American Society of Addiciton Medicine
Apr 10, 2025 Reporting from Rockville, MD
The ASAM Weekly for April 9th, 2025
https://www.asam.org/news/detail/2025/04/10/the-asam-weekly-for-april-9th--2025
Apr 10, 2025
Averted lung cancer deaths due to reductions in cigarette smoking in the United States, 1970–2022

The ASAM Weekly for April 9th, 2025.Substring(0, maxlength)

American Society of Addictin Medicine

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The ASAM Weekly for April 9th, 2025

Apr 10, 2025
ASAM weekly

This Week in the ASAM Weekly

An article in Cancer celebrates the millions of American lives saved over many decades because of tobacco control. It is worth reading, not just for its findings but because it frames a story of how America addressed the harms of substance use — successfully. 

One can begin with the 1964 US Surgeon General’s report that drove an American awakening to the harms of tobacco use. Such evidence-based leadership (Benzinga) was eventually followed by thoughtful interventions: bans on flavored cigarettes (The Hill), funding for smoking cessation (NBC), and even excise taxes (Reuters). Clear clinical guidance was also important, even when some of that guidance was a little late in the game (JAMA Internal Medicine).

Tobacco control also benefited from having an overwhelmingly clear link to harm and a consensus on pathology (at least with lung cancer). This is not always the case with other substances (Biomolecules), other illnesses (Obesity), or other behaviors (Nature Reviews Psychology)...for now.

Tobacco control even targeted different socioeconomic groups because tobacco was used differently by different people, in different regions, and throughout different industries (MMWR). This diversity was appreciated because survey data unites data points (The Associated Press).

In hindsight though, it’s not clear whether tobacco control is an addiction story about being a first, about getting it right, or just about getting lucky — but it’s a compelling story, and “people are drawn to simple, mythical stories [that] explain complex issues” (Popular Mechanics). We have such a story with tobacco control and should storytell it more often when talking about addiction.

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM; John A. Fromson, MD; Jack Woodside, MD

Benzodiazepine Tapering Webinar Series

Registration is now open for ASAM's Benzodiazepine Tapering Webinar Series, which was designed to support implementation of the Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits.  

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Call for Applications: Fourth Edition ASAM Criteria Correctional Settings and Reentry Volume 

Applications to join the writing committees for the Correctional Settings and Reentry Volume of the Fourth Edition of The ASAM Criteria are now being accepted until May 9, 2025.  

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Lead Story 

Averted lung cancer deaths due to reductions in cigarette smoking in the United States, 1970–2022 🔓

CA: A Cancer Journal for Clinicians 

Smoking prevalence peaked in the 50s and 60s but has declined following the US Surgeon General’s report in 1964 on smoking-associated health risk. As 85% of lung cancer is attributable to smoking, the authors evaluated this impact by assessing lung cancer deaths averted, and person-years of life (PYL) gained between 1970 and 2022 using cancer mortality data from the CDC. They estimated 3,856,240 lung cancer deaths were averted and 76,275,550 PYL were gained during the study period (average of 19.8 PYL gained per death averted). The deaths averted were higher in men (2,246,610), but average PYL gained per death averted was higher in women (22.4 years). Lung cancer deaths averted accounted for 51.4% of the estimated decrease in overall cancer deaths. These findings highlight the importance of tobacco controls and interventions and need for ongoing efforts to decrease tobacco use.  

Research and Science 

Risk of Major Congenital Malformations Following Prenatal Exposure to Smoking Cessation Medicines 🔓

JAMA Internal Medicine

This cohort study examined if the use of nicotine replacement therapy (NRT), varenicline, and bupropion during the first trimester of pregnancy is associated with increased risks of major congenital malformations (MCMs).  Looking at 5.2 million births in Australia (state of New South Wales), New Zealand, Norway, and Sweden, researchers found no increased risk of MCMs overall following exposure to NRT (9,325 infants), varenicline (3,031 infants), or bupropion (1,042 infants). Additionally, they found no evidence of higher risk of several malformation subgroups for NRT or varenicline, while the risk of malformation subgroups could not be estimated robustly for bupropion. The results of this study suggest that, considering the harms of smoking, it is reassuring that prenatal use of NRT and varenicline for smoking cessation was not associated with increased risks of MCMs compared with smoking during the first trimester. 

Obesity is associated with progressive brain structural changes 🔓

Obesity

The aim of this study was to investigate the relationship between obesity (OB) progression and brain structural changes. T1-weighted magnetic resonance images were acquired from 258 participants with overweight (OW) or OB and 74 participants with normal weight. Participants with OW or OB were divided into four groups according to BMI grades. Two-sample t tests compared disparities between the four subgroups and the participants with normal weight. Causal structural covariance networks were used to examine the progressive impact of OB on brain structure. Findings suggest that reductions in gray matter volume in individuals with OB may originate from reward/motivation processing regions, subsequently progressing to inhibitory control/learning memory regions, providing a new reference direction for clinical intervention and treatment of OB. 

How effective are remote and/or digital interventions as part of alcohol and drug treatment and recovery support? A systematic review and meta-analysis 🔓

Addiction

Remote interventions for treatment of substance use disorders (SUD) have increased, particularly after the COVID-19 pandemic; to assess their efficacy, the authors conducted a systematic review. This study included 34 RCTs and compared remote interventions supplementing in-person care and remote interventions in place of in-person care to in-person care alone. Persons receiving remote care + in-person care had reduced odds of relapse (OR =0.61, P<0.001) and a reduction in mean days of use (P<0.001) compared to in-person alone. Remote care in place of in-person care was also associated with decreased odds of relapse (OR=0.51, P<0.001) but not a decrease in mean days of use. The authors note that there was concern about a “high” risk of bias in assessing outcomes in many of the studies and recommend further research.   

Learn More 

Rethinking trazodone for insomnia in alcohol use disorder🔓 

Addiction Science and Clinical Practice

This commentary notes that trazodone is commonly considered first-line therapy for treatment of insomnia in patients with alcohol use disorder (AUD). A systematic review found trazodone possibly effective for insomnia with AUD but also noted a possible association with heavier alcohol use. A prospective randomized controlled trial found increased drinking that persisted 3 months after trazodone was discontinued. Several studies of a trazodone metabolite (meta-chlorophenylpiperazine) found it produced effects similar to alcohol and increased craving for alcohol. The authors cite 2 studies of patients with AUD showing improved sleep with reduction of alcohol use. They also note the proven benefits of cognitive behavior therapy for insomnia. They conclude these safer alternatives to trazodone could improve AUD outcomes. 

Synthetic Opioid and Stimulant Co-Involved Overdose Deaths by Occupation and Industry — United States, 2022 🔓 

Morbidity and Mortality Weekly Report 

The authors note that some persons using opioids also use psychostimulants (amphetamines or similar) or cocaine to reduce sedation and improve workplace performance. They used vital statistics data (with cause of death and occupation information) to identify 69,893 synthetic opioid-involved overdose deaths. Overall, 53.6% of these deaths co-involved stimulants, and by occupation, ranged from 43.4% to 57.5%. The occupations co-involving psychostimulants tended to be physically demanding, such as farming, fishing, mining, construction, or sports. Those co-involving cocaine tended to be less physically demanding, such as business, financial, administration, and health care occupations. The authors speculate that this could be due to psychostimulants’ longer duration of action or lower cost. They also note that rates of cocaine-involved deaths are higher in urban than rural areas. 

Does Cannabis Use Contribute to Schizophrenia? A Causation Analysis Based on Epidemiological Evidence 🔓

Biomolecules

A literature search found 18 relevant studies concerning the association of cannabis use and schizophrenia or psychosis-like events. Ten of these studies were suitable for meta-analysis, which yielded an overall odds ratio of 2.88 (CI 2.2-3.7) for the association of cannabis with schizophrenia/psychosis. Two studies focused on adolescents (14-16 years) with 10-year follow-up and found even higher odds ratios (26.7 and 6.5) than for cannabis use later in life. Three studies found greater risk for males than females. Using criteria that suggest causation, the authors conclude that cannabis likely played a causative role in the increased risk of schizophrenia/psychosis, particularly during adolescence. They speculate that cannabis may affect synaptic plasticity during adolescence.

The illusion of control in problematic gambling behaviour

Nature Reviews Psychology

The "illusion of control" is when people overestimate their ability to influence random events. First identified by Ellen Langer in 1975, it occurs when individuals believe they can control outcomes that are actually beyond their control, like pressing buttons to speed up processes. Langer's research showed that people valued lottery tickets more when they chose their own numbers, even though it didn’t affect their chances. She also found that physical involvement, like throwing a roulette ball, increased the illusion of control. Later studies confirmed that early wins in games of chance reinforced this illusion, influencing behaviors like gambling. Recent research shows that while early wins boost the illusion, it weakens with more trials or random outcomes, and the underlying cognitive mechanisms remain under study.