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This study aimed to evaluate the clinical efficacy and safety of administering intermittent theta burst stimulation (iTBS) to the medial prefrontal cortex for tobacco use disorder. A randomized sham-controlled trial was conducted, with 38 participants receiving 28 sessions of active (n=25) or sham (n=13) iTBS (2 sessions/day, 600 pulses/session, 110% resting motor threshold, AFz target) along with smoking cessation education (Forever Free © booklets) over 14 visits. Primary outcomes included self-reported cigarette consumption and abstinence, verified by urinary cotinine tests. Secondary outcomes included symptoms of tobacco use disorder, negative mood, and safety/tolerability. Both active and sham groups reported reduced cigarette consumption (β = −0.12, p = 0.015), cigarette craving (β = −0.16, p = 0.002), and tobacco withdrawal symptoms (β = −0.05, p < 0.001). However, there were no significant time x group interaction effects for any measure. Similarly, the two groups had no significant differences in urinary cotinine-verified abstinence. Adverse events occurred with similar frequency in both groups. There were no differences in cigarette consumption between the active and sham iTBS groups, both groups decreased cigarette consumption similarly. Further research is needed to compare iTBS to standard high-frequency rTMS and explore the potential differences in efficacy. Despite limitations, this study contributes to experimental design considerations for TMS as a novel intervention for tobacco and other substance use disorders, emphasizing the need for a more comprehensive understanding of the stimulation parameters and target sites. • Intermittent theta burst stimulation (iTBS) was tested for tobacco use disorder. • iTBS was administered on the medial prefrontal cortex for 14 visits. • Both active and sham iTBS reduced the number of cigarettes per day. [ABSTRACT FROM AUTHOR]

High prevalence and harmful consequences of hazardous drinking among medical-surgical patients underscore the importance of intervening with drinking to improve patients' health. This study evaluated a novel intervention, "Drinking Options - Motivate, Shared Decisions, Telemonitor" (DO-MoST). In a randomized design, 155 medical-surgical patients with untreated hazardous drinking were assigned to enhanced usual care or DO-MoST, and followed 3, 6, and 12 months later. We conducted intent-to-treat and per-protocol analyses. For the primary outcome, percent days of alcohol abstinence in the past 30 days, intent-to-treat analyses did not find superior effectiveness of DO-MoST. However, per-protocol analyses found abstinence increased between 3 and 12 months among participants assigned to DO-MoST who engaged with the intervention (n=46). Among DO-MoST-assigned participants who did not engage (n=27), abstinence stayed stable during follow-up. Group comparisons showed an advantage on abstinence for Engaged compared to Non-Engaged participants on change over time. Intent-to-treat analyses found that DO-MoST was superior to usual care on the secondary outcome of physical health at 12 months; per-protocol analyses found that Engaged DO-MoST-assignees had better physical health at 12 months than Non-Engaged DO-MoST-assignees. DO-MoST-assignees had lower odds of receiving substance use care during follow-up than usual care-assignees. Patients engaged in DO-MoST showed a greater degree of abstinence and better physical health relative to the non-engaged or usual care group. DO-MoST may be a source of alcohol help in itself rather than only a linkage intervention. Work is needed to increase DO-MoST engagement among medical-surgical patients with untreated hazardous drinking. • Untreated hazardous drinking harms medical-surgical patients and needs intervention. • RCT studied Drinking Options - Motivate, Shared Decisions, Telemonitor (DO-MoST). • Patients engaged in DO-MoST had better abstinence and physical health than others. • DO-MoST may be a source of alcohol help in itself, not only a linkage intervention. [ABSTRACT FROM AUTHOR]

This study aimed to test the causal effect of different text message interventions on reducing alcohol consumption indirectly by altering desire to get drunk. Participants were young adults randomized to interventions with different behavior change techniques: self-monitoring alone (TRACK); pre-drinking plan feedback (PLAN); post-drinking alcohol consumption feedback (USE); pre- and post-drinking goal feedback (GOAL); and a combination of techniques (COMBO) who completed at least 2 days of both pre- and post-drinking assessments over 12 weeks of intervention exposure. On the two days per week they planned to drank alcohol, participants were asked to report desire to get drunk (0 "none" to 8 "completely"). The next day, participants reported drinking quantity. Outcomes included binge drinking (defined as 4+ drinks for a woman and 5+ drinks for a man) and drinks per drinking day. Mediation was tested using path models of simultaneous between-person and within-person effects using maximum likelihood estimation. At the between-person level, controlling for race and baseline AUDIT-C and within-person associations, 35.9 % of the effects of USE and 34.4 % of the effects of COMBO on reducing binge drinking were mediated through desire to get drunk. 60.8 % of the effects of COMBO on reducing drinks per drinking day were mediated through desire to get drunk. We did not find significant indirect effects for any other text-message intervention. Findings support the hypothesized mediation model where desire to get drunk partially mediates the effects of a text message intervention using a combination of behavior change techniques on reducing alcohol consumption. • Desire to get drunk predicts same-day alcohol consumption in young adults. • A combined text message intervention (COMBO) reduced the desire to get drunk, which in turn, reduces alcohol consumption. • Other interventions using isolated behavior change techniques reduced alcohol consumption but not through desire. [ABSTRACT FROM AUTHOR]

Individuals with regular cannabis use demonstrate adverse health outcomes, yet infrequently seek treatment. Insomnia, a common co-occurring complaint, could be targeted to reduce cannabis use and improve functioning in these individuals. In an intervention development study, we refined and tested the preliminary efficacy of a telemedicine-delivered CBT for insomnia tailored to individuals with regular cannabis use for sleep (CBTi-CB-TM). In this single-blind randomized trial, fifty-seven adults (43 women, mean age 37.6 ± 12.8 years) with chronic insomnia and cannabis use for sleep ≥3 times/week received CBTi-CB-TM (n = 30) or sleep hygiene education (SHE-TM, n = 27). Participants completed self-reported assessments of insomnia (Insomnia Severity Index [ISI]) and cannabis use (Timeline Followback [TLFB] and daily diary data) at pre-treatment, post-treatment, and 8-week follow-up. ISI scores improved significantly more in the CBTi-CB-TM compared to SHE-TM condition (β = −2.83, se=0.84, P = 0.004, d=0.81). At 8-week follow-up, 18/30 (60.0 %) CBTi-CB-TM compared to 4/27 (14.8 %) SHE-TM participants were in remission from insomnia (X2 =12.8, P = 0.0003). The TLFB showed a small reduction in past 30-day cannabis use for both conditions (β = −0.10, se=0.05, P = 0.026); CBTi-CB-TM participants demonstrated greater post-treatment reductions in the % of days cannabis was used within 2 h of bedtime (−29.1 ± 7.9 % fewer days vs. 2.6 ± 8.0 % more days, P = 0.008). CBTi-CB-TM is feasible, acceptable, and demonstrated preliminary efficacy for improving sleep and cannabis-related outcomes among non-treatment-seeking individuals with regular cannabis use for sleep. Although sample characteristics limit generalizability, these findings support the need for adequately powered randomized controlled trials with longer follow-up periods. • Individuals who regularly use cannabis for sleep frequently have insomnia. • CBT for insomnia is feasible and acceptable in those who use cannabis for sleep. • CBT for insomnia may improve insomnia and reduce cannabis use before bedtime. [ABSTRACT FROM AUTHOR]

Background: Most individuals with alcohol use disorder (AUD) do not seek treatment. Stigma and the desire to self-manage the problem are likely explanations. Exercise is an emerging treatment option but studies in non-treatment seeking individuals are lacking. We compared the effects of aerobic exercise, yoga, and treatment as usual (phone-based support) on alcohol consumption in non-treatment seeking adults with AUD.Methods: Three-group parallel, single blind, randomized controlled trial. 140 physically inactive adults aged 18-75 diagnosed with AUD were included in this community-based trial. Participants were randomized to either aerobic exercise (n = 49), yoga (n = 46) or treatment as usual (n = 45) for 12-weeks. The primary study outcome was weekly alcohol consumption at week 13 (Timeline Follow-back).Results: A significant decrease in weekly alcohol consumption was seen in all three groups: aerobic exercise (mean ∆ = - 5.0, 95% C = - 10.3, - 3.5), yoga group (mean ∆ = - 6.9, 95% CI = - 10.3, - 3.5) and TAU (mean ∆ = - 6.6, 95% CI = - 8.8, - 4.4). The between group changes were not statistically significant at follow-up. Per-protocol analyzes showed that the mean number of drinks per week reduced more in both TAU (mean ∆ = - 7.1, 95% CI = - 10.6, - 3.7) and yoga (mean ∆ = - 8.7, 95% CI = - 13.2, - 4.1) compared to aerobic exercise (mean ∆ = - 1.7, 95% CI = - 4.4, 1. 0), [F(2, 55) = 4.9, p = 0.011].Conclusions: Participation in a 12-week stand-alone exercise program was associated with clinically meaningful reductions in alcohol consumption comparable to usual care (phone counseling) by an alcohol treatment specialist. [ABSTRACT FROM AUTHOR]

Background: School-based programs are the most convenient interventions to tackle substance use among youth. "Unplugged" is a Social Influence universal school curriculum developed and tested in the "EU-Dap" project. In 2015, Nigeria implemented a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the effectiveness of "Unplugged" was evaluated through a cluster randomized controlled trial.Methods: The program was adapted to the Nigerian context, assembling suggestions from monitoring forms and interviews, and performing fidelity checks on content and method. Thirty-two secondary schools were extracted from a list provided by the Federal Ministry of Education, and randomly allocated to intervention and control arms. A self-completed anonymous questionnaire was used for baseline and follow-up surveys. The analysis sample finally included 2685 pupils (mean age 14.2 years). Multilevel models were run to estimate program effects on prevalence of self-reported cigarettes, alcohol, and marijuana use. Mediation analysis was performed to identify possible mediators of program effect on alcohol use.Results: Unplugged significantly reduced the prevalence of recent alcohol use in intervention vs control pupils. The effect on prevalence of cigarette and marijuana use was not statistically significant. The program prevented progress and encouraged regress across stages of intensity of alcohol use. Negative beliefs, risk perceptions, and class climate mediated the effect of Unplugged on alcohol use.Conclusions: Unplugged was effective in preventing alcohol use improving beliefs, class climate and risk perceptions among Nigerian students. The implementation of the program at a larger scale in the country should be supported. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic disrupted access to treatment for substance use disorders (SUDs), while alcohol and cannabis retail sales increased. During the pandemic, we tested a tailored digital health solution, Woebot-SUDs (W-SUDs), for reducing substance misuse.Methods: In a randomized controlled trial, we compared W-SUDs for 8 weeks to a waitlist control. U.S. adults (N = 180) who screened positive for substance misuse (CAGE-AID>1) were enrolled June-August 2020. The primary outcome was the change in past-month substance use occasions from baseline to end-of-treatment (EOT). Study retention was 84%. General linear models tested group differences in baseline-to-EOT change scores, adjusting for baseline differences and attrition.Results: At baseline, the sample (age M = 40, SD = 12, 65% female, 68% non-Hispanic white) averaged 30.2 (SD = 18.6) substance occasions in the past month. Most (77%) reported alcohol problems, 28% cannabis, and 45% multiple substances; 46% reported moderate-to-severe depressive symptoms. Treatment participants averaged 920 in-app text messages (SD = 892, Median = 701); 96% of completed lessons were rated positively; and 88% would recommend W-SUDs. Relative to waitlist, W-SUDs participants significantly reduced past-month substance use occasions (M = -9.1, SE = 2.0 vs. M = -3.3, SE = 1.8; p = .039). Secondary substance use and mood outcomes did not change significantly by group; however, reductions in substance use occasions correlated significantly with increased confidence and fewer substance use problems, cravings, depression and anxiety symptoms, and pandemic-related mental health effects (p-value<.05).Conclusions: W-SUDs was associated with significant reductions in substance use occasions. Reduction in substance use occasions was associated with better outcomes, including improved mental health. W-SUDs satisfaction was high. [ABSTRACT FROM AUTHOR]