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Aims An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. Methods Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. Results We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference −20 g/wk, 95% confidence interval −28 to −12). Subgroup analysis showed a similar effect for men and women. Conclusions Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting. [ABSTRACT FROM AUTHOR]

Aim To investigate whether different sequences of 'change talk' utterances within a brief motivational intervention (BMI) are associated with drinking outcomes. Design Speech content analysis of recorded BMI. Setting BMI delivered in an emergency department for at-risk drinking. Participants Ninety-seven subjects who received a BMI. Measurements Ninety-seven BMI were coded in duplicate by two psychologists with the Motivational Interviewing Skill Code (MISC), a Hidden Markov Model was used to identify three different patient states reflecting attitudes regarding changing their drinking behaviour within a BMI: towards change, away from change and non-determined. Adjusted regression models were used to predict drinking at 12 months' follow-up using patient attitudes regarding changing drinking at the beginning, during the intervention and at the end. Findings The dynamic process at place within a BMI was marked mainly by stability: at each point during the intervention, staying in the same attitude was far more likely than transitioning from one attitude to another. When subjects did change from one attitude to another, they were more likely to move from an 'away from change' to a 'towards change' state. At 12 months, subjects with an attitude towards change at the end of the BMI drank significantly less (13.1 drinks per week) than subjects with an attitude away from change, independent of their attitude at the beginning of the intervention. Conclusions Transition in 'change talk' between 'away from change' and 'towards change' appears to be rare in brief motivational intervention for excessive alcohol consumption. Moreover, change talk 'towards change' at the end of the intervention is associated with improved outcomes at follow-up, independently of the type of change talk at the beginning of the intervention, suggesting that it is important to end a BMI session with a positive attitude towards change by the client. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) training among medical students. METHODS: All students (n=131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0. RESULTS: Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for 'Empathy' [p<0.001] and 'MI Spirit' [p<0.001]. Scores were similar between groups for 'Direction', indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p<0.001], MI non-adherent behavior [p<0.001], Closed questions [p<0.001], Open questions [p=0.001], simple reflections [p=0.03], and Complex reflections [p<0.001]. Occurrences were similar between groups regarding 'Giving information'. CONCLUSION: An 8-h training workshop was associated with improved MI performance. PRACTICE IMPLICATIONS: These findings lend support for the implementation of MI training in medical schools. [ABSTRACT FROM AUTHOR]

Background: Many digital interventions for unhealthy alcohol use are based on personalized normative feedback (PNF) and personalized feedback on risks for health (PFR). The hypothesis is that PNF and PFR affect drinkers' perceptions of drinking norms and risks, resulting in changes in drinking behaviors. This study is a follow-up mediation analysis of the primary and secondary outcomes of a randomized controlled trial testing the effect of a smartphone-based intervention to reduce alcohol use., Objective: This study aimed to investigate whether perceptions of drinking norms and risks mediated the effects of a smartphone-based intervention to reduce alcohol use., Methods: A total of 1770 students from 4 higher education institutions in Switzerland (mean age 22.35, SD 3.07 years) who screened positive for unhealthy alcohol use were randomized to receive access to a smartphone app or to the no-intervention control condition. The smartphone app provided PNF and PFR. Outcomes were drinking volume (DV) in standard drinks per week and the number of heavy drinking days (HDDs) assessed at baseline and 6 months. Mediators were perceived drinking norms and perceived risks for health measured at baseline and 3 months. Parallel mediation analyses and moderated mediation analyses were conducted to test whether (1) the intervention effect was indirectly related to lower DV and HDDs at 6 months (adjusting for baseline values) through perceived drinking norms and perceived risks for health at 3 months (adjusting for baseline values) and (2) the indirect effects through perceived drinking norms differed between participants who overestimated or who did not overestimate other people's drinking at baseline., Results: The intervention's total effects were significant (DV: b=-0.85, 95% bootstrap CI -1.49 to -0.25; HDD: b=-0.44, 95% bootstrap CI -0.72 to -0.16), indicating less drinking at 6 months in the intervention group than in the control group. The direct effects (ie, controlling for mediators) were significant though smaller (DV: b=-0.73, 95% bootstrap CI -1.33 to -0.16; HDD: b=-0.39, 95% bootstrap CI -0.66 to -0.12). For DV, the indirect effect was significant through perceived drinking norms (b=-0.12, 95% bootstrap CI -0.25 to -0.03). The indirect effects through perceived risk (for DV and HDD) and perceived drinking norms (for HDD) were not significant. Results of moderated mediation analyses showed that the indirect effects through perceived drinking norms were significant among participants overestimating other people's drinking (DV: b=-0.17, 95% bootstrap CI -0.32 to -0.05; HDD: b=-0.08, 95% bootstrap CI -0.15 to -0.01) but not significant among those not overestimating., Conclusions: Perceived drinking norms, but not perceived risks, partially mediated the intervention's effect on alcohol use, confirming one of its hypothesized mechanisms of action. These findings lend support to using normative feedback interventions to discourage unhealthy alcohol use., Trial Registration: ISRCTN Registry 10007691; https://doi.org/10.1186/ISRCTN10007691., (©Joseph Studer, John A Cunningham, Elodie Schmutz, Jacques Gaume, Angéline Adam, Jean-Bernard Daeppen, Nicolas Bertholet. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.02.2025.)

Introduction: The influence of age on brief motivational interventions (BMI) effects remains unknown. In the present study, we explored whether change in alcohol consumption after BMI differs across age groups and whether these differences are reflected in motivational interviewing (MI) counsellor skills., Method: Secondary analysis of a randomized controlled trial among emergency room (ER) patients screened for unhealthy alcohol consumption. Participants (N = 97, 80 % men, 18-21 y: 19.6 %, 22-29 y: 22.7 %, 30-49 y: 34.0 % and ≥50 y: 23.7 %) received a single BMI in the ER, which was coded using the MI Skills Code 2.0. Alcohol outcomes were measured at 12-month. First, we tested whether BMI effect varied by age group using negative binomial regression for weekly drinking consumption, and logistic regression for change to low-risk drinking. Second, MI counsellor skills (global ratings of empathy, MI spirit and acceptance, and percentages of open questions, complex reflections (CR) and MI-consistent behaviors) were examined through one-way ANOVA or Welch test., Results: The 22-29 y group i) reported lower consumption at follow-up compared to the 30-49 y group (IRR=1.60, p  = .04) and the ≥ 50 y group (IRR=1.67, p  = .03), and ii) was more likely to change to low-risk drinking than the 18-21 y group (OR=11.25, p  = .04). When comparing MI counsellor skills across age groups, higher empathy ratings (F(3,93)= 2.70, p  = .05) and a higher percentage of CR (F(3,93)= 4.10, p  = .009) were recorded for the 22-29 y group., Conclusion: This exploratory study shows that BMI was associated with significantly better 12-month alcohol outcomes among patients aged 22-29 years, which corresponded with higher counsellor empathy ratings and percentage of CR., Competing Interests: none., (© 2024 The Authors.)

Warnings in Europe signal a rise in illicitly-manufactured fentanyl and other high potency synthetic opioids which could destabilize drug markets, strain health systems, and escalate harms of substance use and death. Here, we provide an overview of fentanyl in North America, drawing implications for Switzerland. Fentanyl withdrawal starts sooner, is more severe, and has worse anxiety and pain. Clinical care includes aggressive use of full agonist opioids, opioid agonist therapies (OAT) and adjunctive medications for acute withdrawal, and a need for low-threshold, readily accessible OAT to engage patients and mitigate harms. The US experience suggests the importance of widespread naloxone distribution, peer-based initiatives, early warning systems, and partnerships across patient-groups, healthcare systems, and public health., Competing Interests: Les auteur-es n’ont déclaré aucun conflit d’intérêts en relation avec cet article

Background and Aims: Unhealthy alcohol use is common and causes tremendous harm. Most people with unhealthy alcohol use will never seek formal alcohol treatment. As an alternative, smartphone apps have been developed as one means to provide help to people concerned about their alcohol use. The aim of this study was to test the efficacy of a smartphone app targeting unhealthy alcohol consumption in a general population sample., Methods: Participants were recruited from across Canada using online advertisements. Eligible participants who consented to the trial were asked to download a research-specific version of the app and were provided with a code that unlocked it (a different code for each participant to prevent sharing). Those who entered the code were randomized to one of two different versions of the app: 1) the Full app containing all intervention modules; or 2) the Educational only app, containing only the educational content of the app. Participants were followed-up at 6 months. The primary outcome variable was number of standard drinks in a typical week. Secondary outcome variables were frequency of heavy drinking days and experience of alcohol-related problems., Results: A total of 761 participants were randomized to a condition. The follow-up rate was 81 %. A generalized linear mixed model revealed that participants receiving the full app reduced their typical weekly alcohol consumption to a greater extent than participants receiving the educational only app (incidence rate ratio 0.89; 95 % confidence interval 0.80 to 0.98). No significant differences were observed in the secondary outcome variables ( p >  .05)., Discussion and Conclusion: The results of this trial provide some supportive evidence that smartphone apps can reduce unhealthy alcohol consumption. As this is the second randomized controlled trial demonstrating an impact of this same app (the first one targeted unhealthy alcohol use in university students), increased confidence is placed on the potential effectiveness of the smartphone app employed in the current trial.ClinicalTrials.org number: NCT04745325., Competing Interests: The authors have no conflicts of interests to declare., (© 2024 The Authors.)

Objective: Investigate the effect of change talk (CT) within successive brief motivational interventions (BMIs) as a mechanism of change for alcohol use., Method: We conducted a secondary analysis of data from a randomized controlled trial in which 344 young adults (18-35 years old) admitted to a Swiss emergency department with alcohol intoxication received either BMI ( N = 171) or brief advice ( N = 173). Participants with a baseline audio-recorded BMI were included ( N = 140; median age 23 [ Q 1- Q 3: 20-27], 72.9% men). Up to three booster sessions by phone were offered at 1 week, 1 month, and 3 months. Percent CT and CT Average Strength were used as predictor variables. The outcome was the number of heavy drinking days (HDD) over the 30 days prior to research assessments at 1-, 3-, 6-, and 12-month follow-up. A latent growth curve modeling framework was first used to estimate predictor and outcome variable growth parameters (i.e., intercept and slope) over time, and then to regress HDD growth parameters on CT growth parameters., Results: CT increased specifically from baseline to the 1-week booster session and thereafter remained stable. Higher baseline CT was associated with lower HDD at 1 month (Percent CT: b = -0.04, 95% confidence interval [-0.06, -0.01]; Average Strength: b = -0.99 [-1.67, -0.31]). An increase in CT from baseline to the 1-week booster session was related to a decrease in HDD from 1 month to 12 months (Percent CT: b = -0.08 [-0.14, -0.03]; Average Strength: b = -2.29 [-3.52, -1.07])., Conclusions: Both baseline CT and CT trajectory over the first week are meaningful predictors of HDD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and whether frailty moderates the association., Setting: Northeastern US city., Methods: We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable generalized estimating equation regression models for each fall-related outcome., Results: Among PWH (n = 251; mean age 52 [SD = 10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, and 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR = 1.49, 95% CI: 1.08 to 2.07), multiple falls (AOR = 1.55 95% CI: 1.10 to 2.19), and fall/fracture-related emergency department visit or hospitalization (AOR = 1.81, 95% CI: 1.10 to 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and emergency department visit/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR = 2.26, 95% CI: 1.28 to 4.01 in those frail) but not in those not frail., Conclusion: The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To estimate the effects of providing access to an alcohol intervention based on a smartphone., Design: Randomised controlled trial.., Setting: Four higher education institutions in Switzerland., Participants: 1770 students (≥18 years) who screened positive for unhealthy alcohol use (ie, a score on the alcohol use disorders identification test-consumption (AUDIT-C) of ≥4 for men and ≥3 for women) were randomly assigned by 1:1 allocation ratio in blocks of 10., Intervention: Providing access to a brief, smartphone based alcohol intervention., Outcome Measures: The primary outcome studied was number of standard drinks per week at six months and the secondary outcome was number of heavy drinking days (past 30 days). Additional outcomes were maximum number of drinks consumed on one occasion, alcohol related consequences, and academic performance. Follow-up assessments occurred at months three, six, and 12. Data were analysed by intention to treat and by using generalised linear mixed models with random intercepts for the recruitment site and participants nested within the recruitment site, and with intervention ( v control), time (three months v six months; 12 months v six months), and baseline outcome values as fixed effects., Results: Between 26 April 26 2021 and 30 May 2022, 1770 participants (intervention group (n=884); control group (n=886)) were included. Mean age was 22.4 years (standard deviation 3.07); 958 (54.1%) were women; and 1169 (66.0%) were undergraduate students, 533 (30.1%) were studying for a master's degree, 43 (2.4%) were studying for a doctorate, and 25 (1.4%) were students of other higher education programme. The baseline mean number of standard drinks per week was 8.59 (standard deviation 8.18); the baseline number of heavy drinking days was 3.53 (4.02). Of 1770 participants, follow-up rates were 1706 (96.4%) at three months, 1697 (95.9%) at six months, and 1660 (93.8%) at 12 months. Of 884 students randomly assigned to the intervention group, 738 (83.5%) downloaded the smartphone application. The intervention had a significant overall effect on the number of standard drinks per week (incidence rate ratio 0.90 (95% confidence interval 0.85 to 0.96)), heavy drinking days (0.89 (0.83 to 0.96)), and the maximum number of drinks consumed on one occasion (0.96 (0.93 to 1.00), P=0.029), indicating significantly lower drinking outcomes in the intervention group than in the control group during the follow-up period. The intervention did not affect alcohol related consequences or academic performance., Conclusions: Providing access to the smartphone application throughout the 12 month follow-up was effective at limiting the average drinking volume of university students who had self-reported unhealthy alcohol use at baseline., Trial Registration: ISRCTN 10007691., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: support from the Swiss National Science Foundation for the submitted work. NB reports a grant from: Commission de Promotion de la Santé et de Lutte Contre Les Addictions (CPSLA; Public regional funding from State of Vaud, Switzerland), as co-investigator; honoraria from the Swiss Medical Association, for the development of screening and brief intervention guidelines for primary care providers. AA reports a grant from CPSLA. GG reports a grant from the Swiss National Science Foundation (separate from the trial grant); he is a member of the technical advisory group on alcohol epidemiology, World Health Organization and of FEDESTAT (Federal commission on statistics, Swiss Federal Statistical Office, Berne, Switzerland). JAC reports grants from Canadian Institutes of Health Research (No. CFP 425862) as principal investigator and for a randomised controlled trial on targeting mailed nicotine patch distribution interventions to rural regions of Canada (Canadian Cancer Society, No. 706201, as principal investigator), and as a principal investigator for offering nicotine patches to all households in a municipality with high smoking rates (Canadian Institutes of Health Research, No. 153324). He was also involved in the trial: Does providing a brief Internet intervention for hazardous alcohol use to people seeking online help for depression reduce both alcohol use and depression symptoms among participants with these dual disorders? JM reports grants from NIH/NIDA, CDC, and a subcontract from the Northstar Node of the NIH/NIDA Clinical Trials Network. She also reports consulting fees from the National Committee for Quality Assurance, Expert for Alcohol Screening Learning Collaborative, Boston University, Fellowship Immersion Training, Faculty NYC Dept of Health and Mental Hygiene, buprenorphine mentorship program. She participates in data safety monitoring boards: as chair for extended-release v oral naltrexone for alcohol dependence treatment in primary care; as a member for integrated care for chronic pain and opioid use disorder: the IMPOWR Montefiore/Einstein (IMPOWR-ME) research center; and as a member for the randomised controlled trial of the effects of psilocybin-facilitated experience on the psychology and effectiveness of professional leaders in religion. She is a member of the Committee for the Care of Substance Users with HIV Infection, NYS Department of Health AIDS Institute, HIV Clinical Guidelines Program., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Research has not identified which patients optimally benefit from brief Motivational Interviewing (bMI) for heavy drinking when delivered to young adults in the Emergency Department (ED)., Methods: We conducted secondary analyses of data from a randomized controlled trial in which 344 young adults (18-35 years) presenting to the ED with alcohol intoxication received either bMI or Brief Advice (BA, control group). We used Latent Class Analysis to derive participants' profiles from baseline characteristics (i.e., sex, age, severity of alcohol use disorder, attribution of ED admission to alcohol use, importance, and confidence to change, cognitive discrepancy, anxiety, depression, and trait reactance). We then conducted a moderation analysis to assess the number of heavy drinking days at short-term (1-month) and long-term (12-month) follow-up using negative binomial regressions with interactions between the intervention and derived classes., Results: Fit statistics indicated that a 4-class solution best fit the data. Class 3 (high severity, importance and discrepancy, and low confidence and anxiety) benefitted more from bMI than BA at short- and long-term follow-up than Class 1 (younger; lowest severity, importance, discrepancy, reactance, anxiety and depression, and highest confidence). Class 2 (older; highest severity, importance, discrepancy, reactance, anxiety and depression, and lowest confidence) also benefitted more from bMI than BA than did Class 1 at short-term follow-up. In these significant contrasts, Class 1 benefitted more from BA than bMI. There were no significant interactions involving Class 4 (more likely to be women; low severity; high levels of anxiety, depression, and reactance)., Conclusions: This study identified the patient profiles that benefitted more from bMI than BA among nontreatment-seeking young adults who present intoxicated to the ED. The findings have implications for intervention design and argue for the importance of research aimed at developing intervention content tailored to patient profiles., (© 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Introduction: This study examines normative misperceptions in a sample of participants recruited for a brief intervention trial targeting risky cannabis use., Methods: Participants who were concerned about their own risky cannabis use were recruited to help develop and evaluate intervention materials. At baseline, participants reported on their own cannabis use and provided estimates of how often others their gender and age used cannabis in the past 3 months. Comparisons were made between participants estimates of others cannabis use with reports of cannabis use obtained from a general population survey conducted during a similar time period., Results: Participants (N = 744, mean age = 35.8, 56.2% identified as female) largely reported daily or almost daily cannabis use (82.4%). Roughly half (55.3%) of participants estimated that others their age and gender used cannabis weekly or more often in the past 3 months, whereas the majority of people in the general population reported not using cannabis at all., Conclusions: Normative misperceptions about cannabis use were common in this sample of people with risky cannabis use. Limitations and possible future directions of this research are discussed, as well as the potential for targeting these misperceptions in interventions designed to motivate reductions in cannabis use., Clinicaltrialsorg Number: NCT04060602., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium., Methods: People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm 3 ) adjusting for covariates. Analyses were conducted separately by site., Results: The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively., Conclusions: In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control., (© 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population., Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population., Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing., Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: "General Acceptance of the App," "Importance of the Targeted and Relevant App Content," "Importance of Credibility," "Importance of the App Usability," "Importance of a Simple and Attractive Design," "Importance of Notifications to Ensure App Use over Time." Besides a general acceptance of the app, these themes reflected participants' recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved., Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time., Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691., International Registered Report Identifier (irrid): RR2-10.1186/s13063-020-4145-2., (©Nicolas Bertholet, Elodie Schmutz, John A Cunningham, Jennifer McNeely, Gerhard Gmel, Jean-Bernard Daeppen, Véronique S Grazioli. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 07.03.2023.)

Addictions appear everywhere, mutate, transform with new products and behaviors, playing on our painstaking efforts to try to control them. Drawn into this current, the impression that dominates invites more to understand and to coax rather than to fight. Addictions are our condition, let's deal with it, rather than fight against them. It is therefore a question of knowing the products, that everyone can identify their level of risk, and of giving as many tools as possible, at any age, whatever the behavior or the product. This article shows us that there is a lot to do, from school benches to liver transplantation. There is also a lot to discover, in the recognition of the therapeutic virtues, of cannabinoids for example or even in their prescription, of pharmaceutical heroin for example, sometimes by far the best option., Competing Interests: La Pre Broers est membre du comité de la Société suisse pour le cannabis en médecine mais déclare qu’il n’y a pas de conflit d’intérêts en relation avec cet article. Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Substance-induced consciousness alterations (CA) have mainly been studied among users of psychedelics but not among people using street drugs., Aims: Explore occurrences of three different types of substance-induced CA [ego dissolution (ED), visual pseudo-hallucinations (VPH), anxiety/paranoia (A/P)] and their perceived influences on life, together with their associations with substance use and personality correlates in a general population sample of 25-year-old men., Methods: 2,796 young Swiss men lifetime substance users completed a self-report questionnaire including history of use (never, former, and current) of different substances categories (psychedelics, cocaine, psychostimulants, ecstasy, MDMA, and other drugs), substance-induced ego dissolution (ED), visual pseudo-hallucinations (VPH) and anxiety/paranoia (A/P), the influence of these CA experiences on life, and personality traits (sensation seeking, sociability, anxiety-neuroticism, and aggression-hostility)., Results: 32.2% reported at least one CA (i.e., ED, VPH or A/P), with 20.5% reporting ED, 16.7% VPH, and 14.6% A/P. Former and current use of psychedelics and ketamine was significantly associated with occurrences of all three types of CAs and with a positive influence of CA on life. Associations between the former and current use of other substances and the different types of CA were less consistent, and perceived influences on life were not statistically significant. Sociability was negatively associated with occurrences of all three types of CA. Positive associations were found between anxiety-neuroticism and ED and A/P, between aggression-hostility and A/P, and between sensation seeking and ED and VPH., Conclusion: This study supports the potential for psychedelics to induce CAs perceived as beneficial to life among people using street drugs, possibly reflecting the mechanism underlying the therapeutic potential of psychedelics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Deligianni, Studer, Gmel, Khazaal and Bertholet.)