Plain Language SummaryMany countries are considering new rules for legal cannabis sales. Rules about when and where people can buy cannabis may help reduce how much they buy, which could lower health risks. But we know little about how different rules affect buying behaviour over time. This article uses data from the Züri Can study in Zurich, Switzerland. There are three types of cannabis dispensaries: Cannabis Social Clubs, pharmacies, and a city-run Drug Information Centre. About 2,500 adults can choose one dispensary and buy cannabis for non-medical use. From August 2023 to January 2025, we recorded how often people bought cannabis, and how much they bought each time. We also looked at dispensary opening hours, how many customers they had per hour, and how many different products were available. Pharmacies had the longest opening hours and fewest customers per hour. Within a dispensary, changes in opening hours and number of customers led to slightly more frequent purchases, but it did not change the amount that people bought each time. The number of available products increased over time and was always similar between the dispensary types. It did not influence buying behaviour. People bought cannabis more often in the first month, but in Cannabis Social Clubs and pharmacies, they bought less over time. This suggests that changes in sales conditions have little effect on how much cannabis people buy. Over time, legal access with clear rules, such as letting people buy only from one dispensary, may lead people to buy cannabis less often.

Many studies address the different treatments for crack cocaine use disorder without distinguishing between crack use and cocaine use disorder. Furthermore, they highlight various approaches, such as psychotherapeutic methods, medications and social interventions, whose effectiveness remains contentious for crack use disorder. Our aim is to evaluate the relative effectiveness of these various treatments specifically for crack use disorder. This systematic review followed PRISMA guidelines, we searched Web of Science, Psychinfo and Web of Science for studies between 2014 and july 2024. Eligigibility criteria : Due to the limited number of available studies, we included all studies worldwide with full text available in English or French, published between 2014 and 2024, reflecting the recent increase in interest in crack use. Studies included adults aged 18 years or older with a clinical diagnosis of crack cocaine addiction based on a validated clinical scale. We excluded studies that did not distinguish between crack and cocaine use in their assessment of crack cocaine (or crack/cocaine) use disorder. We reported the randomized controlled trials results based on the type of interventions, including various outcomes: reduction of health and social harm, increased accessibility and retention in healthcare, and reduction in drug use. The reliability of the evidence was assessed using Cochrane's tool for evaluating the risk of bias. We identified 3,313 records, of which 46 were eligible, and 33 were finally included. Among the 33 studies, 15 were randomized controlled trials (RCTs). Among the RCTs, the majority had a moderate risk of bias (8/15), followed by high risk (6/15), and only one had a low risk of overall bias. Contingency management demonstrated significant results in improving abstinence rates, treatment retention, and mental health outcomes. Pharmacological trials showed variable results, though dexamfetamine demonstrated some promise in reducing drug use. Adjunct trials highlighted the potential of transcranial direct current stimulation to improve abstinence rates and quality of life.The other studies collectively underscored the effectiveness of adjunct therapies, case management, peer engagement, outreach, and safer smoking places in addressing substance use, treatment retention and improving related health outcomes. The findings highlight that tailored interventions supported by contingency management approach, enhance engagement and treatment effectiveness.

Individuals with alcohol use disorder (AUD) frequently encounter significant barriers to seeking treatment, with these obstacles often greater for cisgender women and transgender individuals. Negative consequences of AUD are particularly severe in these groups, yet research on their specific treatment barriers is lacking. This study aimed to develop and evaluate the Barriers to AUD Treatment Questionnaire (BAT-Q) and exploratorily examine differences in reported barriers among 112 cisgender men, 154 cisgender women, and 98 transgender individuals who had considered AUD treatment in the past five years. Exploratory factor analysis identified seven reliable domains of barriers: social stigma, comorbid problems and negative care experiences, limited care accessibility, fear of limited inclusivity and discrimination, limited social support, socioeconomic constraints, and negative expectations of care. While comparisons among groups yielded preliminary insights these findings should be interpreted with caution, as confirmatory factor analysis have not yet been conducted. However, transgender individuals reported higher barriers than both cisgender men and women across all domains except socioeconomic constraints. Both cisgender women and transgender individuals experienced greater stigma-related barriers than cisgender men. Higher alcohol and drug use severity predicted greater overall treatment barriers in all groups. Notably, poorer perceived socioeconomic status and low social support were more strongly associated with barriers among women than among cisgender men or transgender individuals. These findings underscore the need for gender-affirming and accessible AUD services. The BAT-Q provides a promising new tool for identifying and addressing specific barriers to treatment, although further validation of its structure is warranted to strengthen the interpretation of group differences.

Early identification for preventing drug misuse among adolescents and young adults (AYAs) is more cost-effective than drug treatment. However, there is a lack of scientific and comprehensive risk models for early identification. This study aimed to construct risk models and association pathways that integrate psychosocial factors influencing drug misuse in AYAs using a machine learning approach. This cross-sectional study included 1,012 Chinese AYAs aged 14-35 years and was conducted from June to December 2023. Key psychosocial factors for drug misuse were identified using the least absolute shrinkage and selection operator and Boruta. A voting classifier combining logistic regression, K-Nearest Neighbors, support vector machine, and 5-fold cross-validation was used for model training and bootstrapping method wan applied for testing. Shapley additive explanation was used to determine the importance of each risk factor. A Bayesian network (BN) model was constructed to explore possible association pathways for drug misuse. A total of 3.85% of participants reported drug misuse. Significant risk factors included environmental exposure to drug misusers, working in nightlife venues, cognition of traditional drug types, perceived risks of drug misuse, permissive attitude towards drug misuse, refusal self-efficacy of drug misuse, externalizing problem behavior, sensation-seeking, and adverse childhood experiences (ACEs). The voting model showed strong performance (recall: 94.10%; area under the curve: 98.11%; accuracy: 92.63%; precision: 34.15%; F-score: 49.68%). The BN model revealed that ACEs played a central role in risk assessment of drug misuse. AYAs working in nightlife venues, with low refusal self-efficacy of drug misuse, and exposure to drug misusers, had exceeding 90% probability of drug misuse. ACEs serve as a primary risk factor, with a significant impact on social environmental influences. AYAs with ACEs and those working in nightlife venues require targeted and early interventions to prevent drug misuse.

Introduction: Objective measures for the severity of addiction are needed to identify and appropriately stratify patients into effective treatment groups for intervention and recovery. Our aim was to determine if blood-derived, dopamine-related biomarkers hold predictive validity in patients with cocaine use disorder (CUD). Methods: A total of 349 participants (163 patients with moderate-to-severe CUD and 186 healthy control participants without a history of substance use disorder) were recruited for a cross-sectional case-control study in the East of England, UK. Data on individual differences in CUD-related traits, e.g., impulsivity, sensation-seeking, were collected. Measurements included mRNA transcription of dopamine-related genes (DRD2, DRD3, DRD4, and COMT) and risk alleles (rs6277, rs1800497, rs12364283, rs6280, and rs4680). Results: CUD patients showed elevated DRD2 mRNA in peripheral blood (B0 = 0.43, 95% CI [0.13, 0.73], pFDR = 0.020) and the DRD2-related rs6277 risk allele was associated with CUD diagnosis (odds ratio = 2.16, 95% CI [1.15, 4.17], p = 0.02). DRD2 mRNA levels related to self-reported impulsivity (B0 = −0.17, 95% CI [−0.32, −0.03], p = 0.013). Conclusions: Blood-based expression of DRD2 may be a useful biomarker related to CUD diagnosis and related traits.

Introduction: Sociodemographic background factors, gambling game type, depressive symptoms, and comorbid substance use have been associated with gambling disorder, but the associations of these factors with treatment outcomes remain unclear. This study examined background factors in participants of a clinical trial, identifying factors which were associated with treatment outcomes such as gambling urge and quality of life. Methods: This was a secondary analysis of a single-center 12-week randomized placebo-controlled clinical trial investigating the effects of as-needed intranasal naloxone combined with psychosocial support in the treatment of gambling disorder. Independent variables were analyzed with linear mixed models, with analyses both including and excluding treatment allocation. Results: Sociodemographic factors or game types were not associated with treatment outcomes. Adherence to trial medication and high self-perceived readiness to change gambling behavior were associated with greater reduction in gambling urge and severity, and greater increase in gambling self-efficacy and quality of life. Higher scores for depressive symptoms were associated with more severe gambling and a slightly greater decrease in gambling urge, as well as a greater increase in quality of life. When included as a nuisance factor, treatment allocation abolished most statistically significant results. Conclusion: Participants with high medication adherence had improved treatment outcomes compared to participants with low medication adherence, possibly representing greater motivation and commitment to treatment. More severe depressive symptoms were associated with a greater reduction in gambling urge but not gambling severity.

Introduction: Anabolic-androgenic steroid (AAS) consumers frequently experience elevated physical and psychological risks, yet the psychological mechanisms linking risk exposure to health outcomes remain poorly understood. This study examined whether general confidence in managing substance use and minimising harm mediates the relationship between clinical risk and quality of life among AAS consumers engaged with community-based alcohol and other drug (AOD) services. Methods: Intake data from 517 adults (93.4% male) reporting lifetime AAS use were analysed, drawn from a broader cohort of 18,786 clients at Lives Lived Well services between 2020 and 2024. Mediation analyses tested whether two confidence variables: (1) substance use management and (2) harm minimisation, explained associations between clinical risk (defined by World Health Organisation – Alcohol, Smoking and Substance Involvement Screening Test steroid risk score), and three quality of life domains: physical, psychological, and overall wellbeing. Results: Higher clinical steroid risk scores were significantly associated with poorer quality of life across domains; however, these effects were fully mediated by lower general confidence in managing substance use and minimising harm among clients who reported AAS use. Confidence in consumption practices buffered against physical undesired effects, while confidence in harm reduction was strongly linked to psychological wellbeing. Conclusions: Among AAS consumers in AOD treatment, broader substance use confidence appears meaningfully related to quality of life. While the confidence measures are general rather than AAS-specific, these findings provide a preliminary insight into confidence-related processes in a clinically underexamined group. Interventions that promote these strategies may offer a critical mechanism for ensuring this cohort physical and psychological wellbeing.

Introduction: Recovery from substance use disorder (SUD) spans clinical, functional, and personal dimensions. However, research covering these domains, particularly in populations with complex problems such as those with mild to borderline intellectual disabilities (MBIDs), remains limited. This study explored different recovery outcomes and their relationship with treatment dropout during the first 12 weeks of inpatient treatment, while also examining whether the presence of MBID affected the outcomes. Methods: A naturalistic, prospective cohort study was conducted with patients undergoing inpatient SUD treatment at a Salvation Army Clinic in The Netherlands. Recovery outcomes (clinical, functional, personal) and predictors of dropout were assessed over 12 weeks. MBID (yes/no) was determined using the SCIL screening tool. Data were analyzed using repeated measures (M)ANCOVA to evaluate recovery trajectories and logistic regression to explore associations between recovery levels and dropout. Results: Of the 157 participants, 66% screened positive for potential MBID, and 40% dropped out within 12 weeks. For completers, significant improvements were observed across all recovery domains over time (all p < 0.001). Psychological problems decreased by a mean of 9.6 points (95% CI: 7.5–11.8), physical problems by a mean of 3.7 points (95% CI: 2.0–5.4), and craving by a mean of 7.5 points (95% CI: 6.4–8.6). Functional recovery increased by a mean of 5.1 points (95% CI: −1.4 to 11.7), and personal recovery by a mean of 5.7 points (95% CI: 3.5–7.9). Lower baseline recovery levels were associated with greater relative improvements but lower endpoint scores. Lower baseline functional recovery was a small but significant predictor of dropout. MBID status did not affect recovery trajectories. Conclusions: The findings suggest a multidimensional recovery process during early phases of inpatient treatment, irrespective of MBID status. Baseline recovery levels play a crucial role in shaping outcomes, underscoring the importance of early assessments. Importantly, these findings indicate that those worst off at baseline profit most from treatment.

Introduction: Individuals with compulsive buying-shopping disorder (CBSD) often engage in criminal behaviors like fraud and theft, influenced by materialistic values, impaired moral judgment, and low self-control. Psychological mechanisms linking CBSD and criminality are yet not well understood. This study examines psychological/personality factors contributing to criminal tendencies in individuals with CBSD. Methods: An online survey recruited participants through social media, Websites, and academic institutions. Eligible participants were ≥18 years with German language skills. Ethical approval was granted by Hannover Medical School. Measures included the Pathological Buying Screener (PBS), Materialistic Value Scale, Big Five Inventory, Rosenberg Self-Esteem Scale, the Dirty Dozen for Dark Triad traits, and a self-developed questionnaire on criminal behavior. Results: Forty-three participants scored above (CBSD+) and 166 participants below (CBSD−) the PBS cutoff for CBSD. The CBSD+ group showed higher materialism, lower self-esteem, elevated Dark Triad traits, and more criminal behaviors compared to the CBSD− group. Nearly 70% of the CBSD+ group reported at least one criminal behavior. A multiple linear regression (enter method) identified higher PBS scores, younger age, and lower extraversion as predictors of more criminal buying-shopping-related behaviors. Conclusion: The findings reveal the intricate factors contributing to criminal behavior in CBSD. The lack of significant association between neuroticism, dark personality features, and the amount of criminal behaviors needs further investigation. The explained variance of 39% indicates that additional influences on criminal behavior remain to be explored. Future research should aim for more diverse samples and longitudinal designs to enhance generalizability and understanding of these complex relationships.

Introduction: Recurrent depression is a challenging and common disorder in clinical psychiatry. Comorbid substance use disorder poses a challenge to effective treatments. The association between depression and substance abuse is widely documented, but less is known about how the recurrence of depression is associated with substance use disorders and the temporal connections between the two disorders in adolescence and early adulthood. Methods: In this study, we analyzed the associations between recurrent depression and substance use patterns in former adolescent psychiatric inpatients, during initial inpatient hospitalization and follow-up period of 10–15 years. Study population consisted of 235 individuals admitted for adolescent psychiatric inpatient care, of whom 84 were in recurrent depression group and 151 were in single depressive episode group. Substance use experimentation ages, substance use frequencies during adolescence, onset ages of substance use disorders, and number of substance use disorder diagnoses in adolescence and early adulthood were analysed between the two groups. Results: Recurrent depression was associated with alcohol use disorders (p = 0.014) and multiple drug use disorders (p = 0.034) in early adulthood in males. In logistic regression analysis, alcohol use disorder was found to associate with recurrent depression in males (OR 3.6, 95% CI 1.27–10.75, p = 0.017). There was no statistically significant difference in temporal associations between recurrent or single-episode depression in regard to onset age of substance use. Conclusions: Our results emphasize the need for early recognition and integrated treatment of substance use and depression in adolescence.