Although alcohol-associated liver disease (ALD) is a leading cause of liver transplantation, most patients with ALD are never evaluated. This study aims to investigate the prognostic assessment process of medical professionals often involved in treating patients with ALD. We wanted to assess the possible effect of disease understanding, stigmatisation, experience in transplantation and addiction medicine on the liver transplantation evaluation process. The study was conducted as an anonymous online survey. In total, 407 health professionals were included in the study (291 medical doctors, 86 nurses, and 30 psychologists). The participants were invited to review five cases of potential liver transplantation candidates and assess the prognostic outcome ("positive control", "negative control", "missing illness insight", "missing social support", "abstinence under six months"). Mean prognostic assessment scores were significantly different between the cases, with abstinence under six months being graded the highest, followed by lack of social support and lack of disease insight. We fitted a linear regression to model the influence of stigmatisation, individual alcohol use, disease understanding, and experience in transplant and addiction medicine on the appraisal of each case. All models were significant (Model 1: R = 0.201, p = .005; Model 2: R = 0.312, p < 0.001; Model 3: R = 0.291 p < 0.001; Model 4: R = 0.283, p < 0.001; Model 5: R = 0.285, p < 0.001). All factors had a significant effect on one or more of the cases. The findings suggest that patient and evaluator characteristics significantly impact the prognostic assessment process of patients with ALD and highlight potential biases when assessing the prognosis.

Introduction: Early identification for preventing drug misuse among adolescents and young adults (AYAs) is more cost-effective than drug treatment. However, there is a lack of scientific and comprehensive risk models for early identification. This study aimed to construct risk models and association pathways that integrate psychosocial factors influencing drug misuse in AYAs using a machine learning approach. Methods: This cross-sectional study included 1,012 Chinese AYAs aged 14–35 years and was conducted from June to December 2023. Key psychosocial factors for drug misuse were identified using the least absolute shrinkage and selection operator and Boruta. A voting classifier combining logistic regression, K-nearest neighbors, support vector machine, and 5-fold cross-validation was used for model training and bootstrapping method wan applied for testing. Shapley additive explanation was used to determine the importance of each risk factor. A Bayesian network (BN) model was constructed to explore possible association pathways for drug misuse. Results: A total of 3.85% of participants reported drug misuse. Significant risk factors included environmental exposure to drug misusers, working in nightlife venues (WNVs), cognition of traditional drug types, perceived risks of drug misuse, permissive attitude toward drug misuse, refusal self-efficacy of drug misuse (RSEDM), externalizing problem behavior, sensation-seeking, and adverse childhood experiences (ACEs). The voting model showed strong performance (recall: 94.10%; area under the curve: 98.11%; accuracy: 92.63%; precision: 34.15%; F-score: 49.68%). The BN model revealed that ACEs played a central role in risk assessment of drug misuse. AYAs WNVs, with low RSEDM and exposure to drug misusers, had exceeding 90% probability of drug misuse. Conclusion: ACEs serve as a primary risk factor, with a significant impact on social environmental influences. AYAs with ACEs and those WNVs require targeted and early interventions to prevent drug misuse.

Introduction: Gambling behaviour among adolescents is a serious public health concern. Adolescents’ involvement in gambling is often related with substance use and antisocial behaviours. This study aims to examine the association of substance use and antisocial behaviours with gambling among Italian early adolescents. Methods: The analytical sample of the present study included 1,822 students attending 29 secondary schools in nine NHS districts of Piedmont region and the city of Rome who participated in the baseline survey of the experimental controlled trial “GAPUnplugged.” The association of lifetime cigarette smoking, alcohol drinking, drunkenness, illicit drug use, violence, and stealing with the probability of any gambling and regular gambling was estimated through multilevel mixed-effect regression models. Results: The prevalence of any gambling and regular gambling in the last 30 days was 36.4% and 12.7%, respectively. After adjustment for potential confounders, cigarette smoking, alcohol drinking, drunkenness, violence, and stealing were significantly associated with an increased probability of both gambling outcomes. The link of gambling outcomes with alcohol drinking and drunkenness was higher for females, whereas the association with violence and stealing was higher for males. Conclusion: Due to the association of gambling with other problem behaviours during early adolescence, school-based health promotion and prevention interventions should address multiple risk behaviours simultaneously. Prevention of one risk behaviour may contribute to the prevention of other risk behaviours.

Introduction: Population-level substance use research primarily relies on self-reports, which often underestimate actual use. Hair analyses offer a more objective estimate; however, longitudinal studies examining concordance are lacking. Previous studies showed that specific psychological and behavioral characteristics are associated with a higher likelihood of underreporting substance use, but the longitudinal stability of these associations remains unclear. We compared the prevalence of illegal and non-medical prescription substance use assessed with self-reports and hair analyses and predicted underreporting across two time points. Methods: Data were drawn from a community cohort study. At the first time point, the sample with self-report and hair analysis comprised 1,002 participants (Mage = 20.6 [SD = 0.38] years, 50.2% female), of which 761 (Mage = 24.5 [SD = 0.38] years, 48.3% female) also provided hair at the second time point. We compared substance use 3-month prevalence rates assessed by self-reports and hair analyses for the most frequent substances cannabis/tetrahydrocannabinol (THC), amphetamines, Ecstasy/3,4-methylenedioxymethamphetamine (MDMA), cocaine, ketamine, codeine, and opioid painkillers. Binary logistic regressions were conducted to test behavioral and psychological predictors of underreporting. Results: Self-reported past-year prevalence rates of non-medical substance use were high, specifically for cannabis (56% prevalence rate at age 20/49% at age 24), Ecstasy (13%/14%), codeine (13%/11%), cocaine (12%/13%), and opioid painkillers (4%/11%). Comparing self-report and hair-analysis 3-month prevalence rates over time, consistent underreporting (similar underreporting rates between time points and investigation of false negatives) was observed for daily cannabis (22%/23%), Ecstasy/MDMA (41%/52%), cocaine (30%/60%), ketamine (61%/72%), and codeine use (48%/51%). Underreporting of Ecstasy/MDMA, cocaine, ketamine, and opioid painkillers significantly increased. Contrarily, weekly to daily cannabis (31%/18%), amphetamine (95%/11%), and opioid painkiller use (12%/66%) were overreported. Hair analysis-derived 3-month prevalence rates of cocaine (9%/23%) and ketamine (2%/6%) strongly increased over time, while decreasing for codeine (11%/8%). Balanced accuracies were higher for hair analysis compared to self-reports for daily cannabis, Ecstasy/MDMA, cocaine, ketamine, and codeine but lower for weekly to daily cannabis and amphetamines, while fairly similar for opioid painkillers. Accuracy metrics were largely stable for cannabis measures but partially varied over time for other substances, which was likely driven by the large changes in underreporting. False negative reports were associated across both time points, indicating an intra-individual consistency of underreporting. At both time points, delinquency and attention-deficit hyperactivity disorder symptoms were associated with an increased likelihood of accurately reporting cocaine use, while internalizing symptoms increased the likelihood of accurately reporting codeine use. Conclusion: Consistent and changeable underreporting emphasizes the importance of objective substance use assessments, specifically for studies investigating cocaine, Ecstasy/MDMA, ketamine, and codeine.

Introduction: Although recreational cannabis use and abuse are expressive worldwide, the comparison of worldwide used psychotherapies, such as cognitive behavior therapy, with contingency management in the treatment of cannabis use disorder remains inconclusive. Methods: We screened all articles published on MEDLINE (via PubMed) published until October 2023 and conducted a systematic review with meta-analysis. Results: Sixteen studies were included, and contingency management intervention likely promotes abstinence outcomes and more negative urinalyses for adults or adolescents with cannabis use disorder. Discussion: This review provides moderate- to high-quality evidence that contingency management can be used to treat cannabis use disorder. However, further trials need to be developed to analyze the quantity of substance use, personal achievements, and operational improvements after treatment.

Introduction: Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success. Method: A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables. Results: Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission. Discussion/Conclusion: Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.

DI-fusion, le Dépôt institutionnel numérique de l'ULB, est l'outil de référencementde la production scientifique de l'ULB.L'interface de recherche DI-fusion permet de consulter les publications des chercheurs de l'ULB et les thèses qui y ont été défendues.

Introduction: The aim of the present study was to examine for the first time the factorial, construct, and predictive validity of the motivation for treatment (MfT) scale in a cohort of patients undergoing inpatient-qualified alcohol withdrawal treatment with the goal of referring patients to further treatment. The MfT scale has previously been evaluated in different settings of substance abuse treatment, revealing factorial ambiguity. To the best of our knowledge, the present study is the first study that conducted comprehensive factor analyses versus separate analyses of the factors conducted in prior studies in order to clarify the aforementioned factorial ambiguity. Methods: A total of 249 patients (mean age 45.2 years (SD = 10.3); 34.4% females) with alcohol dependence were assessed. Data were obtained from four inpatient clinics specialized in qualified alcohol withdrawal treatment in Germany. First, confirmatory factor analyses were carried out to examine the fit of the four models discussed in the literature. Second, an exploratory factor analysis was conducted. Correlations of the new factors with other motivational constructs and referral to a subsequent treatment were investigated as measures of construct and predictive validity. Results: None of the four models showed an acceptable fit to the data in confirmatory analyses. The exploratory analysis suggested to eliminate seven items because of inappropriate factor loadings and resulted in a shortened MfT scale, which consists of three factors based on 17 items. For the latent variables “problem recognition,” “desire for help,” and “treatment readiness,” satisfactory composite reliability was found with 0.82, 0.80, and 0.78, respectively. Evidence for predictive validity was found in the correlation between “treatment readiness” and referral to a subsequent treatment. Discussion/Conclusion: The new shortened MfT scale exhibited remarkable parsimony, which is desirable in settings such as withdrawal treatment, where patients frequently are cognitively or physically impaired. Despite its briefness, construct and predictive validity were better than in the original version of the MfT scale. The factorial validity of the suggested scale needs to be corroborated in further research.

Introduction: According to the literature, early initiation to cannabis use and a dependent pattern of use are important risk factors for the development of mental health disorders. However, there are few cohort studies which look at the development of mental health disorders associated with cannabis use among young people with cannabis use disorder (CUD). The aim of the study was to determine the cumulative incidence of mental health disorders and the risk of developing mental health disorders among minors who commenced treatment for CUD in Catalonia during 2015–2019. Methods: This was a retrospective fixed cohort study, matched for confounding variables, based on data from the Catalan Health Surveillance System. The exposed cohort comprised young people who entered treatment for CUD during 2015–2019 (n = 948) and who were minors on the date of commencing treatment. Matching was done with a paired cohort (n = 4,737), according to confounding variables. Individuals with a diagnosis of a mental health disorder prior to the study period were excluded. The cumulative incidence was calculated for mental health disorders for the exposed and the paired cohorts and stratified by type of mental disorder. Incidence rate ratios were estimated using the conditional Poisson model with robust variance, stratified by sex. Results: The cumulative incidence for development of a mental health disorder was 19.6% in the exposed cohort and 3.1% in the paired cohort; with higher incidence among females (females 32.7%; males 15.8%). The exposed cohort had an 8.7 times increased risk of developing a mental health disorder than the paired cohort. The most frequent diagnoses were reaction to severe stress, adjustment disorder, and personality disorders. Conclusion: This study confirmed that the exposed cohort was at increased risk of developing mental health disorders compared to the paired cohort. To date, few studies have analyzed the association between cannabis use and the development of mental health disorders, considering cannabis dependence. Further studies should be undertaken considering CUD. In addition, more studies are needed to understand the factors that determine the development of CUD. Further research in these areas would contribute to the design of prevention strategies aimed at those young individuals with a higher risk of developing cannabis dependence and suffering its consequences.