Multi-level prediction of substance use: Interaction of white matter integrity, resting-state connectivity and inhibitory control measured repeatedly in every-day life.

Substance use disorders are characterized by inhibition deficits related to disrupted connectivity in white matter pathways, leading via interaction to difficulties in resisting substance use. By combining neuroimaging with smartphone-based ecological momentary assessment (EMA), we questioned how biomarkers moderate inhibition deficits to predict use. Thus, we aimed to assess white matter integrity interaction with everyday inhibition deficits and related resting-state network connectivity to identify multi-dimensional predictors of substance use. Thirty-eight patients treated for alcohol, cannabis or tobacco use disorder completed 1 week of EMA to report substance use five times and complete Stroop inhibition testing twice daily. Before EMA tracking, participants underwent resting state functional MRI and diffusion tensor imaging (DTI) scanning. Regression analyses were conducted between mean Stroop performances and whole-brain fractional anisotropy (FA) in white matter. Moderation testing was conducted between mean FA within significant clusters as moderator and the link between momentary Stroop performance and use as outcome. Predictions between FA and resting-state connectivity strength in known inhibition-related networks were assessed using mixed modelling. Higher FA values in the anterior corpus callosum and bilateral anterior corona radiata predicted higher mean Stroop performance during the EMA week and stronger functional connectivity in occipital-frontal-cerebellar regions. Integrity in these regions moderated the link between inhibitory control and substance use, whereby stronger inhibition was predictive of the lowest probability of use for the highest FA values. In conclusion, compromised white matter structural integrity in anterior brain systems appears to underlie impairment in inhibitory control functional networks and compromised ability to refrain from substance use.

Cost-effectiveness of drug consumption rooms in France: a modelling study.

BACKGROUND: People who inject drugs (PWID) experience many health problems which result in a heavy economic and public health burden. To tackle this issue, France opened two drug consumption rooms (DCRs) in Paris and Strasbourg in 2016. This study assessed their long-term health benefits, costs and cost-effectiveness. METHODS: We developed a model to simulate two fictive cohorts for each city (n=2,997 in Paris and n=2,971 in Strasbourg) i) PWID attending a DCR over the period 2016-2026, ii) PWID attending no DCR. The model accounted for HIV and HCV infections, skin abscesses and related infective endocarditis, drug overdoses and emergency department visits. We estimated the number of health events and associated costs over 2016-2026, the lifetime number of quality-adjusted life-years (QALYs) and costs, and the incremental cost-effectiveness ratio (ICER). RESULTS: The numbers of abscesses and associated infective endocarditis, drug overdoses, and emergency department visits decreased significantly in PWID attending DCRs (-77%, -69%, and -65%, respectively) but the impact on HIV and HCV infections was modest (-11% and -6%, respectively). This resulted in savings of €6.6 (Paris) and €5.8 (Strasbourg) millions of medical costs. The ICER of DRCs was €30,600/QALY (Paris) and €9,200/QALY (Strasbourg). In scenario analysis where drug consumption spaces are implemented inside existing harm reduction structures, these ICERs decreased to €21,400/QALY and €2,500/QALY, respectively. CONCLUSIONS: Our findings show that DCRs are highly effective and efficient to prevent harms in PWID in France, and advocate extending this intervention to other cities by adding drug consumption spaces inside existing harm reduction centers.

[Anorexia nervosa: An addiction? Application of the addiction model to eating disorders. A narrative commented review]. / L'anorexie mentale : une addiction ? Application du modèle addictologique aux troubles du comportement alimentaire. Une revue narrative commentée.

OBJECTIVES: Addiction offers a framework for the understanding of eating disorders, particularly those characterized by hyperphagia, with growing interest in food addiction. However, the application of the addiction model to anorexia nervosa remains more controversial. In this commented narrative review, we examine and discuss the addictive features of anorexia nervosa. METHODS: Commented narrative review of the literature. RESULTS: Anorexia nervosa could be the consequence of the loss of control of several objects of positive reinforcement: food restriction, physical hyperactivity, and food itself. Craving has been little studied in the field of eating disorders. When investigated, studies mainly focus on food cravings and tend to highlight food cravings that are inversely correlated with the restrictive nature of the disorder. This would thus be less found in anorexia nervosa, in which it is nevertheless reported. The existence of a pre-existing food craving, or its appearance secondary to food restriction, is currently under discussion. In the meantime, the question of a craving for food restriction, underpinned by the gratifying effect of fasting, is raised. CONCLUSIONS: The management of eating disorders has its place within the addiction care sectors. An integrative approach should be favored, for anorexia nervosa, combining, on the one hand, classic nutritional care, and, on the other hand, care within the framework of addiction treatment. Finally, in people with an eating disorder, the search for an addiction to food, food restriction and physical activity, including a systematic assessment of craving, should be systematized.

Smartphone-based virtual agents and insomnia management: A proof-of-concept study for new methods of autonomous screening and management of insomnia symptoms in the general population.

Insomnia is the most frequent sleep disorder, and the COVID-19 crisis has massively increased its prevalence in the population, due to psychosocial stress or direct viral contamination. KANOPEE_2 is a smartphone-based application that provides interactions with a virtual agent to autonomously screen and alleviate insomnia symptoms through an intervention programme giving personalized advices regarding sleep hygiene, relaxation techniques and stimulus-control. In this proof-of-concept study, we tested the effects of KANOPEE_2 among users from all over the country (France) who downloaded the app between 1 June and 26 October 2020 (to focus on effects after the end of COVID-19 confinement). Outcome measures include insomnia severity (Insomnia Severity Index) and sleep/wake schedules measured by a sleep diary. One-thousand and thirty-four users answered the screening interview (Mage  = 43.76 years; SD = 13.14), and 108 completed the two-step programme (Mage  = 46.64 years; SD = 13.63). Of those who answered the screening, 42.8% did not report sleep complaints, while 57.2% presented mild-to-severe insomnia symptoms. At the end of the intervention, users reported significantly fewer sleep complaints compared with the beginning of the intervention (Insomnia Severity Indexbeginning  = 13.58; Insomnia Severity Indexend  = 11.30; p < 0.001), and significantly increased their sleep efficiency (sleep efficiencybeginning  = 76.46%; sleep efficiencyend  = 80.17%; p = 0.013). KANOPEE_2 is a promising solution both to provide autonomous evaluation of individuals' sleep hygiene and reduce insomnia symptoms over a brief and simple intervention. These results are very encouraging for addressing the issue of insomnia management in people exposed to major psychosocial stress and the consequences of COVID-19 infection.

Stigma Attached to Smoking Pregnant Women: A Qualitative Insight in the General French Population.

INTRODUCTION: Cigarette consumption during pregnancy has major health consequences for women and unborn children. The stigma of smoking during pregnancy might hinder mothers-to-be's access to adequate healthcare and smoking cessation, especially in disadvantaged groups. This qualitative study was designed to describe extensively the public stigma associated with smoking during pregnancy. AIMS AND METHODS: Participants were French adults recruited from the general population through social networks (N = 100). They were asked to answer three pairs of open-ended questions regarding cognitions, emotions, and behaviors elicited in the general population by pregnant smoking women. An inductive thematic analysis was performed and interjudge agreement was computed on 30% of the corpus analyzed deductively. Finally, independence (chi-square) between themes and gender, education, parenthood, and smoking status was tested. RESULTS: Themes (n = 25) were defined regarding cognitions (n = 9, eg, irresponsible, thoughtless, and unmindful), emotions (n = 8, eg, anger and disgust), and behaviors, (n = 8, eg, inform and persuade, and moralize and blame). Global interjudge agreement was strong (κ = .8). No difference was observed in themes according to gender, parental status, or education, indicating a heterogenous awareness of stigma. However, some differences were observed according to smoking status (χ 2 = 69.59, p = .02) (eg, nonsmokers more frequently stressed immorality). CONCLUSIONS: The stigma associated with smoking during pregnancy includes various components that might be measured and targeted in interventions to improve access to adequate healthcare and smoking cessation in this specific population. IMPLICATIONS: This qualitative study explores the stigma that the general French population attaches to pregnant women who smoke. Themes regarding cognitions (eg, irresponsible, thoughtless, and unmindful), emotions (eg, anger and disgust), and behaviors (eg, inform and persuade, and moralize and blame) were identified. These themes could guide further research regarding scale development and antistigma interventions to support smoking cessation.

Real-time cognitive performance and positive symptom expression in schizophrenia.

Deficits in cognitive functions are frequent in schizophrenia and are often conceptualized as stable characteristics of this disorder. However, cognitive capacities may fluctuate over the course of a day and it is unknown if such variation may be linked to the dynamic expression of psychotic symptoms. This investigation used Ecological Momentary Assessment (EMA) to provide mobile tests of cognitive functions and positive symptoms in real time. Thirty-three individuals with schizophrenia completed five EMA assessments per day for a one-week period that included real-time assessments of cognitive performance and psychotic symptoms. A subsample of patients and 31 healthy controls also completed a functional MRI examination. Relative to each individual's average score, moments of worsened cognitive performance on the mobile tests were associated with an increased probability of positive symptom occurrence over subsequent hours of the day (coef = 0.06, p < 0.05), adjusting for the presence of psychotic symptoms at the moment of mobile test administration. These prospective associations varied as a function of graph theory indices in MRI analyses. These findings demonstrate that cognitive performance is prospectively linked to psychotic symptom expression in daily life, and that underlying brain markers may be observed in the Executive Control Network. While the potential causal nature of this association remains to be investigated, our results offer promising prospects for a better understanding of the underlying mechanisms of symptom expression in schizophrenia.

Item Response Theory Analyses of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Criteria Adapted to Screen Use Disorder: Exploratory Survey.

BACKGROUND: Screen use is part of daily life worldwide and morbidity related to excess use of screens has been reported. Some use of screens in excess could indicate a screen use disorder (ScUD). An integrative approach to ScUD could better fit the polymodal reality of screens, and concurrent problems with screens, than a split approach, activity by activity. In that paradigm, a pragmatic and operationalized approach to study a potential ScUD requires the use of common criteria, for all screens and activities done on screens, in a single questionnaire. OBJECTIVE: Our goals were (1) to describe screen uses in a general population sample and (2) to test the unidimensionality, local independence, and psychometric properties of the 9 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) internet gaming disorder (IGD) criteria adapted to screen use in a community sample. We hypothesized that the 9 DSM-5 IGD criteria adapted to ScUD would show unidimensionality, local independence, and good discrimination, with criteria distributed on the severity continuum. METHODS: This cross-sectional survey in a French suburban city targeted adults and adolescents. A self-administered questionnaire covered the main types of screens used and their use for various activities in the past month. Presence of ScUD diagnostic criteria in past 12 months was also self-evaluated in the questionnaire. Factor and 2-parameter Item Response Theory analysis were used to investigate the dimensionality, local independence, and psychometric properties of the ScUD criteria. RESULTS: Among the 300 participants, 171 (57.0%) were female (mean age 27 years), 297 (99.0%) used screens, 134 (44.7%) reported at least one criterion (potential problem users), and 5 (1.7%) reported 5 or more criteria and endorsed an ScUD. The most endorsed criteria were loss of control (60/300, 20.0%) and preoccupation (52/300, 17.3%). Screen types used and screen activities differed between participants with no ScUD criteria and those with at least one ScUD criterion. The latter were more likely to have a computer as the most used screen type, and more video gaming, communication/social network, and watching news and research of information as activities. Unidimensionality was confirmed by all fit indices. Local independence was confirmed by the absence of residual correlation between the items. Criteria had relatively high factor loading, with loss of interest in other recreational activities having the highest. However, criteria with the lowest factor loading all remained above the cut-offs, sanctioning unidimensionality. Most discriminating criteria were loss of interests, preoccupation, deceive/cover up, and risk/lose relationship/opportunities, which also provided the most information on the measurement of the latent trait. CONCLUSIONS: We described screen uses in a French community sample and have shown that the adaptation of the DSM-5 IGD to "ScUD" has good psychometric validity and is discriminating, confirming our hypothesis. We suggest to use those criteria to assess potential "ScUD." Further studies should determine if all criteria are needed and whether others should be added.

The Pregnant Smoker Stigma Scale - Public Stigma (P3S-PS): development and validation in general French population.

While pregnancy smoking stigma is widely acknowledged, no psychometrically sound tool to measure it exists. This study was designed to build the Pregnant Smoker Stigma Scale - Public Stigma (P3S-PS) for assessing the stigma of pregnancy smoking in the general French population. A total of 342 adults were recruited online to take the P3S-PS and some items (condemnation/rejection, and support for punitive actions) from other scales. Exploratory factor analysis was performed. Measurement invariance was tested according to gender and smoking status. Temporal reliability was checked after two weeks (n = 72). The P3S-PS has 26 items and four dimensions: "derogatory cognitions," "negative emotions and behaviors," "personal distress," and "information provision." All dimensions were correlated (r = .36 to .75) and have good internal consistency (α.>.70), temporal reliability (ICC>.75), and measurement invariance. Validity is exhibited through the P3S-PS's association with condemnation and rejection (r = .32 to .53), support for punitive actions (r = .35 to .65), and presence of pregnant smokers in the close circle (r = -.23 to -.40). The P3S-PS is a promising tool that exhibits good psychometric qualities. This scale will be useful to trigger research regarding the stigma of smoking while pregnant.

Smartphone-Based Virtual Agents to Help Individuals With Sleep Concerns During COVID-19 Confinement: Feasibility Study.

BACKGROUND: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. OBJECTIVE: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. METHODS: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. RESULTS: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. CONCLUSIONS: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.

Motivations for using electronic cigarettes in young adults: A systematic review.

Background: The most common reasons why adults use e-cigarettes are to stop or reduce tobacco smoking. However, it is unclear if this reason is evenly distributed between young and older adults. Objectives: describe the motivations for e-cigarette use amongst young adults aged 18-25 and compare the reasons for using e-cigarettes of people who currently or formerly used tobacco products to those who had never smoked tobacco prior e-cigarette use. Methods: PubMed®, Scopus®, Cochrane Library®, SocINDEX®, PsycARTICLES®, Psychology and Behavioral Sciences Collection® and PsycINFO® databases were used. English written articles were screened up to March 2018. Depending on study design, quality was assessed using The STROBE or RATS checklists. Results: Six articles were included in the review, all with a moderate quality of evidence. Independently of smoking status, curiosity was the most frequently reported reason for initiating the use of e-cigarettes in young adults. Reasons for continuing to use e-cigarettes were various. The continued use of e-cigarettes could be either a means to replicate smoking habits, or a way for a different and personalized use of nicotine by inhalation. Conclusions: Reasons for using e-cigarettes in young adults are varied and are not limited to stopping smoking.

Feasibility and validity of mobile cognitive testing in patients with substance use disorders and healthy controls.

BACKGROUND AND OBJECTIVES: Mobile testing of executive deficits in substance-related addictions is highly novel but requires validation. METHODS: Sixty-one individuals (34 patients, 27 healthy controls) completed Ecological Momentary Assessments with mobile executive tests. RESULTS: Compliance with the tests was high (78% to 91%) in both the patient and control groups. No fatigue effects were detected, practice effects were observed for controls only, and convergent validity was found relative to neuropsychological assessments. Conclusions The use of mobile cognitive testing is feasible and valid in this population. Scientific Significance Mobile cognitive tests provide new opportunities for both research and clinical intervention. (Am J Addict 2018;27:553-556).

Pertinence of Titration and Age-Based Dosing Methods for Electroconvulsive Therapy: An International Retrospective Multicenter Study.

BACKGROUND: Although the dosage of electroconvulsive therapy (ECT) stimulus has a major impact on the efficacy and safety of this treatment, the method used to determine an optimal dosage remains a matter of debate. OBJECTIVE: We investigated factors influencing the seizure threshold (ST) in a large-sample study and compared age-based and titration dosing methods in terms of charge. METHODS: A retrospective study examined data from 503 patients across France and Canada. The patients underwent right unilateral (RUL) or bitemporal (BT) ECT during a titration session before undergoing ECT. Seizure threshold and charge differences between age-based and titration-predicted methods were derived for each RUL and BT patient and compared according to sex, age, and anesthetic agents. RESULTS: Based on our results, ST is a function of electrode placement, sex, age, and anesthetic agents. Titration and age-based methods led to completely different patterns of charges for the same electrode placement, especially in elderly and in women in the RUL group. Regression models showed that differences between the age-based and titration methods varied with respect to age, sex, and anesthetic agent. Specifically, significant effects of sex and age were observed for RUL ECT and of sex and anesthetics for BT ECT. CONCLUSIONS: This study revealed that several factors significantly influence the prediction of ECT dose, depending on individuals and treatment modalities. Caution should be exercised when using nonindividualized methods to calculate ST.

Mortality Associated With Time in and Out of Buprenorphine Treatment in French Office-Based General Practice: A 7-Year Cohort Study.

In France, most cases of opioid use disorder are treated with buprenorphine by general practitioners in private practice. Using reimbursement data of a representative sample of the French population, Echantillon Généraliste des Bénéficiaires, we investigated mortality during periods when patients were in and out of treatment in a cohort of 713 new users of buprenorphine having a mean (SD) follow-up of 4.5 (1.5) years. The mortality rate was 0.63 per 100 person-years (95% CI, 0.40-0.85) overall. In a multivariate Cox regression model, compared with being in treatment, being out of treatment was associated with a markedly increased risk of death (hazard ratio = 29.04; 95% CI, 10.04-83.99). Buprenorphine appears to be a strong protective factor against mortality.

A socio-structural approach to preventing injection drug use initiation: rationale for the PRIMER study.

BACKGROUND: Injection drug use remains a primary driver of HIV and HCV-related harms globally. However, there is a gap in efforts to prevent individuals from transitioning into injecting. People who inject drugs (PWID) play a key role in the transition of others into injecting, and while behavioral interventions have been developed to address this phenomenon, socio-structural approaches remain unexplored. To that end, we hypothesize that certain interventions designed to reduce injecting-related risk behaviors may also reduce the risk that PWID expose and introduce others into injecting. Identifying the preventive potential of existing interventions will inform broader efforts to prevent injecting and related harms. METHODS: The Preventing Injecting by Modifying Existing Responses (PRIMER) study is a multi-country mixed methods study with an aim to investigate whether specific interventions (e.g., opioid substitution therapy, supervised injection facilities, stable housing, incarceration environments) and related factors (e.g., public injecting and gender) influence the likelihood that PWID initiate others into injecting. This study will (1) investigate the PWID participation in injection initiation; (2) identify factors influencing the risk that PWID expose others to or facilitate injection initiation; (3) describe drug scene roles that increase the risk of PWID facilitating injection initiation; and (4) evaluate the impact of structural, social, or biomedical interventions on the risk that PWID facilitate injection initiation. It does so by pooling observational data from cohort studies of PWID in six cities: Vancouver, Canada; San Diego, USA; Tijuana, Mexico; Paris, Marseille, and Bordeaux, France. RESULTS: Team members are conducting a prospective, multi-site study of PWID (n = 3050) in North America and France that includes quantitative and qualitative data collection through four separate cohort studies of PWID (San Diego, STAHR II; Tijuana, El Cuete IV; Vancouver, V-DUS; Bordeaux, Marseille, Paris and Strasbourg, COSINUS). CONCLUSIONS: PRIMER is the largest study of injection initiation to date and the first to investigate structural approaches to preventing injection drug use initiation. Findings have the potential to inform the development and scale up of new and existing interventions to prevent transitions into injecting. TRIAL REGISTRATION: Preventing Injecting by Modifying Existing Responses (PRIMER), NIDA DP2-DA040256-01 .

Usefulness and validity of the modified Addiction Severity Index: A focus on alcohol, drugs, tobacco, and gambling.

BACKGROUND: Individuals who seek treatment for an addictive disorder often exhibit comorbid substance use disorders and/or gambling disorder. The lack of a unique severity assessment instrument might be an obstacle for individuals to access integrated and comprehensive treatment. This paper aimed to examine the usefulness and validity of a modified version of the Addiction Severity Index (mASI) to assess all substance use disorders (including tobacco) and gambling. METHODS: Participants (N = 833) were interviewed with the mASI and completed a validity battery questionnaire. The validity and the reliability of the mASI were examined. RESULTS: The mASI was reliable, and its 9 assessed domains showed a relative independence, supporting its multidimensionality. CONCLUSIONS: The standardized properties of the mASI permit a comprehensive and systematic assessment of all addictive disorders independent of individuals' perceived problems and treatment settings, hence facilitating personalized treatment planning.

Risk Factors for Borderline Personality Disorder in Treatment Seeking Patients with a Substance Use Disorder: An International Multicenter Study.

Borderline personality disorder (BPD) and substance use disorders (SUDs) often co-occur, partly because they share risk factors. In this international multicenter study, risk factors for BPD were examined for SUD patients. In total, 1,205 patients were comprehensively examined by standardized interviews and questionnaires on psychiatric diagnosis and risk factors, and it was found that 1,033 (85.7%) had SUDs without BPD (SUD) and 172 (14.3%) had SUD with BPD (SUD + BPD). SUD + BPD patients were significantly younger, more often females and more often diagnosed with comorbid adult attention deficit/hyperactivity disorder. SUD + BPD patients did not differ from SUD patients on most risk factors typical for SUD such as maternal use of drugs during pregnancy or parents having any SUD. However, SUD + BPD patients did have a higher risk of having experienced emotional and physical abuse, neglect, or family violence in childhood compared to SUD patients, suggesting that child abuse and family violence are BPD-specific risk factors in patients with SUDs.

An overview of and rationale for changes proposed for pathological gambling in DSM-5.

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of pathological gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.

Making alcohol and tobacco preventable deaths truly preventable! Addiction as a modifiable risk factor for alcohol and tobacco preventable mortality.

Worldwide, health professionals from all specialties are encouraging patients to reduce alcohol use if not abstain, and abstinence is clearly encouraged for tobacco. However, for users of substances that meet diagnostic criteria for substance use disorder (addiction), reducing use or abstaining will be difficult without appropriate addiction treatment. Moreover, this group is the most at risk and the most likely to benefit from reducing use. We propose research-based arguments to better combine encouragement to reduce or abstain from alcohol and tobacco to systematic screening for addiction and facilitated access to addiction treatment to make alcohol and tobacco preventable deaths truly preventable.

Systematic review of patient contribution to the development of alcohol craving measurements.

Craving is considered one of the defining characteristics for alcohol or substance use disorders. There is no consensus on the underlying processes of craving, although multiple models exist. Craving is a very individualistic symptom and has to be self-reported. Several instruments have been developed to measure craving, without a recognized gold standard. The patient's perspective appears critical to determine the relevance of the numerous existing tools. We assessed the contribution of patients to the development of these instruments. We performed a systematic review of instruments measuring alcohol craving published from 2012 to 2023 from three databases (PubMed, PsycInfo, and Embase) in addition to those identified in a previous review by Kavanagh et al. from 1990 to 2012. We included all articles related to the development or validation of instruments for the assessment of alcohol craving. We identified and included in this review the corresponding instruments. Articles translating existing instruments without validation or on single-item instruments were excluded. We analyzed the articles in accordance with COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations to assess patient involvement in the creation of patient-reported outcome measures (PROM). Two key aspects were investigated: (1) the general design, encompassing the quality of construct description, identification of elements pertinent to a PROM, particularly the inclusion of concepts provided by patients, and (2) the quality of cognitive interviews (when conducted), to evaluate the comprehensiveness and comprehensibility of the PROM. We included 22 articles identifying 16 instruments for measuring alcohol craving. Patients only contributed to item development for one instrument and its short version (QAU and AUQ). None of the instruments met all of the developmental quality criteria, with 14 classed as "inadequate" and two as "doubtful." The current instruments measuring alcohol craving were developed with poor patient contribution, although most articles did not adequately report patient involvement. Patients' perspectives on craving should be explored for future patient-centered approach.

The stigma of smoking among women: A systematic review.

BACKGROUND: Smoking stigma has been well documented, but little is known regarding its specific features and effects on women. Notably, women face unique social, cultural, and economic challenges that may interact with smoking stigma and impact health outcomes. This review investigates the extent to which smoking women encounter and internalise stigma, while examining the various coping mechanisms they employ to manage these negative experiences. METHODS: In November 2022, major databases were systematically searched with no time restrictions. After applying inclusion and exclusion criteria, 23 studies (three quantitative and 20 qualitative) met our criteria. We conducted a quality assessment and summarised the findings pertaining to public stigma, self-stigma, and coping strategies. RESULTS: The stigma about smoking emerges from a variety of sources, such as family, healthcare providers, or internet forums. Women smokers are universally aware of the negative image they have in society. Yet, their experiences and management of the stigma of smoking are shaped by other variables such as cultural background, social class, or motherhood status. Smoking stigma produces ambivalent effects, such as concealment, reduced usage of support services, and to a lesser extent, smoking cessation motivation. CONCLUSIONS: These results indicate that smoking stigma is an important social justice and public health issue and that further research is needed to better prevent its effects on women's well-being and health behaviours.