Journal: Drug and Alcohol Dependence, 2025, doi: 10.1016/j.drugalcdep. 2025.112856
Authors: Patience M. Dow, Christopher M. Santostefano, Landon D. Hughes, Elizabeth G. Stettenbauer, Theresa I. Shireman, Julie M. Donohue, Lisa Peterson, & Jaclyn M. W. Hughto
Abstract:
Background: Twelve state Medicaid programs limit the monthly number of covered prescriptions. Such cap policies may force enrollees to forego essential medications with important health consequences. We aimed to determine the impact of cap policies on acute care use and all-cause mortality among enrollees with opioid use disorder (OUD).
Methods: Using 2016–2019 T-MSIS Analytical Files, we propensity-score matched enrollees with OUD in 12 states with cap policies and 26 states without cap policies. Outcomes measured over 12 months included emergency department (ED) visits, hospitalization, and all-cause mortality and were analyzed via generalized linear regression models. We conducted subgroup analyses by use of medications for OUD (MOUD) and comorbidity level and sensitivity analyses to examine the role of cap policy characteristics.
Results: Unadjusted risks were 64.0 % vs. 62.5 % for ED visits, 27.6 % vs. 27.5 % for hospitalizations, and 3.2 % vs. 2.7 % for mortality in cap states and non-cap states, respectively. After adjustment, hospitalization risk was higher (RR=1.89, 99.5 %CI:1.13,3.16) in cap states than non-cap states whereas ED visits and mortality did not differ. There were largely no outcome differences by cap status in subgroups. Strict prescription limits allowing 3–4 prescriptions monthly (RR=1.90, 95 %CI:1.09,3.30) and lack of MOUD exemptions (RR=2.23, 95 %CI:1.32,3.78) were associated with increased hospitalization risk relative to non-cap states.
Conclusions: Medicaid prescription cap policies were associated with increased hospitalization risk, but there were no differences in ED use or all-cause mortality. Cap policies may undermine the health of individuals with OUD and could be counterproductive to state efforts to curb Medicaid spending.
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Journal: Addictive Behaviors, 2025, doi: 10.1016/j.addbeh.2025.108473
Authors: Ian T. McKay, & Danielle K. Nadorff
Abstract:
Introduction: Relapse rates following adolescent substance use disorder (SUD) treatment remain high, highlighting a need for innovative interventions that improve engagement and target key psychosocial mechanisms of recovery. Drawing on Social Cognitive Theory, this pilot study evaluated a novel, strength-based Entrepreneurial Education Program (EEP) designed to reduce relapse risk by increasing self-efficacy, positive affect, and emotion regulation.
Methods: Twenty-seven adolescent males (M age = 15.18) in residential SUD treatment were assigned to either the EEP intervention (n = 15) or a treatment-as-usual control group (n = 12). The EEP consisted of four weekly sessions integrating entrepreneurial skill-building with Dialectical Behavior Therapy (DBT) principles. Validated measures of self-efficacy, affect, emotion regulation, depression, anxiety, and stress were administered at baseline and post-intervention (4 weeks).
Results: Between-group analyses showed the EEP group had a significantly greater improvement in self-efficacy (p = 0.019) and greater reductions in anxiety (p < 0.001) and stress (p = 0.04) compared to the control group. Between-group differences for emotion regulation and positive affect were not statistically significant.
Conclusions: A brief, entrepreneurship-focused psychosocial intervention can effectively target critical antecedents of relapse in adolescents with SUD. By building self-efficacy and improving affect regulation in an engaging, non-traditional format, the EEP shows promise as an adjunctive therapy to enhance treatment outcomes. Future research should include larger, more diverse samples and long-term behavioral follow-up.
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Journal: AJPM Focus, 2025, doi: 10.1016/j.focus.2025.100431
Author: Nayoung Kim, Jesse T. Kaye, & Danielle E. McCarthy
Abstract:
Introduction: Healthcare systems could reduce disparities in the toll of tobacco use by advising all patients who use tobacco to quit. This study examined U.S. adult population-based estimates of past year tobacco use and of healthcare provider advice to quit tobacco, and disparities in these rates across sociodemographic and substance use characteristics.
Methods: Cross-sectional data from the 2015-2019 National Survey on Drug Use and Health were used to estimate rates of tobacco use and tobacco cessation advice as a function of patient sociodemographic characteristics and other substance use.
Results: 28% of U.S. adult healthcare patients reported past year tobacco use. Only 52% of them recalled receiving tobacco cessation advice from healthcare providers. Tobacco use was elevated among: people with co-occurring substance use or disorders, men, non-Hispanic White people, those identifying as lesbian, gay, or bisexual, those with incomes below $30,000, those with no college degree, those in rural areas, and those with non-Medicare or no insurance. Rates of receiving quitting advice were lower among: people who use alcohol or cannabis, those with cannabis use disorder, men, minoritized racial/ethnic groups, those with incomes below $30,000, and those in urban areas. Conversely, people with no college degree, public insurance, and those with alcohol or illicit drug use disorder reported higher advising rates.
Conclusions: Some groups with high tobacco use prevalence received quitting advice at low rates. Healthcare provider advice to quit tobacco may not reach all patients who use tobacco, particularly those with co-occurring alcohol or cannabis use or cannabis use disorder.
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Journal: Addictive Behaviors, 2025, doi: 10.1016/j.addbeh.2025.108442
Authors: E. Melinda Mahabee-Gittens, Nicole Mack, Carla M. Bann, Jamie E. Newman, Junfang Zhao, Kenneth D. R. Setchell, Lara Stone, … Stephanie L. Merhar
Abstract:
Background: There is a paucity of information on tobacco and cannabis use patterns in pregnant women who use opioids. Our objective was to examine sociodemographic, tobacco, and cannabis use patterns during pregnancy among pregnant women with opioid use.
Methods: We recruited 206 pregnant women with biochemically verified opioid use during pregnancy, of whom 98 self-reported taking only medications for opioid use disorder (MOUD) and 108 reported taking other opioids during pregnancy. We examined sociodemographic characteristics and self-report of tobacco and cannabis use overall and by trimester. Chi-square and t-tests were used to assess differences between the MOUD-only vs other opioids groups. Logistic regression models were used to examine differences in factors associated with tobacco and cannabis use.
Results: Mean (SD) age was 30.7 years (4.6); 81.9 % were non-Hispanic White, and 92.6 % had public insurance. Of the 91 women taking MOUD only and completing the substance use self-report, 50 (54.9 %) reported tobacco use only, 3 (3.3 %) reported cannabis use only, and 24 (26.4 %) reported both tobacco and cannabis use. Tobacco and cannabis use was similar for women taking other opioids (p = 0.98). Adjusted odds ratios indicated that there was consistent use of all tobacco products (p = 0.28) including e-cigarette products (p = 0.18) throughout all 3 trimesters of pregnancy. There was decreased use of cannabis over the course of pregnancy with 29.8 % using cannabis during the first trimester and 16.5 % during the last trimester (p = 0.0003).
Conclusions: While we observed no differences in tobacco and cannabis use between those taking MOUD only versus other opioids, we observed high rates of tobacco and cannabis use among pregnant women with opioid use. These findings underscore the need for tobacco and cannabis use education and cessation interventions throughout pregnancy for those with OUD.
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Journal: Journal of Child & Adolescent Trauma, 2025, doi: 10.1007/s40653-025-00738-6
Authors: Alexander Wren, Madi DeFrain, Autumn Minor, & Rhonda K. Lewis
Abstract:
Adverse childhood experiences (ACEs) are defined as experiences in childhood that increase the likelihood of people engaging in maladaptive behaviors, such as using tobacco or illicit drugs. The current study surveyed 115 undergraduates enrolled at a mid-sized Midwestern University to examine the prevalence of and relationships between adverse childhood experiences and substance use behaviors among college students. A factor analysis was conducted on this college sample to determine how the ACE-10 items were structured. Findings revealed that most students had experienced at least one type of ACE, and that parental divorce was the most ubiquitous form. Results also demonstrated that students who had used a substance at least once in their lifetime experienced more types of ACEs than those who had never used a substance. Limitations and future directions are discussed.
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