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Background Drug overdose is a leading cause of death and opioid-related deaths increased by more than 300% from 2010 to 2020 in New York State. Experts holding a range of senior leadership positions from across New York State were asked to identify the greatest challenges in substance misuse prevention, harm reduction, and treatment continuum of care. Expert input was used to shape funding priorities. Method Individual semi-structured interviews of sixteen experts were conducted in April and May 2023. Experts included academics, medical directors, leaders of substance misuse service agencies, administrators of a state agency, a county mental health commissioner, the president of a pharmacy chain, and a senior vice president of an addiction-related national non-profit. Zoom interviews were conducted individually by an experienced qualitative interviewer and were recorded, transcribed, and coded for content. An initial report, with the results of the interviews organized by thematic content, was reviewed by the research team and emailed to the expert interviewees for feedback. Results The research team identified five major themes: 1. Siloed and fragmented care delivery systems; 2. Need for a skilled workforce; 3. Attitudes towards addiction (stigma); 4. Limitations in treatment access; and 5. Social and drug related environmental factors. Most experts identified challenges in each major theme; over three-quarters identified issues related to siloed and fragmented systems and the need for a skilled workforce. Each expert mentioned more than one theme, three experts mentioned all five themes and six experts mentioned four themes. Conclusions Research, educational, and programmatic agendas should focus on identified topics as a means of improving the lives of patients at risk for or suffering from substance use-related disorders. The results of this project informed funding of pilot interventions designed to address the identified care challenges.

Objectives The types of opioids abused in the United States have changed from prescription opioids to heroin to fentanyl. However, the types of opioids abused may differ by demographic factors, especially among middle-aged adults. We examined national trends in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex. Methods Using 1999-2018 data from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research database, we examined overdose mortality rates per 100 000 population in 2018 among adults aged 45-64 that involved natural and semisynthetic opioids, heroin, synthetic opioids (excluding methadone), and methadone. We tested for significant differences in mortality rates by race/ethnicity and sex. We plotted drug-specific trends by race/ethnicity and sex from 1999 to 2018. Results In 2018, non-Hispanic White adults had the highest rates per 100 000 population of natural and semisynthetic overdose mortality (men: 8.7; women: 7.9; P < .001), and non-Hispanic Black adults had the highest rates of heroin (men: 17.7; women: 5.4; P < .001) and synthetic opioid (men: 36.0; women: 11.2; P < .001) overdose mortality. Men had significantly higher overdose mortality rates than women did for deaths involving natural and semisynthetic opioids, heroin, and synthetic opioids, but not methadone. From 1999 to 2018, mortality rates increased sharply for heroin and synthetic opioids, increased modestly for natural and semisynthetic opioids, and decreased for methadone. The greatest increases were among non-Hispanic Black men for heroin overdose (3.3 in 1999 to 17.7 in 2018) and synthetic opioid overdose (0.1 in 1999 to 36.0 in 2018). Conclusions Policy making should consider unique subgroup risks and alternative trajectories of opioid use other than people being prescribed opioids, developing opioid use disorder, subsequently moving to heroin, and then to fentanyl.

The question of how individual differences related to self-regulation interact with alcohol use patterns to predict intimate partner aggression (IPA) is examined. We hypothesized that excessive drinking will be related to partner aggression among those who have low self-regulation. In addition, we explored the extent to which differences in self-regulation in one partner may moderate the relationship between alcohol use and partner aggression. A sample of married or cohabitating community couples ( = 280) ages 18-45 was recruited according to their classification into four drinking groups: heavy drinking in both partners ( = 79), husband only ( = 80), wife only ( = 41), by neither ( = 80), and interviewed annually for 3 years. IPA, drinking, and scores on measures of negative affect, self-control, and Executive Cognitive Functioning (ECF) were assessed for both members of the couple. The Actor Partner Interdependence Model (APIM) was used to analyze longitudinal models predicting the occurrence of IPA from baseline alcohol use, negative affect, self-control and ECF. Actor self-control interacted with partner self-control such that IPA was most probable when both were low in self-control. Contrary to prediction, actors high in alcohol use and also high on self-control were more likely to engage in IPA. Partner alcohol use was predictive of actor IPA when the partner was also high in negative affect. Low partner ECF was associated with more actor IPA. These findings suggest that self-regulatory factors within both members of a couple can interact with alcohol use patterns to increase the risk for relationship aggression.

To treat addiction, people need help to develop psychosocial skills in addition to taking medication, says Kenneth E. Leonard.

Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally. Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration. This United States National Institutes of Health-funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study-a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner's minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner's minority stress, hazardous drinking, and IPA perpetration. Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024. The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies. DERR1-10.2196/28080.

(1) Background: Gender differences between men’s and women’s parenting roles are well-documented as the “second shift”. We examined the main effects and interaction of work distress and parenting distress with energy (i.e., vigor) in a sample of 310 dual-income, different-sex couples with kids married for approximately nine years. (2) Methods: We used actor–partner interdependence modeling (APIM) to examine how spouses’ distress was associated with their energy. (3) Results: For both wives and husbands, there were negative associations between the actor’s parenting distress and their energy level and between the actor’s work distress and their energy level. However, only wives experienced a significant interaction of work and parenting distress such that high levels of both forms of distress were associated with low levels of energy, indicating that only wives experience this form of work–family conflict. (4) Conclusions: When women experience more strain at home than men, they may need more time to recover from their work and family duties. If they cannot do so, they will have less energy to carry out their responsibilities and may be at a higher risk of future adverse health outcomes.

Background Alcohol use disorder (AUD) is a highly prevalent public health problem that contributes to opioid- and benzodiazepine-related morbidity and mortality. Even though co-utilization of these substances is particularly harmful, data are sparse on opioid or benzodiazepine prescribing patterns among individuals with AUD. Objective To estimate temporal trends and disparities in opioid, benzodiazepine, and opioid/benzodiazepine co-prescribing among individuals with AUD in New York State (NYS). Design/Participants Serial cross-sectional study analyzing merged data from the NYS Office of Addiction Services and Supports (OASAS) and the NYS Department of Health Medicaid Data Warehouse. Subjects with a first admission to an OASAS treatment program from 2005–2018 and a primary AUD were included. A total of 148,328 subjects were identified. Measures Annual prescribing rates of opioids, benzodiazepines, or both between the pre- (2005–2012) and post- (2013–2018) Internet System for Tracking Over-Prescribing (I-STOP) periods. I-STOP is a prescription monitoring program implemented in NYS in August 2013. Analyses were stratified based on sociodemographic factors (age, sex, race/ethnicity, and location). Results Opioid prescribing rates decreased between the pre- and post-I-STOP periods from 25.1% (95% CI, 24.9–25.3%) to 21.3% (95% CI, 21.2–21.4; P <.001), while benzodiazepine (pre: 9.96% [95% CI, 9.83–10.1%], post: 9.92% [95% CI, 9.83–10.0%]; P =.631) and opioid/benzodiazepine prescribing rates remained unchanged (pre: 3.01% vs. post: 3.05%; P =.403). After I-STOP implementation, there was a significant decreasing trend in opioid (change, −1.85% per year, P <.0001), benzodiazepine (−0.208% per year, P =.0184), and opioid/benzodiazepine prescribing (−0.267% per year, P <.0001). Opioid, benzodiazepine, and co-prescription rates were higher in females, White non-Hispanics, and rural regions. Conclusions Among those with AUD, opioid prescribing decreased following NYS I-STOP program implementation. While both benzodiazepine and opioid/benzodiazepine co-prescribing rates remained high, a decreasing trend was evident after program implementation. Continuing high rates of opioid and benzodiazepine prescribing necessitate the development of innovative approaches to improve the quality of care.

Pathways from maternal tobacco, marijuana, stress, and anger in pregnancy to infant reactivity and regulation (RR) at 9 months of infant age were examined in a low‐income, diverse sample beginning in the first trimester of pregnancy, with fetal growth and postnatal stress/anger as potential mediators, and infant sex as a moderator. Participants were 247 dyads (173 substance‐exposed infants). There were no direct effects of prenatal risk on RR and no moderation by sex. However, there were significant indirect effects on RR via poor fetal growth and higher postnatal anger. The study adds to the sparse literature on joint effects of tobacco and marijuana, and highlights the role of fetal growth and maternal anger as important pathways from prenatal risk to infant RR.

Cannabis is the most frequently used illicit drug among pregnant women, but data describing the effects of prenatal cannabis exposure and concurrent nicotine and cannabis exposures on neonatal growth are inconsistent. Testing of meconium, the first neonatal feces, offers objective evidence of prenatal cannabis exposure, but the relative ability of meconium testing and maternal self-report to identify affected neonates remains unclear. Eighty-six pregnant women provided detailed self-reports of daily cannabis and tobacco consumption throughout pregnancy. Cannabinoids and tobacco biomarkers were identified in oral fluid samples collected each trimester and quantified in meconium at birth. Cannabis-using women were significantly more likely to also consume tobacco, and smoked similar numbers of cigarettes as non-cannabis-using tobacco smokers. As pregnancy progressed, fewer women smoked cannabis and those who continued to use cannabis reported smoking a smaller number of cannabis joints, but positive maternal oral fluid tests cast doubt on the veracity of some maternal self-reports. More neonates were identified as cannabis exposed by maternal self-report than meconium analysis, because many women quit cannabis use after the first or second trimester; meconium was more likely to be positive if cannabis use continued into the third trimester. Cannabis exposure was associated with decreased birth weight, reduced length, and smaller head circumference, even after data were controlled for tobacco coexposure. Prenatal cannabis exposure was associated with fetal growth reduction. Meconium testing primarily identifies prenatal cannabis exposure occurring in the third trimester of gestation.