Category: Substance Use

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Bariatric Surgery Increases the Risk of Alcohol Problems

On By ModernMedia
Sleeve gastrectomy. Credit: Scientific Animations CC4.0

The body absorbs alcohol much more rapidly after bariatric surgery, researchers from Norway have found. Patients need to know this when they choose the kind of surgery they will have.

“Bariatric surgery can come with a price. Patients have a significantly higher risk of developing alcohol problems than if they did not undergo surgery,” said Magnus Strømmen, a researcher at the Centre for Obesity Research at St. Olavs Hospital and a PhD research fellow at the Norwegian University of Science and Technology (NTNU).

Between one and two per cent of the population in Norway has undergone bariatric surgery. The most commonly used surgical methods are gastric bypass and gastric sleeve.

Both methods make patients eat less and feel full faster. This is partly due to reduced volume on the stomach, and partly due to hormonal changes. But a person’s changed anatomy also has consequences for what happens when they drink alcohol.

“In a normal stomach, a significant part of the alcohol will be broken down and thus not pass into the bloodstream. This is due to an enzyme that is secreted in the lining of the stomach. It is this protective mechanism that we deprive the patient of when we operate on the stomach. In addition, what you drink passes much faster into the intestine,” says Strømmen.

The small intestine’s big job is absorption. Since the stomach’s ability to break down alcohol more or less stops, significantly more alcohol passes directly into the bloodstream. That’s true even if the patient drinks the same as before the operation.

You get drunk faster

In a new study, Strømmen and his colleagues have had 33 adult patients undergo stress tests with alcohol. The participants consumed measured amounts of vodka mixed with orange juice both before bariatric surgery, and 3, 12 and 36 months after the operation, after which they had their blood alcohol levels measured after they had consumed the alcohol.

“Our findings show that alcohol uptake almost doubles, both after gastric bypass and gastric sleeve. Perhaps an even more dangerous finding, from a substance-abuse perspective, is that patients reach the maximum blood concentration in only half the time. These effects are lasting, probably lifelong,” Strømmen said.

In other words: The patients were intoxicated faster, and to a much greater extent, by the same amount of alcohol, and it took longer to get sober.

“The effects were more pronounced for people who had gastric bypass surgery. But that does not mean that the sleeve operation is harmless in terms of subsequent alcohol abuse,” Strømmen said.

Gastric bypass (left) and gastric sleeve are the most common forms of bariatric surgery today. In gastric bypass, a corner of the stomach is connected directly to the small intestine, so that both the stomach and one meter of the small intestine are disconnected. In gastric sleeve surgery, part of the stomach is removed so that the volume is reduced, without reconnecting the intestines. Illustration: Kari C Toverud, CMI

Bypass had a 69 per cent higher risk than sleeve

In another study, the researchers compared the risk of getting an alcohol abuse diagnosis after the two bariatric surgeries. The researchers analysed data from the Norwegian Patient Registry linked to the Norwegian Prescription Database for 17,800 patients operated on in the period from 2008 to 2018.

They found that patients who had gastric bypass surgery had a 69 per cent higher risk of being diagnosed with an alcohol-related problem than patients with a gastric sleeve. Bariatric patients who were given an alcohol-related diagnosis also had a higher mortality rate and used specialist health services more than patients who underwent bariatric surgery and who did not receive an alcohol diagnosis.

“It is important that patients, their relatives and health personnel, especially in general medicine, substance abuse and gastro medicine, share this knowledge. These Norwegian studies, based on different data sources and different methodologies, indicate that some of our patients struggle with alcohol problems as a complication from the surgery. Alcohol problems can cost the patient, their relatives, and society a great deal,” Strømmen said.

He likes to tell patients that they need to practice saying no.

“They will suddenly be in social contexts where friends and surroundings expect you to drink as much as before the operation. But your physiology has changed. That means you need to be more careful than before,” he said.

Risk factors for bariatric surgery must be investigated

“We can’t just tell people what to do or not to do,” says Associate Professor Magnus Strømmen. “I believe more that patients need to be educated about the mechanisms behind it. Knowledge can motivate people to be more careful with alcohol. They need to know how altered alcohol absorption can affect their actions while under the influence and that all alcohol intake doubles the stress on their organs. Photo: Aleksander Mjøen

He himself has been involved in building up the obesity outpatient clinic at St. Olavs Hospital in Trondheim. Now he wants to be sure that clinics incorporate this new information into their daily practice. Patients must be assessed individually in relation to the risk of alcohol problems.

“We find that many patients have a clear idea of what type of surgery they want when they are referred. And for a long time, this was given very great importance in the decisionmaking. But obesity is not just a single phenotype. Despite having a large body, patients are very different, also in terms of health,” he said.

Some patients may have type 2 diabetes, others struggle with heartburn. Some may have more extensive obesity and thus desire greater weight loss.

“For a patient like this, gastric bypass may be best. Other conditions may make you want to recommend gastric sleeve. Now we know that the operations result in different risks of alcohol problems. This means we must also investigate the patient’s risk factors for substance abuse before we decide which operation the patient should have. Where patients have several risk factors, gastric sleeve may be a better alternative, but we must also ask whether high-risk patients should be operated on at all,” Strømmen said.

Patients need to know

He wants patients to receive more specific information before the operation.

“It is important that patients make their decision to undergo surgery on a genuinely informed basis. It is not enough to say that their alcohol uptake will change. Patients should be educated about the mechanisms behind increased risk after surgery, and not least how to react differently to alcohol intoxication after surgery as a result of the sudden increase. This information can at best prevent patients from developing alcohol-related problems,” he said.

The patient’s risk factors for substance abuse should be considered before the type of surgery is chosen.

“I think most obesity clinics can get much better at their alcohol history, ie, a thorough conversation about the patient’s alcohol habits and any risk factors. We need to get better at asking the right questions, and make a more precise assessment. But this also requires transparency from the patients. I believe that good patient education can make patients understand why it is important to be honest about these things,” says Strømmen.

Drugs can replace bariatric surgery

In recent years, more effective drugs have been developed against obesity. Strømmen believes these should be considered for everyone before surgery, but especially for those at increased risk of alcohol abuse.

“The current guidelines state that we should not operate on patients with an active substance abuse problem, and that high-risk patients should abstain from alcohol after surgery. However, the guidelines do not provide any guidelines for how patients should be screened.  The lack of specification is a problem because this is information that many clinicians are reluctant to ask for, and which patients may be afraid to share,” he said.

By Ingebjørg Hestvik – Published 25.06.2026

References:

Strømmen, M., Dale, O., Klöckner, C. et al. Ethanol pharmacokinetics before and after sleeve gastrectomy and Roux-en-Y gastric bypass: a 3-year prospective study (the BAR-TRIAL). Int J Obes (2026).https://doi.org/10.1038/s41366-026-02113-3

Strømmen, M., Bakken, I.J., Sandvik, J. et al. Alcohol use disorders and related morbidity and mortality after sleeve gastrectomy and Roux-en-Y gastric bypass: a nation-wide registry study (the BAR-REGISTER). Int J Obes (2026). https://doi.org/10.1038/s41366-026-02123-1

Source: Norwegian SciTech News

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Even Low Alcohol Consumption Linked to Cancer and Heart Risks

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Study provides much-needed benchmark with finding that alcohol consumption is associated with increased risk above one drink per day for both men and women

Photo by Pavel Danilyuk on Pexels

Even what many consider to be moderate drinking is linked to an increased risk of death, disability, and chronic diseases such as cancer and heart disease, according to a new study published in the Journal of Studies on Alcohol and Drugs.

“This study provides the most comprehensive US estimates to date of lifetime risks of alcohol-attributable mortality and morbidity, showing that even moderate levels of consumption increase the risk of premature death and disability,” said study co-author Katherine M. Keyes, PhD, professor of Epidemiology at Columbia University Mailman School of Public Health. “No protective effect of drinking was observed even at low levels,” noted Keyes, whose research focuses on alcohol use and other substances epidemiology across the life course.

The findings show mortality risk from alcohol of 1 in 25 for people who consumed an average of 14 drinks per week. In contrast, drinking up to 7 drinks per week was associated with only minimally elevated risks for most conditions.

“Even low levels of alcohol use come with health risks,” says first study author Kevin Shield, PhD, an associate professor at the University of Toronto and a senior scientist who leads the World Health Organization (WHO)/Pan American Health Organization (PAHO) Collaborating Centre in Addiction and Mental Health. “And that risk continues to increase the more someone drinks.”

The researchers, from the United States and Canada, aimed to estimate how lifetime drinking habits affect Americans’ risk of illness and death related to alcohol. After medical experts reviewed more than 7200 scientific articles on alcohol-related diseases and injuries to determine the level of risk for each condition, the researchers applied those risks to large national health data sets. They then used statistical modelling to estimate how different drinking levels influence long-term health outcomes.

The study offers more concrete guidance than the new US Dietary Guidelines, which currently advise Americans to “limit alcoholic beverages” without specifying how much alcohol is safe to drink. Previous guidelines recommended a daily limit of two alcoholic drinks for men and one for women. The definition of a ‘drink’ varies by beverage type, typically 12 ounces (340mL) for beer, 5 ounces (140mL) for wine, and 1.5 ounces (40mL)for spirits, although that too can vary by alcohol concentration.

While the new US Dietary Guidelines contain a useful ‘less-is-best’ message, they provide no quantitative framework, according to the authors. This study was designed to do just that across the drinking spectrum. 

It turns out that an average of two drinks per day, which might be considered ‘moderate’ from a social standpoint, is associated with a substantially elevated risk of a premature death caused by alcohol, they explain.

In addition to mortality risk, researchers examined how drinking patterns influence chronic and acute alcohol-related conditions such as cancer – including oesophageal, oral, and breast – cardiovascular disease, liver disease, and injury. 

The study overturns a common misconception that alcohol can protect health. The researchers did not observe a significant protective effect of alcohol on overall health at any level of consumption. They noted that at low levels, alcohol may be associated with a reduced risk of ischemic heart disease and stroke. But when you look across the full range of health outcomes, including cancer and other chronic diseases, those potential benefits are outweighed by the risks even at 7 drinks per week.

Statistical modelling used in the study to determine health risks was based on “the best possible data,” according to the team. But they caution one should not assume that means one person’s individual health risk is the same as what is reported here – that depends on other factors like lifestyle, genetics, drinking patterns, and other choices that differ person to person.

The researchers estimated risk for all health conditions known to be causally related to alcohol and then aggregated these estimates to determine the total health risk. Yet, new research continues to emerge that links alcohol with additional health conditions, such as pancreatic cancer. “Understanding those relationships, and how much alcohol contributes to those risks, is an area that still needs further work,” says Keyes and Shield.

By finding that alcohol consumption is associated with increased risk above one drink per day for both men and women, the study offers a much-needed benchmark.

“Having a clearer threshold helps people better understand what level of drinking is associated with increased risk and make more informed decisions when drinking.”

In an accompanying editorial, Robert M. Vincent, a former associate administrator for the US Substance Abuse and Mental Health Services Administration, discusses his view of the behind-the-scenes environment in which the study was produced. “The Alcohol Intake and Health report was explicitly invited to inform alcohol guidance during development of the Dietary Guidelines for Americans, 2025–2030,” he writes. “Despite the study’s adherence to its mandate, its findings were sidelined.”

See the paper for a full list of co-authors and their institutions.

Source: Columbia University Mailman School of Public Health

Categories : Mental Health Substance UseTags :

Cannabis and Tobacco Co-use Increases Psychosis Chances in High-risk Cohorts

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Results highlight concern about co-use, a growing trend that has been understudied until now

Photo by Thought Catalog on Unsplash

A new multisite study published May 12 in Nature Mental Health found that using cannabis and tobacco together increases the risk of developing psychotic disorders like schizophrenia among those considered high risk.  

Researchers led by Heather Ward, MD, assistant professor of Psychiatry and Behavioral Sciences and director of Neuromodulation Research at Vanderbilt Health, analysed data from more than 1,000 participants in the North American Prodrome Longitudinal Study, which tracks individuals at “clinical high risk” for psychosis. These individuals often experience mild or early symptoms but have not yet developed a full psychotic disorder.  

“The prevalence of cannabis and tobacco use, known as ‘co-use,’ has been rising in the general population for the past several decades, while exclusive tobacco use has declined and exclusive cannabis use has been on the rise,” Ward said. “However, little is known about cannabis and tobacco co-use in adolescents at risk for psychosis.”  

Substance use patterns – tobacco only, cannabis only, co-use, other substances and no substance use – were assessed over a two-year period in 734 individuals at clinical high risk for psychosis and 278 healthy controls.   

“People with psychosis are much more likely to use cannabis and tobacco than the general population. Because of their heavy cannabis and tobacco use, people with psychosis are also disproportionately affected by the negative consequences of cannabis and tobacco use,” said Ward, who recently presented study findings at the Society of Biological Psychiatry Annual Meeting in an oral session titled, “High Stakes: Consequences of Cannabis Use in Vulnerable Populations.”  

According to Ward, in people with psychosis, tobacco use is associated with a 20-year decreased life expectancy compared to the general population, that is attributable to the medical consequences of tobacco use, such as cardiovascular disease, heart attack, stroke and lung cancer.  

“In people in their first episode of psychosis, it is estimated that 25%–50% use cannabis. Cannabis use is associated with more severe psychosis symptoms, poor response to treatment and psychiatric hospitalisations. There is even evidence that cannabis use may cause psychosis in people who are already at risk,” Ward said.  

“Tobacco and cannabis use in isolation have devastating consequences for people with psychosis, so we wanted to see if people who co-use cannabis and tobacco had more severe psychiatric symptoms and if they were at greater risk for developing psychosis in the first place.”  

The study found that regular use of either cannabis or tobacco was linked to anxiety, depression and early psychotic experiences. However, people who used cannabis and tobacco together did not show worse short-term symptoms than those using just one.  

However, the biggest difference appeared over time. Those who used cannabis heavily and tobacco lightly were almost three times more likely to develop psychosis compared to those who used neither substance.  

The results highlight concern about co-use, a growing trend that has been understudied until now. Researchers defined co-use in the study as “using substances at the same time, on the same occasion, or within a defined time frame where their effects may overlap.”  

“We found that cannabis and tobacco co-use was associated with a nearly threefold increased risk of developing psychosis in people who were already at risk,” Ward said. “There is evidence to suggest that using tobacco and cannabis together may have synergistic effects on the brain.  

“Smoking tobacco and cannabis together increases absorption of THC, the psychoactive component of cannabis. It is possible that co-use itself is contributing to the development of psychosis. However, it is also possible that the people who are going to develop psychosis anyway have an underlying predisposition to using both cannabis and tobacco.”  

Ward said it is important for both patients and clinicians to know that cannabis and tobacco co-use is a risk factor for psychosis. Stopping use of cannabis and tobacco may improve mental health symptoms, and it is possible that stopping cannabis and tobacco co-use could reduce risk of developing psychosis in the first place.  

The next step is to replicate this finding in other groups of people at risk for psychosis, and “we need to test if stopping cannabis and tobacco use reduces risk of developing a psychotic disorder,” Ward said.  

Source: Vanderbilt University Medical Center

Categories : Addiction Substance UseTags :

From Alcohol to Gambling, Lyra Data Show Escapist Behaviours Climb amid Sustained Stress

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Photo by Niek Doup on Unsplash

Lyra Southern Africa’s latest behavioural health data reveals a steady year‑on‑year rise in addictive behaviours among South African employees, reflecting how prolonged stress is reshaping the ways people cope, escape and self‑manage emotional pressure.

Drawn from a five‑year analysis of Employee Wellness Programme trends, the data shows total addictive behaviour cases increasing from 1.79 percent of all cases in 2021 to 2.85 percent in 2025. While this may appear modest when viewed only as a percentage point shift, it in fact represents close to 60 percent growth over the period. Clinicians caution that this scale of increase reflects a material change in coping patterns, unfolding alongside heightened financial, social and psychological strain.

“This is not about sudden spikes or isolated events,” says Dubekile Mugumbate, Business Intelligence and Consulting Manager at Lyra Southern Africa. “It’s about stress that has become part of everyday life, and the coping strategies people reach for when that stress doesn’t let up.”

Lyra’s clinicians note that addictive behaviours rarely appear in isolation. They are often intertwined with anxiety, burnout, relationship strain and overwhelming life pressure. In the current climate, marked by economic uncertainty, rising living costs and ongoing instability at both household and societal levels, more people are turning to behaviours that offer short‑term relief or distraction.

Alcohol remains the most prevalent addictive behaviour across all five years, showing consistent year‑on‑year growth. Alcohol‑related cases have nearly doubled over the period, rising from just over 1 percent of all cases in 2021 to slightly above 2 percent in 2025. Clinicians describe this as a familiar pattern in high‑stress environments, where alcohol becomes an accessible and socially acceptable form of escape from relentless pressure. “When pressure is constant, people reach for what’s available and what works quickly to ‘numb the pain’,” Mugumbate explains.

Drug‑related cases present a different picture. While still significant, drug use and misuse shows a gradual decline as a proportion of addictive behaviour cases over the same period. This does not signal reduced risk, but rather changing access and preference as people gravitate toward behaviours that feel easier to hide or justify in daily life.

Gambling shows one of the sharpest increases. Though starting from a low base, gambling‑related cases more than quadrupled in the data set between 2021 and 2025. Clinicians link this rise to the normalisation of online betting platforms, instant gratification mechanics and the false sense of control gambling can offer to people feeling powerless in other areas of their lives.

Pornography use and sex‑related addictions remain smaller categories overall, but they continue to surface consistently year after year. These behaviours are often framed by employees not as addiction at first, but as stress relief, boredom management or emotional escape. Over time, however, they frequently intersect with shame, relationship breakdown and emotional withdrawal.

Internet and social media addiction, while still representing a smaller proportion of cases, shows renewed growth in 2025 after earlier fluctuations. Lyra clinicians note that constant digital engagement offers immediate distraction, connection and numbing, particularly during periods of uncertainty, loneliness or emotional overload.

Generational insights reveal important differences in how addictive behaviours manifest. Gen Y continues to represent the largest share of cases across all five years. This group consistently accounts for around a third of addictive behaviour presentations, reflecting the compounded pressures of mid‑career responsibility, financial obligation, dependants and expectation overload. For many, escapist behaviours become a way to briefly step away from relentless demand.

“For many Gen Y employees, the load never really comes off,” says Mugumbate. “Escapist behaviours can become the only space where the system pauses, even briefly.”

Gen Z follows closely behind, with a notable dip and resurgence over the period. Clinicians working with younger employees describe a generation navigating early career insecurity, limited disposable income and high exposure to digital environments that reward compulsive engagement.

Gen X shows steady growth year on year, particularly in the later years of the data. Here, addictive behaviours often emerge alongside cumulative burnout, long‑term stress and emotional fatigue rather than risk‑taking alone.

Gen Alpha presentations remain small but concerning. Drug use and pornography are more pronounced within this group than might be expected, highlighting early exposure, digital accessibility and the role of unmonitored online spaces. Clinicians stress the importance of early intervention as these patterns form at younger ages.

Baby Boomers make up a small proportion of cases but tend to present later and with more entrenched patterns. When addictive behaviours do surface in this group, they often intersect with grief, retirement‑related identity loss, health challenges or financial anxiety.

Across all generations, the common thread is escapism. Each behaviour offers momentary relief from stress, whether through numbing, distraction, stimulation or perceived control. In a high‑stress environment, those short breaks can become coping habits, and habits can harden into dependency.

“The rise we’re seeing in addictive behaviours is closely linked to the sustained pressure South Africans have been living under for several years now,” says Mugumbate. “When stress becomes chronic, people don’t always look for long‑term solutions. They look for immediate relief, and that’s where these behaviours come in.”

She adds that organisations often underestimate how closely stress, mental health and addictive behaviours are connected in the workplace.

“Addictive behaviour is rarely about the behaviour alone it’s a signal that something deeper is going unmet. In the current environment, many employees feel overwhelmed, financially stretched and emotionally depleted. Employers who want to protect productivity and wellbeing need to understand that prevention, early support and open conversation are far more effective than waiting until patterns become entrenched.”

As economic pressure, uncertainty and emotional fatigue continue to define daily life for many South Africans, the data suggests that addictive behaviours will remain a growing risk where people are left to cope alone. Organisations that recognise these patterns and invest in accessible, stigma‑free support play a critical role in helping employees find healthier ways to manage the weight they are carrying.

Categories : Mental Health Substance UseTags :

It Is Time for SA to Get Serious About the Link Between Substance Abuse and Mental Health

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Around 3.8 million people in South Africa developed depression in 2024, researchers estimate in a major modelling study. Photo from Pixabay CC0

By Gauta Mashego

Substance abuse is both a symptom and a consequence of untreated mental illness, and government needs to urgently step in to confront this dangerous overlap, argues Gauta Mashego of SECTION27.

Mental health globally has been in crisis for years. The strain on mental health was especially visible when the world stood still during the COVID-19 pandemic. The prevalence of anxiety and depression increased by 25% in the first year of the global outbreak of the SARS-CoV-2 virus, according to the World Health Organization. However, as the pandemic eased and life returned to the usual, open conversations around mental health also tapered off.

In South Africa, as in many low-and-middle income countries, people struggle with mental health disorders such as anxiety and depression. Around 3.8 million people in South Africa developed depression in 2024, estimate researchers in a major modelling study published as a preprint in March on medRxiv.

Mental health is shaped by many factors

Several studies worldwide report a high prevalence of substance use among people with mental illness compared to the general population.

Researchers have found that patients who suffer from psychotic disorders, such as schizophrenia and bipolar mood disorder, were more likely to abuse alcohol and illegal substances. Indeed, findings from a community survey highlighted a substantial burden of co-occurring mental disorders and alcohol use among men in three provinces in South Africa.

What also makes our society vulnerable to both mental health conditions and increased use of drugs and the development of substance use disorders, is our historical context of apartheid as well as socio-economic factors such as poverty, unemployment, and violence. Researchers have argued that mental health problems are related directly to poverty, while others also make the case that the poor are at greater risk than the rich to suffer from mental illness. At the same time, those living with mental illness are more likely to remain trapped in poverty due to high treatment costs, reduced productivity, and stigma around mental illness.

The kids are not alright

Underage drinking further complicates an already complex problem.

Up-to-date statistics of underage drinking in South Africa are limited, however the matter was thrust into the spotlight on Christmas day in 2025 when a disturbing video circulated on social media showing children between the ages of 6 and 12 consuming alcohol in the presence of adults.

Providing insights into the drinking behaviours of adolescents aged between 11 and 18, a 2019 Human Sciences Research Council study in townships across three provinces found that most had their first drink at the age of 13 or 14 years.

Highlighting the extent of underage drinking among Grade 8–11 learners from public schools in all nine provinces, the 2011 South African Youth Risk Behaviour Survey recorded that around 17% of 13-year-olds and 18% of 14-year-olds had engaged in drinking five or more drinks within a few hours on one or more days in the preceding month.

Mental disorders that commonly co-occur with alcohol use disorders in adolescents include antisocial disorders, mood disorders, and anxiety disorders.

Young people’s drinking habits are often linked to factors such as social norms, and the accessibility and affordability of alcohol. Added to this, since young people are often prolific consumers of media, they are frequently exposed to alcohol advertising and marketing, which encourages the consumption of alcohol.

But there is some hope.

The Liquor Amendment Bill aims to amend the Liquor Act of 2003 to prohibit the advertising, promotion or product placement of liquor in all forms of media. The Amendment Bill is at a very early stage in the legislative process, and it is likely to take time before we see any changes to the law (and longer before we see its implementation).

Other legislative changes debated include raising the legal drinking age from 18 to 21 and keeping schools alcohol-free, and more generally to place a moratorium on new liquor licences and stronger enforcement against Liquor Act violations.

South Africa also has a National Drug Master Plan 2019-2024. It was released by the Department of Social Development, and importantly, it recognises addiction as a chronic disease affecting the brain and behaviour.

However, experts say that while it is a great document, the Central Drug Authority which is tasked with implementing the plan, needs more power and resources to implement the plan’s recommendations.

South Africa also has a National Mental Health Policy Framework and Strategic Plan (2023-2030), that was introduced by the Department of Health. Similarly to its previous iteration, the latest plan envisions the integration of mental healthcare into primary healthcare. A key objective of the new plan is to ensure that mental healthcare users have access to care near their places of work. Another aim is to strengthen collaboration between government departments like education and social development to ensure that mental health is incorporated in planning and service development.

However, as it stands, many public healthcare facilities lack mental health professionals, with rural and underserved communities having little to no access to care. Only about 50% of public hospitals offering mental health services have a psychiatrist, while the country has less than one psychologist for every 100 000 people.

Shortages of mental health professionals mean patients often wait months for appointments. For an adolescent or a child who experiences anxiety, depression or suicidal thoughts, these delays can feel unbearable and it is quite possible that they may give up before receiving help. Currently, only one in ten children diagnosed with treatable mental conditions will have access to care.

While South Africa developed extensive legislative and policy frameworks to give effect to the constitutional right to healthcare, including mental healthcare, constitutional promises must make a difference in the lives of people. Unfortunately, millions of people in the country face barriers to mental healthcare, exposing the persistent gap between constitutional promises and lived reality.

When families lack access to counselling, community-based mental health services and early intervention programmes, harmful coping mechanisms continue to be passed down rather than prevented. To achieve the objectives of the Mental Health Policy Framework by 2030 and to catch up with the National Drug Master Plan that lapsed in 2024, stronger political will and meaningful action are urgently required. This is a crisis South Africa can’t evade.

*Mashego is a candidate attorney with SECTION27.

Note: Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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Categories : Substance UseTags :

Family Dinners May Reduce Substance Use Risk for Many Adolescents

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Regular bonding over meals may help prevent kids from using alcohol, cannabis, and e-cigarettes, but those with significant stress or trauma need additional support

Photo by Vanessa Loring on Pexels

Anew study from researchers at Tufts University School of Medicine finds that regular family dinners may help prevent substance use for a majority of US adolescents, but suggests that the strategy is not effective for youth who have experienced significant childhood adversity.

The findings provide important insights for practitioners looking to help families prevent substance use, as well as for researchers aiming to develop interventions that better account for adolescents’ unique experiences.  

For the study, published January 19 in the Journal of Aggression, Maltreatment & Trauma, researchers analysed online survey data from 2090 US adolescents ages 12 to 17 and their parents. Participants from around the country were asked about the quality of their family meals – including communication, enjoyment, digital distractions, and logistics – as well as adolescents’ alcohol, e-cigarette, and cannabis use in the previous six months.

The researchers then examined how these patterns differed based on adolescents’ experiences of household stressors and exposure to violence, as reported by both the children and parents. Instead of counting each adverse experience equally, the researchers created a weighted score based on how strongly the different experiences are linked to substance use in prior research and this national sample.

Higher family dinner quality was associated with a 22% to 34% lower prevalence of substance use among adolescents who had either no or low to moderate levels of adverse childhood experiences. 

“These findings build on what we already knew about the value of family meals as a practical and widely accessible way to reduce the risk of adolescent substance use,” said Margie Skeer, the study’s lead author, professor and chair of the Department of Public Health and Community Medicine at the School of Medicine.  

“Routinely connecting over meals – which can be as simple as a caregiver and child standing at a counter having a snack together – can help establish open and routine parent-child communication and parental monitoring to support more positive long-term outcomes for the majority of children,” added Skeer. “It’s not about the food, timing, or setting; it’s the parent-child relationship and interactions it helps cultivate that matter.”

Adverse childhood experiences reported by participants in the study included parents being divorced; a family member being diagnosed with a substance-use disorder; someone in the family having a mental-health disorder; the adolescent witnessing violence; the adolescent often being teased about their weight; a parent using non-prescribed drugs daily; or the adolescent experiencing sexual or physical dating violence.  

The study found that family meals offered little protection for adolescents whose adversity score reached the equivalent of four or more experiences – a population that encompasses nearly one in five U.S. high school students younger than 18, according to a study of the most recent Youth Risk Behavior Survey data.  

“While our research suggests that adolescents who have experienced more severe stressors may not see the same benefits from family meals, they may benefit from more targeted and trauma-informed approaches, such as mental health support and alternative forms of family engagement,” said Skeer.  

She added that future research should explore whether other supportive routines – beyond shared meals or outside the family environment – can help protect adolescents exposed to highly stressful or traumatic childhood experiences. 

Source: Tufts University

Categories : Mental Health Substance UseTags :

Study: Adolescent Cannabis Use Linked to Doubling Risk of Psychotic and Bipolar Disorders

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Photo by Thought Catalog on Unsplash

Adolescents who use cannabis could face a significantly higher risk of developing serious psychiatric disorders by young adulthood, according to a large new study published in JAMA Health Forum. The longitudinal study followed nearly half a million adolescents ages 13 to 17 through age 26 and found that past-year cannabis use during adolescence was associated with a significantly higher risk of incident psychotic (doubled), bipolar (doubled), depressive and anxiety disorders.

The study was conducted by researchers from Kaiser Permanente, the Public Health Institute’s Getting it Right from the Start, the University of California, San Francisco and the University of Southern California, and was funded by a grant from NIH’s National Institute on Drug Abuse (R01DA0531920).

The study analysed electronic health record data from routine paediatric visits between 2016 and 2023. Cannabis use preceded psychiatric diagnoses by an average of 1.7 to 2.3 years. The study’s longitudinal design strengthens evidence that adolescent cannabis exposure is a potential risk factor for developing mental illness.

“As cannabis becomes more potent and aggressively marketed, this study indicates that adolescent cannabis use is associated with double the risk of incident psychotic and bipolar disorders, two of the most serious mental health conditions,” said Lynn Silver, MD, program director of the Getting it Right from the Start, a program of the Public Health Institute, and a study co-author.

The evidence increasingly points to the need for an urgent public health response — one that reduces product potency, prioritises prevention, limits youth exposure and marketing and treats adolescent cannabis use as a serious health issue, not a benign behaviour. 

Lynn Silver, MD, Program Director, PHI’s Getting it Right from the Start

Cannabis is the most used illicit drug among U.S. adolescents. The Monitoring the Future study shows use rising with grade level — from about 8% in 8th grade to 26% in 12th grade — and according to the 2024 National Survey on Drug Use and Health, more than 10% of all U.S. teens aged 12 to 17 report past-year use. At the same time, average THC levels in California cannabis flower now exceed 20%, far higher than in previous decades, and concentrates can exceed 95% THC.

Unlike many prior studies, the research examined any self-reported past-year cannabis use, with universal screening of teens during standard pediatric care, rather than focusing only on heavy use or cannabis use disorder.

“Even after accounting for prior mental health conditions and other substance use, adolescents who reported cannabis use had a substantially higher risk of developing psychiatric disorders — particularly psychotic and bipolar disorders,” said Kelly Young-Wolff, PhD, lead author of the study and senior research scientist at the Kaiser Permanente Division of Research.

This study adds to the growing body of evidence that cannabis use during adolescence could have potentially detrimental, long-term health effects. It’s imperative that parents and their children have accurate, trusted, and evidence-based information about the risks of adolescent cannabis use.

Kelly Young-Wolff, PhD, Lead Study Author and Senior Research Scientist, Kaiser Permanente Division of Research

The study also found that cannabis use was more common among adolescents enrolled in Medicaid and those living in more socioeconomically deprived neighbourhoods, raising concerns that expanding cannabis commercialisation could exacerbate existing mental health disparities.

Source: Public Health Institute

Categories : Substance Use UrologyTags :

Ketamine is Giving More Young People Bladder Problems – An Expert Explains

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A growing number of people in the UK are using ketamine recreationally. Photo by Colin Davis on Unsplash

Heba Ghazal, Kingston University

Urology departments in England and Wales have reported seeing an increase in the number of 16- to 24-year-olds being admitted for bladder inflammation associated with ketamine use.

This appears to coincide with an increase in ketamine use – with the number of adults and teens entering treatment for ketamine abuse last year jumping substantially compared to even just a few years previously.

Ketamine abuse can have many affects on the bladder, causing frequent urination, night-time urination, sudden urges, leakage, inflammation, pain in the bladder or lower back and blood in the urine. These symptoms can be severe, make daily life very difficult and may even be permanent in some cases.

Ketamine was first approved in 1970 for human use as an anaesthetic. More recently, studies have suggested that ketamine used at low doses may have antidepressant effects.

But a growing number of people are now using ketamine recreationally. It acts as a dissociative drug, causing users to feel detached from themselves and their surroundings. It can produce hallucinogenic, stimulant and pain-relieving effects, which last one to two hours.

Users typically snort or smoke powdered ketamine, or inject liquid ketamine or mix it into drinks in order to experience the drug’s effects. Snorting usually produces stronger effects and more noticeable symptoms than swallowing it.

Ketamine users can develop tolerance to the drug quickly, needing higher doses to get the same effects. This is probably due to the body and brain adapting to become more efficient at breaking down the drug. Frequent users often need to take twice the amount of occasional users to get the same effect.

Bladder damage

Frequent, high-dose ketamine use can cause serious damage to the bladder, urinary tract and kidneys. In severe cases, the bladder may need to be removed.

The first recorded cases of ketamine affecting the bladder were reported in Canada in 2007, where nine people who used ketamine recreationally had severe bladder problems and blood in their urine. Later, a bigger study in Hong Kong found the same issues in 59 people who had used ketamine for more than three months.

Ketamine, as with any other drug, is metabolised in the body where it’s broken down and excreted in urine.

When ketamine is broken down, it turns into chemicals that can seriously harm the bladder. When these by-products stay in contact with the urinary tract for a long time, they irritate and damage the tissue.

The bladder is damaged first, because it holds urine the longest. Later, the ureters (tubes connecting the kidney to the bladder) and the kidneys can also be affected.

Over time, the bladder can shrink and become stiff, causing strong urinary symptoms. The ureters can become narrow and bent, sometimes described as looking like a “walking stick.” This can lead to backed-up urine in the kidneys (hydronephrosis).

Ketamine also increases oxidative stress, which damages cells and causes bladder cells to die. This breaks the protective bladder lining, making it leaky and overly sensitive.

All these changes can make the bladder overactive, extremely sensitive and painful, often causing severe urges to urinate and incontinence.

Bladder damage from ketamine use happens in stages.

In the first stage, the bladder becomes inflamed. This can often be reversed by stopping ketamine and taking certain medication – such as anti-inflammatory drugs, pain relievers or prescription drugs that reduce bladder urgency and help the bladder lining heal.

In the second stage, the bladder can shrink or become stiff. In this stage, treatment is similar to stage one, but a bladder wash may also be required. This is where a catheter is used to put liquid medication directly into the bladder. The drug coats the bladder’s inner lining, helping to restore its protective layer and reduce inflammation.

Botulinum toxin injections may also be used to relax the bladder and reduce pain and urgency. Stopping ketamine remains essential to prevent further damage.

In the final stage, permanent damage occurs to the bladder and kidneys. Over time, if the kidneys are affected, it can lead to kidney failure. Dialysis (a treatment where waste products and excess fluid are filtered from the blood) or even surgery may be required to repair kidney function and the urinary system.

Although ketamine has been a class B drug since 2014, it’s unfortunately affordable and accessible – costing as little as £3 per gram in some parts of the UK. Raising awareness about the risks of ketamine use is essential to prevent these serious health problems.

Heba Ghazal, Senior Lecturer, Pharmacy, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Obstetrics & Gynaecology Substance UseTags :

Effectiveness of Common Treatments for Opioid Use Disorder in Mothers and Infants

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Photo by Alina Matveycheva

Over the last 20 years, substance use-related deaths have more than doubled for women of reproductive age. Overdose deaths are now a leading cause of maternal mortality in the US, and in some states, the leading cause.

Still, substantial gaps remain in understanding how different treatment approaches influence the short- and long-term health of mothers and infants, as well as their broader economic impacts over time.  

New research published this month in the journal JAMA Pediatrics found that while established medications for opioid use disorder in mothers – buprenorphine and methadone – are both superior and cost saving compared to alternative treatment pathways (naltrexone, medication-assisted withdrawal or no treatment), buprenorphine produced the greatest health gains and cost savings for mothers and infants.

Using a mathematical simulation model, the study projected the health and cost outcomes for pregnant individuals with opioid use disorder and their infants over their lifetime. The economic model captured how treatment decisions during pregnancy can have lasting health and economic consequences, such as risks of preterm birth, that extend from infancy through adulthood and drive substantial downstream health effects and costs. Outpatient buprenorphine emerged as the optimal treatment in most scenarios tested (58%-100%) and in nearly every lifetime scenario that incorporated both mother and infant trajectories (99%). In other words, across thousands of simulations, buprenorphine consistently produced the best health outcomes and lower costs compared to alternative strategies. 

The study, led by Ashley Leech, PhD, assistant professor of Health Policy at Vanderbilt University Medical Center, and Stephen Patrick, MD, MPH, O. Wayne Rollins Distinguished Professor of Health Policy and chair of the Department of Health Policy and Management at Emory University, is among the first to compare the short- and long-term health benefits and costs of opioid use disorder treatment for mothers and infants, examining outcomes during pregnancy, postpartum and beyond the infant’s first year of life using simulation modeling.

Existing studies have not examined outcomes beyond the infant’s first year of life. The study used a hypothetical treatment group modeled on known demographic and other social factors to estimate differences in outcomes and cost savings over time for each treatment and population group. The paper found that, although neonatal opioid withdrawal syndrome (NOWS) has received much of the clinical attention as a marker of poor infant health after opioid exposure during pregnancy, preterm birth and low birth weight carry greater morbidity and mortality and played a more significant role in shaping long-term infant outcomes. Notably, buprenorphine, despite its direct association with NOWS, was protective against these critical outcomes. 

“Nationwide, we have seen a significant growth of pregnant women with opioid use disorder, but there have not been comprehensive models that evaluate trade-offs of different medications and strategies,” said Patrick. “This study evaluated the trade-offs we face as clinicians – How will medications affect moms and babies? With the evidence we have available, what can we expect years from now? Bottom line, we found that buprenorphine treatment in pregnancy was cost saving and improved outcomes for mothers with opioid use disorder and their babies.”

The researchers emphasised, however, that patient-centred care and patient choice remain essential to sustaining treatment. “While we found that buprenorphine yielded the greatest health gains and was cost saving across all model variations, methadone could still be a viable option for mothers, and at the individual level, it might work better for some,” said Leech, the lead author of the study. “Buprenorphine shows clear benefits for long-term infant outcomes, but it can be more difficult for patients to start and stay on this treatment because, as a partial agonist, it may not feel as strong to those dependent on drugs like heroin or fentanyl. Methadone, by contrast, is often easier for patients to initiate and sustain.

“This is an opportunity to make sure buprenorphine works as well as possible – by ensuring pregnant individuals receive effective doses across trimesters (since they often need higher and increasing amounts for effectiveness compared to nonpregnant patients) and by removing unnecessary Medicaid restrictions.”

The study estimated substantial cost savings to public insurance programmes like Medicaid, finding that treating pregnant individuals this year could save roughly $4 billion in infant-related lifetime costs alone.  

“Medicaid is the largest payer for pregnant individuals and those with substance use disorders. Our research shows that treatment is not only effective but also has the potential to generate significant savings for Medicaid, benefiting both mothers and their children’s long-term health,” Leech said.

Source: Vanderbilt University Medical Center

Categories : Substance UseTags :

Study Untangles the Complex Relationship Between Cannabis and Binge Drinking

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Photo by Pavel Danilyuk on Pexels

Binge drinking is most common among younger adults, and using cannabis during late adolescence or early adulthood is known to increase the risk of engaging in binge drinking. Now, new research from the Arizona State University Department of Psychology shows that this increase in risk of binge drinking from cannabis use varies with age, peaking around age 20.

“We found that during ages 18 to 20, cannabis motivates people to binge drink more often, while later in adulthood, around age 24, it motivates them to binge drink less. This dichotomy has consequences for prevention and treatment efforts,” said Jack Waddell, assistant professor of psychology at ASU and first author on the study.

The study used cannabis use and alcohol consumption data from the National Consortium on Alcohol and Neurodevelopment in Adolescence, a long-term study of over 500 participants with sites in California, Oregon, North Carolina and Pennsylvania. The work was published in Alcohol Clinical and Experimental Research.

Not just one substance

Waddell described the interaction of cannabis use and alcohol consumption as a complex relationship. 

He has previously found that individuals who use both alcohol and cannabis report higher rates of substance use disorder than those who use just one. Yet, he has also found that many individuals who use both alcohol and cannabis perceive using them together as being protective against some of the negative consequences of excessive drinking.

In the current study, he and his collaborators expected using cannabis to consistently increase the likelihood of the study participants engaging in binge drinking, not for it to flip from enabling excessive drinking in late teens and early 20s to blunting it around age 24.

“People are reducing their binge drinking but they’re switching to cannabis. This can be viewed positively from a harm-reduction standpoint, but it is important to understand that there are still a lot of risks associated with cannabis use,” Waddell said.

Digging into the dynamics of substance use

Waddell wants to understand how people end up using more than one substance, and to do this, he plans to study how people think about and use substances on a day-to-day basis.

“What is it that motivates the transition from using one substance to more than one? Is it someone’s affective experiences – their emotions and moods – whenever they’re using alcohol or cannabis that makes them want to add the other? Is it the social environment?” he asked.

Going forward, Waddell plans to use technology-enhanced momentary assessments, which are questionnaires or check-ins delivered by push notification on an app or text message, to study people’s behavior in the moment. 

Having a finer-grained level of access to how different kinds of substance use interact with and influence each other will lead to better treatment and prevention strategies.