Multi-level prediction of substance use: Interaction of white matter integrity, resting-state connectivity and inhibitory control measured repeatedly in every-day life.

Substance use disorders are characterized by inhibition deficits related to disrupted connectivity in white matter pathways, leading via interaction to difficulties in resisting substance use. By combining neuroimaging with smartphone-based ecological momentary assessment (EMA), we questioned how biomarkers moderate inhibition deficits to predict use. Thus, we aimed to assess white matter integrity interaction with everyday inhibition deficits and related resting-state network connectivity to identify multi-dimensional predictors of substance use. Thirty-eight patients treated for alcohol, cannabis or tobacco use disorder completed 1 week of EMA to report substance use five times and complete Stroop inhibition testing twice daily. Before EMA tracking, participants underwent resting state functional MRI and diffusion tensor imaging (DTI) scanning. Regression analyses were conducted between mean Stroop performances and whole-brain fractional anisotropy (FA) in white matter. Moderation testing was conducted between mean FA within significant clusters as moderator and the link between momentary Stroop performance and use as outcome. Predictions between FA and resting-state connectivity strength in known inhibition-related networks were assessed using mixed modelling. Higher FA values in the anterior corpus callosum and bilateral anterior corona radiata predicted higher mean Stroop performance during the EMA week and stronger functional connectivity in occipital-frontal-cerebellar regions. Integrity in these regions moderated the link between inhibitory control and substance use, whereby stronger inhibition was predictive of the lowest probability of use for the highest FA values. In conclusion, compromised white matter structural integrity in anterior brain systems appears to underlie impairment in inhibitory control functional networks and compromised ability to refrain from substance use.

[Anorexia nervosa: An addiction? Application of the addiction model to eating disorders. A narrative commented review]. / L'anorexie mentale : une addiction ? Application du modèle addictologique aux troubles du comportement alimentaire. Une revue narrative commentée.

OBJECTIVES: Addiction offers a framework for the understanding of eating disorders, particularly those characterized by hyperphagia, with growing interest in food addiction. However, the application of the addiction model to anorexia nervosa remains more controversial. In this commented narrative review, we examine and discuss the addictive features of anorexia nervosa. METHODS: Commented narrative review of the literature. RESULTS: Anorexia nervosa could be the consequence of the loss of control of several objects of positive reinforcement: food restriction, physical hyperactivity, and food itself. Craving has been little studied in the field of eating disorders. When investigated, studies mainly focus on food cravings and tend to highlight food cravings that are inversely correlated with the restrictive nature of the disorder. This would thus be less found in anorexia nervosa, in which it is nevertheless reported. The existence of a pre-existing food craving, or its appearance secondary to food restriction, is currently under discussion. In the meantime, the question of a craving for food restriction, underpinned by the gratifying effect of fasting, is raised. CONCLUSIONS: The management of eating disorders has its place within the addiction care sectors. An integrative approach should be favored, for anorexia nervosa, combining, on the one hand, classic nutritional care, and, on the other hand, care within the framework of addiction treatment. Finally, in people with an eating disorder, the search for an addiction to food, food restriction and physical activity, including a systematic assessment of craving, should be systematized.

Cost-effectiveness of drug consumption rooms in France: a modelling study.

BACKGROUND: People who inject drugs (PWID) experience many health problems which result in a heavy economic and public health burden. To tackle this issue, France opened two drug consumption rooms (DCRs) in Paris and Strasbourg in 2016. This study assessed their long-term health benefits, costs and cost-effectiveness. METHODS: We developed a model to simulate two fictive cohorts for each city (n=2,997 in Paris and n=2,971 in Strasbourg) i) PWID attending a DCR over the period 2016-2026, ii) PWID attending no DCR. The model accounted for HIV and HCV infections, skin abscesses and related infective endocarditis, drug overdoses and emergency department visits. We estimated the number of health events and associated costs over 2016-2026, the lifetime number of quality-adjusted life-years (QALYs) and costs, and the incremental cost-effectiveness ratio (ICER). RESULTS: The numbers of abscesses and associated infective endocarditis, drug overdoses, and emergency department visits decreased significantly in PWID attending DCRs (-77%, -69%, and -65%, respectively) but the impact on HIV and HCV infections was modest (-11% and -6%, respectively). This resulted in savings of €6.6 (Paris) and €5.8 (Strasbourg) millions of medical costs. The ICER of DRCs was €30,600/QALY (Paris) and €9,200/QALY (Strasbourg). In scenario analysis where drug consumption spaces are implemented inside existing harm reduction structures, these ICERs decreased to €21,400/QALY and €2,500/QALY, respectively. CONCLUSIONS: Our findings show that DCRs are highly effective and efficient to prevent harms in PWID in France, and advocate extending this intervention to other cities by adding drug consumption spaces inside existing harm reduction centers.

Gender and Drug Use Discrimination Among People Who Inject Drugs: An Intersectional Approach Using the COSINUS Cohort.

Purpose: Injection drug use is strongly associated with stigmatization by loved ones, healthcare providers, and society in general. This stigmatization can have negative consequences on the health of people who inject drugs (PWID) and limit their access to care. Women who inject drugs face greater stigma than men because of gendered social norms and the intersectional effect between gender and drug use identities. For this analysis, we aimed to study discrimination - which is closely linked to stigmatization - experienced by PWID, considering the intersectionality between drug use discrimination and gender discrimination in the French context. Methods: We used data from the COSINUS cohort study, conducted between June 2016 and May 2019 in four French cities. We selected 427 of the 665 PWID who regularly injected drugs enrolled in COSINUS, at three months of follow-up, and performed multivariable logistic regression to identify factors associated with self-reported drug use discrimination. Results: Women comprised 20.6% of the study sample. Sixty-nine percent of the participants declared drug use discrimination and 15% gender discrimination. In the multivariable regression analysis, PWID who had hurried injection out of fear of being seen were almost twice as likely to have experienced drug use discrimination (OR [95% CI]: 1.77 [1.15, 2.74], p = 0.010). Likewise, women experiencing gender discrimination were almost three times as likely to have experienced drug use discrimination (OR [95% CI]: 2.84 [1.07,7.56], p=0.037). Conclusion: Women who inject drugs experienced gender and drug use intersectional discrimination. This could be a reason for the low attendance rates of women in healthcare settings. In addition, discrimination negatively impacted injection drug use practices (eg, hurried injection), particularly for people with unstable housing who injected in public spaces. We recommend introducing adapted services in healthcare facilities for women who inject drugs, and creating a favorable social and physical environment for all PWID in order to improve their health and access to care.

The stigma of smoking among women: A systematic review.

BACKGROUND: Smoking stigma has been well documented, but little is known regarding its specific features and effects on women. Notably, women face unique social, cultural, and economic challenges that may interact with smoking stigma and impact health outcomes. This review investigates the extent to which smoking women encounter and internalise stigma, while examining the various coping mechanisms they employ to manage these negative experiences. METHODS: In November 2022, major databases were systematically searched with no time restrictions. After applying inclusion and exclusion criteria, 23 studies (three quantitative and 20 qualitative) met our criteria. We conducted a quality assessment and summarised the findings pertaining to public stigma, self-stigma, and coping strategies. RESULTS: The stigma about smoking emerges from a variety of sources, such as family, healthcare providers, or internet forums. Women smokers are universally aware of the negative image they have in society. Yet, their experiences and management of the stigma of smoking are shaped by other variables such as cultural background, social class, or motherhood status. Smoking stigma produces ambivalent effects, such as concealment, reduced usage of support services, and to a lesser extent, smoking cessation motivation. CONCLUSIONS: These results indicate that smoking stigma is an important social justice and public health issue and that further research is needed to better prevent its effects on women's well-being and health behaviours.

Drug consumption rooms are effective to reduce at-risk practices associated with HIV/HCV infections among people who inject drugs: Results from the COSINUS cohort study.

AIMS: The primary aim of this study was to evaluate the impact of drug consumption rooms (DCRs) in France on injection equipment-sharing, while the secondary aims focused upon their impact on access to hepatitis C virus (HCV) testing and opioid agonist treatment (OAT). DESIGN: The COhort to identify Structural and INdividual factors associated with drug USe (COSINUS cohort) was a 12-month longitudinal study of 665 people who inject drugs (PWID), conducted in Bordeaux, Marseille, Paris and Strasbourg. We used data from face-to-face interviews at enrolment and at 6-month and 12-month visits. SETTING AND PARTICIPANTS: The participants were recruited in harm reduction programmes in Bordeaux and Marseille and in DCRs in Strasbourg and Paris. Participants were aged more than 18 years, French-speaking and had injected substances the month before enrolment. MEASUREMENTS: We measured the impact of DCR exposure on injection equipment sharing, HCV testing and the use of medications for opioid use disorder, after adjustment for significant correlates. We used a two-step Heckman mixed-effects probit model, which allowed us to take into account the correlation of repeated measures and to control for potential bias due to non-randomization between the two groups (DCR-exposed versus DCR-unexposed participants). FINDINGS: The difference of declared injection equipment sharing between PWID exposed to DCRs versus non-exposed was 10% (1% for those exposed versus 11% for those non-exposed, marginal effect = -0.10; 95% confidence interval = -0.18, -0.03); there was no impact of DCRs on HCV testing and OAT. CONCLUSIONS: In the French context, drug consumption rooms appear to have a positive impact on at-risk practices for infectious diseases such as human immunodeficiency virus (HIV) and hepatitis C virus.

Stigmatization of people with addiction by health professionals: Current knowledge. A scoping review.

Background: Stigma of people with substance and non-substance use disorders (SNSUD) is a long-known phenomenon. The aim of this review was to assess the stigmatization, by health professionals, of people with SNSUD, its characteristics and change over time. Methods: A scoping review of literature reviews was conducted with systematic search of PubMed, Scopus and PsycINFO databases. Results: From the 19 selected reviews, all focused on people with SUD (PWSUD) only and 20 % to 51 % of health professionals had negative attitudes/beliefs about SUD. Addiction training and clinical experience with PWSUD were associated with a less negative attitude. Health professionals' negative beliefs, lack of time or support were associated with less involvement in addiction care. Tobacco use disorder, SUDs other than alcohol and tobacco, relapse, psychiatric comorbidity or criminal records were associated with a more negative attitude. The influence of several variables potentially related to stigmatization was inconsistent across selected reviews. The evolution of stigmatization over time was not systematically assessed and showed mixed results. Conclusions: The stigmatization of PWSUD has an impact on their care, and a change in some variables could reduce its importance: moral model of addiction, health professionals' negative beliefs, lack of training, time, and role support. Teaching what addiction is according to the medical chronic disease model, and developing stigma-focused training could improve caregivers' attitudes and further reduce stigma. Further studies are needed to determine whether stigma of PWSUD by health professionals has changed over time and to characterize stigma for people with non-substance use disorders.

Predictors of users' adherence to a fully automated digital intervention to manage insomnia complaints.

OBJECTIVE: Fully automated digital interventions show promise for disseminating evidence-based strategies to manage insomnia complaints. However, an important concept often overlooked concerns the extent to which users adopt the recommendations provided in these programs into their daily lives. Our objectives were evaluating users' adherence to the behavioral recommendations provided by an app, and exploring whether users' perceptions of the app had an impact on their adherence behavior. MATERIAL AND METHODS: Case series study of individuals completing a fully automated insomnia management program, conducted by a virtual agent, during December 2020 to September 2022. Primary outcome was self-reported adherence to the behavioral recommendations provided. Perceptions of the app and of the virtual agent were measured with the Acceptability E-Scale and ECA-Trust Questionnaire. Insomnia was evaluated with the Insomnia Severity Index at baseline (phase 1), after 7 days of sleep monitoring (phase 2) and post-intervention (phase 3). RESULTS: A total of 824 users were included, 62.7% female, mean age 51.85 (±12.55) years. Of them, 32.7% reported having followed at least one recommendation. Users' trust in the virtual agent and acceptance of the app were related to a pre-intervention effect in insomnia severity (phase 2). In turn, larger pre-intervention improvements predicted better adherence. Mediational analyses showed that higher levels of trust in the virtual agent and better acceptance of the app exerted statistically significant positive effects on adherence (ß = 0.007, 95% CI, 0.001-0.017 and ß = 0.003, 95% CI 0.0004-0.008, respectively). DISCUSSION: Users' adherence is motivated by positive perceptions of the app's features and pre-intervention improvements. CONCLUSIONS: Determinants of adherence should be assessed, and targeted, to increase the impact of fully automated digital interventions.

Does food use disorder exist? Item response theory analyses of a food use disorder adapted from the DSM-5 substance use disorder criteria in a treatment seeking clinical sample.

BACKGROUND: Increased consumption of food that are high in energy and sugar have been pointed as a major factor in the obesity epidemic. Impaired control of food intake and the concept of food addiction has been developed as a potential contributor. Our objective was to evaluate the dimensionality and psychometric validity of diagnostic criteria for food addiction adapted from the 11 DSM-5 substance use disorder (SUD) criteria (i.e.: Food Use Disorder (FUD) criteria), and to evaluate the influence of age, gender, and body mass index (BMI). METHODS: Cross-sectional observational study including 508 participants (56.1% male; mean age 42.2) from outpatient treatment clinics for obesity or addiction disorders at time of admission. FUD diagnostic criteria were analyzed using confirmatory factor and 2-parameter item response theory analyses. Differential Item and Test Functioning analyses were performed across age, gender, and BMI. RESULTS: We demonstrated the one-factor dimensionality of the criteria set. The criterion "craving" presented the strongest factor loading and discrimination parameter and the second-lowest difficulty. We found some significant uniform differential item functioning for body mass index. We found some differential test functioning for gender and BMI. CONCLUSIONS: This study reports, for the first time, the validity of a potential Food Use Disorder (derived from the 11 DSM-5 SUD criteria adapted to food) in a sample of treatment seeking adults. This has great implications both at the clinical level and in terms of public health policy in the context of the global obesity epidemic.

The daily association between affect and alcohol use: A meta-analysis of individual participant data.

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

The Craving-Manager smartphone app designed to diagnose substance use/addictive disorders, and manage craving and individual predictors of relapse: a study protocol for a multicenter randomized controlled trial.

Background: The rate of individuals with addiction who are currently treated are low, and this can be explained by barriers such as stigma, desire to cope alone, and difficulty to access treatment. These barriers could be overcome by mobile technologies. EMI (Ecological Momentary Intervention) is a treatment procedure characterized by the delivery of interventions (messages on smartphones) to people in their daily lives. EMI presents opportunities for treatments to be available to people during times and in situations when they are most needed. Craving is a strong predictor of relapse and a key target for addiction treatment. Studies using Ecological Momentary Assessment (EMA) method have revealed that, in daily life, person-specific cues could precipitate craving, that in turn, is associated with a higher probability to report substance use and relapse in the following hours. Assessment and management of these specific situations in daily life could help to decrease addictive use and avoid relapse. The Craving-Manager smartphone app has been designed to diagnose addictive disorders, and assess and manage craving as well as individual predictors of use/relapse. It delivers specific and individualized interventions (counseling messages) composed of evidence-based addiction treatments approaches (cognitive behavioral therapy and mindfulness). The Craving-Manager app can be used for any addiction (substance or behavior). The objective of this protocol is to evaluate the efficacy of the Craving-Manager app in decreasing use (of primary substance(s)/addictive behavior(s)) over 4 weeks, among individuals on a waiting list for outpatient addiction treatment. Methods/design: This multicenter double-blind randomized controlled trial (RCT) will compare two parallel groups: experimental group (full interventional version of the app, 4 weeks, EMA + EMI), versus control group (restricted version of the app, 4 weeks, only EMA). Two hundred and seventy-four participants will be recruited in 6 addiction treatment centers in France. Discussion: This RCT will provide indication on how the Craving-Manager app will reduce addictive use (e.g., better craving management, better stimulus control) in both substance and behavioral addictions. If its efficacy is confirmed, the app could offer the possibility of an easy to use and personalized intervention accessible to the greatest number of individuals with addiction. Clinical Trial Registration: ClinicalTrials.gov: NCT04732676.

The centrality of craving in network analysis of five substance use disorders.

BACKGROUND AND AIMS: Among the 11 current diagnostic criteria, craving is a potential central marker for understanding and for treatment of Substance Use Disorders (SUD). Our objective was to explore craving centrality across SUD based on the study of symptom interactions in cross-sectional network analyses of DSM-5 SUD diagnostic criteria. We hypothesized the centrality of "Craving" in SUD across substance types. DESIGN: Participants from the ADDICTAQUI clinical cohort with regular use (2 times per week threshold for a substance) and at least one DSM-5 SUD. SETTING: Outpatient substance use treatment services in Bordeaux, France. PARTICIPANTS: The sample of 1359 participants, had a mean age of 39 years old and 67% were males. The prevalence of SUD over the time course of the study was: 93% for alcohol, 98% for opioids, 94% for cocaine, 94% for cannabis and 91% tobacco. MEASUREMENTS: Construction of a Symptom Network Model conducted on the DSM-5 SUD criteria evaluated over the past 12 months for Alcohol-, Cocaine-, Tobacco-, Opioid- and Cannabis Use disorder. FINDINGS: The only symptom that consistently remained in terms of centrality was "Craving" [3.96 - 6.17] (z-scores), indicating that it exhibits a high degree of connections in the entire symptom network regardless of the substance. CONCLUSION: Identifying craving as central in SUD symptoms network confirms the role of craving as a marker of addiction. This constitutes a major avenue in the understanding of the mechanisms of addiction, with implications to ameliorate diagnostic validity and clarify treatment targets.

Mood Variability, Craving, and Substance Use Disorders: From Intrinsic Brain Network Connectivity to Daily Life Experience.

BACKGROUND: Substance use disorders (SUDs) are major contributors to morbidity and mortality rates worldwide, and this global burden is attributable in large part to the chronic nature of these conditions. Increased mood variability might represent a form of emotional dysregulation that may have particular significance for the risk of relapse in SUD, independent of mood severity or diagnostic status. However, the neural biomarkers that underlie mood variability remain poorly understood. METHODS: Ecological momentary assessment was used to assess mood variability, craving, and substance use in real time in 54 patients treated for addiction to alcohol, cannabis, or nicotine and 30 healthy control subjects. Such data were jointly examined relative to spectral dynamic causal modeling of effective brain connectivity within 4 networks involved in emotion generation and regulation. RESULTS: Differences in effective connectivity were related to daily life variability of emotional states experienced by persons with SUD, and mood variability was associated with craving intensity. Relative to the control participants, effective connectivity was decreased for patients in the prefrontal control networks and increased in the emotion generation networks. Findings revealed that effective connectivity within the patient group was modulated by mood variability. CONCLUSIONS: The intrinsic causal dynamics in large-scale neural networks underlying emotion regulation play a predictive role in a patient's susceptibility to experiencing mood variability (and, subsequently, craving) in daily life. The findings represent an important step toward informing interventional research through biomarkers of factors that increase the risk of relapse in persons with SUD.

Craving dynamics and related cerebral substrates predict timing of use in alcohol, tobacco, and cannabis use disorders.

Background: Patients treated for Substance Use Disorders exhibit highly fluctuating patterns of craving that could reveal novel prognostic markers of use. Accordingly, we 1) measured fluctuations within intensively repeated measures of craving and 2) linked fluctuations of craving to connectivity indices within resting-state (rs) brain regions to assess their relation to use among patients undergoing treatment for Alcohol, Tobacco and Cannabis Use Disorders. Method: Participants -64 individuals with SUD for tobacco, alcohol, or cannabis and 35 healthy controls-completed a week of Ecological Momentary Assessment (EMA) during which they reported craving intensity and substance use five times daily. Before EMA, a subsample of 50 patients, and 34 healthy controls also completed resting-state (rs)-MRI acquisitions. Craving temporal dynamics within each day were characterized using Standard Deviation (SD), Auto-Correlation Factor (ACF), and Mean Successive Square Difference (MSSD). Absolute Difference (AD) in craving between assessments was a prospective prediction measure. Results: Within-day, higher MSSD predicted greater substance use while controlling for mean craving. Prospectively higher AD predicted later increased substance use independently of previous use or craving level. Moreover, MSSD was linked to strength in five functional neural connections, most involving frontotemporal systems. Cerebello-thalamic and thalamo-frontal connectivity were also linked to substance use and distinguished the SUD from the controls. Conclusion: To the best of our knowledge, this is the first study to indicate that instability in craving may be a trigger for use in several SUD types, beyond the known effect of craving intensity.

The Executive Functioning Paradox in Substance Use Disorders.

Deficits in neurocognitive functioning are trait-like vulnerabilities that have been widely studied in persons with substance use disorders (SUD), but their role in the craving-use association and relapse vulnerability remains poorly understood. The main objectives of this study were to examine whether executive capacities moderate the magnitude of the craving-substance use relationship, and if this influence is correlated with the functional connectivity of cerebral networks, combining rsfMRI examinations and ecological momentary assessment (EMA). Eighty-six patients beginning outpatient treatment for alcohol, tobacco or cannabis addiction and 40 healthy controls completed neuropsychological tests followed by EMA to collect real-time data on craving. Fifty-four patients and 30 healthy controls also completed a resting-state fMRI before the EMA. Among the patients with SUD, better verbal fluency and resistance to interference capacities were associated with a greater propensity to use substances when the individual was experiencing craving. Preliminary rsfMRI results identified specific networks that interacted with executive performance capacities to influence the magnitude of the craving-use association. Individuals with better executive functioning may be more prone to relapse after craving episodes. Specifically, better resistance to interference and cognitive flexibility skills may reduce attention to distracting stimuli, leading to a greater awareness of craving and susceptibility to use substances.

Realist evaluation of three programmes aimed at reducing harm and risks associated with alcohol consumption in the Nouvelle Aquitaine region of France: the ECIAE study protocol.

INTRODUCTION: In Europe, alcohol consumption is responsible for many diseases, disabilities, injuries and premature deaths. In France, alcohol consumption represents an important health burden, due to its frequency, scale and the serious damage it causes. One of the keys to addressing the problem would appear to be the adoption of harm and risk reduction approaches. In order to operationalise this strategy, the Nouvelle Aquitaine Regional Health Agency is funding three different programmes to reduce the harm and risks associated with alcohol consumption: Alcochoix, Iaca and ETP (Education Thérapeutique du Patient) Conso-repère. We are interested in understanding how, under what circumstances, through which mechanisms and for which population the different programmes work. METHODS AND ANALYSIS: The ECIAE study (a cross-evaluation of the 3 programs Iaca/Alcochoix/ ETP (Patient Therapeutic Education) is a theory-based evaluation where the realist evaluation method is used to explore effects, intervention mechanisms and the influence of context on outcomes. This realist evaluation is based on multiple case studies in two nested levels. At the first level, each centre implementing the programme will represent a case. At the second level, each programme will represent a case in which a set of activities is conducted to achieve risk reduction objectives. ETHICS AND DISSEMINATION: The project will be carried out in full compliance with existing legislation and international conventions. It was subject to analysis, including a privacy impact assessment conducted by the Data Protection Officer of the University of Bordeaux. The University of Bordeaux has ensured that all the regulatory procedures related to the ECIAE study have been carried out. The dissemination plan includes scientific papers, seminars, a report and recommendation and a public restitution. The study will provide evidence-based results to help health authorities roll out strategies to reduce risks and harm associated with alcohol use.

Realist evaluation of the impact, viability and transferability of an alcohol harm reduction support programme based on mental health recovery: the Vitae study protocol.

INTRODUCTION: Addiction is considered a chronic disease associated with a high rate of relapse as a consequence of the addictive condition. Most of the current therapeutic work focuses on the notion of relapse prevention or avoidance and the control of its determinants. Since only a small portion of patients can access alcohol addiction treatment, it is crucial to find a way to offer new support towards safe consumptions, reductions or cessations. The harm reduction (HR) approach and mental health recovery perspective offers another way to support the patient with alcohol addiction. Vitae is a realist evaluation of the impact, viability and transferability of the IACA! programme, an HR programme based on the principle of psychosocial recovery for people with alcohol use disorders. METHODS AND ANALYSIS: The Vitae study adheres to the theory-driven evaluation framework where the realist evaluation method and contribution analysis are used to explore the effects, mechanisms and influence of context on the outcomes and to develop and adjust an intervention theory. This study is a 12-month, multi-case, longitudinal descriptive pilot study using mixed methods. It is multi-centred, and carried out in 10 addiction treatment or prevention centres. In this study, outcomes are related to the evolution of alcohol use and the beneficiaries trajectory in terms of psychosocial recovery during these 12 months after the start of IACA!. The target number of participants are 100 beneficiaries and 23 professionals. ETHICS AND DISSEMINATION: This research was approved by the Committee for the Protection of Persons Ouest V n°: 21/008-3HPS and was reported to the French National Agency for the Safety of Health Products. All participants will provide consent prior to participation. The results will be reported in international peer-reviewed journals and presented at scientific and public conferences. TRIAL REGISTRATION NUMBERS: NCT04927455; ID-RCB2020-A03371-38.

Efficacy of a Smartphone-Based Virtual Companion to Treat Insomniac Complaints in the General Population: Sleep Diary Monitoring Versus an Internet Autonomous Intervention.

(1) Background: Insomnia is the most prevalent sleep disorder worldwide and cognitive behavioral therapy is the front-line treatment. Digital health technologies have a role to play in screening and delivering interventions remotely and without the need for human intervention. The KANOPEE app, which provides a screening and behavioral intervention for insomnia symptoms through an interaction with a virtual agent, showed encouraging results in previous studies during and after the COVID-19 lockdown, but has not yet been evaluated in a controlled study. This study aims at comparing the benefits of KANOPEE, a smartphone application dealing with insomnia complaints, with another application proposing an electronic sleep diary named "My Sleep Diary". The acceptance and potential benefits of these digital solutions are tested in real-life settings (i.e., without soliciting human medical resources) and in the general population. (2) Methods: Subjects were included if they downloaded one of the apps between December 2020 and October 2021, and were of legal age. Both apps were available on downloading platforms in France. Primary outcome was Insomnia Severity Index (ISI), and secondary outcomes were total sleep time (TST), sleep efficiency (SE) and wake time after sleep onset (WASO). (3) Results: A total of 535 users completed the intervention with KANOPEE and 489 users completed My Sleep Diary, both for 17 days. KANOPEE users improved their ISI score significantly more than sleep diary users (interaction Time*Group: F(2,2002) = 17.3, p < 0.001). Similar results were found for nocturnal sleep parameters (TST) (KANOPEE users gained 48 min of sleep after intervention, while My Sleep Diary users gained only 16 min of sleep), and particularly in the population with moderate to severe initial sleep complaints (F(4,1980) = 8.9, p < 0.001). Other sleep markers (SE and WASO) were significantly improved in the KANOPEE users compared to the sleep diary ones (p < 0.001). (4) Conclusions: KANOPEE provides significantly greater benefits than an electronic sleep diary regarding reduction of insomnia complaints and estimated nocturnal sleep characteristics in a self-selected sample of the general population. Population with the most severe initial ISI score (≥15) benefited the most from the KANOPEE App compared to filling up a simple sleep diary.

Item Response Theory Analyses of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Criteria Adapted to Screen Use Disorder: Exploratory Survey.

BACKGROUND: Screen use is part of daily life worldwide and morbidity related to excess use of screens has been reported. Some use of screens in excess could indicate a screen use disorder (ScUD). An integrative approach to ScUD could better fit the polymodal reality of screens, and concurrent problems with screens, than a split approach, activity by activity. In that paradigm, a pragmatic and operationalized approach to study a potential ScUD requires the use of common criteria, for all screens and activities done on screens, in a single questionnaire. OBJECTIVE: Our goals were (1) to describe screen uses in a general population sample and (2) to test the unidimensionality, local independence, and psychometric properties of the 9 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) internet gaming disorder (IGD) criteria adapted to screen use in a community sample. We hypothesized that the 9 DSM-5 IGD criteria adapted to ScUD would show unidimensionality, local independence, and good discrimination, with criteria distributed on the severity continuum. METHODS: This cross-sectional survey in a French suburban city targeted adults and adolescents. A self-administered questionnaire covered the main types of screens used and their use for various activities in the past month. Presence of ScUD diagnostic criteria in past 12 months was also self-evaluated in the questionnaire. Factor and 2-parameter Item Response Theory analysis were used to investigate the dimensionality, local independence, and psychometric properties of the ScUD criteria. RESULTS: Among the 300 participants, 171 (57.0%) were female (mean age 27 years), 297 (99.0%) used screens, 134 (44.7%) reported at least one criterion (potential problem users), and 5 (1.7%) reported 5 or more criteria and endorsed an ScUD. The most endorsed criteria were loss of control (60/300, 20.0%) and preoccupation (52/300, 17.3%). Screen types used and screen activities differed between participants with no ScUD criteria and those with at least one ScUD criterion. The latter were more likely to have a computer as the most used screen type, and more video gaming, communication/social network, and watching news and research of information as activities. Unidimensionality was confirmed by all fit indices. Local independence was confirmed by the absence of residual correlation between the items. Criteria had relatively high factor loading, with loss of interest in other recreational activities having the highest. However, criteria with the lowest factor loading all remained above the cut-offs, sanctioning unidimensionality. Most discriminating criteria were loss of interests, preoccupation, deceive/cover up, and risk/lose relationship/opportunities, which also provided the most information on the measurement of the latent trait. CONCLUSIONS: We described screen uses in a French community sample and have shown that the adaptation of the DSM-5 IGD to "ScUD" has good psychometric validity and is discriminating, confirming our hypothesis. We suggest to use those criteria to assess potential "ScUD." Further studies should determine if all criteria are needed and whether others should be added.