Journal: Drug and Alcohol Dependence, 2026, doi: 10.1016/j.drugalcdep.2026.113225
Authors: Jane Macky, Calum Handley, Kimberly C. Kirby, Benjamin Fitzpatrick, Jaime Kishpaugh, Caroline West, … & Julie M. McCarthy
Abstract:
Introduction: Community Reinforcement and Family Training (CRAFT) is an evidence-based approach that promotes family skills to encourage people with substance use disorders to seek treatment. To enhance scalable CRAFT implementation, we assessed three digital counselor training models for fidelity, feasibility/acceptability, and implementation potential.
Method: Participants (47 counselors) were randomized to one of three digital training programs. Tutorial (T): two-week CRAFT modules. Tutorial + Self Study Materials (TM): two-week tutorial plus 13 modules of training materials (e.g., session videos/checklists) released over 10 weeks after the tutorial. Tutorial + Self Study Materials + Coaching (TMC): two-week tutorial, 10 weeks of additional materials, plus feedback and coaching on ≥one recorded CRAFT sessions. Participants completed assessments at baseline, two weeks, and 12-weeks. The primary outcome was CRAFT fidelity. Secondary outcomes included CRAFT knowledge, feasibility, acceptability, and implementation potential.
Results: TMC participants demonstrated the highest CRAFT fidelity and knowledge with 83% of counselors achieving proficiency (T:0%; TM:67%). Feasibility was highest for completing the tutorial (73-100% of participants), then the CRAFT session recording and coaching (79%), and the self-study materials (56-75%). 93% of participants were satisfied with their training program. Implementation potential scores were high across all training groups.
Conclusions: The TMC training yielded the best balance of CRAFT fidelity, feasibility/acceptability and implementation potential. TM had the next highest fidelity, and its significantly lower cost/effort may aid implementation in resource-limited settings. T alone was not sufficient to facilitate CRAFT fidelity. Digital training has promise for expanding CRAFT implementation and potentially addressing clinical workforce gaps.
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Journal: Frontiers in Psychiatry, 2026, doi: 10.3389/fpsyt.2026.1755153
Authors: Wendy Insalaco, Charlotte Clapham, Brett Gelino, Jami Mayo Barney, Brianna Billings, Jennifer D. Ellis, … & Jill A. Rabinowitz
Abstract:
Introduction: Mental health monitoring is crucial to long-term recovery in substance use disorder (SUD) treatment; however, little is known about how changes in physiological indicators align with changes in self-reported mental health over time.
Methods: We examined longitudinal associations of resting heart rate (RHR) and heart rate variability (HRV) collected via a WHOOP® photoplethysmography device with self-reported stress, anxiety, and depressive symptoms among individuals in SUD treatment. Participants (N = 59) continuously wore the device and completed at least two mental health and stress assessments during the first month of residential treatment.
Results: Linear regression results indicated favorable changes in mental health and/or physiologic metrics, with notable heterogeneity in concurrent subject-level trends. Among participants with decreased RHR (better physiological functioning), 39% (N=23) also endorsed decreased stress, 42% (N=25) decreased anxiety, and 39% (N=23) improved depressive symptoms. Of those with increased HRV (greater stress adaptability), 39% (N=23) endorsed decreased stress, 39% (N=23) improved anxiety, and 41% (N=24) reduced depressive symptoms.
Discussion: Concurrent changes in physiologic and mental health metrics during the first month of treatment varied across participants. These findings highlight the importance of integrating subjective mental health measures with physiological indicators to capture clinically relevant change during early SUD treatment.
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Journal: Journal of Cannabis Research, 2026, doi: 10.1186/s42238-026-00455-3
Authors: Rebecca Hebert, Kevin F. Boehnke, & Spruha Joshi
Abstract:
Background: Although nearly 80% of Americans reside in a county with a legal, regulated cannabis dispensary, the majority of cannabis consumed in the U.S. is still obtained from unregulated, illicit sources. Illicit cannabis carries greater health risks and is generally less preferred than regulated cannabis, yet its lower price makes it attractive to many customers. However, comparative research on price differentials between the legal and illicit markets across states is scarce. Establishing cannabis price benchmarks is essential to ensure that legal markets are competitively priced and can effectively displace the illicit trade.
Methods: We used crowdsourced data from PriceofWeed.com to estimate the cost of illicit cannabis in 2018-2024 and data from state government websites to estimate the cost of legal cannabis in Colorado, Oregon, California, Massachusetts, Michigan, Illinois, Maine, and Connecticut. We compared illicit prices by recreational dispensary status in all 50 states and D.C. and examined legal vs. illicit prices within the eight aforementioned recreational states.
Results: The median price per gram of illicit cannabis was significantly lower in recreational states, compared to non-recreational states ($7.10 vs. $8.90, p < 0.001). While illicit and legal prices were not significantly different over the entire study period, there were significant differences within years and within states. In Colorado, California, and Michigan, legal cannabis was significantly less expensive than illicit cannabis, while in Massachusetts, Illinois, Maine, and Connecticut, illicit cannabis was significantly less expensive than legal cannabis.
Conclusions: We saw lower illicit market prices in states with recreational dispensaries. Our results suggest that the price ranking of legal versus illicit cannabis within a given state differs depending on the state’s recreational market maturity, with states with older markets – all of which also had more flexible licensing policies – having a legal cannabis price advantage.
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Journal: Alcohol Clinical and Experimental Research, 2026, doi: 10.1111/acer.70330
Authors: Caroline B. Cary, Emily O. B. Hynes, Mishka Terplan, Kelly A. McNamara, Vitor S. Tardelli, Thiago M. Fidalgo, … & Kevin Young Xu
Abstract:
Despite well-documented harms of prenatal alcohol exposure, evidence-based treatment guidelines for alcohol use disorder (AUD) during pregnancy remain limited. We systematically reviewed international clinical practice guidelines to examine how they address the full cascade of AUD care during pregnancy, including diagnosis, engagement, treatment initiation, and retention. We searched over 40 clinical practice guideline databases (including PubMed and Guidelines International Network) and gray literature sources globally, identifying 1045 records. Using the Population, Interventions, Comparators, Attributes, Recommendation Characteristics (PICAR) framework, we evaluated guidelines from medical organizations in English-speaking nations addressing alcohol use and AUD management in pregnancy. Our final analysis included 18 guidelines from the United States, Canada, the United Kingdom, Australia/New Zealand, and the World Health Organization published from 2014 to the present. Two reviewers independently assessed each guideline using the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence (AGREE-REX) framework to evaluate quality and risk of bias. We used narrative synthesis to summarize findings across key concepts and care cascade stages. Nearly all guidelines (94%) described risks of alcohol exposure and recommended counseling on cessation (89%), yet few extended beyond these early cascade stages. Only 44% mentioned medications for AUD (MAUD), and merely 17% discussed specific psychosocial treatments. Among guidelines addressing MAUD, only one cautiously supported use, while three explicitly recommended against it. Most guidelines (61%) ended treatment recommendations at referral to specialty care, with half limiting guidance to acute alcohol withdrawal management. Taken together, our findings reveal a stark misalignment between screening emphasis and treatment guidance. While guidelines consistently recommend universal screening and brief intervention, they provide minimal actionable frameworks for managing AUD throughout pregnancy. This gap leaves clinicians without evidence-based pathways for comprehensive AUD treatment during the prenatal period, highlighting an urgent need to strengthen both the evidence base and clinical guidance for AUD management in pregnancy.
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Journal: Addiction, 2026, doi: 10.1111/add.70478
Authors: Alexander Y. Walley, Debbie M. Cheng, Nathan Vandergrift, Marc Larochelle, JaNae Holloway, Jennifer L. Brown, … & T. John Winhusen
Abstract:
Aim: We evaluated whether community-level naloxone distribution, medication for opioid use disorder treatment and retention and incident high-risk opioid prescribing rates were associated with opioid overdose death rates.
Design: Observational cohort conducted using 2019 to 2023 community-level data as an exploratory analysis of the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS). Exposures included: (1) community-level naloxone distribution, past 12-months, categorized as ≤1000 units per 100 000 population vs. 1001-3000 units per 100 000 population vs. >3000 units per 100 000 population; (2) individuals treated with buprenorphine per 100 000 adult population in the current quarter; (3) individuals retained on buprenorphine for ≥ 180 days per 100 000 adult population in the current quarter; and (4) incident high-risk opioid prescribing per 100 000 adult population in the current quarter.
Setting and participants: Population-based study of 67 communities with 8.2 million adults in Kentucky, Massachusetts, New York and Ohio, USA, with required annual opioid overdose death rates of > 25 per 100 000 adult population and at least 30% rural. Across the 67 communities participating in the HCS, the adult population was 31% 18-34 years, 31% 35-54 years, 38% 55 years and over, 52% female, 73% non-Hispanic White, 15% non-Hispanic Black and 7.4% Hispanic.
Measurements: Quarterly community-level opioid overdose death rates from 2020 through 2023.
Findings: The 2019 annual rates were 40.4 opioid overdose deaths, 1287 naloxone rescue units distributed, 977.7 people received buprenorphine treatment, 546.3 people retained for more than 180 days on buprenorphine and 1266.7 high-risk opioid prescribing incidents per 100 000 population. In models adjusted for state, community age, sex, race/ethnicity, rurality, HCS intervention group assignment, 2019 rates of opioid overdose death, naloxone distribution, buprenorphine and high-risk opioid prescribing, and the ratio of opioid overdose deaths involving fentanyl, an increase in 100 people treated with buprenorphine per 100 000 population was associated with a decrease of 0.92 [95% confidence interval (CI) = -1.30 to -0.55] in the quarterly opioid overdose death rate, while an increase of 100 people retained on buprenorphine for more than 180 days per 100 000 population was associated with a decrease of 1.3 (95% CI = -1.8 to -0. 76). There were no statistically significant associations between naloxone distribution or incident high-risk opioid prescribing with change in quarterly opioid overdose death rates.
Conclusions: In this exploratory analysis, increases in both buprenorphine treatment and retention were statistically significantly associated with decreases in opioid overdose death rates, after adjusting for baseline rates of buprenorphine treatment and retention.
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