Jason P. Connor

Background: Amphetamine- and cannabis-induced psychoses are common clinical presentations that are difficult to differentiate from primary psychotic disorders. However, there are limited guidelines around the appropriate use of antipsychotic medications to treat these disorders. This review examined the literature considering the optimal drug, dose and duration of antipsychotic therapy to treat and prevent relapse of amphetamine- and cannabis-induced psychoses. Methods: A systematic review was conducted to identify original empirical studies considering antipsychotic drugs for the management of amphetamine- and cannabis-induced psychoses. Appraisal of included randomised controlled trials used the Cochrane risk-of-bias 2 and Joanna Briggs Institute critical appraisal tools, and the appropriate Joanna Briggs Institute tool for non-randomised controlled trials. Primary outcomes were measures of psychotic symptoms and rates of relapse of psychosis. Standardised mean differences were calculated where possible, and a narrative synthesis was completed. Results: This review included 11 studies investigating amphetamine-induced psychosis, totalling 724 participants, and 4 studies investigating cannabis-induced psychosis, totalling 1872 participants. Aripiprazole, haloperidol, olanzapine, paliperidone, quetiapine and risperidone were associated with reduced psychotic symptoms in amphetamine-induced psychosis; however, no regimen was superior. Likewise, risperidone, haloperidol and olanzapine were associated with reduced psychotic symptoms in cannabis-induced psychosis. There was no data regarding relapse following antipsychotic treatment for amphetamine-induced psychosis, and limited evidence to guide practice recommendations regarding relapse prevention following antipsychotic treatment for cannabis-induced psychosis. Conclusions: This review found support for the effectiveness of antipsychotic drugs in reducing amphetamine- and cannabis-induced psychosis symptoms. However, a lack of studies including follow-up post-cessation of treatment meant that there is currently insufficient evidence to guide recommendations about which regimen is most effective at preventing relapse to psychosis.

Background and aims: Increased risk of alcohol dependence is recognised following bariatric surgery. Modified gastrointestinal anatomy and neurohormonal profiles lead to altered alcohol metabolism, peak blood alcohol concentrations and enhanced reward circuits and cravings. For patients with metabolic associated fatty liver disease, bariatric surgery has been shown to reduce liver fibrosis; however, the impact of bariatric surgery on alcohol consumption and consequent liver fibrosis has not been well‐characterised using validated measures. This study examined the changes in alcohol consumption patterns, alcohol dependence and validated liver fibrosis measures before and after bariatric surgery. Design, setting and participants: A retrospective cohort study assessing patients seeking treatment for alcohol problems with a history of gastric sleeve (GS) or Roux‐en‐Y Gastric Bypass (RYGB) in a quaternary hospital in Brisbane, Australia. Measurements: Validated measures of alcohol dependence [Alcohol Use Disorders Identification Test (AUDIT) and brief Michigan Alcohol Screening Test (bMAST)] and non‐invasive liver fibrosis (FIB4 and APRI) were compared pre‐ and post‐surgery. Findings: Twenty patients were identified with prior GS and 10 patients with RYGB. Following bariatric surgery, body mass index was reduced by 14.5 (±9.39) kg/m ² . Metabolic co‐morbidities were less frequent post‐surgery. Pre‐surgery, the mean AUDIT score was 10.2 ± 8.9, with 9 patients having scores indicative of alcohol dependence. Mean AUDIT increased statistically significantly post‐surgery (18.1, standard deviation ±11.4; P < 0.001) with 29 patients meeting criteria for alcohol dependence. AUDIT components relating to both consumption (volume, frequency) and harmful consequences of alcohol increased following surgery. Despite surgery lowering metabolic liver fibrosis risk, worsened liver fibrosis was observed [mean FIB4 (0.98 ± 1.8) and APRI (0.41 ± 0.83) increased; P < 0.05]. Conclusion: Within a cohort of adults seeking treatment for alcohol problems, increases in alcohol consumption and alcohol‐related harm were observed following bariatric surgery. Despite improvement in risk factors for metabolic‐associated fatty liver disease after surgery, non‐invasive markers for hepatic fibrosis worsened, likely in the setting of harmful alcohol intake and associated liver injury. This supports the role of bariatric surgery pre‐operative assessment and post‐operative follow‐up to identify and manage alcohol‐related problems and associated liver disease risk.

Background and Aims: Global changes in cannabis legislation have raised concerns about the potential impact of cannabis advertising on cannabis use and intentions to use. This systematic review and meta‐analysis evaluated the relationship between self‐reported exposure to cannabis advertising across various media platforms and self‐reported cannabis use and use intentions. Design: Systematic review and meta‐analysis of eligible quantitative studies using random‐effects models. Setting: All included studies were conducted in the United States or Canada. Participants: Participants ranged in age from 11 to 65 + years across 21 included studies. Measurements: Studies measured self‐reported exposure to cannabis‐related advertising and either cannabis use or intentions to use cannabis. Three types of exposure were examined: [1] general cannabis advertising (a composite measure including billboards, storefront/sidewalk, magazines, social media, and other types of advertising avenues), [2] internet/social media advertising, and [3] storefront/sidewalk advertising. Findings: A total of 2588 records were identified through database searches (PubMed, Scopus, and PsycINFO; January 2024). After title and abstract screening, 45 underwent full text review; of these, 21 studies met inclusion criteria. Most were cross‐sectional (86%, n = 18), and three were longitudinal. Ten cross‐sectional studies were eligible for meta‐analysis, which found a statistically significant association between cannabis advertising exposure and cannabis use (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI] [1.32, 2.30]). Statistically significant heterogeneity was found (Q [11] = 22.73, P < 0.05, I ² = 42.3%) and therefore, based on methodological comparability, three additional meta‐analyses were conducted by exposure type. General cannabis advertising (3 studies) exposure was statistically significantly associated with cannabis use (aOR = 1.67, 95% CI [1.27, 2.21]); internet/social media advertising (5 studies) also showed a statistically significant association (aOR = 3.38, 95% CI [1.07, 10.66]); exposure to storefront/sidewalk advertising (3 studies) was not statistically significantly associated with cannabis use (aOR = 1.25, 95% CI [0.95, 1.66]). Across studies, methodological quality was mostly good (48%) or satisfactory (43%), with 10% rated as unsatisfactory. Conclusion: There appears to be a generally positive association between exposure to cannabis advertising and cannabis use, with a consistent positive relationship observed between advertising exposure and intentions to use.

Background and aims: Social media vaping awareness campaigns can potentially reduce youth vaping prevalence but creating effective campaign materials is time-consuming and resource-intensive. Artificial Intelligence (AI) offers capabilities for rapidly producing materials at scale, however, little is known about how youth perceive AI-generated multimedia materials combining images and text. This two-phase qualitative study explores whether, and how, AI-generated vaping awareness materials can deter youth vaping.Methods: In Phase 1, two focus groups with adolescents in Queensland, Australia (n=10 total; mean age:16.3) evaluated 120 AI-generated materials created with an automated-AI framework (zero-shot prompting, single-prompt usage, automatic text-image integration). Participants sorted materials into “effective” or “ineffective” categories and suggested improvements. Using this feedback, 25 new materials were developed through an AI-co-design framework (few-shot prompting, iterative prompting, manual text-image integration). In Phase 2, semi-structured interviews with young adults (n=9, mean age:23) identified effective material characteristics. Both phases used inductive thematic analysis.Results: Participants in Phase 1 identified limitations in materials developed with an automated-AI framework: misaligned text-image combinations, artificial imagery, unrealistic vaping devices and inauthentic language. Phase 2 revealed six characteristics of effective materials: (1) visual appeal, (2) immediate consequences, (3) relevant to youth, (4) clear calls to action, (5) avoid ambiguity/fearmongering, and (6) tailor to diverse youth. Conclusions: AI can generate individual text and image components for health promotion campaigns, but automated-AI multimedia material development is unlikely to succeed. Effective implementation will require co-designing with young people to guide material refinement and design integration.

Background and aims: E‐cigarette use (vaping) has increased in Australia despite restrictive policies. Little is known about the profiles and reasons to vape in this tightly regulated setting. This study aimed to determine the distinct profiles of individuals who vape and the socio‐demographic, psychological and substance use related correlates of these profiles. Design: Observational study using cross‐sectional data from from the 2022–2023 National Drug Strategy Household Survey. Setting: Australia. Participants: 21 500 respondents aged 14 years and older. Measurements: Latent class analysis was used to identify distinct subgroups based on smoking status, vaping status, use of nicotine vapes, prescription vapes, inability to stop or cut down on the use of vapes and motivations to vape. Multinomial logistic regression explored the sociodemographic, mental health and substance use correlates of each identified class. Findings: A five‐class solution was identified among the 18.7% of survey participants who have ever vaped. Class 1 (Experimented with vapes to quit smoking, 4.1%) predominantly included individuals who smoked daily and had experimented with vapes, presumably in the context of smoking cessation. Class 2 (Experimented with vapes for curiosity, 9.2%) mostly included individuals who had never smoked but had tried vaping once or twice out of curiosity. Class 3 (Exclusive Vaping, 4.2%) was characterised by individuals who regularly vaped but had never smoked. Class 4 (Non‐use, 80.3%) comprised individuals who did not currently smoke or vape. Class 5 (Using vapes to quit smoking, 2.2%) featured individuals who smoked and used e‐cigarettes as a cessation aid. Using Class 4 (non‐use) as a reference group, respondents in other classes, especially those in Class 5 (using vapes to quit smoking) reported very high psychological distress [odds ratio (OR) = 4.0, 99.6% confidence interval (CI) = 2.3–6.9], hazardous alcohol consumption (OR = 2.1, 99.6% CI = 1.4–3.3) and use of illicit drugs in the past year (OR = 6.4, 99.6% CI = 4.6–9.0). Conclusions: Australians who vape appear to be associated with younger age, lower educational attainment, higher psychological distress and higher recent use of other substances compared with Australians who do not vape.

Background and aim: Cannabis use is associated with psychiatric comorbidities, and the use of elta‐9‐tetrahydrocannabinol (THC) and cannabidiol (CBD) produces different neurophysiological and pharmacological effects. This study estimated the strength of associations between vaping of THC and CBD with depressive and anxiety symptoms in adolescents. Design: Observational data were drawn from three years of the nationally representative US National Youth Tobacco Survey (2021–2023). The survey adopted a probabilistic stratified, three‐stage cluster design. Setting: The United States. Participants: A total of 69 899 adolescents aged 11 to 18, with 51.3% males. Measurements: CBD and THC cannabis vaping behaviours; Patient Health Questionnaire 2‐item and Generalised Anxiety Disorder 2‐item, which respectively assess depressive and anxiety symptoms. Logistics regression analyses were conducted after multiple imputation and adjusting for covariates. Findings: Relative to those who did not vape, adolescents who vaped THC only [adjusted odds ratio (aOR) = 1.40, 95% confidence interval (CI) = 1.20–1.64] or dual CBD/THC (aOR = 1.51, 95% CI = 1.22–1.86) were more likely to experience depressive symptoms; whereas those who vaped CBD only (aOR = 1.74, 95% CI = 1.24–2.46) or THC only (aOR = 1.18, 95% CI = 1.01–1.38) were more likely to experience anxiety symptoms. When the sample was restricted to adolescents who had vaped cannabis products, those who only vaped CBD had a higher likelihood of experiencing anxiety symptoms (aOR = 1.51, 95% CI = 1.05–2.17), relative to those who exclusively vaped THC. Conclusions: Among adolescents, Δ‐9‐tetrahydrocannabinol (THC) vaping and dual THC/cannabidiol vaping might be associated with an increased risk of experiencing depressive symptoms. In contrast, adolescents who vape cannabidiol may have a higher likelihood of experiencing anxiety symptoms.

Background and aims: Understanding lifetime alcohol exposure is fundamental to appreciating the risks of alcohol dependence and the multiplicity of alcohol‐related harms, such as cirrhosis. However, most research relies on self‐reported alcohol use measures that rarely extend beyond recent consumption. This represents a critical limitation in assessing the relationship between alcohol exposure and biological or psychological outcomes. Concerns about recall bias may be overstated and risk obstructing translational research into long‐term effects of alcohol, including treatment engagement. This scoping review examined the evidence for the reliability and validity of self‐reported measures of lifetime alcohol consumption. Methods: We searched the MEDLINE, EMBASE and PsycINFO databases in June 2024 for English‐language articles published since 1970. We included studies that performed at least one of the following psychometric assessments on a lifetime alcohol exposure measure: test–retest reliability, internal consistency, concurrent validity or construct validity. Results: The search identified 1607 unique records. After title and abstract screening, 24 studies underwent full‐text review, with nine meeting the inclusion criteria. Most studies were conducted in North America (78%). The most frequently used instrument was the Lifetime Drinking History (LDH) (67%). Across all studies, there were 6010 participants (3478 male, 2532 female), with sample sizes ranging from 49 to 3255. In 78% of studies, alcohol exposure data were collected via face‐to‐face interview. Eight studies assessed test–retest reliability, with retest intervals ranging from 14 days to 13 years; none assessed internal consistency. Three studies (33%) formally assessed validity. Where assessed, test–retest reliability and concurrent and construct validity were moderate to strong. Test–retest reliability ranged from 0.67 to 0.92, and concurrent and construct validity with external reference measures ranged from 0.40 to 0.80, indicating generally acceptable performance. Conclusions: Existing instruments for measuring lifetime alcohol exposure appear to be valid and reliable and can overcome concerns regarding biases; however, these instruments vary in structure, lack standardisation and may fail to capture binge or episodic drinking, highlighting important gaps for refinement.

Background: Few personalized behavioral treatments are available to reduce the risk of prescription opioid–related harm among patients with chronic noncancer pain. Objective: We aimed to report on the second phase of the co-design of a digital brief intervention (BI) based on patient and health professional preferences. Methods: Eligible patients with chronic noncancer pain (n=18; 10 women; mean age 49.5, SD 6.91 y) from public hospital waitlists and health professionals (n=5; 2 women; mean age 40.2, SD 5.97 y) from pain and addiction clinics completed semistructured telephone interviews or participated in focus groups exploring BI preferences, needs, and considerations for implementation. Grounded theory was used to thematically analyze the data. Results: We identified 5 themes related to intervention content from patient reports: relevance of the biopsychosocial model and need for improved awareness and pain psychology education; nonpharmacological strategies and flexibility when applying coping skills training; opioid use reflection and education, with personalized medication and tapering plans; holistic and patient-inclusive assessment measures and feedback; and inclusion of holistic goals targeting comfort and happiness. Five themes related to the process and guiding principles were identified: therapist guided; engaging features; compassionate, responsive, person-centered care; a digital solution is exciting, maximizing reach; and educate and normalize system and policy challenges. Finally, 5 themes were reflected in the health professionals’ reports: digital health use is rare but desired; digital health is useful for patient monitoring and accessing support; patient motivation is important; a digital BI app is likely beneficial and at multiple care points; and safe medication use and managing pain goals. The reported barriers from health professionals were intervention intensity, potential costs, and patient responsiveness; factors facilitating the implementation were the alignment of digital BIs with clinical models, a stepped-care approach, and feedback. Conclusions: This co-design study identified key content areas, guiding principles, enabling factors, and barriers from both patients and health professionals to guide the development of digital BIs. The knowledge gathered should inform future iterations of co-designing digital BIs for the population most at risk of the harmful effects of opioid medications.

Background: Opioid medications are important for pain management, but many patients progress to unsafe medication use. With few personalized and accessible behavioral treatment options to reduce potential opioid-related harm, new and innovative patient-centered approaches are urgently needed to fill this gap. Objective: This study involved the first phase of co-designing a digital brief intervention to reduce the risk of opioid-related harm by investigating the lived experience of chronic noncancer pain (CNCP) in treatment-seeking patients, with a particular focus on opioid therapy experiences. Methods: Eligible patients were those aged between 18 and 70 years with CNCP at a clinically significant level of intensity (a score of ≥4 of 10). Purposive sampling was used to engage patients on public hospital waitlists via mail or through the treating medical specialist. Participants (N=18; n=10 women; mean age 49.5 years, SD 11.50) completed semistructured telephone interviews. Interviews were transcribed verbatim, thematically analyzed using grounded theory, and member checked by patients. Results: Eight overarching themes were found, listed in the order of their prominence from most to least prominent: limited treatment collaboration and partnership; limited biopsychosocial understanding of pain; continued opioid use when benefits do not outweigh harms; a trial-and-error approach to opioid use; cycles of hopefulness and hopelessness; diagnostic uncertainty; significant negative impacts tied to loss; and complexity of pain and opioid use journeys. Conclusions: The findings of this study advance progress in co-designing digital brief interventions by actively engaging patient partners in their lived experiences of chronic pain and use of prescription opioid medications. The key recommendations proposed should guide the development of personalized solutions to address the complex care needs of patients with CNCP.