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The ASAM Weekly for January 14th, 2025
This Week in the ASAM Weekly
It’s interesting that in 2025, Greece is still struggling to embrace smoking bans that have successfully been applied for years in other countries. Although the inexplicably low price of cigarettes (~5 euros) is briefly mentioned, a New York Times article focuses more on an ingrained cultural phenomenon that’s heeding progress - the Greek mentality.
In America, we have our own ingrained cultural phenomena that heed progress, particularly when it comes to addiction. The United States Surgeon General has been making headlines with an advisory to place cancer warnings on alcohol-containing beverages because “there is a direct link between alcohol and fatal cancers.” (HHS) Yet this comes on the heels of a report from the National Academies of Sciences which finds alcohol to be less harmful than what many experts have said (NASEM). Maybe we should ask our colleagues in Canada or at the World Health Organization.
Sometimes when the US is making progress, we have to acknowledge that we got a late start. SAMHSA has published updated opioid treatment program (OTP) guidelines based on important changes from 2024, but methadone access in the US is still woefully behind many other countries (PCSS).
Thankfully, the US leads with funding scientific research. The Adolescent Brain Cognitive Development (ABCD) Study is a remarkable endeavor, and a recent study of ABCD data could make us re-evaluate our “current causal assumptions and how we think about addiction.” (JAMA Network Open) Let’s just hope it doesn’t inspire more “criticism” about the brain disease model (WSJ). There are only so many cultural phenomena this newsletter can handle.
But that’s why we have a podcast. Take a listen to our latest episode in which Drs. Fiellin and Strain “disagree” about treatment resistant addiction. It just might have something to do with the American mentality...
Thanks for reading,
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM; Jack Woodside, MD; John A. Fromson, MD
Lead Story
Review of Evidence on Alcohol and Health 🔓
National Academies of Sciences, Engineering, and Medicine
To inform the next edition of the Dietary Guidelines for Americans (DGA), Congress tasked the National Academies with convening an expert committee to independently review the evidence on the relationship between moderate alcohol consumption and eight health outcomes including obesity, cancer, and cardiovascular disease. This controversial report found that a pattern of moderate drinking was associated with 18 percent fewer cardiovascular disease deaths, a 16 percent lower risk of all-cause mortality, and a 10 percent heightened risk of breast cancer for women.
Research and Science
Neuroanatomical Variability and Substance Use Initiation in Late Childhood and Early Adolescence 🔓
JAMA Network Open
This cohort study of 9,804 participants examined the neuroanatomical features associated with early substance use initiation, and if they precede initiation. Researchers found variability in brain structure, including greater whole brain, cortical, and subcortical volumes. Thinner prefrontal cortex, but thicker cortex otherwise, was significantly associated with early (ie, age <15 years) substance use initiation (ie, alcohol, nicotine, cannabis, or other). The majority of brain structure features associated with substance use initiation were evident among substance-naïve children at baseline who later initiated. These findings suggest neurodevelopmental variability in brain structure may confer risk for early substance involvement.
Journal of General Internal Medicine
In this retrospective study, researchers evaluated the impact of an addiction consultation service on receipt of medication for opioid use disorder (OUD) or alcohol use disorder (AUD), and 30-day readmission. Overall, medication for OUD (MOUD) was administered in 67% of admissions with OUD, and medication for AUD (MAUD) was administered in 18% of admissions with AUD. Patients who received an addiction consult were more likely to receive MOUD (aRR=1.68) and MAUD (aRR=5.62) during hospitalization and at discharge (RR=2.29 and RR=9.48). In addition, those who received a consult were less likely to be readmitted in 30 days (aRR=0.82). Those who received MOUD (aRR=0.83) or MAUD (aRR=0.77) at discharge were also less likely to be readmitted. Overall, the addiction consult service was associated with improved treatment for OUD and AUD and decreased readmissions.
Trends in Opioid Use Disorder in the Veterans Health Administration, 2005-2022 🔓
JAMA Network Open
This cross-sectional study of patients in the Veterans Health Administration (VHA) included approximately 5 million adults per year and examined how the prevalence of opioid use disorder (OUD) among VHA patients changed from 2005 to 2022. The prevalence of OUD increased from 2005 to 2017, peaked in 2017 at 1.16%, and declined until 2022 to 0.97%. The findings suggest that the prevalence of OUD is declining, although continued public health efforts aimed at recognizing, treating, and preventing OUD are warranted.
Journal of Addiction Medicine
Studies of repetitive transcranial magnetic stimulation (rTMS) in alcohol use disorders (AUD) have found mixed results; however, studies have varied in the number of treatments and specific brain regions targeted. This meta-analysis only included studies using at least 10 sessions of high frequency rTMS and randomized controlled trials with control groups receiving sham rTMS. Twelve studies were identified with 252 participants and 223 controls. Immediately after treatment, there was a reduction in craving with a standardized mean difference (SMD)=-0.79, p=0.04 and reduced craving was sustained at 3 months (SMD=-0.44, p<0.01). Results suggested that rTMS targeting the medial prefrontal cortex was more effective than targeting the right or left dorsolateral prefrontal cortex. Researchers concluded a minimum of 10 rTMS sessions reduced alcohol craving that was sustained at 3 months.
Learn More
Seminars in Perinatology
This paper discusses the current knowledge regarding the outcomes of children with prenatal opioid exposure. The authors note that the developmental outcomes of these children are influenced by many factors, eg, exposure to other substances such as stimulants and nicotine. They reference a 2019 study showing that 52% of pregnant individuals using heroin also used methamphetamine. Maternal nutrition, obesity, and mental health, including depression and anxiety, can contribute to developmental delays. Environmental factors such as exposure to lead, air pollution, pesticides, and heat can influence outcomes. Overall, researchers believe most studies that address confounding variables show no significant impact of prenatal opioid exposure on neurodevelopment. They suggest future research address these confounding factors.
Radiology
Structural and functional MRI (fMRI) were obtained from participants with OUD receiving methadone and healthy controls. Compared to controls, participants with OUD had smaller volumes in the thalamus and right temporal lobe and larger volumes in brainstem, midbrain, and cerebellum. In participants with OUD, females had larger volumes in the medial prefrontal cortex than males (p<0.05) but were not different from healthy controls. Increased volume correlated with increased functional connectivity in the cerebellum and brainstem. The authors conclude that participants with OUD had brain alterations in opioid receptor-dense regions.
THC Ingestions and Child Protective Services: Guidelines for Practitioners
Journal of Addiction Medicine
There has been a rise in accidental ingestion by children of tetrahydrocannabinol (THC)-containing products, as they have been decriminalized and increasingly present in households. There has been some support for reporting every accidental ingestion to Child Protective Services (CPS), but the authors argue against this blanket recommendation given potential negative impacts, including to families, unnecessary use of limited CPS resources, and disparate impact on low-income and non-White communities. The authors suggest a case-by-case approach using the following questions: 1) Was it unintentional? 2) Did parents/guardians take steps to prevent ingestion? 3) If substance ingested was not THC, would it be reportable? 4) Are there any other contributing factors?
In The News
People Say Addiction is a Disease. Mine Wasn't.
The Wall Street Journal
SAMHSA Releases Federal Guidelines for Opioid Treatment Programs and Explanatory Video Series
Providers Clinical Support System
Alcohol Consumption and Cancer Risk: Key Data
US Department of Health and Human Services
Surgeon General Calls for Cancer Warnings on Alcohol
The New York Times
Greeks Are Defying an Indoor Smoking Ban, Even After 14 Years
The New York Times