This Week in Addiction Medicine from ASAM

Reflections on the preparation, implementation, and sustainability of a virtual SUD clinic: A public health response to the opioid epidemic
Journal of Substance Use and Addiction Treatment
This is an exploratory case study to identify barriers, facilitators, and implementation needs during the phases of implementation of a virtual SUD clinic offering low-barrier MOUD across the state of Texas. From January 2022 to September 2023, researchers conducted 10 individual and 11 group periodic reflections with 16 individuals (including clinic leadership, operation staff, and providers) to evaluate implementation activities, clinic processes, and events during the rollout of the virtual clinic. In the preparation phase, participants emphasized the importance of strong leadership, effective workforce and technology infrastructure, staff training, and mission alignment. During implementation, participants highlighted the need for strong interprofessional communication, continuous reflection and evaluation, and medication supply chain management, as well as the challenge of workforce turnover. In the sustainment phase, participants identified a need for diversified funding and intentional growth.
 
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Efficacy and safety of pharmacological interventions for the treatment of cocaine use disorder: A systematic review and network meta-analysis
Addiction
Cocaine use disorder (CUD) is an increasingly widespread concern worldwide. Various pharmacological treatments have been investigated for CUD, but their efficacy remains unclear, and none have been licensed for treatment. This systematic review and network meta-analysis assessed the comparative effectiveness, safety, and acceptability of pharmacological interventions for the treatment of CUD and prevention of relapse. The authors found no convincing evidence for the effectiveness of any pharmacological treatments for cocaine use disorder.
 
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2025 National Survey on Drug Use and Health (NSDUH)
SAMHSA
The 2025 National Survey on Drug Use and Health (NSDUH) shows encouraging trends among adolescents and young adults with broad declines across past-month nicotine, alcohol, and marijuana use, and binge drinking, as well as reduced rates of substance use disorders, major depressive episodes, and suicidality. 
Conversely, troubling overall increases occurred in past-month nicotine vaping and marijuana use, past-year use of marijuana and hallucinogens, and past-year marijuana use disorder. Interestingly, it is important to point out that these increases are driven by use among adults aged 26 or older. For each of these indicators, use among adults 26 or older all increased whereas use among youth 12 to 17 and young adults aged 18 to 25 either declined or remained stable. 
Furthermore, while youth mental health improved, suicide indicators among adults aged 26-49 and 50+ rose between 2021 and 2025.  These findings highlight the importance of ensuring a lifespan approach to suicide prevention and mental health promotion and treatment initiatives, including incorporating age-related changes in physical abilities and social environments into prevention strategies. 
 
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Association between GLP-1 receptor agonists and alcohol-related hospitalisations among adults with alcohol use disorder: Multi-target trial emulation study
BMJ Open
This retrospective cohort study using target trial emulation evaluated the association between use of newer glucagon-like peptide-1 receptor agonists (GLP-1 RAs; semaglutide, tirzepatide) and alcohol-related hospitalizations among adults with alcohol use disorder (AUD) and type 2 diabetes (T2D) or obesity. The authors found that among adults with AUD and T2D or obesity, initiation of newer GLP-1 RAs was associated with a lower observed risk of alcohol-related hospitalization. 
 
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Trends in alcohol-related deaths in the United States over 55 years: 1968-2023
Alcohol, Clinical and Experimental Research 
This study of alcohol-related mortality trends since 1968 used primarily death certificate data from the CDC WONDER database. Between 1998 and 2023 there were 1.3 million alcohol-related deaths. Overall age-adjusted mortality rates (AAMR) per 100,000 increased from 13 to 19. Rates increased from 1968 to 1980, declined from 1980 to 2000, and began an accelerating increase from 2000 to 2023, with a peak during COVID.  AAMRs were higher for males (increasing from 20 to 28) than for females (increasing from 7 to 11). AAMR declined by 50% for Black individuals (from 28 to 14) and nearly doubled for Whites (increasing from 11 to 21) resulting in a dramatic racial inversion. Among age groups, the highest mortality was for 65+, attributed to baby boomer heavy drinking plus frailty of age. The largest increases were seen in the Midwest with the Northeast remaining stable. 
 
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Comparison of buprenorphine treatment by virtual-only vs. traditional clinicians 
Journal of Substance Use and Addiction Treatment 
Few patients with opioid use disorder (OUD) receive medications for OUD (MOUD), such as buprenorphine. Given that many patients, particularly those in rural communities, do not live near a clinician who prescribes MOUD, telemedicine could increase MOUD access. However, clinicians and policymakers are concerned about the quality of the virtual-only model.  This study compared the care provided by virtual-only versus traditional clinicians.  The authors found few substantive differences in who used virtual-only care. For example, patients initiating buprenorphine with virtual-only versus traditional clinicians were equally likely to live in urban areas. Patients initiating buprenorphine with virtual-only clinicians had more visits in the 6 months after the initiation and were more likely to be on buprenorphine at 6 months, but had fewer days of continuous buprenorphine treatment. These results can inform ongoing debates about the strengths and weaknesses of virtual-only OUD care. 
 
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Adjunctive psychosocial interventions and opioid abstinence among patients receiving buprenorphine: A randomized clinical trial
JAMA Network Open
This randomized clinical trial of 340 adults with opioid use disorder (OUD) taking buprenorphine examined the comparative effectiveness of 2 psychosocial treatments—cognitive- behavioral therapy (CBT) and peer recovery support (PRS)—on opioid abstinence when used as adjunctive therapy to office-based buprenorphine treatment in adults with OUD.  Researchers found that neither PRS, CBT, nor a combination of these psychosocial interventions yielded differential effects on opioid abstinence. These results suggest that adjunctive psychosocial interventions may not enhance buprenorphine treatment outcomes in the early stages of treatment.
 
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Alcohol intake and health study: No protective effect at low levels, with mortality increasing to 1 in 25 at 14 Drinks per week
Journal of Studies on Alcohol and Drugs
This study used a cause-specific modeling approach to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person’s average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health. Researchers found that alcohol consumption, including at what may be perceived as “moderate” levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day.
 
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Social media use trajectories and substance use experimentation: A prospective cohort study
The American Journal of Psychiatry
An analysis of data from more than 7,000 adolescents over 5 years found significant associations between rising social media use trajectories and substance use. Four distinct social media use trajectories were identified, with greater social media use over time throughout early adolescence being proportionally associated with an elevated likelihood of substance use.
 
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Benzodiazepine tapering: Evidence limitations and research recommendationsJournal of Addiction Medicine 
This systematic review of publications (2000-2023) concerning tapering benzodiazepines (BZDs) was used to inform the Joint Clinical Practice Guideline on Benzodiazepine Tapering, published in 2025. Rates of taper were often faster than recommended, such as 25%-50% reduction in the initial 1-2 weeks. There was little information on long-term outcomes such as protracted withdrawal and quality of life, and some studies had high rates of attrition. Patients were often switched from short- to long-acting BZDs; however, there are no data on the effect on withdrawal severity or outcomes. There is little information about adverse events such as mortality and suicidality, despite insurance data associating discontinuing BZDs and mortality. The authors conclude the evidence base for tapering BZDs is deficient and list 10 areas for future research. 
 
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