Search Results (27)

This review examines convergent neurobiological mechanisms linking stress and drugs that drive stress-induced drug-related behaviors. It first outlines the main theoretical frameworks explaining substance use disorders (SUDs), emphasizing vulnerability factors—particularly stressful life events—that increase addiction risk. The analysis integrates preclinical evidence demonstrating that chronic stress facilitates cross-sensitization to psychostimulants and accelerates drug self-administration, underscoring how stress and drugs converge on glutamatergic and dopaminergic transmission within the Nucleus Accumbens (NAc). Special attention is given to the glial cells, particularly microglia and astrocytes, in mediating stress-induced neuroimmune activation and glutamate dysregulation in the NAc. Three major themes related to microglia–astrocyte crosstalk are addressed: (i) the contribution of these glial cells to neuroimmune and glutamatergic alterations induced by stress; (ii) their role in synaptic and structural plasticity changes within the NAc; and (iii) the mechanisms by which stress and drug exposure reshape glial–neuronal communication, driving the comorbidity between stress and SUDs. A dedicated section focuses on key neuroimmune signaling pathways—particularly the TNF-α/NF-κB axis—and their involvement in stress-induced vulnerability to cocaine addiction. Finally, the review discusses preclinical evidence supporting the therapeutic potential of repurposed glutamate-modulating agents as promising pharmacological candidates for treating comorbid stress and cocaine-use disorder. Full article

Background: This review examines the prevalence of substance abuse and related disorders in South Pacific nations. Methods: The review focused on data included in reports published since 2000 from countries like Samoa, Papua New Guinea, Fiji, and French Polynesia, excluding Hawaii, New Zealand, Australia, and American Samoa. Prevalence studies indexed in Medline, CINAHL, PsycInfo, Embase, and Cochrane were screened and retrieved. Joanna Briggs Institute critical appraisal tools were used to assess included studies. Results: Ten studies with diverse methods, such as national surveys, were analysed. Results show high variability in prevalence across countries, sexes, and ethnicities. Notably, tobacco and betel nut use are prevalent. Indigenous populations and men face higher SUD burdens. Discussion: inconsistencies in study methods and reliance on self-reporting limit direct comparison. Data on co-occurring disorders and polysubstance use are limited, highlighting research gaps. The review emphasises the need for culturally sensitive, standardised research to monitor emerging trends like synthetic drug use. Policy suggestions call for targeted interventions and improved surveillance to reduce disparities and support vulnerable populations in Pacific Island communities. Full article

Background: Inequities in pain management are well documented in chronic pain and outpatient settings, yet little is known about disparities in inpatient Acute Pain Service (APS) care. This study evaluated demographic, clinical, and social factors associated with APS utilization and outcomes in an urban safety-net hospital, with a subgroup analysis of trauma patients who presented with at least three rib fractures. Methods: We performed a retrospective cohort study of two patient populations from our institution: (1) all patients receiving APS consultation from 1 January 2020 to 1 November 2022 (n = 1445) and (2) all patients with traumatic rib fractures during this time, stratified by APS consult status (n = 650). Demographics, insurance, comorbidities, opioid prescribing, and discharge outcomes were analyzed using descriptive statistics, multivariable logistic regression, and log-linear models. As APS consultation criteria were not standardized during the study period, referral patterns reflected routine clinical practice rather than predefined eligibility criteria. Results: Across the full APS cohort, patients were disproportionately represented from vulnerable groups: 30.5% were Black, 81.0% had public insurance, and 32.9% had a substance use disorder (SUD). Methadone use was a strong predictor of non-home discharge, including discharges to a medical facility, hospice, or against medical advice (AMA). In the rib fracture cohort, patients receiving APS consults had significantly higher injury severity scores (Injury Severity Score 17.1 vs. 13.0, p < 0.001). Black patients were less likely to receive APS consult (17.3% vs. 28.8%, p = 0.024). However, this association appeared to be attributable to the younger age and male predominance within this subgroup, as both factors were identified as significant predictors of APS consultation. Conclusions: APS utilization at a high-volume safety-net hospital highlights the intersection of medical vulnerability and structural inequities, with greater involvement among patients who were members of racial and ethnic minorities, publicly insured, or diagnosed with SUD. In trauma populations, younger Black men were over-represented, reinforcing the heightened injury risks Black men may face and the downstream effects on patient care. Taken together, these results highlight how APS involvement acts not only as a marker of increased injury severity but also as an intervention to improve care for vulnerable patient populations. As APS teams regularly serve these populations, they are well-positioned to bridge broader gaps through the integration of addiction and social support services, individualized pain management, and seamless coordination of care across specialties. These findings underscore the need for standardized consultation criteria and integration of social and addiction medicine resources into APS care models. Full article

Background/Objectives: Patient satisfaction is increasingly recognized as a key indicator of the effectiveness of substance use disorder (SUD) treatment. While some studies suggest disparities in satisfaction across treatment settings, there remains limited research examining these differences, particularly among vulnerable populations. This study aimed to assess patient perceptions of satisfaction with opioid use treatment services and explore how demographic and socioeconomic factors influence these experiences. Methods: Conducted between 1 February and 31 March 2025, the study took place at a longstanding Opioid Treatment Program in Philadelphia. A total of 217 participants receiving treatment were recruited through convenience sampling during routine clinic visits. Data collection involved an electronically administered survey using the validated Client Satisfaction Questionnaire-8, with both quantitative and qualitative components. Quantitative data were analyzed using SAS 9.4, while qualitative responses underwent thematic analysis in Excel. Results: Findings revealed an average satisfaction score of 27.16, with employment status emerging as a significant predictor; employed individuals reported lower satisfaction (β = −1.118, p = 0.040), and race showed a marginal association. Qualitative analysis highlighted themes such as supportive staff, financial struggles, and personal growth. Conclusion: The results emphasize the need for equitable, culturally responsive treatment approaches that account for socioeconomic disparities in patient experience and care quality. Full article

Background: Adolescence is a vulnerable period for the onset of severe psychiatric conditions, such as psychotic spectrum disorders. Non-adherence to antipsychotics is a common problem in young people with these conditions and paves the way for relapse, rehospitalization, and functional impairment. Co-occurring substance use disorders (SUDs) further undermine adherence and worsen outcomes. Long-acting injectable antipsychotics (LAIs) improve adherence and outcomes in adults, but none are licensed for use in individuals under 18. This review seeks to distill the available evidence on LAIs’ use in adolescents, from efficacy to safety, and to outline clinical practice recommendations. Methods: A narrative review was conducted. The evidence was organized by drug class: risperidone, paliperidone, aripiprazole, and other antipsychotics (olanzapine, haloperidol, first-generation depots). Results: Evidence in adolescents remains sparse and heterogeneous. Risperidone LAI has shown improvements in symptom severity, functioning, and behavioral control in bipolar disorder and schizophrenia, though commonly associated with side effects. Paliperidone palmitate demonstrated benefit in first-episode schizophrenia and autism spectrum disorder with intellectual disability, reducing hospital use but carrying risks of EPS and hyperprolactinemia. Aripiprazole LAI showed functional gains, short-term tolerability, and encouraging acceptance in case reports. Other LAIs were used in highly resistant cases with some clinical benefit, though extrapyramidal adverse events were common. Conclusions: The current literature provides limited data, and no clinical guidelines exist for the use of LAI in adolescents. Nonetheless, off-label use is reported in selected cases in clinical practice. Best practice is to start with oral stabilization, then use the lowest effective LAI with psychosocial support and close monitoring. When SUD co-occurs, LAIs may also help mitigate risks related to misuse/diversion of oral medication, provided that care includes systematic SUD screening and early intervention. Prospective controlled studies are urgently needed to establish long-term efficacy and safety in this vulnerable population. Full article

Exposure to chronic stress creates vulnerability to drug misuse and presents a barrier to sustained recovery for many individuals experiencing substance use disorders (SUDs). Preclinical literature demonstrates that stress modulates psychostimulant intake and seeking, yet there are wide gaps in our understanding of the specific mechanisms by which stress promotes brain changes that may govern addiction-related behaviors. Recent data suggest that microglia, innate immune cells in the central nervous system, are highly responsive to chronic stressors, and several mechanistic links have been explored highlighting the critical role microglia play in stress-related brain adaptation. Importantly, psychostimulants may engage similar microglial machinery, which opens the door for investigation into how microglia may be involved in shaping motivation for psychostimulants, especially in the context of stress exposure. The aims of this review are threefold: 1. Offer a brief overview of microglial biology in the adult brain. 2. Review current methods of interrogating microglial function with a focus on morphometric analyses. 3. Highlight preclinical research describing how microglia contribute to brain changes following chronic stress and/or psychostimulant exposure. Ultimately, this review serves to prime investigators studying the intersection of stress and SUDs to consider the relevant impacts of microglial actions. Full article

The effects of climate change and urbanisation, such as more intense rainfall and changing land use patterns, are putting increasing pressure on urban drainage systems. This study proposes a comprehensive methodology for evaluating the effectiveness of sustainable urban drainage systems (SUDSs) in mitigating flooding and managing stormwater in both current and future scenarios. The approach integrates geospatial data, including digital elevation models (DEMs) and land use information, to delineate catchments and characterise hydrological parameters. Historical rainfall records and hydrological modelling were employed to define two baseline storm events: an extreme storm involving 422 mm of rainfall over 2 h, and an average storm involving 2.84 mm of rainfall over 1 h and 18 min. Future scenarios were developed by updating these baseline events using annual rates of change in maximum and average precipitation derived from climate projections between 2025 and 2100. The analysis incorporates seven CMIP6 climate scenarios: SSP1-1.9, SSP1-2.6, SSP4-3.4, SSP4-2.5, SSP4-6.0, SSP3-7.0, and SSP5-8.5. A stochastic simulation of 1000 storms per year was carried out using a custom-built conceptual hydrological model based on CN and developed in Python, which reflects interannual variability. The results show that extreme storm volumes could increase by up to seven times and average storm volumes by up to two and a half times. Additionally, discharge peaks could exceed baseline values by up to 20% in some years, suggesting an increased occurrence of extreme runoff events. The methodology assesses SUDS performance by comparing runoff and hydrological responses between baseline and future estimates. This framework enables vulnerabilities and adaptation needs to be identified, ensuring the long-term effectiveness of SUDSs in managing urban flood risk. Addressing uncertainties in climate and land use projections emphasises the importance of integrating SUDS assessments into wider urban resilience strategies. Full article

This study examines the interplay between problematic smartphone use (PSU) and substance use disorders (SUDs) among Brazilian college students, also addressing associated emotional distress (e.g., depression, anxiety, and stress). A total of 3130 students (M_age = 23.6; SD_age = 5.34) participated in an online survey featuring validated measures for assessing PSU, alcohol and drug consumption, and emotional distress. Participants were categorized into problematic smartphone use (PSU) and non-problematic use (nPSU) groups. The prevalence of PSU was 46.9%, notably higher among female students, those lacking a religious affiliation, individuals living alone, and the unemployed. PSU individuals showed significantly elevated rates of alcohol, cannabis, and other illicit substance use, along with greater emotional distress. Network analysis revealed that weekly alcohol consumption and stress symptoms exhibited the highest centrality indices (e.g., stress with high betweenness; alcohol with strong expected influence), underscoring their key roles in connecting PSU and SUDs. These findings suggest that PSU and SUDs may share underlying emotional vulnerabilities, highlighting the need for integrated intervention strategies targeting both conditions concurrently. Full article

Background/Objectives: The homeless population (HP) is a heterogeneous group characterized by the absence of stable and conventional housing, often relying on public spaces and deteriorated environments for shelter and survival, either temporarily or permanently. This group is exposed to multiple health vulnerabilities, with substance use disorder (SUD) identified as a significant risk factor for suicidal behavior. The aim of this study was to conduct a scoping review of the relationship between PAS use and suicide among homeless individuals. Methods: A comprehensive literature search was performed using five databases: PubMed, Scopus, SciELO, LILACS, and Google Scholar. Studies were selected based on their relevance to the topic, and data were extracted regarding substance use, suicide-related outcomes, and associated sociodemographic and clinical factors. Results: The findings indicated a strong association between PAS use and increased suicidal ideation and behavior among homeless individuals, particularly among youth, men, and women. Opioids and alcohol were the most frequently reported substances in this context. Additional factors such as unemployment, exposure to violence, social inequalities, and mental health disorders further exacerbated the risk of suicide in this population Conclusions: The reviewed literature underscores the urgent need for integrated, context-sensitive interventions addressing both substance use and mental health among the homeless. Tailored public health strategies focused on prevention, harm reduction, and psychosocial support are essential to reducing suicide risk and promoting overall well-being in this highly vulnerable group. Full article

In recent decades, the impacts of urbanization on the hydrological cycle have led to an increase in the frequency and magnitude of urban flooding events, and this is also amplified by the effects of climate change. Sustainable Drainage Systems (SuDS) provide a revolutionary change in this field, improving the sustainability and resilience of cities. This research explores the integration of different SuDS with the aim of significantly reducing both the flow volume and celerity of floods in a residual urban catchment area of the metropolitan city of Querétaro (Mèxico), where extreme rainfall frequently occurs. This catchment is a representative suburb of urban pressure and environmental degradation problems. Currently, managing storm water under climate uncertainty through a multi-disciplinary approach is a major concern in this urban area. A 1D–2D coupling model of shallow water equations, the finite volume method, an unstructured meshing method, and a hybrid parallel computing application defined the optimal configuration of SuDS at catchment scale to reduce the flood vulnerability in Querétaro. Specifically, in this paper, we explore the management issues of the proposed SuDS configuration that acts as a water resource system with multiple purposes. A generic simulation model called MODSIM was applied to simulate the designed urban drainage system under a balanced IPCC future climate scenario in terms of reliability, resilience and vulnerability against water scarcity. The proposed hierarchical Reliability–Resilience–Vulnerability approach appears to be effective in evaluating the system performance, showing that the complete satisfaction of non-essential water uses in Querétaro can be assured at a 65% rate of reliability for a large range of reservoir storage conditions. Full article

We explored the intricate interplay of biological, social, and psychological factors contributing to substance use disorder (SUD) and co-occurring psychiatric symptoms. Drug misuse is a global concern, with increasing prevalence rates affecting mental well-being and safety. The spectrum of SUD includes polysubstance users, posing challenges for treatment and associated health outcomes. Various psychoactive substances like cannabis, hallucinogens, opioids, and stimulants impact addiction vulnerability, with marijuana being widely used globally. Gender differences in SUD prevalence have narrowed, with women escalating drug consumption rapidly once initiated. Age disparities in substance use highlight regional variations among adolescents. Comorbidities with psychiatric symptoms are common, with mood and anxiety disorders frequently observed. This study aimed to analyze factors influencing SUD development and maintenance to inform prevention strategies and treatment recommendations. By conducting a systematic search of databases, sixty articles were reviewed, revealing diverse methodologies and geographic locations. Biological factors, including neurotransmitter systems like endocannabinoid and dopaminergic systems, play a significant role in addiction. Genetic and neurobiological factors contribute to cannabis addiction susceptibility. Social factors such as childhood experiences and parenting styles influence substance use behaviors. Psychological factors like personality traits and mental health conditions interact with SUD development. Understanding these multifaceted interactions is crucial for designing effective interventions to address the complexities of SUD and co-occurring psychiatric symptoms. Full article

Positive psychology is a rapidly expanding and recent empirical. interdisciplinary research topic (i.e., within the last 25 years). Early evidence supported that targeting positive variables (i.e., empathy or kindness) has numerous benefits, including improving health outcomes, vocational success, psychological well-being, and interpersonal connectedness. Positive Psychological Interventions (PPIs) are activities and behavioral interventions that target positive variables to promote adaptive functioning (e.g., reducing depression or promoting psychological well-being). PPIs may make excellent contributions to treating substance use, substance use disorders (SUDs), and substance use problems because the interventions can partially shift the notable negative treatment focus (e.g., avoiding the consequences of using) onto positive aspects (e.g., pursuing an ideal future). Current substance use treatment outcomes demonstrate a need for improvements (e.g., low abstinence rates and lifetime symptom remission of SUDs), and positive psychology may provide a framework for improving existing treatments. In the current paper, the author reviewed research supporting the use of PPIs in substance use treatments, provide suggestions for PPI applications, examine advantages and practical issues, outline the current limitations, and provide future directions for continuing this line of work. The author aimed to encourage researchers to advance substance use treatment improvements with positive psychology because the growing consequences from substance use (e.g., the growing frequency of accidental fatal overdose) and the variable, limited treatment outcomes, placing those who use substances in a uniquely vulnerable position. Full article

Adherence to vaccination recommendations is a challenge for national immunization programs. We quantified adherence to COVID-19 vaccination recommendations in people with substance use disorders (SUDs) attending an outpatient addiction center in Rome, Italy; we investigated the determinants of adherence, and also analyzed patient risk perception and compliance with preventive measures. A multivariable logistic regression model identified predictors of adherence to vaccination recommendations, with statistical validity tested by estimating adjusted odds ratios (aORs) and 95% confidence intervals (CIs). From December 2021 to January 2022, 200 SUD patients completed a questionnaire, 80% of whom reported being vaccinated against SARS-CoV-2 (minimum one dose). Negative predictors of vaccine uptake included being non-Italian (aOR: 0.36, 95% CI: 0.13–0.97), having coexisting comorbidities (aOR: 0.35, 95% CI: 0.13–0.95), and previous use of heroin (aOR: 0.24, 95% CI: 0.08–0.71). No difference was found for cocaine use, demographic characteristics, previous COVID-19 infection, methadone therapy, or compliance with preventive measures. Major reasons for non-adherence to vaccination recommendations were fear of side effects, insufficient recognition of the importance of vaccination, bureaucratic issues, and lack of trust in the authorities. Given their vulnerability, additional efforts are needed to facilitate access to vaccination for people with SUDs, and to limit disinformation around vaccines.. Full article

As time passes, the long-term effects of the COVID-19 pandemic are becoming increasingly apparent. The extreme restrictions imposed during the pandemic have had detrimental impacts on the most vulnerable groups, such as individuals suffering from substance and/or alcohol disorders (SUDs). This study reports quarterly laboratory data on alcohol and drug use in 150 subjects with SUDs that were examined using hair analysis for 2 years before the start of pandemic until after the end of the Italian health emergency. Overall, it was found that the number of subjects who used heroin, cocaine, and MDMA all decreased during the 2020 and 2021 lockdowns, increasing during reopening and subsequently stabilizing close to pre-COVID levels. Cannabis use was less impacted, remaining stable throughout the pandemic. Alcohol and benzodiazepine use both increased significantly during the lockdowns, displaying an opposing trend. While benzodiazepine use progressively returned to baseline levels, alcohol remained at significantly increased levels, even in September 2022. Long-term heavy drinking combined with substance use should be seriously considered, since these results in several health and social problems alongside alcohol-related comorbidities. Thus, appropriate response plans should be implemented both during and after the pandemic, whilst focusing on those who are most vulnerable. Full article

Deficits in neurocognitive functioning are trait-like vulnerabilities that have been widely studied in persons with substance use disorders (SUD), but their role in the craving–use association and relapse vulnerability remains poorly understood. The main objectives of this study were to examine whether executive capacities moderate the magnitude of the craving–substance use relationship, and if this influence is correlated with the functional connectivity of cerebral networks, combining rsfMRI examinations and ecological momentary assessment (EMA). Eighty-six patients beginning outpatient treatment for alcohol, tobacco or cannabis addiction and 40 healthy controls completed neuropsychological tests followed by EMA to collect real-time data on craving. Fifty-four patients and 30 healthy controls also completed a resting-state fMRI before the EMA. Among the patients with SUD, better verbal fluency and resistance to interference capacities were associated with a greater propensity to use substances when the individual was experiencing craving. Preliminary rsfMRI results identified specific networks that interacted with executive performance capacities to influence the magnitude of the craving–use association. Individuals with better executive functioning may be more prone to relapse after craving episodes. Specifically, better resistance to interference and cognitive flexibility skills may reduce attention to distracting stimuli, leading to a greater awareness of craving and susceptibility to use substances. Full article