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Introduction Clinical trials require sufficient samples recruited within limited time and budget constraints. Trials with minors are additionally burdened by the requirement for youth assent and parental permission. This paper details the use of Facebook ads and traditional paper mailings to enroll 797 adolescent girls for a longitudinal, web-based, drug abuse prevention trial. Data on sample representativeness and retention are also provided. Methods Facebook ads appeared on the pages of females aged 13 or 14 years who reside in the U.S. Ads linked girls to a recruitment website. Girls who wanted more information submitted contact information and were mailed information packets to their homes containing, among other things, youth assent and parent permission forms. Returned forms were verified for accuracy and validity. Results The Facebook ad campaign reached 2,267,848 girls and had a unique click-through rate of 3.0%. The campaign cost $41,202.37 with an average cost of $51.70 per enrolled girl. Information packets were mailed to 1,873 girls. Approximately one-half of girls returned the forms, and 797 girls were enrolled. The Facebook campaign's success varied by ad type, month, and day of the week. Baseline data revealed comparability to national data on demographic and substance use variables. Conclusions Results suggest that Facebook ads provide a useful initial point of access to unparalleled numbers of adolescents. Clinical trials may benefit from a two-fold recruitment strategy that uses online ads to attract interested adolescents followed by traditional recruitment methods to communicate detailed information to adolescents and parents.

Background Parachuting, also called bombing, is a way to ingest psychoactive substances wrapped into cigarette paper, toilet paper, etc. There is little data describing parachuting in terms of substances use, context of use and, most importantly, the motivations for using such wrappers, although some authors hypothesized that parachute could be used for pharmacokinetic reason. However, inconsistently, some authors report that parachutes are used for sustained-release whereas others report that users are looking for an immediate effect. Research design and methods Considering parachute as a “home-made” dosage form, we have applied the dissolution testing to characterize the dissolution performance of a substance wrapped into a parachute and to characterize whether a parachute represents an immediate-release form or not. Results This in-vitro study provides the first pharmacokinetic data for drugs wrapped in parachutes. It shows that parachute acts as sustained-release form when made with a cigarette paper wrapper, but as immediate release form in the presence of alcohol or if wrapped with toilet paper. Conclusions An important message to harm reduction is that users must be aware that a parachute can have unexpected pharmacokinetics and have to avoid taking another parachute in the absence of an immediate-effect to avoid overdose.

It has been claimed that smartphone usage constitutes a behavioral addiction, characterised by compulsive, excessive use of one's phone and psychological withdrawal or distress when the phone is absent. However, there is uncertainty about key phenomenological and conceptual details of smartphone addiction. One of the central problems has been understanding the processes that link smartphone usage, and addiction. The question this paper aims to answer is straightforward: based on measures utilised in the literature, what does 'behavior' mean in the context of smartphone addiction? A scoping review of the smartphone addiction literature was undertaken. This identified 1305 studies collecting smartphone addiction data. Just under half (49.89%) of all published smartphone addiction papers did not report the collection of any smartphone specific behaviors. Those that did tended to focus on a small cluster of self-reported behaviors capturing volume of overall use: hours spent using a smartphone per day, number of pickups, duration of smartphone ownership, and types of app used. Approximately 10% of papers used logged behavioral data on phones. Although the theoretical literature places increasing focus on context and patterns of use, measurements of behavior tend to focus on broad, volumetric measures. The number of studies reporting behavior has decreased over time, suggesting smartphone addiction is becoming increasingly trait-like. Both major phone operating systems have proprietary apps that collected behavioral data by default, and research in the field should take advantage of these capabilities when measuring smartphone usage.

The aim of this paper was to explore responses to alcohol health information labels from a cross sectional survey of people who drink alcohol from 29 countries.This paper draws on findings from the Global Drug Survey (GDS) - an annual cross sectional online survey.75,969 (64.3% male) respondents from 29 countries were included in the study.Respondents were shown seven health information labels (topics were heart disease, liver, cancer, calories, violence, taking two days off and myth of benefits of moderate drinking). They were asked if the information was new, believable, personally relevant, and if it would change their drinking. A multivariate multilevel Bayesian logistic regression model was used to estimate predicted probabilities for newness, believability, relevance and if messages would change drinking behaviour by country and information label.Predicted probabilities showed substantial variability in responses across countries. Respondents from Colombia, Brazil and Mexico were more likely to consider drinking less as well as have lower levels of previous awareness. Those from Denmark and Switzerland were not as likely to say the labels would make them consider drinking less. The cancer message was consistently the newest and most likely to make people consider drinking less across countries.Country differences in responses to messages can be used to create targeted harm reduction measures as well as inform what should be on labels. The provision of such health information on alcohol product labels may play a role in raising awareness of the risk of drinking. Global comparisons of responses to alcohol health information labels: a cross sectional study of people who drink alcohol from 29 countries.

Survival analysis is a class of models that are ideal for evaluating questions of timing of events, which makes them well-suited for modeling the development of a process such as initiation of substance use, development of addiction, or post-treatment recovery. The focus of this review paper is to demonstrate how survival models operate in a broader developmental framework and to offer guidance on selecting the appropriate model on the basis of the research question at hand. We provide a basic overview of survival models and then identify several key issues, explain how they pertain to research in the addiction field, and describe studies that utilize survival models to address questions about timing. We discuss the importance of carefully selecting the metric and origin of the time scale that corresponds to developmental process under investigation and we describe types of censoring/truncation. We describe the value of modeling covariates as time-invariant versus time-varying, and make the distinction between time-varying covariates and time-varying effects of covariates. We also explain how to test for substantive differences due to the timing of the assessment of the predictor. We finish the paper with a presentation of relatively novel extensions of survival models, including models that integrate standard statistical mediational analysis with discrete-time survival analysis, models that simultaneously consider order and timing of multiple events, and models that involve joint modeling of longitudinal and survival data. We also present our own substantive examples of various models in an Appendix containing annotated syntax and output.

Ambulatory assessment (AA) methodologies have the potential to increase understanding and treatment of addictive behavior in seemingly unprecedented ways, due in part, to their emphasis on intensive repeated assessments of an individual's addictive behavior in context. But, many analytic techniques traditionally applied to AA data - techniques that average across people and time - do not fully leverage this potential. In an effort to take advantage of the individualized, temporal nature of AA data on addictive behavior, the current paper considers three underutilized person-oriented analytic techniques: multilevel modeling, p-technique, and group iterative multiple model estimation. After reviewing prevailing analytic techniques, each person-oriented technique is presented, AA data specifications are mentioned, an example analysis using generated data is provided, and advantages and limitations are discussed; the paper closes with a brief comparison across techniques. Increasing use of person-oriented techniques will substantially enhance inferences that can be drawn from AA data on addictive behavior and has implications for the development of individualized interventions.

Aims Brief interventions delivered by doctors and other healthcare practitioners might be meaningfully enhanced by understanding what individual experiences might lead patients to cut down. The aim of the current paper was to explore the experiences that might lead people to reduce their alcohol consumption and to compare these findings between respondents from 21 different countries. Methods Global Drug Survey is an online cross sectional, opportunistic anonymous survey. This paper includes 72,209 respondents from 21 counties with over 250 respondents (60.8% male). Results Almost a third (32.9%) of participants reported that they would like to drink less alcohol over the next 12 months, and a third thought their GP would tell them to cut down if they were honest about their drinking. The primary experiences that were rated as most likely to lead to a change in behaviour were related to physical health, sexual assault and having to seek emergency medical treatment. Respondents from Germany were more likely to select embarrassment as a motivation to reduce drinking than those from other counties. Females were more likely to report indicate motivations related to sexual regret, sexual assault or seeking treatment. Older participants and those in the low risk audit category were more likely to report embarrassment or forgetfulness as potential motivation for change. Conclusion Understanding the different motivations that may lead individuals to change their drinking behaviours can be used to inform targeted brief interventions and targeted public health guidance.

Aim To review the literature on psychosocial interventions for addiction affected family members in Low and Middle Income Countries (LMIC). Methods A systematic review with a detailed search strategy focussing on psychosocial interventions directed towards people affected by addiction without any gender, year or language specifications was conducted. Identified titles and abstracts were screened; where needed full papers retrieved, and then independently reviewed. Data was extracted based on the aims of the study, to describe the modalities, acceptability, feasibility and effectiveness of the interventions. Results Four papers met our selection criteria. They were published between 2003 and 2014; the total sample size was 137 participants, and two studies were from Mexico and one each from Vietnam and Malaysia. The predominantly female participants comprised of parents, spouses and siblings. The common components of all the interventions included providing information regarding addiction, teaching coping skills, and providing support. Though preliminary these small studies suggests a positive effect on affected family members (AFM). There was lowering of psychological and physical distress, along with a better understanding of addictive behaviour. The interventions led to better coping; with improvements in self-esteem and assertive behaviour. The interventions, mostly delivered in group settings, were largely acceptable. Conclusions The limited evidence does suggest positive benefits to AFMs. The scope of research needs to be extended to other addictions, and family members other than spouse and female relatives. Indigenous and locally adapted interventions are needed to address this issue keeping in mind the limited resources of LMIC. This is a field indeed in its infancy and this under recognised and under-served group needs urgent attention of researchers and policy makers.

Kimberly Young’s early work on Internet addiction (IA)has been pioneering and her early writings on the topic inspired many others to carry out research in the area. Young's (2015) recent paper on the 'evolution of Internet addiction' featured very little European research, and did not consider the main international evidence that has contributed to our current knowledge about the conceptualization, epidemiology, etiology, and course of Internet-related disorders. This short commentary paper elaborates on important literature omitted by Young that the present authors believe may be of use to researchers. We also address statements made in Young’s (2015) commentary that are incorrect (and therefore misleading) and not systematically substantiated by empirical evidence.

This paper describes two phases of formative research that were undertaken to develop a smoking cessation treatment module that has the goal of improving adherence with the nicotine patch in HIV-positive Latino smokers. Each research phase (Phase I and II) was conducted independent of the other and used different methods to inform the development of the intervention. Phase I interviewed n=14 smokers who had previous experience using the nicotine patch to gain detailed understanding of how, when, and why they used it; their perceived barriers to using it; and their perspective on ways to improve adherence to it. Phase II provided n=35 smokers with brief smoking cessation treatment and nicotine patches, then interviewed them in “near real time” over a two month period about their use of the patch during a quit attempt (e.g., perceived barriers and facilitators). Authors of the paper conducted a qualitative analysis of the themes emerging from the interview transcripts across these two phases. Results indicated that consistent use of the nicotine patch was associated with maintaining high motivation for use (i.e., not necessarily motivation to quit, but motivation to continue patch use); linking its use with established daily routines (e.g., with taking other medications, with brushing teeth); and maintaining realistic expectations for patch efficacy (e.g., that users may still experience some level of craving and/or withdrawal). This information will used to develop and pilot test a brief treatment module that focuses on improving nicotine patch adherence.

The use of medications to treat substance use disorders (SUDs) has emerged as a potentially central part of the treatment armamentarium. In this paper we present data from several recent US national surveys showing that despite the clinical promise of these medications, there has been limited adoption of pharmacotherapies in the treatment of SUDs. The data reveal variable patterns of use of disulfiram, buprenorphine, tablet naltrexone, acamprosate and injectable naltrexone. After examining the environmental and institutional context for the adoption of pharmacotherapies, the specific organizational facilitators and barriers of medication adoption are considered. The paper concludes with a discussion of the minimal clinical and administrative guidance available to enhance adoption, the lack of client and consumer knowledge of medications that puts a brake on their adoption and availability, and the difficulties that must be surmounted in bringing new medications to market.

Background Substance use disorders and non-substance addictive behaviors are major, growing health concerns. Efficient screening primary care settings encouraged but its widespread implementation is restricted without an appropriate screening approach for clinical practice or guidance for practitioners choose an appropriate screening test. This study aims to identify addictive disorder screening tests which are validated in primary care and suggest steps to help practitioners select the appropriate test. Method A systematic review of the literature through Pubmed, PsycINFO and The Cochrane Library was performed from database inception to December 21, 2020. The search strategy included three research topics: screening, addictive disorders, and primary care. Selection criteria included published studies evaluating the validity of an addictive disorder screening test in primary care settings. Results 8638 papers were selected, and 50 studies were included. Seventeen questionnaires validated in primary care covered the main substance use disorders, but none screened for non-substance addictive behaviors. Tests such as ASSIST, S2BI, SUBS and TAPS screen for a variety of substance use disorders while others such as TICS and CAGE-AID only have a few questions to improve feasibility. However, some shorter tests had weaker psychometric properties. Conclusions Seventeen addictive disorder screening tests validated in primary care are available. The feasibility and acceptability in primary care of the shorter tests needs to be assessed. A transversal screening test, adapted to the constraints of primary care, that enables clinicians to detect substance use disorders and non-substance addictive behaviors is needed.

Background Alcohol use in people who inject drugs (PWID) with hepatitis C virus (HCV) infection accelerates liver disease progression. This paper describes the prevalence and associated correlates of alcohol use among HCV antibody positive PWID. Methods In a large cohort of HCV antibody positive PWID (N = 1623) followed from 2005 to 2013, we characterized alcohol use using the AUDIT-C. We used multivariable logistic regression with generalized estimated equations to examine socio-demographic, clinical, and substance use correlates of alcohol use. Results At their initial visit, 41% reported no, 21% reported moderate, and 38% reported heavy alcohol use. The odds of moderate and heavy alcohol use increased with greater intensity of substance use represented by a composite summary variable which ranged from 0 to 3 substances (street-acquired prescription drugs, non-injection cocaine/heroin, and injection drugs) used. Compared to those who used no drugs, those who used 3 substances had 3.71 odds (95% CI: 3.07–4.48) of moderate alcohol use and 3.65 odds (95% CI: 3.20–4.16) of heavy alcohol use. Conclusions The prevalence of moderate/heavy alcohol use is high among HCV antibody positive PWID and occurs frequently in combination with other drug use. This may contribute to progressive liver fibrosis thus limiting the gains achieved from HCV cure. Public health interventions need to address the overlapping epidemics of HCV, alcohol use, and other substance use in this population.

This paper provides a tutorial companion for the methodological approach implemented in Huh et al. (2015) that overcame two major challenges for individual participant data (IPD) meta-analysis. Specifically, we show how to validly combine data from heterogeneous studies with varying numbers of treatment arms, and how to analyze highly-skewed count outcomes with many zeroes (e.g., alcohol and substance use outcomes) to estimate overall effect sizes. These issues have important implications for the feasibility, applicability, and interpretation of IPD meta-analysis but have received little attention thus far in the applied research literature. We present a Bayesian multilevel modeling approach for combining multi-arm trials (i.e., those with two or more treatment groups) in a distribution-appropriate IPD analysis. Illustrative data come from Project INTEGRATE, an IPD meta-analysis study of brief motivational interventions to reduce excessive alcohol use and related harm among college students. Our approach preserves the original random allocation within studies, combines within-study estimates across all studies, overcomes between-study heterogeneity in trial design (i.e., number of treatment arms) and/or study-level missing data, and derives two related treatment outcomes in a multivariate IPD meta-analysis. This methodological approach is a favorable alternative to collapsing or excluding intervention groups within multi-arm trials, making it possible to directly compare multiple treatment arms in a one-step IPD meta-analysis. To facilitate application of the method, we provide annotated computer code in R along with the example data used in this tutorial.

Introduction Prescription rates for antidepressants (ADs) are high and continue to increase, despite evidence of significant adverse effects, including withdrawal symptoms, and marginal benefit relative to placebo only for short-term treatment of major depression. Such high rates seem to be explicable more in terms of long term usage and repeat prescribing rather than by increases in depression or new patients. Method This paper reports the responses of a convenience sample of 752 people who had taken antidepressants, but no other psychiatric drugs, ‘within the last two years’ and completed the Medications for Mental Health Survey online in the UK. Results Most participants had either come off antidepressants (34%) or had tried and failed (36%). Of those still taking them 76% had been doing so for at least a year and 36% for five years or more. 26% expected to take them forever. About half (48%) did not have their drugs reviewed at least every three months. Most (65%) had never had a discussion with the prescriber about coming off. Nearly half (45%) of those who had stopped the drugs had done so without consulting their doctor. However, of those who came off after consulting their doctor, the majority (65%) experienced the doctor to be supportive. Conclusions The findings are consistent with the idea that high rates are largely explicable by chronic usage, which in turn is partially explained by withdrawal symptoms. Prescribers should strive to establish collaborative relationships in which patients are fully informed about withdrawal effects and their views, about starting and finishing medication, should be explored and valued.

A recent systematic review examining online gaming addiction among children and young adults was published in Addictive Behaviors (i.e., Rosendo-Rios, TrottShukla, 2022). However, dozens of papers were missing from the review. One of the reasons why so many studies were not in the review is likely to be because of the search terms used. None of the search terms included the words 'adolescent', 'adolescence', 'emerging adults', 'excessive gaming', 'gaming disorder', 'video game addiction' or 'problematic gaming'. Moreover, studies were also included in the review if the mean age of the total sample was 25 years or below. This meant that some studies in the review included some participants who were not children, adolescents or emerging adults. It also meant that many studies were not included that had mean ages below the age of 26 years because they were not picked up by the search strategy. Given the high number of studies that were not included in the review, readers should view this systematic review as 'suggestive' of research in the area of problematic gaming in youth rather than 'definitive'.

Introduction Opiate use disorder is a common condition in healthcare services in Ireland, where over 200 opiate overdose deaths occur annually. There is limited addiction medicine education at undergraduate level and medical graduates may not be adequately prepared to diagnose and manage opioid use disorders and emergency drug overdose presentations. Therefore, we examined final-year medical students' learning experiences and attitudes toward opioid use disorder, overdose and community naloxone provision as an emerging overdose treatment. Methods We administered an anonymous paper-based survey to 243 undergraduate medical students undertaking their final professional completion module prior to graduation from University College Dublin, Ireland. Results were compared with parallel surveys of General Practitioners (GPs) and GP trainees. Results A total of 197 (82.1%) completed the survey. Just under half were male, and most were aged under 25 (63.3%) and of Irish nationality (76.7%). The students felt moderately prepared to recognise opioid use disorder, but felt less prepared to manage other aspects of its care. Most had taken a history from a patient with an opioid use disorder (82.8%), and a third had witnessed at least one opioid overdose. Although 10.3% had seen naloxone administered, most had never administered naloxone themselves (98.5%). Half supported wider naloxone availability; this was lower than support rates among GPs (63.6%) and GP trainees (66.1%). Conclusions Our findings suggest an unmet learning need in undergraduate training on opioid use disorder, with potential consequences for patient care.

Addiction is a complex biopsychosocial phenomenon, impacted by biological predispositions, psychological processes, and the social environment. Using mathematical and computational models that allow for surrogative reasoning may be a promising avenue for gaining a deeper understanding of this complex behavior. This paper reviews and classifies a selection of formal models of addiction focusing on the intra- and inter-individual dynamics, i.e., (neuro) psychological models and social models. We find that these modeling approaches to addiction are too disjoint and argue that in order to unravel the complexities of biopsychosocial processes of addiction, models should integrate intra- and inter-individual factors.

UK society has a complex relationship with alcohol; it is ever-present within social activities, yet alcohol problems are heavily stigmatised. As such, the nuance of acceptability is a key focus for understanding societal perceptions and understandings of alcohol. This research explored how the boundary between acceptable and problematic alcohol use was negotiated in justifying drinking behaviors. The paper draws upon data from two World Cafés and five focus groups conducted in the UK with 76 participants including 25 males and 51 females aged 18 to 82. Data was analysed using discursive psychology with a focus on how participants disclosed and accounted for alcohol consumption. The analysis highlighted two key discursive patterns: 1) Speakers created an interactionally-specific boundary of acceptable alcohol use. 2) Speakers built upon this boundary, justifying and portraying their own drinking as socially acceptable. The boundary of acceptable alcohol use was locally constructed and shifted between speakers and contexts. This locally occasioned boundary demonstrates the challenge of objective guidance - such as the UK Chief Medical Officer's unit guidelines - in relation to individualistic behaviors. Implications are discussed for how alcohol policy, health campaigns, and alcohol practitioners may consider this orientation to justifying drinking behaviors to make alcohol reduction efforts more effective.

This study examines the relationship between personal networks and polysubstance use among people who use drugs (PWUD) in a medium sized city in the Midwest. A large body of work has demonstrated that personal relationships have an ambivalent association with substance use. On the one hand, a supportive network is associated with safer drug use practices and dramatically improves the outlook for recovery. However, individuals whose personal networks are composed of co-drug use partners are more likely to engage in risky practices. We argue that this notion of “supportive” social contacts and “risky” social contacts is ultimately incomplete: risky behaviors are introduced and further developed in a social context, often with the people who provide emotional support. We argue that personal networks with more multiplex relationships (where co-drug use and confiding fuse) are harmful because they combine norms of trust and reciprocity with drug use. We use data from the Rural Health Cohort (RHC) study to test this idea. The sample consists of 120 adult PWUD in a medium sized city located in southeastern Nebraska who were recruited using respondent-driven sampling. Participants listed up to nine confidants and nine co-drug use partners, indicating any overlap between the two networks. Our results demonstrate that multiplex ties are as strongly associated with polysubstance use as simple co-drug use relationships. As the drug crisis has increasingly shifted to underserved populations outside large urban centers, this paper represents an important advance in our understanding of the current drug crisis.

Ambulatory assessment of smoking behavior has greatly advanced our knowledge of the smoking cessation process. The current article first provides a brief overview of ecological momentary assessment for smoking cessation and highlights some of the primary advantages and scientific advancements made from this data collection method. Next, a discussion of how certain data collection tools (i.e., smoking topography and carbon monoxide detection) that have been traditionally used in lab-based settings are now being used to collect data in the real world. The second half of the paper focuses on the use of wearable wireless sensors to collect data during the smoking cessation process. Details regarding how these sensor-based technologies work, their application to newer tobacco products, and their potential to be used as intervention tools are discussed. Specific focus is placed on the opportunity to utilize novel intervention approaches, such as Just-In-Time Adaptive Interventions, to intervene upon smoking behavior. Finally, a discussion of some of the current challenges and limitations related to using sensor-based tools for smoking cessation are presented, along with suggestions for future research in this area.

Research indicates that the evidential bases for many harm reduction policies targeting hazardous consumptions (including tobacco, alcohol and gambling) have been distorted by commercial industries that derive revenue from such commodities. These distortions are best illustrated by research on tobacco and alcohol, which indicates similar tactics used by industries to determine favourable policy environments through engineering of evidence, among other approaches. Although there is concern that gambling research is similarly vulnerable to commercial interests, the relevant literature lags far behind other fields and the aim of this paper is to increase familiarity with tactics used by industries for influencing research. It summarises the conceptual and empirical bases for expecting conflicts between goals of public health and companies that profit from hazardous consumptions. It also summarises evidence describing practices deployed by tobacco corporations, which include third-party techniques and the selective funding of research to manufacture doubt and deflect attention away from the consequences of smoking. It then reviews both early and emerging evidence indicating similar strategies used by alcohol industry, and uses this literature to view practices of the gambling industry. It argues that parallels regarding selective funding of research and third-party techniques provide grounds for strong concern about commercial influences on gambling research, and implementation of precautionary approaches to management of vested interests.

Mobile apps provide a highly accessible way of reducing alcohol use in young people. This paper determines the 1-month efficacy and 2, 3 and 6 month outcomes of the Ray's Night Out app, which aims to increase alcohol knowledge and reduce alcohol use in young people. User-experience design and agile development processes, informed by the Information-Motivation-Behavioral skills model and evidence-based motivational interviewing treatment approaches guided app development. A randomized controlled trial comparing immediate versus 1-month delayed access to the app was conducted in 197 young people (16 to 25 years) who drank alcohol in the previous month. Participants were assessed at baseline, 1, 2, 3 and 6 months. Alcohol knowledge, alcohol use and related harms and the severity of problematic drinking were assessed. App quality was evaluated after 1-month of app use. Participants in the immediate access group achieved a significantly greater increase in alcohol knowledge than the delayed access group at 1-month, but no differences in alcohol use or related problems were found. Both groups achieved significant reductions in the typical number of drinks on a drinking occasion over time. A reduction in maximum drinks consumed was also found at 1 month. These reductions were most likely to occur in males and problem drinkers. Reductions in alcohol-related harm were also found. The app received a high mean quality (M = 3.82/5, SD = 0.51). The Ray app provides a youth-friendly and easily-accessible way of increasing young people's alcohol knowledge but further testing is required to determine its impact on alcohol use and related problems.

Despite evidence for the efficacy of buprenorphine treatment in primary care, few studies have identified factors associated with treatment success, nor have such factors been evaluated in community settings. Identifying correlates of treatment success can facilitate the development of treatment models tailored for distinct populations, including low-income communities of color. The current study examined client-level socio-demographic factors associated with treatment success in community-based buprenorphine programs serving vulnerable populations.Data were abstracted from client records for participants (N=445) who met DSM-IV criteria for opioid dependence and sought treatment at one of Behavioral Health Leadership Institute's two community-based recovery programs in Baltimore City from 2010 to 2015. Logistic regression estimated the odds ratios of treatment success (defined as retention in treatment for ≥90days) by sociodemographic predictors including age, race, gender, housing, legal issues and incarceration.The odds of being retained in treatment ≥90days increased with age (5% increase with each year of age; p0.001), adjusting for other sociodemographic factors. Clients who reported unstable housing had a 41% decreased odds of remaining in treatment for 90 or more days compared to clients who lived independently at intake. Treatment success did not significantly differ by several other client-level characteristics including gender, race, employment, legal issues and incarceration.In vulnerable populations, the age factor appears sufficiently significant to justify creating models formulated for younger populations. The data also support attention to housing needs for people in treatment. Findings from this paper can inform future research and program development.

The purpose of the present paper was to examine the extent to which college students underestimate the quantity of alcohol they will consume during Spring Break (SB), and whether individual, interpersonal, and contextual factors may be related to underestimation of SB drinking and drinking consequences. College students participated in web-based surveys prior to and after SB (N = 603; 57% women). Overall, results indicated that individual factors (being male, being a member of a fraternity or sorority, previously experiencing more alcohol-related consequences, and intending to drink less during SB), interpersonal factors (reporting friends encourage getting drunk), and contextual factors (going on a SB trip with friends and receiving drinks from others) predicted underestimating peak drinks consumed during SB. Underestimating the peak number of drinks to be consumed on SB was associated with experiencing a greater number of alcohol-related consequences. Targeted interventions designed specifically to focus on underestimation of college student drinking and the impact of SB contextual and interpersonal factors may be an important area of study to reduce negative consequences of alcohol use during SB.

The present paper describes the general knowledge of smoking and nicotine among a sample of current smokers living with HIV ( n = 271) who were recruited via Amazon Mechanical Turk. Descriptive statistics were used to report sociodemographic and smoking characteristics, as well as knowledge about smoking and nicotine. The sample was comprised of relatively light smokers, both in terms of cigarettes per day ( M = 8.1, SD = 9.7) and dependence (67.5% had low dependence according to the Heaviness of Smoking Index). The majority of participants correctly identified smoking as being a potential cause of various smoking-related conditions and correctly identified constituents in cigarette smoke. However, a majority of participants also misattributed nicotine as being a potential cause of smoking-related illness. Accurate knowledge about nicotine was low. These misperceptions are of particular concern for vulnerable populations, such as persons living with HIV, who are disproportionately burdened by the prevalence of smoking and associated morbidities and mortality. These misperceptions could have unintended consequences in the wake of a potential nicotine reduction policy, such that reduced nicotine content products are perceived as safer than normal nicotine content products currently available for sale. Additionally, incorrect knowledge about nicotine has implications for the uptake and continued use of nicotine replacement therapy.

Introduction How adolescents think about their future (i.e., future orientation) impacts their risk-taking behavior. The purpose of the present analysis was to explore whether future orientation (future planning, perceived risk to future goals, and positive future expectations) was associated with nonmedical use of stimulants and analgesics in a sample of high school students. Methods Information on future orientation and nonmedical use of prescription drugs (NMUPD) were collected using a paper-and-pencil survey from a sample of 9th–12th grade students in a Midwestern school. Results Higher perceived risk to future goals and positive future expectations were associated with a lower likelihood of self-reported nonmedical use of stimulants (n = 250; OR = 0.46, 95% CI: 0.26, 0.83; OR = 0.15, 95% CI: 0.05, 0.47, respectively). Only higher perceived risk to future goals was associated with a lower likelihood of self-reported nonmedical use of analgesics (n = 250; OR = 0.40, 95% CI: 0.24, 0.68). In a follow-up analysis limited to students who endorsed alcohol or marijuana use, perceived risk to future goals remained associated with a lower likelihood of nonmedical use of stimulants and analgesics. Conclusions Results suggest that risk perception might be a salient protective factor against both nonmedical use of stimulants and analgesics. Overall, the differential impact of conceptualizations of future orientation might depend on the class of prescription drug used, demonstrating a need to consider prescription drugs individually in the development of future studies and interventions.

A number of typical consequences for alcohol and other substances have been well documented. However, a specific category of consequences which has received no attention in the existing literature includes acts (other than sexual assault) committed upon incapacitated individuals. We have termed this behavior body vandalism (BV), defined as the direct manipulation of an incapacitated individual through the addition of markings, objects or substances, removal of property or hair, or relocation of a body. The purpose of this paper is to provide a preliminary examination of rates of experiencing and variations in positive and negative perceptions of this behavior from the victim's perspective. A pilot study was conducted aimed at examining the rates and demographic characteristics of body vandalism in a national sample of 981 adults. The majority of individuals had witnessed BV, half had perpetrated, and over 40% had been a victim in their lifetime. Rates of lifetime victimization and perpetration were low (1-2 times). Perpetrators most often targeted their friends and alcohol was typically a factor in victimization. Over half of victims reported experiencing positive social outcomes as a result of being victimized and about a third reported negative emotional outcomes. Findings suggest that experiences of body vandalism are relatively common, especially in young adults, associated with alcohol consumption, and result in both positive and negative outcomes for victims. This study offers evidence for BV as an outcome of social drinking, suggests contexts that increase the risk of BV occurrence, and provides a foundation from which future studies can build.

Previous research has reported on the benefits of mutual support groups. However, such groups do not routinely collect data on participant outcomes. Moreover, the effect of collecting outcomes measures on these groups is unknown. The objective of this mixed methods study was to elicit participant views on using a novel, purpose built digital platform for routine outcome monitoring (ROM) as a standard component of a mutual support group. SMART Recovery, or the Self-Management and Recovery Training program, is group-based and uses professional clinicians to facilitate discussion and foster mutual support for a range of addictive behaviours, alongside Cognitive Behavioural Therapy and Motivational Interviewing techniques. This paper reports on the qualitative component of this study and how participants perceive ROMs, and the potential shift to technological resources. Twenty semi-structured telephone interviews were conducted with participants from SMART Recovery groups across New South Wales, Australia. Participants discussed their use of mutual support within group meetings to manage their recovery, including: naming their goals in front of peers; learning from clinicians and group discussion; and developing reciprocal and caring relationships. They also described any previous experience with routine outcomes measures and how digital technologies might enhance or hinder group function. Participants valued mutual support groups and reported that digital technologies could be complementary to physical, weekly group meetings. They were also concerned that the introduction of technological resources might pose a threat to physical meetings, thereby risking their access to mutual support. Findings have implications for the implementation of ROM when delivered via digital mechanisms, and indicate threats and opportunities that warrant consideration for future initiatives.

Aims Drinking alcohol in outdoor public places (e.g. streets and parks) and outside of formally organised events is perceived and reported as antisocial behaviour and may be indicative of a problematic relationship with alcohol, and other clinical needs. This paper aims to address a lack of qualitative research on street drinking in the United Kingdom and develop a textured understanding of the lived-experience of how some women engage in street drinking, in the context of one London borough. Method The authors collected semi-structured interviews as part of a larger mixed methods study on street drinking from April to August 2018. A sub-set of interviews ( n = 3) with women who were accessing local drug and alcohol services and had a history of street drinking behaviour were selected as a case series for triangulating analysis with a smaller, homogenous sample. These data were analysed using Interpretative Phenomenological Analysis with a reflexive, feminist, social constructionist approach. Results The authors developed and named a superordinate theme, Constellations of Safety and Hazards for Women Drinking in Public and Private. Within this, four themes were defined and illustrated from the data: Drinking outdoors to be away from hazards at home; Women's awareness of geo-temporal factors to moderate risk; Women identifying risks of accepting drinks from strangers; and Threats of untreated trauma within histories of heavy drinking. Definitions and illustrations from participants aid explanations of how the texts add detail or disruption to dominant discourses. Conclusion The case studies illustrating how these women have experienced alcohol misuse and behaviour change provide reflexive accounts of exercising agency in managing embodied and affective states of vulnerability. This was demonstrated by asserting choice around environmental spaces and friendships, even when still in positions deemed as ‘risky’. These three women's decisions around drinking in public, outdoor spaces were shaped by complex interactions of interpersonal, intrapersonal, socio-economic, and cultural structures. Understanding behaviours is improved with data that situates people in contexts where they experience and make sense of their lives.

Valid and reliable measures of craving are essential for both clinical practice and research. Brief measures are particularly valuable for clinical and research settings in which assessment burden needs to be minimized. The Craving Scale is a 3-item measure of craving that has been previously validated in cocaine-dependent samples. This brief measure has also demonstrated predictive validity in both alcohol and opioid use disorder; however, its psychometric properties in these disorders are not well characterized. The aim of this paper was to extend prior psychometric analyses of the Craving Scale to a large sample of adults seeking treatment for substance use disorders (N = 1,283). Analyses of readability indicated that the Craving Scale was written between a 7-8th grade reading level and had minimal grammatical complexity. The Craving Scale demonstrated strong internal consistency reliability (omega = 0.81), a single-factor latent structure, and adequate concurrent and discriminant validity. Importantly, results were similar when analyses were run separately for alcohol and opioid craving and in men and women, supporting measure invariance across these key groups. Our results provide further support for the reliability and validity of the Craving Scale for use in people with substance use disorders.

Objectives In 2016, the US Surgeon General issued a Call to Action to address adolescent e-cigarette use and school-based prevention interventions are an effective component of comprehensive tobacco control. This study describes the development and dissemination of CATCH My Breath, an e-cigarette prevention program for middle and high school students. Methods Starting in 2014, a university and nonprofit collaboration designed, formatively evaluated, pilot tested, and disseminated the CATCH My Breath Program (CMB). The team used Social Cognitive Theory to develop the program and Diffusion of Innovations Theory to disseminate the program. Dissemination strategies were applied beginning in 2016. This paper describes the application of both theories and the resulting reach of CMB. Results Since dissemination began, CMB has been rapidly adopted, following the typical diffusion normal curve. As of June 2020, approximately 4,000 schools in the United States have adopted the program, 70,000 teachers have taught the program, and 1,400,000 students have been exposed to program materials. Conclusion The application of Social Cognitive Theory and Diffusion of Innovation Theory resulted in effective prevention results and rapid, widespread adoption of the CMB. This level of adoption and implementation represents 25% of the school marketplace. CMB should be considered as the school component of the recommended combustible and e-cigarette prevention and control toolkit, alongside mass media, marketing restrictions, retail access, taxation, flavor ban, and FDA premarket approval. Other public health interventions seeking rapid adoption should consider applying principles of Diffusion of Innovation as a guide for development and dissemination.

IntroductionYouth e-cigarette use has been rising, however U.S. prevalence data are generally reported without disaggregating by individuals’ use of other tobacco products. It is not clear how the proportion of youth e-cigarette users naïve to all combustible tobacco is changing.MethodsAnnual prevalence estimates of ever and current (defined as past 30-day use) tobacco use prevalence by school type are reported using the 2014-2019 National Youth Tobacco Surveys (NYTS) with mutually exclusive categories of e-cigarette, smokeless tobacco, and/or combustible tobacco product use. T-tests were used to compare annual estimates with the preceding year. The annual percent change (APC) for each category from 2014-2018 were analyzed using JoinPoint regression. Data for 2019 were reported separately due to the change in survey format from paper to electronic.ResultsCurrent use of only e-cigarettes among HS students who never used combustible tobacco increased significantly from 2014-2018 (APC = +42.4%, 95% CI: 0.7, 101.3); by 2019, prevalence peaked at 9.2% (95% CI: 8.2, 10.2) among never combustible users and 8.3% (95% CI: 7.3, 9.3) among former combustible users. This coincided with significant declines in use of only combustible tobacco (APC=-14.5%, 95% CI: −18.3, −10.5).ConclusionsUse of only e-cigarettes among US youth with no history of combustible tobacco use has increased substantially over time, even as combustible tobacco use continues to plummet. Of the 17.5% (95% CI: 15.7, 19.0) of HS students who currently used only e-cigarettes (but not other tobacco) in 2019, more than half have no history of combustible tobacco use.

Research on alcohol use depends heavily on the validity of self-reported drinking. The present paper presents data from 647 days of self-monitoring with a transdermal alcohol sensor by 60 young adults. We utilized a biochemical measure, transdermal alcohol assessment with the WrisTAS, to examine the convergent validity of three approaches to collecting daily self-report drinking data: experience sampling, daily morning reports of the previous night, and 1-week timeline follow-back (TLFB) assessments. We tested associations between three pharmacokinetic indices (peak concentration, area under the curve (AUC), and time to reach peak concentration) derived from the transdermal alcohol signal and within- and between- person variation in alcohol dependence symptoms. The WrisTAS data corroborated 85.74% of self-reported drinking days based on the experience sampling data. The TLFB assessment and combined experience sampling and morning reports agreed on 87.27% of drinking days. Drinks per drinking day did not vary as a function of wearing or not wearing the sensor; this indicates that participants provided consistent reports of their drinking regardless of biochemical verification. In respect to self-reported alcohol dependence symptoms, the AUC of the WrisTAS alcohol signal was associated with dependence symptoms at both the within- and between- person level. Furthermore, alcohol dependence symptoms at baseline predicted drinking episodes characterized in biochemical data by both higher peak alcohol concentration and faster time to reach peak concentration. The results support the validity of self-report alcohol data, provide empirical data useful for optimal design of daily process sampling, and provide an initial demonstration of the use of transdermal alcohol assessment to characterize drinking dynamics associated with risk for alcohol dependence.

Background\ud \ud Peer support is widely acknowledged to be an important factor in recovery from problem drinking. Many seek this from support groups, including those online. Whilst Alcoholics Anonymous (AA) and other 12-step groups have provided help to many people, some individuals do not find them useful. This paper aims to contribute to the current limited knowledge on non-12-step groups, i.e., those that do not follow the approach of AA.\ud \ud Methods\ud \ud Twenty-five semi-structured interviews were carried out with users of five non-12-step alcohol online support groups (AOSGs) which differed in approach to recovery from problem drinking, size and location. The study was publicised via the groups, and interviewees self-selected. Data were analysed using thematic and template analysis.\ud \ud Results\ud \ud The most important benefit of the groups, according to most interviewees was finding ‘someone like me’: something that many did not feel they could do elsewhere, including in AA. Another key perceived difference from 12-step groups was that their groups provided support without requiring them to follow a set programme for recovery. The groups respected individuals' rights to choose their own goal for sobriety (e.g., abstinence, moderate drinking) and to choose how they achieved it. Other key benefits included seeing that recovery is possible and sharing experiential information. Some disadvantages of using the forums are also discussed.\ud \ud Conclusion\ud \ud The findings report the experiences and perceptions of twenty-five users of non-12-step AOSGs. These are groups that have received little research attention so the findings offer a rare insight into users' opinions on these sources of peer support.

Introduction Elaborated Intrusion (EI) Theory holds that both functional and dysfunctional motivational cognitions are characterized by their intensity, cognitive availability and involvement of imagery, and can be assessed in terms of their frequency and cross-sectional nature. Recently published data on the Motivational Thought Frequency (MTF-A) and State Motivation (SM-A) scales for alcohol control, which were based on EI theory, have shown acceptable fit for a three-subscale structure (Intensity, Imagery, Availability). However, subsequent analyses on the MTF's adaptation to diabetic regimen adherence suggested superior fit from a four-factor model, splitting Imagery into Incentives and Self-Efficacy Imagery. The current paper reanalyzed data on the MTF-A and SM-A, including an additional item on each and using a more robust statistical approach. Methods Participants (n = 504) reporting recent high-risk drinking or were currently trying to control alcohol consumption volunteered to complete an online survey that included the MTF-A, SM-A, Alcohol Use Disorders Identification Test and Readiness to Change Questionnaire. Confirmatory factor analyses employed robust maximum likelihood (MLR) with Yuan-Bentler χ2 adjustment, and presented internal consistencies using omega. Results After omission of multivariate outliers, SM-A data were available from 399 participants, and MTF-A data from 351. Better fit was found for the four-factor model on both measures, and high internal consistencies were obtained for all subscales. Incentives Imagery and Self-Efficacy Imagery were both associated with greater alcohol problems and readiness to change. Conclusions The four-factor structures are statistically superior and more theoretically coherent, and allow a focused assessment of key targets of motivational interventions.

Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost.To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques.Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%.Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size.Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community.

Introduction Attentional biases for alcohol related information (AB) have often been reported for heavy drinkers. These attentional biases have been found to have predictive value regarding relapse in abstaining alcoholics. Similarly impaired inhibitory processes have also been found to be associated with heavy drinkers. This paper describes a new experimental paradigm that can be utilised to investigate attentional bias towards alcohol-related visual stimuli, specifically the ability to inhibit the orientation of initial and sustained attention, towards peripherally appearing stimuli. In this way we hope to study a novel aspect of attentional biases and how they relate to substance abuse. Methods We used a novel eye-tracking task which aims to measure inhibitory processes for AB. The experiment utilised a gaze contingency paradigm to measure the compulsion to process or attend to alcohol stimuli. 86 undergraduate participants were recruited (31 males; 55 females), aged 18–49 years (m = 20.88; sd = 4.52). A ‘break frequency’ variable was computed for each participant. This was the number of times that participants tried to look at peripheral stimuli. We argue that this variable is a direct measure of how distracting peripheral stimuli were. Results It was found that reported alcohol use was associated with the eye-tracking break frequency measure of inhibitory control. Thus, heavy drinking may be associated with decreased inhibitory control and increased attentional bias. Conclusions Results suggest that attentional bias is not just a process of stimuli becoming prioritised, but also stimuli becoming compulsory to attend and process.

Research consistently shows that individuals high in impulsivity are at increased risk for excessive alcohol use and alcohol-related problems including alcohol use disorders (AUDs). Recent theorizing posits that working memory (WM) ability might moderate this association, but extant studies have suffered from methodological shortcomings, particularly mischaracterizing WM as a single, unitary construct and using only cross-sectional designs. This paper reports two studies that attempted to replicate and extend previous investigations of the relationship between WM, impulsivity, and alcohol involvement using two independent samples. Study 1 used a large ( N = 489 at baseline), prospective cohort of college students at high and low risk for AUD to investigate interactions between WM capacity and impulsivity on cross-sectional and prospective alcohol involvement. Study 2 used a large ( N = 420), cross-sectional sample of participants in an alcohol challenge study to investigate similar interactions between WM updating and impulsivity on recent alcohol involvement. Whereas Study 1 found that WM capacity moderates the relationship between some measures of impulsivity and alcohol involvement, with effects prospectively predicting alcohol involvement for up to three years, Study 2 did not find similar moderation effects when using measures of WM updating. These findings highlight the multifaceted nature of WM, which is often overlooked in the alcohol and impulsivity literature.

This paper investigated how depressive symptoms moderate the role of peer cannabis use on developmental patterns of individual cannabis use from adolescence to young adulthood, controlling for a broad set of individual and family factors. Data from two sources were analyzed separately: two saturated schools in the National Longitudinal Study of Adolescent to Adult Health Waves I–III (N = 1550) covering 1994–2001; and three schools in the CARBIN study, covering 2012–2014. Discrete mixture models identified developmental trajectories of cannabis use in each data source, and logit models linked network and depressive symptom information to the trajectories. Five similar cannabis use trajectories were identified in both datasets: Nonuse, Low, Moderate, Increasing, and High. Peer cannabis use at baseline predicted higher individual cannabis use trajectories, controlling for a wide range of factors. However, the association between peer cannabis use and higher levels of use (Moderate and High) attenuated as the adolescent's level of depressive symptoms increased. Although these results may suggest that depression dampers adolescents' susceptibility to peer influence, these results are also consistent with the notion that depressed adolescents withdraw from their peer groups, distancing them from the initial source of peer influence over time. The resulting isolation may place adolescents at higher risk of adverse outcomes.

Internet gaming disorder (IGD), defined as “Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress,” is a condition for further study in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5 (1), and research publications in gaming and internet addiction have increased rapidly in the last decade (2,3). Its precise definition continues to generate considerable controversy (4–7) and a multitude of measuring tools (8–13). Significant overlap in the neurobiology underlying both behavioral addictions and substance use disorders have been found in animal models and human brain imaging studies (14–16), starting with Gambling Disorder, which entered the DSM-III in 1980, and, as starting points for studying this phenomenon, the criteria for diagnosing IGD have been derived from different facets of Gambling Disorder, Substance Use Disorder, Impulse Control Disorders, and the developing field of Internet Addiction (17–20). Given rapid expansion of internet use and gaming technology over the past 20 years, a review of available prevalence measurements could potentially allow for detection of an epidemiological trajectory for this disorder. Prior to IGD being listed as a Condition for Further Study in the DSM-5, the terminology for the phenomenon of excessive online gaming was not standardized, with nomenclature varying from problematic online gaming, pathological gaming, gaming addiction, excessive gaming, gaming use disorder, videogame addiction, videogame dependency to conflations with internet addiction, internet use disorder, pathological internet use, problematic internet use, technology use disorder, pathological technology use, to compulsive internet use (10,21–30). In this paper, we take an agnostic approach to the specific criteria being used to measure this phenomenon, and are interested in whether the reported prevalence of this disorder has changed with time, given the rapidly expanding access to internet games, and the exponential growth of publications in the area of psychopathology related to technology (31–34). To this end, we have undertaken a targeted review of the literature regarding the prevalence of Internet Gaming Disorder in any population, organized in a linear manner spanning the emergence of the earliest publications regarding gaming addiction in the 1990s, through the end of 2016.

Web-based behavioral interventions for substance use are being developed at a rapid pace, yet there is a dearth of information regarding the most effective methods for recruiting participants into web-based intervention trials. In this paper, we describe our successful recruitment of participants into a pilot trial of web-based Acceptance and Commitment Therapy (ACT) for smoking cessation and compare traditional and web-based methods of recruitment in terms of their effects on baseline participant characteristics, association with study retention and treatment outcome, yield, and cost-effectiveness. Over a 10-week period starting June 15, 2010, we recruited 222 smokers for a web-based smoking cessation study using a variety of recruitment methods. The largest portion of randomized participants were recruited through Google AdWords (36%), followed by medical Internet media (23%), standard media (14%), word of mouth (12%), broadcast emails (11%), and social media (6%). Recruitment source was not related to baseline participant characteristics, 3-month data retention, or 30-day point prevalence smoking abstinence at the 3-month outcome assessment. Cost per randomized participant ranged from $5.27/participant for word of mouth to $172.76/participant for social media, with a mean cost of $42.48/participant. Our diversified approach to recruitment, including both traditional and web-based methods, enabled timely enrollment of participants into the study. Because there was no evidence of a substantive difference in baseline characteristics, retention, or outcomes based on recruitment channel, the yield and cost-effectiveness of recruitment methods may be the more critical considerations in developing a feasible recruitment plan for a web-based smoking cessation intervention study.

A review of the literature was conducted to examine substance use screening instruments commonly used with adolescents in medical settings, their comparative usefulness, and SBIRT (Screening, Brief Intervention, and Referral to Treatment).We screened two databases (Ovid MEDLINE and PsycINFO) targeting journal articles dealing with screening for alcohol and drug use in adolescence as well as adolescent SBIRT.Adolescents preferred paper forms and computerized questionnaires over interviews with physicians or nurses. The CRAFFT was the best studied instrument for screening for alcohol/drug use and related problems, and is the only tool with data to support its use in medical settings. Other screening instruments require more testing/evaluation in more representative samples of adolescents in primary care settings. Long term follow-up data to establish the efficacy of SBIRT in adolescence are not available. Innovative computerized approaches to screening for substance use in this population have recently been proposed. Although promising, they require further evaluation.The CRAFFT has the most consistent data to support its use in primary care settings. The effects of SBIRT in adolescence have not been adequately evaluated. Adolescents' opinions and preferences for SBIRT should be studied to improve their acceptance.

Objective This paper explores the association between work intensity, alcohol and/or other drug (AOD) use, and related risk factors and consequences among an at-risk youth sample that has received a first-time AOD offense. This study extends previous research focused primarily on school-based samples. Method We examined the association between work intensity, AOD use, AOD-related consequences, and social environment among adolescents referred to a diversion program called Teen Court (N = 193). Participants were surveyed prior to the start of the Teen Court program. Mean age was 17 (SD = 1.1), 67% of the sample was male; 45% Hispanic or Latino/a; 45.1% White; 10% Other. Results Greater work intensity among these youth was related to greater alcohol-related negative consequences and greater contact with co-workers who engaged in risky behaviors, but it was not significantly associated with past month AOD use. Conclusions Understanding the relationship between work intensity and AOD use among youth who are at-risk is critical to informing clinicians and public officials about the potential effects of employment in this population. Findings suggest that work intensity may be associated with negative consequences from alcohol use and increased contact with risky co-workers, all of which could contribute to the development of problems in the future.

Acculturation to U.S. society has been associated with an increase in drinking and binge drinking among Hispanics. This paper examines the association between acculturation and three drinking-related outcomes: average number of drinks consumed, binge drinking, and drinking 12 drinks or more in a single day in four major Hispanic national groups. The 2006 Hispanic Americans Baseline Alcohol Survey used a multistage cluster sample design to interview 5224 adult Hispanics (18+ years) in five selected U.S. metropolitan areas: Miami, New York, Philadelphia, Houston, and Los Angeles. The four national groups interviewed were: Puerto Ricans, Cuban Americans, Mexican Americans, and South/Central Americans. The survey response rate was 76%. Data on drinking behavior were collected and the analyses include bivariate and multivariate regression techniques. Multivariate analysis did not show an association between acculturation and volume of drinking, binge drinking, or drinking 12 or more drinks in a single day among men. Acculturation stress, however, was associated with drinking 12 or more in a day among men. Among women, high acculturation was associated with a higher volume of drinking, and it also interacted with national group to increase the likelihood of binge drinking. Acculturation does not have a homogeneous effect on drinking across gender and Hispanic national groups. The results confirm that acculturation has a more consistent association with increased drinking and binge drinking among women than among men. The effect of acculturation is therefore gender-specific. This heterogeneity across Hispanic national groups must be considered in future research, treatment, and prevention efforts.

This paper examines alcohol-related social problems among Mexican Americans living along the U.S.–Mexico border and in non-border areas. Interviews were conducted among Mexican Americans in the border regions of California, Arizona, New Mexico, and Texas (N = 1307). Non-border respondents were interviewed primarily in Houston and Los Angeles (N = 1288) as part of the Hispanic Americans Baseline Alcohol Survey (HABLAS). Both the border and HABLAS surveys employed multistage cluster sample designs (response rates were 67% and 76%, respectively). In the bivariate analysis, there were no significant differences between border and non-border areas in the proportion of those with one or more social problem. In non-border areas, the prevalence of alcohol problems did not differ significantly by age. However, along the border the prevalence of alcohol problems was significantly different across age groups, with 18 to 29 year old men and women having the highest prevalence. The final models showed no residence effect on problem likelihood. Drinking was strongly associated with problems. Although young border residents had higher problem prevalence rates than older residents, the logistic regression models showed no effect of border residence on the likelihood of problems, indicating that problems are due to alcohol consumption, not the border environment. The border, however, did appear to influence more drinking among young people. Regardless of residence, alcohol treatment and preventive interventions tailored to Mexican Americans are essential and special attention should be focused on younger individuals near the border.

Background: Comorbidity of mental disorders and substance use continues to be a major problem. To inform the development of more effective interventions for these co-existing disorders, this paper aimed to determine if there are clear variations in the reasons for tobacco, alcohol or cannabis use across people with different mental disorders. Methods: Data from five randomized controlled trials on co-existing disorders that measured reasons for tobacco, alcohol or cannabis use using the Drug Use Motives Questionnaire, Reasons for Smoking Questionnaire or via free response are reported and combined. Two studies involved participants with depression, two involved participants with a psychotic disorder and one involved participants with a range of mental disorders. A series of logistic regressions were conducted to examine differences in reasons for tobacco, alcohol or cannabis use and to compare these reasons between people with psychotic disorders or depression. Results: Participants had a mean age of 38 (SD=12) and just over half (60%) were male. Forty-six percent of participants had a psychotic disorder and 54% experienced depression. Data from 976 participants across the five studies were included in the analyses. Tobacco and alcohol were primarily used to cope, while cannabis was primarily used for pleasure. People with psychotic disorders were more likely than people with depression to use tobacco for coping, pleasure and illness motives. People with depression, in contrast, were more likely to use alcohol for these reasons and social reasons. Conclusions: It may be important to tailor interventions for co-existing mental disorders and substance use by substance type and type of mental disorder. For example, interventions might be improved by including alternative coping strategies to tobacco and/or alcohol use, by addressing the social role of alcohol and by helping people with mental disorders using cannabis to gain pleasure from their lives in other ways.

This paper examines the health status and functioning of an aging cohort of individuals with a history of heroin dependence with a focus on gender differences.Study subjects were originally sampled from methadone maintenance clinics in California in the 1970s and completed follow-up interviews in 2005-09. Out of the original study sample (N=914), 343 participants (44.3% female) were interviewed (70.6% of those not deceased). Bivariate analyses examined gender differences in participants' overall health status and physical and mental health problems. Scores on SF-36 scales were compared with general population norms by gender and age, as well as between participants in the study sample who did and did not report past-year drug use.Average age of the study sample was 58.3 (SD=4.9) years for males and 55.0 (SD=4.1) years for females. There were no significant gender differences in past-year drug use (38% of sample) or injection drug use (19%). Women reported significantly more chronic health problems and psychological distress compared with men, and overall poorer health and functioning compared with general population norms. Men under 65 had poorer physical health and social functioning compared with population norms. Men in the study sample reporting past-year substance use had poorer physical functioning, but less bodily pain, than non-users, whereas women with past-year substance use had poorer mental health than other women.Individuals with a history of heroin dependence have poorer health and functioning than their counterparts in the general population. At a younger age, women reported poorer overall health status and more chronic health and mental health problems than men. Study findings may inform interventions for this population, particularly related to gender-specific treatment needs.

The concern that addiction treatment be grounded in science has been recognized and enthusiastically endorsed in both the clinical and research communities. With recognition of the gap between knowledge development and application, there has been a recent emphasis on developing strategies for more effective application, i.e., for the incorporation of evidence-based practice in routine clinical programming. This has translated to a need to develop strategies designed to achieve organizational change and a field of study whose objective is to better understand how to expedite change in treatment organizations and their clinical practices. This paper focuses on the roles and responsibilities of researchers, practitioners, and the federal government in achieving changed practice and applying new knowledge to improve treatment. Even though great strides have been made to shift the emphasis from dissemination of knowledge to its application, much still remains to be done in the development and testing of additional application strategies specific to the substance abuse treatment field. Future considerations for implementation research are discussed.

This review reports on the results of a comprehensive literature search of studies examining the physical and mental health characteristics of older adults in the United States who use heroin. Multiple databases were searched for papers meeting the inclusion criteria of heroin users who were age 50 years or older. A total of 14 articles covering 9 different studies met the review inclusion criteria. All of the studies were convenience samples, and seven of the nine studies (77.8%) were entirely drawn from substance abuse treatment programs, primarily methadone maintenance programs. Findings from the qualitative studies suggest that the marginalization of older heroin users was a predominant experience that impacted the intent to seek treatment as well as treatment retention. While articles reported high levels of physical and psychological/psychiatric comorbidities with substance misuse, research on heroin use and methadone treatment among older adults is scant and the quantitative findings are inconsistent. The articles reviewed in this study demonstrate that the needs of this population will be significant, yet the development of appropriate interventions and treatment for older adult heroin users will be contingent on empirical research that adequately describes mental and physical health problems.