American Society of Addiciton Medicine
Jan 22, 2025 Reporting from Rockville, MD
The ASAM Weekly for January 21st, 2025
https://www.asam.org/news/detail/2025/01/22/the-asam-weekly-for-january-21st--2025
Jan 22, 2025
Current Advances in Behavioral Addictions

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The ASAM Weekly for January 21st, 2025

Jan 22, 2025

This Week in the ASAM Weekly

It’s always tempting to make predictions at the start of a new year. Let’s begin with The American Journal of Psychiatry‘s January issue, which is dedicated to psychedelic psychiatry and begins with an Editor’s Note that leads us down the long, strange history of psychedelics. The narrative culminates in a modern-day renaissance, part of which has seen a 40% jump in ketamine use in recent years (Journal of Affective Disorders). But since the state of psychedelic research is still not well-established, it might benefit from a series of open access, living systematic reviews (Nature Mental Health).

The future of telehealth is also looking…more stable? The DEA and HHS have finalized a rule allowing clinicians to prescribe buprenorphine for up to 6 months without an in-person appointment, preserving much needed access to a life-saving medication (Roll Call). All this comes as the threat of fentanyl-containing counterfeit pills continues to grow throughout the US and may soon become a problem more globally (Lancet Public Health). 

Nicotine has a way of coming back into style even if we’re trying to make it a thing of the past. In a potential world-first, US regulators are proposing to cap the level of nicotine in cigarettes to non-addictive levels, but opponents are warning of unintended consequences (Reuters). Let’s hope the worst might be the use of more smokeless products, like the recently FDA-authorized Zyn nicotine pouches (NBC News). If not, there are always incentives, such as contingency management — a tried and tested but underutilized approach that has lasting effects, even with tobacco cessation (Cochrane Database of Systematic reviews).

Now, where does alcohol fit into all of this? Humans' relationship with it spans millennia, yet it's gaining renewed attention in 2025. As research points to mounting health concerns, experts and individuals alike still aren’t quite sure what to make of it all (The New York Times). However one might look at it — from doctors (Medscape) to medical schools (MedPage Today) — medicine’s relationship with alcohol is changing. 

It’s a change for the better but doesn’t stop with alcohol. What 2025 might be predicting is that we’re re-assessing addiction and talking more about the relationships we have with all of its nuanced behaviors (American Journal of Psychiatry).

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 

Current Advances in Behavioral Addictions: From Fundamental Research to Clinical Practice

The American Journal of Psychiatry

This narrative review discusses five clinically relevant and prevalent behavioral addictions that are common and often co-occur with psychiatric disorders such as depression and anxiety. Gambling disorder is the only behavioral addiction recognized as a clinical disorder in the DSM-5, and internet gaming disorder is included as a condition requiring further research. ICD-11 categorizes gambling and gaming disorders as disorders due to addictive behaviors. Additional behavioral addictions may include compulsive sexual behavior disorder, compulsive buying-shopping disorder, and problematic use of social media. Validated diagnostic instruments exist, with empirical support varying across conditions. No medications have approved indications from regulatory bodies for behavioral addictions, and cognitive-behavioral therapy has the most empirical support for efficacious treatment. Treatment optimization involving pharmacotherapy, psychotherapy, neuromodulation, and their combination warrants additional investigation.

Research and Science 

Utility of Candidate Genes From an Algorithm Designed to Predict Genetic Risk for Opioid Use Disorder ðŸ”“ 

JAMA Network Open

The FDA recently approved a commercial algorithm (AdvertD) that predicts risk for OUD using 15 genetic variants (single nucleotide variants) involved in brain reward pathways. The reported sensitivity is 83% and specificity 79%. The paper's authors discuss potential bias in genetic risk prediction. Genomes from different global regions (eg, European, African, Asian) have different frequencies of alleles that can bias the association with OUD. The authors tested the algorithm in 452,664 individuals from a Veterans Affairs program (33,669 with OUD). Of the 15 variants, 13 were associated with OUD; however, after correcting for global genetic ancestry only 3 were associated with OUD, yielding a sensitivity of 51% and specificity of 55%, only “slightly better than random guessing.” They conclude that genetic risk algorithms must be evaluated using “rigorous standards to reduce sources of bias.”

Incentives for smoking cessation

Cochrane Database of Systematic reviews

In this Cochrane review, researchers assessed 48 studies to evaluate the evidence around impact of incentives/contingency management on smoking cessation in mixed populations and pregnant populations. Across the studies included, there was a significant range in the amount of incentive offered and if an incentive was given at the final long-term follow-up visit. Overall, there was high-certainty evidence that incentives improved smoking cessation rates at long-term follow-up in both the mixed and pregnant populations. Further, the incentives’ effectiveness was sustained, even when incentive was not provided at final visit. The authors do suggest additional studies to compare various incentive schedules and low- versus high-value incentive programs.

Effectivenessof tobacco advertising, promotion and sponsorship bans on smoking prevalence, initiation and cessation: a systematic review and meta-analysis ðŸ”“ 

Tobacco Control

Tobacco smoking is still one of the leading causes of mortality worldwide. One of the proposed strategies to reduce tobacco use is a control measure aimed at curbing tobacco advertising, promotion, and sponsorship (TAPS). In this meta-analysis study, researchers examined the impact of bans on TAPS on smoking initiation, cessation, and overall prevalence. Overall, bans on TAPS were associated with a decrease in overall smoking prevalence (aOR=0.8) and decreased smoking initiation (aOR=0.63). However, bans on TAPS were not associated with a change in smoking cessation (aOR=1.10). These findings support the use of bans on TAPS as a public health measure to decrease tobacco smoking.

Learn More 

Psychedelics in Psychiatry: Oh, What A Trip! ðŸ”“ 

The American Journal of Psychiatry

This special issue of the American Journal of Psychiatry highlights the ongoing research into psychedelics' psychiatric applications, marking a significant shift from fringe science to mainstream legitimacy. The field has seen rapid growth, with over 1,000 participants in clinical trials and billions in investment — indeed, a “renaissance period for psychedelic research.” However, key scientific and research protocol methodological questions remain around issues such as safety, efficacy, and the role of psychological support. The issue addresses these concerns, exploring the potential benefits and challenges of psychedelics like psilocybin and MDMA, while emphasizing the need for further research to ensure clinical success.

An initiative for living evidence synthesis in clinical psychedelic research 

Nature Mental Health

Despite enthusiasm for psychedelics for treatment of mental disorders there remain questions such as durability of effects, side effects, and an unclear mechanism of action. The pace of research makes systematic reviews rapidly outdated. The authors describe the creation of a living systematic review, available on a public dashboard (SYSPRES – Synthesis of Psychedelic Research Studies) and updated with new evidence as it becomes available. Cochrane methods will be used to assess study quality and bias. Phase 1 will address MDMA for PTSD and psilocybin for depression; phase 2 will evaluate both LSD and psilocybin for anxiety; and phase 3 will assess safety. This living systematic review will keep up-to-date information available to all.

The public health risks of counterfeit pills ðŸ”“

The Lancet Public Health

Illicit fentanyl in the form of counterfeit pills has increased from 10% of seizures in 2017 to 49% in 2023. Counterfeit pills are often indistinguishable from legitimate pills and can appeal to users, such as adolescents, who would reject drugs in powder form. Overdose deaths are increasing among adolescents, doubling between 2019 and 2020. Counterfeit pills can be purchased in Mexico from pharmacies that appear legitimate. In Canada, 20% of pills with fentanyl also contained a benzodiazepine, increasing overdose risk. Recommendations include public education about counterfeit pills, particularly directed at younger age groups. Drug checking services should be available. Information about new substances should be broadcast and obtained from drug checking, drug seizures, and overdose toxicology. Also, efforts to prevent diversion of pharmaceuticals should consider that demand may be diverted to counterfeit pills.

Trends and characteristics in ketamine use among US adults with and without depression, 2015-2022

Journal of Affective Disorders

Clinical interest in and eventual approval of the use of ketamine for treatment of depression may have also impacted recreational use. The authors utilized the National Survey on Drug Use and Health (NSDUH) to examine trends in recreational use of ketamine between 2015 and 2022 in the general population and those with depression. Overall, ketamine use increased over the study period. Between 2015 and 2019, ketamine use increased more among those with depression (139.3% increase) versus those without depression (77.8% increase). The increase was similar in both populations between 2021 and 2022. The authors noted other risk factors including younger age, higher education, and opioid misuse were associated with ketamine use, and suggest education is needed to mitigate potential risk of recreational ketamine use, in the context of potential clinical benefits.