A Bayesian mixed effects support vector machine for learning and predicting daily substance use disorder patterns

The Evidence for SBIRT in Adolescents

Project SARET: An interprofessional education (IPE) lens examines substance use disorders research education for health professional students.

BackgroundChildhood maltreatment increases the risk of substance use and substance use disorder (SUD) in adolescence and adulthood, with social support potentially mitigating this relationship. However, research in Ethiopia on mediating factors remains limited. This study uses structural equation modeling (SEM) to evaluate the influence of childhood maltreatment on substance use and the mediating role of social support among students in Gondar Town, Northwest Ethiopia.MethodA cross-sectional study was conducted from April 18 to May 9, 2023, among 1,235 preparatory and public high school students in Gondar Town who were selected via simple random sampling. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), which yields a total score ranging from 28 to 140. For descriptive analysis, scores were categorized as “none” for values between 25 and 36 or as “some form of childhood maltreatment” for scores above 37. Substance use was measured using the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS-1) tool. Problematic substance use was defined as any response greater than “never” within the past 12 months. Social support was evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS). Structural equation modeling analyzed the relationships, calculating the mediation proportion.ResultsThe median age was 17 years, with 63.24% female participants. Of the students, 85.42% reported a history of childhood maltreatment, 23.48% had problematic alcohol use, and 10.04% had problematic drug use in the past 12 months. Childhood maltreatment significantly increased substance use (β = 1.181, 95% CI (lower, upper): 0.223–1.821). Specific maltreatment types—physical abuse (β = 1.422, 95% CI (lower, upper): 0.590–2.423), sexual abuse (β = 0.653, 95% CI (lower, upper): 0.652–1.320), emotional abuse (β = 2.252, 95% CI (lower, upper): 1.402–4.307), physical neglect (β = 4.101, 95% CI (lower, upper): 1.042–0.904), and emotional neglect (β = 1.513, 95% CI (lower, upper): 0.831–3.059)—were positively associated with substance use. Social support negatively mediated 28.30% of this relationship, reducing the effect of maltreatment on substance use.ConclusionPhysical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect all increase the likelihood of substance use. However, social support mitigates the relationship between childhood maltreatment and substance use. These findings highlight the need for interventions strengthening social support to mitigate the impact of maltreatment on substance use in Ethiopia.

Letter to editor

The need for mental health services, and substance use treatment in particular, among deployed military personnel is well known and can hardly be debated 1-4. However, the need of the children in families with deployed parents is relatively poorly understood and remains a critically important and largely unaddressed public health issue in the United States 5-7. This is why the manuscript by Acion and colleagues 6 is both timely and important, as it examines the increased risk of alcohol and drug use among children from deployed families. The findings, while descriptive in nature, clearly demonstrate higher levels of current alcohol use, heavy alcohol use, current marijuana use, current illegal drug use and current prescription drug misuse among children in deployed families versus children in other families. This issue is particularly troubling given that the United States has had a substantial increase in deployed military personnel in recent years and a corresponding increase in the number of children who have had their parents deployed. An emerging literature outlines a range of psychosocial issues among children in military-connected families 5, 8. The issue of increased substance use among the children in military families appears to be troubling, in particular because substance use may exacerbate many of the other issues these children and youth are facing 5. It has been well documented that alcohol and substance misuse is a pervasive problem among military personnel and veterans that extends to their families 3, 4, 8, 9. Recent findings indicate that half the substance abuse treatment admissions among veterans aged 21–39 years involve alcohol as the primary substance of abuse 10. Additionally, research concerning army soldiers examined shortly after returning from deployment show that 27% met criteria for alcohol abuse 1. As such, it is not surprising that alcohol misuse is a critically important problem not only for those serving in the military, but also for their family members. However, data on substance use among family members, particularly the children, are lacking 5-7. While most attention has been given to the deployed family member, less attention has been given to the children of the deployed family members. These children may be vulnerable to a host of issues that also include mobility and disruption of care and social networks 5. Several new strategies have been proposed 11, and recent initiatives have been launched to understand more clearly and address the broader issues of family functioning in this population 12, 13. For example, in 2010 the National Institute of Drug Abuse and the Department of Veteran Affairs launched a program to support research on substance abuse among US military personnel, veterans and their families 1. However, it is not yet clear how these initiatives will address the growing needs of at-risk children in military families specifically and what the outcomes may be pertaining to prevention and intervention initiatives, including screening and treatment services. The paper by Acion and colleagues 6 suggest that schools and health-care providers conduct screening for early substance use and facilitate access to services among youth at heightened risk for substance use. Similarly, the American Academy of Pediatrics recommends that pediatricians screen and evaluate youth routinely for substance use and provide office interventions and referrals for patients who are using alcohol or other substances 14. While this policy does not address military-connected families specifically, if the policy were implemented fully, with particular attention to youth whose parents are deployed, substance use issues in this population could be addressed more promptly and thoroughly, and then evaluated in future research. Additionally, the National Institute of Alcohol Abuse and Alcoholism has disseminated the recently developed Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide [15], which will greatly streamline interaction with youth and provide guidance to practitioners on this important topic. In addition to these new tools and initiatives, it will be important to establish future research priorities regarding substance use among the children in military-connected families 5. It is particularly important to identify strategies to reduce and delay alcohol use in this population and seek to prevent the consequences of early alcohol and substance use 16, 17. Additionally, providing reassurance to the impacted communities will also be important by implementing additional protection to these youth to offset the hardship their families have faced. To conclude, military-connected youth have substantially higher levels of substance use than other youth for a number of reasons and, as such, it should be considered an important health disparity. This issue, as do other disparities, merits commensurate increased attention and provision of resources to these affected children and youth. Unfortunately, lack of action to address this issue more deliberately raises important questions about our capacity, commitment and willingness to provide the support services that many of these children need and deserve. None.

When Addiction Co-Occurs With Traumatic Brain Injury

Background: The co-occurrence of mental and substance use disorders (SUDs) poses major public health challenges. Understanding their prevalence and risk factors is critical for developing targeted interventions. Aim: To estimate the prevalence of substance use and risk of co-occurring common mental disorders in three South African provinces (Western Cape, Eastern Cape [EC] and North West [NW]). Setting: The study was conducted in three provinces in South Africa (Madibeng district in NW province, King Sabata Dalindyebo [KSD] in the EC and Khayelitsha in the Western Cape). Methods: A stratified multistage random household survey was conducted using the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalised Anxiety Disorder Assessment (GAD-7) and Primary Care PTSD Screen (PC-PTSD-5) to assess mental disorders. Alcohol and substance use were measured with the Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT). Weighted prevalence estimates were calculated, and Rao–Scott adjusted Chi-square tests accounted for the complex survey design. Unweighted Chi-square tests explored demographic associations. Results: Of 1597 participants, 64.9% screened positive for at least one mental disorder. The prevalence of alcohol use disorder (AUD) was 31.9% and SUD 7.4%. Co-occurrence of AUD and SUD was 6.3%. Alcohol use disorder was significantly associated with depression, anxiety and posttraumatic stress disorder (PTSD), whereas SUD (excluding alcohol) showed no significant associations. Conclusion: Psychiatric comorbidity was partly associated with substance use. The findings highlight a substantial burden of co-occurring alcohol use and mental disorders among South African men, underscoring the need for integrated, trauma-informed primary healthcare services. Contribution: The study provides population-based evidence to inform service delivery and policy for under-resourced settings.

To investigate whether initiation of glucagon-like peptide-1 (GLP-1) receptor agonists is associated with both reduced risks of incident alcohol, cannabis, cocaine, nicotine, opioid, and other substance use disorders (SUDs) in people with no history of SUDs (protocol 1) and with reduced risk of SUD related adverse clinical outcomes among people with a pre-existing SUD (protocol 2). Emulation of eight parallel, new user, active comparator target trials using electronic health records: seven trials for each incident SUD outcome (protocol 1) and one trial for adverse outcomes in people with pre-existing SUD (protocol 2). US Department of Veterans Affairs. From a base population of 606 434 US veterans with type 2 diabetes, participants were assigned to one of the two protocols and followed for up to three years. Trial 1 (primary trial) of protocol 1 included 524 817 initiators of GLP-1 receptor agonists (n=124 001) or sodium-glucose cotransporter-2 (SGLT-2) inhibitors (n=400 816). Protocol 2 included 81 617 initiators of GLP-1 receptor agonists (n=16 768) and SGLT-2 inhibitors (n=64 849). Incident outcomes were alcohol, cannabis, cocaine, nicotine, opioid, other SUDs, and a composite of these outcomes. Adverse outcomes among participants with pre-existing SUDs included SUD related emergency department visits, SUD related hospital admissions, and SUD related mortality, and drug overdose and suicidal ideation or attempt. Hazard ratios and net three year risk difference (NRD) per 1000 people were reported based on inverse probability weighted (standardised mortality ratio weighted) cause specific Cox survival models. Compared with initiation of SGLT-2 inhibitors, initiation of GLP-1 receptor agonists was associated with reduced risk of disorders related to alcohol use (hazard ratio 0.82 (95% confidence interval (CI) 0.78 to 0.85); NRD per 1000 people -5.57 (-6.61 to -4.53)), cannabis use (0.86 (0.81 to 0.90), NRD -2.25 (-3.00 to -1.50)), cocaine use (0.80 (0.72 to 0.88), NRD -0.97 (-1.37 to -0.57)), nicotine use (0.80 (0.74 to 0.87), NRD -1.64 (-2.19 to -1.09)), and opioid use (0.75 (0.67 to 0.85), NRD -0.86 (-1.19 to -0.52)), and other SUDs (0.87 (0.81 to 0.94), NRD -1.12 (-1.68 to -0.55)) and composite outcome of all incident SUDs (0.86 (0.83 to 0.88), NRD -6.61 (-7.95 to -5.26)). Among people with pre-existing SUDs, initiation of GLP-1 receptor agonists was associated with reduced risk of SUD related emergency department visits (0.69 (0.61 to 0.78), NRD -8.92 (-11.59 to -6.25)), SUD related hospital admissions (0.74 (0.65 to 0.85), NRD -6.23 (-8.73 to -3.74)), and SUD related mortality (0.50 (0.32 to 0.79), NRD -1.52 (-2.32 to -0.72)), and drug overdose (0.61 (0.42 to 0.88), NRD -1.49 (-2.43 to -0.55)) and suicidal ideation or attempt (0.75 (0.67 to 0.83), NRD -9.95 (-13.14 to -6.77)). Analyses of treatment adherence showed directionally consistent results with analyses of treatment initiation for both incident SUDs and adverse outcomes among participants with pre-existing SUDs. Use of GLP-1 receptor agonists was consistently associated with reduced risks of developing various incident SUDs, suggesting a broad preventive effect across multiple substance types. Use was also associated with reduced risks of adverse clinical outcomes in people with pre-existing SUDs. These observational data suggest a potential role for GLP-1 receptor agonists in both the prevention and the treatment of various SUDs, warranting further evaluation.

1. Kirstin A. M. Nackers, MD* 2. Patricia Kokotailo, MD, MPH* 3. Sharon J. L. Levy, MD† 1. *Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2. †Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA. The American Academy of Pediatrics recommends screening for alcohol and other drug use at adolescent health supervision visits and appropriate acute-care visits, (1) yet many clinicians find addressing substance use with youth to be a challenge. After completing this article, the reader should be able to: 1. Describe the use trends for alcohol and common other drugs by youth in the United States. 2. Explain the primary care clinician’s role in screening and management of alcohol and substance use. 3. Using motivational interviewing techniques, adopt an in-office brief intervention across the spectrum of adolescent substance use. 4. Analyze the utility of urine drug testing in various clinical situations, such as random screening in a low-risk patient/population, testing an adolescent who self-reports ongoing substance use, monitoring adherence to treatment for a substance use disorder, and evaluating a patient with signs/symptoms of acute toxicity. Adolescent drug and alcohol use remains a major issue in the United States. The American Academy of Pediatrics (AAP) recommends screening for use of these substances at adolescent health supervision visits and appropriate acute-care visits. (1) Primary care clinicians (PCCs) serve an important role in both the identification and management of alcohol and substance use disorders (SUDs). This role comes with many challenges, including managing the dynamics of families that may be in crisis, issues of adolescent confidentiality, and high variability of local resources to support patients in need of treatment for SUDs. In this article, we review the epidemiology of alcohol and substance use, the approach to screening and treatment, the issue of adolescent confidentiality, and the role of urine drug testing. ### Epidemiology The epidemiology of adolescent substance use must be …

To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. Retrospective national cohort study of Veterans diagnosed with OUD (n=65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD+1 SUD) and with multiple SUDs (OUD+≥2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD+1 SUD and 35.9% had OUD+≥2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD+1 SUD [adjusted odds ratio (aOR)=0.87, 95% confidence interval (CI)=0.82-0.93] and patients with OUD+≥2SUDs (aOR=0.65, 95% CI=0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD+1 SUD (aOR=0.91, 95% CI=0.86-0.97)and for those with OUD+≥2SUDs (aOR=0.79, 95% CI=0.74-0.84). Patients with OUD+1 SUD (aOR=1.85, 95% CI=1.77-1.93) and patients with OUD+≥2SUDs (aOR=3.25, 95% CI=3.103.41) were much more likely to have a SUD clinic visit. The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.

Substance use is a leading cause of burden of disease worldwide. Selective prevention programs can help reduce the development of problematic substance use and disorders. To examine effects of a selective, personality-targeted substance use prevention program on alcohol, cannabis, tobacco, nonmedical opioid, and illicit polysubstance use among adolescents with elevated levels of personality traits associated with frequent and risky substance use. This prespecified secondary analysis of a cluster-randomized clinical trial assessed the effectiveness of a personality-targeted cognitive-behavioral intervention (PreVenture) in reducing substance use during adolescence. Participants included grade 7 students attending 31 secondary schools in the Greater Montreal Area, Canada (2012-2013 school year), who screened as having elevated levels of anxiety sensitivity, hopelessness, impulsivity, or sensation seeking. Schools were randomized to either the intervention (15 schools) or the control group (16 schools). Data were analyzed in January to March 2025. Schools delivered a 2-session, personality-targeted group-based cognitive-behavioral intervention designed to help students recognize, challenge, and manage personality-specific emotions, behaviors, and cognitions associated with substance use in adolescence. Self-reported frequency of alcohol, cannabis, smoking tobacco, nonmedical use of opioids, and illicit polysubstance use were measured by the Detection of Alcohol and Drug Problems in Adolescents. A total of 3861 students from 31 schools were screened; 1669 students (847 [50.7%] female; mean [SD] age, 12.83 [0.47] years) were at elevated risk of substance use and included in the intention-to-treat sample. The 31 schools were randomized, with 16 schools with 964 students in the control group and 15 schools with 705 students in the intervention group. Multilevel bayesian mixed-effects models indicated that students in the intervention group had slower increases in the frequency of alcohol (odds ratio [OR], 0.92; 95% credible interval [CrI], 0.85-1.00), cannabis (OR, 0.75; 95% CrI, 0.66-0.86), tobacco smoking (OR, 0.79; 95% CrI, 0.70-0.96), and illicit polysubstance use (OR, 0.56; 95% CrI, 0.35-0.89) over 4 years. Effects did not differ by sex. This secondary analysis of a cluster-randomized clinical trial found that personality-targeted interventions protected against the escalation in substance use during adolescence, with similar effects for males and females. ClinicalTrials.gov Identifier: NCT01655615.

The aim of the study was to investigate whether the prevalence of self-declared depressive symptoms among adolescents attending secondary schools in Krakow is associated with increased frequency and type of psychoactive substance use, and whether depressive symptoms, viewed as a categorical or dimensional variable, may be important in detecting risk of psychoactive substance use among adolescents. A cross-sectional analysis was performed in a group of 1,515 17-year-old students with the use of the Beck Depression Inventory and an original Stimulants questionnaire. The analysis of the risk of using psychoactive substances was carried out in relation to independent variables expressed as continuous variables. In the group of boys, each additional point on the Beck scale increased the overall risk of substance use by 3.3%, cigarette smoking by 2.7%, drinking alcohol by 2.7%, and drug use by 4%. In the group of girls, each additional point on the Beck scale increased the risk of substance abuse - overall by 3.7%, cigarette smoking by 3.6%, drinking alcohol by 3.1%, and drug use by 5.9%. Depressive symptoms, approached as a continuous variable, increase the risk of psychoactive substance use in both boys and girls, in particular a strong relationship is observed in the group of girls with low severity of symptoms. The presence of declared depressive symptoms increases the risk of using psychoactive substances, especially alcohol and tobacco, and to a lesser extent drugs, in both boys and girls. The use of a dimensional approach made it possible to identify the relationship between increasing depressive symptoms and psychoactive substance use in the group of girls regarded as 'healthy' ('with a negative screening diagnosis') in the categorical approach.

This study assessed the clinical efficacy of nirmatrelvir plus ritonavir (NMV-r) in treating patients with coronavirus disease-2019 (COVID-19) and substance use disorders (SUDs). This study included two cohorts: the first examined patients with SUDs, with and without a prescription for NMV-r, while the second compared patients prescribed with NMV-r, with and without a diagnosis of SUDs. SUDs were defined using ICD-10 codes, related to SUDs, including alcohol, cannabis, cocaine, opioid, and tobacco use disorders (TUD). Patients with underlying SUDs and COVID-19 were identified using the TriNetX network. We used 1:1 propensity score matching to create balanced groups. The primary outcome of interest was the composite outcome of all-cause hospitalization or death within 30 days. Propensity score matching yielded two matched groups of 10 601 patients each. The results showed that the use of NMV-r was associated with a lower risk of hospitalization or death, 30 days after COVID-19 diagnosis (hazard ratio (HR), 0.640; 95% confidence interval (CI): 0.543-0.754), as well as a lower risk of all-cause hospitalization (HR, 0.699; 95% CI: 0.592-0.826) and all-cause death (HR, 0.084; 95% CI: 0.026-0.273). However, patients with SUDs had a higher risk of hospitalized or death within 30 days of COVID-19 diagnosis than those without SUDs, even with the use of NMV-r (HR, 1.783; 95% CI: 1.399-2.271). The study also found that patients with SUDs had a higher prevalence of comorbidities and adverse socioeconomic determinants of health than those without SUDs. Subgroup analysis showed that the benefits of NMV-r were consistent across most subgroups with different characteristics, including age (patients aged ≥60 years [HR, 0.507; 95% CI: 0.402-0.640]), sex (women [HR, 0.636; 95% CI: 0.517-0.783] and men [HR, 0.480; 95% CI: 0.373-0.618]), vaccine status (vaccinated <2 doses [HR, 0.514; 95% CI: 0.435-0.608]), SUD subtypes (alcohol use disorder [HR, 0.711; 95% CI: 0.511- 0.988], TUD [HR, 0.666; 95% CI: 0.555-0.800]) and Omicron wave (HR, 0.624; 95% CI: 0.536-0.726). Our findings indicate that NMV-r could reduce all-cause hospitalization and death in the treatment of COVID-19 among patients with SUDs and support the use of NMV-r for treating patients with SUDs and COVID-19.

Efficacy of mindfulness-based relapse prevention in a sample of veterans in a substance use disorder aftercare program: A randomized controlled trial

Objective: The study examined factors in the risk trajectory for substance use disorder (SUD) over a 10–12-year period in children with attention-deficit/hyperactivity disorder (ADHD). Method: N = 145 children between the ages of 7 and 16 with ADHD and healthy controls (HCs) were assessed every 2 years for 10–12 years as part of a larger, longitudinal investigation. Onset of SUD was examined using Cox proportional hazards modeling, and included child and parent psychopathology, and parental warmth as well as other key factors. Results: Low paternal warmth and maternal SUD were predictors of SUD in n = 59 ADHD participants after adjusting for gender, child oppositional defiant disorder (ODD), paternal SUD, maternal/paternal ADHD, maternal/paternal major depressive disorder, maternal/paternal anxiety and low maternal warmth in the Cox model. Conclusions: Longitudinal study findings suggest that in addition to the established risk of ADHD and maternal SUD in development of child SUD, low paternal warmth is also associated with onset of SUD. This was evident after controlling for pertinent parent and child psychopathology. These findings suggest that paternal warmth warrants further investigation as a key target for novel interventions to prevent SUD in children with ADHD. More focused investigations examining paternal parenting factors in addition to parent and child psychopathology in the risk trajectory from ADHD to SUD are now warranted.