Gateway Drug Research Articles

Is cannabis a slippery slope? Associations between psychological dysfunctioning, other substance use, and impaired driving, in a sample of active cannabis users.

Cannabis is a gateway drug that can lead to the engagement of other substances. Psychological dysfunctioning and dependence have been highlighted as primary components to substance misuse. The purpose of this study was to investigate what aspects of cannabis use and psychological dysfunctioning are associated with the engagement of other substances and impaired driving. Subject to screening, 200 active adult cannabis users completed an online survey. Existing data involving non-cannabis users (N = 833) were also implemented as comparative data. The comparisons suggested that cannabis users were far more likely to have used other drugs in the past 12 months, compared to non-cannabis users. Bivariate correlations and multiple regressions indicated that the degree of cannabis use and likely dependence, psycho-social motives for using cannabis, emotion dysregulation, and psychopathology were positively associated with the frequency of using and driving on other substances. Finally, an ANOVA demonstrated that outside of age, there were no apparent differences in substance use behaviours, motives for using cannabis, and psychological dysfunction, between medicinal and black-market cannabis users. These findings highlight the potential benefits of incorporating self-regulatory concepts into current road safety initiatives, which aim to reduce the interconnected issue of substance misuse and impaired driving behaviours.

Restoration of the ecological network structure based on the spatiotemporal changes of the wintering Grus japonensis habitat in the Yancheng coastal area

As an Asian endemic species, Grus japonensis (G. japonensis) reproduction and survival rely on natural wetland resources. G. japonensis is adept at long-distance flight, thereby displaying distinct network structural characteristics in its utilization of habitat within its range. Therefore, scientific restoration and management of the ecological network (ENs) are urgently needed. On the basis of the data of G. japonensis and environmental data, this study used the MaxEnt model, stepping-stone theory, and circuit models to analyze the spatiotemporal changes in the ENs structure of G. japonensis habitat. The primary factors influencing the habitat suitability of G. japonensis was the distance to Phragmites australis (P. australis) community. The area of ecological source areas decreased from 56,528.59 hm2 in 1987 to 14,040.20 hm2 in 2021, with the distribution range contracting from Beihuan (BH), Nanhuan (NH), Hexin (HX) and Tiaozini (TZN) to Hexin (HX). Between 1987 and 2007, there were dense ecological corridors along the coastal areas. However, by 2021, only BH and HX had dense ecological corridors between them. The node centrality of HX decreased from 900.78 in 1987 to 264.64 in 2021, with the most significant decrease between 2007 and 2021. On this basis, the expanded habitat area, the stepping stone area in 2021 and the ecological source area of 2007 with low development intensity were taken as restoration areas. The restoration areas were classified into two types based on their distribution: landing nodes and expansion nodes. The addition of landing nodes enhanced the overall stability of the ENs, resulting in an increase in the centrality of nodes from 264.64 to 398.08. Finally, an optimization and restoration framework for the habitat network based on identifying priority restoration areas, land use type transformation, and enhancing ENs stability for habitat restoration was proposed.

Predictive Model of Risk Behaviour in the University Student Community

Aim. The study aimed to attempt to explain the probable causality of undertaken risk behaviours in a group of university students, from the perspective of various predictors (which included low individual and social resources, as well as other risk behaviours). The choice of predictors was dictated, among other things, by the assumptions of risk behaviour theory and gateway theory. Methods. The research was conducted among university students from many cities in Poland. Empirical data were collected using the survey method. The tool was a survey questionnaire, constructed from the author's scale and the Resilience Scale by Gail Wagnild in the Polish adaptation by Janusz Surzykiewicz and Karol Konaszewski (2019). The data were statistically analysed. The target procedure became path analysis. Results. The study revealed several plausible predictive factors for specific risk behaviours of students. Analyses included behavioural categories such as the use of psychoactive substances and behaviour associated with them, risky sexual contact, low physical and psychosocial health care, dangerous behaviour in daily life, and disclosure of images and private data on the Internet. Each form of risky behaviour was situated in the model. The predictive factors in the path structure were identified as, among others, low social and cultural resources and low levels of resilience. It also appeared that some risk behaviours may be predictors for others. Conclusion. The study reveals that not only syndromes of risk behaviours, but even entire risk pathways creating the possibility to infer probable causality, are noticeable in the group of university students.

Commentary on Conde et al.: Evidence and gap map offer an important opportunity for dialogue and refinement of the gateway hypothesis controversy.

Commentary on Conde et al.: Evidence and gap map offer an important opportunity for dialogue and refinement of the gateway hypothesis controversy.

Examining the Gateway Hypothesis and Mapping Substance Use Pathways on Social Media: Machine Learning Approach.

Substance misuse presents significant global public health challenges. Understanding transitions between substance types and the timing of shifts to polysubstance use is vital to developing effective prevention and recovery strategies. The gateway hypothesis suggests that high-risk substance use is preceded by lower-risk substance use. However, the source of this correlation is hotly contested. While some claim that low-risk substance use causes subsequent, riskier substance use, most people using low-risk substances also do not escalate to higher-risk substances. Social media data hold the potential to shed light on the factors contributing to substance use transitions. By leveraging social media data, our study aimed to gain a better understanding of substance use pathways. By identifying and analyzing the transitions of individuals between different risk levels of substance use, our goal was to find specific linguistic cues in individuals' social media posts that could indicate escalating or de-escalating patterns in substance use. We conducted a large-scale analysis using data from Reddit, collected between 2015 and 2019, consisting of over 2.29 million posts and approximately 29.37 million comments by around 1.4 million users from subreddits. These data, derived from substance use subreddits, facilitated the creation of a risk transition data set reflecting the substance use behaviors of over 1.4 million users. We deployed deep learning and machine learning techniques to predict the escalation or de-escalation transitions in risk levels, based on initial transition phases documented in posts and comments. We conducted a linguistic analysis to analyze the language patterns associated with transitions in substance use, emphasizing the role of n-gram features in predicting future risk trajectories. Our results showed promise in predicting the escalation or de-escalation transition in risk levels, based on the historical data of Reddit users created on initial transition phases among drug-related subreddits, with an accuracy of 78.48% and an F1-score of 79.20%. We highlighted the vital predictive features, such as specific substance names and tools indicative of future risk escalations. Our linguistic analysis showed that terms linked with harm reduction strategies were instrumental in signaling de-escalation, whereas descriptors of frequent substance use were characteristic of escalating transitions. This study sheds light on the complexities surrounding the gateway hypothesis of substance use through an examination of web-based behavior on Reddit. While certain findings validate the hypothesis, indicating a progression from lower-risk substances such as marijuana to higher-risk ones, a significant number of individuals did not show this transition. The research underscores the potential of using machine learning with social media analysis to predict substance use transitions. Our results point toward future directions for leveraging social media data in substance use research, underlining the importance of continued exploration before suggesting direct implications for interventions.

Understanding marijuana use initiation vs. frequency of use on risk for hallucinogen use: testing for mediating mechanisms underlying the gateway hypothesis

ABSTRACT The gateway hypothesis posits that marijuana use initiation may lead to neurological changes predisposing individuals to escalation to harder drug use later on. However, there is limited research, which has examined marijuana as a gateway drug leading to hallucinogen use and examination of mechanisms linking the two drug use behaviors. This study examined marijuana use as a predictor of hallucinogen use and tested for mediation via social, affective, and cognitive mechanisms. The Pathways to Desistance data were analyzed. This is a longitudinal dataset comprised a sample of 1,354 justice-involved youth. Path analyses were used to test for direct and indirect effects of interest. Findings indicated that elevated marijuana use frequency prior to baseline was a significant predictor of increased log-odds of later hallucinogen use. None of sensation-seeking, impulse control, nor deviant peer association significantly mediated this relationship. Ever having used marijuana prior to baseline was not significantly related to later hallucinogen use risk and no mediation effects were identified for this independent variable. Results indicated that higher frequency marijuana use may result in gateway effects for later hallucinogen use. Both marijuana use variables were also statistically significant predictors of increased sensation-seeking, diminished impulse control, and greater deviant peer association.

The effect of youth marijuana use on high-risk drug use: Examining gateway and substitution hypothesis

Youth high-risk drug use causes harm to individuals and raises social concerns in the United States (US). To prevent youth high-risk drug use effectively, it is crucial to identify and address the significant risk factors. Some view the use of low-risk drugs (e.g., marijuana) as one such risk factor, though studies posit conflicting arguments about the effect of youth marijuana use. Some argue that youth marijuana use is a gateway to high-risk drug use; therefore, youth marijuana use boosts the likelihood of high-risk drug use. However, others postulate that there is a substitution effect of youth marijuana use, in which youth marijuana use replaces and, therefore, reduces their high-risk drug use. Our study aims to clarify these two conflicting arguments by examining the following hypotheses: (i) there is a significant discrepancy in youth high-risk drug use between marijuana-using youths and non-marijuana-using youths, and (ii) youths who consume marijuana are significantly more likely to use high-risk drugs after controlling for individual and environmental characteristics. To test our hypotheses, we analyzed nationally representative youth survey data collected between 2010 and 2019, determining the annual average comparison and performing comparative multiple regression analyses. The results from these analyses show that there is a significant gateway effect of youth marijuana use, with youth marijuana use significantly increasing high-risk drug use after controlling for individual and environmental risk factors. Considering the recent marijuana legalization trends in the US, this finding suggests that policymakers should pay close attention to the gateway effect of youth marijuana use.

A Subsurface Stepping Stone Hypothesis for the Conquest of Land by Arthropods

The conquest of land by arthropods is commonly believed to be a surface phenomenon associated with the arrival of photosynthetic plants, atmospheric oxygenation, and an ozone shield in the mid-Paleozoic Era. However, recent molecular and fossil evidence suggests terrestrial fauna may have first appeared in the Cambrian, before the proliferation of plants and ozone, which are thought to be essential for survival. This raises the question—how could arthropods survive on land without established plants and an ozone shield? We propose a hypothesis that chemolithoautotrophic cave ecosystems, independent of photosynthesis, may have served as a subsurface stepping stone, providing a possible explanation for the land invasion enigma. Chemolithoautrophic caves have offered abundant food and radiation protection, enabling ancient arthropods to evolve strategies to adapt to new frontiers through gradual dispersion from the sea to shielded cave waters, then to cave hygropetric margins of cave waters, and, finally, to the surface.

Drug Dependency Due to Traumatic Childhood Experiences and Low Emotional Intelligence of Juvenile Felons in India

ABSTRACT Children involved with the juvenile justice system for engaging in unlawful acts are more likely than their peers of the same age to use cannabis and alcohol, which increases the likelihood of adverse behavioral outcomes and prolonged involvement with the judicial system. This study focuses on the relationship between child maltreatment, emotional intelligence and drug dependence among children in conflict with the law. The participants of the study are 130 justice-involved male juveniles in the Indian state of Tamil Nadu who are given the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), the Juvenile Victimization Questionnaire (JVQ), and Emotional Intelligence Scale (EIS) for assessment. Interviews are conducted to obtain the data required for the study. For the statistical analysis, frequency, t-test, correlation, and regression analyses are used. Results of the study indicates that low level/lack of emotional intelligence which enhances the likelihood of juveniles being in conflict with the law and engaging in harmful, drug-dependent behavior. No significant relationship is observed between child maltreatment and drug-dependent behavior. For these juveniles, marijuana serves as the gateway drug. Peer influence and school dropout have a substantial influence on drug-dependent behavior.

Assessment of Substance Use Among High School Students in Northern Cyprus Based on the Gateway Hypothesis

This study is a quantitative survey study based on the data of the research project on the Use of Alcohol, Cigarettes and Other Addictive Substances in Northern Cyprus High Schools students conducted by the Turkish Republic of Northern Cyprus Anti-Drug Commission. In this study, data were collected from 763 high school students in 6 districts in the north of Cyprus through the European School Research Project Alcohol and Other Drugs (ESPAD Survey) Survey, using the stratified sampling method, through the guidance and psychological counselling services of the schools. According to findings of this study, as the smoking age falls, so does the age of switching to e-cigarettes. Similarly, as the age of first cigarette and e-cigarette smoking declines, so does the age of daily use of cigarettes and e-cigarettes. When the regression results of the research are evaluated, it is seen that students' lifetime smoking frequency, age at beginning smoking, e-cigarette smoking frequency, age at first e-cigarette smoking, hookah smoking frequency, and usage of heated non-combustible tobacco products did not predict bonsai use. However, an increase in the frequency of cannabis use among students significantly predicts bonsai consumption.

E-cigarettes may serve as a gateway to conventional cigarettes and other addictive drugs.

Electronic cigarettes (e-cigarettes) are devices that allow the user to inhale nicotine in a vapor, and are primarily marketed as a means of quitting smoking and a less harmful replacement for traditional cigarette smoking. However, further research is needed to determine if vaping nicotine via e-cigarettes can be effective. Conversely, nicotine has been considered a gateway drug to alcohol and other addictive drugs and e-cigarettes containing nicotine may have the same effects. Previous reports have shown that e-cigarette use may open the gate for the use of other drugs including conventional cigarettes, cannabis, opioids, etc. The increasing prevalence of e-cigarettes, particularly among youth and adolescents in the last decade have led to an increase in the dual use of e-cigarettes with alcohol, cannabis, and other illicit drug use like heroin and 3-4-methylenedioxymethamphetamine (MDMA). The advent of e-cigarettes as a device to self-administer addictive agents such as cocaine and synthetic cathinones may bring about additional adverse health effects associated with their concurrent use. This review aims to briefly describe e-cigarettes and their different generations, and their co-use with other addictive drugs as well as the use of the device as a tool to self-administer addictive drugs, such as cocaine, etc.

Gaining a (tube) foothold – trends and status following two decades of the long-spined echinoid Diadema setosum (Leske, 1778) invasion to the Mediterranean Sea

The Eastern Mediterranean Sea is an exceptional habitat. Its relative isolation and distinct characteristics create a unique ecosystem recognized as a marine biodiversity hot spot, where one-fifth of the species are endemic. Yet, native Mediterranean biodiversity is under increasing threat, mainly due to massive alien species invasions of Indo-Pacific origin. To date, more than 800 non-indigenous species have been reported in the Eastern Mediterranean Sea, justifying its reputation as one of the most severely affected habitats in the world in terms of marine biological invasions. Here we summarized the Mediterranean invasion dynamics of the long-spined echinoid Diadema setosum (Leske, 1778), one of the most ubiquitous Indo-Pacific sea urchin species. We show an alarming exponential population growth of D. setosum throughout the Eastern Mediterranean since 2018, following more than a decade of ‘invasion lag’ since its first detection in 2006. Molecular analyses illustrate the presence of a single genetic D. setosum clade in the Mediterranean Sea – corresponding to the Arabian Peninsula clade of this species, reinforcing the notion of a Red Sea origin. Our data support the current working hypothesis that the initial introduction of D. setosum occurred in the Northern Levantine Basin from which it gradually expanded in both north-west and south-east trajectories – in contrast to a stepping-stone hypothesis of gradual advancement from the opening of the Suez Canal. Demographic data of D. setosum along the Israeli Mediterranean coastline reveals a well-established population of broad size distributions, from juveniles to adult individuals of remarkably large size. Additionally, we provide evidence of the reproductive capacity of D. setosum in its new environment. Due to the magnitude of Diadema’s ecological footprint, it poses a severe threat to the entire Eastern Mediterranean Sea, including the Levantine Basin and South Aegean Sea, calling for rapid and coordinated action at both national and regional scales.

Testing the cannabis gateway hypothesis in a national sample of Spanish adolescents

BackgroundThe gateway hypothesis holds that the use of legal substances (i.e., tobacco and alcohol) increases the risk of initiating in cannabis use which, in turn, increases the chances of using other illegal substances. The validity of this hypothesis has been the subject of intense debate in recent years, finding sequences with a different order. Moreover, this pattern has been scarcely studied in Spain, where characteristics related to cannabis use are meaningfully different to other countries. This study aims to examine the gateway effects of cannabis towards other legal and illegal substances in Spanish adolescents. Material and methodsData were obtained from the Ministry of Health in Spain, through a representative survey of addictive behaviors of 36,984 Spanish adolescents (Mage = 15.7, SD = 1.2, 51.4% females). ResultsLifetime cannabis use increased the likelihood of later legal substance use, both tobacco (OR = 2.0; 95%CI 1.81, 2.22) and alcohol (OR = 1.93; 95%CI 1.61, 2.31), as well as illegal substances (OR = 5.36; 95%CI 4.80, 5.98) and polysubstance (OR = 18.24; 95%CI 14.63, 22.73). Early age of cannabis use onset significantly increased the likelihood of subsequent legal and illegal substance use (ORs between 1.82 and 2.65). ConclusionsThese findings confirm and expand the available evidence on cannabis as a gateway substance. These results can help to drive preventive strategies for substance use in Spanish adolescents.

Brooklyn District Branch Honors Residents for Outstanding Research

Back to table of contents Previous article Next article APA & MeetingsFull AccessBrooklyn District Branch Honors Residents for Outstanding ResearchMark MoranMark MoranSearch for more papers by this authorPublished Online:4 May 2023https://doi.org/10.1176/appi.pn.2023.06.6.24aKunal Gandhi, M.D., of Brookdale University Hospital Medical Center received first prize for his oral presentation titled “Is Cannabis a Gateway Drug? A Retrospective Analysis of American Adolescents” at the Brooklyn Psychiatric Society Resident Scholarly Presentation Competition. His colleagues on the project were fellow trainees Nishat Kulkarni, M.D., and Saral Desai, M.D.The team analyzed 2019 data from the CDC’s Youth Risk Behavior Surveillance System to identify the prevalence of lifetime cannabis use among American adolescents, the prevalence of co-occurring substance use, and the odds of co-occurring substance use among participants with any lifetime cannabis use. They found that cannabis use was correlated with increased odds of ever using certain substances such as alcohol, tobacco, hallucinogens, and stimulants but was not correlated with increased odds of ever using opiates or injection drugs.Other oral presentations were by Galen Ballentine, M.D., of SUNY Downstate, Gabriela Arth, M.D., of Maimonides Medical Center, and Stanley Nkemjika, M.D., M.P.H., of Interfaith Medical Center.First prize for a poster presentation was awarded to Kelvin Oke, M.D., of Interfaith Medical Center for his research on “Adolescent Crimes: Association of Multiple Substance Use With Arrests Among Adolescents.” His colleagues on the project were Christian Nwabueze, M.D., Dr.P.H., Sana Kazi, M.D., Muhammad Azam, M.D., Bamidele Johnson, M.D., Ph.D., Jacky Petion, M.D., and Ayodeji Jolayemi, M.D.Oke and colleagues analyzed 2018 data from the Treatment Episode Data Set—Admission (TEDS-A), a national data system of annual admissions to, and discharges from, substance use treatment facilities.They looked at the association between multiple substance use in the past 30 days and criminal arrest within that same period. Multiple substance use is defined as use of at least one illicit drug (cocaine, heroin, hallucinogens, methamphetamines, and inhalants), and alcohol or marijuana or both.They found that use of multiple substances was associated with higher odds of arrests than the use of a single substance.Also presenting posters were Nishat Kulkarni, M.D., of Brookdale University Hospital Medical Center; Megan Hophing, M.D., of Maimonides Medical Center; and Hagar Kandel, M.B.B.Ch., of SUNY Downstate. ■ ISSUES NewArchived

Brooklyn Resident Competition Develops Young Researchers

Back to table of contents Previous article Next article APA & MeetingsFull AccessBrooklyn Resident Competition Develops Young ResearchersMark MoranMark MoranSearch for more papers by this authorPublished Online:4 May 2023https://doi.org/10.1176/appi.pn.2023.06.6.24AbstractThe competition, founded and coordinated for 31 years by APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc., promotes resident involvement with APA and the Brooklyn district branch, while helping resident scholars advance their careers as psychiatric researchers.In March 1992, Ramaswamy Viswanathan, M.D., Dr.Med.Sc., then president of the Brooklyn Psychiatric Society (BPS), organized and moderated the first annual Brooklyn Psychiatric Society (BPS) Resident Scholarly Presentations Competition.APA Deputy Medical Director and Chief of Research Nitin Gogtay, M.D. (left), served as a judge in the resident scholarly presentations competition. With him are Kusum Viswanathan, M.D., chief medical officer at Brookdale University Medical Center, and APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc.Mark MoranThis year’s competition 31 years later, which took place in April at Interfaith Medical Center in central Brooklyn, marked his last year coordinating the event. Viswanathan, who is president-elect of APA and professor and interim chair of psychiatry at SUNY Downstate Health Sciences University, is turning over coordination of the event to Maria Bodic, M.D., a psychiatrist at Maimonides Medical Center.The competition brings together resident scholars from psychiatric training programs at four Brooklyn hospitals—Brookdale University Hospital Medical Center, Maimonides Medical Center, SUNY Downstate Health Sciences University, and Interfaith Medical Center. The residents present poster and oral presentations on a variety of research projects, with winners selected by a panel of research experts (Brooklyn District Branch Honors Residents for Outstanding Research).Kelvin Oke, M.D., a resident at Interfaith Medical Center, received first prize in the poster competition for his research project titled “Adolescent Crimes: Association of Multiple Substance Use With Arrests Among Adolescents.”Mark MoranWhen he originated the competition, Viswanathan and his wife, Kusum Viswanathan, M.D., a pediatric hematologist-oncologist who is now the chief medical officer at Brookdale, donated what he called “a modest amount of money” to pay for some of the expenses related to the competition over the years.“At the time we originated it, it was an innovative program and the first such program to be organized by a district branch of APA,” he told Psychiatric News. “It has helped strengthen our residents’ involvement with APA and promoted their professional development.”Kunal Gandhi, M.D. (left), received first prize for his oral presentation titled “Is Cannabis a Gateway Drug? A Retrospective Analysis of American Adolescents.” With him are Tolu Olupona, M.D., president of the Brooklyn Psychiatric Society, and APA President-elect Ramaswamy Viswanathan, M.D., Dr.Med.Sc.Mark MoranThe judges were Nitin Gogtay, M.D., APA deputy medical director and chief of research; Aparna Dole, M.D., a clinical instructor in psychiatry at New York University Grossman School of Medicine; and Jose Vito, M.D., a clinical professor of psychiatry at NYU Langone Health. Vito is also past president of the New York County Psychiatric Society.“The BPS Resident Scholarly Presentations Competition is an outstanding way for young psychiatrist researchers to hone their skills at gathering and analyzing data on topics relevant to psychiatric practice and patient care and presenting their findings in a professional setting,” Gogtay said. “I urge these young researchers and all residents interested in research to join APA and avail themselves of the mentorship and resources offered by APA’s Division of Research.”Following opening remarks by LaRay Brown, CEO of One Brooklyn Health, Gogtay spoke about APA and the work of the Division of Research, especially around DSM, PsychPRO (APA’s mental health registry), and the APA Research Consortium.Brooklyn Psychiatric Society President Tolu Olupona, M.D., director of residency training at Interfaith Medical Center, credited Viswanathan and Linda Majowka, BPS executive director, for shepherding the program over many years.The competition “is a great opportunity for psychiatry residents in Brooklyn to showcase their scholarly activity to their peers and other faculty from psychiatry residency programs in Brooklyn,” she told Psychiatric News. “Residents and faculty also network with colleagues from other programs during the event, and the activity helps residents in training to build their CV as they grow in their academic careers.” ■ ISSUES NewArchived

A history of ethanol intake accelerates the development of morphine analgesic tolerance: A protective potential for omega-3 fatty acids.

Adolescence is a critical life period during which significant neurodevelopmental changes occur within the central nervous system. Consistently, substance abuse in this stage has been found to induce persistent changes in brain responsiveness to future drug challenges. Nowadays, heavy episodic alcohol consumption during adolescence, also known as binge-drinking behavior, is a growing concern in modern societies. On the other hand, alcohol is well known to act as a gateway drug, that is, it promotes the individual's craving for consumption of other drugs of abuse. With this in mind, we aimed to assess whether adolescent ethanol exposure could alter the development of tolerance and dependence to morphine, as an available common opioid drug. Tail flick test was used to measure thermal nociceptive changes in adult male Wistar rats undergone ethanol/vehicle exposure during adolescence. Furthermore, morphine withdrawal syndrome was induced by naloxone injection, and behavioral signs were recorded for 20 min. It was found that adolescent ethanol intake facilitates morphine analgesic tolerance and decreases baseline latency; however, the severity of dependence is not significantly altered. Moreover, we found that 15 days of treatment with omega-3 fatty acids (O3) prevents the mentioned ethanol-induced changes suggesting a therapeutic potential for this compound. O3 supplementation, as an inexpensive and noninvasive method, may assist the clinicians to reverse the adverse effect of alcohol binge drinking on adolescents' brains and to reduce the vulnerability to drug exposure in adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Direct Effects of Cannabis Intoxication on Motivations for Softer and Harder Drug Use: An Experimental Approach to the Gateway Hypothesis.

Aims: This study experimentally tested whether there is a gateway-type effect of cannabis administration on tobacco and cocaine motivation and whether motivational responses predicted use 6 months later. Methods: A 2 (condition: active cannabis vs. placebo joint)×3 (substance stimulus type: tobacco, cannabis, and cocaine) factor within-subjects design for both implicit and explicit motivation. Both experimental sessions were conducted in a cannabis dispensary ("coffeeshop") in Amsterdam and were separated by ∼1 week, followed by a 6-month online follow-up. Eighty-five participants between 18 and 27 years of age (57% male), who used cannabis, tobacco, and cocaine <15 times per month, participated in session 1 (session 2: N=79 and follow-up: N=81). Counterbalanced over sessions, participants smoked an active and a placebo joint following a paced puffing procedure. Before and after smoking, craving and avoidance (explicit motivation) were assessed using visual analog scales, and after smoking, the stimulus response compatibility test was completed to assess approach biases (implicit motivation). Self-reported intoxication and similarity to their usual smoking experience were assessed at the end of both sessions. Self-reported frequency/quantity and dependence symptoms for tobacco, cannabis, and cocaine were assessed at all time points. A linear mixed model approach was used to assess the effects of condition, substance stimulus type, and their interactions on explicit and implicit motivation. Results: In the active condition, participants reported higher levels of intoxication and an experience more similar to their usual smoking experience than in the placebo condition. There was no significant effect of condition, substance type, or their interaction on approach bias. Participants exhibited increased cannabis craving during the placebo condition only and increased explicit cannabis avoidance during the active condition only. Explicit tobacco avoidance decreased during both conditions. Baseline measures did not predict use at 6-month follow-up. Conclusions: In light users, cannabis intoxication did not affect implicit and explicit tobacco or cocaine motivations. Tobacco avoidance decreased regardless of condition, indicating that the cannabis cue-rich setting-rather than tetrahydrocannabinol itself-may momentarily increase the likelihood to smoke tobacco. However, motivation at baseline did not predict use 6 months later, deeming any gateway-like function unlikely.

Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study.

Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design. The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design? This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach. Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice. When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice.

Are Dietary Supplements a Gateway to Doping? A Retrospective Survey of Athletes’ Substance Use

Background: It is proposed that the use of dietary supplements might lead to the use of doping substances. This has been termed the gateway hypothesis. However, within an athletic sample, no research has examined the order in which these substances are consumed and what may explain the progression from dietary supplement use to doping. Objective: To identify whether dietary supplement use precedes doping and examine what moderates the dietary supplement-doping relationship. Methods: Competitive athletes (N=1,081, 42.0% female; Age=29.3±10.8 years) completed an online survey measuring dietary supplement use, doping use, doping subjective norms and age of using a supplement and/or doping substance. Results: Dietary supplement users were 11 times more likely to dope than non-users (OR=11.28, 95% CI = 2.72 to 46.77). Age for first use of a dietary supplement was younger than use of a doping substance (mean difference=-4.5±5.1 years old, p<0.001, d=0.90). Over three-quarters of doping users reported using a dietary supplement first (77.1%), whereas a small proportion of athletes started using dietary supplements and doping at the same time (12.5%) and some used doping substances before using dietary supplements (10.4%). Moderation analysis revealed that dietary supplement users may be more likely to dope because of a more favourable social acceptance of using prohibited substances than non-users. Conclusions: Data suggest that dietary supplement use is more likely to precede doping. However, not all doping users begin with using dietary supplements, which highlights the importance of measuring the temporal order of dietary supplement and doping use in future research.

"We want what's best for patients." nurse leaders' attitudes about medical cannabis: A qualitative study.

The majority of states have legalized medical cannabis. Nurse leaders must be prepared for an increase in patients' use of the drug across all care settings. To explore nurse leaders' attitudes towards, knowledge of, and experiences with medical cannabis. : Descriptive qualitative study design. 28 nurse leaders-19 in four focus groups of 3-7 participants and another 9 in interviews. Semi-structured, one-on-one interviews and focus groups of nurse leaders about their attitudes towards and experiences with patients' use of medical cannabis. Thematic analysis was used to identify themes and subthemes. Four major themes were identified: overwhelming support for legalized medical cannabis; importance of overcoming the stereotype of a gateway drug; problematic mismatch between federal and state cannabis policies; and nursing needs to be move involved. There was strong support for legalized medical cannabis to meet patients' needs; yet, respondents reported little discussion about or education regarding medical cannabis among nurses. Inconsistent federal and state cannabis policies were viewed as especially problematic and in need of alignment.