Days Of Abstinence Research Articles

Patient Engagement in Providing Telehealth SUD IOP Treatment: A Retrospective Cohort Study

Background: Substance use disorders (SUDs) remain a growing public health issue, with drug- and alcohol-related deaths continuing to increase. A myriad of barriers prevent many with SUDs from seeking care. Telehealth interventions are well-positioned to reduce barriers and increase engagement in SUD treatment. The SUD intensive outpatient program (IOP) is specifically designed for telehealth and offers evidenced-based care delivered by SUD professionals as well as asynchronous assignments to enhance treatment. This study explores the feasibility of providing a telehealth IOP. Methods: participant engagement, reasons for disengagement, and days of abstinence were examined using existing records from a cohort of participants between 2021 and 2023 (n = 4724). Results: Nearly 80% of participants remained engaged in the program for 30 days, and 91% attained at least 30 consecutive days of abstinence over the course of treatment. Nearly 45% demonstrated a successful response to care and no longer required IOP treatment. Those who finished the IOP completed over 70% of the asynchronous assignments. Conclusions: Results support the feasibility and effectiveness of delivering a telehealth IOP for SUDs.

Hypocretin Receptor 1 Blockade Early in Abstinence Prevents Incubation of Cocaine Seeking and Normalizes Dopamine Transmission.

Abstinence from cocaine use has been shown to elicit a progressive intensification or incubation of cocaine craving/seeking that is posited to contribute to propensity for relapse. While the mechanisms underlying incubation of cocaine seeking remain elusive, considerable evidence suggests that abstinence from cocaine promotes mesolimbic dopamine adaptations that contribute to exaggerated cocaine seeking. Consequently, preventing these dopamine adaptations may reduce incubation of cocaine seeking and thereby reduce the likelihood of relapse. In the present studies, we first examined if incubation of cocaine seeking was associated with aberrant dopamine transmission in the nucleus accumbens after seven days of abstinence from intermittent access to cocaine. Given the extensive evidence that hypocretins/orexins regulate motivation for cocaine, we then examined to what extent hypocretin receptor 1 antagonism on the first day of abstinence prevented incubation of cocaine seeking and dopamine adaptations later in abstinence. Results indicated that abstinence from intermittent access to cocaine engendered robust incubation of cocaine seeking in both female and male rats. We also observed aberrant dopamine transmission, but only in rats that displayed incubation of cocaine seeking. Further, we showed that a single injection of the hypocretin receptor 1 antagonist, RTIOX-276, on the first day of abstinence prevented incubation of cocaine seeking and aberrant dopamine transmission. These findings suggest that hypocretin receptor 1 antagonism may serve as a viable therapeutic for reducing cocaine craving/seeking, thus reducing the likelihood of relapse.

Association of individual and neighborhood socioeconomic status with outcomes of a smoking cessation intervention provided in the lung cancer screening setting.

Lung cancer screening (LCS) offers a teachable moment for smoking cessation. This study assesses whether individual- or neighborhood-level SES is associated with tobacco abstinence and completion of a smoking cessation intervention in the LCS context. Secondary analysis of a clinical trial (NCT03611881) that tested the effectiveness of smoking cessation treatment for smokers scheduled for LCS (N = 615) in eastern Massachusetts, USA from 2019 to 2024. Outcomes were self-reported 7-day smoking abstinence and study follow-up completion at 6-months. Independent variables were individual SES (high school or less [low SES] vs. post-high school education [high SES]); neighborhood SES (Area Deprivation Index [ADI], range: 0-100, categorized as: highest 15 % [low SES] vs. remaining 85 % scores [high SES]), and a combination of both measures. Logistic regression models tested the association between outcomes and SES measures, adjusted for covariates. 32 % of participants had low individual SES. The mean sample ADI was 19.9 (SD: 12.8). Smoking cessation was higher among those with high vs. low neighborhood SES (15.7 % vs. 7.4 %, p-value = 0.03). Study completion was marginally higher among those with high vs. low individual SES (84.5 % vs. 78.1 %, p = 0.05). In multivariable models, these associations were not significant, but individuals with high individual and low neighborhood SES were more likely to complete the study than those with both low individual and low neighborhood SES, (OR: 6.04, 95 %CI: 1.47-24.7). Individual and neighborhood SES were not independently associated with the study outcomes in the multivariable analysis, but combinations of individual and neighborhood SES differentially affected treatment completion.

Efficacy of Screening and Brief Intervention for Alcohol Misuse in Opioid Agonist Maintenance Treatment: A Randomized Clinical Trial

ABSTRACT Alcohol misuse is common in persons on opioid agonist maintenance treatment (OAMT). We tested the efficacy of screening and brief intervention (SBI) for harmful/hazardous alcohol use in buprenorphine/naloxone (BNX)-assisted OAMT. It was a double-blind, parallel-group, randomized trial, where 150 participants with alcohol misuse (Alcohol Use Disorder Identification Test – AUDIT 8–19) on BNX were allocated equally to receive either a single session SBI or screening and brief advice (control). Participants were followed up at three months. The primary outcome was the change in AUDIT; other outcomes were risk transition, change in the frequency of heavy drinking, days of abstinence from alcohol, Gamma-glutamyl transferase (GGT) levels, non-prescription opioid use, and adherence to BNX. Follow-up data was gathered from 138 participants. SBI participants had a higher reduction in AUDIT scores at the follow-up (F = 129. 173, df = 1, p < .001, ηp 2 =.469). A higher proportion of participants transitioned to a low-risk category in the SBI group. The SBI group showed a higher reduction in heavy drinking and days of alcohol abstinence. Although the proportion of persons with normal serum GGT increased in both groups, the difference was not significant at the follow-up. The SBI group performed better in non-prescription opioid use and BNX adherence.

Evaluating a 30-day alcohol abstinence challenge in heavy-drinking individuals with and without chronic pain: feasibility, safety, and perceived benefits

IntroductionTo combat high-risk alcohol consumption, we introduced a 30-day alcohol abstinence challenge targeted at heavy drinkers with and without chronic pain. Our study aimed to assess the challenge's feasibility and safety and to explore its perceived benefits. Our exploratory aim was to identify participants' coping strategies during the challenge. MethodsOur single-arm study recruited heavy drinkers from a pain clinic and a university setting (n = 34, 64.7% chronic pain). Participants underwent a modified community-based 30-day challenge, which included motivational interviewing, an individualized start date, and weekly phone check-ins. ResultsWe found the 30-day challenge was feasible and safe; 72.3% of eligible heavy drinkers participated in the challenge with no serious adverse events. Most challengers (94.1%) reported some benefit from the challenge, which included improvements in alcohol withdrawal symptoms, sleep, and alcohol abstinence self-efficacy, but not in pain. We identified 25 perceived benefits and 21 coping strategies. ConclusionOur study confirms that a 30-day alcohol abstinence challenge is a feasible and safe intervention for heavy drinkers with and without chronic pain, yielding notable health benefits. The challenge also facilitated the development of effective coping strategies. Future studies should explore the long-term benefits of such interventions in broader outpatient settings.

Evaluating the Impact of a Game (Inner Dragon) on User Engagement Within a Leading Smartphone App for Smoking Cessation: Randomized Controlled Trial.

Smartphone apps are a convenient, low-cost approach to delivering smoking cessation support to large numbers of individuals. Yet, the apps are susceptible to low rates of user engagement and retention. This study aims to test the effects of a new game module (called Inner Dragon) integrated into Smoke Free (23 Limited), a leading smoking cessation app with established efficacy. The primary outcomes measured user engagement with the app. A 2-arm, parallel-group, randomized controlled trial was conducted in the United States with an 8-week follow-up. Adult individuals who smoked ≥1 cigarettes daily and planned to quit smoking within 7 days were recruited and randomized (N=500), with equal allocation. Both groups received free access to the original Smoke Free app with "core" features of its smoking cessation program (eg, a diary and craving log). The treated group received additional access to the integrated Inner Dragon game that incorporated several game mechanics designed to increase user engagement. User engagement outcomes were the number of unique app sessions, average minutes per session, days with a session, and program adherence. Self-reported and verified smoking abstinence and app satisfaction were also assessed. The main analysis estimated the intention-to-treat effect of access to Inner Dragon on each outcome. Further analyses assessed effect modification by participant characteristics and the association of intensity of game use with program adherence and abstinence. Overall, user engagement was greater for treated versus control participants: they had 5.3 more sessions of Smoke Free (mean 29.6, SD 36.5 sessions vs mean 24.3, SD 37.9 sessions; P=.06), 0.8 more minutes per session (mean 6.9, SD 5.4 min vs mean 6.1, SD 5.2 min; P=.047), and 3.4 more days with a session (mean 14.3, SD 15.3 days vs mean 11.9, SD 14.3 days; P=.03). Program adherence, based on the number of times core features of the original Smoke Free app were used, was higher for treated versus control participants (mean 29.4, SD 41.3 times vs mean 22.6, SD 35.6 times; P=.03). Self-reported 7-day and 30-day point-prevalence abstinence and verified 7-day point-prevalence abstinence at 8 weeks did not significantly differ by study group. The mean repeated 1-day prevalence of quitting was higher among the treated group versus the control group (mean 17.3%, SD 25.6 vs mean 12.4%, SD 21.3; P=.01). App satisfaction and the motivation to (stay) quit did not differ by study group. Higher intensity of game use was associated with increased program adherence and self-reported abstinence. Findings suggest that the Inner Dragon game increased user engagement and program adherence. Additional refinements to the game design may clarify whether the game increases abstinence rates. Overall, it is feasible to deploy games and gamification to enhance user engagement in existing smoking cessation interventions. ClinicalTrials.gov NCT05227027; https://clinicaltrials.gov/study/NCT05227027.

Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study.

In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app-based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data. This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design. American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback. In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks-4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change -3.2, SD 3.9; P<.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day. In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements.

The impact of voluntary wheel-running exercise on hippocampal neurogenesis and behaviours in response to nicotine cessation in rats

RationaleThe literature indicates that nicotine exposure or its discontinuation impair adult hippocampal neurogenesis in rats, though the impact of exercise on this process remains unclear. We have previously shown that disturbances in the number of doublecortin (DCX, a marker of immature neurons)-positive (DCX+) cells in the dentate gyrus (DG) of the hippocampus during nicotine deprivation may contribute to a depression-like state in rats.ObjectivesThis study aimed to investigate the effect of running on hippocampal neurogenesis, depression-like symptoms, and drug-seeking behaviour during nicotine deprivation.MethodsThe rats were subjected to nicotine (0.03 mg/kg/inf) self-administration via an increasing schedule of reinforcement. After 21 sessions, the animals entered a 14-day abstinence phase during which they were housed in either standard home cages without wheels, cages equipped with running wheels, or cages with locked wheels.ResultsWheel running increased the number of Ki-67+ and DCX+ cells in the DG of both nicotine-deprived and nicotine-naive rats. Wheel-running exercise evoked an antidepressant effect on abstinence Day 14 but had no effect on nicotine-seeking behaviour on abstinence Day 15 compared to rats with locked-wheel access.ConclusionsIn summary, long-term wheel running positively affected the number of immature neurons in the hippocampus, which corresponded with an antidepressant response in nicotine-weaned rats. One possible mechanism underlying the positive effect of running on the affective state during nicotine cessation may be the reduction in deficits in DCX+ cells in the hippocampus.

The Relation of Insulin Resistance With Free Androgen Index and Endothelial Dysfunction Marker YKL-40 and Its Effect on Male Infertility: A Prospective Study.

In this study, the effects of insulin resistance and the role of the endothelial dysfunction marker YKL-40 in male infertility were investigated. This study was conducted with male patients who underwent fertility investigations in the in vitro fertilization (IVF) unit of a tertiary center. Semen samples were evaluated after two to five days of sexual abstinence. The hormonal and lipid profiles, fasting glucose and insulin levels, and YKL-40 values of the patients were assessed. The Homeostatic Model Assessment (HOMA) index was calculated, and those with a score of 2.5 and above were considered insulin resistant (IR). In total, 75 patients, 34 with IR and 41 without IR, were included. The groups had similar ages, heights, weights, and BMIs. Additionally, the semen parameters were similar between the groups. The median fasting glucose and insulin levels were significantly greater in the insulin-resistant group (p=0.008 and p<0.00, respectively). There were no significant differences in terms of the serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid stimulating hormone (TSH), sex hormone binding globulin (SHBG), high-density lipoprotein (HDL), or low-density lipoprotein LDL) levels. Total testosterone levels were lower in the IR group than in the group without IR (p<0.001). Both the total serum cholesterol and triglyceride levels were greater in the IR patients (p=0.031 and p=0,002, respectively). Compared with the patients without IR, the IR patients had a lower free androgen index. The serum YKL-40 levels were similar between the groups, and there were no correlations between YKL-40 and the other parameters. This initial study investigating the serum YKL-40 level in men with and without IR revealed no relationship between YKL-40 levels and IR. Nonetheless, higher total serum cholesterol and triglyceride levels and lower total serum testosterone and free androgen indices were found in participants with IR.

Prize-based Incentives for Smoking Cessation Among People with HIV: A Sequential Multiple Assignment Randomized Trial (SMART).

Contingency management (CM) is an incentive-based approach that has demonstrated efficacy for smoking cessation in various populations. There is an unmet need for feasible and effective smoking cessation interventions in people with HIV (PWH). The study purpose is to assess efficacy of prize-based CM for smoking cessation in PWH using a Sequential Multiple Assignment Randomization Trial (SMART) design selected to tailor intervention intensity based on early treatment response. During phase 1, 129 participants were randomly assigned to high-magnitude prize CM (HM-CM) or standard of care (SoC) for 4 weeks. Participants who did not reduce smoking were randomized in Phase 2 to continued counseling with HM-CM plus monitoring support or only continued monitoring support for 8 weeks. Participants who reduced smoking were randomized to booster monitoring with low-magnitude CM or no additional care. Outcomes were biochemically-verified smoking reduction and 7-day abstinence prevalence at post-treatment, 6-month and 12-month follow-up. Phase 1 responders (based on biochemical indicators of smoking reduction) were significantly less likely to return to smoking (during treatment and at 6- and 12-months) if they received low-magnitude incentives. Notably, initial exposure to CM vs. SoC did not increase rate of phase 1 response, and high-magnitude incentives later in treatment did not lead to greater smoking cessation for early treatment non-responders. Weekly CM sessions in the first four weeks of smoking cessation intervention did not perform significantly better than SoC. However, brief booster CM sessions aimed at maintaining early smoking cessation hold clinical promise and warrant further investigation. This represents the first trial to examine the use of contingency management for smoking cessation among people with HIV within the context of a Sequential Multiple Assignment, Randomized Trial (SMART) design.

Pulmonary and Cardiac Smoking-Related History Improves Abstinence Rates in an Urban, Socioeconomically Disadvantaged Patient Population.

Tobacco use continues to take the lives of many, and targeted interventions can counter this health burden. One possible target population is patients who have had a smoking-related diagnosis, as they may have a greater drive to quit. To assess whether patients with previous cardiac or pulmonary conditions directly attributable to smoking have greater rates of abstinence post-discharge from hospitalization in the CHART-NY trial. CHART-NY was a randomized comparative effectiveness trial comparing a more intensive versus a less intensive smoking cessation intervention after hospital discharge. We divided the 1618 CHART-NY participants into a smoking-related history group of 597 and a nonsmoking-related history group of 1021 based on cardiac or pulmonary conditions in a retrospective chart review. We conducted chi-squared analyses on baseline characteristics. Using follow-up survey data, we conducted chi-squared analyses on abstinence outcomes and made logistic regression models for the predictive value of smoking-related conditions on abstinence. A total of 1059 and 1084 participants in CHART-NY who completed both 2- and 6-month follow-up surveys respectively. Self-reported 30-day abstinence at 2- and 6-month follow-up and survey data for baseline characteristics. Those abstinent at 6-month follow-up were more likely to have a smoking-attributable history (OR = 1.40, 95% CI 1.09-1.81). When stratified based on intervention, only the intensive counseling group was significant (OR = 1.53, 95% CI 1.08-2.17). The regression model using a smoking-related comorbidity score was significant at 6months (OR = 1.29, p = 0.03), and the multivariate logistic regression model analyzing each smoking-related condition separately demonstrated significance for myocardial infarction at 6months (OR = 1.66, p = 0.03). People who smoke who have experienced smoking-related conditions may be more likely to benefit from smoking cessation interventions, especially intensive telephone-based counseling. Multiple conditions had an additive effect in predicting long-term abstinence after intervention, and myocardial infarction had the greatest predictive value.

Orbitofrontal cortex to dorsal striatum circuit is critical for incubation of oxycodone craving after forced abstinence.

Relapse is a major challenge in treating opioid addiction, including oxycodone. During abstinence, oxycodone seeking progressively increases, a phenomenon termed incubation of oxycodone craving. We previously demonstrated a causal role of orbitofrontal cortex (OFC) in this incubation. Here, we studied the interaction between glutamatergic projections from OFC and dopamine 1-family receptor (D1R) signaling in dorsal striatum (DS) in this incubation in male rats. We first examined the causal role of D1R signalling in DS in incubated oxycodone seeking. Next, we combined fluorescence-conjugated cholera toxin subunit B (CTb-555, a retrograde tracer) with Fos (a neuronal activity marker) to assess whether the activation of OFC→DS projections was associated with incubated oxycodone seeking. We then used a pharmacological asymmetrical disconnection procedure to examine the role of the interaction between projections from OFC and D1R signalling in DS in incubated oxycodone seeking. We also tested the effect of unilateral pharmacological inactivation of OFC or unilateral D1R blockade of DS on incubated oxycodone seeking. Finally, we assessed whether contralateral disconnection of OFC→DS projections impacted non-incubated oxycodone seeking on abstinence day 1. We found that D1R blockade in DS decreased incubated oxycodone seeking and OFC→DS projections were activated during incubated oxycodone seeking. Moreover, anatomical disconnection of OFC→DS projections, but not unilateral inactivation of OFC or unilateral D1R blockade in DS, decreased incubated oxycodone seeking. Lastly, contralateral disconnection of OFC→DS projections had no effect on oxycodone seeking on abstinence day 1. Together, these results demonstrated a causal role of OFC→DS projections in incubation of oxycodone craving.

Changes in nucleus accumbens core translatome accompanying incubation of cocaine craving.

In the 'incubation of cocaine craving' model of relapse, rats exhibit progressive intensification (incubation) of cue-induced craving over several weeks of forced abstinence from cocaine self-administration. The expression of incubated craving depends on plasticity of excitatory synaptic transmission in nucleus accumbens core (NAcC) medium spiny neurons (MSN). Previously, we found that the maintenance of this plasticity and the expression of incubation depends on ongoing protein translation, and the regulation of translation is altered after incubation of cocaine craving. Here we used male and female rats that express Cre recombinase in either dopamine D1 receptor- or adenosine 2a (A2a) receptor-expressing MSN to express a GFP-tagged ribosomal protein in a cell-type specific manner, enabling us to use Translating Ribosome Affinity Purification (TRAP) to isolate actively translating mRNAs from both MSN subtypes for analysis by RNA-seq. We compared rats that self-administered saline or cocaine. Saline rats were assessed on abstinence day (AD) 1, while cocaine rats were assessed on AD1 or AD40-50. For both D1-MSN and A2a-MSN, there were few differentially translated genes between saline and cocaine AD1 groups. In contrast, pronounced differences in the translatome were observed between cocaine rats on AD1 and AD40-50, and this was far more robust in D1-MSN. Notably, all comparisons revealed sex differences in translating mRNAs. Sequencing results were validated by qRT-PCR for several genes of interest. This study, the first to combine TRAP-seq, transgenic rats, and a cocaine self-administration paradigm, identifies translating mRNAs linked to incubation of cocaine craving in D1-MSN and A2a-MSN of the NAcC.

Comparison of the Level of Vitamins A, D and E of Plasma Seminal of Azoospermia and Normozoospermia.

&lt;b&gt;Background and Objective:&lt;/b&gt; Biological exploration of male infertility is important for its treatment. Seminal plasma, by its composition, presents numerous molecules that can be exploited in the investigation of new sperm biomarkers. The evaluation of new biomarkers of azoosperm seminal plasma aims to identify vitamins A, D and E which can serve as discriminating biochemical markers in the exploration of azoospermia. &lt;b&gt;Materials and Methods:&lt;/b&gt; Thirty normozoospermic and 30 azoospermic sperm samples were collected by masturbation after three days of sexual abstinence from consulting patients at the Pasteur Institute of Côte d'Ivoire. After centrifugation of the sperm, the seminal plasma was collected and were analyzed for vitamin A, D and E. After extracting the vitamins from the seminal plasma, they were quantified using high-performance liquid chromatography. &lt;b&gt;Results:&lt;/b&gt; The concentration of vitamin A in seminal plasma from normal samples was 1.66±1.81 and 0.28±0.52 mg/L in pathological samples. The average vitamin D concentration in seminal plasma of normospermia was 0.27±0.40 and 0.08±0.12 mg/L in seminal plasma of azoospermia. For vitamin E, the results obtained show an average concentration of 2.56±3.58 mg/L in normal ejaculate and 0.33±0.51 mg/L in pathological ejaculate. Only vitamins A and E showed a significant difference in the two categories of sperms. &lt;b&gt;Conclusion:&lt;/b&gt; The determination of the concentration of vitamins A, D and E in seminal plasma showed that only vitamins A and E can serve as a biomarker for the differentiation of normozoospermic and azoospermic sperm.

Peer navigation for smoking cessation in people with HIV who smoke: a pilot randomized controlled trial.

People with HIV (PWH) cite smoking within their social networks as a barrier to quitting. We examined the feasibility, acceptability, and preliminary efficacy of a tailored intervention, Peer Navigation Social Support for Smoking cessation (PNSS-S), designed specifically for PWH who smoke. We randomized 64 PWH who smoked (mean age 54.5 years; 41% female) to PNSS-S or standard care (SC). After meeting with a clinic nurse to discuss quitting strategies and pharmacotherapy, the PNSS-S group received 12 weekly phone calls from a trained HIV peer navigator (PN), who provided smoking cessation counseling and social support for quitting. Outcomes were assessed at 12- and 24-weeks. Sixty-two percent of participants indicated interest in quitting at baseline. PN utilization was high with a mean number of weekly calls completed of 8.9 (SD 3.1), demonstrating excellent feasibility. Higher treatment satisfaction scores (29.1 [SD 3.0]) were reported in PNSS-S, compared to control (25.8 [SD 4.1], t = -3.39, d = 0.89, p = .001). Notably, positive social support for quitting increased significantly from baseline to week 12 in PNSS-S (17.4 [SD 11.4] to 25.1 [SD 12.2], p = .01), whereas SC showed no significant change (t = 1.11, df 29, p = .24). At week 24, 5 (16.6%) participants in PNSS-S and 3 (8.8%) in SC endorsed 7-day point prevalence smoking abstinence: OR=2.05 95% CI=[0.45-10.88]. Peer-based smoking cessation counseling increased the odds of abstinence and significantly increased social support for quitting. Further study is warranted. Cross training HIV peer navigators to address smoking cessation may be a cost-effective approach, as it utilizes existing HIV clinic-based resources. By strengthening social support and providing a peer-based approach, this intervention may help reduce the burden of tobacco-related health issues in this population, ultimately contributing to better overall health and longevity for PWH. Further research is needed to refine and expand upon these findings.

Residual and enduring effects of cannabis use on cognitive and psychomotor function: A study of adults during unrestricted cannabis use, short-term abstinence, and protracted abstinence.

The impact of cannabis on cognitive and psychomotor function is important to understand, given the role of the endocannabinoid system in these critical processes. The literature has shown robust acute negative effects of cannabis on cognition and psychomotor skills during intoxication, and to a lesser degree, persisting effects following short-term abstinence up to 4 weeks. However, whether these decrements resolve after long-term cessation of use remains unclear. We evaluated cognitive and psychomotor function in 31 adults with current cannabis use during unrestricted use (UNR) and after a 3-day abstinence (RES), 23 adults with former cannabis use (> 90 days abstinent; FU), and 58 nonusing controls (CON) using the cognition and motor batteries of the National Institutes of Health Toolbox. Linear mixed models showed no significant differences in cognitive and motor performance between UNR, RES, and FU groups. Group effects emerged such that CON outperformed UNR on the Oral Reading Recognition Test, and CON outperformed both UNR and RES on the Picture Vocabulary Test. In terms of psychomotor function, FU, RES, and UNR performed better than CON on the Grip Strength Test. In this comprehensive examination of cognitive and psychomotor performance in adults with cannabis use with 3 days to > 90 days of abstinence, our results indicated that the cognitive impacts of chronic, heavy cannabis use are observable during short-term abstinence but remit after > 90 days of abstinence. This highlights widespread impacts of cannabis use abstinence across cognitive and psychomotor domains. Future studies are needed to evaluate whether these effects are also observable with use reduction, as opposed to abstinence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cannabis Use and Subsequent CIGARETTE Discontinuation among U.S. Adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1-5.

This study examined the association between current co-use of cannabis and cigarettes in the past 30 days, and subsequent cigarette discontinuation (past 30-day point prevalence abstinence) among U.S. adults with established cigarette use in the Population Assessment of Tobacco and Health (PATH) Study. Additionally, we investigated the impact of co-use on the subsequent discontinuation of all combustible tobacco products. A total of 26,381 observations contributed by 8,218 adults with established cigarette use (i.e., smoked ≥ 100 cigarettes in their lifetime, and currently smoking cigarettes every day or some days) from Waves 1-5 of the PATH Study were included in the analysis. Weighted Generalized Estimating Equations (GEE) models were used to evaluate the association between current co-use at baseline (Waves 1-4) with the outcomes assessed at the subsequent wave (cigarette and combustible tobacco discontinuation at Waves 2-5). Final models included: demographic characteristics (age, sex, race and ethnicity, educational attainment), behavior characteristics (intention to quit, internalizing symptoms, externalizing symptoms, substance use problems), and wave-pair. Over one-third (35.91%) of cigarette users self-reported co-use during the study period. Cannabis use among adults with established cigarette use increased over time. Co-use was associated with a decreased odds of cigarette smoking discontinuation at follow-up, after adjusting for covariates (aOR: 0.81; 95% CI: 0.72, 0.93; p=0.0018). Similar effect sizes were observed for discontinuation of all combustible tobacco products (aOR: 0.75; 95% CI: 0.65, 0.86; p<.0001). Cannabis use among adults who smoke cigarettes was inversely related to subsequent cigarette discontinuation, suggesting that co-use may reduce likelihood of successful tobacco cessation. Findings demonstrate that cannabis use may lead to lower odds of discontinuation among adults with established cigarette use; therefore, individuals that co-use cigarettes and cannabis may need additional tobacco cessation support. Notably, this study observed an increase in co-use of cigarettes and cannabis, emphasizing the need for researchers and public health programs to shift their focus towards understanding and addressing concurrent substance use among adults who smoke cigarettes.

Impact of Quitline Services on Tobacco Cessation: An Application of Modern Epidemiological Methods.

This study investigated the effectiveness of quitline service intensity (high vs. low) on past 30-day tobacco abstinence at 7-months follow-up, using observational data from the Oklahoma Tobacco Helpline (OTH) between April 2020 and December 2021. To assess the impact of loss to follow-up and non-random treatment assignment, we fit the parameters of a marginal structural model to estimate inverse probability weights for censoring (IPCW) and treatment (IPTW) and combined (IPCTW). The Risk Ratio (RR) was estimated using modified Poisson regression with robust variance estimator. Of the 4,695 individuals included in the study, 64% received high-intensity cessation services, and 53% were lost to follow-up. Using the conventional complete case analysis (responders only), high-intensity cessation services were associated with abstinence (RR=1.18; 95 CI: 1.04, 1.34). The effect estimate was attenuated after accounting for censoring (RR=1.14; 95% CI: 1.00, 1.30). After adjusting for both baseline confounding and selection bias via IPTCW, high-intensity cessation services were associated with 1.23 times (95% CI: 1.08, 1.41) the probability of abstinence compared to low-intensity services. Despite relatively high loss to follow-up, accounting for selection bias and confounding did not notably impact quit rates or the relationship between intensity of quitline services and tobacco cessation among OTH participants.

Sex-specific effects of chronic stress prior to cocaine exposure on cue- vs drug-induced relapse after prolonged abstinence

The comorbidity between cocaine use disorder (CUD) and trauma/stressor-related disorders suggests a connection between neurophysiological changes induced by stress and those that lead to cocaine use. Due to the unexpected and sometimes uncontrollable nature and timing of stressful life events, their capacity to induce drug use poses a significant challenge for the administration of cocaine relapse therapy. This study aims to investigate the impact of chronic stress applied prior to cocaine acquisition on the development of cocaine-seeking behavior after different periods of drug abstinence in male and female rats. Rats were exposed to five days of inescapable footshocks (chronic stress) before undergoing extended access cocaine self-administration. Different groups then underwent forced abstinence periods of 1, 15, or 30 days before cue- and cocaine-induced seeking tests. Results showed that, after 30 days of abstinence, stressed females exhibited higher cue-induced, but not cocaine-induced seeking, compared to female controls and to males. In contrast, at 30 days, stressed males showed higher cocaine-, but not cue-induced seeking, versus controls. Such sex-dependent alterations in motivation and drug effects following prolonged abstinence highlight the importance of considering sex-specific differences in stress-related addiction research. Ongoing work should evaluate other stressors and self-administration models to elucidate neurophysiological and hormonal mechanisms underlying the incubation of cocaine craving. Identifying shared pathways between chronic stress and addiction could offer novel strategies for treating trauma/stress-related substance use disorders in a sex-specific manner.

Buprenorphine treatment and clinical outcomes under the opioid use disorder cascade of care

BackgroundChallenges to engagement and retention on buprenorphine undermine treatment of individuals with opioid use disorder (OUD). Under the OUD Cascade of Care framework, we sought to identify patient characteristics and treatment response associated with superior clinical outcomes. MethodsA retrospective cohort study of specialty buprenorphine treatment patients entering treatment (n=19,487) based on EHR records from a large multi-state buprenorphine treatment network (2011–2019). Person-level care episodes were evaluated across treatment intake, engagement (i.e. 2+ visits in the month following intake), and retention at 6, 12, and 24 months. Time to achieving 90 days of continuous opioid abstinence was assessed using Cox proportional hazards regressions models and also assessed as a predictor of long-term retention. ResultsMost patients engaged (82.4 %), but retention steadily declined over 6-month (38.7 %), 12-month (26.2 %), and 24-month (17.1 %) timepoints. Opioid-positive baseline tests were associated with lower hazards of achieving continuous abstinence for both buprenorphine-positive (aHR=0.33, p<.001) and buprenorphine-negative (aHR=0.49,p<.001) intakes. Opioid abstinence was associated with buprenorphine-positive baseline testing (aHR=1.59,p<.001), especially for those testing opioid-negative (aHR=1.82,p<.001). Patients who achieved and sustained abstinence at 6 months in care were 4.1 and 5.5 times as likely to achieve 12-month and 24-month retention, respectively, compared to patients with intermittent opioid use. ConclusionTreatment discontinuation was concentrated early in care and buprenorphine and opioid status at intake were prognostic of achieving and sustaining abstinence. Early abstinence was associated with higher likelihood of subsequent stage progression. Implementing interventions to support early clinical stability for high-risk patients is critical to improve clinical outcomes.