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The ASAM Weekly for March 26th, 2024

Mar 26, 2024

This Week in the ASAM Weekly

Punitive policies for substance use are examples of how we can miss the forest for the trees. On a case-by-case basis, we’d all agree that substance use is not healthy for the mother-baby dyad, but a recent review found that punitive laws intended to decrease substance use in such cases actually do little to reduce harms as a whole, and there’s a possibility they could increase them instead (International Journal of Drug Policy). The same can be seen with mandatory sentencing laws. Although politicians are correct to punish the criminal act of “drug dealing,” overly punitive laws risk entangling others -- partners, friends, and even good Samaritans -- while resulting in increased overdose deaths and overcrowding in jails (Yahoo).

But are there times when policies may not be strong enough? Alcohol remains the most prevalent substance involved in emergency department visits (SAMHSA) while alcohol-related cirrhosis and deaths continue to rise. Even though studies have shown that more restrictive alcohol policies can reduce mortality from alcohol-related liver disease, it seems like our policies may not be going far enough (MedPage Today).

Similarly, there is a loophole in FDA policy which allows disposable e-cigarettes to continue being sold in a variety of youth-appealing flavors. When combined with other, more clandestine features, disposable e-cigarettes become incredibly effective in exposing adolescents and young adults to more frequent and persistent nicotine use (Pediatrics). A corresponding commentary to this prospective study points a finger at a marketing sleight-of-hand: the intent is harm-reduction but the outcome is increased sales.

It’s not easy to balance the individual’s needs (or wants) with that of the larger group- and vice versa. That’s why humanity developed the scientific method and further guardrails around research. But an article in The NY Times about the late Dr. Roland Griffiths raises concerns about whether these expectations were followed in his psychedelic research. The article shows how suggestibility can alter the delicate balance between hope and hopelessness, but also how it can heal or harm by the fact that we are all susceptible to it.

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

Disposable E-Cigarette Use and Subsequent Use Patterns in Adolescents and Young Adults 🔓

Pediatrics

Utilizing sequential surveys in adolescents and young adults, the study evaluated the association between disposable e-cigarette (E-cig) use versus non-disposable E-cig and subsequent E-cig use. Those reporting the use of disposable e-cigs at baseline reported greater number of use days in past 30-days. In the follow-up survey, while controlling for demographics and baseline e-cig use patterns, disposable e-cig use was associated with continued e-cig use (OR=1.92) and greater number of times used daily (IRR=1.29). The authors note that disposable E-cigs are generally inexpensive, relatively easy to hide, and sold in various flavors (not regulated compared to non-disposable forms) and thus recommend comprehensive policies to regulate all forms of nicotine products.

Research and Science

Association of semaglutide with reduced incidence and relapse of cannabis use disorder in real-world populations: a retrospective cohort study 🔓

Molecular Psychiatry

Semaglutide has been found to be associated with decreased alcohol and nicotine use and is being investigated for effects on alcohol, nicotine, cocaine and opioids, but not cannabis. As cannabis is one of the most frequently used substances worldwide and increasing in the United States, the authors utilized electronic health records to assess association between semaglutide and cannabis use disorder (CUD) diagnosis among persons being treated for obesity or Type II Diabetes Mellitus (T2DM). The authors found a lower incidence of CUD diagnosis associated with semaglutide use in treatment for obesity (HR=0.56) and T2DM (HR=0.40). While the authors note additional preclinical and clinical trials are needed, they acknowledge that there may be a potential benefit of semaglutide for CUD.

Punitive legal responses to prenatal drug use in the United States: A survey of state policies and systematic review of their public health impacts

International Journal of Drug Policy

In this paper, the authors conducted a literature review and legal survey evaluating punitive responses to prenatal drug use and potential public health impact. In the legal survey, they found that approximately half of states have some form of punitive legislation, most commonly civil child abuse. The authors do note that while direct criminal policies are infrequent, many jurisdictions do prosecute prenatal drug use under other criminal statutes. In the literature review, the authors found that punitive policies were generally not associated with improved health outcomes, and often associated with harms for one or more studied outcomes. In addition, the authors note most of the studies did not consider racial or income-related differences in policy effects, though punitive policies disproportionately target low-income and racial minority populations.

Problematic pornography use across countries, genders, and sexual orientations: Insights from the International Sex Survey and comparison of different assessment tools 🔓

Addiction

Problematic pornography use (PPU) is a common manifestation of the newly introduced Compulsive Sexual Behavior Disorder diagnosis in the 11^th edition of the International Statistical Classification of Diseases and Related Health Problems. There is a relative absence of data on PPU outside Western countries and among women, as well as gender and sexually diverse individuals. This study validated three measures to assess the severity of problematic pornography use across languages, countries, genders, and sexual orientations in 26 languages: the Problematic Pornography Consumption Scale (PPCS, and PPCS-6, respectively), and the Brief Pornography Screen (BPS). The problematic pornography use risk is estimated to be 3.2–16.6% of the population of 42 countries and varies among different groups (e.g. genders) based on the measure used.

Learn More

The Association of Acute Intoxication and Threats to Masculinity on Laboratory-Based Sexual Aggression

The Journal of Studies on Alcohol and Drugs

Men's alcohol intoxication and perceptions of their masculinity as precarious are independently related to men's perpetration of sexual aggression. The goal of this study was to assess if precarious masculinity, measured as a static trait, and acute alcohol intoxication, measured in a laboratory setting, were positively associated with men's perpetration of laboratory-based sexual aggression after their masculinity is threatened. The study found that acute alcohol intoxication facilitated men's sexually aggressive responding toward women when their masculinity was threatened. Consistent with pertinent theory and research, this effect suggests that acute intoxication facilitates men's focus on salient cues (i.e., threatened masculinity), which then may proximally motivate sexual aggression. Sexual aggression prevention programs should continue to address alcohol in their programming.

Dissociable encoding of motivated behavior by parallel thalamo-striatal projections 🔓

Current Biology

The successful pursuit of goals relies on motivational states that are guided by internal drivers, such as hunger or fear. The paraventricular nucleus of the thalamus (PVT) is a midline thalamic nucleus that shapes motivated behaviors via its projections to the nucleus accumbens (NAc) and monitors internal state via interoceptive inputs from the hypothalamus and brainstem. This study used fiber photometry to investigate the in vivo dynamics of these two distinct PVT neuronal types in mice performing a foraging-like behavioral task. The authors discovered that PVTD2(+) and PVTD2(−) neurons encode the execution and termination of goal-oriented actions, respectively. The results highlight the existence of two parallel thalamo-striatal projections that participate in the dynamic regulation of goal pursuits and provide insight into the mechanisms by which the brain tracks motivational states to shape instrumental actions.

Drug Abuse Warning Network (DAWN): Alcohol-Related ED Visits Short Report

SAMHSA

This Drug Abuse Warning Network short report examines emergency room visits involving alcohol between January 2021 and September 2023. The report consists of three pages of graphs summarizing the data. During the 33 months covered, there were 8,566,725 emergency room visits involving alcohol, and 19% involved at least one other substance. The most common diagnoses were alcohol intoxication (37%), alcohol use disorder (24%), injury or poisoning (16%), and alcohol withdrawal (12%). Visits by males were over double those by females. The South had the lowest rate of visits/100,000 people, about half the rate in other regions. The age group 26 to 44 years had the highest rate of visits/100,000.

Psychotherapies at a Glance: Consensus Guideline–Recommended Psychotherapies for Adults With Psychiatric Disorders

The American Journal of Psychotherapies

This article reviewed guidelines from multiple nations concerning the use of specific types of psychotherapy for treatment of a range of psychiatric disorders. The authors searched for guidelines that were based on reviews of evidence. The results are presented in a Psychotherapies-at-a-Glance tool, a table listing nine psychotherapies with details and a list of diagnoses that they have been recommended for. A separate table lists 10 psychiatric diagnoses with the psychotherapies that have been recommended. For substance use, the authors list the following psychotherapies: cognitive behavioral therapy, contingency management, family and couples therapy, motivational interviewing, and 12-step facilitation. They intend for the tool to be used in teaching and to guide clinicians in designing treatment plans.

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