Addiction Audio

Dr Perski explains the evolution of Ecological Momentry Assessment (EMA) studies and how they have been used to collect granular data relating to everyday experiences. Olga's latest review focuses on EMA studies and smoking, looking at lapse and relapse. She talks about how EMA can be used to test and develop models and theories of addiction in ways that cross-sectional studies cannot. She also covers how you can use EMA to capture fluctuating and dynamic changes among people who use drugs."If we go back to thinking about more traditional survey based studies which would measure these constructs weeks apart - knowing that lapses can happen very rapidly in response to very rapidly increased cravings or a cue in the environment. For example, in a bar or restaurant where someone would pick up a cigarette that can very rapidly lead to a lapse. I think that helps emphasis the point that Ecological Momentary Assessment and maybe also sensor data is required in order to pick up these very very rapid fluctuations."Olga then talks about developing an appraisal tool for assessing the quality of EMA studies, which involves looking at reporting guidelines. She then talks about how and why open science principles can be applied to EMA studies.Original article: Within-person associations between psychological and contextual factors and lapse incidence in smokers attempting to quit: A systematic review and meta-analysis of Ecological Momentary Assessment studies by Olga Perski and Colleagues. Published in Addiction (2023)

Rob talks to Dr Will Lawn about his research into the acute effects of cannabis on young people and adults. Will talks about setting up a study looking at young people and adults’ experiences of using cannabis with different levels of cannabidiol. He talks about the challenges of blinding participants to different types of cannabis; about how to manage the placebo effect when participants can become quickly aware of whether they have or have not had cannabis and the challenges of running a trial involving a controlled drug.He discusses the study’s findings that suggest that teenagers respond similarly to adults in the acute stages of cannabis use and experience the same short-term harms as adults.He also talks about the importance of selecting the best episode of The Simpsons for an academic study.“In the last four to five years there’s been a swing towards thinking CBD doesn’t really moderate the impact of THC at these kind of 1 to 30mg dose levels”Dr Will Lawn is a Lecturer at King’s College London Psychology DepartmentOriginal article: ‘The acute effects of cannabis with and without cannabidiol in adults and adolescents: a randomised, double-blind, placebo-controlled, crossover experiment by Will Lawn and colleagues. Published in Addiction (2023) 

In this episode, Dr Katherine East talks about her recent article on heated tobacco product use. When conducting this research, Katie talked to former and current smokers who use IQOS to understand the words they use to describe themselves and what they do in relation to heated tobacco products. Katie and Rob then talk about how the language can reflect identity and how this can influence the risk of people relapsing to smoking or other forms of nicotine use. They discuss the importance of social norms and how language can play a substantial role in shaping those norms. Katie explains why some potential words that might have been used have since been discarded, including “heaters” and “IQOSers”. They also talk about different social circumstances and how heated tobacco use, vaping and smoking identities interact. Link to Katie’s previous podcast“Lots of people refer to it as smoking still…. It also means less having to explain what it is because very few people have heard of IQOS”“The way that people refer to things and they way they think about themselves as product users can influence their behaviour.”“Whilst people referred to IQOS use as smoking they were very resistant to being identified as a smoker”. Original article: ‘It's not what you'd term normal smoking’: a qualitative exploration of language used to describe heated tobacco product use and associated user identity by Katherine East and colleagues. Published in Addiction (2022).

In this episode, Harry Tattan-Birch talks about his recent article on the increased popularity of disposable vaping products. He discusses the difference between this new generation of vaping products compared with the original versions.He talks about the data that suggest a rise in vaping alongside a lack of change in use of nicotine products overall. And the three reasons why disposable vapes have become more popular; including the low up-front cost, nicotine delivery/nicotine salts, and the convenience.“You can just walk into a shop, buy a device, open the packet and instantly start using it. you don’t have to know anything about coils… the concentration of e-liquid, you don’t have to charge it.”Harry also talks about how the team were able to publish relatively soon after noticing the trend. He talks about using data from the Smoking Toolkit Study and how this supports efficient and effective publishing, enabling researchers to see what’s happening real-time on the nicotine market. Original article: Rapid growth in disposable e-cigarette vaping among young adults in Great Britain from 2021 to 2022: a repeat cross-sectional survey by Harry Tattan-Birch and colleagues. Published in Addiction (2022)

In this episode of Addiction Audio, Rob Talks to Dr Ashley Gearhardt from the University of Michigan about whether highly processed foods can be considered to be addictive substances.Dr Gearhardt starts by defining highly processed foods before covering the issues that arise from having an addictive substance (such as food) that you can’t ‘opt out’ of. Ashley makes comparisons with other addictive substances noting that highly processed foods can induce cravings and lead to a loss of control. She then talks about which foods have a bigger impact on addictive behaviours highlighting foods that contain refined sugars and added fats such as pizzas and donuts.Rob and Ashley then discuss the limits to research whereby there is little agreement on how to define an addictive substance. This is in stark contrast with a growing consensus on how to identify addictive behaviours. There are, for example, agreed diagnostic criteria for addiction, but there is less agreement on how to define whether a substance is addictive.They also talk about how a substance that isn’t intoxicating can be addictive.“It isn’t necessarily the amount of pleasure or liking you get at the moment you consume them [highly processed foods], but the ability that they have to sensitise motivation systems to want more and more and more”“We argue that we need to treat these highly processed foods, not so much as foods per se but as highly refined substances that have been engineered to be incredibly rewarding.”Original article: Highly processed foods can be considered addictive substances based on established scientific criteria by Ashley Gearhardt and Alexandra DiFeliceantonio. Published in Addiction (2022)

In this episode of Addiction Audio, Rob talks to Ebtesam Saleh a Doctoral student at the Charite university in Berlin. Ebtesam talks about her recent systematic review of qualitative research on substance use among refugees. She talks about talks about the limitations of using survey data to explore this issue and how qualitative research can help contextualise the problems faced by refugees in a culturally sensitive way. Ebtesam discusses the impact that research can have and how researchers can minimise the potential for re-traumatisation through research interviews. She also discusses the cultural differences in how people view substances and substance use. With substances like coca, betul quid and prescription drugs being viewed, legislated and used in different ways in different countries. There are also multiple barriers to treatment that refugees can experience from stigma to a lack of resources and including structural factors such as health insurance requirements in different countries. Ebtesam then talks about the many refugee groups whose experiences are not present in the literature:“For example, Yemen hosts many refugee populations from African conflict countries; while Yemen itself is a country struggling with civil war, so it looks like a refugee crisis within a country of crisis. So, a crisis within the crisis”

In this episode of Addiction Audio, Drs Mignonne Guy and Megan Piper talk about their work on the racial equity taskforce for the Society for Research on Nicotine and Tobacco (SRNT). It was a powerful and wide-ranging discussion about developing anti-racist practice, social constructs of race, research methods, society organisations and research funding structures. Megan and Mignonne began by talking about why the racial equity taskforce was set up, how they determined what to do and the findings of the SRNT policy review. They then discuss wider issues of race and inequality that run throughout academia, describing how health disparity research can be suppressed and discouraged as well as the impact of the tobacco industry’s racist history. The discussion then focuses on how key research concepts – including methods often considered central to public health research – need to change or be replaced in order to eliminate the impact of structural racism on research and on population health. They finally offer advice to organisations about how to undertake their own racial equity reviews. “When we look at our policies and we see that there’s nothing about race, no, that’s not surprising … because that’s how this invisible dominant whiteness takes over everything – by excluding those groups and not explicitly referring to other populations.” - Dr Mignonne Guy  “So, this scientific premise that we have been operating under and training …. so many scientists under that the population can be controlled for doesn’t work. [This] really does elevate the importance of studying specific populations because their experiences are so very different they can’t be controlled for.” - Dr Megan Piper “We’re asking people to divest from their scientific legacy and to try to construct something new and be part of that and pioneering this type of work” - Dr Mignonne Guy

In this episode we talk to Dr Sharon Cox about developing an ontology around nicotine and tobacco products. Sharon also talks about the importance of ontologies and how they are important for research. She talks about how to manage disagreements when developing a system that categorises and defines products, behaviours and properties. “So, as researchers, which we are, we should be pedants and we should think it’s important that the products we write about we write about with accuracy.”  “Because we want to be clear, we want to be really clear with the public. We want to make sure that we’re writing lay outputs, developing ad campaigns advising companies….. we want to make sure that we’re communicating the science of our subject as clearly as we can. And that really starts with our academic work.”  Original article: Toward an ontology of tobacco, nicotine and vaping products by Sharon Cox and colleagues. Published in Addiction (2022)

In this episode, Professor Matt Hickman talks about using population modelling to identify the population implications of Opioid Agonist Treatment (OAT). He covers the impact that OAT has on drug-related deaths and other causes of mortality as well as how models can be used to explore what mortality rates would have been without OAT in New South Wales, Australia.Professor Hickman talks about their findings that, without OAT, the number of overdose deaths would have been 50% higher.“So, what we were trying to do in this study was to model the counter-factual of how many deaths there would be if there hadn’t been any opioid agonist treatment. In theory the ideal model would be a trial in which you have OAT versus no OAT in a population, now clearly that’s unethical and can’t be done.”He also talks about how the research team set up a dynamic model that they used to explore the data, matching incarceration and OAT records. They then used those data alongside findings from systematic reviews to model the hypothetical impact of OAT on a real population.“We’ve done models before, theoretical models which say ‘if we increase the opioid agonist treatment programme and we increase duration at a certain point what impact would that have?’ but that’s rarely based on actual real data. So …there’s modelling and there’s modelling, and this model is based on real empirical data and we think that gives it a bit more credence”. Original paper here: Modeling the population-level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia by Antoine Chaillon and colleagues. Published in Addiction (2022)