反差系列

This Week in the ASAM Weekly

Addiction health crises share fundamental characteristics. Potency, or toxicity, drives negative outcomes; co-use develops as the crisis matures; and there are missed opportunities to intervene when individuals engage within a health care setting ().

Increased access leads to increased harm. At first, the burden mostly affects certain demographics or regions, but when a multiplier kicks in—like regulatory loopholes, social media attention, or online sales—the crisis can quickly spread (). Once it goes global, though, it never really goes away (). 

Informing the broader public then becomes a cornerstone of crisis response. The information needed, however, comes from research that takes time; whether studying chronic illness (), the impact on families (), or the significance of financial well-being (), a timely response requires early recognition. 

Gambling addiction incorporates all the characteristics mentioned above, but no one is calling it a crisis …yet (). Whenever that time comes, gambling could be recognized for another characteristic—someone always makes a profit in an addiction crisis. 

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

Lead Story  

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Scientific Reports

This study compared memory performance in patients treated with methadone or buprenorphine for drug abuse to healthy controls using the Wechsler Memory Scale. Healthy controls performed better than both treatment groups in mental control. Methadone patients scored higher than controls in personal and general information, while buprenorphine patients scored lower in associate learning. Longer buprenorphine treatment was linked to better overall memory scores, and patients on methadone for over two years showed better awareness of place and time compared to long-term buprenorphine users. Overall, neither medication showed major negative effects on memory except for mental control, which was impaired in both groups. Buprenorphine appeared to better preserve memory function over time than methadone.

Research and Science 

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Addiction

This systematic review and meta-analysis of longitudinal cohort studies from high-income countries investigated the link between caregiver alcohol use and child maltreatment, expanding beyond previous studies that focused only on physical abuse. Researchers found that caregivers with alcohol-related diagnoses had significantly higher odds of both new incidents and recurrence of child maltreatment compared to those without such diagnoses. While any caregiver drinking showed a possible association with maltreatment, the evidence was less certain. Despite some variability and limitations in the data, the findings suggest caregiver alcohol use is a significant risk factor for child maltreatment, highlighting the need for stronger measures to reduce alcohol-related harm.

Annals of Epidemiology

In Tennessee between 2019 and 2022 there were 11,970 fatal overdoses. This study used data from the Tennessee Department of Health reporting system to examine the presence of bystanders during these overdoses. Overall, bystanders were present in 25% of cases and were less likely to be present for decedents over age 55 (14%) or in large inner cities (16%). Most bystanders were family members (27%), intimate partners (27%), or friends (21%). In addition to calling 911, bystanders performed CPR 27% of the time or gave naloxone 6% of the time. Since in 75% of fatal overdoses no bystander was present, the authors stress the importance of not using alone. There is a need to raise awareness of the availability of naloxone since it was used in only a small proportion of overdoses. 

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Journal of Addiction Medicine

This study examined the relationship between financial well-being and alcohol use during the COVID pandemic. The study sample consisted of 250 individuals, including 32% with AUD and 68% without AUD. A history of AUD had a significant interaction with a lower level of financial well-being. A lower level of financial well-being was associated with increased drinking (AUDIT) and an increase in depression (PHQ-9) and anxiety (GAD-7). Individuals with a history of AUD were less likely to apply for financial assistance, which the authors speculate may be a result of an inability to fulfill daily tasks. The authors conclude that during periods of financial instability there is an association between financial stress and alcohol use. They suggest efforts to improve availability of financial assistance to individuals with AUD and financial stress.

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PLOS One

In this cross-sectional study, researchers examined accidental substance-related toxicity deaths in Ontario between 2018 and 2022. Over the study period, the most involved substances were opioids (84.1%), stimulants (60.9%), alcohol (13.4%), and benzodiazepines (7.8%). Of note, there was an increase in the combined involvement of both opioids and stimulants in deaths over the study period (30.7% to 45.3%). Among the individuals who died, 60.9% had received a prior diagnosis of substance use disorder and 19.9% had been treated for a substance-related toxicity in the year prior to death. These findings demonstrate the changing landscape of substance-related toxicity, specifically the increasing involvement of multiple substances, but also highlight potential missed opportunities to intervene with patients seen in health care settings.

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BMC Psychiatry

Previous functional MRI studies show different patterns of brain activation for craving associated with drug withdrawal and craving induced by drug cues. This study measured craving in 150 individuals with methamphetamine use disorder (MUD) during withdrawal, utilizing images of drug use and drug paraphernalia, including a virtual reality scene of actors using methamphetamine during a card game and inviting the observer to “take a hit.” The virtual reality drug use scene produced significantly greater craving than either withdrawal craving or the paraphernalia images. The withdrawal craving was positively associated with all the cue-induced cravings suggesting a shared neurobiological mechanism. The MUD severity score was positively correlated with both withdrawal craving and cue-induced craving. Virtual reality can create complex and relevant cues that induce stronger craving than images of drug paraphernalia.

Addictive Behaviors

This study assessed the global disease burden caused by tobacco use from 1990 to 2021 using the Global Burden of Disease database. Researchers found that deaths and disability-adjusted life years (DALYs) related to tobacco have increased annually worldwide, with cardiovascular and chronic respiratory diseases being the most affected. Males experience a significantly higher burden than females. Regions with higher Socio-Demographic Index (SDI) levels saw greater reductions in tobacco-related disease burden, while low to middle SDI countries continue to suffer higher impacts. Projections to 2040 indicate that tobacco-related deaths and disease burden will keep rising globally but at a slower pace. Overall, despite some progress, low and middle SDI countries remain disproportionately affected.

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Addiction

In this prospective cohort study over 20 years, researchers examined the association between light, moderate, and heavy alcohol consumption and incidence of cardiometabolic risk markers. Overall, light, moderate, and heavy alcohol consumption were associated with increased incidence of hyperglycemia, high blood pressure, and hypertriglyceridemia. Moderate and heavy alcohol consumption were also associated with increased incidence of metabolic syndrome and abdominal obesity. Across all 5 risk markers, the associations were linear, with increasing incidence associated with increasing alcohol intake. These findings suggest that long-term alcohol intake, even within guidelines, may increase risk of chronic disease, including cardiovascular disease. 

In the News 

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JAMA Medical News

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CATO at Liberty Blog, CATO Institute

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USA Today

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The Conversation

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British Broadcasting Corporation (BBC)

STAT