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The relationship between cannabis and psychosis and schizophrenia has tested the field of addiction for decades, and in some ways serves as measure of our ability to provide a credible contribution to public health. As cannabis is used widely, many people are interested in the risks the drug poses to mental health. This paper focuses upon a seminal study examining this, the trajectory of subsequent research findings and what this has meant for understanding and communicating risk factor information. These studies provided evidence of a dose-response relationship between cannabis and psychosis, and that for those individuals with schizophrenia cannabis exacerbated their symptoms. The findings fit with a multi-causal model in which vulnerability interacts with a precipitating agent to produce a disease outcome. Even though this is a common model in epidemiology, it has proved difficult to communicate it in this case. This may be because at a population level the increased risk is weak and the vulnerabilities relatively rare. It may also be because people bring strongly held preconceptions to interpreting a complex multi-causal phenomenon. [ABSTRACT FROM AUTHOR]

Aims: To estimate the associations between high‐risk alcohol consumption and (1) severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) seroconversion, (2) self‐reported new SARS‐CoV‐2 infection and (3) symptomatic COVID‐19. Design Prospective cohort study. Setting: Indiana University Bloomington (IUB), IN, USA. Participants: A total of 1027 IUB undergraduate students (64% female), aged 18 years or older, residing in Monroe County, Indiana, seronegative for SARS‐CoV‐2 at study baseline. Measurements Primary exposure was high‐risk alcohol consumption measured with an Alcohol Use Disorders Identification Test (AUDIT) questionnaire score of 8 or more. Primary outcome was SARS‐CoV‐2 seroconversion since baseline, assessed with two SARS‐CoV‐2 antibody tests, at baseline (September 2020) and end‐line (November 2020). Secondary outcomes were (a) self‐reported new SARS‐CoV‐2 infection at the study end‐line and (b) self‐reported symptomatic COVID‐19 at baseline. Findings Prevalence of high‐risk alcohol consumption was 32 %. In models adjusted for demographics, students with high‐risk alcohol consumption status had 2.44 [95% confidence interval (CI) = 1.35, 4.25] times the risk of SARS‐CoV‐2 seroconversion and 1.84 (95% CI = 1.04, 3.28) times the risk of self‐reporting a positive SARS‐CoV‐2 infection, compared with students with no such risk. We did not identify any association between high‐risk alcohol consumption and symptomatic COVID‐19 (prevalence ratio = 1.17, 95% CI = 0.93, 1.47). Findings from sensitivity analyses corroborated these results and suggested potential for a dose–response relationship. Conclusions: Among American college students, high‐risk alcohol consumption appears to be associated with higher risk for severe acute respiratory syndrome coronavirus 2 seroconversion/infection. [ABSTRACT FROM AUTHOR]

Aims: To predict the effects of perfect adherence to the French alcohol consumption guidelines, a maximum of 10 standard alcoholic drinks per week with no more than two standard alcoholic drinks per day, during a 36‐year period (2014–50). Design This simulation study is an adaption of the Sheffield Alcohol Policy Model. The dose–response relationship between alcohol consumption and alcohol‐attributable cancer risks was defined by cancer site‐specific risk functions, each modelled as a continuous risk. These estimates were used to compute the potential impact fraction (PIF) associated with alcohol consumption by cancer site. Setting: The French general adult population during a 36‐year period (2014–50). Participants: For the baseline scenario, the current distribution of consumption levels, the counterfactual scenario and perfect adherence to the French alcohol consumption guidelines, we generated for each gender and age group 1000 randomly distributed alcohol consumption values from calibrated group‐specific gamma distribution. Measurements The predicted number of new cancer cases among men and women in France between 2015 and 2050 that could have been prevented by following the French government's alcohol consumption guidelines. Findings The simulation predicted that perfect adherence to the French government's alcohol consumption guidelines would prevent, on average, an estimated 15 952 cancer cases per year after the PIF reached its full effect, which would have represented 4.5% of new cancer cases in 2015. The number of averted cancer cases over the study period were highest for oral cavity, oropharynx and hypopharynx cancer (respectively, 118 462, 95% CI = 113 803–123 022 and 11 167, 95% CI = 10 149–12 229] for men and women; liver and intrahepatic bile ducts cancer (123 447, 95% CI = 112 581–133 404 and 2825, 95% CI = 2208,4095); colorectal cancer (89 859, 95% CI = 84 651–95 355 and 12 847, 95% CI = 11 545–14 245); and female breast cancer (61 649, 95% CI = 56 330–67 452). Conclusion: This simulation study of the French general population predicted that perfect adherence to the French government's alcohol consumption guidelines (no more than 10 standard alcoholic drinks per week and two per day) would prevent almost 16 000 cancer cases per year. [ABSTRACT FROM AUTHOR]

A diagnosis of alcohol use disorder is associated with a higher risk of dementia, but a dose–response relationship between alcohol intake consumption and cognitive impairment remains unclear. Alcohol is associated with a range of effects on the central nervous system at different doses and acts on a number of receptors. Acute disorders include Wernicke's encephalopathy (WE), traumatic brain injury, blackouts, seizures, stroke and hepatic encephalopathy. The most common manifestations of chronic alcohol consumption are Korsakoff's syndrome (KS) and alcohol‐related dementia (ARD). There is limited evidence for benefit from memantine in the treatment of ARD, but stronger evidence for the use of high‐dose parenteral thiamine in the progression of neuropsychiatric symptoms for WE. Accumulating evidence exists for pharmacological treatment in the prevention of hepatic encephalopathy. Rehabilitation of people with ARD may take several years, and requires an approach that addresses physical and psychosocial factors. [ABSTRACT FROM AUTHOR]

Background and aims Precision, personalized or stratified medicine, which promises to deliver the right treatment to the right patient, is a topic of international interest in both the lay press and the scientific literature. A key aspect of precision medicine is the identification of biomarkers that predict the response to medications (i.e. pharmacogenetics). We examined why, despite the great strides that have been made in biomarker identification in many areas of medicine, only in oncology has there been substantial progress in their clinical implementation. We also considered why progress in this effort has lagged in addiction medicine. Methods We compared the development of pharmacogenetic biomarkers in oncology, cardiovascular medicine (where developments are also promising) and addictive disorders. Results The first major reason for the success of oncologic pharmacogenetics is ready access to tumor tissue, which allows in-vitro testing and insights into cancer biology. The second major reason is funding, with cancer research receiving, by far, the largest allocation by the National Institutes of Health (NIH) during the past two decades. The second largest allocation of research funding has gone to cardiovascular disease research. Addictions research received a much smaller NIH funding allocation, despite the major impact that tobacco use, alcohol consumption and illicit drug use have on the public health and healthcare costs. Conclusions Greater support for research on the personalized treatment of addictive disorders can be expected to yield disproportionately large benefits to the public health and substantial reductions in healthcare costs. [ABSTRACT FROM AUTHOR]

Background and aims Previous research demonstrates that the number of problems related to each additional drink consumed on any drinking occasion, dose-response, varies non-linearly across average drinking quantities. We test predictions from a dynamic model of drinking behavior that locates this heterogeneity in drinkers' efforts to equilibrate between costs and benefits of use. Design Equations derived from the theoretical model are used to assess dose-response across drinking quantity subgroups using censored regressions. Setting Fourteen California, USA, college campuses surveyed from 2003 to 2011. Participants A total of 37 762 undergraduate college students 18 years of age and older. Measurements Drinking patterns, five physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) and student demographics. Findings The number of physiological problems related to each additional drink consumed was an inverse function of average drinking quantities ( b = 0.2947, Z = 21.92, P<0.001), differed by drinker age (of-age drinker b = -0.1144, Z = -3.95, P < 0.001) and gender (male b = -0.3379, Z = -18.56, P<0.001) and, at the population level, drinking three drinks per occasion was associated with the greatest number of problems. Conclusions Among US college students, all drinkers exhibit greater risks for physiological problems related to alcohol use (hangover, memory loss, medical treatment for overdose, nausea/vomiting, passing out) when drinking greater amounts of alcohol, but heavier drinkers (those who consume more on average) exhibit fewer problems for each additional drink consumed (less dose-response) than light and moderate drinkers. Light and moderate drinkers exhibit greater dose-response, with three drinks per occasion associated with the greatest number of problems. [ABSTRACT FROM AUTHOR]

Aims To update and extend analysis of the dose-response relationship of injury and drinking by demographic and injury subgroups and country-level drinking pattern, and examine the validity and efficiency of the fractional polynomial approach to modeling this relationship. Design Pair-matched case-cross-over analysis of drinking prior to injury, using categorical step-function and fractional polynomial analysis. Setting Thirty-seven emergency departments ( EDs) across 18 countries. Participants A total of 13 119 injured drinkers arriving at the ED within 6 hours of the event. Measurements The dose-response relationship was analyzed by gender, age, cause of injury (traffic, violence, fall, other) and country detrimental drinking pattern ( DDP). Findings Estimated risks were similar between the two analytical methods, with injury risk doubling at one drink [odds ratio ( OR) = 2.3-2.7] and peaking at about 30 drinks. Although risk was similar for males and females up to three drinks ( OR = 4.6), it appeared to increase more rapidly for females and was significantly higher starting from 20 drinks [female OR = 28.6; confidence interval ( CI ) = 16.8, 48.9; male OR = 12.8; CI = 10.1, 16.3]. No significant differences were found across age groups. Risk was significantly higher for violence-related injury than for other causes across the volume range. Risk was also higher at all volumes for DDP-3 compared with DDP-2 countries. Conclusions There is an increasing risk relationship between alcohol and injury but risk is not uniform across gender, cause of injury or country drinking pattern. The fractional polynomial approach is a valid and efficient approach for modeling the alcohol injury risk relationship. [ABSTRACT FROM AUTHOR]