Search Results (191)

Background: Substance Use Disorder (SUD) is frequently associated with psychiatric comorbidity, including psychotic symptoms, impulsivity and neurodevelopmental traits. The influence of age and duration of substance use on these clinical characteristics and on treatment retention remains insufficiently understood. Objectives: To examine the influence between age, duration of substance use, clinical presentation, patterns of violence, and treatment retention in individuals with SUD. Methods: A prospective 6-month cohort study was conducted at the Alcoholism Treatment Unit of the CAUSA Hospital Complex in Salamanca, Spain. A total of 264 patients with SUD were classified into two groups: prolonged substance use (≥55 years of age or ≥25 years of substance use; n = 127) and shorter substance use trajectories (<55 years and <25 years of substance use; n = 137). Participants completed structured clinical interviews and validated measures of quality of life, impulsivity, autistic traits, addiction severity, psychotic symptoms and violence. Non-parametric analyses were applied (α = 0.05; 95% CI). Results: Younger participants showed a significantly higher prevalence of auditory and visual hallucinations and persecutory delusions at baseline. During follow-up, both groups exhibited a reduction in physical aggression while driving and an increase in insults and verbal threats. No significant differences were observed in recent uncontrolled violence. Positive screening results for ADHD, autistic traits and impulsivity were not associated with treatment retention. Lower baseline physical functioning was associated with reduced completion of the 6-month follow-up assessment. Conclusions: Age and duration of substance use were associated with differences in the clinical presentation of SUD. Younger individuals exhibited a greater burden of psychotic symptoms and violence-related behaviours, whereas poorer physical functioning was associated with lower follow-up retention among individuals with prolonged substance use histories. These findings support the importance of age-sensitive assessment and management strategies in patients with SUD. Full article

Background/Objective: Emotion regulation (ER) is closely linked to decision-making (DM). Although executive functions (EF) are often suggested as a key mechanism underlying this relationship, evidence from different clinical conditions remains fragmented. This scoping review aims to map the literature on the relationship between ER and DM in clinical populations, with a specific focus on the interaction between EF and ER in shaping adaptive DM processes, particularly in populations characterised by cognitive impairment and emotional dysregulation. Methods: A search of electronic databases was conducted to identify empirical studies examining ER, EF and DM in clinical populations. Sixteen studies involving patients with dementia, traumatic brain injury, autism spectrum disorder, substance and behavioural addictions were included. Results: Difficulties in ER were associated with altered DM. EF, particularly inhibitory control, working memory, and cognitive flexibility, were found to be key processes linking emotional states to decision outcomes. Clinical groups consistently showed a tendency to prefer immediate rewards despite potential long-term negative consequences and experienced difficulties integrating emotional and cognitive information. Conclusions: This scoping review emphasises the importance of moving beyond reductionist explanations of DM and to adopt an integrative approach. ER and EF should be conceptualised as interacting components of a broader self-regulatory system shaping decision behaviour. Developing this framework will be crucial to enable targeted clinical and neurorehabilitation interventions for individuals experiencing impaired DM. Full article

Veterinary medicine fundamentally revolves around working with people to positively influence how they care for their animals. Veterinarians have traditionally used directive advice-giving when providing clients with recommendations, which can inadvertently push clients further away from change despite good intentions by evoking resistance and leaving the underlying motivational and contextual barriers to change unaddressed. Motivational interviewing (MI), a collaborative communication approach originally developed for addiction counselling, has been widely adapted across many fields because of its proven effectiveness in strengthening intrinsic motivation to change. MI was first applied in veterinary medicine approximately a decade ago with a small but growing evidence base. This review introduces the theoretical foundations of MI, how it can be applied within different types of clinical consultations, as well as the challenges of developing and sustaining competency in practice and ethical implications specific to the veterinarian–client–animal relationship, including the proxy motivation problem where clients bear the costs of behaviour change for benefits experienced primarily by their animal. This review then critically appraises the veterinary MI literature, which has largely focused on communication training outcomes with limited research on the downstream effects on client behaviour or animal welfare, highlighting important research gaps to promote an increased uptake of MI in clinical practice. Full article

Background/Objectives: Fear of missing out (FoMO) describes the concern of missing out on a rewarding experience, a contemporary psychological phenomenon that has yet to be explored in relation to addictive eating. This exploratory study examined the relationship between FoMO and addictive eating, and the effect of reward-related eating and mental health status (anxiety, depression, and stress) on the relationship. Methods: A sample of 227 adults (mean age 49.4 years; 79.3% women) completed an online survey to assess addictive eating (Yale Food Addiction Scale), FoMO (Fear of Missing Out Scale), reward-related eating (Reward-Based Eating Drive Scale), anxiety, depression, and perceived stress (GAD-7, PHQ-8, PSS-4). Mediation and moderated mediation analyses were performed to determine relationships between variables. Results: A direct relationship between FoMO and addictive eating was found. The relationship was partially mediated by reward-related eating after accounting for BMI and gender. Anxiety severity was a significant moderator of the relationship between reward-related eating levels and addictive eating symptoms. Conclusions: This study provides insights that can assist in informing interventions to mitigate the negative effects of FoMO on eating behaviours, particularly among populations vulnerable to anxiety. Full article

This study examined associations between problematic Internet use, video game addiction, physical activity, perceived physical fitness, and psychological distress in pre-service teachers. A cross-sectional survey was completed by 404 education students from the University of La Laguna using validated measures (CERI, Vela Test, IPAQ-short, IFIS, GHQ-28). Descriptive, correlational, group-comparison, and binary logistic regression analyses were conducted. The prevalence of video game addiction was low (4%), and problematic Internet use was rare (1%), although 25.3% showed moderate-risk Internet use. Within the small group of students with video game addiction, male students showed relatively higher risk scores; however, this was not significantly associated with physical or emotional well-being. Problematic Internet use was positively associated with psychological distress (r = 0.267, p < 0.001) and poorer physical health indicators. Perceived physical fitness was inversely associated with distress (r = −0.248, p < 0.001) and, together with problematic Internet use, emerged as the strongest predictors with clinically relevant distress (GHQ ≥ 13) in the logistic model. A focus group (n = 4) provided exploratory qualitative insights into participants’ perceptions of digital behaviours, particularly regarding perceived loss of control and its potential associations with academic, physical, and emotional well-being. Full article

Background: Despite the general interest in WPV against healthcare workers, there is evidence that this topic has comparatively fewer studies conducted in the context of community settings than in hospital settings. Given the current general transition of care from hospital to community, this study aims to analyze whether community settings present different characteristics in comparison with hospital settings on this topic in Italy. Methods: A retrospective observational study was conducted from 2020 to 2024 on aggressions reported by HCWs in hospitals and community settings belonging to a Local Health Authority of Turin in Piedmont. For physical and non-physical aggressions, a monthly time trend series was constructed. A Mantel–Haenszel fixed-effect meta-analysis was performed to obtain the odds ratio (OR) in two settings. Variables relative to aggressions included the gender of victims, their professional category (medical doctors, nurses, other HCWs), the type and gender of perpetrators (relative, patient, or unknown person), age groups of perpetrators (under 30, 30–49, ≥50), the nature of aggression (physical, non-physical), recidivism, involvement of law enforcement, and time of occurrence (morning, afternoon, or evening/night). Events within hospitals were further classified into emergency department, psychiatric ward, and other wards, while events within community settings were classified as drug addiction service units (serDs), long-term care (including specialist outpatient services, home services, and nursing homes) (LTC), mental health centres, and penitentiary assistance. Results: The results highlighted that fewer WPV incidents were reported in community settings than in hospital settings, even though reported incidents showed a more pronounced increase over time. Differences were observed in a few characteristics of WPV (age classes of aggressors, recidivism, time of aggression, profession of the assaulted worker, and specific location). Only the gender of the assaulted (female workers) (OR = 3.11, 95% CI: 1.27–7.61; p = 0.013; OR = 0.32, 95% CI: 0.13–0.79; p = 0.013 for non-physical and physical violence, respectively, compared to male workers) was identified as a specific risk factor for community settings. Conclusions: Modern health systems are experiencing a transition from hospital-centred to community-centred care settings. This study suggested that WPV is a significant concern, even outside the hospital. Community-based services often involve direct interaction with frail and chronically ill patients and their caregivers, as well as care delivery in diverse and sometimes less controlled environments, which may influence exposure to aggressive behaviours. The identification of setting-specific risk patterns in both hospital and community contexts provides valuable insights into workplace violence and may support the planning and implementation of targeted interventions aimed at mitigating the frequency and burden of WPV. Full article

Adolescence is established as a critical period for the onset of substance use and addictive behaviours. Sports participation can act as a protective factor that coexists with risk and protective variables. This study aims to analyse the association between habits, risk perception and lifetime and annual alcohol consumption and gambling at distinct stages of adolescence and to establish risk profiles. Cross-sectional study with the participation of 914 federated footballers selected by cluster sampling. Data on sociodemographic characteristics, consumption, risk perception and habits were collected. Descriptive analyses, χ², principal component analysis, K-means and ordinal logistic regressions were performed. Two main components were extracted that explained 54.3% of the variance (KMO = 0.69). Four clusters were obtained, showing transitions between them. The WLE and AWU variables were established as risk factors for consumption (OR > 1), while the protective risk perception variables (OR < 1) varied according to the stage and consumption analysed. Full article

Background: Experiential avoidance (EA) refers to the tendency to evade or suppress unpleasant internal experiences, such as distressing thoughts, emotions, or bodily sensations. Increasing evidence indicates that EA plays a central role in the onset and maintenance of addictive behaviours. Objective: To synthesise quantitative evidence on the association between experiential avoidance (EA), operationalised as psychological inflexibility, and psychoactive substance use (PSU) outcomes, including substance use frequency/quantity, craving, dependence severity, relapse/abstinence, and treatment response, and to characterise putative pathways (EA as predictor/mediator) and correlates (e.g., affect regulation and trauma-related factors). Methods: A systematic search was conducted in SCOPUS, Web of Science, PubMed, and APA PsycNet, following PRISMA 2020 guidelines. Eligible studies included experimental and observational designs, clinical and non-clinical populations, and publications from January 2000 to January 2026 in English or Spanish. Primary outcomes were PSU behaviour and severity (frequency/quantity, craving, dependence symptoms, relapse/abstinence) and treatment outcomes; secondary outcomes included emotional and behavioural correlates linked to EA. Results: Across studies, higher levels of EA were consistently associated with greater substance use—particularly alcohol, tobacco, cannabis, and other illicit drugs. EA frequently mediated the relationships between emotional dysregulation, trauma exposure, and addictive behaviour. Elevated EA was also linked to impulsivity, psychiatric comorbidity, and poorer treatment adherence and outcomes. Interventions explicitly targeting EA—most notably Acceptance and Commitment Therapy (ACT)—showed promising effects in reducing avoidance and substance use. Conclusions: Experiential avoidance emerges as a transdiagnostic process underlying vulnerability to, and persistence of, substance use disorders. Integrating third-wave behavioural interventions that promote psychological flexibility may enhance the efficacy of addiction treatment. Future research should explore these mechanisms in culturally diverse and under-represented contexts. Full article

Substance Use Disorder (SUD) constitutes a major and persistent global public health burden, accounting for approximately 600,000 deaths annually, largely driven by opioid use. Despite substantial advances in addiction neuroscience, currently approved therapeutic strategies remain limited in efficacy, as they predominantly target isolated neurobiological processes and fail to concurrently address core mechanisms such as glutamatergic hyperactivity, mesolimbic hypodopaminergic, and dysfunction of cortical and executive control networks. This mechanistic fragmentation contributes to persistently high relapse rates and underscores the need for integrative and multitarget therapeutic approaches. Within this context, ibogaine has re-emerged as a clinical candidate due to its distinctive multimodal neuropharmacological profile and its reported capacity to modulate multiple pathways implicated in addictive behaviours. However, the clinical translation of ibogaine remains substantially constrained by fragmented and heterogeneous evidence, the absence of regulatory frameworks in several jurisdictions, limited phytochemical validation and standardization of available formulations, and unresolved concerns regarding cardiac safety. This scoping review critically synthesizes the available preclinical and clinical literature on ibogaine in the treatment of SUD, with particular emphasis on reported effects on withdrawal symptoms and craving, dose–response relationships, and the occurrence of cardiac adverse events. By clarifying the current state of the evidence and delineating key translational constraints, this review defines the conditions under which ibogaine, an indole alkaloid isolated from Tabernanthe iboga Baill. (Apocynaceae), may warrant continued investigation. The hypothesis of a neurobiological “reset”, supported by emerging preclinical and clinical data, positions ibogaine as a compound of relevance in addiction research and highlights the need for rigorous pharmacological, toxicological, and regulatory evaluation to inform safer and more standardized clinical pathways. Full article

Background/Objectives: Adolescence represents a critical period for the formation of lifestyle habits that often persist into adulthood, significantly shaping long-term health outcomes and contributing to the development of non-communicable diseases. This study aims to assess the impact of Food Game, a secondary school-based programme, delivered throughout the academic year, to promote healthy eating, physical activity, and sustainability awareness among students. Methods: As part of the Food Game programme, 184 adolescents aged 14–16 years from the Milan area (Italy) completed two questionnaires, administered before and after the intervention (November 2024, April 2025), evaluating dietary habits, lifestyle behaviours, and attitudes toward sustainability. This uncontrolled intervention study assessed dietary changes using a composite score [0–14], with higher scores indicating healthier eating patterns. Pre–post intervention differences were analysed using paired t-tests for continuous variables and McNemar’s test for categorical variables. Results: After participation in Food Game, a significant improvement in mean dietary score from 7.6 to 8.2 (p < 0.001) occurred. Overall, 28.3% of the students worsened their score and 53.2% improved (≥1-point increase), including a significant improvement (≥2-point increase) in 29.4%. Fruit, vegetable, and fish intake increased, while consumption of meat, processed meat, and snacks decreased (p < 0.05). Waste recycling did not change (94.6%), and tap water non-significantly increased. No significant changes were observed in water intake, physical activity, screen time, or addictive behaviours. Conclusions: These findings support the potential of peer-led gamified interventions to promote healthier eating in youth. Future controlled studies are required to rigorously evaluate the Food Game programme’s effectiveness in relation to adolescents’ diet, lifestyle, and sustainability habits. Full article

Modern lifestyles are increasingly plagued by physical inactivity, social disconnection, digital addiction, and excessive time indoors—factors that negatively impact the health and well-being of both humans and their companion dogs (Canis familiaris). Evidence shows that nature exposure, physical activity, and human–animal bond (HAB) each enhance physical, mental, and social well-being, yet these domains have rarely been examined together as an integrated therapeutic triad. We introduce a new conceptual framework of bonded green exercise, defined as shared physical activity between a bonded human and dog in natural environments. Synthesizing existing evidence across human and canine sciences into a testable conceptual integration, we posit that bonded green exercise may plausibly activate evolutionarily conserved, synergistic mechanisms of physiological, behavioural, and affective co-regulation. Four testable hypotheses are proposed: (H1) triadic synergy: combined domains produce greater benefits than additive effects; (H2) heterospecific benefit: parallel health gains occur in both species; (H3) behavioural amplification: dogs acts as catalysts to drive human participation in nature-based activity; and (H4) scalable health promotion: bonded green exercise represents a low-cost, accessible, One Health approach with population-level potential. This framework highlights how intentional, shared physical activity in nature may potentially offer a novel low-cost and accessible model for enhancing health, lifespan, welfare, and ecological stewardship across species. Full article

Introduction: The COVID-19 pandemic had significant effects on mental health and lifestyle behaviours, especially among university students who experienced academic disruptions, social isolation, and fewer social interactions. Alcohol consumption has long been part of student culture. Still, the influence of post-pandemic academic reintegration on drinking patterns and psychological distress remains relatively unexplored, particularly in countries like Portugal, where student traditions heavily shape consumption habits. This study aimed to describe the prevalence of alcohol consumption, depression, anxiety, and stress in a sample of Portuguese university students during the post-pandemic academic period, and to explore associations with sociodemographic variables. Methods: A cross-sectional study was conducted in November 2021 with 90 students from a private higher education institution in northern Portugal. Data were collected via an online questionnaire including sociodemographic information, the Alcohol Use Disorders Identification Test (AUDIT), and the Depression, Anxiety and Stress Scale (DASS-21). Result: The majority of the participants were not at risk of alcohol addiction (95.3%). In total, 15.1% of students reported anxiety symptoms ranging from severe to extremely severe. A binomial logistic regression was performed to ascertain the effects of being away from home and psychological distress (DASS-42 score), on the likelihood that participants were at risk of alcohol addiction (Level 3 and 4 in the AUDIT scale). The logistic regression model was statistically significant, χ²(2) = 9.20, p = 0.010. Living away from home was associated with a substantially lower likelihood of high-risk status (B = −2.79, p = 0.034), corresponding to an odds ratio of 0.06, indicating a strong protective effect. DASS-42 total score was positively associated with high-risk status (B = 0.04, p = 0.039), such that higher psychological distress increased the odds of being classified as high risk. Conclusions: The findings reveal a low prevalence of alcohol risk but heightened symptoms of anxiety, depression, and stress. Psychological distress notably increases the likelihood of hazardous alcohol use, emphasising the importance of targeted mental health and alcohol-use interventions among university students. Full article

Background/Objectives. Chronic benzodiazepine (BDZ) use is frequently maintained beyond recommended durations due to neuroadaptation, psychological dependence, and withdrawal-related issues. Passiflora incarnata L., herba (P. incarnata) has shown anxiolytic and GABAergic activity that may mitigate withdrawal symptoms, while cognitive-behavioural therapy (CBT) targets maladaptive beliefs and behaviours sustaining BDZ misuse. This study investigates the independent and interactive effects of P. incarnata and CBT on BDZ dose reduction during a three-month tapering program. Methods. This retrospective observational study included 186 outpatients with anxiety or depressive disorders in clinical remission undergoing BDZ tapering, of whom 93 received a dry extract of P. incarnata as adjunctive treatment and 93, matched for diagnosis, age and sex, followed a standard tapering protocol. BDZ doses were assessed at baseline and three months. CBT was recorded as a binary variable based on the information documented in the medical records. An ANCOVA was performed to assess the impact of CBT and P. incarnata on BDZ reduction (change in mg diazepam equivalents), adjusting for sex, age, education, baseline anxiety and depression scores, initial BDZ and antidepressant dosage. A subgroup analysis was conducted to investigate the role of P. incarnata dosage in BDZ reduction. Results. Both CBT and P. incarnata were associated with significantly greater reductions in BDZ dosage at three months (CBT: p = 0.005, effect size: 0.032; P. incarnata: p < 0.001, effect size: 0.128). A significant interaction between CBT and P. incarnata was also observed (p = 0.037, effect size: 0.018), indicating a synergistic effect when both interventions were combined. Baseline sociodemographic characteristics, BDZ and antidepressant dosage and symptom severity did not differ significantly between groups. Patients taking 400–600 mg of P. incarnata dry extract showed a higher BDZ reduction compared to those taking 200 mg. Conclusions. These findings suggest that P. incarnata and CBT exert independent yet complementary effects in supporting BDZ tapering. Their combination appears to enhance dose reduction beyond either intervention alone, supporting a multimodal approach that addresses both neurobiological and psychological components of BDZ addiction. Prospective controlled studies are needed to confirm these results and to clarify their impact on long-term discontinuation outcomes. Full article

Background: Adults with attention-deficit/hyperactivity disorder (ADHD) often have comorbid substance use disorders (SUDs). In Italy, individuals with both ADHD and heroin use disorder (HUD) are usually treated in addiction services with opioid agonist therapy (OAT), but stimulant medications are rarely prescribed. This may create a treatment gap for core ADHD symptoms. Aim: This study examined the clinical and behavioural profiles of ADHD patients with HUD who receive OAT but no stimulant treatment, compared to ADHD patients without opioid use disorder (ADHD/NoHUD) on standard pharmacotherapy. All participants were considered treatment responders in their respective services. Methods: Data were collected from two outpatient clinics and included 103 adult ADHD patients assessed using validated tools for symptom severity, emotional dysregulation, and global functioning. Differences between groups were analysed using univariate tests and logistic regression. Results: The ADHD+HUD group was significantly older and showed higher levels of emotional dysregulation, impulsivity, and current cocaine use. Despite clinical stability, these individuals presented a more severe psychopathological profile than their ADHD/NoHUD counterparts, who received stimulant-based treatment. Conclusions: Although limited by its cross-sectional nature and setting-related confounders, the study indicates that OAT alone may not be sufficient to manage neurodevelopmental symptoms in ADHD+HUD patients. Further research is necessary to assess the safety and efficacy of integrated stimulant-based treatments, ideally within dual disorder services combining psychiatric and addiction expertise. Full article

Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16–25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, and goal pursuit. However, our knowledge of young people’s subjective experiences of rewards and goals in relation to self-harm behaviour remains limited. Our study aimed to investigate how young people who self-harm experience enjoying and wanting rewards and pursuing goals in daily life and whether this experience changes during periods of self-harm. We also explored their use of mental imagery as a key cognitive process to support motivation. Methods. We conducted two parallel focus groups online (total of N = 12) with young people (mean age = 12.2, SD = 3; nine women, two men, and one non-binary) with a past-year history of self-harm behaviour. Qualitative data was analysed using inductive thematic analysis. Two young people with lived experience of self-harm informed the topic guide and data interpretation. Examples of questions were “Do you think your experiences of enjoying and/or looking forward to pleasant things are related in any way to self-harm, or not?” and “Do you visualise things you enjoy or may look forward to? If you do, how is that experience?”. Results. There were six themes: rewards need deserving, high self-standards, keeping control, trapped into long-term goals, unhelpful mental imagery, and self-harm alters the experience and anticipation of rewards and goal attainment. Most young people reported enjoying conditional rewards and working towards long-term goals that tend to be unattainable and beyond their control. Imagining these goals was experienced as unhelpful by most. For all young people, periods of self-harm thwarted enjoyment and goal achievement, shifted the preference to short-term immediate gratification, including from self-harm behaviour, and devalued long-term goals. However, our data cannot determine if these experiences are specific to young people who self-harm. Conclusions. Our findings indicate that the reciprocal relationship between motivational processes and self-harm behaviour in young people warrants further investigation. Helping individuals develop more adaptive rewards and goals, including appreciation of short-term goals and use of motivational mental imagery, could represent valued support for young people with self-harm. Full article