IntroductionAdults with attention-deficit/hyperactivity disorder (ADHD) use tobacco, cannabis, alcohol, cocaine and non-prescribed stimulants far more than the general population. The self-medication hypothesis holds that people with ADHD, including those undiagnosed, use substances to relieve core symptoms rather than for recreation or shared vulnerability to addiction, and is widely invoked to reframe illicit substance use as undiagnosed ADHD. How this claim is framed and tested has not been mapped across substances.ObjectiveTo map the literature invoking self-medication of ADHD symptoms in adults, substance by substance, and to characterise how each source frames the concept relative to misuse, recreational or shared-liability accounts.Eligibility criteriaEmpirical studies, reviews, commentaries, preprints and trial-register records on self-medication of ADHD symptoms with a psychoactive substance in adults or predominantly adult samples; English; inception to 21 July 2026.Information sourcesPubMed, OpenAlex and Consensus, with ClinicalTrials.gov and a preprint search. Searches were conditioned on self-medication and motive terminology, so the corpus maps the self-medication literature and does not sample the misuse or shared-liability literature independently.Charting methodsSources were charted for substance, design, population, operationalisation of self-medication, and a framing category (self-medication-framed; mixed; misuse- or shared-liability-framed; neutral/descriptive). A descriptive map was built by substance. No critical appraisal or evidence-strength ranking was made.ResultsOf 937 records identified and 820 screened, 109 sources (1986–2026) met the criteria. Coverage was heaviest for non-prescribed stimulants (n=35), cannabis (n=29), nicotine (n=25) and alcohol (n=17); no eligible ketamine source was identified. Self-medication framing was most prevalent, and uniquely accompanied by experimental data, for nicotine; prevalent but observational for cannabis; coexisted with academic and recreational motives for stimulants; and alcohol was mostly framed as comorbidity or shared liability. Self-medication was overwhelmingly inferred from association or motive report rather than tested against symptom change.ConclusionsSelf-medication framing is substance-specific in prevalence and accompanying evidence. Because the search was conditioned on self-medication terminology, the map describes how the literature frames the claim and does not adjudicate between competing accounts. Applying self-medication as a blanket explanation for substance use in people with ADHD symptoms is not warranted by how the claim has been tested.
Kratom and 7-OH should be regulated, experts agree. They’re split on how
Kratom leaf products, often used to ease chronic pain, anxiety, or withdrawal from opioids, have been sold in the U.S. for decades, largely skirting any regulatory restrictions despite a known risk for physical dependence. But increasingly, Americans are turning to newer, more potent products made with a semi-synthetic kratom derivative, 7-hydroxymitragynine, or 7-OH.
Clinicians and recovery advocates warn that highly-concentrated 7-OH could be even more addictive than kratom, though research is scarce. Most people agree that some sort of guardrails need to be put into place. They disagree, however, on what those regulations should be.
Acceptability and Feasibility of a Virtual Family-Based Single-Session Intervention for Young Teens at High Risk for Substance Use Disorder: Single-Arm Pilot Trial
<strong>Background:</strong> Preventive interventions to delay substance use disorder (SUD) are ideally delivered during early adolescence, a critical period for exposure to substance use (SU) risk factors. Young teens (aged 12-14 years) engaging in occasional use of alcohol, cannabis, or tobacco use, or with a family history of SUD, are at increased risk for SUD. Although behavioral-ecological family therapy is effective for prevention, many families face access barriers. Single-session interventions (SSIs) may offer an accessible, low-intensity alternative. <strong>Objective:</strong> This open pilot trial aimed to evaluate the acceptability, feasibility, and potential usefulness of a family-based SSI targeting improvements in family practices that prevent SUD. <strong>Methods:</strong> Participants were 9 young teens engaging in occasional SU or with a family history of SUD and their parent. The SSI involved a virtual 2-hour family consultation with a trained family coach. Acceptability was measured via Program Feedback Scale, feasibility via SSI completion rate, and potential usefulness via pre-post changes in parenting self-efficacy. <strong>Results:</strong> The SSI was acceptable to parents and teens (mean Program Feedback Scale scores ≥3) and feasible (8/9, 88.89% of parent-teen dyads completed the SSI). Among the 8 completing dyads, most participants (13/16, 81.25%) selected Communication and Problem Solving as their primary target for change. Parents reported increases in parenting self-efficacy from pre- to post-SSI. <strong>Conclusions:</strong> Findings support the SSI’s acceptability and feasibility for young teens at high risk for SUD. A randomized clinical trial is needed to confirm the SSI’s acceptability, feasibility, and efficacy, as well as to address potential for delivery by a lay workforce. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT06538922; https://clinicaltrials.gov/study/NCT06538922
Smartphone addiction, physical activity engagement, and sleep quality in Chinese adolescents: a parallel and serial mediation model
IntroductionExcessive smartphone use has become a major public health concern among adolescents, particularly in China where smartphone use is widespread. Although smartphone addiction is consistently associated with poor sleep quality, the mechanisms underlying this association remain insufficiently understood. This study examined whether physical activity engagement and depressive symptoms operate as parallel and serial mediators linking smartphone addiction to sleep quality in Chinese adolescents.MethodsA cross-sectional survey was conducted among 612 adolescents (Mage = 14.2 years, SD = 1.6; 51.3% female) from four secondary schools in Hubei Province, China. Participants completed the Smartphone Addiction Scale–Short Version, the Physical Activity Questionnaire for Adolescents, the Pittsburgh Sleep Quality Index, and the Depression subscale of the Depression Anxiety Stress Scales-21. Path analysis of observed composite scores with robust maximum likelihood estimation and bias-corrected bootstrapping (5,000 resamples) was used to test the proposed parallel and serial mediation model.ResultsSmartphone addiction was positively associated with poor sleep quality (β = .38, p <.001). Both physical activity (indirect effect = .04, 95% CI [.01,.07]) and depressive symptoms (indirect effect = .14, 95% CI [.09,.19]) significantly mediated this association in parallel. In addition, the serial pathway from smartphone addiction to low physical activity, elevated depressive symptoms, and poor sleep quality was significant (indirect effect = .02, 95% CI [.01,.04]). The mediators collectively accounted for 52.6% of the total effect.DiscussionThese findings suggest that problematic smartphone use is associated with poorer adolescent sleep through behavioral and psychological pathways involving reduced physical activity and elevated depressive symptoms. School-based interventions that promote physical activity while reducing problematic smartphone use may help protect adolescent sleep and mental health. Longitudinal and experimental designs are needed to establish causal direction and inform intervention development.
Trait, state, and behavior in adolescent NSSI addiction: a serial mediation model linking childhood trauma to NSSI addiction
BackgroundDespite growing recognition of non-suicidal self-injury (NSSI) as a potential behavioral addiction, the sequential mechanisms linking childhood trauma to NSSI addiction remain unclear. This study examined a serial mediation model testing whether trait impulsivity and depressive symptoms sequentially mediate this relationship, with NSSI function as a behavioral coping mechanism.MethodsThis cross-sectional study included 163 Chinese adolescents diagnosed with major depressive disorder and a history of NSSI. Participants completed the Childhood Trauma Questionnaire-Short Form, the Short UPPS-P Impulsive Behavior Scale, the Children’s Depression Inventory, and the Ottawa Self-Injury Inventory (Functions and Addictive Features subscales). Serial mediation analysis (PROCESS Model 6, 5,000 bootstrap resamples), controlling for demographic and clinical covariates, tested the hypothesized five-step sequential model.ResultsChildhood trauma was positively associated with NSSI addiction, and this association was predominantly mediated: the total indirect effect accounted for 56.2% of the total effect. Indirect effects involving NSSI function in combination with upstream mediators were significant, including the full sequential path (B = 0.0033, 95% CI [0.0007, 0.0083]), whereas simple mediations via impulsivity, depression, or NSSI function alone were not.ConclusionThese findings support a trait-state-behavior-addiction cascade in which childhood trauma is associated with trait impulsivity and depressive symptoms that, in combination with the reinforcing function of NSSI, are linked to addictive features of NSSI. The model advances theoretical understanding of NSSI addiction and offers actionable clinical targets for prevention and intervention. Longitudinal studies are needed to confirm causal directions.
Adolescent non-suicidal self-injury scale – short form: revision and evaluation of its reliability and validity
ObjectiveNon-suicidal self-injury (NSSI) is a clinically significant concern among adolescents, and its accurate yet efficient assessment is essential for research, early identification, and intervention. Existing Chinese instruments—most notably the 19-item Adolescent Self-Harm Questionnaire (ASHS)—are relatively lengthy and ill-suited to rapid, large-scale screening. The present study had two aims: (a) to develop a short form of the ASHS, the Adolescent Non-Suicidal Self-Injury Scale–Short Form (ANSSI-SF), by integrating classical test theory (CTT) item analysis with genetic algorithm (GA) cross-validation, and (b) to evaluate its reliability, validity, and screening utility relative to the parent scale.MethodsUsing a convenience sample of 1,090 primary and secondary school students, seven items—one for each of seven behavioral categories derived from a functional–typological framework of self-harm—were selected on the basis of CTT item statistics and GA cross-validation. The scale was evaluated through item analysis, internal-consistency and split-half reliability, exploratory and confirmatory factor analysis (EFA/CFA), correlations with theoretically related constructs, known-groups comparisons (gender; smartphone addiction), and consistency and screening-accuracy analyses against the full 19-item ASHS.ResultsIt indicated that all items demonstrated strong correlations with the total score, and both internal consistency and split-half reliability reached satisfactory levels.A unidimensional factor structure also exhibited good model fit. Additionally, scale scores were significantly positively correlated with related psychological indicators such as depression, anxiety, and sleep problems, and effectively differentiated differences in self-injurious behavior across gender and smartphone addiction groups.GA cross-validation confirmed that the selected items balanced parsimony with full coverage of all seven behavioral categories.DiscussionThese findings indicate that the ANSSI-SF is a brief, reliable, and valid instrument that preserves the content breadth of the parent ASHS while substantially reducing administration burden. It is well suited to rapid, large-scale screening and early identification of at-risk adolescents, facilitating timely referral and prevention. Limitations include convenience sampling from a single region and the absence of test–retest reliability; future research should validate the scale in clinical and diverse cultural samples and examine its predictive validity.
Trauma-informed psychological support alongside long-acting injectable buprenorphine: clients’ perspectives on the Buvidal psychological support service (BPSS) pilot in Wales
BackgroundOpioid use disorder (OUD) is associated with persistent drug use, high relapse rates, and significant morbidity, mortality, and psychosocial harm. While Long-Acting Injectable Buprenorphine (LAIB), marketed as Buvidal, offers improved pharmacological management over traditional opioid substitution therapy (OST), the mental clarity provided by LAIB often surfaces unresolved trauma and mental health needs. Integrating trauma-informed psychological care alongside pharmacological intervention is increasingly recognized as critical to optimize recovery outcomes for individuals with co-occurring psychiatric co-morbidities and substance use disorder.ObjectiveThis evaluation aimed to explore client experience of the Buvidal Psychological Support Service, a tiered trauma-informed psychological service, piloted to support individuals with OUD receiving LAIB in Wales, UK.MethodsQualitative data were derived from nine semi-structured interviews with BPSS service users, exploring their experiences, perceived impacts, and recovery journeys through reflexive thematic analysis.ResultsFindings indicated the transition to LAIB was often transformative but exposed trauma and emotional difficulties previously masked by substance use, making the availability of timely psychological support critical for maintaining abstinence and wellbeing. Clients valued the BPSS’s rapid access, continuity, person-centered care and non-judgmental ethos, reporting enhanced agency, emotional regulation, and social reintegration. Relapse prevention was strongly linked to psychological support alongside pharmacological treatment.ConclusionThe findings suggest that participants experienced BPSS as a valuable adjunct to LAIB, particularly where increased mental clarity brought trauma-related and emotional difficulties into focus. The pilot highlights the potential value of integrating trauma-informed psychological support within LAIB pathways, while further evaluation is needed to assess transferability and longer-term outcomes.
Effect of transcranial alternating current stimulation (NET Device™) on psychostimulant withdrawal severity and time course: a real-world data analysis
BackgroundPsychostimulant use disorder is a life-threatening condition with no FDA-approved treatment. Stimulant withdrawal symptoms impede treatment engagement and are unaddressed by standard of care. The NET Device, a non-invasive transcranial alternating current stimulator, is FDA-cleared for opioid withdrawal suppression. No studies have evaluated whether NET Device use attenuates psychostimulant withdrawal.MethodsElectronic health record and device utilization data were collected from 109 stimulant-only users and 112 stimulant/opioid co-users (N = 221 adults total; Mage=39.2, SDage=10.7; 119M) entering residential addiction treatment (n = 168) or detention centers (n = 53). The Amphetamine Cessation Symptom Assessment (ACSA) was administered at baseline and 1 hour (day 1), and twice daily on days 1–7. A linear mixed model (LMM) with random intercepts and slopes was used to analyze the trajectory of ACSA scores.ResultsACSA severity and time course were similar across settings (residential vs. detention). A two-phase LMM separated acute (baseline to 1 hour) and post-acute withdrawal symptom reductions. Relative to baseline ACSA scores, stimulant-only and co-user groups each reported significant reductions at 1 hour (46% and 33%), day 2 morning (59% and 42%), and decelerating log-time trajectory through day 4 (79 hours), the primary analysis window. Estimates beyond day 4 rest on 6.9% of observations and are reported as exploratory only.ConclusionNET Device monotherapy was associated with rapid reduction in psychostimulant withdrawal severity regardless of setting and opioid co-use. No device-related adverse events were reported. These real-world data support initiation of a sham-controlled randomized trial to evaluate NET Device efficacy for stimulant use disorder.
Relationship between loneliness and self-efficacy: the mediating role of internet addiction and the moderating role of sleep quality
IntroductionThis study aimed to examine the association between loneliness and self-efficacy among adolescents and to investigate whether internet addiction mediated this association and whether sleep quality moderated the direct and indirect pathways. Although previous research has demonstrated significant associations between loneliness and both general and social self-efficacy, the behavioral mechanisms underlying these associations and the conditions under which their strength may vary remain insufficiently understood.MethodsA cross-sectional survey was conducted among 1,323 students in Grades 7–9 from two schools in Baotou, Inner Mongolia, China. Participants completed the UCLA Loneliness Scale, the General Self-Efficacy Scale, the Internet Addiction Diagnostic Questionnaire, and the Athens Insomnia Scale. A moderated mediation model was used to examine the mediating role of internet addiction and the moderating role of sleep quality in the association between loneliness and self-efficacy.ResultsLoneliness was negatively associated with self-efficacy. Internet addiction partially mediated the association between loneliness and self-efficacy. In addition, sleep quality moderated the direct association between loneliness and self-efficacy and the first stage of the indirect pathway from loneliness to internet addiction. Specifically, the associations of loneliness with self-efficacy and internet addiction varied across different levels of sleep quality.DiscussionThese findings provide a more comprehensive understanding of the mechanisms linking loneliness to adolescent self-efficacy by identifying internet addiction as an important behavioral mediator and sleep quality as a moderating factor. The findings highlight the importance of considering problematic Internet use and sleep quality when developing interventions aimed at promoting adolescents’ psychological adjustment, self-efficacy, and well-being.
Attachment and Substance Use Disorder: An Interventional Study in an Addictology Day Hospital
Conditions: Addiction Disorders
Interventions: Behavioral: attachment-focused therapeutic program; Behavioral: psychoeducation-based intervention (standard care)
Sponsors: Centre Hospitalier de Cadillac
Completed
Interventions: Behavioral: attachment-focused therapeutic program; Behavioral: psychoeducation-based intervention (standard care)
Sponsors: Centre Hospitalier de Cadillac
Completed