Substance Use & Addiction Journal

Some state legislatures have passed laws that allow or require that districts and schools maintain naloxone on campus. In response to the ongoing opioid and overdose epidemic, school and district nurses are increasingly involved in the development of policies related to naloxone administration. This study examined how some Texas districts and schools developed and implemented policies related to access to and availability of naloxone.

We surveyed personnel who requested a standing order for naloxone from the Texas Opioid Training Initiative (N = 388 active contacts, 25.0% response rate) and conducted semi-structured interviews with a subset of survey respondents (N = 16). Most respondents were district or school nurses.

Respondents used multiple resources to develop their policies, including other schools’ policies, extant medication policies, professional associations, and legislative language. Most respondents (87% district-level; 100% school-level) reported that naloxone was available. Common locations for naloxone storage were a nurse’s office (72% respondents) and a closet or cabinet in a common area (41%).

Supporting district and school nurses in developing policies on access to and availability of naloxone can build confidence in school staff’s preparedness to respond to overdose.

Despite cannabis’ increased popularity, limited research has assessed effects of advertising messages or warnings, particularly their complexity. This study examined effects of advertising message and warning complexity on young adults’ perceptions.

In 2024, US adults ages 18 to 34 (n = 3581; 40.8% past-month cannabis use) completed an online survey-based experiment using a 2 × 3 factorial design (advertising message: simple vs complex; warning: none vs simple vs complex), then reported perceived addictiveness, harm, cautiousness, appeal, and interest (0 = none – 7 = extremely). Multivariable regression assessed conditions and their interactions with 1 another and past-month use in relation to perception outcomes.

Complex (vs simple) advertising message exposure was associated with higher perceived addictiveness (B = 0.35, standard error [SE] = 0.06), harm (B = 0.21, SE = 0.06), appeal (B = 0.34, SE = 0.06), and interest (B = 0.20, SE = 0.06). Complex (vs no) warning exposure was associated with higher addictiveness (B = 0.23, SE = 0.08); simple or complex warning exposure was associated with higher harm (B = 0.20, SE = 0.07; B = 0.20, SE = 0.08). A significant interaction indicated that complex advertising message exposure was associated with larger increases in addictiveness and harm among nonusers but minimal effect in users. In analysis stratified by past-month use, an interaction among users indicated that complex warning exposure was associated with higher addictiveness among those exposed to the simple advertising message but had the opposite effect in those exposed to the complex advertising message.

Desired effects were yielded by complex advertising messages (interest, appeal) and warnings (risk). However, complex advertising messages may overpower effects of complex warnings among users. Additional research is needed to understand these dynamics and inform regulations.

Substance use disorders (SUDs) are a leading public health concern in the United States. Food addiction (FA), as a common comorbidity or substitute addiction of SUDs, is not currently a fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis, with overlaps with SUDs and eating disorders (EDs). How FA is addressed in SUD treatment is understudied.

Cross-sectional survey interviews with service providers (N = 85) from 68 SUD treatment facilities across 20 U.S. states asked an open-ended question on how FA was addressed. Descriptive statistics of FA prevalence were reported; Chi-square tests were used to assess bivariate associations between facility funding sources, FA treatment, and referral availability. Thematic analysis was conducted to identify emerging over-arching themes regarding FA-related practice.

Eight themes were identified: formal treatment offered at the facility; no treatment; referral for treatment; education; screening; monitoring; comorbidities or triggers of FA; and potential misunderstandings of FA. Among the 80% of facilities observing FA issues, 29% provided explicit/formal treatment, and 53% made referrals to ED treatment facilities. Facilities that accept insurance (P = .046) and self-pay (P = .008) were more likely to make referrals. Methamphetamine use, substitute addiction, trauma, homelessness experience, and malnutrition were potential FA triggers. Potential misconceptions about FA and EDs may undermine appropriate treatment.

Formalizing FA assessment and diagnosis, and improving reimbursement mechanisms, may reduce potential health inequities between market-driven and publicly funded SUD treatment centers in FA treatment and referral resources. More training on FA, integrating evidence-based FA screening, monitoring, and treatment measures, is warranted to improve holistic SUD treatment quality and outcomes.

As of 2026, physicians must complete an Accreditation Council for Graduate Medical Education (ACGME)–accredited addiction medicine fellowship to seek addiction medicine board certification. While the ACGME has developed general goals and objectives, they also allow for curricular flexibility. Little is known, however, about how individual programs meet these requirements.

To describe how addiction medicine fellowship training programs meet ACGME requirements, including commonalities and innovative curricular and education strategies.

In 2025, 5 experts in addiction education developed a survey tool to capture comparisons of addiction medicine fellowship curricula. The principal investigator (R.S.) sent this survey via e-mail to 104 addiction fellowship program directors; responses were kept anonymous and not linked to individual programs. Data were analyzed using quantitative descriptive statistics and inductive and deductive thematic analysis.

Forty-seven of 104 program directors (45%) completed the survey. Program directors described both shared elements and unique features of their curricula, reflecting differences in program settings, available community resources, specialty focus, faculty diversity and expertise, and patient population.

There is a wide array of curricula that meet addiction medicine fellowship ACGME requirements. Future research and efforts should describe individual programs’ curricula in more depth to support new and existing programs in growing and improving their programs to suit the growing demand for diverse practices in addiction medicine and to recruit fellows with aligned interests.

Stigma toward people with substance use disorders (SUDs) has been documented across health professions and is associated with negative impacts.

We created a freely available, documentary-style video intervention aimed at reducing SUD stigma among healthcare workers. The video features narrative from people with SUD and commentary by healthcare workers experienced in addiction treatment. Participants working in clinical and non-clinical roles viewed and briefly discussed the video documentary, and were asked to complete a pre- and post-survey that included the Medical Condition Regard Scale (MCRS). We evaluated differences in attitudes among participants completing both surveys using paired t-tests.

Four hundred seventy-one people completed a pre-survey, 366 completed a post-survey, and of these, 276 provided paired responses. Among paired responses, 63% were from medical students, 19% medical providers, 3% residents/fellows, 9% clinical staff, and 6% non-clinical staff and pharmacists. Attitudes endorsed were highly positive prior to the intervention with a mean MCRS score of 52.3 ± 7.8 (range 6–66). Scores increased to 55.2 ± 7.6, P < .001, pre to post. Change was positive across items, indicating stronger agreement with non-stigmatizing attitudes and treatment optimism, and greater disagreement with negative attitudes and treatment pessimism. Improvements were seen across roles, and these changes were significant (P < .05) in all but 2 small subgroups: non-clinical staff (n = 14) and residents/fellows (n = 8).

Viewing a freely available documentary-style video featuring personal narrative from patients with SUD and commentary from SUD-focused professionals was effective in reducing healthcare worker stigma toward people with SUDs and in anticipating the positive impact of treatment encounters.

Despite the variety of treatment programs for those with or at risk for substance use disorders (SUD), relatively little is known about treatment goals beyond substance use reduction across treatment settings. Understanding these treatment goals may inform the tailoring of treatment and improve implementation.

This study compares treatment goals across 4 years at 3 treatment facilities. All sites were situated in West Alabama, a geographic region known for substantial health, economic, and educational disparities as well as behavioral and mental health stigma. Psychosocial treatment goals were examined by site using de-identified psychotherapy notes and a modified version of an established treatment goal coding inventory (the Bern Inventory of Treatment Goals).

Of 306 individuals who consented to research, 48.37% (N = 148) attended at least one psychotherapy treatment session using evidence-based treatment approaches with a focus on substance use reduction. Session notes indicated, as expected, that the most common treatment goals across sites focused on SUD prevention or recovery. Many other treatment goals were mentioned targeting anxiety, trauma, somatic symptoms, interpersonal relations, exploration of self, and personal growth. While interpersonal treatment goals such as navigating parenthood predominated across sites, specific problems and symptoms as well as subcategories within well-being/functioning, exploration of self and personal growth varied.

Many core treatment goals for SUD are consistent across settings among those at risk for or receiving treatment. However, specific treatment goals vary by site and stage of recovery (e.g., prevention to maintenance of positive change). Issues of lifespan development inform psychotherapeutic themes categorized through modification of an established treatment goal coding inventory. Counseling and psychotherapy can augment patients’ quality of life across many treatment goals, including substance use reduction and recovery maintenance, and this is critical to holistic recovery health outcomes.

Health and mental health systems are increasingly employing community health workers and peer support specialists to expand service reach and effectiveness, yet role definitions and competency standards vary widely. Little is known about how to train or prepare these professionals to collaborate with health care teams, engage peers and community members, and address complex health and mental health needs. Tobacco use remains a leading cause of illness and death in the United States and disproportionately impacts people with low incomes and people with mental health conditions, including substance use disorders. Support for Tobacco Recovery Training (STaRT) was developed to provide brief but comprehensive training to support engagement in evidence-based tobacco treatment. This study describes STaRT’s development and evaluates knowledge, reach, and satisfaction among graduates during its first 2 years.

We developed STaRT using a community-engaged process with peer specialists, behavioral health professionals, and academic partners. The final program includes 8 self-paced online modules emphasizing recovery-oriented language, communication strategies, evidence-based treatment, and resource navigation. We collected demographics and a knowledge assessment at baseline, and a post-knowledge assessment and evaluation upon training completion. We used descriptive statistics to summarize demographics and evaluation items and a choropleth map of trainees demonstrates reach. We evaluated change in knowledge using a paired samples t-test.

From November 2023 through October 2025, 256 trainees graduated from STaRT. Trainees were primarily women (83%) and worked across diverse settings, including public health, mental health, community health, and social service settings. Mean knowledge scores increased from 83% to 97% (P < .01). Trainees represented 46/105 counties, with reach ranging from 1 to 43 graduates/100 000 population. Program satisfaction was high (mean 4.6/5).

STaRT is a feasible, scalable, and peer-informed training model that improves knowledge and expands the tobacco recovery workforce. Findings suggest strong potential for implementation and adaptation beyond Kansas.

Suicide is a significant public health concern in the U.S. that has been rising steadily over the last 2 decades. Addressing substance use as a form of suicide prevention may help counteract the rising suicide rate, as alcohol and opioids are found in 22% and 20% of individuals who died by suicide, respectively. The Substance Abuse and Mental Health Services Administration envisions crisis response as addressing both substance use and suicide, including through the 988 Suicide and Crisis Lifeline. Unfortunately, few report they would contact 988 if they were experiencing a substance use issue. We sought to explore reasons for, barriers to, and likelihood of contacting 988 for substance use and inform future efforts to increase utilization.

A survey of 1090 U.S. adults was conducted November 6 to 10, 2025 via the AmeriSpeak Omnibus, a nationally representative bi-monthly multi-client survey using the AmeriSpeak Panel.

Only 18% of respondents reported they would contact 988 if they were experiencing substance use issues. No cost (41%), immediate support while on a wait list for treatment (32%), and avoiding stigma (32%) were the most commonly reported motivators for contacting 988 for substance use support. Being advertised as a suicide and crisis lifeline (22%), lack of follow-up (14%), and lack of training among counselors (13%) were reported as barriers. Familiarity with 988 was associated with likelihood of contacting 988 for substance use support for at least 1 listed reason (81% of those extremely/very familiar vs 51% not very/not at all familiar). Responses varied by education, gender, race/ethnicity, and age.

Findings identified factors that influence the public’s likelihood of contacting 988 for substance use support and suggest a need for standardized substance use intervention protocols and targeted messaging tailored to specific audiences.

Cardiovascular side effects are commonly reported by men who use anabolic-androgenic steroids (AAS), yet little is known about the factors that increase risk. This study examines data from the 2024 Global Drug Survey (GDS2024) to identify whether route of administration (ROA), image-and performance enhancing drug (IPED) polypharmacy and licit substance use are associated with self-reported cardiovascular-related concerns.

The dataset comprised 1167 males (≥16 years) who had used AAS within the previous 12 months. Descriptive statistics summarized demographic and substance use characteristics. Chi-square tests explored associations between self-reported cardiovascular side effects and ROA (oral vs injectable), IPED polypharmacy, and licit substance use respectively. Independent predictors were identified through multivariable binary logistic regression. Associations between substances were investigated using pairwise models. Visualizations included heatmaps, bar charts, forest plots, trend stability, and performance comparisons across models.

Showed that, among AAS consumers, 35.7% reported a self-reported cardiovascular-related concern. Alcohol (79.4%), tobacco (42.0%), and E-cigarette use (40.5%) were prevalent among AAS consumers. Clenbuterol use differed significantly by ROA, reported by 28.4% of oral and 24.3% of injectable AAS consumers. Injectable AAS use was strongly associated with concurrent human hormone growth (HGH) and insulin use. In adjusted models, injectable AAS use showed the strongest association with self-reported cardiovascular-related concerns (OR = 10.57, P < .001), followed by oral AAS use (OR = 1.92, P < .001) and clenbuterol use (OR = 1.44, P = .044). Age, HGH, insulin, alcohol, tobacco, and e-cigarette use were not significantly associated with cardiovascular-related concerns. Pairwise analyses indicated that clenbuterol-containing substance combinations were associated with higher odds of reporting cardiovascular-related concerns, highlighting the relevance of ROA and patterns of concurrent substance use.

Negative cardiovascular health concerns among AAS consumers are most strongly associated with oral routes and use of substances like clenbuterol.

Undergraduate medical education is increasingly incorporating harm reduction (HR). Assessments of HR curricula have focused on skills like overdose reversal. The literature lacks evaluations of curricula that more broadly teach HR-based physician-patient communication.

From academic years 2022 to 2024, a Harvard Medical School student working group collaborated with faculty to take a quality improvement approach to incorporating HR into the substance use interview curriculum. We implemented two Plan-Do-Study-Act cycles. We measured the effectiveness of HR education in the 2023 Substance Use interview session by surveying students on a 5-point Likert scale (ranging from 1 = strongly disagree to 5 = strongly agree). We also conducted a focus group with four students to provide qualitative insights into the curriculum’s impact and areas for improvement. We thematically analyzed the focus group session based on Borkan’s Immersion/Crystallization methodology.

Thirty-three students completed the pre-survey and post-survey (19.4% response rate). In the survey, self-reported HR understanding improved, from mean 3.6 on the Likert scale to 4.2 (P < .001). Students strongly agreed with being interested in harm reduction before and after the session (mean pre-survey score: 4.3). In the focus group, students identified patient stories as helpful for improving understanding of HR communication. They expressed difficulty understanding the relationship between HR and abstinence-based approaches like Alcoholics Anonymous and recommended more diverse patient perspectives during the session and more HR exposure throughout medical school.

A half-day session on the substance use interview showed promise for teaching HR communication principles. For future HR communication curricula, our results favor retaining an emphasis on patient narratives and ensuring representation of diverse patients. Future research can assess whether harm reduction education translates into improved patient care.

Driven by concerns of gabapentin misuse and other harms, Kentucky (KY) and West Virginia (WV) became the first states to classify gabapentin as a schedule V controlled substance in July 2017 and June 2018, respectively. This study examined the association of these policies with gabapentin utilization among Medicaid beneficiaries.

Using a controlled interrupted time series design, we modeled a segmented generalized least squares regression and calculated the immediate and trend changes of gabapentin prescriptions among Medicaid enrollees in 2 states (KY, WV), separately. North Carolina (NC) was used as a control to account for secular changes; there was no controlled substance designation for gabapentin in NC during the study period. Total outpatient prescriptions per quarter (Q) were calculated from Medicaid’s publicly available State Drug Utilization Data, and rates were established using state-specific combined Medicaid and CHIP average enrollment for the period 2016 to 2019. Multiple sensitivity analyses were performed, including a phase-in period model and internal negative control model, to assess robustness of results.

Overall, utilization rates of gabapentin were higher in KY and WV relative to NC throughout the study period. The gabapentin controlled substance classification in KY was associated with a sustained decrease in trend (−10.6 prescriptions per 1000 enrollees per quarter; 95% CI: −13.6, −7.6) relative to NC. An immediate decrease in prescription rate (−18.9 prescriptions per 1000 enrollees; 95% CI: −32.7, −5.1) and a sustained decrease in trend (−3.8 prescriptions per 1000 enrollees per quarter; 95% CI: −7.1, −0.5) was observed in WV relative to NC.

Our results show an association between decreased gabapentin utilization among Medicaid enrollees and classifying gabapentin as a schedule V controlled substance in KY and WV. Future research should focus on fully understanding the policy’s impact on other populations and potential unintended or downstream effects.

Emergency departments (EDs) serve as a critical point of care for individuals with unmet substance use disorder (SUD) treatment needs. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach designed to proactively identify and mitigate substance use risk. We sought the perspectives of individuals responsible for delivering ED-based SBIRT to better understand the impact on patients and ED processes and identify challenges in implementing SBIRT.

In-depth interviews were conducted with clinicians and supervisors (n = 9) involved in SBIRT delivery at 2 emergency departments in King County, Washington, United States. Thematic analysis was used.

ED-based SBIRT has benefits to patients as well as other providers. SBIRT leverages teachable moments following substance-related injuries and emphasizes patient autonomy to provide a form of substance use care that would not otherwise be available in the ED. There are ancillary benefits to the ED, including improved interprofessional collaboration, increased capacity for substance use care, and perceived destigmatization among other healthcare providers. Persistent resource constraints—including limited reimbursement for core components of SBIRT and lack of access to many treatment options—were identified as challenges to implementation.

Reliable referral networks, integration of immediate treatment access, and sustained investment in staff training are critical to maximizing the benefits of SBIRT programs. While gaps in the behavioral health continuum continue to present challenges, SBIRT remains a vital intervention for connecting patients to care and shaping ED practices toward improved SUD outcomes. These findings are relevant for individuals responsible for implementing similar programs as well as implementation-focused researchers.

Substance use during pregnancy is a growing public health concern, yet little is known about how universal screening translates into the identification of a substance use disorder (SUD) and treatment engagement, across the perinatal SUD continuum of care. Persistent disparities in screening, identification, and treatment may contribute to missed opportunities for timely intervention and exacerbate inequities in maternal health. This study examined national patterns of substance use screening, SUD prevalence, and treatment engagement among pregnant women in the United States.

Data were drawn from the 2021 to 2023 National Survey on Drug Use and Health. The sample consisted of pregnant females aged 12 to 49 years (N = 2 051; weighted population estimate 2,037,128). Outcomes included healthcare professional-initiated screening for drug and alcohol use, SUD diagnosis, and SUD treatment engagement. Researchers estimated the prevalence of each outcome and conducted survey-weighted logistic regression to assess sociodemographic, clinical, and structural correlates.

Nearly two-thirds of pregnant women (64.7%) reported being screened for substance use in the past year, 14.3% met criteria for a past-year SUD, and only 10% of those with SUD received treatment. Screening and SUD prevalence varied significantly by age, race/ethnicity, educational attainment, income level, insurance type, mental health status, and criminal justice involvement. Screening alone was not associated with treatment receipt; however, a provider-initiated conversation about treatment options and/or substance use was associated with more than 10-fold higher odds of treatment engagement. Substantial attrition between screening and treatment was observed, with disparities across sociodemographic and geographic groups.

Most pregnant women receive substance use screening nationwide, but few who meet the criteria for a SUD ultimately receive treatment, indicating critical gaps in the perinatal SUD care continuum. Findings underscore the need to strengthen post-screening follow-up, including provider communication, care coordination, and integrated obstetric-behavioral health models, to ensure that identification leads to timely, patient-centered treatment. Addressing the barriers and inequities in screening, diagnosis, and treatment engagement is essential for advancing maternal health equity and improving outcomes for pregnant women with SUD.

Neurocognitive symptoms (NCS)—including difficulties with attention, memory, and executive functioning—are common among patients receiving long-term opioid therapy (LTOT) for pain. Although cognitive impairment may influence safety, its relationship to opioid overdose has not been evaluated at scale. This study assessed whether NCS are associated with opioid overdose among Veterans prescribed LTOT.

We conducted a retrospective cohort study using national Veterans Health Administration (VHA) data. Patients prescribed LTOT (≥90 days of continuous opioid prescriptions) in 2018 were included. NCS during LTOT episodes were measured via diagnostic codes and natural language processing. The primary outcome was fatal and nonfatal opioid overdose, identified through ICD codes. A Cox proportional hazards model estimated the association between NCS and overdose events, adjusting for demographics, co-occurring diagnoses, VHA visits, opioid dose, and LTOT duration.

The opioid overdose risk for patients with NCS, compared with those without, during LTOT receipt was higher, risk ratio (95% CI) = 5.80 (3.99-8.41). Cox regression analysis showed that adjusted hazard ratio (aHR) of opioid overdose was significantly higher for patients with NCS during LTOT (aHR 2.54 [2.10-3.06]). Factors associated with increased overdose risk included black race, presence of a substance use disorder, cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, opioid dose >50 mg morphine equivalent daily dose, and LTOT duration of 12 months or fewer. Sensitivity analyses yielded similar results. Age between 45 and 64 (vs 75 and older) was associated with decreased overdose risk.

Neurocognitive symptoms are independently associated with increased risk of opioid overdose among Veterans receiving LTOT. Incorporating cognitive screening into opioid safety assessments may help identify individuals at heightened risk and inform tailored risk mitigation strategies.

Hospitals increasingly start methadone treatment for opioid use disorder (OUD). Rapid methadone titration has been described in hospitals with addiction consult teams; however, most hospitals lack these specialty services. We evaluated whether a pharmacist-led rapid methadone titration protocol (“RAMP-UP”) increased the proportion of hospitalizations that reached a minimally therapeutic dose of methadone (≥60 mg) before discharge.

We conducted a retrospective, quasi-experimental, pre-post study comparing outcomes 7 months before versus 7 months after the implementation of RAMP-UP. The study included all adults admitted to a large academic medical center between March 2022 and April 2023 who newly initiated methadone for OUD. We used multivariable regression with generalized estimating equations to evaluate the primary outcome of achieving a total daily methadone dose of at least 60 mg by hospital discharge. Secondary outcomes included days to therapeutic dose, total daily methadone dose, and opioid-related safety events.

We identified n = 155 admissions, 55 pre-intervention and 100 post-intervention, among 124 unique patients with OUD. After RAMP-UP, a higher proportion of encounters reached ≥60 mg total daily dose (TDD) of methadone, but this difference was not significant in adjusted analyses (45.5% pre-implementation vs 60.0% post-implementation, P = .06). Post-implementation encounters had higher methadone TDD on discharge (62 vs 55 mg; P = .04) and, among those who reached 60 mg TDD, achieved this dose faster (9.0 vs 4.0 days, P < .001). Safety events were uncommon and similar (11.0% vs 12.7%; P = .80).

Pharmacist-guided rapid titration accelerated attainment of therapeutic methadone doses and did not increase adverse events. Although the adjusted increase in the proportion achieving ≥60 mg TDD by discharge was not statistically significant, these findings demonstrate how inpatient clinical pharmacists can modernize inpatient OUD care.

Adolescent smoking continues to pose significant public health challenge, persisting due to a multifaceted interplay of internal and external factors. The present study aimed to explore internal and external factors that may influence adolescents’ smoking behaviors in Crete, Greece.

Conducted as part of Phase A of the European-funded FRESHAIR4Life Program; this cross-sectional study included adolescents aged 14 to 21 years, recruited between January and February of 2024. Ten educational institutions in the Municipality of Heraklion, Crete, were selected, including high schools (n = 7), technical schools (n = 2), and universities (n = 1).

The sample consisted of 179 participants with a mean (SD) age of 16.8 (1.9). Smoking history was reported by 34% (n = 60). Older adolescents had higher odds of ever smoking (OR = 1.57, 95% CI: 1.32-1.88; P < .001). The most prevalent reasons for smoking initiation were reported to be addiction after the initial use of nicotine products (60%), stress (43%), and to look cool and attractive (27%). Ignoring smoking’s negative consequences was positively associated with ever smoking (OR = 3.89, 95% CI: 1.85-7.99, P < .001). The perception of smoking as a risk factor for the development of illness (OR = 2.6, 95% CI: 1.2-5.3, P = .012), and concerns about the health impact (OR = 5.7, 95% CI: 2.3-14.1, P < .001) were positively associated with non-smoking behaviors. External factors positively associated with ever smoking were smoking exposure at school (OR = 2.81, 95% CI: 1.36-5.81; P = .005), use of nicotine products by parent(s) (OR = 7.64, 95% CI: 1.95-29.96, P = .004), close friend(s) (OR = 12.88, 95% CI: 3.24-51.15, P < .001), and sibling(s) (OR = 25.13, 95% CI: 3.23-195.63, P = .002).

Our findings highlight the need for multifaceted, targeted interventions. Future research should evaluate tailored interventions and investigate emerging potential influences like social media and alternative nicotine products on youth smoking.

The current study investigates the roles of assertive outreach, individual participant involvement, and treatment significant other (TSO) involvement through the Medication Adherence Therapy: Psychosocial Leverage Using a Significant other (MAT-PLUS) intervention on extended-release naltrexone (XR-NTX) adherence for the treatment of opioid and/or alcohol use disorder (OUD/AUD).

Participants receiving XR-NTX for OUD and/or AUD received 16 weeks of the MAT-PLUS intervention through a prior randomized controlled trial (RCT). Logs tracked XR-NTX adherence, treatment team outreach, and participant/family communications and sessions.

Of the contact types examined, only the number of family sessions attended significantly predicted next XR-NTX dose receipt (OR = 8.74, 95% CI [1.84, 54.41]) in n = 12 participants.

Family involvement is an important component of OUD/AUD treatment that may improve XR-NTX adherence.

Treatment of opioid use: Medication Adherence Therapy (MAT-PLUS), https://clinicaltrials.gov/study/NCT03567356?term=MAT-PLUS&rank=1, NCT03567356

Motor vehicle accidents (MVAs) are a major cause of unintentional injury deaths in the United States. Substance use, particularly alcohol and cannabis, is a well-established contributor to impaired driving and fatal MVAs. This study aimed to analyze mortality trends from MVAs associated with substance use from 1999 to 2020 in the United States.

We conducted a retrospective analysis using the CDC WONDER database, examining death certificates from 1999 to 2020 that recorded both MVAs and substance use in individuals aged ≥15 years. Data were stratified by sex, age group (15-64 and ≥65), race (white and black), and US census region. Age-adjusted mortality rates (AAMRs) were calculated, and temporal trends were analyzed using the Mann-Kendall trend test. Jointpoint regression analysis was used to calculate Average Annual Percentage Change (AAPC).

A total 24 152 deaths were recorded, with an overall AAMR of 0.46 per 100 000 population. While overall trends were stable, a significant increase in AAMR was observed among women (AAPC: 3.04% increase; P = .002), particularly white women (+4.3%) and women in the West (+2.0%). Older men (≥65) also experienced a significant rise (τ: 0.63; P < .001). Men consistently had higher mortality than women across all demographics (P < .001). Regionally, men in the Northeast experienced a significant decline (τ: −0.57).

While total substance-related MVA mortality remained stable, the rising mortality among women, older men, and certain subgroups highlights shifting risk profiles. These findings underscore the need for targeted, demographically inclusive public health strategies and equitable resource allocation to reduce preventable deaths.