Estimating the economic consequences of substance use and substance use disorders

Animal models of cocaine use: importance of social context and co-use

Cocaine-use disorders (CUDs) continue to be a major public health problem that requires effective treatments. Despite decades of preclinical research, there are no FDA-approved pharmacotherapies for cocaine use. While there are numerous potential reasons why no efficacious treatments have been identified or approved for cocaine use, we discuss two possible reasons in this review: the low number of studies incorporating social variables and the overlooking of the clinical reality of polysubstance use. These variables impact drug use across the substance-use cycle, including vulnerability, maintenance, and treatment. Recent preclinical and clinical data suggest that cocaine users who engage in polysubstance use should be viewed as a distinct and more prevalent population who require unique behavioral and pharmacological approaches to reduce cocaine use. Therefore, to understand the neurobiology and eventual treatments for CUDs, both variables should be included in animal models.

Integrated Prevention Infrastructure: A Framework for Addressing Social Determinants of Health in Substance Use Policy Making

Substance use and misuse remain formidable public health challenges and are intricately linked to social determinants of health (SDOH). Addressing SDOH requires structural interventions along with clinical support to change relevant policies. In this article, the authors review structural interventions known as prevention infrastructures and provide a framework for considering how different models of prevention infrastructures can be used to address SDOH that contribute to substance use. In particular, they introduce a typology of prevention infrastructures and explain how different infrastructure types can affect policy decision making across contexts and how these models can interact with each other. Furthermore, they consider the importance of cultural responsiveness in the creation of effective infrastructures to support communities and policy makers within organizations and government.

Strengthening Neuroplasticity in Substance Use Recovery Through Lifestyle Intervention

The incidence of substance use and behavioral addictions continues to increase throughout the world. The Global Burden of Disease Study shows a growing impact in disability-adjusted life years due to substance use. Substance use impacts families, communities, health care, and legal systems; yet, the vast majority of individuals with substance use disorders do not seek treatment. Within the United States, new legislation has attempted to increase the availability of buprenorphine, but the impact of substance use continues. Although medications and group support therapy have been the mainstay of treatment for substance use, lifestyle medicine offers a valuable adjunct therapy that may help strengthen substance use recovery through healthy neuroplastic changes.

Using Interactive Television Instruction (ITV) to Reduce the Propensity to Engage in Substance Abuse and Drug Trafficking Among Vulnerable Adolescents in Nigeria

This study examined the impact of ITV intervention on reduction in the propensity to abuse substances and engage in drug trafficking. The researcher conducted this study using an experiment of 517 vulnerable adolescents aged 10-19 years. The participants were randomly assigned to control (n = 258) and treatment (n = 259) groups. The researchers found a significant main effect of treatment conditions on reduction in the propensity to engage in substance abuse and drug trafficking among vulnerable adolescents. That is, before the intervention, there was no significant statistical difference between the control and treatment groups on the propensity to engage in substance abuse and drug trafficking. However, vulnerable children who received the intervention reported a significant reduction in propensity after the intervention. The results highlight the usefulness of ITV as a behaviour change strategy for vulnerable children.

Ostracism Predicting Suicidal Behavior and Risk of Relapse in Substance Use Disorders

INTRODUCTION

The present study investigated the predictive relationship between ostracism and suicidal behaviors in individuals with substance use disorders. It also attempts to highlight the mediating role of the risk of relapse between ostracism and suicidal behavior.

METHODS

The study was based on a cross-sectional survey design. The sample comprised 100 men aged between 30 to 45 years (M = 35.25, SD = 3.06) from Karachi. The purposive sampling technique was employed. The study employed demographic forms and three self-reporting measures: the Ostracism Experience Scale (OES-A), the Advance Warning of Relapse Questionnaire 3.0 (AWARE), and the Suicide Behaviors Questionnaire-Revised (SBQ-R).

RESULTS

Ostracism significantly predicted relapse risk and suicidal behavior. Risk of relapse positively predicted both dimensions of ostracism (ignored: r = 0.33, p < 0.01; excluded: r = 0.43, p < 0.01) and suicidal behavior (r = 0.35, p < 0.01). Additionally, the risk of relapse strongly correlated with overall ostracism score (r = 0.43, p < 0.01). However, no significant mediating effect of ostracism on suicidal behavior was found. The effect was mediated through the risk of relapse (B indirect = 0.12, 95% CI = 0.04, 0.23). These findings suggest that ostracism increases the likelihood of recurrence, which in turn is associated with suicidal behavior. The mediation model explained 17% of the variation in suicidal behavior.

CONCLUSION

The findings propose the importance of addressing ostracism as a risk factor for suicidal behavior and relapse in substance use disorders. The results suggest that reducing the adverse effects of ostracism and improving social support for individuals can have a significant impact on their mental health.

The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada

BACKGROUND

Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days.

METHODS

Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors.

RESULTS

Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use.

CONCLUSIONS

The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.

Classifying alcohol control policies enacted between 2000 and 2020 in Poland and the Baltic countries to model potential impact

AIMS

The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020.

METHODS

Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all-cause mortality and alcohol-attributable hospitalizations was discussed.

RESULTS

All Baltic countries implemented stringent availability restrictions on off-premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans.

CONCLUSIONS

This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland).

Are restrictions in sales hours of alcohol associated with fewer emergency room visits in Lithuania? An interrupted time-series analysis

INTRODUCTION

On 1 January 2018, an amendment to the alcohol control law was introduced in Lithuania which, among other changes, reduced trading hours for alcoholic beverages by 4 h for weekdays and Saturdays, and by 9 h for Sundays. The objective of the current study was to quantify the potential association of this law with the numbers and types of emergency room (ER) visits in Lithuania, in general and specifically for Sundays, for all ER visits, for injury-related ER visits and specifically for alcohol poisoning as a 100% alcohol-attributable cause.

METHODS

Sex-stratified time-series analysis-based models for the period 2016-2019 were used to test for associations and for potential alternative explanations (e.g., the increase in minimum legal drinking age, which occurred at the same time).

RESULTS

Overall, while the reduction in sales hours for both sexes was associated with slight increases in all types and in injury-related ER visits on a weekly basis, the association with ER visits for alcohol poisoning was in the opposite direction for men in all models. Specifically, among men, it was associated with an approximate decrease of 20% of alcohol poisoning-related ER visits on Sundays and an approximate decrease of 12% of alcohol poisoning-related ER visits for all seven weekdays.

DISCUSSION AND CONCLUSIONS

As predicted, restrictions on availability were associated with marked reductions in ER visits for alcohol poisoning in men. However, contrary to expectations, there were no overall reductions in overall ER visits, nor reductions in injury-related ER visits.

Health-related quality of life in patients with substance use disorders enrolled to the residential treatment in Sri Lanka: a retrospective cross-sectional study

PURPOSE

Substance use disorder (SUD) is a serious public health concern that requires continuum care with effective treatment modalities such as residential rehabilitation. Improvement in health-related quality of life (HRQoL) is one of the determinants of treatment and rehabilitation effectiveness. Therefore, a retrospective cross-sectional study was carried out in seven residential rehabilitation centres in Sri Lanka to determine the HRQoL of the rehabilitees with SUD.

METHOD

The HRQoL of 464 individuals at their enrolment and during the rehabilitation period was assessed using EuroQol five-level five-dimensional questionnaire (EQ-5D-5L). Data were analysed using IBM SPSS version 26.

RESULTS

The majority of the participants were Sinhala (n = 419, 90.3%) and Buddhist (n = 368, 79.3%) males (n = 461, 99.4%). Most were unmarried (n = 302, 65.1%), young adults (n = 385, 83.0%) who have pursued secondary or higher education (n = 276, 59.5%) and 87.3% were employed (n = 405). Most of the selected centres use biopsychosocial model (n = 4, 57.1%) as the rehabilitation approach while rest practice therapeutic community (n = 3, 42.9%). The average EQ-5D-5L index [range =( - 0.45)-1.00] of the rehabilitees at their enrolment was 0.52 ± 0.28 and the EQ-5D-5L Visual Analogue Scale (EQ-5D-5L VAS) score (range = 0-100%) was 47.17% ± 23.48%. The values were increased up to 0.83 ± 0.18 (EQ-5D-5L index) and 84.25% ± 16.79% (EQ-5D-5L VAS) during the rehabilitation period. Only 19.4% of the rehabilitees had a normal or upper normal HRQoL (≥ 0.75 EQ-5D-5L Index) at their enrolment and 72.2% of rehabilitees reported normal or upper normal HRQoL during the rehabilitation period.

CONCLUSION

A significant improvement in the HRQoL of the participants was observed during the residential treatment in comparison to the enrolment, despite the differences in the rehabilitation programs.

Predicting the Impact of Alcohol Taxation Increases on Mortality-A Comparison of Different Estimation Techniques

AIMS

To examine how standard analytical approaches to model mortality outcomes of alcohol use compare to the true results using the impact of the March 2017 alcohol taxation increase in Lithuania on all-cause mortality as an example.

METHODS

Four methodologies were used: two direct methodologies: (a) interrupted time-series on mortality and (b) comparing predictions based on time-series modeling with the real number of deaths for the year following the implementation of the tax increase; and two indirect methodologies: (c) combining a regression-based estimate for the impact of taxation on alcohol consumption with attributable-fraction methodology and (d) using price elasticities from meta-analyses to estimate the impact on alcohol consumption before applying attributable-fraction methodology.

RESULTS AND CONCLUSIONS

While all methodologies estimated reductions in all-cause mortality, especially for men, there was substantial variability in the level of mortality reductions predicted. The indirect methodologies had lower predictions as the meta-analyses on elasticities and risk relations seem to underestimate the true values for Lithuania. Directly estimated effects of taxation based on the actual mortalities seem to best represent the true reductions in alcohol-attributable mortality. A significant increase in alcohol excise taxation had a marked impact on all-cause mortality in Lithuania.