Search Results (256)

Background/Objectives: Alcohol misuse among medical students is commonly attributed to academic stress, yet the specific role of coping mechanisms in this relationship has received limited attention. We investigated whether substance use coping, rather than stress exposure itself, drives alcohol use risk in Romanian medical students, and whether distinct coping-based subgroups can be identified through cluster analysis. Methods: We conducted a cross-sectional survey among 244 medical students (mean age 21.95 ± 3.27 years; 67.2% female) at the University of Medicine and Pharmacy of Craiova, Romania. Alcohol use was measured with the AUDIT and coping strategies with the Brief COPE. Analyses included Mann–Whitney U tests, Spearman correlations, multiple linear and binary logistic regression, and k-means clustering. Results: At-risk drinking (AUDIT ≥ 8) was identified in 19.7% of participants. The tendency to use substances to cope with stress (substance use coping) was the strongest predictor of AUDIT scores in both linear regression (B = 2.090, p < 0.001, R² = 0.513) and logistic regression (OR = 2.026, p < 0.001). Male sex independently predicted at-risk status (OR = 2.572, p = 0.025), while planning was protective in both models (B = −0.657, p = 0.005; OR = 0.691, p = 0.029). Humor also emerged as a significant risk factor (OR = 1.638, p = 0.005). K-means analysis (k = 5) revealed five coping profiles with significantly different AUDIT distributions (Kruskal–Wallis H = 47.26, p < 0.001). The Substance-Oriented cluster (13.1% of students) had a mean AUDIT of 12.66, compared with 3.00–4.13 in other clusters. Conclusions: In a subgroup of medical students, alcohol use appears integrated into the coping repertoire rather than merely being a consequence of stress. The identified coping profiles should be interpreted as prototypical configurations with overlapping boundaries rather than discrete categorical types, given the low silhouette coefficient (0.094) of the cluster solution. The strong predictive effect of substance use coping should be interpreted with the caveat that the Brief COPE Substance Use subscale and the AUDIT share content related to alcohol use behavior, which may inflate the observed association. These findings point to the need for coping-specific interventions. Planning skills training and a more nuanced understanding of humor’s role in drinking contexts may offer avenues for prevention. However, the logistic model’s sensitivity of 50.0% indicates that coping-based identification alone would miss approximately half of at-risk students, underscoring the need for further refinement before clinical application. Full article

Benzydamine is a nonsteroidal anti-inflammatory drug widely used in topical formulations but occasionally misused orally at high doses for psychoactive effects. Data regarding the safety of benzydamine at supratherapeutic doses are limited and mainly focus on central nervous system effects. Even less information is available concerning its safety during pregnancy, despite the increased risk of unplanned pregnancies among users of psychoactive substances. In this preliminary study, we aimed to evaluate the maternal and fetotoxic potential of benzydamine to support future targeted reproductive toxicity investigations. Pregnant Wistar rats received benzydamine throughout gestation, followed by cesarean section and evaluation of fetal viability, fetal body weight at term, and macroscopic abnormalities. Maternal biochemical parameters related to hepatic, renal, and metabolic function, and oxidative stress markers, were also assessed. Results were compared with those of a control group. No significant differences in routine biochemical parameters were observed between groups; however, benzydamine exposure was associated with reduced fetal body weight and increased maternal plasma malondialdehyde levels. These findings suggest that benzydamine may impair fetal growth through indirect maternal toxicity and oxidative stress rather than direct teratogenic effects. Full article

Therapeutic termination of pregnancy (TToP) represents an intervention that is performed for medical reasons, such as risks to maternal health or severe fetal anomalies. Advances in prenatal screening and diagnostic tools—including serum markers, ultrasound, cell-free fetal DNA, chorionic villus sampling and amniocentesis—have significantly improved early detection and clinical decision-making. This narrative review synthesizes current knowledge on the genetic, environmental and psychosocial determinants that influence the decision of the patients to pursue TToP. The literature search was performed primarily using PubMed database, while Scopus and Google Scholar were used to identify additional relevant studies. Some of the selected studies, as well as certain sections of this review, address both therapeutic and voluntary termination of pregnancy, whereas others focus exclusively on TToP. Moreover, this review describes the types of abortion (medical or surgical/aspiration) along with their management strategies to prevent or address potential complications. It is well known that demographic, cultural and socio-economic factors continue to influence the access to TToP, as well as the perceptions of it. Psychiatric comorbidities (such as anxiety, affective and psychotic disorders) are observed with a higher prevalence among women undergoing TToP and may influence both the decision and psychological outcomes post-procedure. While most women report emotional relief after TToP, some of them experience depression, post-traumatic stress disorder or substance misuse. Legal and ethical considerations further complicate access to safe abortion, leading to situations where patients may resort to unsafe procedures, which result in higher rates of morbidity and mortality. Data from the EUROCAT network show rising trends in congenital anomalies like trisomy 13, trisomy 18 and caudal regression syndrome (conditions commonly associated with TToP). Therefore, it is mandatory to form a multidisciplinary team in these cases, integrating medical, psychological and ethical dimensions. Ensuring safe, evidence-based and compassionate access to TToP remains a critical component of reproductive healthcare. Full article

Background: Depression in men often goes unrecognized, even though it leads to high rates of suicide. Men may show symptoms that are external, behavioral, or physical, which traditional assessment tools focused on internal symptoms do not adequately reflect. Methods: A narrative review was carried out to gather evidence on depression scales tailored for men. We searched PubMed up to November 2025 for studies discussing the development, validation, and clinical use of the Gotland Male Depression Scale (GMDS), the Male Depression Risk Scale (MDRS-22 and MDRS-7), and the Gender-Sensitive Depression Screening scale (GSDS-26). We organized the findings by instrument. Results: The studies indicate that male-sensitive scales capture symptom domains such as emotional suppression, anger, risk-taking behaviors, substance misuse, and somatic complaints. The GMDS has demonstrated applicability across psychiatric, somatic, and paternal perinatal populations. The MDRS-22 and MDRS-7 were particularly sensitive to externalizing symptom patterns associated with male presentations of depression and behavioral profiles linked to elevated suicide risk. The GSDS-26 integrates both prototypical and externalizing symptoms, enabling the identification of diverse depressive profiles. However, the current evidence base remains limited due to a reliance on non-clinical samples and the scarcity of long-term and cross-cultural validation studies. Conclusions: Male-sensitive depression scales may serve as useful complementary screening tools that improve recognition of male-typical depressive presentations and behavioral patterns associated with increased suicide risk. Further clinical and longitudinal research is needed to confirm their diagnostic accuracy and clinical utility. Full article

Internet gaming disorder (IGD) and nonmedical prescription drug use (NMPDU) are prevalent, co-occurring concerns among young adults. Although prior research links problematic gaming and substance misuse, few studies have examined this relationship in non-college populations or whether student status modifies this association. This study examined the relationship between Gaming Addiction Scale (GAS) score and NMPDU among 1022 Rhode Island young adults aged 18 to 25. In the total sample, 44.6% identified as cisgender heterosexual female, 42.4% as sexual or gender minority (SGM), and 13.0% as cisgender heterosexual male. Multivariable logistic regression estimated the adjusted association between GAS scores and NMPDU, and an interaction term between GAS and student status was tested. Overall, 12.1% reported lifetime NMPDU. Higher GAS scores were associated with increased odds of NMPDU (adjusted odds ratio [AOR] = 1.05; 95% confidence interval [CI]: 1.01–1.09). Student status alone was not significantly associated with NMPDU; however, a significant interaction was observed between GAS and student status (AOR = 1.09, 95% CI: 1.01–1.18, p = 0.031). Higher GAS scores were positively associated with NMPDU, with student status strengthening this association. Findings support screening for problematic gaming, particularly among students, and integrated prevention strategies addressing both behavioral and substance-related risks. Full article

There is a need to enhance the behavioral health (BH) workforce. Paraprofessionals and peers are often on the “front lines” working with families affected by substance misuse. While they possess valuable lived experience, they often lack the requisite education to be most effective, resulting in high burnout and turnover. This study describes a novel training program for paraprofessionals working in family BH that included three online, 8-week courses (Level I) and a 12-month supervised apprenticeship (Level II). This study measured program satisfaction and effectiveness (knowledge, confidence, and perceived competence) and explored effects on career intention. A sample of paraprofessionals in the BH workforce provided data at baseline, after Level I, and after Level II. After Level II, 87% of participants rated their satisfaction with the program as high. Statistically significant improvements were found for knowledge, confidence, and competence across all domains. Almost all participants reported increased confidence after each level (93% and 94%, respectively). The majority (69%) reported increased interest in continuing their BH career and education. Overall, results suggest that the program was well-received by participants and was associated with improvements. Results provide preliminary support for apprenticeship-based training to enhance the BH workforce and address workforce challenges. Full article

Metabolic and bariatric surgery (MBS) has evolved into a highly effective neurohormonal intervention for severe obesity; however, it introduces unique long-term vulnerabilities, particularly regarding alcohol (AUD) and substance use disorders (SUD). This review synthesizes the epidemiological, pharmacokinetic, and neurobiological drivers of postoperative substance misuse. Procedures like Roux-en-Y gastric bypass (RYGB) radically alter ethanol metabolism, eliminating first-pass metabolism and accelerating gastric emptying, while simultaneously recalibrating reward pathways, creating a “reward gap” that facilitates addiction transfer. These physiological shifts exacerbate critical micronutrient deficiencies (thiamine, B12, iron), increase the risk of post-bariatric hypoglycemia, and correlate with higher rates of liver cirrhosis and suicide. Furthermore, substance use is a primary driver of suboptimal weight loss trajectories and weight regain. Mitigation requires a lifelong, multidisciplinary framework involving preoperative risk stratification, validated screening (e.g., AUDIT-C), and targeted nutritional supplementation to safeguard the long-term metabolic and psychological benefits of MBS. Full article

Treatment seeking among individuals who misuse substances can be a complex process, with many factors contributing to treatment seeking. Guided by Gelberg–Andersen’s Behavioral Model for Vulnerable Populations, this research seeks to establish predisposing, enabling, and need factors contributing to treatment seeking during COVID-19. A total of 201 individuals participated in the study. Contrary to existing literature, no predisposing factors were associated with treatment seeking during COVID-19. However, variations were seen in enabling and need factors. Perceiving a need for treatment and having reliable transportation to treatment were associated with treatment seeking during COVID-19, underlying the importance of addressing both physical barriers to treatment and readiness for treatment. Additional enabling factors contributing to treatment seeking were a history of past treatment and differing types of recovery supports, underscoring the importance of addressing structural access barriers and individual-level determinants of treatment seeking. More research is needed on individual differences in perception of need that lead to treatment seeking. Full article

Traumatic injuries represent a significant public health challenge, affecting millions worldwide annually and necessitating acute pain management that frequently involves the use of opioid analgesics to mitigate discomfort and facilitate recovery. Although opioids remain an integral part of post-traumatic injury pain management, their use exposes trauma survivors to the risk of developing persistent use, misuse, or opioid use disorder (OUD). Pre-injury health determinants, such as age, gender, psychiatric conditions, medical conditions, and substance use history, may interact with injury-related factors to acutely escalate the risk for misuse and addiction. Despite the growing recognition of these potential vulnerabilities, there remains a lack of evidence-based clinical decision support on modifiable and non-modifiable risk factors specific to post-traumatic injury opioid risk trajectories. This review summarizes the literature related to the multifactorial contributors to opioid misuse and addiction following traumatic injury such as patient-level (e.g., demographics, behavioral health), injury-related (e.g., severity, type), and system-level (e.g., prescribing patterns) characteristics. A comprehensive literature search, inclusive of the literature from 1995 to November 2025, was performed in PubMed/MEDLINE, Scopus, and Google Scholar using combinations of terms related to “opioids,” “misuse,” “addiction,” “trauma,” and “injury.” Search keywords and operators were developed in collaboration with a university librarian. Reference lists of articles were searched and synthesized. Case reports, case series, editorials, mini-reviews, letters to editor without original data, and qualitative studies were excluded. The findings of the review are expected to provide insight into clinical-decision making as it relates to the management of pain, pain-related distress and functional impact, and co-occurring conditions that may impact injury-related outcomes and the potential likelihood of substance misuse and addiction. Full article

In recent years, xylazine has emerged as a cutting agent combined with illicit drugs to extend their effects. The present study aimed to discover drug use patterns associated with xylazine-positive and -negative urine toxicology drug screens and to assess whether xylazine can be used as a marker for exposure to designer drugs/new psychoactive substances in our study population. This is a retrospective analysis of urine toxicology results from two different analytical platforms: a targeted, structurally confirmatory, high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS) assay that quantifies 136 drugs and metabolites including xylazine; and a non-targeted ThermoFisher Orbitrap Tribrid mass spectrometry system (Thermo Scientific^TM, Bremen, Germany) in combination with database searches for the identification of drugs not captured by the targeted assay. All participants were patients receiving care through the Addiction Research and Treatment Services (ARTS), with documented substance misuse, undergoing routine urine drug toxicology testing at the iC42 Clinical Toxicology. Data analysis was performed using Sciex OS version 2.2.0.5738 after extraction using the targeted, structurally confirmatory and quantitative LC-MS/MS platform (SCIEX, Framingham, MA, USA). The drug patterns found in xylazine-positive and -negative urine samples were statistically significantly different (p < 0.001), indicating different consumption patterns associated with xylazine. Moreover, the overall concentrations of drugs (normalized to creatinine) were also statistically significantly different with higher concentrations in the urine samples that tested negative for xylazine. In contrast, samples that were positive for xylazine contained significantly higher concentrations of various designer drugs/new psychoactive substances as detected by the untargeted platform (p < 0.0001). The results indicated that xylazine has become increasingly common in Denver’s drug circulation and that xylazine may be used as a marker to prompt reflex testing with non-targeted high-resolution mass spectrometry assays in combination with database searches to test for the exposure to designer drugs/new psychoactive substances in our patient population. Full article

Effective pain management is central to anesthesia, critical care, and perioperative medicine, and opioids remain essential agents for moderate-to-severe pain despite ongoing concerns regarding their safety and misuse. This narrative review synthesizes the current knowledge on opioid mechanisms, clinical indications, safety considerations, and evolving strategies aimed at optimizing their use. Opioids exert their analgesic effects primarily through μ-, δ-, and κ-opioid receptors, which modulate central and peripheral nociceptive pathways. They maintain a well-established role in acute postoperative and cancer-related pain, whereas their use in chronic non-cancer pain remains controversial. Contemporary evidence suggests that physiological dependence and addiction are less frequent in appropriately selected and monitored patients, although the risk increases in the presence of psychological comorbidity, prior substance use, or adverse social determinants of health. Unequal access, prescribing variability, and persistent disparities further complicate global opioid management strategies. Recent advances, including partial agonists such as buprenorphine, dual-mechanism agents such as tapentadol, individualized titration, opioid rotation, and the integration of multimodal analgesia, support safer and more tailored prescribing. Non-pharmacological interventions, including behavioral and physical therapies, increasingly complement pharmacological strategies to minimize opioid exposure and improve functional outcomes. Clinicians must balance analgesic efficacy with adverse effects, such as tolerance, opioid-induced hyperalgesia, sedation, and respiratory depression, particularly in perioperative and critically ill populations. Opioids remain indispensable for selected indications but should be incorporated into a comprehensive, patient-centered, multimodal analgesic approach that prioritizes safety, ongoing reassessment, and individualized risk mitigation. Full article

Background/Objectives: Mental health screening in athletes is an essential process to support well-being and sustainable performance. The Athlete Psychological Strain Questionnaire (APSQ) represents the ten-item triage step of the Sport Mental Health Assessment Tool-1 (SMHAT-1), created by the International Olympic Committee. We aimed to gather relevant information concerning the validity of the APSQ in different cultural settings. Methods: The study was designed as a scoping review and included 19 articles from Scopus, PubMed, Embase, Web of Science, and Google Scholar databases. Articles were written in English and tested the APSQ validity. Results: Different studies used the original or the translated version of APSQ and tested its benchmarked validity against other validated questionnaires, ran confirmatory and exploratory analyses, test–retest stability, calculated diagnostic metrics, and internal consistency. Most studies agreed on the good internal consistency, with optimal Cronbach’s alpha values, test–retest reliability, three-factor solution, convergent validity with scales assessing distress, divergent validity with well-being scales as demonstrated by significant correlation coefficients. The cut-off showed good accuracy for anxiety and depressive symptoms in terms of AUC, sensitivity, and specificity, but, in some cases, a limited ability (based on the AUC) to detect sleep concerns, alcohol misuse, substance use, and disordered eating (as measured by BEDA-Q). Some authors suggested that using different cut-offs, including all questionnaires from SMHAT-1 Step 2, or using a clinical interview, might mitigate these concerns. Conclusions: Different cultural environments might influence the validity of APSQ. A structured translation and validation study is advised before implementing APSQ in a different language. Full article

Benzodiazepines (BZDs) are globally prevalent psychotropic substances valued for their anxiolytic, hypnotic, anticonvulsant, and myorelaxant properties. Pharmacologically, they act as positive allosteric modulators of the ionotropic GABA_A receptor, enhancing inhibitory synaptic transmission. However, prolonged use poses a significant public health concern, risking adverse effects such as cognitive impairment, motor incoordination, tolerance, and physical dependence. The development of tolerance is mediated by complex neurobiological changes, notably the downregulation of GABA_A receptor subunits and a compensatory sensitization of excitatory glutamatergic systems. Effective management of established dependence requires comprehensive psychological intervention coupled with pharmacological substitution (switching to a long-acting BZD) and gradual dose tapering. Preventive measures are complex, emphasizing short-term prescriptions, minimum effective dosing, and selecting non-pharmacological or alternative pharmacological agents, such as SSRIs/SNRIs, to mitigate the risk of developing tolerance and dependence. This expert review aims to compile the most relevant, representative, and recent literature summarizing the pharmacology, clinical indications, adverse effects, misuse, and abuse of BZDs that ultimately lead to BZD use disorder (BUD). It also details the involved neurobiological mechanisms and discusses critical preventive and therapeutic strategies, providing readers with the main aspects to consider for addressing this global public health problem. Full article

Prescription drug misuse among youth is a significant public health problem that can lead to negative consequences, including addiction and overdose deaths. This study examined the effectiveness of an evidence-based hybrid approach in preventing prescription drug misuse outcomes in high school students. The prevention program used a combination of e-learning modules and classroom activities to enhance social and personal competence skills and refusal skills to deter prescription drug misuse and other types of substance misuse. Findings indicated that prescription sedative misuse was lower among students who received the hybrid prevention program compared to students in the control group. Perceived risk of using prescription sedatives, painkillers, and stimulants prescribed for someone else was higher in the intervention group relative to the control group students. These findings indicate that a comprehensive, universal school-based hybrid prevention program can produce positive impacts on sedative use and perceived risks of prescription drug misuse. Full article

Codeine, an opioid analgesic present in many over-the-counter (OTC) formulations, is frequently misused through non-medical extraction techniques such as cold water extraction (CWE). These practices carry substantial risks, including incomplete removal of hepatotoxic co-formulants, contamination, and highly unpredictable dosing. We report a fatal case of a 29-year-old man who ingested codeine extracted from Antidol^® tablets in combination with energy drinks and psychotropic medications. Post-mortem LC–MS/MS analysis revealed the presence of codeine (0.66 µg/mL), morphine (0.02 µg/mL), hydroxyzine (2.52 µg/mL), alprazolam (0.15 µg/mL), paracetamol (30.64 µg/mL), and additional substances in blood samples. Concentrations of codeine and hydroxyzine exceeded therapeutic ranges and were consistent with values reported in fatal intoxications, confirming a poly-drug poisoning. This case highlights the danger associated with non-medical codeine use, particularly when combined with central nervous system (CNS) depressants, and underscores the need for stricter regulation of OTC codeine-containing products as well as improved public awareness of the risks associated with domestic extraction methods. Full article