Substance Use Research Articles

Targeting Higher-Order Dimensions of Personality in Treatment as a Parsimonious Means to Address Co-Occurring Psychopathology

People with borderline personality disorder (BPD) commonly have co-occurring mental health conditions that may be accounted for by higher-order factors in dimensional models of psychopathology. BPD Compass is a cognitive-behavioral treatment developed to target broad personality domains (i.e., negative affectivity, antagonism, disinhibition) associated with BPD and related conditions. The purpose of the present study was to explore the extent to which BPD Compass can serve as a transdiagnostic intervention for these comorbid conditions. Participants (N = 100; Mage = 28.13, 73.7% female, 79.6% White, 66% sexual minority) were assigned to either immediately begin treatment (randomized and naturalistic) or receive treatment after an 18-week waiting period. At baseline, participants met criteria for an average of 3.28 (SD = 2.02, range: 0-8) comorbid diagnoses ranging in clinical severity from 3.30 (for substance use disorder) to 4.91 (for persistent depressive disorder). Post-treatment clinical severity ratings (CSRs) for those randomized to receive BPD Compass were below clinical thresholds for all assessed conditions except premenstrual dysphoric disorder, whereas post-waitlist CSRs remained above clinical thresholds for all disorders except bipolar II, agoraphobia, and major depressive disorder. Collapsed across all patients who received BPD Compass, pre- to post-treatment improvements in were significant and large in magnitude for most disorders assessed. These results suggest that BPD Compass may be an efficacious transdiagnostic intervention, though our small sample and high rate of dropout warrant further study.

The Circumstances Surrounding Fatal Pediatric Opioid Poisonings, 2004-2020.

There is little understanding of the circumstances behind fatal pediatric opioid poisonings. Our objective was to characterize opioid fatalities according to child, family, and household factors. We used data from the National Fatality Review-Case Reporting System to describe the circumstances behind the deaths of children 0 to 17 years of age who died of an opioid poisoning (ie, prescription opioid, heroin, illicit fentanyl) between 2004 and 2020. Decedents were stratified into age groups: 0-4, 5-9, 10-14, and 15-17 years. The majority (65.3%) of the 1696 fatal opioid poisonings occurred in the child's own home. Prescription opioids contributed to 91.8% of deaths, heroin contributed to 5.4%, and illicit fentanyl to 7.7%. Co-poisonings with nonopioid substances occurred in 43.2% of deaths. Among 0- to 4-year-olds, 33.9% died of homicide and 45.0% had a primary caregiver with a history of substance use/abuse. Among 10- to 14-year-olds and 15- to 17-year-olds, respectively, 42.0% and 72.8% of decedents had a history of substance use/abuse. In each age group, at least 25.0% of children were victims of previous child maltreatment. A history of maltreatment and substance use-whether on the part of the caregiver or the child-are common factors surrounding fatal pediatric opioid poisonings, the majority of which occur in the child's own home. Families with children of all ages would benefit from interventions focused on opioid prescribing, storage, disposal, and misuse. These findings also underscore the urgency of ensuring that access to naloxone becomes universal for families with a history of maltreatment and/or substance use.

Factors associated with financial exploitation in older adults: A systematic review

ObjectivesThis systematic review aimed to identify and analyze factors associated with financial exploitation in older adults. MethodsA comprehensive search strategy was implemented in December 2023, across three major databases (PubMed, Web of Science, and Scopus), along with Google Scholar as a search engine, without restrictions on publication year. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) and CONSORT tool. ResultsAmong the initial 985 articles identified, 26 fulfilled the inclusion criteria. The majority of studies were conducted in the USA and had a cross-sectional design. Key factors identified included cognitive function, depression and emotional health, physical health, social support and interpersonal relationships, living arrangements, race, and personality traits. ConclusionThis review highlights the complex factors linked to financial exploitation in older adults, with cognitive function, depression, and social support as key predictors. However, inconsistencies in age, marital status, and substance use call for further research. Targeted interventions are essential to reduce the risk of exploitation.

Syndemic Conditions Associated with Hazardous Alcohol Consumption among Sexual Minority Men in San Francisco

BackgroundHazardous alcohol consumption (HAC) is prevalent among sexual minority men (SMM). Using syndemic theory, this study aimed to identify the number of syndemic conditions, including their combinations, and their association with HAC among SMM in San Francisco. MethodWe conducted a secondary analysis of cross-sectional data from 246 SMM who consume alcohol. Syndemic factors included multiple substance use, depressive symptoms, HIV/STI status, and houselessness. We conducted a multivariable logistic regression to estimate the odds of HAC associated with increasing syndemic conditions. We further examined which combinations of three syndemic factors were associated with the highest odds for HAC. ResultsThe average age was 40.7; participants were predominantly White (33.3%) and Black/African American (29.7%) and graduated from high school (92.7%). The prevalence of HAC increased with the number of syndemic conditions: 13.6% with none, 30.9% with one, 51.9% with two, 65.1% with three, and 69.2% with four conditions. A significant log-linear trend was observed, with two syndemic conditions increasing the odds of HAC over fivefold (AOR=5.05, 95% CI=1.68–15.15), and three and four syndemic conditions increasing the odds by more than eightfold (AOR=8.82, 95% CI=2.74–28.39; AOR=8.55, 95% CI=2.26–32.28). The combination of depressive symptoms, HIV/STI status, and houselessness tripled the odds for HAC (OR=3.07, 95% CI=1.34–7.04). ConclusionHAC was associated with increasing syndemics, and specific conditions (depression, HIV/STI, and houselessness) had the greatest odds of HAC. These findings underscore the need for comprehensive screening and integrated interventions targeting these co-occurring conditions to reduce HAC in this population.

Take Care of the Patient: Pharmacists Should Advocate for Overdose Prevention Centers (OPC) as Harm Reduction.

Overdose prevention centers (OPCs) are places where people can bring previously obtained substances to use under the supervision of trained healthcare professionals who are prepared to intervene in the event of an overdose. Healthcare professionals, counselors and peer support provide services including naloxone distribution, provision of sterile injection equipment, counseling services, referrals to necessary providers, and above all, a safe and compassionate space for people to get the care they need. This is a method of harm reduction that has been used globally for decades and is now gaining traction in the United States. Pharmacists play a vital role in harm reduction for patients, and they should support the legalization and establishment of overdose prevention centers across the country to extend this essential service. A compelling body of evidence shows that overdose prevention centers reduce overdose deaths, emergency department visits for overdoses, wounds relating to injection drug use and reduce emergency medical service utilization in the area surrounding the centers. They also reduce drug use and discarded hazardous drug paraphernalia in public areas. Overdose prevention centers also provide wrap-around services that aid in holistic care of the person, including referrals to inpatient substance use treatment, detoxification, primary care, transportation and housing. It is the responsibility of pharmacists to advocate for the needs of patients, and overdose prevention centers will provide an effective avenue for pharmacists to deliver counseling and medication management services as part of care of the individual.

Patient experiences in outpatient substance use disorder treatment: A qualitative study exploring both clinical and non-clinical contexts

Patient experiences in outpatient substance use disorder treatment: A qualitative study exploring both clinical and non-clinical contexts

Self-Reported Use of Prohibited Substances and Methods Among Athletes of the Brazilian Delegations.

Use of prohibited substances and methods (doping) by elite athletes is a complex and multifactorial behavior. Understanding the factors associated with doping behavior is crucial to identifying potential intervention targets to reduce doping among this group. However, there are limited data on the prevalence and correlations of self-reported prohibited substance use among Brazilian Olympic athletes. We present data from a cross-sectional, self-reported online survey. Participants were elite Brazilian athletes who participated in the 2020 Olympic and Paralympic Games. A total of 209 athletes (52.6% females) from both Brazilian delegations were surveyed. The self-reported doping use of prohibited substances or methods was found to be 7.2%. Receiving a recommendation from a medical doctor, even knowing that the substance is prohibited, was associated with an increased risk of self-reported doping use (OR = 17.474; 95% CI = 4.664-65.470, P < 0.001). Nearly 1 in 10 athletes reported use in their careers. Medical recommendation to use substances was the only factor associated with an increased risk of doping among elite athletes.

The Common Denominators of Parkinson's Disease Pathogenesis and Methamphetamine Abuse.

The pervasiveness and mortality associated with methamphetamine abuse have doubled during the past decade, suggesting a possible worldwide substance use crisis. Epitomizing the pathophysiology and toxicology of methamphetamine abuse proclaims severe signs and symptoms of neurotoxic and neurobehavioral manifestations in both humans and animals. Most importantly, chronic use of this drug enhances the probability of developing neurodegenerative diseases manifolds. Parkinson's disease is one such neurological disorder, which significantly and evidently not only shares a number of toxic pathogenic mechanisms induced by methamphetamine exposure but is also interlinked both structurally and genetically. Methamphetamine-induced neurodegeneration involves altered dopamine homeostasis that promotes the aggregation of α-synuclein protofibrils in the dopaminergic neurons and drives these neurons to make them more vulnerable to degeneration, as recognized in Parkinson's disease. Moreover, the pathologic mechanisms such as mitochondrial dysfunction, oxidative stress, neuroinflammation and decreased neurogenesis detected in methamphetamine abusers dramatically resemble to what is observed in Parkinson's disease cases. Therefore, the present review comprehensively cumulates a holistic illustration of various genetic and molecular mechanisms putting across the notion of how methamphetamine administration and intoxication might lead to Parkinson's disease-like pathology and Parkinsonism.

Affects, dissociative symptoms and addictive behaviours: Insights from clinical and non-clinical samples

ObjectivesCurrent literature links substance abuse with primary emotions and dissociative symptoms, but little research combines these relationships. This study investigates the clinical significance of these concepts and the mediating role of dissociative symptoms in the relationship between primary emotions and substance abuse. MethodsStudy 1 included 517 adults (77.6 % female, Age: M = 27.84) from the community. Path analysis examined the relationships between primary emotions (BANPS-GL), dissociative symptoms (FDS), psychopathology (BSI-18), and substance abuse (WHO-ASSIST). Study 2 involved 73 inpatients with substance use disorders (SUD) compared to 73 matched individuals from the general population, totalling 146 participants (21.9 % female, Age: M = 34.90). MANOVA and Discriminant analysis assessed the differences and contributions of the variables to group separation. ResultsSignificant correlations were found between the FDS and the WHO-ASSIST, all BSI-scales, and all primary emotions except SEEKING. The FDS was a key mediator between primary emotions and substance abuse (WHO-ASSIST) and effectively differentiated between the clinical and general population groups. ConclusionsThese findings highlight the role of dissociative symptoms in the relationship between emotional experiences and addictive behaviour. Future research should consider dissociative symptoms in the prevention and treatment of addictive disorders.

Medications for opioid use disorder and other evidence-based service offerings in faith-affiliated treatment centers: Implications for implementation partnerships

IntroductionAmidst an ongoing surge of opioid use disorder (OUD) incidence, clinicians and policymakers are seeking partnerships with faith communities – including with faith-affiliated treatment centers (FATCs) – to expand access to evidence-based OUD treatment. However, little is known whether FATCs differentially offer such evidence-based treatment services, particularly medications for opioid use disorder (MOUD) and co-occurring mental health care. MethodsWe use the 2021 National Substance Use and Mental Health Services Survey (N-SUMHSS) to examine differences in provision of several OUD services, including MOUD, psychological treatments, mental health services, medical services, recovery support services, and services related to treatment accessibility, between self-identified FATCs and non-FATCs. We also explored differences in characteristics related to insurance, licensure, and accreditation. ResultsFATCs were less likely than non-FATCs to offer almost all measure of MOUD and more likely to refuse to accept clients who use MOUD. They were also less likely to report using telemedicine. However, they were more likely to offer residential treatment, Twelve Step facilitation, and transitional housing. We find little evidence that FATCs offer co-occurring mental health treatments at different rates than non-FATCs. ConclusionMore research is needed to examine the factors that drive these differences, especially in MOUD and transitional housing. When partnering with FATCs, clinicians and policymakers should seek common ground with FATCs and recognize the philosophies, values, and concerns that may potentially be driving these differences.

Functional Adaptation in the Brain Habenulo-Mesencephalic Pathway During Cannabinoid Withdrawal.

The mesolimbic reward system originating from dopamine neurons in the ventral tegmental area (VTA) of the midbrain shows a profound reduction in function during cannabinoid withdrawal. This condition may underlie aversive states that lead to compulsive drug seeking and relapse. The lateral habenula (LHb) exerts negative control over the VTA via the GABA rostromedial tegmental nucleus (RMTg), representing a potential convergence point for drug-induced opponent processes. We hypothesized that the LHb-RMTg pathway might be causally involved in the hypodopaminergic state during cannabinoid withdrawal. To induce Δ9-tetrahydrocannabinol (THC) dependence, adult male Sprague-Dawley rats were treated with THC (15 mg/kg, i.p.) twice daily for 6.5-7 days. Administration of the cannabinoid antagonist rimonabant (5 mg/kg, i.p.) precipitated a robust behavioral withdrawal syndrome, while abrupt THC suspension caused milder signs of abstinence. Extracellular single unit recordings confirmed a marked decrease in the discharge frequency and burst firing of VTA dopamine neurons during THC withdrawal. The duration of RMTg-evoked inhibition was longer in THC withdrawn rats. Additionally, the spontaneous activity of RMTg neurons and of LHb neurons was strongly depressed during cannabinoid withdrawal. These findings support the hypothesis that functional changes in the habenulo-mesencephalic circuit are implicated in the mechanisms underlying substance use disorders.

Does an Osteoporosis-like Condition Jeopardize the Osseointegration Process around Dental Implants Placed in Animal Models? A Systematic Review.

Knowing that osteoporosis is a metabolic disease that could decrease dental implant success and survival, the purpose of this review was to gather information on the characteristics of implant osseointegration in animal models of induced osteoporosis. By pointing out the role of some factors that could improve the success rate in these situations, this study aimed to enhance the knowledge about this process that can be further translated to clinical designs. A systematic search in PubMed/Medline, Lilacs, Cochrane Library, Scopus and Web of Science was conducted to identify information between 2002 and 2023 regarding osseointegration of dental implants in animal models of induced osteoporosis. The following search strategy was utilized and adjusted to each database: (((dental implant) AND (Osseointegration)) AND (osteoporosis)) AND/OR (osteoporosis treatment). The inclusion criteria were animal studies in English, involving the placement of an osseointegrated implant in osteoporotic bone, and evaluating bone to implant contact (BIC) %. Exclusion criteria were studies in humans, in vitro studies, procedures involving any kind of bone graft and studies evaluating medication related osteonecrosis of the jaw. A standardized data extraction form was used to record data for each study, covering article title, date, authors, number of animals, purpose of study, type of analysis used by authors, follow-up, type of implant, test and control groups, intervention and conclusions. The risk of bias of the included studies was assessed using the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE) Risk of Bias tool.20 Results: A total of 204 articles were found for evaluation and selection. All of the 43 selected studies evaluated the bone-implant contact (BIC) %. Other parameters such as bone to implant mechanical interface, bone area (BA) and bone volume (BV) ratio were also evaluated in some of the studies. There was a tendency for compromised results of implant osseointegration in the presence of osteoporosis. Modification of the implant surface, systemic and local use of anti-resorptive drugs and other substances, showed benefits for the implant success in osteoporotic sites. Still, no consensus among studies on the superiority of systemic medications in improving the process of peri-implant bone repair, was observed. Although it is possible to improve the osseointegration of implants in osteoporotic bone, either by using systemic or local factors, the metabolic bone syndrome caused by osteoporosis can jeopardize the osseointegration of dental implants.

Corrosion-oriented self-healing coating based on ZnMg MOF for efficient corrosion protection of aluminum alloy via in-situ LDH film formation

A corrosion-oriented self-healing coating system relying on metal–organic framework (MOF) based nanofiller is designed for aluminum alloy protection. The nanofiller is comprise of ZnMg MOF nanoparticle as a framework, salicylaldoxime corrosion inhibitors inside the MOF, and a polydopamine layer on the MOF surface. The Al3+ ions generated from the aluminum alloy substrate at the damaged coating area can etch the nanofiller, causing the collapse of the nanofiller and releasing the corrosion inhibitors to suppress the corrosion process in time. Subsequently, Zn2+ and Mg2+ ions from the nanofiller co-precipitate with Al3+ to form a dense AlZnMg layered double hydroxide (LDH) film, which provides further protection performance at the exposed alloy surface. Electrochemical impedance spectroscopy results demonstrate that the intact MOF@S/P coating exhibits a remarkable corrosion resistance property. For the damaged coating, the self-healing performance originated from the formation of LDH layer and the release of corrosion inhibitors gradually took effect, with the |Z|0.01Hz value increasing 2.27 times within 14 days. Moreover, under near-infrared irradiation, the photothermal effect of polydopamine will accelerate the release of corrosion inhibitor, the formation of LDH film, as well as the shape memory effect of coating defect for an efficient recovery of the corrosion resistance property. This novel coating system enables a corrosion-driven and location-specific repair with in-situ deposition of both an inhibitor film and an LDH film. As the first work to fully utilize and consume nanofillers on demand, this approach prevents inadequate use of healing agents, addressing a significant challenge in corrosion-driven self-healing coatings. The self-healing mechanism ensures target-oriented corrosion protection that makes the most efficient use of the healing substances.

Substance Use in Adolescent and Young Adult Cancer Survivors: An Integrative Review.

The adolescent and young adult (AYA) ages are a time when individuals are susceptible to risky behaviors, including binge drinking, tobacco, marijuana, and illicit drug use. AYAs are at an increased risk for developing chronic health problems compared with their healthy peers, and substance use can pose additional risks. The purpose of this review is to compare substance use in AYAs with their healthy peers and identify contributing factors. A literature search was conducted of PubMed, Scopus, and OVID databases using keywords substance*, adolescent*, adolescence*, teens*, teenager*, young adult*, pediatric*, childhood*, cancer*, and oncology*. The initial search yielded 148 articles. Inclusion criteria specified English language and articles from January 1, 2013, to December 31, 2023. Studies were excluded if they did not include participants aged <18 years and without a noncancer comparison group. Five relevant articles were included after review and appraisal. Substance use was examined by substance use type and contributing factors, including caregiver-AYA relations, age, and depression/coping. Findings were mixed for substance use, including tobacco and alcohol use. Findings indicate no consistent pattern-substance use was both more and less common in AYAs than in their noncancer peers, or substance use did not differ between AYAs and their noncancer peers. With mixed results, each study identified some level of substance use in AYAs. Given this knowledge, when treating AYAs, providers should be diligent about screening for substance use during each visit. AYAs should be educated about the risk of substance use, especially as a vulnerable, at-risk population.

Effective Strategies for Managing Substance Use Disorders in Older Adults in Nursing Homes

Substance use disorder is very prevalent in nursing home (NH) residents due to aging, the number of prescription drugs that are being used to manage their physical and psychological pain, and several discharges with the diagnosis of substance use disorder from hospitals to NH for aftercare support. However, many nursing homes are not equipped to provide adequate care for residents with a diagnosis of substance use. The staff is not well-trained to care for this type of population, which is becoming a challenge for the staff to manage residents in-house, leading to overdose, recurrent hospitalization, and unsuccessful discharges to communities due to relapses and an increase in the number of frequent flyers. Substance use disorder has become a significant public health concern in the United States, especially in the older population from the past couple of decades, which tends to increase. Discharging older adults with substance use disorders into nursing homes without ensuring established resources in the long-term care setting raises safety and quality concerns, emphasizing a pressing need for innovative preventive and management approaches for substance use disorders to meet unique needs of older adults in nursing homes. Purpose: The purpose of the study is to explore and identify the interventions, treatments and care models to effectively manage substance use disorders in older residents who are living in nursing homes. The study further focuses on the unique challenges that are faced by older adults and staff in nursing homes to understand the need for integrating addiction treatments in Long-term care settings to assess the need to enhance care strategies to improve resident outcomes, which includes handling overdose emergencies, prevention, rehabilitation and relapse management of substance use disorders (SUDs). Scope: Provides valuable insights for future researchers and points out the need for collaborative models among the rehabilitation, addiction centers, and LTC and the need for virtual health platforms to improve access to care, interdisciplinary approaches, and policy innovation on resident retention and optimum resource allocation to reduce the health care cost of frequent flyers or unnecessary hospitalizations, therefore, improve patient outcomes.

Validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale.

Stigma against people who have alcohol and drug problems severely affects their health and well-being. An instrument based on stigma theory assessing individual-level stigma is essential for a comprehensive understanding of their stigma. We evaluated the validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale (SU-SMS-J) among a population who had alcohol or drug use problems. Adults with experience in substance use disorders from psychiatry outpatient departments and rehabilitation facilities participated in the self-administered questionnaire survey. Confirmatory factor analysis was conducted to test the structural validity of the 5-factor model proposed in other language versions, and factor loadings and correlation between the subscales were confirmed. The correlations between the SU-SMS-J and psychometric properties related to substance use (e.g., severity of substance use, motivation to change) were investigated to assess concurrent validity. Internal consistency was assessed using Cronbach's alpha coefficients. Data from 126 participants were analyzed. The 5-factor model was acceptable with good or reasonable model fit indices. The correlations between subscales were weak to moderate, and this result suggested the SU-SMS-J assessed different but related components of stigma: enacted, anticipated, and internalized stigma from different stigma sources (family and healthcare workers). The SU-SMS-J and subscales showed moderate concurrent validity. Internal consistency was mostly sufficient, with Cronbach's alpha coefficients of 0.86 for all items and 0.66-0.93 for subscales. The SU-SMS-J is valid and reliable for use among populations with substance use problems in various settings in Japan.

Mental Health Experiences Among Undergraduate Nursing Students in a New Zealand Tertiary Institution: A Time for Change.

Nursing students in undergraduate programmes exhibit comparable, sometimes higher, levels of poor mental health and substance use compared to the general population; however, this area remains under-researched in New Zealand. The study involved 172 nursing students enrolled in the Bachelor of Nursing programme at one tertiary institution in Auckland, New Zealand. Employing a mixed-methodology approach, a 29-question survey comprising both open and closed questions was administered to explore the students' experiences with mental health and substance use, as well as their access to support services. Quantitative data were analysed using SPSS version 29 descriptive statistics, while a general inductive approach guided the qualitative analysis. A significant proportion of participants (75%) reported experiencing emotional distress during their studies, with anxiety being the most prevalent (78.5%). A smaller percentage disclosed substance use (8.1%) including excessive alcohol use, cannabis use, nicotine use, vaping cannabis and some refusal to reveal substance use. Surprisingly, less than 1% (n = 0.6) utilised institutional support services. Three qualitative themes were identified including emotional distress and associated effects, emotional and psychological impacts on nursing students' academic journey and tertiary support systems. The findings highlight the urgent need to address the mental health and addiction challenges experienced by nursing students, given their potential adverse effects on academic success and overall well-being. Urgent action is needed to integrate mental health training into the curriculum and provide faculty support. In this study, the underutilisation and inadequacy of institutional support services signal a need for institutional reforms to provide access and personalised mental health support to nursing students. Providing essential skills and support for student success contributes to the overall well-being of the nursing workforce.

Cariprazine in Bipolar Disorder and Substance Use: A Dual Approach to Treatment?

Bipolar disorder (BD) is characterized by recurrent episodes of mania, hypomania, and depression and is often complicated by comorbid substance use disorders (SUDs). Up to 60% of individuals with BD experience SUDs, which exacerbate mood instability and increase the risk of rapid cycling, suicide, and poor clinical outcomes. Current treatment strategies, including lithium and valproate, show limited efficacy in treating both BD and SUD. Psychotherapeutic approaches such as cognitive behavioral therapy (CBT) offer benefits but lack a specific focus on substances such as cannabis and cocaine. Since there is still debate on how to treat this comorbidity, there is a need to find new therapeutic options; this mini-review examines the pharmacological properties of cariprazine and its emerging role in the treatment of comorbid BD and SUD. Cariprazine, an atypical antipsychotic with partial agonism at dopamine D2 and D3 receptors, has shown promise in treating both mood symptoms and cognitive dysfunction in BD. Its unique affinity for D3 receptors, which are involved in motivation and reward processing, may offer advantages in reducing drug craving. Clinical trials indicate that cariprazine effectively treats manic, depressive, and mixed episodes in BD with a favorable side effect profile, particularly at lower doses. Preliminary results suggest its potential to reduce craving and substance use in individuals with co-occurring BD and SUD. Therefore, cariprazine, with its unique pharmacodynamic mechanism, could be further studied for the treatment of BD in comorbidity with SUD. However, evidence on the role of cariprazine in the treatment of SUDs remains limited, based primarily on case reports and animal studies. Further research, including large-scale clinical trials, is needed to determine its full efficacy in this dual diagnosis.

Preadolescent individual, familial, and social risk factors associated with longitudinal patterns of adolescent alcohol, cannabis, and other illicit drug use in a population-representative cohort.

The aim of this exploratory study was to identify developmental patterns of adolescent concurrent alcohol, cannabis, and other illicit drug use and their preadolescent individual, familial, and social risk factors in a population-representative cohort from the province of Quebec, Canada (N = 1,593; 48.4% male). Age 12-17 years self-reports of alcohol, cannabis, and other illicit drug use were collected. Latent growth modeling was used to analyze developmental patterns of single- or polysubstance use (SU/PSU), and multinomial regression examined their association with risk factors assessed at age 10-12 years. Five developmental patterns were revealed, including nonusers (12.8% sample) and four classes reflecting different levels of SU/PSU (5.8%-37.5%), varying in severity based on onset, frequency, and type of substances used. Boys and girls were similarly represented throughout SU/PSU patterns. In comparisons with nonusers, several preadolescent risk factors were associated with increasing severity of SU/PSU. Possibly indexing fearlessness/disinhibition, low internalizing symptoms were common to all adolescent users. An earlier onset of substance use and increasing use of substances throughout adolescence were linked with having deviant peers for all user classes but later-onset users. Preadolescents manifesting externalizing problems and exposed to family adversity in addition to the above risk factors showed the earliest onset and most frequent adolescent SU/PSU, especially those also exposed to less appropriate parenting. Consistent with the developmental model of substance use, the nature, number, and severity of preadolescent risk factors distinguished between the type and severity of SU/PSU patterns in adolescence and call for a consistent strategy of universal, selective, and indicated preventive interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Holistic Harm Reduction Center Model: A Commentary

Substance addiction is a chronic, relapsing disorder characterized by compulsive drug seeking, loss of control over consumption, and a negative emotional state when access to the drug is restricted. Substance Use Disorders (SUDs) are associated with severe health issues including suicide and co-occurring diseases like HIV and hepatitis C, and mental health problems. Although the present SUD treatment models prioritize abstinence, achieving abstinence during a treatment episode is challenging as majority of individuals with SUDs continue using drugs during treatment. To address this challenge in the current SUD treatment model, harm reduction has emerged as a strategy that focuses on interventions such as naloxone distribution, syringe services, safe drug use education and other strategies that reduce harmful outcomes such as substance-related overdose death and disease transmission while improving quality of life. This commentary proposes a Holistic Harm Reduction Model that can be incorporated by harm reduction centers aimed at reducing risky drug use behavior and overdose deaths, and ultimately improving public health outcomes in the community. The proposed holistic model includes new components such as trauma-informed care and referral and a brief mindfulness intervention along with the already existing harm reduction approaches such as Licensed Practical Nurses (LPNs) and harm reduction managers to provide comprehensive healthcare services, distribution of supplies; education; referral and linkage to other services, including medications for substance use disorder; and participant data collection and analysis.