Risk For Substance Use Disorders Research Articles

Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis.

Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use. The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic. Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described. Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre- and post-regulatory change and pre- and post-COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time. Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances-particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility.

Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022

Abstract Background Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents. Methods This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p < 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period. Conclusions Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors. Key messages • The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls. • While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.

Prevalence and correlates of common mental disorders in people living with HIV in primary health care facilities in Ekurhuleni district.

There is paucity of data regarding the prevalence of common mental disorders (CMDs) in people living with HIV (PLHIV) in Ekurhuleni Health District (EHD), South Africa. Also, there is an association between CMDs and poor HIV treatment outcomes. Guidelines therefore recommend that healthcare practitioners screen for CMDs in PLHIV. To determine the prevalence and correlates of CMDs in PLHIV in primary health care facilities in Ekurhuleni district. Seven primary health facilities in Ekurhuleni district. A cross-sectional study was conducted in which data were collected from 403 randomly selected participants, using a questionnaire that incorporated the scores of the Patient Health Questionnaire (PHQ)-9, generalised anxiety disorder (GAD)-7 and substance use disorder (SUD) criteria of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). The proportion screening positive for CMDs was calculated. 'R' statistical software was used for univariate and multivariate analysis, with a confidence interval (CI) of 95%. Most participants (63%) were female and the mean age was 43 ± 11 years. Forty per cent of participants screened positive for CMDs, 16.6%, 15.1% and 24.1% screened positive for depression, GAD and SUD, respectively. Common mental disorders were associated with poor adherence and HIV non-suppression, while increasing age and being female were associated with reduced risk of CMDs. The risk of severe SUDs in males was 11 times compared to females. During assessment, clinicians screened only 16%, 14% and 40% of the cohort for depression, GAD and SUDs, respectively. The prevalence of CMDs remains high. Adherence to recommendations to screen for CMDs in PLHIV is low.Contribution:This study reveals a low CMD screening rate, estimates the prevalence of CMDs in PLHIV in Ekurhuleni district, and its impact.

Functional brain connectivity predictors of prospective substance use initiation and their environmental correlates

BackgroundEarly substance use initiation (SUI) places youth at substantially higher risk for later substance use disorders. Furthermore, adolescence is a critical period for the maturation of brain networks, the pace and magnitude of which are susceptible to environmental influences and may shape risk for SUI. MethodsWe examined whether patterns of functional brain connectivity during rest (rsFC), measured longitudinally in pre-and-early adolescence, can predict future SUI. Next, in an independent sub-sample, we tested whether these patterns are associated with earlier environmental exposures, specifically neighborhood pollution and socioeconomic dimensions. We utilized data from the Adolescent Brain Cognitive Development (ABCD) Study®. SUI was defined as first-time use of at least one full dose of alcohol, nicotine, cannabis, or other drugs. We created a control group (N = 228) of participants without SUI who were matched with the SUI group (N = 233) on age, sex, race/ethnicity, and parental income and education. ResultsMultivariate analysis showed that whole-brain rsFC from 9-10 to 11-12 years of age (prior to SUI) prospectively differentiated the SUI and control groups. The SUI-related rsFC pattern was also related to aging in both groups, suggesting a pattern of accelerated maturation in the years prior to SUI. This same pattern of rsFC was predicted by higher pollution, but not neighborhood disadvantage (adjusted for family socioeconomic factors) in an independent sub-sample (N = 2,854). ConclusionBrain functional connectivity patterns in early adolescence that are linked to accelerated maturation can predict SUI in youth and are associated with exposure to pollution.

Substance use disorder risk assessment: positive emotional experiences with first time use and substance use disorder risk.

Substance Use Disorder (SUD) screening tools used in current practice are designed to identify SUD once patients have begun regular dangerous drug use. While these screening tools are valuable, prevention and avoidance of SUD would save countless lives. The climbing number of deaths due to drug overdose make screening for and prevention of SUD imperative. This study addresses this care gap. The aim was to develop a simple screening tool for patients who may be prone to develop Alcohol Use Disorder (AUD) and/or SUD prior to addiction. It was hypothesized that participants with initially positive emotional experiences would be correlated with a future SUD diagnosis. The study involved a self-administered survey using a cross-sectional design and was carried out over one-month in the spring of 2021. Those patients who presented to the MAT clinic (SUD group) were seen in a separate area than the patients presenting for urgent care (Comparison group). Participants (N=259) were voluntarily recruited from MAT and Urgent care: Patients receiving acute care were assigned to the Comparison (N = 126, 50.8% female, 5.7% non-white, 27.2% age < 34) and those receiving treatment for SUD were assigned to the MAT group (N =133, 40.8% female, 4.8% non-white, 36.8% ≤34). The survey questioned demographics (4 items), risk factors for AUD/SUD (6items), information about first alcohol/opioid experiences (16 items), and factors for seeking AUD/SUD treatment and recovery (2 items). Feelings were categorized as positive (e.g., euphoria, happiness, self-confident), neutral (e.g., nothing, normal), or negative (e.g., depressed, sad, sick). The MAT group felt more positive feelings with first usage of alcohol and opioids compared to the comparison group (p<.001). With first usage of opioids specifically, MAT (0.13 ± 0.04) and comparison (0.29 ± 0.07) groups differed (p <.001). Over half (55.3%), of the MAT participants reported feeling self-confident with first use of alcohol while only 29.7% of the comparison reported this (p<.001). Over three-fifths (63.7%) of the MAT group reported feeling of euphoria with the first usage of opioids compared to one-tenth (9.8%) in the comparison group (p<.001). This retrospective cross-sectional report shows the first affective responses to substances may predict risk for future SUD and could be a prevention screening tool. Asking patients about positive feelings with first usage of alcohol/opioids could be a simple screening tool employed for prevention.

Comparing cognitive behavioral therapy and social prescribing in patients with loneliness on long-term opioid therapy to reduce opioid misuse: protocol for a randomized controlled trial

BackgroundPatients with chronic pain on opioids frequently experience loneliness, which is associated with poorer health outcomes and higher risk for opioid misuse and opioid use disorder. Given that almost half of opioids are prescribed in primary care, a critical need exists for the development and testing of interventions to reduce loneliness in primary care patients at risk for opioid misuse. Cognitive behavioral therapy and social prescribing have been shown to be efficacious in reducing loneliness and improving outcomes in other populations but have not been tested in patients at risk for substance use disorder. The overall objective of our study is to reduce opioid misuse and opioid use disorder by addressing loneliness in patients on long-term opioid therapy in real-world primary care settings.MethodsWe will conduct a 3-arm pragmatic, randomized controlled trial to compare the effectiveness of two group-based, telehealth-delivered interventions with treatment as usual: (1) cognitive behavioral therapy to address maladaptive thought patterns and behaviors around social connection and (2) a social prescribing intervention to connect participants with social opportunities and develop supportive social networks. Our primary outcome is loneliness as measured by the UCLA Loneliness Scale and our dependent secondary outcome is opioid misuse as measured by the Common Opioid Misuse Measure. We will recruit 102 patients on long-term opioid therapy who screen positive for loneliness from 2 health care systems in Washington State. Implementation outcomes will be assessed using the RE-AIM framework.DiscussionOur study is innovative because we are targeting loneliness, an under-addressed but critical social risk factor that may prevent opioid misuse and use disorder in the setting where most patients are receiving their opioid prescriptions for chronic pain. If successful, the project will have a positive impact in reducing loneliness, reducing opioid misuse, improving function and preventing substance use disorder.Trial RegistrationNCT06285032, issue date: February 28, 2024, original.

Sex-specific differences in brain activity dynamics of youth with a family history of substance use disorder.

An individual's risk of substance use disorder (SUD) is shaped by a complex interplay of potent biosocial factors. Current neurodevelopmental models posit vulnerability to SUD in youth is due to an overreactive reward system and reduced inhibitory control. Having a family history of SUD is a particularly strong risk factor, yet few studies have explored its impact on brain function and structure prior to substance exposure. Herein, we utilized a network control theory approach to quantify sex-specific differences in brain activity dynamics in youth with and without a family history of SUD, drawn from a large cohort of substance-naïve youth from the Adolescent Brain Cognitive Development Study. We summarize brain dynamics by calculating transition energy, which probes the ease with which a whole brain, region or network drives the brain towards a specific spatial pattern of activation (i.e., brain state). Our findings reveal that a family history of SUD is associated with alterations in the brain's dynamics wherein: i) independent of sex, certain regions' transition energies are higher in those with a family history of SUD and ii) there exist sex-specific differences in SUD family history groups at multiple levels of transition energy (global, network, and regional). Family history-by-sex effects reveal that energetic demand is increased in females with a family history of SUD and decreased in males with a family history of SUD, compared to their same-sex counterparts with no SUD family history. Specifically, we localize these effects to higher energetic demands of the default mode network in females with a family history of SUD and lower energetic demands of attention networks in males with a family history of SUD. These results suggest a family history of SUD may increase reward saliency in males and decrease efficiency of top-down inhibitory control in females. This work could be used to inform personalized intervention strategies that may target differing cognitive mechanisms that predispose individuals to the development of SUD.

Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis.

Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses. There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025). The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

Sex differences in distributed error-related neural activation in problem-drinking young adults

BackgroundDetecting and responding to errors is central to goal-directed behavior and cognitive control and is thought to be supported by a network of structures that includes the anterior cingulate cortex and anterior insula. Sex differences in the maturational timing of cognitive control systems create differential periods of vulnerability for psychiatric conditions, such as substance use disorders. MethodsWe examined sex differences in error-related activation across an array of distributed brain regions during a Go/No-Go task in young adults with problem alcohol use (N=69; 34 females; M=19.4 years). Regions of interest previously linked to error-related activation, including anterior cingulate cortex, insula, and frontoparietal structures, were selected in a term-based meta-analysis. Individual differences in their responses to false alarm (FA) inhibitory errors relative to “go” trials (FA>GO) and correct rejections (FA>CR) were indexed using multivariate summary measures derived from principal components analysis. ResultsFA>GO and FA>CR activation both revealed a first component that explained the majority of the variance across error-associated regions and displayed the strongest loadings on salience network structures. Compared to females, males exhibited significantly higher levels of the FA>GO component but not the FA>CR component. ConclusionsMales exhibit greater salience network activation in response to inhibitory errors, which could be attributed to sex differences in error-monitoring processes or to other functions (e.g., novelty detection). The findings are relevant for the further characterization of sex differences in cognitive control and may have implications for understanding individual differences in those at risk for substance use or other cognitive control disorders.

Benzodiazepine use for anxiety disorders is associated with increased long-term risk of mood and substance use disorders: A large-scale retrospective cohort study

BackgroundBenzodiazepines (BZDs) are widely prescribed for anxiety disorders. However, the long-term implications on mental health remain uncertain, especially the potential association between chronic BZD use and subsequent diagnosis of mood and substance use disorders (SUDs). MethodWe conducted a 5-year retrospective cohort study by analyzing the TriNetX database, a real-time electronic medical record network. The study population was defined as patients aged 18–65 with anxiety disorders (ICD-10-CM: F40-F48). We employed propensity score matching to pair a BZD-exposed cohort (≥12 BZD prescriptions) with a BZD-unexposed control cohort. The outcomes were defined as depressive disorders, bipolar disorders, and SUDs. We employed Kaplan-Meier analyses to assess the survival probability over five years following diagnosis and BZD exposure; log-rank test to obtain the hazard ratio (HR) with 95 % confidence interval (CI). ResultsWe identified and matched 76,137 patients in the study and control cohorts. Compared to the control cohort, the BZD-exposed group exhibited significantly higher risks of being diagnosed with depressive disorders (HR, 2.64; 95 % CI, 2.59–2.68), bipolar disorders (HR, 4.39; 95 % CI, 4.15–4.64), overall substance use disorders (HR, 3.00; 95 % CI, 2.92–3.08), alcohol use disorder (HR, 3.38; 95 % CI, 3.20–3.57), stimulant use disorder (HR, 3.24; 95 % CI, 2.95, 3.55), cannabis use disorder (HR, 2.93; 95 % CI, 2.75–3.11), inhalant use disorder (HR, 4.14; 95 % CI, 3.38–5.06), and nicotine use disorder (HR, 2.72; 95 % CI, 2.63–2.81). ConclusionOur findings demonstrate a concerning association between BZD use and an increased risk of being diagnosed with various mood disorders and SUDs.

Impact of childhood adversity on acute subjective effects of stimulant and opioid drugs: Evidence from placebo-controlled studies in healthy volunteers.

Early-life adversities are known to alter drug reward processing in rodents. Despite the well-known link between early adversity and the risk of substance use disorder, few studies have measured how childhood adversity affects human drug reward. Here, we assessed the relationship between historical childhood adversities and responses to single doses of methamphetamine, d-amphetamine or buprenorphine in healthy participants. Using a secondary analysis approach, we assessed the impact of childhood adversity on drug effects from three randomised, placebo-controlled studies in which healthy volunteers received methamphetamine (20 mg oral; n = 35), d-amphetamine (20 mg oral; n = 54) or buprenorphine (0.2 mg sublingual; n = 35). Ratings of feeling effect, liking, disliking, feeling high and wanting more of the drug were collected 15-210 min post-administration, and heart rate changes were analysed using random-intercept mixed-effect models. The area under the curve from these and previous studies was calculated to visualise the relationship between childhood adversity severity and drug effects. Greater childhood adversity was associated with reduced feel effects (significant three-way interactions b = -0.07, 95% CI [-0.12, -0.02], p = 0.009), like effects (b = -0.07, 95% CI [-0.13, -0.00], p = 0.038) and feel high (b = -0.06, 95% CI [-0.10, -0.01], p = 0.020) towards the stimulant drugs 90-180 min post-administration. Childhood adversity was not significantly associated with other subjective or heart rate responses to the drugs. Overall, participants with more childhood adversities reported dampened subjective responses to stimulant drugs, but not to buprenorphine. Future studies should examine the generalisability of these relationships, to identify the mechanisms underlying the link between childhood adversity and drug responsiveness.

Dysregulation of kappa opioid receptor neuromodulation of lateral habenula synaptic function following a repetitive mild traumatic brain injury

Mild traumatic brain injury (mTBI) increases the risk of affective disorders, anxiety and substance use disorder. The lateral habenula (LHb) plays an important role in pathophysiology of psychiatric disorders. Recently, we demonstrated a causal link between mTBI-induced LHb hyperactivity due to excitation/inhibition (E/I) imbalance and motivational deficits in male mice using a repetitive closed head injury mTBI model. A major neuromodulatory system that is responsive to traumatic brain injuries, influences affective states and also modulates LHb activity is the dynorphin/kappa opioid receptor (Dyn/KOR) system. However, the effects of mTBI on KOR neuromodulation of LHb function are unknown. Here, we first used retrograde tracing in male and female Cre mouse lines and identified several major KOR-expressing and two prominent Dyn-expressing inputs projecting to the mouse LHb, highlighting the medial prefrontal cortex (mPFC) and the ventromedial nucleus of the hypothalamus (VMH) as the main LHb-projecting Dyn inputs that regulate KOR signaling to the LHb. We then functionally evaluated the effects of in vitro KOR modulation of spontaneous synaptic activity within the LHb of male and female sham and mTBI mice at 4 week post-injury. We observed sex-specific differences in spontaneous release of glutamate and GABA from presynaptic terminals onto LHb neurons with higher levels of presynaptic glutamate and GABA release in females compared to male mice. However, KOR effects on the spontaneous E/I ratios and synaptic drive ratio within the LHb did not differ between male and female sham and mTBI mice. KOR activation generally suppressed spontaneous glutamatergic transmission without altering GABAergic transmission, resulting in a significant but sex-similar reduction in net spontaneous E/I and synaptic drive ratios in LHb neurons of sham mice. Following mTBI, while responses to KOR activation at LHb glutamatergic synapses remained intact, LHb GABAergic synapses acquired an additional sensitivity to KOR-mediated inhibition where we observed a reduction in GABA release probability in response to KOR stimulation in LHb neurons of mTBI mice. Further analysis of percent change in spontaneous synaptic ratios induced by KOR activation revealed that independent of sex mTBI switches KOR-driven synaptic inhibition of LHb neurons (normally observed in sham mice) in a subset of mTBI mice toward synaptic excitation resulting in mTBI-induced divergence of KOR actions within the LHb. Overall, we uncovered the sources of major Dyn/KOR-expressing synaptic inputs projecting to the mouse LHb. We demonstrate that an engagement of intra-LHb Dyn/KOR signaling provides a global KOR-driven synaptic inhibition within the mouse LHb independent of sex. The additional engagement of KOR-mediated action on LHb GABAergic transmission by mTBI could contribute to the E/I imbalance after mTBI, with Dyn/KOR signaling serving as a disinhibitory mechanism for LHb neurons of a subset of mTBI mice.

TAPS-tool reveals severe under detection of substance use problems in patients with severe mental illness.

Substance use disorders (SUD) and associated problems are highly prevalent but often undetected in patients with Severe Mental Illness (SMI). This study investigates the prevalence, under-detection, and variables associated with a high risk of SUD in a Dutch sample of adult outpatient SMI patients (N = 83). Substance use (The Tobacco, Alcohol, Prescription medication, and other Substance use -TAPS-tool), quality of life (Manchester Short Assessment of Quality of Life-MANSA), general functioning (Health of the Nation Outcome Scale-HoNOS), DSM-5 classifications and patient characteristics (age, education, marital status) were assessed. Detection of SUD was determined by calculating % agreement of DSM-5 classification to TAPS outcome. A logistic regression analysis was performed to determine the association of patient characteristics, quality of life and general functioning to an increased risk of SUD as determined by the TAPS. Concerning prevalence, 89% of the patients used tobacco, above guideline-recommended daily limits of alcohol, illicit drugs or prescription medications for nonmedical purposes. Almost all smokers, half of the alcohol users and three-quarter of the patients that use marihuana or stimulant drugs had a high risk of SUD. All patients with high risk of SUD associated with alcohol, drugs or medications also had SUD associated with tobacco use. Concerning under detection less than half of the patients with a high risk of SUD according the TAPS had a SUD in their DSM-5 classification. Gender, partner, age and satisfaction about the relationship with family had a significant association with a high risk of SUD. Screening for addiction in an SMI sample with the TAPS-tool revealed a high prevalence of substance use and a high risk of SUD. TAPS outcomes compared to the clinically obtained DSM-5 classification revealed a high degree of under-detection of substance use problems. Smoking seems to pose a specific additional risk of addiction and deserves more attention in treatment to achieve greater health care benefits.

Genome-wide meta-analyses of cross substance use disorders in European, African, and Latino ancestry populations.

Genetic risks for substance use disorders (SUDs) are due to both SUD-specific and SUD-shared genes. We performed the largest multivariate analyses to date to search for SUD-shared genes using samples of European (EA), African (AA), and Latino (LA) ancestries. By focusing on variants having cross-SUD and cross-ancestry concordant effects, we identified 45 loci. Through gene-based analyses, gene mapping, and gene prioritization, we identified 250 SUD-shared genes. These genes are highly expressed in amygdala, cortex, hippocampus, hypothalamus, and thalamus, primarily in neuronal cells. Cross-SUD concordant variants explained ~ 50% of the heritability of each SUD in EA. The top 5% individuals having the highest polygenic scores were approximately twice as likely to have SUDs as others in EA and LA. Polygenic scores had higher predictability in females than in males in EA. Using real-world data, we identified five drugs targeting identified SUD-shared genes that may be repurposed to treat SUDs.

Risk of substance use disorder after bariatric surgery: A systematic review of the literature

ObjectiveIn relation with the growing literature suggesting an increased risk of alcohol or other substance use disorder after bariatric surgery, we aimed to review the risk of any substance use disorder in patients undergoing bariatric surgery. MethodsA systematic review of the relevant literature was conducted from November 2019 to December 2021, using PubMed, Cochrane and Web of science. ResultsIn total, 44 articles were included in the review. Most of the studies find out an increased risk of alcohol and drugs use disorders two years after surgery, with a large proportion of new onset. Young age, males, history of psychiatric disorder and bypass surgery were potential risk factors. An increased risk of substance use disorder regarding to analgesics or psychotropic drugs was retrieved in 5 out of 8 studies. Results for tobacco use were conflicting. ConclusionWe showed that an increased risk of substance use disorder seems to appear 2 years after bariatric surgery, concerning not only preoperative users, but also new users.

The Epidemic of Congenital Syphilis in the Indigenous and Rural Populations of South Dakota.

From 2020 to 2023, South Dakota witnessed a substantial increase in cases of congenital syphilis (CS), with the highest rates identified in rural and Native American (NA) communities. Here, we discuss 3 severe cases of CS in premature infants born to NA individuals and communities in South Dakota with poor access to prenatal care. The infants in these 3 cases presented with varying clinical conditions, including respiratory failure, persistent pulmonary hypertension of the newborn, severe direct hyperbilirubinemia, feeding intolerance, and necrotizing enterocolitis. Lack of prenatal care and other systemic health disparities likely contributed to the increased disease burden. For NA communities, rurality, limited resources, systemic racism, historical trauma, and lack of trust in medical institutions likely contribute to inadequate prenatal care. All 3 of these cases also occurred in pregnant people with a present or history of substance use disorders, which may have led to further hesitancy to seek care because of fear of prosecution. To combat the rising number of syphilis and CS cases, we advocate for new and continued outreach that provides education about and testing for sexually transmitted diseases to NA and rural populations, increased care coordination, the integration of point-of-care testing and treatment strategies in lower resource centers, and legislative allocation of additional resources to engage pregnant people with or at risk for substance use disorders.

Patterns of substance use and initiation timing in adults with substance abuse: a comparison between those with and without attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a prevalent psychiatric disorder in childhood and adolescence, persisting into adulthood in 60% of cases, with an adult age prevalence rate of 4%. substance use disorder (SUD) is a recognized comorbidity with significant social and financial implications, necessitating detailed investigation. This longitudinal study focused on adults with SUD in addiction detention in two camps including Toska and Chitgar in the west and south of Tehran during 2021-2022. Participants underwent assessment using the Structured Clinical Interview for DSM Disorders (SCID) to identify individuals with SUD, excluding those with major mental problems. The remaining subjects were assessed by Conner's questionnaire. And positive cases underwent a comprehensive ADHD interview. The study comprised 50 individuals with ADHD and 90 without ADHD, allowing for a comparative analysis of the onset age of substance use and patterns across both groups. The substances examined included alcohol, cannabis, crack, methamphetamine, tramadol, methadone, opium, ecstasy, morphine, and hypnotics. The study revealed a lower age of onset of substance use in the ADHD group. Furthermore, individuals with ADHD exhibited higher rates of alcohol, cannabis, methamphetamine, and tramadol use, while the non-ADHD group showed elevated usage of Ritalin, methadone, ecstasy, morphine, and hypnotics. Prompt diagnosis and treatment of ADHD regarding the lower onset age of substance use and a further range of high-risk substances, such as alcohol, methamphetamine, and crack, would be crucial. Additionally, based on these findings, policy recommendations should emphasize early ADHD screening and intervention strategies to mitigate the risk of substance use disorders, thereby addressing the associated social and financial burdens.

Gene × environment effects and mediation involving adverse childhood events, mood and anxiety disorders, and substance dependence.

Adverse childhood events (ACEs) contribute to the development of mood and anxiety disorders and substance dependence. However, the extent to which these effects are direct or indirect and whether genetic risk moderates them is unclear. We examined associations among ACEs, mood/anxiety disorders and substance dependence in 12,668 individuals (44.9% female, 42.5% African American/Black, 42.1% European American/white). Using latent variables for each phenotype, we modelled direct and indirect associations of ACEs with substance dependence, mediated by mood/anxiety disorders (the forward or 'self-medication' model) and of ACEs with mood/anxiety disorders, mediated by substance dependence (the reverse or 'substance-induced' model). In a subsample, we tested polygenic scores for the substance dependence and mood/anxiety disorder factors as moderators in the mediation models. Although there were significant indirect paths in both directions, mediation by mood/anxiety disorders (the forward model) was greater than that by substance dependence (the reverse model). Greater genetic risk for substance use disorders was associated with a weaker direct association between ACEs and substance dependence in both ancestry groups (reflecting gene × environment interactions) and a weaker indirect association in European-ancestry individuals (reflecting moderated mediation). We found greater evidence that substance dependence reflects self-medication of mood/anxiety disorders than that mood/anxiety disorders are substance induced. Among individuals at higher genetic risk for substance dependence, ACEs were less associated with that outcome. Following exposure to ACEs, multiple pathways appear to underlie the associations between mood/anxiety disorders and substance dependence. Specification of these pathways could inform individually targeted prevention and treatment approaches.

Functional brain connectivity predictors of prospective substance use initiation and their environmental correlates.

Early substance use initiation (SUI) places youth at substantially higher risk for later substance use disorders. Furthermore, adolescence is a critical period for the maturation of brain networks, the pace and magnitude of which are susceptible to environmental influences and may shape risk for SUI. We examined whether patterns of functional brain connectivity during rest (rsFC), measured longitudinally in pre-and-early adolescence, can predict future SUI. In an independent sub-sample, we also tested whether these patterns are associated with key environmental factors, specifically neighborhood pollution and socioeconomic dimensions. We utilized data from the Adolescent Brain Cognitive Development (ABCD) Study®. SUI was defined as first-time use of at least one full dose of alcohol, nicotine, cannabis, or other drugs. We created a control group (N = 228) of participants without SUI who were matched with the SUI group (N = 233) on age, sex, race/ethnicity, and parental income and education. Multivariate analysis showed that whole-brain rsFC prior to SUI during 9-10 and 11-12 years of age successfully differentiated the prospective SUI and control groups. This rsFC signature was expressed more at older ages in both groups, suggesting a pattern of accelerated maturation in the SUI group in the years prior to SUI. In an independent sub-sample (N = 2,854) and adjusted for family socioeconomic factors, expression of this rsFC pattern was associated with higher pollution, but not neighborhood disadvantage. Brain functional connectivity patterns in early adolescence that are linked to accelerated maturation and environmental exposures can predict future SUI in youth.

Characteristics of Adolescents with and without a Family History of Substance Use Disorder from a Minority Cohort.

Family history (FH+) of substance use disorder (SUD) is an established risk factor for offspring SUD. The extent to which offspring psychological traits or the family environment, each of which may be relevant to familial transmission of SUD risk, vary by FH+ in socioeconomically disadvantaged populations is less clear. We compared the family/social environmental and psychological characteristics of 73 FH+ and 69 FH- youth ages 12-16, from a study of parental criminal justice system involvement in a primarily low-income, minority urban population. A latent profile analysis (LPA) empirically identified groups of subjects with similar psychological characteristics, which were then compared by FH+. FH+ youths were found to have greater mean household size, greater parental psychological aggression, and a higher mean number of adverse childhood experiences, even without considering parental SUD. FH+ individuals had lower report card grades according to parental report and were more likely to have a history of externalizing disorders than FH- individuals. However, FH+ was not significantly associated with many psychological characteristics or with the class membership from the LPA. In conclusion, among a population of low-income, minority urban youth, FH+ was associated with differences in the family environment and only subtle differences in individual psychological characteristics.