and tapentadol are chemically related opioids prescribed for the analgesia of moderate to severe pain. Although safer than classical opioids, they are associated with neurotoxicity and behavioral dysfunction, which arise as a concern, considering their central action and growing misuse and abuse. The hippocampal formation is known to participate in memory and learning processes and has been documented to contribute to opioid dependence. Accordingly, the present study assessed molecular and cellular alterations in the hippocampal formation of Wistar rats intraperitoneally administered with 50 mg/kg tramadol or tapentadol for eight alternate days. Alterations were found in serum hydrogen peroxide, cysteine, homocysteine, and dopamine concentrations upon exposure to one or both opioids, as well as in hippocampal 8-hydroxydeoxyguanosine and gene expression levels of a panel of neurotoxicity, neuroinflammation, and neuromodulation biomarkers, assessed through quantitative real-time polymerase chain reaction (qRT-PCR). Immunohistochemical analysis of hippocampal formation sections showed increased glial fibrillary acidic protein (GFAP) and decreased cluster of differentiation 11b (CD11b) protein expression, suggesting opioid-induced astrogliosis and microgliosis. Collectively, the results emphasize the hippocampal neuromodulator effects of tramadol and tapentadol, with potential behavioral implications, underlining the need to prescribe and use both opioids cautiously.

Examination of COVID stress syndrome facets and relations to substance misuse using profile analysis via multidimensional scaling (PAMS).

The COVID-19 pandemic has contributed to significant societal challenges, including increased substance misuse. The COVID stress syndrome is a constellation of interrelated processes that occur in response to pandemics, including danger/contamination fears, fears concerning economic consequences, xenophobia, compulsive checking/reassurance-seeking, and pandemic-related traumatic stress symptoms. In the present study, using a sample of 812 adults collected during the early stages of the COVID-19 pandemic in May 2020, we examined the relations between identified profiles of the COVID Stress Scales (CSS) and behavioral and cognitive aspects of substance misuse. Using profile analysis via multidimensional scaling (PAMS), we identified two core profiles of the CSS, which explained 60 % of the variance in participant responding: 1) High compulsive checking & Low xenophobia and 2) High xenophobia & Low danger/contamination. The first profile is consistent with the COVID stress syndrome, while the second profile aligns with the COVID disregard syndrome, which is a constellation of interrelated processes distinguished by a denial or downplaying of the seriousness of the COVID-19 pandemic and lack of perceived vulnerability to disease. Both profiles demonstrated significant positive correlations with drug and alcohol misuse, respectively. However, only the High xenophobia & Low danger/contamination profile demonstrated relations with cognitive aspects of substance misuse via positive and negative correlations with positive and negative expectancies of alcohol use, respectively. These findings provide further support for the relationship between the COVID stress syndrome and substance misuse and offer insight into how unique profiles of this syndrome may impact pandemic-related mental and public health interventions.

Vulnerability Factors, Adjustment, and Opioid Misuse in Chronic Noncancer Pain Individuals.

Several person variables predate injury or pain onset that increase the probability of maladjustment to pain and opioid misuse. The aim of this study was to evaluate the role of 2 diathesis variables (impulsiveness and anxiety sensitivity [AS]) in the adjustment of individuals with chronic noncancer pain and opioid misuse. The sample comprised 187 individuals with chronic noncancer pain. The hypothetical model was tested using correlation and structural equation modeling analyses. The results show a significant association between impulsiveness and AS and all the maladjustment variables, and between impulsiveness and AS and opioid misuse and craving. However, although the correlation analysis showed a significant association between adjustment to pain and opioid misuse, the structural equation modeling analysis showed a nonsignificant association between them (as latent variables). The findings support the hypothesis that both impulsiveness and AS are vulnerability factors for maladaptive adjustment to chronic pain and opioid misuse. PERSPECTIVE: This article adds to the empirical literature by including AS and impulsiveness as antecedent variables in a model of dual vulnerability to chronic pain maladjustment and opioid misuse. The findings suggest the potential utility of assessing both factors in individuals in the first stages of chronic pain.