American Society of Addiciton Medicine

Home Publications The ASAM Weekly Detail

The ASAM Weekly for November 19th, 2024

This Week in the ASAM Weekly

Did you know that wasps can outdrink bees? Or even humans? That’s because wasps have a duplication of the alcohol dehydrogenase (ADH) gene which enables highly efficient alcohol metabolism. A new study, using a novel technique (isotope carbon-13 labeling), measured this ramped-up metabolism, and its findings could re-orient us back to metabolism as a therapeutic target for AUD (PNAS).

This is relevant because not enough people with AUD receive appropriate treatment, and for those with alcohol-associated liver disease (ALD), the likelihood is much less. A new study highlights an opportunity for hepatologists and gastroenterologists to help fill the AUD treatment gap in patients with ALD (Medscape). While liver disease is only one of many alcohol-related illnesses, there is a broader phenomenon – known as the alcohol harm paradox – in which socioeconomic status is inversely related to alcohol harms. A study from Norway finds that after adjusting for consumption volume, the paradox does exist, but the reasons for its existence are not well understood (BMC Public Health). 

One thing we do know is that the paradox is not necessarily a result of heavier drinking patterns, because those patterns don’t seem to discriminate. In fact, Americans across the nation experienced higher rates of heavy alcohol use or AUD during the pandemic, and this has unfortunately persisted (Annals of Internal Medicine). Binge drinking is a particularly harmful pattern of heavy drinking, and there are certain neuroimaging finds that could help us predict its onset (Drug and Alcohol Dependence). On a side note, how is it that the lower limit of binge drinking (BAC = 0.08) also happens to be the upper limit to legally drive in most localities?

Keep all this in mind the next time you see a wasp fly into a drink. Because wasps have an extra gene for ADH, they can drink a lot of alcohol. Humans do not, so we experience different kinds of harms, paradoxes, and questionable limits for impaired driving. Because you clicked on an email titled “how to survive enormous amounts of alcohol,” you know more than you probably ever wanted to about wasps flying into drinks. 

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 

Suicide in people prescribed opioid-agonist therapy in Scotland, United Kingdom, 2011–2020: A national retrospective cohort study ðŸ”“

Addiction

This retrospective cohort study aimed to determine if opioid agonist therapy (OAT) in Scotland is protective against suicide, and measure trends in suicide rates in those with opioid dependence over time. The study included 46,453 individuals who received at least one prescription for OAT between 2011 and 2020 with over 304,000 person-years (pys) of follow-up. Results suggested that people with opioid dependence in Scotland have a greater risk of suicide than the general population. Treatment is protective, with rates of suicide lower among those on opioid agonist therapy. Suicide rates have decreased over time, during a period in which drug-related death rates in Scotland have risen to globally high levels.

Research and Science 

Neurostructural features predict binge drinking in emerging adulthood: Evidence from a 5-year follow-up study ðŸ”“ 

Drug and Alcohol Dependence

This study investigated whether the anatomic structure of brain regions in adolescence could predict drinking behavior in early adulthood. First-year college students (n=68) underwent brain MRI scans, and from an alcohol use assessment 5 years later (average age 23.6 years), had their drinking behavior expressed as the number of binge episodes during the previous 6 months. Researchers found that greater surface area of the caudal division of the middle frontal gyrus was associated with increased future binge episodes (RR=2.24, p=0.005). Also, smaller surface area of the right caudal anterior cingulate cortex was associated with increased future binge episodes (RR=0.61, p=0.004). The authors conclude that neuroimaging has the potential to identify individuals at risk for alcohol use problems.

A randomized controlled trial on the effect of cranial electrotherapy stimulation on depression, anxiety, and craving in addicted male patients undergoing methadone maintenance treatment ðŸ”“

BMC Psychiatry

Neuromodulation through brain stimulation may be a non-pharmacological intervention to treat mental health and substance use disorders. In this randomized controlled trial, researchers evaluated cranial electrotherapy stimulation (CES) in men with opioid use disorder (OUD) on methadone maintenance for impact on depression, anxiety, and opioid cravings. Patients in the placebo and intervention groups saw a significant decrease in anxiety and cravings symptoms, while the intervention group also had a significant decrease in depression symptoms. The intervention group had a statistically significant larger decrease in cravings symptoms, but not in depression and anxiety symptoms. The authors suggest CES may be a useful adjuvant therapy for OUD to reduce cravings.

Effects Of Medicaid Waivers On Use Of Medications For Opioid Use Disorder And Nonfatal Overdoses In 17 States

Health Affairs

Federal policy that prohibits use of federal funds for Medicaid services for inpatient facilities with focus on mental health or substance use has been considered a hurdle to provision of the full continuum of care for opioid use disorder (OUD). Starting in 2015, states could apply for a waiver to use federal funds in this setting; the waiver also requires states to provide all types of medication for OUD (MOUD), including in inpatient settings. In this study, researchers evaluated whether there was a difference in MOUD use and non-fatal overdoses between states that received the waiver and those that did not. Overall, they did not find a significant difference in MOUD use and non-fatal overdose between states with and without the waiver. They did find a significant increase in methadone use in states with the waiver, but this was accounted for by changes in methadone coverage under Medicaid. 

Learn More 

How to survive enormous amounts of alcohol ðŸ”“ 

PNAS

Researchers discovered that, unlike bees, wasps have an extreme tolerance to alcohol, due to efficient alcohol dehydrogenase (ADH) activity. This allows wasps to survive beer and consume alcohol-rich food sources. Experiments revealed that even when exposed to 80% ethanol, Oriental hornets did not experience health or behavioral effects. This contrasts with bees, whose high ethanol exposure leads to severe effects, including death. ADH gene duplication in hornets accelerates ethanol metabolism 200x faster than in bees. Findings suggest targeting ADH and related enzymes could help develop treatments for alcohol use disorder.

Screened Out — How a Survey Change Sheds Light on Iatrogenic Opioid Use Disorder 

The New England Journal of Medicine

The 2019 National Survey on Drug Use and Health (NSDUH) estimated 1.6 million Americans had OUD; however, individuals taking opioids as prescribed were instructed to skip the OUD screening questions. In 2021, a method change screened these individuals for OUD, and in 2022, the estimate rose to 6.1 million Americans with OUD. If you include patients receiving MOUD, who may not currently have DSM-5 symptoms of OUD, the figure rises to 9.4 million. There is a large group of patients taking opioids as prescribed who have OUD. Their most common DSM-5 criteria were craving, difficulty cutting down, and a great deal of time spent obtaining and using opioids. The authors believe that improved epidemiology of OUD will help direct limited treatment resources more efficiently.

Trends in Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional Study ðŸ”“

Annals of Internal Medicine

This nationally representative study suggests that the prevalence of any alcohol use and heavy alcohol use during the COVID-19 pandemic (2020 vs. 2018) showed absolute increases of 2.7% (relative increase, 4.0%) and 1.0% (relative increase, 20.2%), and that the increases were sustained in 2022. Potential causes of this sustained increase include normalization of and adaptation to increased drinking due to stress from the pandemic, and disrupted access to medical services. The research also suggests that certain subgroups may have experienced greater increases in heavy alcohol use. The results draw further attention to the potential alcohol-related public health effects that may remain from the pandemic. This study was limited by potential selection bias and was conducted while the pandemic was ongoing. Close follow-up is needed to determine whether increases in heavy alcohol use persist.

The alcohol harm paradox: is it valid for self-reported alcohol harms and does hazardous drinking pattern matter?🔓

BMC Public Health

Alcohol harms are known to be more common among persons in low socioeconomic positions (SEP) compared to those in high SEP, adjusted for alcohol consumption. In this study of an adult population in Norway, researchers assessed if hazardous drinking patterns and having a spouse/partner may play a role in this difference. Overall, 9% of participants reported alcohol-related consequences or alcohol dependence symptoms, with the highest proportion found in the low SEP group. Alcohol consumption volume increased with increasing SEP, but episodes of drinking to intoxication or 6+ drinks and volume proportion of consumption that was spirits was higher in low SEP. Researchers found that having a spouse attenuated some of the alcohol harms. The authors note based on their finding, drinking patterns could only explain some of the paradox of increased harms found in low SEP, and additional research is needed.