Substance use among college students has negative academic and health outcomes. Identifying substances that are more commonly used by students than non-students can reveal specific risks in the college environment. To examine associations between college enrollment and prevalence and trends of use of a comprehensive list of substances. The sample included 2015-2019 participants in the National Survey on Drug Use and Health who were aged 18 to 22 and who were full-time enrolled or not enrolled in college. Prevalence of substance use was calculated for four subgroups: college males ( = 6,707), college females ( = 8,284), non-college males ( = 10,019), and non-college females ( = 9,266). Multivariate logistic regression was used to model the relationships between enrollment and substance use. Temporal trends in substance use prevalence were calculated for each subgroup. College enrollment was associated with prescription stimulant misuse (aOR 1.50, 95% CI: 1.35-1.67), alcohol use (aOR 1.36, 95% CI: 1.27-1.47), and binge drinking (aOR 1.22, 95% CI: 1.15-1.30). From 2015 to 2019, the only substance whose use significantly increased among any subgroup was cannabis. The increase occurred among females only (+4.7% in college females and +5.6% in non-college females; both  < .01). College enrollment is most strongly associated with prescription stimulant misuse, suggesting that colleges should consider explicitly including stimulant misuse prevention in their health promotion strategies. The increasing use of cannabis among females warrants clinicians' attention to routine screening for use and provision of information about the mental health impacts of cannabis.

The large-scale identification of people at risk of transitioning from relatively lower-risk to higher-risk alcohol use (e.g. problem drinking) remains a public health challenge despite advances in the identification of risk and protective factors. This observational study used machine learning to identify Reddit (social media platform) posting activity associated with transitioning from lower- to higher-risk forms of alcohol use. We employed bottom-up and top-down approaches to identify lower- and higher-risk alcohol-related subreddits. Using a non-parametric negative control procedure, we estimated each of 10,006 Reddit communities' risk of progression from lower- to higher-risk alcohol-related communities and applied a random forest model to predict progression among individual Reddit members. Eligible Reddit members had posted on Reddit for two or more years before their first post in a lower-risk alcohol-related community and for three or more years after that ( = 4,160). Our methodology identified 42 alcohol-related communities, four of which were suggestive of problem drinking. Five communities were significantly associated with progression. Random forests model's risk scores for individual members correlated with their progression to higher-risk communities at 0.30; the model predicted progression of individual Reddit members with a 0.92 area under the curve. Posting in communities dedicated to other substance use, depression, and occupation in the food service industry was associated with posting activity suggestive of problem drinking 3 years later. Posting activity on Reddit may be used for early detection of people at higher risk of transitioning from lower- to higher-risk forms of alcohol use.

Long-term use of supraphysiologic doses of anabolic-androgenic steroids (AAS) has been associated with impaired visuospatial memory in young men but little is known about its cognitive effects in middle-aged men. We compared cognition in middle-aged men with histories of long-term AAS use and age-matched non-users. We administered cognitive tests from the CANTAB battery to 76 weightlifters aged 37-60 years (mean [SD] 48.5 [6.5] years), of whom 51 reported at least 2 years of cumulative AAS use and 25 reported no AAS exposure. We found no significant AAS user versus non-user group differences on visuospatial, verbal memory, emotional recognition, or executive function tasks (corrected 's ≥ .00089; effect sizes ≤ .5). Our null visuospatial task findings contrast with our prior younger cohort study (mean age 37.1 [7.1] years), in which we found impaired visuospatial task performance in people who use AAS, and with other reports of cognitive impairments in younger men use AAS. Men who use AAS may develop early visuospatial memory deficits that stabilize by middle age while middle-aged non-users' performance may "catch up" due to normal age-related visuospatial declines. Similar effects could contribute to our null findings on other tasks. Between-study cohort substance use differences or environmental factor differences that modify cognition, such as study geographical location and time of year, also could contribute to our discordant findings. Since young adult male AAS users experience increased mortality from unnatural causes, improving our understanding of AAS cognitive effects in this age group is important.

The concurrence of homelessness and alcohol use disorder (AUD) has negative consequences in affected individuals. Managed alcohol programs (MAPs), a harm reduction strategy based on providing regular doses of alcohol to individuals with AUD, have emerged as a potential solution to reduce alcohol-related harms. This study examined the impact of a MAP implemented in Barcelona on patterns of alcohol and other psychoactive substance use, health, and quality of life among people who use drugs and were experiencing homelessness. The research also incorporated a gender perspective and focused on individuals who had accessed a residential center. A descriptive qualitative design was used, employing semi-structured interviews with eight participants who were enrolled in the MAP (three women, five men) and four program professionals. Thematic analysis was used to analyze the resulting data. The domains guiding the study appeared as outcome themes: patterns of use of alcohol and other substances, health, quality of life and impact on female-identified participants. Participants reported improved health due to reduced consumption of alcohol and other substances, better anxiety management, and reconnection to health services. The participants reported enhanced quality of life, including feeling safer, and better use of time, which had been spent on meeting their basic needs. Women reported that a key benefit of the program was living in a sexism-free environment. These results appear to demonstrate that harm reduction strategies prioritizing basic needs and adopting a gender-sensitive perspective can positively impact the health and quality of life of people experiencing homelessness with AUD.

While medications for opioid use disorder (MOUD) are effective in reducing overdoses, widespread adoption and implementation of MOUD remains inadequate. Innovative approaches to promote MOUD use and to support people in their medication-assisted recovery (MAR) are needed. Recovery residences that serve people taking MOUD are steadily growing in number, yet little is known about how MOUD and the MAR pathway is promoted within the recovery residence setting. The purpose of this qualitative analysis was to describe how recovery residences facilitate MOUD initiation and support residents' MAR pathway. We conducted interviews with 93 residents (59.1% male; 38.7% female) living in recovery residences located in five Texas cities that served people taking medication for opioid use disorder. We found that recovery residence staff addressed linkage to care gaps in their communities by connecting people who might benefit from MOUD to appropriate providers. Recovery residence staff also strengthened participants' community of MAR-supportive peers by hosting or connecting residents to Medication-Assisted Recovery Anonymous meetings. Additionally, recovery residences helped some residents overcome common logistical barriers (e.g. transportation issues, housing instability, distance to providers) that hinder MOUD access. Recovery residences that serve people taking MOUD are a well-positioned recovery support service to promote MOUD initiation and the MAR pathway.

Amid the national opioid epidemic, it is important to assess trends in opioid prescriptions. Long-acting opioids (LAOs) are of particular interest as they are among the most intensely misused prescription opioids. Moreover, understanding geographic trends in opioid prescriptions may help identify state-level variations, illustrating state-specific disparities. The study aims to determine geographic trends in overall and LAO prescriptions under Medicaid and Medicare Part D from 2013 to 2021. We used data from the Centers for Medicare & Medicaid Services on opioid prescriptions from 2013 to 2021. The opioid prescribing proportion was calculated as the number of opioid claims divided by the total number of overall drug claims. The LAO prescribing proportion was calculated as number of LAO claims divided by total opioid claims. Despite a general decrease nationwide, Medicaid opioid prescribing proportions increased in Iowa, Montana, and Virginia. There was an increasing trend in the national-level Medicaid LAO prescribing proportion from 2017 to 2021, with a 14.1% point increase (p for the annual percent change [APC]<0.05). For Medicare Part D, the overall prescribing proportions fell by 1.7% points from 2013 to 2021, while the LAO prescribing proportion fell by 3% points from 2016 to 2021 (p for APC < .05). The increasing trends in national-level Medicaid LAO prescribing and Medicaid opioid prescribing in Iowa, Montana, and Virginia are concerning, and have implications for clinical opioid prescribing. The decreasing trends in Medicare Part D may reflect ongoing efforts in opioid prescription management.

Ketamine has emerged as a prominent substance of misuse. Leptin, an adipocyte-derived polypeptide hormone, has been implicated in the development of addiction. Sex-specific changes in leptin levels have been demonstrated following acute ketamine administration; the persistence of long-term ketamine use on leptin levels is uncertain. To assess the sex-difference of leptin levels, and their persistence, in individuals with ketamine use disorder (KUD) compared to healthy controls. Plasma leptin levels were measured in 62 healthy controls (37 males, 25 females) and 68 participants with KUD (50 males, 18 females) on the first day (baseline) and after 1 and 2 weeks of abstinence. As leptin levels are affected by body mass index (BMI), BMI-adjusted leptin (leptin/BMI ratio) was also examined. Mixed model for repeated measures was used to examine changes after ketamine abstinence. Compared to same-sex controls, female, but not male, participants with KUD demonstrated lower leptin levels and leptin/BMI ratio at baseline, week 1, and week 2 (leptin levels:  = .001, 0.006 and 0.032, respectively; leptin/BMI ratio:  = .004, 0.022, and 0.09, respectively). Repeated measures showed that leptin levels and the leptin/BMI ratio increased after 2 weeks of abstinence in male participants with KUD ( = .002 and 0.011, respectively), but females did not show such an increase ( > .05). Sex-specific differences were observed in leptin levels and the leptin/BMI ratio in individuals with KUD compared to controls. Lower leptin levels in females with KUD persisted after 2 weeks of abstinence.

During the COVID-19 pandemic, caregiving responsibilities may have been associated with increased substance use. To characterize substance use to cope with stress and willingness to seek help among (i) parents, (ii) unpaid caregivers of adults, and (iii) parent-caregivers. Data were analyzed for 10,444 non-probabilistic internet-based survey respondents of the COVID-19 Outbreak Public Evaluation (COPE) initiative (5227 females, 5217 males). Questions included new or increased substance use, substance use in the past 30 days to cope, insomnia, mental health, and willingness to seek help. Nearly 20% of parents and unpaid caregivers of adults each reported new or increased use of substances to cope with stress or emotions; 65.4% of parent-caregivers endorsed this response. Compared to non-caregivers, all caregiver groups had higher odds of new or increased use of substances, with parent-caregivers showing the largest effect size (aOR: 7.19 (5.87-8.83),  < .001). Parent-caregivers had four times the adjusted odds of using drugs other than cannabis (aOR: 4.01 (3.15-5.09),  < .001) compared to non-caregivers. Caregivers may initiate or increase substance use as a coping strategy when under stress. The higher odds of substance use underscores the importance of efforts to screen for sleep disturbances and adverse mental health symptoms, particularly among parent-caregivers. Clinicians may consider asking patients about family situations more broadly to help identify people who may be experiencing stress related to caregiving and, if indicated, offer treatment to potentially alleviate some of the risks.

Prior meta-analyses have evaluated digital interventions for alcohol exclusively and alcohol/tobacco combined. These meta-analyses showed positive outcomes pertaining to alcohol and alcohol/tobacco combined. Yet questions remain pertaining to the effect of digital cognitive-behavioral therapy (CBT) on reducing alcohol and drug use. The purpose of the meta-analysis was to determine the mean effect size, relative to control groups, of digital CBT, for posttest reductions in drug and/or alcohol use. The Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria was used to guide this review and meta-analysis. Electronic databases (APA PsycArticles, Academic Search Complete, APA PsycInfo, CINAHL Complete, ERIC, MEDLINE, Psychology and Behavioral Sciences Collection, Social Sciences Full Text, Social Work Abstracts, SocINDEX), clinicaltrials.gov, reference lists were searched. The protocol was registered in PROSPERO (ID#: CRD42023471492). The CBT interventions included cognitive restructuring. All but one of the effect sizes favored digital CBT (from -0.02 to -1.45). After the removal an outlier, a small, significant, random effects model Hedges' summary effect of -0.23 (95% confidence interval: -0.32, -0.14,  < .0001) showed a reduction in substance use at the posttest, favoring digital CBT relative to the control group. A variety of control conditions were used; however, the effects sizes had minimal heterogeneity ( = 17,  = 5.34,  = 16.9,  = .39). The funnel plot and Egger regression test intercept (0.01,  = .99) lacked publication bias. The meta-analytic findings suggest digital CBT is an efficacious treatment for reducing alcohol and drug use overall.

Opioid-related overdoses significantly contribute to mortality in pregnancy and the postpartum period. Few studies report risk factors predisposing pregnant and postpartum patients with opioid use disorder (OUD) to overdose. This scoping review aims to describe the risk factors predisposing pregnant and postpartum patients with OUD to overdose. Included studies identified pregnant and/or postpartum patients with OUD and differentiated between those who experienced overdose and those who did not. Of the 1060 articles, 8 met the criteria, examining 90,860 pregnant and postpartum patients with OUD. Consistent use of medications for OUD (MOUD) during pregnancy and the postpartum period was the most frequently identified factor reducing overdose risk. Critical times of heightened overdose risk include the first trimester and the 7-12-month postpartum period. Pregnancy complications, such as stillbirth, severe maternal morbidity, preterm birth, and cesarean delivery, also increase risk. Opioid overdose is associated with being houseless, incarcerated, young, unmarried, publicly insured, not graduating high school, co-occurring substance use disorders, and inadequate prenatal care. Legislative changes, such as not classifying OUD in pregnancy as "child abuse" and increasing Medicaid reimbursement for Screening, Brief Intervention, and Referral to Treatment programs, are crucial to reducing risk. The impact of race and the influence of co-occurring psychiatric disorders was inconsistently reported. This scoping review identifies significant risk factors for opioid overdose in pregnant and postpartum patients. Improving access through enhanced Medicaid reimbursement, non-punitive reporting policies, and non-stigmatized care are keys to reducing overdose.

Rural and frontier communities face high rates of opioid use disorders (OUDs). In 2021, the Rural Addiction Implementation Network (RAIN) sought to establish a rural hospital/clinic-system practice-based research network (RH-PBRN) to facilitate implementation of evidence-based addiction-related prevention, treatment, and recovery (PTR) services to reduce the morbidity of OUD and substance use disorder (SUD) in rural communities. To describe the goals and implementation of PTR activities of RAIN, a novel RH-PBRN. RAIN identified teams of external/internal facilitators at four rural hospitals/clinic-networks to achieve at least 15 PTR activities involving OUD and other SUDs. RAIN utilized an implementation-facilitation approach: facilitators assessed the implementation environment and promoted interventions to overcome barriers to PTR implementation. Other interventions included site visits, community of learning calls, and e-communication. RAIN assessed and recorded facilitators and barriers to implementation, milestone attainment, and outcomes of PTR activities. At 18 months, we queried facilitators about the fidelity and implementation of RAIN activities. RAIN established an HP-PBRN in four sites (Idaho, Montana, Utah, and Wyoming). Within the HP-PBRN, 20 PTR activities were established ( = 7,  = 10,  = 3; range 3-7 per site). Barriers to implementation of PTR activities included competing clinical demands, especially due to COVID-19, lack of dedicated effort for staff at sites, and stigma of addiction and its treatment. Facilitators of implementation included the use of trained expert facilitators and communication between the sites. RAIN implemented 20 addiction-related PTR activities in four rural hospitals/clinic-networks. RAIN's intervention model could be replicated to address addiction-related harms in other rural communities.

Traveling to meet sexual partners and substance use are associated with increased risk of infectious disease. It is important to understand what factors may increase substances use or increased infection transmission risk (IITR) sexual behaviors among rural LGBTQ+ individuals. This study investigates substance use and sexual behaviors associated with increased infection transmission risk among rural LGBTQ+ individuals, and how these are associated with relationship type (friends or romantic partners) and travel distance. Participants (18 years+, identify as LGBTQ+, and provided a $25 gift card) were recruited from Illinois (25 counties), in 2021. Data included demographics, sexual and drug use behaviors, and assessed how these behaviors varied by relationship type and distance traveled (e.g. when meeting friends out-of-state). The 398 participants were 79.1% White and 12.3% Black. By orientation, 29% heterosexual, 36% gay/lesbian, and 35% bisexual/other. By identity, 43% cisgender male, 51% cisgender female, and 6% genderqueer/other. Alcohol use while visiting out-of-state friends was more frequent among transgender (vs cisgender men; OR = 9.686, 95% confidence interval = 2.123-44.19), and individuals traveling > 1/month (all  < .050). Infection-related sexual behaviors while visiting out-of-state romantic partners was more frequent among prescription medication misuse (all  < .050) and traveling > 1/week (vs < 1/month; OR = 3.399, 95% CI = 1.037-11.144). This study of rural LGBTQ+ identified that alcohol use was associated with travel to visit out-of-state romantic partners, and prescription medication misuse increased infection-related sexual behavior during out-of-state travel. Health professionals can develop substance use and increased infection transmission risk sexual behavior interventions on gender minority groups in rural areas and target those who are traveling.

Alcoholic liver disease (ALD) significantly contributes to global morbidity and mortality. The role of inflammatory cytokines in alcohol-induced liver injury is pivotal yet not fully elucidated. To establish a causal link between inflammatory cytokines and ALD using a Mendelian Randomization (MR) framework. This MR study utilized genome-wide significant variants as instrumental variables (IVs) for assessing the relationship between inflammatory cytokines and ALD risk, focusing on individuals of European descent. The approach was supported by comprehensive sensitivity analyses and augmented by bioinformatics tools including differential gene expression, protein-protein interactions (PPI), Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, and analysis of immune cell infiltration. Our findings reveal that increased levels of stem cell growth factor beta (SCGF-β, beta = 0.141,  = .032) and interleukin-7 (IL-7, beta = 0.311,  = .002) are associated with heightened ALD risk, whereas higher levels of macrophage inflammatory protein-1α (MIP-1α, beta = -0.396,  = .004) and basic fibroblast growth factor (bFGF, beta = -0.628,  = .008) are linked to reduced risk. The sensitivity analyses support these robust causal relationships. Bioinformatics analyses around inflammatory cytokine-associated SNP loci suggest multiple pathways through which cytokines influence ALD. The genetic evidence from this study convincingly demonstrates that certain inflammatory cytokines play directional roles in ALD pathogenesis. These findings provide insights into the complex biological pathways involved and underscore the potential for developing targeted therapies that modulate these inflammatory responses, ultimately improving clinical outcomes for ALD patients.

Although nitrous oxide (N₂O) is increasingly misused recreationally, its use and risks among medical students who have professional access to it are rarely explored. To investigate the recreational use of N₂O among medical students in Paris Region (France). This cross-sectional study used an online questionnaire distributed in 2022 through social networks, to all medical students (undergraduate student from the 2nd year of medical studies to residents until the end of the residency) from the six medical universities in Paris Region. We collected demographic characteristics, patterns of N₂O consumption, co-consumptions, and N₂O training (academic course or self-training). Factors associated with N₂O consumption and complications were analyzed using multivariable logistic regressions. The questionnaires of 444 students (mean age: 25.9 years (SD = 2.69), 75.5% female, and 63.74% residents) were analyzed. Recreational N₂O consumption was reported by 71.85% of students and 20.50% consumed at least monthly. N₂O consumption was associated with being a resident (versus undergraduate student) (adjusted OR (aOR) = 3.07[1.45-6.72];  < .01), receiving training on N₂O (aOR) = 3.13[1.84-6.24];  < .01), and consumption of cannabis (aOR = 18.21[3.47-104.26];  < .01), ecstasy (aOR = NA,  = .048) and poppers (aOR = 13.9[2.64-77.94];  < .01). Complications (mainly dizziness, paresthesia and burns) were reported in 8.15% of students consuming N₂O. They were associated with consuming more than 10 balloons per intake (aOR = 6.04[1.32-25.00);  < .01) and inversely associated with receiving training (aOR = 0.35[0.14-0.86];  = .01). Almost three-quarters of medical students experienced recreational N₂O consumption, particularly with poly-drug use. Given that complications were associated with high consumption and lack of education, risk training and screening for N₂O consumption could be beneficial.

Longitudinal Measurement Invariance (LMI) is critically important to evaluate changes in alcohol expectancies over time. However, past research has not explored the longitudinal properties of the Spanish Expectancy Questionnaire Short Form (EQ-SF). To examine the reliability, sources of validity (structural, invariance across sex, and concurrent validity), and LMI of the Spanish EQ-SF among young adults who engage in binge drinking. Participants ( = 279; 48.4% female) completed the EQ-SF and, two months later, completed it again along with measures of alcohol use, drinking motives, and protective behavioral strategies (PBS). We performed confirmatory factor analysis for structural validity and measurement invariance analysis for longitudinal and sex stability. The eight-factor intercorrelated model (i.e. social facilitation, fun, sexual disinhibition, tension reduction, antisocial effects, negative emotional states, negative physical effects, and cognitive impairments) provided the best fit ((df) = 497.29(224), = .962, = .064, = .049). This model was invariant across sex and time. Reliability coefficients (Ordinal alpha) for each dimension were consistently strong at both time points (from .72 to .93 at T1 and .73 to .91 at T2). Positive alcohol expectancies at baseline were positively related to alcohol use and drinking motives and negatively related to PBS at follow-up, demonstrating predictive validity. Our results support the temporal invariance of the EQ-SF scores among Spanish young adults who engage in binge drinking. The evidence supports the suitability of this measure for accurately assessing changes in alcohol expectancies over time in interventions aimed at preventing binge drinking in young adults.

Medication disposal programs have been promoted as one solution to the opioid crisis, but uptake by community members has been minimal. To clarify perceptions of medication disposal options among people who have been prescribed an opioid analgesic in North Carolina to inform interventions that can facilitate the disposal of unused opioids. In 2022, we conducted focus groups with participants who received an opioid medication in the past year to gain information to develop an intervention related to the disposal of unused opioid medication (12 focus group discussions (FGDs); total  = 37; 30 identified as female, 6 as male, and 1 as another gender). Participants were shown a slide with the Food and Drug Administration's recommended disposal options and asked about their perceptions of each option. Themes were derived using an inductive, thematic, qualitative approach. Seven themes about perceptions of medication disposal programs emerged from the data. Four of the themes reflect potential barriers to medication disposal: failed disposal attempts, lack of sufficient education on proper disposal, unclear meaning of specific disposal language, and concerns about existing disposal options. Three of the themes provide insight on potential facilitators of medication disposal: preference of low-cost disposal options, ease and accessibility among disposal methods, and preferred disposal methods. Patients should be provided clear and consistent guidance from prescribers and dispensing pharmacists on when and how to dispose of unused medications and opportunities to dispose of medications at no cost to the patient.

Rural areas in the United States have been severely impacted by recent rises in substance use related mortality and psychosocial consequences. There is a dearth of treatment resources to address substance use disorder (SUD). Rural recovery houses (RRH) are important services that provide individuals with SUD with an environment where they can engage in recovery-oriented activities, but dropout rates are unacceptably high, and evidence-based interventions such as contingency management (CM) may reduce dropout and improve outcomes for RRH residents. In this paper, we describe the results of a national convening of experts that addressed important issues concerning the implementation of CM within the context of RRHs. Twelve experts (five female) in the areas of CM, RRH and rural health participated in a one-day facilitated meeting that used nominal group technique to identify expert consensus in three areas as they pertain to RRH: (a) facilitators and barriers to CM implementation, (b) elements necessary for successful program building based on group feedback, and (c) recommendations for future implementation of CM. Several RRH- and system-level barriers and facilitators to implementing CM were identified by the panel, and these were categorized based on the level of importance for and ease of implementation. CM funding, staff and resident buy-in, set policies, education on CM, and consistent fidelity to CM procedures and tracking were identified as important requirements for implementing CM in RRH. We provide recommendations for the implementation of CM in RRH that may be useful in this context, as well as more broadly.

Little is known regarding the extent to which substance use disorder (SUD) treatment facilities adopt comprehensive services to meet patients' medical and social needs. To examine trends in the availability of comprehensive services within outpatient SUD treatment facilities from 2018 to 2022. We used data from the Mental Health and Addiction Treatment Tracking Repository, a national database of SUD treatment facilities ( = 13,793). We examined the availability of four domains of comprehensive services and four types of SUD treatment services from 2018 to 2022. We conducted bivariate and multivariate logistic regression predicting the availability of a comprehensive service model (defined as having at least one service from each service domain), controlling for organizational and community characteristics. Comprehensive services were increasingly offered from 2018 to 2022. In unadjusted and adjusted models, facilities which were externally accredited (OR: 1.50; 95%CI: 1.30-1.74), accepted Medicaid (OR: 1.51; 95%CI: 1.30-1.74), performed community outreach (OR: 2.05; 95%CI: 1.80-2.33), provided naloxone and overdose education (OR: 3.50; 95%CI: 3.06-3.99), had a robust SUD treatment infrastructure (OR: 2.33; 95%CI; 2.08-2.62), and were located in a county with a lower percentage of White residents (OR: 0.99; 95%CI: 0.99-0.99), a higher percentage of residents in poverty (OR: 1.02; 95%CI: 1.00-1.03), and the Northeast compared with the South (OR: 1.21; 95%CI: 1.01-1.45), had significantly higher odds of adopting a comprehensive service model. Findings highlight the importance of factors reflecting experience with organizational change efforts and enhanced external support. Policymakers working to enhance the uptake of comprehensive services should focus on obtaining the financial and technical support necessary to develop these models.

Many national studies fail to account for discordance between sexual orientation dimensions (e.g. a mismatch between sexual identity and sexual attraction) or sexual identity fluidity (e.g. changes in sexual identity over time). To examine the longitudinal relationships among sexual identity fluidity/stability, sexual orientation discordance/concordance, and alcohol and other drug use disorder symptoms. The study used nationally representative longitudinal data from Waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) study of US adolescents and adults ( = 24,591). Substance use disorder symptoms were most prevalent (45.8%) among bisexual-stable females relative to all other sexual identity subgroups. The adjusted odds ratios (AORs) of substance use disorder symptoms were significantly higher among bisexual-stable females vs. heterosexual-stable females in all models (AOR range: 1.94-2.32), while no such associations were found for males. Sexual identity-attraction discordant females had significantly greater AORs (17/20 instances) of substance use disorder symptoms compared to concordant females; this finding was not as consistent for males (6/20 instances). Sexual orientation discordance was significantly associated with substance use disorder symptoms, especially among females discordant in their sexual identity and attraction. Bisexual-stable and discordant females are at highest risk of developing symptomatic substance use; it is vital that they receive screening, no matter where they are in their coming out process. This study highlights pitfalls of relying solely on cross-sectional data using a single sexual orientation dimension to understand the relationship between sexual orientation and substance use disorder.

X-ray absorption spectroscopy (XAS) is a widely used substance analysis technique. It bases on the different absorption coefficients at different energy level to achieve material identification. Additionally, the combination of spectral technology and deep learning can achieve auto detection and high accuracy in material identification. Current methods are difficult to identify drugs quickly and nondestructively. Therefore, we explore a novel approach utilizing XAS for the detection of prohibited drugs with common X-ray tube source and photon-counting (PC) detector. To achieve automatic, rapid, and accurate detection of drugs. A CdTe detector and a common X-ray source were used to collect data, then dividing the data into training and testing sets. Finally, the improved transformer encoder model was used for classification. LSTM and ResU-net models are selected for comparation. Fifty substances, which are isomers or compounds with similar molecular formulas of drugs, were selected for experiment substances. The results showed that the improved transformer model achieving 1.4 hours for training time and 96.73% for accuracy, which is better than the LSTM (2.6 hours and 65%) and ResU-net (1.5 hours and 92.7%). It can be concluded that the attention mechanism is more accurate for spectral material identification. XAS combined with deep learning can achieve efficient and accurate drug identification, offering promising application in clinical drug testing and drug enforcement.