Objective Prenatal substance use is associated with negative outcomes for both the pregnant person and child. Entering substance use treatment during pregnancy is associated with improved outcomes but there are many barriers to treatment such as stigma. To improve prevention and treatment outcomes, it is critical to understand the relationship between risk/protective factors for substance use during pregnancy and to look for temporal changes in these relationships. Method Pregnant people (N = 32) with substance use disorder and a history of trauma exposure were included in this secondary analysis. Participants completed ecological momentary assessment (EMA), three times per day for 28 days. We used time-varying effects models (TVEMs) to examine the effects of craving on substance use, PTSD symptoms on craving, prenatal bonding on craving, and PTSD symptoms on prenatal bonding. Results Craving predicted substance use from gestational weeks 19.58 to 26.96. The relationship decreased over time and was not significant after week 27. PTSD symptoms predicted cravings at three times (weeks: 19.96–20.30, 23.36–31.68, 36.22–36.79). Maternal-fetal quality of attachment predicted craving from weeks 19.58–25.63. Maternal-fetal intensity of preoccupation predicted craving from weeks 19.58–22.42 and 31.31–31.87. PTSD symptoms predicted maternal fetal quality of attachment between weeks 25.06–26.20. There was no relationship between PTSD symptoms and maternal-fetal intensity of preoccupation over time. Conclusions These findings support prior research on the relationship between risk/protective factors for substance use during pregnancy. However, these relationships appear to fluctuate over time indicating that other factors might impact substance use during pregnancy.

Background There are documented health disparities concerning Asian American and Pacific Island (AAPI) adults who smoke combustible tobacco, yet little work has identified factors related to worse smoking outcomes among these individuals. This is the first study to test whether cannabis use among AAPI adults who smoke tobacco is related to more severe cigarette dependence, and whether negative affect and negative reinforcement expectancies play a role in those relations. Method The current study tested this among AAPI adults (N = 530; 42.8% female, aged 18–75) who endorsed current tobacco smoking and completed an online survey. Results Participants who used cannabis (i.e. nicotine-cannabis dual use) were more likely to be born in the U.S. and reported more anxiety, depression, cigarettes per day (CPD), cigarette dependence, barriers to smoking cessation, and negative consequences and negative reinforcement smoking outcome expectancies. The relations of nicotine-cannabis dual use status with cigarette dependence and barriers to cessation occurred indirectly via anxiety (not depression). The relations of dual use status with CPD, dependence severity, and perceived barriers to cessation occurred indirectly via negative reinforcement expectancies. The relations of dual use with all three smoking outcomes also occurred via anxiety’s relation with negative reinforcement expectancies and negative reinforcement expectancies’ relations with smoking outcomes. Conclusions Results highlight several clinical correlates of cannabis dual use among AAPI adults who smoke combustible tobacco cigarettes and suggest that anxiety and the expectation that smoking may help manage such negative emotions may play important roles in smoking processes among this group.

Background The Recovery Capital (RC) model encompasses the key factors supporting recovery. Understanding RC, and how it changes over time, is important for supporting recovery processes and evaluating treatment effectiveness. There are 11 validated measures of adults’ RC, but none are validated for adolescents, who have distinct recovery experiences/needs. We conducted a Delphi study with professionals working with adolescents to develop an initial measure of adolescent RC (MARC). Methods We recruited addiction professionals (i.e. clinicians or researchers) to complete a two-round Delphi examining consensus on 78 draft RC items from the Assessment of Recovery Capital (ARC) and Multidimensional Inventory of Recovery Capital (MIRC) measures. In each round, participants rated item importance (5-point scale) and provided comments. In the first round, 11 participants completed the Delphi (73% male; Mean experience years = 16.45, SD = 11.66) and 7 (64%) returned to Round 2. Results Overall, there was strong agreement that many of the presented items were important for capturing adolescent RC. The MIRC items were generally considered more acceptable compared to the ARC items. Professionals recommended revisions to better capture wellbeing beyond substance use and to reflect broader environmental influences. Conclusions Based on expert feedback, we propose an initial measure of 61 items to capture adolescent RC. Findings highlight the importance of a youth-specific RC measure that reflects adolescents’ developmental context, wellbeing needs, and environments. This measure can strengthen treatment by identifying individualized barriers/supports, guide progress monitoring beyond substance use outcomes, and inform interventions. Future work should incorporate adolescent feedback to the MARC.

Background Despite recent increases in gabapentin misuse among Black Americans who use opioids, there is a dearth of research examining gabapentin misuse among this high-risk group. The current study examines associations between health-related risk factors (e.g. pain and insomnia) and gabapentin misuse among Black adults who use opioids, as well as gender differences in these associations. Method Data were derived from a mixed-methods study examining opioid misuse among Black adults. The current sample included participants who confirmed lifetime prescription opioid misuse during the study survey (n = 758). Stepwise logistic regression analyses, controlling for age, education, and past 30-day depression and anxiety, were used to examine main and interaction effects of pain, insomnia, and gender on odds of gabapentin misuse. Pain was assessed using the Brief Pain Inventory, and insomnia was assessed using the Insomnia Severity Index. Gabapentin misuse, depression, and anxiety were assessed using a modified version of the Addiction Severity Index – Lite. Results Overall, approximately, 16% of participants reported gabapentin misuse in the past 30 days. Analyses showed a significant main effect of age (AOR = 1.03, 95%CI [1.01, 1.04]), gender (AOR = 5.60, 95%CI [2.44, 12.86]), pain (AOR = 2.54, 95%CI [1.24, 5.22]) and insomnia (AOR = 2.86, 95%CI [1.24, 6.38]) on odds of gabapentin misuse, and a significant interaction between gender and insomnia (AOR = .36, 95%CI [.13, .95]). Conclusions Findings highlight a need to address sleep concerns among Black adults who misuse opioids and gabapentin, and for intervention approaches tailored by race and gender.

Gambling regulation can be informed by various conceptual models, such as the public health model which views it as being intrinsically harmful like tobacco, and which therefore implies the use of population-based harm prevention measures. The children’s game of whack-a-mole has also been used to describe the challenges of online gambling regulation, where new regulatory issues continue to emerge. Here I explore the implications of seeing gambling regulation like the strategic gambling game of poker – a metaphor that is close to home, and which directs attention on the gambling industry’s ability to constantly innovate its products and practices. I argue that gambling policy should not just act on current products and practices, but also strategically consider potential harmful innovation. Using international examples, I show how gambling regulations have failed by stating key terms vaguely, by containing exploitable loopholes, and by giving gambling operators strategic flexibility in regulatory compliance more broadly. A more strategic regulatory approach is therefore recommended, which follows an expert poker player’s mindset by anticipating and countering potential gambling operator responses. This means defining key terms concretely, implementing broadly applicable policies, and restricting gambling operators to evidence-informed actions. Other implications of the model include minimizing operators’ informational advantages over regulators. Reductions in populations harms can only be achieved by recognizing the inherent mutability of gambling products and the industry’s utilization of technology. While the whack-a-mole metaphor sees these challenges as being insurmountable, I argue that better outcomes could be obtained by taking a strategic approach to gambling regulation.

Background Despite widespread recognition of spirituality’s role in addiction recovery, the field lacks robust theoretical frameworks for understanding how spirituality develops. This study addresses this gap by applying the developmental processes dimension of Canda et al.’s Operational Model of Spirituality, specifically crisis, gradual growth, and life-cycle transitions, to foundational Alcoholics Anonymous (AA) texts. Notably, the model draws on diverse, non-Western foundations, positioning it for cross-cultural extension beyond AA. By examining these developmental pathways within AA, we seek to advance theoretical understanding of temporal patterns of spiritual transformation during recovery. Method Using deductive qualitative content analysis, we examined two foundational AA texts: Alcoholics Anonymous and Twelve Steps and Twelve Traditions. A structured codebook based on Canda’s developmental processes was developed through iterative refinement. Two coders independently analyzed the texts using sentence-level structural coding. Rigor was ensured through peer review, external audit, reflexive journaling, and coder triangulation. Results The analysis revealed distinct developmental patterns aligned with Canda’s framework. Crisis processes involve movement from denial to acknowledgment. Gradual growth reflects tension between seeking quick fixes and cultivating sustained integration. Life-cycle transitions mark shifts from passive hope to active engagement, characterized by identity reconstruction and relational repair. These processes demonstrate a recognizable arc from disruption to integration. Conclusions Canda’s developmental processes provide a theoretically grounded framework for understanding spiritual transformation during addiction recovery, complementing existing biopsychosocial and recovery capital frameworks. The model is particularly well-suited for cross-cultural extension to recovery frameworks beyond AA and suggests pathways for theory-driven interventions across diverse recovery contexts.

Glucagon-like peptide-1 receptor agonists (GLP-1s) have rapidly transitioned from treatments for type 2 diabetes to widely used weight-loss medications. While compounds such as Semaglutide and Tirzepatide are clinically approved, the experimental triple-agonist Retatrutide has begun circulating through illicit online markets. Despite growing clinical research on their metabolic effects, little is known about how these substances are being incorporated into bodybuilding cultures. This study explores how GLP-1s, particularly Retatrutide, are discussed within online weight-training communities and how they are positioned relative to non-medical insulin use. Two netnographies of publicly accessible forums were conducted, analyzing 1,774 Reddit posts on Retatrutide and 12,392 posts from two major bodybuilding forums. Reflexive thematic analysis revealed that GLP-1s are framed as tools for improving insulin sensitivity, nutrient partitioning, and lean mass accrual, often promoted as a ‘safer’ alternative to insulin. These findings highlight risks related to unapproved compounds, misinformation, and polysubstance use within online enhancement communities.

Background Problematic social media use (PSMU) is characterized by maladaptive behaviors and symptoms paralleling addiction. Despite rising prevalence, PSMU lacks formal diagnostic criteria, underscoring the need to investigate its underpinnings. The present study aimed to investigate both psychosocial and neurobiological features that underpin the six characteristics of PSMU (i.e. conflict, mood modifications, relapse, salience, tolerance, withdrawal). Methods A battery of psychometric scales and a magnetic resonance imaging (MRI) scan were administered to 79 individuals (n = 55 female) aged 15-35 years. One psychosocial PCA included mental health symptoms and eight social media behaviors. A second neurobiological PCA included the volume of six brain regions involved in reward. Principal components explaining the most variance (eigenvalue > 1) were extracted for regression analyses with total PSMU and the six characteristics. Results Psychosocial component one, which reflected negative mental health, was significantly associated (p<.001) with total PSMU (t = 6.74), and all six PSMU characteristics (conflict; t = 4.23, mood modifications; t = 4.43, relapse; t = 5.05, salience; t = 5.55, tolerance; t = 5.86, and withdrawal; t = 3.48). The six characteristics showed differing patterns of associations with psychosocial and neurobiological components. Withdrawal was the only PSMU characteristic significantly associated with a neurobiological component (t = 2.02, p<.05). Conclusion The present study is the first to use a biopsychosocial approach to explore PSMU characteristics, integrating social media behaviors, psychological factors, and structural brain patterns. These findings highlight the possibility of differing risk factors distinct to the six PSMU characteristics.