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The ASAM Weekly for May 21st, 2024

This Week in the ASAM Weekly

Childhood trauma is a risk factor for mental illness, yet understanding causation has been difficult. A study using population attributable fractions that controlled for common confounders found that childhood trauma accounts for 21-41% of mental health disorders in Australia, with alcohol and drug use disorders being high on that list (JAMA Psychiatry).

Childhood trauma is also associated with drug overdose deaths. Over 320,000 children in the US are estimated to have lost a parent in the past 10 years to drug overdose (JAMA Psychiatry). When including gun deaths, it is projected that 1.19 million children (1999-2020) have experienced parental death from firearms or overdose in the past 20 years (JAMA).

How we protect children then is an important question. Mandatory reporting for substance-exposed newborns can be harmful to children, but a trauma-informed process may be more protective and effective (JAMA Pediatrics). Adolescents who use substances are at a higher risk for psychiatric and substance use disorders, so identifying predictors of initiation can help with prevention and early intervention. It turns out that self-reported sociodemographic data can be more predictive than neurocognitive or neuroimaging data (American Journal of Psychiatry). Is it possible that somehow childhood trauma is better accounted for in sociodemographic data? 

Childhood trauma, like addiction, is a multi-disciplinary concern, and like addiction, our understanding of it needs to evolve: recognition, awareness, advocacy, research, definition, diagnosis, prevention, and treatment are all part of this. It is reassuring to know that the studies mentioned above were published in high-impact journals from different disciplines all within the same week. 

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

 

ASAM Clinical Considerations for Engagement and Retention of Non-Abstinent Patients in Substance Use Treatment

ASAM has made available for public comment a draft of its Clinical Considerations for Engagement and Retention of Non-Abstinent Patients in Substance Use Treatment document. The deadline for feedback is June 3.

Click Here for More Information

 
 

Lead Story

Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment

JAMA Psychiatry

Studies have demonstrated that childhood maltreatment is strongly associated with mental health conditions, but this study uses a quasi-experimental design and meta-analysis to assess proportion of various mental health issues that are attributed to childhood maltreatment. The authors found that approximately 25% of mental health disorders (anxiety, depression, alcohol use disorder (AUD), substance use disorders (SUD), self-harm, and suicide) could be attributed to childhood mistreatment, accounting for approximately 1.8 million cases in Australia. Approximately 27% of AUD and 32% of SUD were attributed to childhood maltreatment. The findings strongly support the importance of efforts to prevent childhood maltreatment. 

 

ASAM Clinical Algorithm Subcommittee 
CALL FOR APPLICATIONS!

The ASAM Clinical Algorithm Subcommittee is looking for members to collaborate on refining the 4th Edition clinical algorithms for ASAM Criteria-based assessment tools! Click the link below to learn more and apply.

Applications due May 31, 2024.

Apply Here


Research and Science

Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021

JAMA Psychiatry

Children who lose parents can face significant short- and long-term negative outcomes related to substance use, mental and physical health issues, and housing and financial insecurity. This study estimated the number of children who lost a parent due to overdose between 2011 and 2021, including trends and demographics. The authors estimated 321,566 children lost a parent during the study period, with the number per 100,000 increasing annually from 27 in 2011 to 63.1 in 2021. They also found significant disparities by race, with rates particularly high among non-Hispanic American Indian and Alaska Native people. The authors suggest programs to address the opioid epidemic and overdose crisis should also consider the burden placed on children who lose parents. 

Youth Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020

JAMA

This study explored the estimated rates of US youth (younger than 18 years) who have lost a parent due to drug poisoning or firearms. Using cross-sectional methodology and publicly available data between 1999 and 2020, an estimated 1.19 million US youth had a parent die by drug poisoning or firearms. In 2020, drugs and firearms caused 23% of all parental deaths compared with 12% in 1999, and Black youth experienced a disproportionate burden, mainly due to firearm deaths of fathers. Results of this modeling study suggest that US youth are at high and increasing risk of experiencing parental death by drugs or firearms.

A quantitative feedback intervention to reduce binge drinking in young adults

Journal of Studies on Alcohol and Drugs

The purpose of this study was to evaluate the feasibility (recruitment and retention rates), acceptability, and preliminary efficacy testing of a short-term “know your numbers (KYN)” intervention on motivating young adults to reduce their engagement in binge drinking. At 4-weeks there was a 62% increase in contemplation scores (indicating higher motivation), and a decrease in US Alcohol Use Disorders Test (USAUDIT) scores with an increase in the percent of participants classified as low-risk drinkers. No differences were found between baseline and 4-week phosphatidylethanol (PEth) levels or number of binge episodes. Focus group results revealed satisfaction with the KYN approach but the need to understand how PEth levels and USAUDIT scores corresponded to health consequences and alcohol use levels.

Predictors of Substance Use Initiation by Early Adolescence

The American Journal of Psychiatry

Early initiation of substance use is associated with increased risk of developing a substance use disorder and psychosocial issues as an adult. In this study, researchers assessed multiple factors to evaluate which may be associated with early initiation, including demographics, culture, environment, neurocognitive testing, and MRIs. The most predictive factor was religion, with religious preference of Mormon being protective and religious preference for Jewish being associated with increased likelihood. In addition, Black race was also found to be protective. Significant modifiable factors associated with increased likelihood of early initiation include substance availability and peer use of alcohol and nicotine. The authors did note that neurocognitive testing and imaging did not improve ability to predict early initiation. Overall, sociodemographic factors seem to be the best predictors. 

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Mandatory Child Protective Services Reporting for Substance-Exposed Newborns and Peripartum Outcomes

JAMA 

In many states, reporting of prenatal substance exposure (PSE) is mandatory, with no exception for prescribed opioids including MOUD. Parents prescribed MOUD believe this reporting is unjust and stigmatizing. In Massachusetts, only half of PSE reports are found to represent child abuse or neglect. In May 2021, Boston Medical Center began reporting PSE only when there were concerns about child protection. This change resulted in a 45% decrease in the number of newborns reported. However, there was no associated change in the proportion of newborns discharged home with a biological parent. The authors believe that reporting only when there are protection concerns would help conserve state resources and reduce stigma. 

A qualitative study of experiences with physical activity among people receiving opioid agonist therapy ðŸ”“

Substance Abuse Treatment, Prevention, and Policy

This study surveyed patients in outpatient opioid treatment clinics in Norway concerning exercise. Thirteen semi-structured interviews were completed, identifyinghealth barriers to exercise, such as knee pain, back pain, and reduced lung function. Researchers noted that previously, the patients’ exercise focused on high-adrenaline activities, but now they more interested in improving their health. There was a preference for group exercise to enhance social connections, but also fear that some group members may be intoxicated and put them at risk for relapse. Other barriers were the suspension of group activities during COVID and the cost of gym memberships. The authors note the importance of addressing physical limitations and social dynamics.

BRAIN at 10: A View from the National Institute on Alcohol Abuse and Alcoholism ðŸ”“

National Institutes of Health

This is an interview with George Koob, PhD, Director of NIAAA, about collaboration between NIAAA and the NIH BRAIN initiative. The BRAIN (Brain Research through Advancing Innovative Neurotechnology) initiative is “aimed at revolutionizing our understanding of the human brain.” NIAAA has benefited from understanding the role of neuron and non-neuronal cells in alcohol use disorder (AUD), effects of alcohol use on the brain, and how brain circuits result in behaviors seen in AUD. This collaboration has advanced the use of imaging in the study of AUD. Dr. Koob anticipates new knowledge of AUD and the development of novel treatments.