Search

Aims This study investigated the value of citation counts as an index of quality in the field of addiction and examined factors that contribute to papers being cited more or less frequently. Design The number of times papers published by the journal Addiction in 1995–98 that had been cited up to May 2000 were counted using the Science and the Social Science Citation Indexes. Articles in nine of the monthly issues from 1997 were rated by two independent expert raters for quality. Factors related to citation counts were also examined including: country of origin of the paper, substance type, solicited versus unsolicited papers and methodology used. Findings A total of 417 unsolicited research reports were included in the citation analysis, of which 79 were also subjected to quality ratings. The experts showed a moderate level of agreement in their ratings (intraclass correlation = 0.39, p < 0.001). However, there was no correlation between number of citations and expert ratings of article quality (R < 0.1). Papers from developing countries received significantly fewer citations than papers from other countries but substance type (e.g. nicotine, opiate, alcohol) and methodology (e.g. survey, treatment trial) were not related to number of citations. Conclusions This study involved just one journal but raised an important issue: the number of citations received by papers on addiction appears to reflect the geographical region of study rather than what experts would consider as 'quality'. If these findings are found to generalize they call into question the use of citation‐related indices as measures of quality in this field and perhaps in others as well. To our knowledge our methodology has not been used before and could be adapted to study the value of citations more widely. [ABSTRACT FROM AUTHOR]

INTRODUCTION Motivations for using electronic nicotine delivery systems (ENDS) include quitting or reducing cigarette smoking, flavor, and addiction. This study examines whether the primary reason for continued ENDS usage changes over time, and its association with device and liquid characteristics. METHODS Data are from a longitudinal cohort study and include 526 US adults (=21 years) using ENDS frequently (=5 days/week) as self-reported, and uploaded photos of their most used ENDS devices and liquids and self-reported primary reason for continued ENDS usage in wave 2 (December 2020-April 2021) and wave 5 (February-April 2023). Device-liquid grouping was defined by device (disposable/disposable pod/refillable pod/tank, adjustable/no adjustable settings) and liquid (salt/freebase) characteristics. A device was classified as having adjustable settings if it allowed users to modify the power, coil, or airflow. Data were analyzed using multivariable logistic regressions and McNemar tests. RESULTS From wave 2 to 5, the primary reason for continued ENDS usage significantly changed, with more participants reporting addiction (29.2% vs 34.6%, p<0.001); and significantly more participants used disposable devices (salt, no adjustable settings) (7.9% vs 25.2%, p<0.001). Compared to those using tanks (freebase, adjustable settings), participants using devices with nicotine salt liquids were more likely to report addiction (AOR>2; 95% CI: 1.12-8.19); and participants using disposable devices (salt, no adjustable settings) were less likely to report quitting/reducing smoking as the primary ENDS use reason after controlling for smoking status and sociodemographic characteristics (AOR<0.6; 95% CI: 0.14-0.995). CONCLUSIONS Over a 2.5-year period, the proportion of participants continuing to use ENDS at least 5 days/week because of addiction grew, and participants' motivations varied by device-liquid grouping. Restrictions on nicotine salts may disproportionately impact those using ENDS because of addiction; and regulations targeting tanks with freebase liquids may disproportionately impact those using ENDS for smoking cessation/reduction. [ABSTRACT FROM AUTHOR]

This paper describes my experiences with coming to understand my own relationship with alcohol dependency and addiction. Disability studies has offered me a lens and guide through which I have critically interrogated discourses about addiction, while examining the ways dominant and counter-narratives have impacted my own recovery process. In this paper, I review historical information about the emergence of culturally accepted recovery ideologies in the United States that have led to a dominant disease model perspective. Then, I explain the disability studies-informed theoretical underpinnings of this paper, which include discourse theory and disability studies as applied to alcohol addiction. Using disability studies and autoethnography as a guide, the body of the paper uses examples from my own journals to elucidate salient themes that emerged about my experiences in early recovery. The paper uncovers the ways I came to understand my own identity related to addiction, how I navigated feelings of stigma and shame, the ways I found recovery spaces that embraced empowering frameworks aligned to a disability studies ethos, and how I discovered community and pride through this experience. [ABSTRACT FROM AUTHOR]

This paper traces the unspoken, implicit white racial logic of the brain disease model of addiction, which is based on seemingly universal, disembodied brains devoid of social or environmental influences. In the United States, this implicit white logic led to "context-free" neuroscience that made the social hierarchies of addiction and its consequences invisible to, and thus exacerbated by, national policies on opioids. The brain disease model of addiction was selectively deployed among the white middle-class population that had long accessed narcotics and pharmaceutical treatments for narcotics disorders from biomedical clinics, as opposed to from illegal sources subject to law enforcement. In turn, new treatments for opioid addiction were racially marketed to the same white clientele to which newly patented opioid analgesics were marketed, tapping into a circumscribed but highly lucrative consumer base that has long benefited from a legally protected, racially segregated safe space for white narcotics consumption. The connecting thread for the contemporary white opioid "crisis," therefore, is white race as a ghost variable in addiction neuroscience and in its pharmaceutical and biotechnological translation. [ABSTRACT FROM AUTHOR]

This article examines the cultural attitude of reluctance in the United States, as reflected in recent opinion polls and federal budgets, toward agency spending in relation to addiction prevention, treatment, and research. The author posits that the prevalent spiritual lens, through which addiction is widely perceived, contributes to hesitancy in committing more to these areas of public funding. Its etiological interpretation of addiction, as a spiritual/moral disease that is innate to afflicted individuals, essentially releases culture and society from accountability for its prevalence. Further, publicity surrounding the New Recovery Advocacy Movement might lead to a complacent belief that a radical movement, addressing addiction on a broad, collaborative, and socioeconomic scale is already occurring. In order to widen the scope of spirituality as it generally pertains to addiction and accommodate the potentialities embedded in positive social change, the construct of spirituality needs to expand beyond the narrow and culturally entrenched notion of inner personal growth through individual effort. Therefore, this paper advances participatory spiritual theory as a means to integrate the reciprocity of socioeconomic and political factors as well as social engagement within a spiritual framework for recovery from addiction. [ABSTRACT FROM AUTHOR]

Objective: Due to a combination of unique circumstances, opioid use and misuse in the United States have escalated dramatically over the past 15 years, resulting in a national crisis. Method: To bring together work that addresses the role that psychologists can play in responding to this crisis, we assembled this special issue. Results: The papers included in this issue underscore critical matters for continued consideration, and point to directions for further action and investigation. Conclusions: Themes that emerged from this collection of papers suggest numerous opportunities for the field as we seek to respond collectively to the crisis now facing our country. Due to a combination of unique circumstances, opioid use has escalated dramatically over the past 15 years, resulting in a national public health crisis. These concluding remarks highlight ways in which psychologists may seek to address this crisis. [ABSTRACT FROM AUTHOR]

Approximately 200 million people in the United States have an addiction disorder that significantly disrupts employment, family relationships, financial stability, and personal health. As a result, addiction has become one of the most critical health care challenges presently facing the American health care system. Research in the last five years has provided substantial evidence that addiction is a neurobiological condition rooted in genetic factors. During the addiction process neurologic changes occur that are responsible for tolerance, craving, and relapse. It appears that once addiction becomes chronic, the brain enters an addicted state that may be irreversible without pharmaceutical intervention. Such alterations in neurochemistry-rather than poor volitional control-account for why addiction is characterized by a chronic, relapsing-remitting course. This paper discusses (a) the neurobiological factors underlying the addiction process, (b) available pharmaceutical treatment, and (c) how recent research regarding the neurobiology of addiction affects occupational therapy's role in addiction rehabilitation. A case study follows that illustrates how occupational therapists can contribute to addiction intervention. [ABSTRACT FROM AUTHOR]

This paper develops a new test for forward-looking behaviour based on the establishment of public smoking restrictions. Given that the announcement of these restrictions effectively increases the future cost of smoking, we should expect forward-looking smokers to curb their consumption before the restriction is effective due to complementarity between present and future consumption. I perform the estimation using detailed, high-frequency household-level purchase data. The results provide evidence against the forward-looking behaviour of smokers. Households do not reduce their cigarette purchases before announced public smoking restrictions are established; they only do so once the restriction is in effect. [ABSTRACT FROM AUTHOR]

The concept of recovery has been an influence on addicted individuals for many decades. But only in the past 15 years has the concept had a purchase in the world of public policy. In the USA, federal and state officials have promulgated policies intended to foster 'recovery-oriented systems of care' and have ratified recovery-supportive laws and regulations. Though of more recent vintage and therefore less developed, recovery policy initiatives are also being implemented in the UK. The present paper describes recovery-oriented policy in both countries and highlights key evaluations of the recovery-oriented interventions. [Humphreys K, Lembke A. Recovery-oriented policy and care systems in the UK and USA. Drug Alcohol Rev 2014;33:13-18] [ABSTRACT FROM AUTHOR]

Since the United States's illegal invasion and occupation of the sovereign nation of Iraq on 20 March 2003, I have published papers that critically interrogate the participation of the “sovereign” US Indigenous nations in this unjust, illegal, imperialistic war. Due to my writings, on 24 June 2007, I was invited to make a presentation at a peace vigil and rally focusing on “What Is the Highest Form of Patriotism?” The speech that I gave is provided in full text in this article, where I probe the United States of America's addiction to patriotism by interrogating and “defying the lies” of some of US patriotism's most cherished ideas, documents, leaders, and slogans. I end with a slight twist of the words of the third Buddhist noble truth, freedom from the addiction to patriotism is possible in this lifetime. [ABSTRACT FROM AUTHOR]

Objective: Heroin use in the United States has reached epidemic proportions. The objective of this paper is to estimate the annual societal cost of heroin use disorder in the United States in 2015 US dollars. Methods: An analytic model was created that included incarceration and crime; treatment for heroin use disorder; chronic infectious diseases (HIV, Hepatitis B, Hepatitis C, and Tuberculosis) and their treatments; treatment of neonatal abstinence syndrome; lost productivity; and death by heroin overdose. Results: Using literature-based estimates to populate the model, the cost of heroin use disorder was estimated to be $51.2 billion in 2015 US dollars ($50,799 per heroin user). One-way sensitivity analyses showed that overall cost estimates were sensitive to the number of heroin users, cost of HCV treatment, and cost of incarcerating heroin users. Conclusion: The annual cost of heroin use disorder to society in the United States emphasizes the need for sustained investment in healthcare and non-healthcare related strategies that reduce the likelihood of abuse and provide care and support for users to overcome the disorder. [ABSTRACT FROM AUTHOR]

• Endogenous cannabinoid and opioid systems have multi-level cross-talks. • Exposure to exogenous opioids dysregulates the endocannabinoid system. • Alterations of the endocannabinoid system are region-specific in the brain. Rates of opioid-related deaths and overdoses in the United States are at record-high levels. Thus, novel neurobiological targets for the treatment of OUD are greatly needed. Given the close interaction between the endogenous opioid system and the endocannabinoid system (ECS), targeting the ECS may have therapeutic potential in OUD. The various components of the ECS, including cannabinoid receptors, their lipid-derived endogenous ligands (endocannabinoids [eCBs]), and the related enzymes, present potential targets for developing new medications in OUD treatment. The purpose of this paper is to review the clinical and preclinical literature on the dysregulation of the ECS after exposure to opioids. We review the evidence of ECS dysregulation across various study types, exposure protocols, and measurement protocols and summarize the evidence for dysregulation of ECS components at specific brain regions. Preclinical research has shown that opioids disrupt various ECS components that are region-specific. However, the results in the literature are highly heterogenous and sometimes contradictory, possibly due to variety of different methods used. Further research is needed before a confident conclusion could be made on how exposure to opioids can affect ECS components in various brain regions. [ABSTRACT FROM AUTHOR]

Background: Policies designed to restrict marketing, access to, and public use of electronic cigarettes (e-cigarettes) are increasingly under debate in various jurisdictions in the US. Little is known about public perceptions of these policies and factors that predict their support or opposition. Methods: Using a sample of US adults from Amazon Mechanical Turk in May 2015, this paper identifies beliefs about the benefits and costs of regulating e-cigarettes and identifies which of these beliefs predict support for e-cigarette restricting policies. Results: A higher proportion of respondents agreed with 8 different reasons to regulate e-cigarettes (48.5% to 83.3% agreement) versus 7 reasons not to regulate e-cigarettes (11.5% to 18.9%). The majority of participants agreed with 7 out of 8 reasons for regulation. When all reasons to regulate or not were included in a final multivariable model, beliefs about protecting people from secondhand vapor and protecting youth from trying e-cigarettes significantly predicted stronger support for e-cigarette restricting policies, whereas concern about government intrusion into individual choices was associated with reduced support. Discussion: This research identifies key beliefs that may underlie public support or opposition to policies designed to regulate the marketing and use of e-cigarettes. Advocates on both sides of the issue may find this research valuable in developing strategic campaigns related to the issue. Implications: Specific beliefs of potential benefits and costs of e-cigarette regulation (protecting youth, preventing exposure to secondhand vapor, and government intrusion into individual choices) may be effectively deployed by policy makers or health advocates in communicating with the public. [ABSTRACT FROM AUTHOR]

By the 1950s, American medical authorities declared obesity to be the nation's leading health care problem prompting a society, already familiar with the rigours of weight control, to extend the bounds of their diet consciousness. This manifested in a ‘self-help movement for fatties’ which witnessed the proliferation of weight loss groups with names such as, Take Off Pounds Sensibly and Fatties Anonymous, and introduced an eclectic blend of mutual aid inspired by Alcoholics Anonymous and psychoanalytic psychiatry. This paper explores the emergence of these mutual aid groups in response to the growing concern about obesity and argues that the rise of weight loss groups was the result of many separate but interacting variables in the context of the post-war United States. The history of the self-help weight loss movement can offer new perspectives on the politics of current obesity management policies, as well as insight into mid-twentieth-century popular culture. [ABSTRACT FROM PUBLISHER]

Introduction: The aim of this study was to assess the knowledge, attitudes, and awareness of pharmacy students toward marijuana use. Methods: Pharmacy students were asked to complete a survey that assess students' knowledge, attitudes, and awareness toward marijuana use. This study also compared students' awareness about the harmful effects of marijuana in comparing with alcohol and smoking tobacco. Participants were asked about the possibilities of marijuana-induced cancer and addiction. Results: Twenty-three percent of pharmacy students reported having used marijuana at some point in their lives. In comparison with tobacco and alcohol, most of the students agreed that tobacco (49%) and alcohol (42%) are more harmful than marijuana (P <.0001). More than sixty percent of students considered marijuana as an addictive substance (P <.02). A 45% of students opposed the possibility of marijuana-induced cancer. Thirty-six percent of the students agreed that marijuana should be legalized for both medical and recreational use with a similar percentage of the students (30 – 32%) believed that marijuana should be legalized for medical use only. Conclusion: With the prevalence of marijuana use and discrepancy among pharmacy students' responses regarding knowledge, attitudes, and awareness pharmacy schools need to adopt educational activities about the benefits and risks of marijuana. [ABSTRACT FROM AUTHOR]

Screening for alcohol and drugs seems to be gaining traction and is becoming more commonplace in the healthcare setting. With emergency departments often being a point of contact for many individuals needing healthcare services, it makes sense to provide screening for substance misuse within this setting. The purpose of this paper is to share how emergency department staff in the Midwest United States implemented a successful Screening, Brief Intervention, Referral and Treatment (SBIRT) program within their hospital. [ABSTRACT FROM AUTHOR]

Gambling and gaming is a very large industry in the United States with about one-third of all adults participating in it on a regular basis. Using novel and unique behavioral data from a panel of casino gamblers, this paper investigates three aspects of consumer behavior in this domain. The first is that consumers are addicted to gambling, the second that they act on 'irrational' beliefs, and the third that they are influenced by marketing activity that attempts to influence their gambling behavior. We use the interrelated consumer decisions to play (gamble) and the amount bet in a casino setting to focus on addiction using the standard economic definition of addiction. We test for two irrational behaviors, the 'gambler's fallacy' and the 'hot hand myth'-our research represents the first test for these behaviors using disaggregate data in a real (as opposed to a laboratory) setting. Finally, we look at the effect of marketing instruments on the both the decision to play and the amount bet. Using hierarchical Bayesian methods to pin down individual-level parameters, we find that about 8% of the consumers in our sample can be classified as addicted. We find support in our data for the gambler's fallacy, but not for the hot hand myth. We find that marketing instruments positively affect gambling behavior, and that consumers who are more addicted are also affected by marketing to a greater extent. Specifically, the long-run marketing response is about twice as high for the more addicted consumers. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking remains the leading cause of preventable death in America, claiming 450,000 lives annually. Chronic Obstructive Pulmonary Disease, caused by smoking in the vast majority of cases, became the third leading cause of death in the U.S. in 2008. The burden of asthma, often exacerbated by tobacco exposure, has widespread clinical and public health impact. Despite this considerable harm, we know relatively little about the natural history of lung disease and respiratory impairment in adults, especially after smoking cessation. Methods/Design: Our paper describes the design and rationale for using the 2004 Federal Bureau of Prisons tobacco ban to obtain insights into the natural history of respiratory diseases in adult men and women of different races/ethnicities who are imprisoned in federal medical facilities. We have developed a longitudinal study of new prison arrivals, with data to be collected from each participant over the course of several years, through the use of standardized questionnaires, medical chart reviews, lung function tests, six-minute walk tests, and stored serum for the analysis of present and future biomarkers. Our endpoints include illness exacerbations, medication and health services utilization, lung function, serum biomarkers, and participants' experience with their health and nicotine addiction. Discussion: We believe the proposed longitudinal study will make a substantial contribution to the understanding and treatment of respiratory disease and tobacco addiction. [ABSTRACT FROM AUTHOR]

Issues: Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge.Approach: This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial µ agonist buprenorphine in the management of concurrent pain and opioid addiction.Implications: Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia.Conclusions: The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy. [ABSTRACT FROM AUTHOR]

This paper is designed to call attention to the paucity of current models of addiction and to sketch the promises of future ones. In surveying the terrain of available treatments in the United States that include the medical and crypto-Christian, it then proceeds to examine two off-shore treatment facilities for chemical dependency that utilize indigenous shamanic techniques in their syncretic—and highly successful—methodologies. An enjoinder to craft a comparative cartography of addiction and the manifold therapeutic options for its treatment, it attempts to bring to light the fact that such a comparative endeavor could greatly improve the abysmal prognoses associated with this debilitating condition. [ABSTRACT FROM AUTHOR]

A four-page paper survey was mailed to 500 randomly-selected substance abuse treatment agencies listed in a national directory to evaluate how often specific methods are employed to assess and treat craving in American substance abuse agencies. Of 426 eligible agencies, 149 (35%), located in 41 states, returned 152 usable replies. Although counselors regularly assessed craving during intake evaluations, they rarely used published self-report questionnaires. Almost one-half of respondents made craving a target of treatment with at least a majority (and sometimes all) of their clients, and only 5% of respondents reported never making craving a target of treatment. A variety of interventions are employed to address craving, including coping skills training, encouraging clients to avoid/leave situations where craving occurs, and providing clients with education about craving. We recommend additional professional education and training to familiarize counselors with standardized craving instruments and exposure interventions that hold promise to ameliorate craving. [ABSTRACT FROM AUTHOR]

ABSTRACT At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and ecological variables contributing to the development of pathological gambling. Advances in this area are hampered by imprecise definitions of pathological gambling, failure to distinguish between gambling problems and problem gamblers and a tendency to assume that pathological gamblers form one, homogeneous population with similar psychological principles applying equally to all members of the class. The purpose of this paper is to advance a pathways model that integrates the complex array of biological, personality, developmental, cognitive, learning theory and ecological determinants of problem and pathological gambling. It is proposed that three distinct subgroups of gamblers manifesting impaired control over their behaviour can be identified. These groups include (a) behaviourally conditioned problem gamblers, (b) emotionally vulnerable problem gamblers and (c) antisocial, impulsivist problem gamblers. The implications for clinical management are discussed. [ABSTRACT FROM AUTHOR]

Jails and prisons have become a final destination for persons with severe mental illness in America. Addiction, homelessness, and fragmentation of services have contributed to the problem, and have underscored the need for new models of service delivery. Project Link is a university-led consortium of five community agencies in Monroe County, New York that spans healthcare, social service and criminal justice systems. The program features a mobile treatment team with a forensic psychiatrist, a dual diagnosis treatment residence, and culturally competent staff. This paper discusses the importance of service integration in preventing jail and hospital recidivism, and describes steps that Project Link has taken towards integrating healthcare, criminal justice, and social services. Results from a preliminary evaluation suggest that Project Link may be effective in reducing recidivism and in improving community adjustment among severely mentally ill patients with histories of arrest and incarceration. [ABSTRACT FROM AUTHOR]

Background: The United States and Canada have observed sharp increases in substance use disorder among women of child-bearing or child-rearing age. Substance use disorder can have deleterious effects on children, families, and communities. Many evidence-based treatments exist, but engaging mothers in treatment is difficult. No recent review is available to help systems and providers understand the facilitators of and barriers to treatment for mothers.Objective: To systematically identify facilitators and barriers to substance use and mental health treatment for mothers with substance use disorder who are pregnant or parenting young children in the United States and Canada.Methods: We systematically searched the literature using five online databases and performed a gray literature search. We included studies published in the past two decades focused on parent or provider perspectives.Results: Our search identified 23 high-quality papers. The majority of papers qualitatively examined the perspectives of treatment-seeking pregnant women and mothers diverse in race/ethnicity, region, and treatment settings. Our synthesis of findings revealed the compelling and complex centrality of motherhood, which served as both a facilitator and barrier. Motherhood often interacted with relational (e.g., perceiving stigma vs. support from providers, family, friends, partners) and structural (e.g., time commitments, childcare) factors to both hinder and help engagement in treatment.Conclusions: Our findings can help policy-makers and practitioners make tangible improvements to the financing and delivery of substance use treatment for mothers. Our review points to specific areas for future research, including an examination of the relationships between various structural factors and treatment outcomes. [ABSTRACT FROM AUTHOR]

This article situates the emergence of sensationalized news reports of "infant addicts" and the concurrently evolving study of neonatal drug withdrawal within the context of the expansion of methadone maintenance treatment (MMT) in the United States. It details how, in the early 1970s, concerns about pregnant narcotic addicts and their infants became part of the politically charged debate over methadone maintenance. The popular press amplified the apprehensions of a vocal group of pediatricians who saw in infants' withdrawal an indication of methadone's inherent harmfulness and potential toxicity. Increased access to MMT and its presumed normalizing effects on reproductive functions augmented these concerns. The ensuing controversy led clinical researchers to define, measure, and systematically study "neonatal abstinence syndrome," whereas the emerging media trope of the infant drug addict effectively undermined the claims made by MMT's proponents about the drug's therapeutic utility. [ABSTRACT FROM AUTHOR]

In 2017, Jane Goodall, the well-known primatologist, wrote a letter to the United States Food and Drug Administration criticising the use of animals to test brain-based theories of addiction. She reasoned that we already know about addiction by observing humans. Several scientists countered that research with humans cannot answer important questions about understanding, preventing, and treating addiction. This commentary draws on epidemiology, psychology, psychodynamic models, learning theories and existentialism. It highlights effective prevention and treatment approaches that are not based on brain models of addiction. Jane Goodall's letter, has, perhaps unwittingly, provided a focal point for reconsidering what kind of research is required to further our understanding of addiction. [ABSTRACT FROM AUTHOR]

Background: Side effects of medications for opioid use disorder (MOUD) such as weight gain contribute to their stigma. Substantial evidence suggests that women have a more severe side effect profile to MOUD than men, and concerns about weight gain during treatment are prevalent. However, the few studies reporting sex differences in weight gain during treatment show conflicting results and are restricted to methadone. In addition, little is known about possible sex differences in weight gain to buprenorphine, which is the most commonly prescribed MOUD in the United States.Methods: To address these issues, we performed a systematic review and meta-analysis on the few studies reporting longitudinal data on sex differences in body mass index (BMI) gain during methadone treatment (Study 1). In a separate study, we also re-analyzed data from trial CTN-0030 of the National Institute on Drug Abuse Clinical Trial Network (NIDA CTN), which involved a 12-week buprenorphine treatment regimen (Study 2; n = 360; 209 Male, 151 Female).Results: For Study 1, across all papers reporting longitudinal data (k = 4, n = 362 OUD patients), there were BMI increases that ranged from 2.2 to 5.4 BMI after at least one year of methadone treatment, but there were no significant sex differences in BMI increases (Standardized Mean Difference, Female > Male = 0.352, SE =0.270; 95 % CI = [-0.18 0.88]; p = .193). Study 2 showed no significant differences in weight before and after 12 weeks of buprenorphine treatment nor did it show sex differences in weight change with treatment (β = 2.34, p = .511).Conclusion: These analyses corroborate evidence of weight gain with methadone treatment but did not observe a sex-based disparity in weight gain with methadone or buprenorphine treatment for OUD. [ABSTRACT FROM AUTHOR]

The article discusses the 1988 U.S. Surgeon General's Report, entitled "Nicotine Addiction" which presented the evidence that tobacco is addictive and showed that nicotine lies at the heart of this addiction. Topics include evidence emerging from studies on tobacco use and nicotine products, evidence emerging from electronic cigarettes (e-cigarettes), and findings of the report on tobacco control.

Aims To discuss an historical episode in which obesity was conceptualized as an addictive disorder and declared to be a major epidemic in the early postwar United States. This history illuminates past consequences of framing obesity as an addiction in ways that may inform constructive policy responses today. Methods Review of secondary and primary sources, including archival documents, relating to obesity in biomedical and popular thought of the 1940s and 1950s. Results In the United States in the late 1940s and 1950s, new medical thinking about obesity reinterpreted overweight and obesity as chiefly the consequence of addiction (understood in the then dominant psychodynamic theory as a psychological defect, oral fixation). This new conception was rapidly taken up in popular discourse and clinical practice, with adverse effects through amplification of weight stigma. Further, in the conservative political context, the addiction concept contributed to an ineffective policy response to the alarming new epidemiological evidence about obesity's consequences. Despite a lack of evidence for efficacy of the intervention, public health efforts focused on correcting individual eating behaviour among obese people by encouraging self-help in lay groups modelled, in part, on Alcoholics Anonymous. Population-level intervention was neglected. Conclusions Current public health policy initiatives must be mindful of the risks of reframing obesity as an addiction. These include inadvertently reinforcing stigma, narrowing responses to those aiming to modify individual behaviour and biology and neglecting population policies aiming to reduce the consumption of energy-dense foods, as all occurred in the 1950s United States. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic sweeps the globe, many veterans with substance use issues have faced the closure of treatment facilities, mandates to shelter in place, and social distancing measures. To better understand their pandemic experiences, substance use changes, and functioning, a survey was nationally administered to a sample of United States veterans reporting substance use issues during the pandemic. The purpose of this cross-sectional online survey for veterans (N = 409) was to report on COVID-19 experiences, safety behaviors, and infection experiences while also investigating the relationship among addictive behaviors, mental and physical health, and COVID-19 impact. Measures also assessed specific substance use concerns, pandemic-related loneliness, and functioning. Though few veterans reported personally receiving a confirmed COVID-19 medical diagnosis (10.5%), the impact of pandemic stressors was evident, with a majority reporting anxiety related to contracting COVID-19 (61.4%) or fear of a family member or close friend contracting COVID-19 (58.7%). Participants reported increased use of alcohol (45.3%), sedatives (36.6%), inhalants (35.7%), tobacco (35.0%), and cannabis (34.9%), attributed specifically to the pandemic. Regression analyses revealed that even when controlling for the contribution of problematic substance use issues, negative pandemic impacts and self-reported COVID-19 related loneliness were related to more impaired physical and mental health functioning during the pandemic. Findings from this sample of veterans with addiction issues add to the growing literature suggesting unique and adverse effects of COVID-19 stressors on functioning while also revealing specific pandemic impacts for this group. [ABSTRACT FROM AUTHOR]

While negative attitudes within the social work community toward clients struggling with addiction may not be ubiquitous, there is evidence that such attitudes remain problematic. Interestingly, there is very little research available concerning factors that may be involved with these adverse attitudes. While extant research suggests social workers demonstrate low empathy toward clients with a Substance Use Disorder (SUD), there is little empirical exploration of the relationship between dispositional empathy and subsequent attitudes. Similarly, a practitioner's spirituality may also influence their views of SUD clients, yet there is little evidence investigating this relationship. This study explored the relationship between empathy, spirituality, and attitudes toward clients with SUDs. Results demonstrated that both empathy and spirituality have some predictive potential and that some dimensions of empathy and spirituality interact. The results also showed that different dimensions were important for social work students and social work practitioners. [ABSTRACT FROM AUTHOR]

After his memoir A Million Little Pieces became a best-selling selection for Oprah's Book Club in 2005, James Frey's meteoric rise as a major writer of the American memoir boom was cut short when it was discovered that he had fabricated some events in the book. The resulting controversy meant that Frey and the memoir as a genre were written off by most of the mainstream press. However, the memoir is closely related to the development of American ideas about individualism and citizenship. As A Million Little Pieces fell afoul of conflicting expectations of memoir as genre, it also became part of a public debate in the USA about the meaning of truth connected to the idea of weapons of mass destruction, the relationship between publishing and television, the image of the addict in American culture, and the value of personal experience in the public realm. This paper explores the debate. [ABSTRACT FROM AUTHOR]

A National Institutes of Health (NIH) expert panel has mentioned a daily methadone dose of at least 60 mg as a best practice in methadone maintenance. The focus of this research is to estimate the percentage of outpatient methadone clients receiving this level of methadone and examine the association between treatment retention and level of methadone dosage as recommended by the NIH expert panel. A sample of 428 methadone clients discharged from methadone treatment facilities from the Alcohol and Drug Services Study (ADSS) was used, representing 109,973 methadone clients nationally. It was estimated that more than two-thirds of methadone clients nationally were receiving below 60 mg/day. While controlling for a number of client and organizational variables, a daily methadone dose of 60 mg/day or above was found to be associated with longer retention in treatment. Exploring factors affecting the utilization of the recommended daily methadone dose remains an important issue in effective delivery of methadone treatment. [ABSTRACT FROM AUTHOR]

When and how do politicians talk about public health crises? Using evidence from the opioid crisis in the United States, this paper assembles and analyzes novel data on Congressional statements to explore the conditions under which politicians (1) issue public statements about opioids and (2) frame the opioid crisis as a predominantly public health or law enforcement problem. We examined 3.8 million Congressional floor speeches and 111,000 public statements to identify (1) floor speeches about drug crises in the 97th to 114th Congresses (1981–2017) and (2) public statements about the opioid crisis in the 116th Congress (2019–2020). Moderate ideology, women, greater overdose deaths, and larger white populations are associated with significantly higher frequencies of opioid statements. Using a dictionary-based text analysis approach, we find that ideologically liberal and African American legislators are more likely to use public health framing, while ideologically conservative members are more likely to use law enforcement framing and refer to national borders or foreign countries in opioid statements. Democrats/liberals more often referenced medication treatment for opioids. These findings imply two broader conclusions about the nature of political discourse in public health crises. First, that political extremists are least likely to talk about opioids suggests that increasing partisan polarization may result in less discussion, emphasis, and expertise in public health issues. Second, the tenor of discourse about opioids and other public health crises is likely to change with partisan electoral waves, potentially hindering long term planning of public health capacity. • Public statements by members of Congress are a source of information about opioids. • We study determinants of the frequency and content of opioid public statements. • Moderates, women, and more impacted districts issue more opioid statements. • Liberal and African American members more often use public health language. • 25% of Democrats and 50% of Republicans used mostly law enforcement language. [ABSTRACT FROM AUTHOR]

In the past four decades, the discourse on addiction in the United States has dramatically changed. Most scholarly and popular accounts have depicted this change as an instance of "medicalization," wherebymedical definitions and imperatives have displaced those of morality, war, or criminal justice. This article seeks to revise that dominant characterization. In fact, the medicalization trend is only one part of a broader discursive shift, in which addiction has been normalized as a form of attachment and conduct--rendered ordinary, even predictable or natural, for a human life. The article reveals this shift through a set of historical readings across four venues in the period 1980-1993: scientific research, diagnostic protocols, judicial practice, and political rhetoric. More than an empirical advance, this shift in addiction discourse reflects a novel construction of the subject in our time. [ABSTRACT FROM AUTHOR]

The treatment of substance use disorders has always been challenging because multiple neurotransmitters mediate addiction. However, with smoking being the leading cause of preventable death and the recent opioid epidemic in the United States, the search for novel solutions becomes more imperative. In this review, we discuss the use of antibodies to treat addictions and highlight areas of success and areas that require improvement, using examples from cocaine, nicotine, and opioid vaccines. Through each example, we examine creative problem‐solving strategies for developing future vaccines, such as using an adenovirus vector as a carrier, designing bivalent vaccines, stimulating Toll‐like receptors for adjuvant effects, and altering the route of administration. Our review also covers passive immunization alone to override or prevent drug toxicity as well as in combination with vaccines for more rapid and potentially greater efficacy. [ABSTRACT FROM AUTHOR]

The rise in drug overdose deaths in the United States necessitates novel approaches to reduce harms. In response, peer recovery support services for substance use disorder have been implemented in clinical and community settings in several states. This descriptive analysis aimed to describe the implementation of hospital-based peer recovery support services for substance use disorder. We describe the implementation of the Peer Recovery Program, which delivers recovery support services 24 hours a day, seven days a week, for patients with substance use disorder in emergency departments and inpatient settings across 20 hospitals. We report program, patient, and referral characteristics and program process measures. From 2016 to 2019, Recovery Specialists received referrals during 30,263 patient visits. In 2019, 65.4% (n = 7,564) of patients were male. Across three subsamples of referrals, patient acceptance of continued recovery support services ranged from 74.8% to 83.0%. At affiliated hospitals in 2019, the median response time from referral to Recovery Specialist arrival at patient bedside was eight minutes (interquartile range = 4–16), and the median duration of initial bedside consultation was 35 minutes (interquartile range = 25–45). In 2019, Recovery Specialists and Patient Navigators attempted 113,442 follow-up contacts, and patients accepted 4,696 referrals provided by Patient Navigators to substance use disorder treatment and other medical, social, and recovery services and supports. This study describes peer recovery support services for substance use disorder delivered in emergency departments and inpatient settings. Evidence of improved patient outcomes is needed prior to widespread adoption. [ABSTRACT FROM AUTHOR]

Background: The opioid use disorder and overdose crisis in the United States affects public health as well as social and economic welfare. While several genetic and non-genetic risk factors for opioid use disorder have been identified, many of the genetic associations have not been independently replicated, and it is not well understood how these factors interact. This study is designed to evaluate relationships among these factors prospectively to develop future interventions to help prevent or treat opioid use disorder. Methods: The Genomics of Opioid Addiction Longitudinal Study (GOALS) is a prospective observational study assessing the interplay of genetic and non-genetic by collecting comprehensive genetic and non-genetic information on 400 participants receiving medication for opioid use disorder. Participants will be assessed at four time points over 1 year. A saliva sample will be collected for large-scale genetic data analyses. Non-genetic assessments include validated surveys measuring addiction severity, depression, anxiety, and adverse childhood experiences, as well as treatment outcomes such as urine toxicology results, visit frequency, and number of pre and post-treatment overdoses extracted from electronic medical records. Discussion: We will use these complex data to investigate the relative contributions of genetic and non-genetic risk factors to opioid use disorder and related treatment outcomes. [ABSTRACT FROM AUTHOR]

Among those who discuss America's opioid crisis, it is popular to claim that we know what we, as a society, ought to do to solve the problem—we simply don't want it badly enough. We don't lack knowledge; we lack the will to act and to fund the right policies. In fact, I've heard two versions of this. Among those who focus on prescription opioids, it is clear that we ought to stop prescribing so many powerful opioid painkillers. And among my public health colleagues focusing on illicit drug use, it is clear that we ought to expand addiction treatment and harm‐reduction services. The problem, however, is that the second claim is not obvious (and, indeed, is denied by many Americans), and the first claim probably isn't even true (at least, not in so crude a form). In short, the opioid crisis presents not only a problem of political will but also one of ethics. It will take work to discover or justify our normative claims in this arena. [ABSTRACT FROM AUTHOR]

In the United States, smoking has been strictly restricted by both federal and state governments. Almost all the policies have imposed high tax on cigarettes for decreasing the number of smokers. In fact, the smoking rate has fallen in the past few decades among the population. The main objective of this study is to evaluate whether the 'traditional' policy still remains effective by applying the dynamic panel strategy to state-level aggregated data in the United States. Our result shows that the remaining smokers up to today are less sensitive to the price hikes than past smokers and that they are likely to 'attenuate' the cost of smoking by stockpiling in advance of the policy enactment when they expect the increase of future price. The empirical results suggest that an increase in the cost may no longer be so valid as it was in past decades. [ABSTRACT FROM AUTHOR]

This study evaluated the efficacy of the Literacy-Free 12 Step Expressive Arts Therapy© curriculum in enhancing personal change and treatment outcomes for populations dually diagnosed with substance use and mental health disorders. It supplemented standard rehabilitation treatment for 47 individuals in a U.S. facility by incorporating 12 Step guidelines, cognitive behavioral therapy, rational emotive behavior therapy, and expressive arts activities. Pre-session and post-session participant ratings revealed positive increases for commitment to recovery, attitude toward making lifestyle changes, and hopefulness. Compared to 101 inpatients at the same facility, curriculum participants evidenced less drop-out, higher treatment completion, and greater personal investment in recovery. [ABSTRACT FROM AUTHOR]

Background: Recovery community centers (RCCs) are the "new kid on the block" in providing addiction recovery services, adding a third tier to the 2 existing tiers of formal treatment and mutual‐help organizations (MHOs). RCCs are intended to be recovery hubs facilitating "one‐stop shopping" in the accrual of recovery capital (e.g., recovery coaching; employment/educational linkages). Despite their growth, little is known about who uses RCCs, what they use, and how use relates to improvements in functioning and quality of life. Greater knowledge would inform the field about RCC's potential clinical and public health utility. Methods: Online survey conducted with participants (N = 336) attending RCCs (k = 31) in the northeastern United States. Substance use history, services used, and derived benefits (e.g., quality of life) were assessed. Systematic regression modeling tested a priori theorized relationships among variables. Results: RCC members (n = 336) were on average 41.1 ± 12.4 years of age, 50% female, predominantly White (78.6%), with high school or lower education (48.8%), and limited income (45.2% <$10,000 past‐year household income). Most had either a primary opioid (32.7%) or alcohol (26.8%) problem. Just under half (48.5%) reported a lifetime psychiatric diagnosis. Participants had been attending RCCs for 2.6 ± 3.4 years, with many attending <1 year (35.4%). Most commonly used aspects were the socially oriented mutual‐help/peer groups and volunteering, but technological assistance and employment assistance were also common. Conceptual model testing found RCCs associated with increased recovery capital, but not social support; both of these theorized proximal outcomes, however, were related to improvements in psychological distress, self‐esteem, and quality of life. Conclusions: RCCs are utilized by an array of individuals with few resources and primary opioid or alcohol histories. Whereas strong social supportive elements were common and highly rated, RCCs appear to play a more unique role not provided either by formal treatment or by MHOs in facilitating the acquisition of recovery capital and thereby enhancing functioning and quality of life. [ABSTRACT FROM AUTHOR]

Like many rural and suburban counties in the Midwestern United States, George County, Indiana is facing increased rates of heroin use, drug-related overdose, and hepatitis C. Following an outbreak of HIV in 2015 in a nearby county, the George County department of health launched an effort to open a needle exchange despite considerable opposition from the community, including ambivalent stances among current and former users of opiates. This article examines these conflicted perspectives noting their grounding in a moral approach to addiction and seeks to explain opposition to the needle exchange program by examining locals' depictions of the religious and moral landscape of the county. This analysis is based on 29 qualitative interviews conducted with 20 people who have experience using heroin or prescription opioid painkillers and 13 other community members involved in local efforts to address addiction. Ethnographic observation of public events was undertaken. Examining the contours of the local moral economy and its links to religious spirituality and practice reveals that the moral model of addiction both mitigates and produces social exclusion and begets conflicted stances towards the presence of an initiative to open a modest needle exchange program. Interviewees expressed a variety of stances towards the initiative feeling that it might decrease the spread of disease, but may not be used effectively. Though it is situated on morally contested terrain, it may be a step towards social inclusion and empowerment for addicted individuals who stake their right to health and a place in the community. [ABSTRACT FROM AUTHOR]

Introduction: The opioid epidemic is a severe problem in the world, especially in the United States, where prescription opioid overdose accounts for a quarter of drug overdose deaths. Objective: To describe psychiatrists' prescription of opioid, benzodiazepine, and buprenorphine in the United States. Methods: We conducted a retrospective cross-sectional study of the 2016 Medicare Part D claims data and analyzed psychiatrists' prescriptions of: 1) opioids; 2) benzodiazepines, whose concurrent prescription with opioids can cause overdose death; 3) buprenorphine, a partial opioid agonist for treating opioid addiction; 4) and naltrexone microsphere, a once-monthly injectable opioid antagonist to prevent relapse to opioid dependence. Prescribers with 11 or more claims were included in the analysis. Results: In Medicare Part D in 2016, there were a total of 1,131,550 prescribers accounting for 1,480,972,766 total prescriptions and 78,145,305 opioid prescriptions, including 25,528 psychiatrists (2.6% of all prescribers) accounting for 44,684,504 total prescriptions (3.0% of all prescriptions) and 131,115 opioid prescriptions (0.2% of all opioid prescriptions). Psychiatrists accounted for 17.3% of benzodiazepine, 16.3% of buprenorphine, and 33.4% of naltrexone microsphere prescriptions. The opioid prescription rate of psychiatrists was much lower than that of all prescribers (0.3 vs 5.3%). The buprenorphine prescription rate of psychiatrists was much higher than that of all prescribers (2.3 vs. 0.1%). There was a substantial geographical variation across the United States. Conclusions: The results show that, proportionally, psychiatrists have lower rates of opioid prescription and higher rates of benzodiazepine and buprenorphine prescription. [ABSTRACT FROM AUTHOR]

In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital utilisation who were housed as part of a scattered‐site Housing First program in a mid‐size city in the northeastern United States. 26 individual, semi‐structured interviews were conducted with Housing First clients in their homes or day program sites between March and July 2017. Interviews were digitally recorded and transcripts were analysed using a qualitative descriptive methodology until thematic saturation was reached. Findings suggest that housing provided the physical location to manage the logistical aspects of care for these clients, and an environment where they were better able to focus on their health and wellness. Study participants reported less frequent use of emergency services and more regular interaction with primary care providers. Additionally, case managers' role in connecting clients to behavioural health services removed barriers to care that clients had previously faced. Housing also facilitated reconnection with family and friends whose relationships with participants had become strained or distant. Changes to physical and social communities sometimes resulted in experiences of stigmatisation and exclusion, especially for clients who moved to areas with less racial and socioeconomic diversity, but participation in the program promoted an increased sense of safety and security for many clients. [ABSTRACT FROM AUTHOR]

The Model for End-Stage Liver Disease (MELD) score has been successfully used to prioritize patients on the United States liver transplant waiting list since its adoption in 2002. The United Network for Organ Sharing (UNOS)/Organ Procurement Transplantation Network (OPTN) allocation policy has evolved over the years, and notable recent changes include Share 35, inclusion of serum sodium in the MELD score, and a ‘delay and cap’ policy for hepatocellular carcinoma (HCC) patients. We explored the potential of a registrant’s change in 30-day MELD scores (ΔMELD30) to improve allocation both before and after these policy changes. Current MELD and ΔMELD30 were evaluated using cause-specific hazards models for waitlist dropout based on US liver transplant registrants added to the waitlist between 06/30/2003 and 6/30/2013. Two composite scores were constructed and then evaluated on UNOS data spanning the current policy era (01/02/2016 to 09/07/2018). Predictive accuracy was evaluated using the C-index for model discrimination and by comparing observed and predicted waitlist dropout probabilities for model calibration. After the change to MELD-Na, increased dropout associated with ΔMELD30 jumps is no longer evident at MELD scores below 30. However, the adoption of Share 35 has potentially resulted in discrepancies in waitlist dropout for patients with sharp MELD increases at higher MELD scores. Use of the ΔMELD30 to add additional points or serve as a potential tiebreaker for patients with rapid deterioration may extend the benefit of Share 35 to better include those in most critical need. [ABSTRACT FROM AUTHOR]

This study uses the search terms 'opiate*', 'opioid*' and 'fentanyl' to analyse social work peer-reviewed literature (n  = 573) between 1978 and 2017. There is an increasing focus on opioid use within literature during the forty-year period—a knowledge base predominantly outside discipline-specific social work journals—and a high prevalence of research from the USA and the UK. The thematic analysis finds a focus on identifying behaviours and risks associated with opioid use, assessment of opioid use and needs of service users in treatment, and intervention and relapse-prevention practices. There are many sound practice-relevant insights. However, the literature is limited in its ability to assess the needs of individuals not in treatment along with documenting preventative methods for opioid-related overdose. This is a significant omission, warranting further research, given the unknowing nature of opioid use associated with increasing rates of overdose throughout the world. [ABSTRACT FROM AUTHOR]

Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countries, although, decreases have been observed in parts of Europe. Opioid misuse is highest in the United States; approximately 11.8 million Americans misused opioids in 2016. Demographic, genetic, psychosocial and structural/environmental factors all play a role in determining who will become an opioid misuser. Strategies such as increased prescribing of non-opioid derived pain relievers, expansion of medication treatment, distribution of naloxone for overdose reversal and supervised consumption sites are some of the solutions posed to reduce the spread and consequences of opioid misuse. Conclusion: Research focused on understanding of opioid neurobiology, as well as empirically based, effective alternatives to pain management and implementation studies on combined prevention and treatment approaches are needed. It will take the combined effort of community members, healthcare professionals, policymakers and researchers in order to prevent and treat opioid misuse. [ABSTRACT FROM AUTHOR]

Background: The US National Institutes of Mental Health Research Domain Criteria (RDoC) seek to stimulate research into biologically validated neuropsychological dimensions across mental illness symptoms and diagnoses. The RDoC framework comprises 39 functional constructs designed to be revised and refined, with the overall goal of improving diagnostic validity and treatments. This study aimed to reach a consensus among experts in the addiction field on the 'primary' RDoC constructs most relevant to substance and behavioural addictions. Methods: Forty‐four addiction experts were recruited from Australia, Asia, Europe and the Americas. The Delphi technique was used to determine a consensus as to the degree of importance of each construct in understanding the essential dimensions underpinning addictive behaviours. Expert opinions were canvassed online over three rounds (97% completion rate), with each consecutive round offering feedback for experts to review their opinions. Results: Seven constructs were endorsed by ≥ 80% of experts as 'primary' to the understanding of addictive behaviour: five from the Positive Valence System (reward valuation, expectancy, action selection, reward learning, habit); one from the Cognitive Control System (response selection/inhibition); and one expert‐initiated construct (compulsivity). These constructs were rated to be related differentially to stages of the addiction cycle, with some linked more closely to addiction onset and others more to chronicity. Experts agreed that these neuropsychological dimensions apply across a range of addictions. Conclusions: The study offers a novel and neuropsychologically informed theoretical framework, as well as a cogent step forward to test transdiagnostic concepts in addiction research, with direct implications for assessment, diagnosis, staging of disorder, and treatment. [ABSTRACT FROM AUTHOR]

Evidence suggests that suicide rates can increase following the suicide of a prominent celebrity or peer, sometimes known as ‘suicide contagion’. The risk of contagion is especially high when media coverage is detailed and sensational. A recent study reported a 10% increase in U.S. suicides in the months following the suicide of comedian Robin Williams, who died in August 2014. The authors tentatively linked this increase to sensational media coverage; however, no content analysis of U.S. media was performed. As such, the aim of the present study is to formally examine the tone and content of U.S. newspaper coverage of Williams’ suicide. The primary objective is to assess adherence to suicide reporting guidelines in U.S. newspapers after his suicide. The secondary objective is to identify common emerging themes discussed in these articles. The tertiary objective is to compare patterns of results in the U.S media with those in the Canadian media. Articles about Williams’ suicide were collected from 10 U.S. newspapers in the 30-day period following his death using systematic retrieval software, which were then examined for adherence to suicide reporting recommendations. An inductive thematic analysis was also undertaken. A total of 63 articles were included in the study. We found that 100% of articles did not call it a ‘successful’ suicide, 96.8% did not use pejorative phrases and 71% did not say ‘commit’ suicide. However, only 11% included information about help-seeking, 27% tended to romanticize his suicide and 46% went into detail about the method. The most prominent emerging theme was Williams’ struggles with mental illness and addiction. These findings suggest that U.S. newspapers moderately adhered to best practice recommendations when reporting Williams’ suicide. Key recommendations were underapplied, which may have contributed to suicide contagion. New interventions targeting U.S. journalists and media may be needed to improve suicide reporting. [ABSTRACT FROM AUTHOR]