Search Results (794)

Drug abuse is a chronic, relapsing disorder marked by compulsive drug-seeking behavior and profound neurobiological consequences. Each year, millions of individuals face serious social and legal repercussions due to addiction. This review synthesizes findings from both preclinical and clinical studies to examine how chronic exposure to substances such as alcohol, cocaine, methamphetamine, and opioids affects the central nervous system. Specifically, it explores the epigenetic modifications induced by these substances, including DNA methylation, histone modifications, and noncoding RNA regulation. The literature was selected using a thematic approach, emphasizing substance-specific mechanisms and their effects on gene expression, synaptic plasticity, and the brain’s reward circuitry. Emerging evidence links these epigenetic changes to long-term behavioral adaptations and even transgenerational inheritance. This review underscores the complex molecular pathways contributing to addiction, vulnerability, and relapse, offering insights into potential therapeutic targets. Full article

Objectives: Social isolation is an important public health issue that is becoming increasingly prevalent among adolescents today. Recognizing the risk of social isolation in children and adolescents during their developmental years can contribute to the prevention of depression and anxiety disorders, as well as risky behaviors such as suicide and substance abuse. Valid and reliable measurement tools are needed to assess social isolation in adolescents. There is a lack of surveys to identify gaps in social isolation among Turkish adolescents. This study aims to adapt the Social Isolation Questionnaire (QIS) scale, which was developed for adolescents, to Turkish culture and to evaluate its psychometric properties. Methods: This descriptive and methodological study was conducted between July and November 2024 with 1922 adolescents. Data were collected using an introductory information form, the QIS, and the UCLA Loneliness Scale. In the evaluation of the data, explanatory and confirmatory factor analysis, Cronbach’s alpha, split-half, item–total score correlation, and test–retest analysis were used. Results: The average age of the adolescents was 13.97 ± 1.67 years (min = 12, max = 17). A total of 50.6% of the adolescents were male and 49.4% were female. A total of 81.2% of the adolescents had a nuclear family structure. Exploratory factor analysis revealed a three-factor structure explaining 55.97% of the variance. The factor loadings were greater than 0.30, and all fit indices were greater than 0.90. The total Cronbach’s α value of the scale was 0.83, while the values for the subdimensions ranged from 0.73 to 0.75. Conclusions: The Turkish version of the QIS is a valid and reliable measurement tool for assessing social isolation in adolescents. This questionnaire can be used by health professionals and researchers to identify adolescents at risk of social isolation and plan appropriate mental health interventions. This questionnaire can be used in studies focusing on adolescent mental health and well-being, contributing to the development and implementation of strategies in line with the Sustainable Development Goals. Full article

This study aimed to map the literature on the clinical role of pharmacists in the care of incarcerated people at correctional facilities and to identify gaps in this field. A scoping review was conducted on 30 July 2024, using the PubMed, Scopus, and LILACS databases. Gray literature was searched via Google Scholar, and references of included studies were manually reviewed. Primary studies of any design reporting pharmacists’ clinical services and/or activities for incarcerated individuals were eligible. Study selection and data extraction were performed independently by two reviewers, with a third resolving disagreements. The search yielded 894 records, from which 27 studies were included. Most studies were conducted in the United States (n = 16; 59%) and France (n = 7; 26%). Eleven (41%) focused exclusively on male populations, and one (4%) on female inmates. Most studies addressed pharmacists’ clinical roles in mental health conditions and substance use disorders (n = 9; 33%), infectious diseases (n = 5; 19%), and diabetes (n = 4; 15%). Clinical services and/or activities related to direct patient care were the most frequently reported (n = 18; 67%). Process measures were reported in 18 studies (67%), and clinical outcomes were the most common type of outcome (n = 13; 48%). This review highlights the pharmacist’s clinical role in treating mental health conditions and substance abuse, infectious diseases, and diabetes in incarcerated care. It underscores the need for further research in low- and middle-income countries, on women’s health, and on other prevalent conditions. Full article

In socio-economically disadvantaged communities, the challenges faced by children with special needs are often overshadowed by more visible issues such as poverty, family instability, and substance abuse. Children, especially those with special needs, are particularly vulnerable in these settings as they are disproportionately impacted by intersecting adversities, including neglect, exploitation, and limited access to education and healthcare. These adversities create a vicious cycle, where disability exacerbates financial hardship, and in turn, economic deprivation negatively impacts early childhood development, further entrenching disability. Conventional models, which require physical presence and focus primarily on diagnosis and treatment within clinical settings, often fail to address the broader social, environmental, and contextual complexities of disability. We propose an Information Technology-based Exit Pathway as an innovative, scalable solution to disrupt this cycle. Anchored in the five pillars of the Community-Based Rehabilitation (CBR) matrix of Health, Education, Livelihood, Social, and Empowerment, the model envisions a multi-level digital platform that facilitates coordinated support across individual, familial, educational, community, regional, and national levels. By improving access to services, fostering inclusive networks, and enabling early intervention, the proposed approach aims to promote equity, social inclusion, and sustainable development for children with special needs in marginalized communities. Full article

Background: Developmental toxicity is defined as adverse effects induced either during pregnancy or as a result of parental exposure. While considerable attention has been devoted to maternal exposure to such chemicals, the role of paternal exposure has often been regarded as less significant. Objective: This study aims to highlight the impact of male-mediated developmental toxicity. Methods: An online search was conducted using PubMed, Scopus, and Google Scholar to identify studies focusing on developmental toxicity in offspring associated with paternal exposure during the preconception period. Results: The scientific literature—ranging from studies on pharmaceutical use to substances of abuse (notably tobacco, alcohol, opioids, and cannabinoids), as well as occupational and environmental exposure to specific compounds (e.g., phthalates, certain organic solvents, pesticides)—indicates that paternal exposure to developmental toxicants can adversely affect offspring health through various biochemical mechanisms. Conclusions: There is substantial experimental evidence of male-mediated developmental toxicity for various chemicals, demonstrating a particular vulnerability of the male germ line to transmissible effects. Several mechanisms have been proposed to explain the biochemical pathways underlying this toxicity. Evidence in humans is more challenging to interpret; however, numerous findings—both concerning substances of abuse and occupational exposures—raise concerns regarding the potential developmental risks to offspring. Full article

Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. A cross-sectional survey was conducted among TB patients attending selected clinics, examining behavioural risks (e.g., smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural challenges (access to healthcare, migration status). The results revealed a significant co-occurrence of TB and HIV (56.1%), alongside high rates of smoking (33.1%) and alcohol use (45.2%). Unemployment (50.2%), inadequate housing, and limited healthcare access, particularly for undocumented migrants (26.2%), were also prominent. Factor analysis demonstrated a syndemic interaction between behavioural and social determinants, underscoring the compounded vulnerability of affected populations. The findings highlight the necessity of integrating medical interventions with social and structural reforms. Recommendations include TB-HIV co-management, substance abuse programmes, improved housing, and inclusive healthcare access. A multisectoral approach addressing both health and socioeconomic inequalities is critical for comprehensive TB control in urban South African contexts. Full article

Substance-induced psychosis is a recognized clinical entity, commonly linked to cannabinoids, stimulants, hallucinogens, alcohol, and polysubstance use. These agents may provoke transient or persistent psychotic symptoms during intoxication or withdrawal. Opioids, however, constitute a noteworthy exception: psychosis is rarely observed during opioid intoxication, and emerging data suggest that opioid agonists might even exert antipsychotic-like effects. This article examines the paradoxical interaction between opioids and psychosis, with attention to clinical reports of psychotic symptoms arising following abrupt discontinuation of methadone or buprenorphine. In numerous cases, symptoms resolved swiftly after reintroduction of the opioid agonist, implying a neuromodulatory role. Opioids, unlike other substances of abuse, seem to lack intrinsic psychotogenic effects and may influence dopaminergic activity via kappa-opioid receptor antagonism and endorphinergic mechanisms. This challenges standard models of substance-induced psychosis and calls for a refined understanding of opioid pharmacodynamics in psychiatric contexts. In psychotic presentations among polysubstance users who also use opioids, restoring opioid agonist therapy should be prioritized, with antipsychotics reserved as second-line options—preferably agents with favorable receptor profiles. Where opioids are not involved, antipsychotics remain first-line, but should be applied judiciously, with efforts to taper when clinically appropriate. Full article

Tau protein is essential for the structural stability of neurons, particularly through its role in microtubule assembly and axonal transport. However, when abnormally hyperphosphorylated or cleaved, Tau can aggregate into insoluble forms that disrupt neuronal function, contributing to the pathogenesis of neurodegenerative diseases such as Alzheimer’s disease (AD). Emerging evidence suggests that similar Tau-related alterations may occur in individuals with chronic exposure to psychoactive substances. This review compiles experimental, clinical, and postmortem findings that collectively indicate a substance-specific influence on Tau dynamics. Alcohol and opioids, for instance, promote Tau hyperphosphorylation and fragmentation through the activation of kinases such as GSK-3β and CDK5, as well as proteases like caspase-3, leading to neuroinflammation and microglial activation. Stimulants and dissociatives disrupt insulin signaling, increase oxidative stress, and impair endosomal trafficking, all of which can exacerbate Tau pathology. In contrast, cannabinoids and psychedelics may exert protective effects by modulating kinase activity, reducing inflammation, or enhancing neuroplasticity. Psychedelic compounds such as psilocybin and harmine have been demonstrated to decrease Tau phosphorylation and facilitate cognitive restoration in animal models. Although the molecular mechanisms differ across substances, Tau consistently emerges as a convergent target altered in substance-related cognitive disorders. Understanding these pathways may provide not only mechanistic insights into drug-induced neurotoxicity but also identify Tau as a valuable biomarker and potential therapeutic target for the prevention or treatment of cognitive decline associated with substance use. Full article

Despite the increasing adoption of a syndemic approach in HIV research, few health communication campaigns have used a syndemic approach in messaging to improve health outcomes for persons living with HIV (PWH). This paper introduces a framework for practitioners and researchers developing health communication messages in support of a syndemic approach to HIV care for PWH in the United States. Grounded in insights from a review of counseling and psychosocial interventions that demonstrated significant positive effects on HIV clinical outcomes, the C4H Framework emphasizes four components: compassion, comprehensive messaging, capacity-building, and coordination. Compassion ensures that messages resonate with individuals experiencing the intertwined challenges of HIV, substance abuse, and mental health issues. Comprehensive messaging integrates a holistic view of the barriers faced by PWH. Capacity-building empowers individuals to effectively engage with and act upon health information. Coordination promotes alignment between stakeholders and resources to ensure consistent and supportive messaging. The C4H Framework bridges the gap between research and practice, offering a foundation for crafting effective communication messages that resonate with individuals facing the complex challenges inherent in HIV syndemics. Future research should explicitly test the effectiveness and acceptability of messages developed using the C4H Framework with people living with HIV. Full article

Substance use is a critical public health issue in the U.S., with Black communities, particularly those with criminal justice contact, disproportionately affected. Chronic exposure to stressors can lead to substance use as a coping strategy. This study used data from 1476 Black adults with criminal justice involvement from the National Survey of American Life to examine how psychosocial stress and sleep disturbances relate to lifetime substance use and to determine if there are any sex differences. Sex-separate generalized linear models for a Poisson distribution with a log-link function estimated prevalence ratios and adjusted prevalence ratios (APRs) for lifetime alcohol abuse, lifetime cigarette, and marijuana use. Independent variables include stressors (family, person, neighborhood, financial, and work-related) and sleep problems, with covariates such as age, SES, and marital status. Lifetime alcohol abuse was associated with family stressors (APR = 2.72) and sleep problems (APR = 3.36) for males, and financial stressors (APR = 2.75) and sleep problems (APR = 2.24) for females. Cigarette use was linked to family stressors (APR = 1.73) for males and work stressors (APR = 1.78) for females. Marijuana use was associated with family stressors (APR = 2.31) and sleep problems (APR = 2.07) for males, and neighborhood stressors (APR = 1.72) for females. Lifetime alcohol abuse, as well as lifetime cigarette and marijuana use, was uniquely associated with various psychosocial stressors among Black adult males and females with criminal justice contact. These findings highlight the role of structural inequities in shaping substance use and support using a Social Determinants of Health framework to address addiction in this population. Full article

Clinical and animal studies suggest that multiple brain systems are involved in mediating reward-motivated and related emotional behavior including the consumption of commonly used drugs and palatable food, and there is evidence that the repeated ingestion of or exposure to these rewarding substances may in turn stimulate these brain systems to produce an overconsumption of these substances along with co-occurring emotional disturbances. To understand this positive feedback loop, this review focuses on a specific population of hypothalamic peptide neurons expressing melanin-concentrating hormone (MCH), which are positively related to dopamine reward and project to forebrain areas that mediate this behavior. It also examines neurons expressing the peptide hypocretin/orexin (HCRT) that are anatomically and functionally linked to MCH neurons and the molecular systems within these peptide neurons that stimulate their development and ultimately affect behavior. This report first describes evidence in animals that exposure in adults and during adolescence to rewarding substances, such as the drugs alcohol, nicotine and cocaine and palatable fat-rich food, stimulates the expression of MCH as well as HCRT and their intracellular molecular systems. It also increases reward-seeking and emotional behavior, leading to excess consumption and abuse of these substances and neurological conditions, completing this positive feedback loop. Next, this review focuses on the model involving embryonic exposure to these rewarding substances. In addition to revealing a similar positive feedback circuit, this model greatly advances our understanding of the diverse changes that occur in these neuropeptide/molecular systems in the embryo and how they relate, perhaps causally, to the disturbances in behavior early in life that predict a later increased risk of developing substance use disorders. Studies using this model demonstrate in animals that embryonic exposure to these rewarding substances, in addition to stimulating the expression of peptide neurons, increases the intracellular molecular systems in neuroprogenitor cells that promote their development. It also alters the morphology, migration, location and neurochemical profile of the peptide neurons and causes them to develop aberrant neuronal projections to forebrain structures. Moreover, it produces disturbances in behavior at a young age, which are sex-dependent and occur in females more than in males, that can be directly linked to the neuropeptide/molecular changes in the embryo and predict the development of behavioral disorders later in life. These results supporting the close relationship between the brain and behavior are consistent with clinical studies, showing females to be more vulnerable than males to developing substance use disorders with co-occurring emotional conditions and female offspring to respond more adversely than male offspring to prenatal exposure to rewarding substances. It is concluded that the continued consumption of or exposure to rewarding substances at any stage of life can, through such peptide brain systems, significantly increase an individual’s vulnerability to developing neurological disorders such as substance use disorders, anxiety, depression, or cognitive impairments. Full article

Background: Anabolic–androgenic steroids (AASs) are commonly used for performance enhancement but have been linked to significant neurobiological consequences. This review explores the impact of AASs on neurochemical pathways, cognitive function, and psychiatric disorders, highlighting their potential neurotoxicity. Methods: A narrative review of current literature was conducted to examine AASs-induced alterations in neurotransmitter systems, structural and functional brain changes, and associated psychiatric conditions. The interplay between AASs use and other substances was also considered. Results: Chronic AASs exposure affects serotonin and dopamine systems, contributing to mood disorders, aggression, and cognitive deficits. Structural and functional changes in the prefrontal cortex and limbic regions suggest long-term neurotoxicity. AASs use is associated with increased risks of depression, anxiety, and psychosis, potentially driven by hormonal dysregulation and neuroinflammation. Co-occurring substance use exacerbates neurocognitive impairments and behavioral disturbances. Discussion: While evidence supports the link between AASs use and neurotoxicity, gaps remain in understanding the precise mechanisms and long-term effects. Identifying biomarkers of brain damage and developing targeted interventions are crucial for mitigating risks. Increased awareness among medical professionals and policymakers is essential to address AASs-related neuropsychiatric consequences. Conclusions: AASs abuse poses significant risks to brain health, necessitating further research and prevention efforts. Evidence-based strategies are needed to educate the public, enhance early detection, and develop effective interventions to reduce the neuropsychiatric burden of AASs use. Full article

This paper presents the development and validation of the Transgender Health, Resilience, Inner Well-Being, Vitality, and Empowerment (THRIVE) Scale. It offers insights into the well-being of transgender and gender-diverse (TGD) individuals, by considering their unique experiences and challenges. TGD individuals often experience significant health disparities, including mental health issues, substance abuse, physical health problems, and difficulty with providers knowing about their needs. A comprehensive quality-of-life assessment could aid in identifying contributions to poor quality of life (QOL) and knowing which resources are needed to address this effectively. Assessments attempting to address these challenges often have not been studied adequately and/or have limitations of being for one-time use, surgery-focused, lengthy, emotionally taxing, and not inclusive of non-binary individuals’ specific needs. Validated among a sample of TGD individuals (N = 61), the THRIVE scale displayed good internal consistency reliability (α = 0.87), as well as convergent and divergent validity. It had significant negative correlations with measures of psychological symptoms and identity distress and positive correlations with measures of life satisfaction and well-being. The THRIVE scale represents a critical advancement in assessing the QOL of TGD individuals and could be an effective tool for individualized care, research, and conversation with these populations. Full article

Background/Objectives: The correlation between drugs and interstitial lung disease (ILD) is reported, but the presence of the substances of abuse in the lung as a cause of disease has never been proved. In this observational study, our aim was to evaluate a possible correlation between ILD radiological findings and cannabinoids presence in broncho-alveolar lavage (BAL) or in resected lung tissue in patients with a history of cannabis smoke. Methods: Data of patients with ILD chest CT scan findings and history of drug use, submitted to BAL (Group 1), or to lung apex removal for pneumothorax (Group 2), were retrospectively collected. In both groups, drug presence was investigated. A subgroup of Group 1 was checked for the concomitant presence in blood. Fisher’s test was used to study the association between the detection of the drug and ILD. Results: In Group 1, cannabinoids were present in 12/26 (46.2%) BAL samples. ILD emerged on chest CT in 75% of the cannabinoid-positive and in 20% of the cannabinoid-negative BAL samples (p = 0.0299). In the subgroup, the patients who tested positive for cannabinoids/cocaine on BAL were 55.6%; 0% were positive only on blood (p = 0.0294). In Group 2, cannabinoids were present in 10/15 (66.7%) specimens. ILD was evident, respectively, in 40% and in 0% of the patients with cannabinoid-positive and cannabinoid-negative surgical specimens (p = 0.2308). Conclusions: The prevalence of ILD in patients with cannabinoid-positive BAL and in those with cannabinoid-positive surgical specimens suggests that ILD could be caused by cannabis smoke. The non-concomitant presence of substances in BAL and in blood advocates the diagnostic usefulness of searching for the drug in the target organ. Full article

Background and Objectives: The worldwide shift toward psychiatric deinstitutionalization has aimed to enhance patient autonomy, social integration, and overall quality of life. However, limited studies have examined how concurrent substance use—particularly alcohol, marijuana, and inhalable drugs—affects clinical outcomes in these populations. This study aimed to evaluate psychiatric patients with varying degrees of institutionalization and investigate whether substance use complicates or exacerbates treatment outcomes. We hypothesized that individuals using substances would demonstrate worse psychosocial functioning, higher healthcare costs, and increased readmission rates. Methods: We performed a cross-sectional study of 95 participants recruited from long-term care facilities. Participants completed the SF-36 survey validated in Romanian. Financial data were collected to gauge direct and indirect healthcare expenditures. Results: Results indicated that 34.7% of participants reported alcohol use, 12.6% used marijuana, and 9.5% used inhalable substances. Substance-using patients experienced higher mean hospitalization costs of approximately USD 3251.8, compared to non-users (USD 2743.6, p = 0.032). Quality-of-life scores were significantly lower among substance users (mean SF-36 score 58.4 vs. 66.7, p = 0.027). Rates of relapse and readmission were also notably higher in the substance-using cohort (42.1%) relative to non-users (29.8%, p = 0.041). Conclusions: To our knowledge, this is the first Romanian study—and one of only a handful in Europe—to quantify how specific substance-use profiles simultaneously alter quality of life and direct healthcare costs in a deinstitutionalized psychiatric population. Our findings highlight the need for integrated interventions targeting both mental health and substance abuse. Full article