Quality & Science

ASAM Weekly Archive

  • News May 18, 2021

    Editorial Comment 5/18/2021: This Week in the Weekly

    This Week in the Weekly.. We have some important articles this week about opioids. An interesting study from the journal Nature found that people with COVID-19 exhibit higher risk of death and health resource utilization beyond the first 30 days of illness and more specifically, have an increased use of pain medications, antidepressants and anxiolytics along with other prescribed medications. - Editor-in-Chief: Nicholas Athanasiou, MD , MBA , FASAM
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  • News May 11, 2021

    Editorial Comment 5/11/2021: This Week in the Weekly

    This Week in the Weekly… The federal government has been making some headlines: the Biden administration is extending a ban on fentanyl-like substances (NBC News), proposing a ban on menthol cigarettes (NY Times), and most importantly (especially if you were a little heartbroken back in January), HHS is relaxing the recommendations to prescribing buprenorphine (HHS.gov). - Editor-in-Chief: Nicholas Athanasiou, MD , MBA , FASAM
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  • News May 11, 2021

    Editorial Comment 5/11/2021: Addiction and The Law

    This week I have the remarkable opportunity to sit on a (virtual) dais sponsored by the American Bar Association, on endemic opioid use disorder. I get to bask in the rays of knowledge of many fine minds and assiduous pathfinders. Among these will be our own advocacy staff, who have been central to the writing of our opioid used disorder (OUD) treatment policy for correctional facilities, as well as policies for those among our membership seeking or needing assistance. Participating will be Presidents of the ABA, the AMA, the APA, and ASAM. It’s a pretty remarkable forum. And it stimulates attention to several websites, including ASAM’s own ASAM Treatment in Correction Settings Toolkit and the ASAM Public Policy Statement on Treatment of Opioid Use Disorder in Correctional Settings - Emeritus Editor: William Haning, MD, DFAPA, DFASAM
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  • News April 19, 2021

    Editorial Comment 4/20/2021: Drugs and Vaccines - Dr. Jenner Would Be Proud

    For some decades, Dr. Tom Kosten and associates have pursued the tantalizing possibility of a cocaine immunization, a vaccination that would result in the excretion or at least inactivation of the drug. This was taken less-seriously than was warranted by many at the time, largely from a failure among those many to understand the underlying principle – binding of a small molecule, cocaine, with a more recognizable and larger molecule, to template a vaccine. In the interval since his initial work, there have been many efforts to create similar immunizations, discussions of which I have sampled here. Most of these are journalistic essays but provide a quick snapshot of the intentions, and the relative successes, for a variety of drug classes. This was brought to mind by two associations: Dr. Athanasiou’s reminder that April 20, or “420” is a banner for the cannabis-using community, mythologically related to 4:20 PM and the usual end of the high school day. (There is also “710”, “OIL” upside-down and thus celebrated on July the 10th, suggesting two distinct quasi-religious sects; but I digress.) The other was the persistent, pervasive presence of the COVID-19 pandemic and the efforts to produce effective immunizations; a loose, but not completely tangential association. Among those immunizing efforts against drug actions, there has been exploration of approaches that would block the more toxic synthetic cannabinoids subsumed under the umbrella of “spice.” - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News April 12, 2021

    Editorial Comment 4/13/2021: Call for Editors

    For ASAM Weekly readers who are not themselves ASAM members, you are owed an update on the parent organization’s activities at this time of year. Over the course of one week, all committees, councils, officers, and members of the Board of Directors will transition, replacing and being replaced by elected and appointed members. The weekend following, ASAM holds its annual scientific conference. For most of us who are involved in instruction or regional continuing medical education, conferences tend to be stacked up at this time of year; in a shameless plug, the Hawaii Addictions Conference provides an example of how inexpensive and how increasingly well-wrought the online trainings can be [ https://blog.hawaii.edu/dop/hac-2021/ ]. All of this by way of reintroducing a solicitation for Assistant Editors, as education at all levels is a fundamental obligation of the Society. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News April 5, 2021

    Editorial Comment 4/6/2021: Easter Egg-on-the-Face of Psychiatric Nomenclature

    The article below cited in the journal Addiction examines the effectiveness of e-cigarettes for smoking cessation. Apart from underlining differences between American and British views of the marketing of medications and appliances, it underscores an important philosophic difference in the definition of the illness state. In the most recent American iteration of diagnostic language (DSM5), the addiction that involves nicotine is referred to as a tobacco use disorder. This has resulted in a particular focus on smokable (combustible) tobacco products as the agent of harm or as the basis for a description of the illness. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News March 22, 2021

    Editorial Comment 3/23/2021: Doctors As Communicators

    The Washington Monthly item at the end of this week’s issue deserves some contemplation. The notion that our stress on addiction as a “… brain disease” may actually be counterproductive, is itself counterintuitive. And yet it is less so if you consider addiction to be the outcome of multiple forces and conditions. It is surely the case that increasingly effective medication aids in recovery; and equally, that recovery is more than a replenishment of some neurotransmitters, and inhibition of others. Yuval Noah Harari (Homo Deus, ch.3) would have us understand that cooperation is requisite to effect change in human behavior. So also would most who belong to community recovery programs, lead psychotherapy seminars, and the like. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News March 16, 2021

    Editorial Comment 3/16/2021: Advancing Racial Justice in Addiction Medicine

    The readers may be best served this week with a renewed link to the 25 February 2021 policy on racial justice. My understanding of social movements is that they are most likely to be successful if 1) their adoption costs the opposition nothing tangible; 2) they are tied to a shared, positive experience (as in “marriage”); and 3) they are persistent, as the drumming of raindrops on a stone. Brevity helps; the linked document is all of 4 pages before the references, and its recommendations occupy only one page. Perhaps start with the “Recommendations”, please, and then you will feel your time best-respected. If you find the concepts and the reasoning are exportable to your own work or other professional setting, please cite freely. The greater the concord, the greater the momentum to long-delayed remedies. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News March 8, 2021

    Editorial Comment 3/9/2021: Cannabinoids and The Pleasure Principle

    The world seems always to seek a newer agent that will bring us to a new level of pleasure, of joy. I have paraphrased Don Draper of Madmen before in his asking, "What is happiness? Happiness is the moment before you need more happiness.” The review article on cannabis (Journal of Psychopharmacology ) below brings the Senior Editor to mind of a previous initiative involving an alcohol substitute that was ostensibly hangover-free, "Alcosynth." The players may differ but the game’s objective stays the same: pleasure without consequences. Whether it is a "nonaddictive” opioid substitute, such as pentazocine (Talwin), meperidine (Demerol), or tramadol (Ultram); vaporized nicotine in place of tobacco fumigation (to supposedly evade damages resulting from tobacco smoke); benzos vs. barbs; or even synthetic sweeteners in that 32 oz. Big Gulp, the alchemists’ search for the hedonic Philosopher’s Stone never abates. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News March 2, 2021

    Editorial Comment 3/2/2021: Mundane Questions Can Be Important Questions, To The Questioner

    Our medical school hosts a weekend curriculum for lay community members, many of whom are retired or have relatives working in medicine. It is spread across several months, and I was asked to speak last week about substance use in the elderly. After the event, I was thrown more than a dozen questions. My responses did not satisfy me in several instances, but you do what you can do when you're standing at a podium in front of 100 potential donors to the school. The show must go on. I don’t expect all in the readership to agree with my answers – after all, a good many of you are certainly smarter than I, or at least more cautious. Here are a few of the audience’s Q & A items: - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News February 22, 2021

    Editorial Comment 2/23/2021: A Brutal And Heedless Sky

    Last week carried the hope of a real holiday, Presidents’ Day; or at least one for the Feds, with the possibility of a trickle-down effect. But by Wednesday, any elation experienced at the prospect of a four-day workweek had been blown either into the Gulf of Mexico or across the Great Lakes by a fierce and unrelenting winter assault. My words of sympathy to colleagues in virtual conferences or just on telephone calls most likely sounded taunting, even micro-aggressive. How could it not? With our own winter weather in Hawai`i dropping at night down to 69°, we’ve not a lot of justification for lamentation. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News February 16, 2021

    Editorial Comment 2/16/2021: Prescriptive Discretion and Buprenorphine

    The final selection below addresses the recent effort on the part of the Department of Health and Human Services to remove specific training requirements for the prescription of buprenorphine, for physicians. As most will be aware, that plan has been suspended subject to further review, but remains alive. The central focus of the article – actually an op-ed piece in The Hill - is on the distinction drawn between physicians and others with prescriptive authority (advanced practice registered nurses and physician assistants). The CARA act of 2016 requires both classes of providers to undergo training in addition to that normally required for obtaining or maintaining a DEA license for the prescription of controlled substances. Presently, the training requirement is significantly greater (3-fold) for non-physicians. The mandate was originally in recognition of the newer indication beyond analgesia for buprenorphine, for opioid use disorder. It was as well a concession to those who contended that, without some form of interpersonal therapy, the medication alone was inadequate. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News February 9, 2021

    Editorial Comment 2/9/2021: Sometimes We Get To Be Gunga Din. Sometimes We Thirst.

    This week’s abstracts all made really good reading; fortunately so, as that will balance the notable absence of a thoughtful editorial. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News February 1, 2021

    Editorial Comment 2/2/2021: Nicotine. Not Smoke. The Drug Is Nicotine.

    In reference to the AHRQ 91 January abstract, below: The jury remains out on the question of which toxins are culpable in injuries sustained by the developing fetus, among mothers who use tobacco products. Is it nicotine, carbon monoxide, any of the complex tars that comprise the smoke, etc.? There is an enduring reversion to the notion that cigarette smoking is the needed target of our efforts; yet in so doing, we sidestep the question of the toxicity of nicotine alone – and thus the risk of lozenges, vaping, gum, any of the delivery systems. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News January 25, 2021

    Editorial Comment 1/26/2021: Sonnet 119

    For 26 January 2021, William Shakespeare’s 119th Sonnet is provided here. It is a meditation on obsession, describing an unfulfillable expectation of an alchemical conversion: the transmutation of evil thoughts and behaviors. You may take issue; but I believe it to be a poem about addiction. Being printed in the New York Times at least makes an article susceptible to commentary and criticism by the readership, even while not strictly meeting peer review standards. A discussion of drug usage by psychology professor Carl Hart is reviewed in the New York Times at this link, and is largely self-referential: https://www.nytimes.com/2021/01/12/books/review/drug-use-for-grown-ups-carl-l-hart.html Focusing principally on heroin use, Hart makes a case for mood-altering drugs as useful, pleasurable, and generally safe over time providing “…a gradual rejection of the overly simplistic idea that drugs are inherently evil, the destroyers of people and neighborhoods.” - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News January 19, 2021

    Editorial Comment 1/19/2021: Drug Use for Grown-Ups

    “I discovered that the predominant effects produced by the drugs discussed in this book are positive,” Carl L. Hart writes in his new book. “It didn’t matter whether the drug in question was cannabis, cocaine, heroin, methamphetamine or psilocybin.” Being printed in the New York Times at least makes an article susceptible to commentary and criticism by the readership, even while not strictly meeting peer review standards. A discussion of drug usage by psychology professor Carl Hart is reviewed in the New York Times at this link, and is largely self-referential: https://www.nytimes.com/2021/01/12/books/review/drug-use-for-grown-ups-carl-l-hart.html Focusing principally on heroin use, Hart makes a case for mood-altering drugs as useful, pleasurable, and generally safe over time providing “…a gradual rejection of the overly simplistic idea that drugs are inherently evil, the destroyers of people and neighborhoods.” - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News January 11, 2021

    Editorial Comment 1/12/2021: Mobs and The Drugs Within Us

    We are accustomed to referring to excitement-seeking individuals as “adrenaline junkies”. It is a pithy characterization regardless of its accuracy, as it explains behaviors that may be innately destructive using a metaphor with which we are very familiar: compulsive and progressive use of the substance that alters a mood state, such that the individual becomes progressively reliant on it. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News January 4, 2021

    Editorial Comment 1/5/2021: Time Is The Only True Unit

    From the movie “Lucy,” 2014, : “Time is the only true unit of measure. It gives proof to the existence of matter. “ So when folks are inclined to be sage and instruct me that New Year’s Day is simply a convention, a calendar heading that has yet to be filled with real data… I, in turn, think of how we mark the anniversaries of those whom we love, including of course their dates of birth and of death. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News December 21, 2020

    Editorial Comment 12/22/2020: Bill, Unmuted

    We hope you, your loved ones, and everyone you know is safe and healthy this holiday season. 2020 has been a difficult year for so many and unfortunately a tragic year for too many. Hopefully, 2021 will bring some much needed joy into peoples’ lives. For now, we’d like to offer you this small tradition of joy with an end-of the-year editorial review in honor of the selfless work Bill has done over the years at the ASAM Weekly. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News December 14, 2020

    Editorial Comment 12/15/2020: Demonstration Of Principles

    If I really mean what I am about to write next, I will preface it with this: please read the four excellent pieces on ethanol and the commentary on stigma assembled below, before you bother with my editorial. If you then have time, maybe then come back to the editorial. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News December 8, 2020

    Editorial Comment 12/8/2020: Practice Pathway

    On November 30, the American Board of Preventive Medicine (ABPM) and ASAM jointly announced the extension of eligibility for completion of Addiction Medicine board certification through the 2025 examination cycle, using the “Practice Pathway”. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News November 30, 2020

    Editorial Comment 12/1/2020: World AIDS Day in the U.S. of 2020; and The Virtues of Virtualism

    World AIDS Day coincides with the submission deadline for this weblog, December 1st. This is a rich territory to mine for parallels in both addiction and infectious disease epidemiologic patterns. I can only intimate the similarities in this short space, so recommend the following exercise: Below are three separate links, describing incidence respectively for HIV disease; opioid prescribing; and COVID-19 cases (both those in this past week and for comparison those in June of this year). ASAM Weekly is a digest, it is intended to abbreviate your immersion in available literature; so I suggest that you simply tap on those websites serially, very briefly, to get a sense of where these illnesses are striking most forcefully. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News November 23, 2020

    Editorial Comment 11/24/2020: A Different Meaning of Recovery

    A recurring theme among the responses to the Covid-19 pandemic has been reconstruction and “normalization,” specifically of the national economy. Folks who work in the field of addictions have ample experience with unstable environments, both the worldly one and the internal milieu. In the latter case, it is wiser to not have great and brittle expectations when helping someone deal with their addiction. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News November 16, 2020

    Editorial Comment 11/17/2020: A Different Election

    My comment this week will be of interest only to ASAM members. I apologize; it is a narrowing of focus that I normally avoid. However, we are approaching the interval in which elections are opened for ASAM Officer and Directorship positions. And as we have been relentlessly taught in recent years, a democracy is only as good as its rate of participation. In fact, these Society elections have been notoriously under-attended by the membership - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News November 10, 2020

    Editorial Comment 11/10/2020: Veterans’ Day

    Referred to as “the Army disease” in the late 19th century, addiction to opium derivatives including morphine allegedly involved as many as 400,000 Civil War combatants. As this estimate derives mostly from Federal disability pension records and the rolls of early veterans’ associations such as the Grand Army of the Republic, it is bound to have excluded survivors of the Confederacy. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News November 2, 2020

    Editorial Comment 11/3/2020: Earthly Rewards

    The tail-end-Charley item in this week’s ASAM Weekly is arguably the most practicable and promising of recent approaches to stimulant addiction, pharmacological or behavioral. The New York Times review of Contingency Management (CM)’s premises, benefits, and obstacles to implementation gives an accurate description for all levels of understanding. Steve Shoptaw and colleagues have demonstrated the concept’s efficacy repeatedly since the early 2000s - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News October 27, 2020

    Editorial Comment 10/27/2020: Moral Posture in Addiction Treatment

    Below, Jim Wahlberg (older brother to the Calvin Klein underwear idol, ”Don’t call me Marky!” Wahlberg), describes his and his son’s experiences of addiction and of recovery. In reading it, I was drawn to parallels between his arguably more-famous brother and those on either side of the national debate on “rights”: The more junior Wahlberg has himself gone through changes, evolutions in opinion and commitments, in the days since he led a boy band. People’s views may soften with education, experience, and development of character; and sometimes we discover that it is our views which want softening. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News October 19, 2020

    Editorial Comment 10/20/2020: National Addiction Treatment Week, 19-25 October 2020

    My mother, who was Australian, found Americans intriguing yet illogical, and strangely misdirected in their sentimentality. She explored this experience by marrying my father in the middle of a world war, so you could not accuse her of lacking a spirit of adventure or of inability to tolerate ambiguity. But she never could quite come to grips with one consequence of American commercialism. “Why,” she would ask, “is there a Mother’s Day in this country. Yet, a national pickle month?” Much of the time I would fall back on my role as callow adolescent, or cynical young adult, and shrug my shoulders, or encourage her to worry about something more important, such as whether Nixon was going to be elected. The seeming lack of honor accorded mothers by yielding an entire month to bottled vegetables was never quite resolved in her lifetime. Despite this, she went ahead and became a naturalized U.S. citizen in 1970. I thought I finally had the answer for her, when, in 2001, the status of pickles appeared to have been downgraded to a National Pickle Day (November 14, in case you are interested: https://nationaltoday.com/national-pickle-day/ ). I was wrong. She was no slouch at research, and I was reminded that she had been a secretary in the Ministry of Defense when my father, on leave from New Guinea, first won her attention. She pointed out to me that the pickle had yielded nothing in this virtual combat for primacy, as there is still a national pickle month as well as, now, a day. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News October 13, 2020

    Editorial Comment 10/13/2020: : OUD Among Healthcare Workers – Another Sort of Immune Response

    The ASAM Board of Directors met over the weekend preceding this issue of ASAM Weekly. It is a quarterly convocation, at one time a two-day affair: more recently one day event via virtual platform. The members of the Board are all unpaid volunteers, for whom travel and rooming is always at their own expense. These past, recent meetings have necessarily been hosted by a flow of electrons, and consequently blissfully economic. Because the Directors are all volunteers, and the Board meetings are only a fragment of their volunteer duties with ASAM, the spirit of collegiality was unusually strong. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News October 5, 2020

    Editorial Comment 10/6/2020: Martha In The Weeds

    I frequently begin my talks by forewarning the audience that I do not know what is going to come out of this box up on my neck. It is a reflection on computers and on our limited control of their moment-to-moment functionality. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News September 29, 2020

    Editorial Comment 9/29/2020: Learning To Be Well

    I joined a recovery meeting last night, in itself no great surprise. But two revelations were provided to me, perhaps one more significant than the other. The more mundane one was that I found myself hearing old familiar friends clearly for once, in years. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News September 21, 2020

    Editorial Comment 9/22/2020: A Story Regarding Projection and Expectations

    From 1988 to 1992, I was the medical director of the alcoholism and drug rehabilitation unit at a facility we’ll call Very Large Army Hospital (VLAH). Coincidentally, “Fred”, a high school classmate, an Army officer and a pediatric oncologist, was also stationed at VLAH. We were at opposite ends of the hospital. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News September 14, 2020

    Editorial Comment 9/15/2020: Subjective Experience

    The Psychiatry Online piece below speaks to the relatedness of the experiences of mental health care workers, inclusive of those working with substance use disorders, to those of their patients. It served as a reminder to me, further stimulated by an ongoing discussion with the Senior Editor, about the importance of subjective experience in defining an illness state. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News September 7, 2020

    Editorial Comment 9/8/2020: A letter from Honolulu

    1990 Marked the first reference to methamphetamine use by inhalation in Hawaii. A case study, involving a pneumonitis with severe respiratory compromise, made sparing reference to signs of intoxication. - Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM
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  • News August 31, 2020

    Editorial Comment 9/1/2020: Doctors helping other doctors

    It was my intent this week to discuss the convergence of the infectious pandemic with drug use endemicity, centering on the Hawaiian experience with methamphetamine. I will defer that to next week. Let me focus instead on our obligation as healthcare professionals within the field of addiction, to take care of ourselves and of each other.
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  • News August 24, 2020

    Editorial Comment 8/25/2020: Persistence

    Marie & Pierre Curie and Henri Becquerel supported an early theory of radioactivity with observations and refinements that also led to the isolation of radium. Leaving aside the impact of this on their respective healths - all suffered radiation sickness at various times, with Marie being the most frequently-identified of the three to die from it - their accomplishments famously required enormous obstinacy and persistence.
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  • News August 17, 2020

    Editorial Comment 8/18/2020: Suicidal ideation

    This week’s lead article correlates substance use disorders (SUD), serious mental illness (SMI), and suicidal ideation (SI) with the COVID-19 pandemic. Similar findings have been remarked in the military population, during wartime, by medical thought leaders in stress disorders and suicide since before the time of Harry Stack Sullivan, in the hope of devising reliable screening instruments.
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  • News August 10, 2020

    Editorial Comment 8/11/2020: Isolation

    Three of the articles reviewed emphasize COVID-19-related risk factors for addiction relapse. Featured prominently are the lack of interpersonal connections, absence of intimacy, and unavailability of feedback; in a single word, isolation.
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  • News August 4, 2020

    Editorial Comment 8/4/2020: The variety of human experience

    Those who are familiar with the superb program by Shankar Vedantam, on National Public Radio, "The Hidden Brain," a weekly interview and analysis of issues in neuroscience and behavior, may also be as accustomed as I in discovering how much I do not know [https://www.npr.org/podcasts/510308/hidden-brain ].
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  • News July 27, 2020

    Editorial Comment 7/28/2020: Masks and the 12th Step

    In Stephanie Brown’s “Treating the Alcoholic” there is a section entitled “a psychological view of the 12 steps.” While paralleling the process of recovery - employing a 12-step model - with psychotherapy, she and George Vaillant have made the case for it being a maturational process.
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  • News July 20, 2020

    Editorial Comment 7/21/2020: The Stifled Voice

    Owing in part to absence, I regret that this week’s commentary is abbreviated, limited to a short quotation. My choice of material reflects this week’s U.S. Presidential decision, which diverted clinical data needed for successful management of the COVID-19 pandemic away from the Centers for Disease Control and Prevention (CDC).
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  • News July 13, 2020

    Editorial Comment 7/14/2020: A Chronicle of Addiction Medicine

    The account of important events can be difficult enough in real time. A national pastime is watching the news and making fun of the various heads that are speaking. At the same time, we generally reserve a certain amount of sympathy for the difficulty of their vocation, and not merely for their performance anxiety.
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  • News July 7, 2020

    Editorial Comment 7/7/2020: Independence Day

    There is a common and grievous tendency to refer to the holiday just passed as “The Fourth of July,” when it is, in fact, “Independence Day”: a celebration specifically of the signing of the Declaration of Independence (plus or minus two days depending on whose account of the date you choose). Benjamin Rush, M.D., senior attending physician in the University of Pennsylvania and Surgeon General of the Continental Army, was very relevantly a signer of the Declaration of Independence of the nascent United States.
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  • News June 29, 2020

    Editorial Comment 6/30/2020: Midyear transitions

    July 1 has a democratizing effect for all program directors of residency training, in all specialties. For one brief week, we are equally humbled. All must pay homage to their minor deities, those institutional ones of scheduling and funding and quality assurance; and to the superordinate deities, the respective specialty boards, and the American College of Graduate Medical Education.
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  • News June 22, 2020

    Editorial Comment 6/23/2020: History of addiction medicine – converging paths

    ACAAM, the association of program directors in addiction medicine, thoughtfully provided certificates of acknowledgment to all of the recent fellowship graduates on June 4th. The acknowledgments included photographs of those about to graduate, and while this is a pretty mundane observation, I was seized by how youthful at least half of the faces appeared to be.
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  • News June 15, 2020

    Editorial Comment 6/16/2020: COVID-19 Resources – Open This Link!

    In April, an ASAM task force was set up, chaired by Doctors Yngvild Olsen and Kelly Clark. The website that was constructed is conveniently arrayed, comprehensive, and exceptionally practical.
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  • News June 8, 2020

    Editorial Comment 6/9/2020: The People’s Universal Journal Club (UJC)

    For some years, Dr. Athanasiou, and before him, Dr. Miotto and I have tried to find a means by which to hold a journal club in addiction medicine that would span the continent. With over 50 fellowships in addiction medicine and a like number of addiction psychiatry fellowships, the call to share resources is less an opportunity than an obligation. The springboard for a universal journal club would in fact be this very weekly e-journal. It has the merit of conveying an overview of the literature in a condensed structure.
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  • News June 1, 2020

    Editorial Comment 6/2/2020: The ways we treat one another

    In almost three millennia of historical record-keeping, humanity continues to vacillate between two poles: claims of special entitlements for one group over another; and imprecations to treat one another with equal regard. We seem to be an uncommonly stupid species, who cannot in all that time come to understand how central to universal happiness is the principle of universal respect.
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  • News May 26, 2020

    Editorial Comment 5/26/2020: Memorial Day

    My custom of observing Memorial Day has been shared by fewer among my university and medical school colleagues as those with past military service age out of life, most of them more quietly than could the honorees. Memorial Day itself historically represented a tribute to those making the most obvious and most necessary contribution to defending a nation, dying in combat.
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  • News May 19, 2020

    Editorial Comment 5/19/20: Does Instructional Function follow Form?

    The ASAM Webinair listed below (The ASAM National Practice Guideline 2020 Focused Update Webinar: Fundamentals), as well as this year’s ASAM Virtual Conference, oblige attention to the evolution in how we teach.
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  • News May 11, 2020

    Editorial Comment 5/12/20: The Janus-faces of enablement

    It’s not so true that the COVID-19 pandemic confinement orders create more free time, as that they oblige even more time than usual, in front of a computer. So it has been that I find myself off on tangents of exploration, seeking the trails of topics and people, night after night.
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  • News May 4, 2020

    Editorial Comment 5/5/2020: Guest Editorial

    In response to our invitation for guest editorials, Dr. Timmen Cermak, past President of the California Society of Addiction Medicine, submitted the following essay on the symbolic and real confinements experienced by a child in an alcoholic family, employing parallels with the current pandemic public health confinements.
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  • News April 27, 2020

    Editorial Comment 4/28/2020: A voice from seven centuries past

    Substance use disorders appear unique. Alone among the illnesses that dwell in the house of medicine, those relating to addiction are characterized phenomenologically, behaviorally; and yet are the outcome of toxic exposure. They do not, unlike lead poisoning or the dementia that develops from diabetes, induce sympathy in the observer.
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  • News April 20, 2020

    Editorial Comment 4/21/2020: A Party, and a Surfing Metaphor

    In Hawaii, we had a teaching party this past week. Okay, in truth, we have one each year, about this time (April-June); which we choose to call, unsurprisingly, the Hawai`i Addiction Conference, or HAC. This has been an annual event in Honolulu from the inception of the University of Hawai`i addiction psychiatry and addiction medicine fellowships in 1998, the first such fellowships west of the Mississippi. Very far west of the Mississippi.
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  • News April 13, 2020

    Editorial Comment 4/14/2020: Transitions in Treatment

    Baumann and Lee’s article in Bloomberg Law leads, with a discussion of the exacerbating impact of the COVID-19 pandemic on those with substance use disorders (SUDs). Regardless of the substance or the pattern of addiction experienced, inaccessibility to treatment and support from risk of contagion is universal. For a month and longer, mutual support groups have been first discouraged, then formally prohibited from meeting in person. Residential and even outpatient treatment facilities have been trammeled. The central organizing theme of recovery has always been affiliation and the over-coming of isolation; social approaches now risk acute illness, disability, and death.
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  • News April 6, 2020

    Editorial Comment 4/7/2020: Every Marine a Rifleman

    The past week – past month, truly – has been filled with abrupt, unfamiliar, seemingly overwhelming tasks. In that space, ASAM chose to bring about an annual conference that customarily occupies 2-1/2 days plus two, day-long added courses, in a medium in which it has had some practice; but never with such ambition. Courses were re-formatted, re-scheduled, re-organized to meet the academic commitments of the original in-person event. Speakers were trained to use unfamiliar media, under curtain-raising and deadline demands rarely experienced in the luxury of the big-tent conferences. It was Chautauqua and Graduate School and prime-time TV, all gemischt. Registrations needed modifying or refunding, venue commitments required re-negotiating, insurance providers engaged, disappointed and angry and just unhappy folks needed solace and aid. That’s not half of it. …It is a course still accessible for three years with attendant CME.
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  • News March 31, 2020

    Editorial Comment 3/31/2020: Brevity

    Brevity in access to courses and presentations, for this week : April 3-4 introduces the distance independent “ASAM Virtual 2020.” A heroic accomplishment by staff and faculty to provide content equal in quality and breadth to that in the annual scientific meetings, it is April 3-4; and because of its electronic facilitation, both real-time and recorded, registration is available to and through the sessions. Additional sessions will be provided throughout the month of April.
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  • News March 23, 2020

    Editorial Comment 3/24/2020: Guidances

    Guidance for our practice of medicine: The ASAM National Practice Guidelines for Opioid Treating Opioid Use Disorder is linked below with introductory comments. The 95-page text, an ASAM Journal of Addiction Medicine Supplement, may be downloaded at no charge. This is a comprehensive update to the original 2015 Guideline, including both major revisions and new material. The ASAM Guideline on Alcohol Withdrawal Management was approved by the ASAM Board on 23 January, and we have re-linked it here for convenience. A final copy without watermark is pending.
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  • News March 16, 2020

    Editorial Comment 3/17/2020: AA-derived Treatment Efficacy

    Readers are encouraged to proceed directly to the lead abstract and its link below, a Cochrane Review examination of the relative efficacies of available psychosocial treatments when compared with facilitated and un-facilitated Alcoholics Anonymous (AA) participation, in the management of alcohol use disorder (AUD).
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  • News March 9, 2020

    Editorial Comment 3/10/2020: Contribution Solicitation

    Periodically we re-state an enduring question: have any of the readers a wish to submit a commentary or a review on a topic in addiction medicine? While subject to peer review by the editorial panel, and thus risking re-writing or even rejection, your words will be treated gently and received gratefully.
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  • News March 2, 2020

    Editorial Comment 3/3/2020: Recovering Healthcare Professionals with Addiction

    On 06 February, ASAM posted “Public Policy Statement on Physicians and Other Healthcare Professionals with Addiction”, acknowledged in the ASAM Advocate and by the Federation of State Physician Health Programs . While it addresses the practice and recovery environments for healthcare professionals as of 2020, the policy invites a review of the role of recovering physicians in developing the very specialties that many of them come to practice, Addiction Medicine and Addiction Psychiatry.
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  • News February 24, 2020

    Editorial Comment 2/25/2020: Transitions (specific), and Transitions (general)

    Transitions (specific): Dr. Chuck Stevens (D.O.), addiction specialist and Methodist Minister, was a familiar figure and voice to many of us. His 27 years of recovery contributed to the survival of, and the fulfillment of ambitions for countless others. His passing in January came at age 67, a number he had not expected to attain; his grace in enduring more than one chronic, progressive illness both instructed and encouraged many who will see this. Transitions (general): Much of my past week was spent in the company of Western Doctors in Recovery, in San Diego, a more compact and regional organization than International Doctors in Alcoholics Anonymous (IDAA), but which shares many of the same aims.
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  • News February 18, 2020

    Editorial Comment 2/18/2020: Models of Addiction

    All efforts to describe addiction as an illness - comparable to those others suffered blamelessly, from misadventure, or from neglect - invariably fall back on models or analogies. The models are useful from a public health standpoint, in devising populational interventions. Heuristically analogies can be examined for flaws, as well, in order to come to a clearer notion of how the disease does not resemble another condition or process; and so prevent investigators from going down blind alleys. They can also clarify descriptive language.
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  • News February 10, 2020

    Editorial Comment 2/11/2020: Over-reaching

    I’m a great one for castigating politicians. For dishonesty. For perfidy. And for that most corrosive of flaws, hypocrisy. I can put my burner on high blue flame, when some stridently vocal Defender of the Faith gets caught in flagrante delicto with some poor hotel staffer. So I can only assume there is something particularly distorted in the mirror of my behavior when I contradict what seem to be my own values.
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  • News February 3, 2020

    Editorial Comment 2/4/2020: Toward a Blueprint of the Brain

    This week’s submissions reflect a strong bias to basic science, unapologetically. There are times when the brain is a three-pound grey pudding with obscure eponyms assigned to slightly darker streaks and patches, waiting to lose a contest between its inebriated owner and a delivery van.
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  • News January 27, 2020

    Editorial Comment 1/28/2020: Allies

    This past month a friend died. He did so quietly, drawing no attention to himself, despite having known for a number of years that this was impending; and certainly imminent within the past few months. I only knew of it because of a kind of long-term, episodic, two-student mini-seminar that we held for each other, on the topic of life’s end. The cause of his death was what will likely occur for many of us who are older - although he was not so very far into middle-age himself - if we are not infected by a Chinese chicken, stricken by a smartphone-distracted Mercedes-Benz driver, or overcome by gravity while a passenger in a helicopter. Nor was it from a substance use disorder, with all its attendant risks of infection and trauma. It was a cancer, for which the merits of 21st-century medicine shone, in that his life’s length and quality were clearly improved by treatment
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  • News January 21, 2020

    Editorial Comment 1/21/2020: Dreams Realized, Dreams Slain

    Some days ago, I was witness to an extraordinary event. That’s not quite right; I was an invited participant, in consequence of the way the event was handled. Two friends married, for whom such a marriage would have resulted in imprisonment, or just as likely, the deaths of either or both spouses, just within this past century. Wonderfully choreographed, with many hundreds of family and friends attending from homes thousands of miles afar, the marriage was between two exceptionally caring healthcare professionals who had been imaginatively, patiently planning toward this point for over eight years.
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  • News January 6, 2020

    Editorial Comment 1/07/2020: Management of Benzodiazepine (BZ) Use Disorder

    The New York Times (NYT) Science section of 03 January carried this eulogy, by Knvul Sheikh*: “Dr. Heather Ashton, 90, Dies; Helped People Quit Anxiety Drugs” An excerpt from this review of Dr. Ashton’s professional life underscores how it is not merely opioids which have led to our dereliction of better judgment, in the prescribing of addiction-activating drugs: “Heather was a remarkable person,” Nicol Ferrier, an emeritus professor of psychiatry at Newcastle University who worked closely with Dr. Ashton, said in an interview. “She was very upset by this problem of benzodiazepine dependence that was essentially caused by doctors overprescribing the medications, and she took it upon herself to help patients struggling to withdraw from them.”
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  • News December 30, 2019

    Editorial Comment 12/30/19: Be Best, Bill

    It is with great pleasure we get to finish off the year with our annual tribute to Bill’s editorials. This is not just some 80’s sit-com ploy to keep our readers’ attention by re-running clips of the most watched episodes- it is a moment to show thanks for all that Bill shares by pouring out his thoughts 51 weeks a year…So let’s take a look back at 2019, make some sense out of it, and get ready for the twenties of the 21st century.
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  • News December 20, 2019

    Editorial Comment 12/24/19: Gifts

    In this holiday season, "gift giving" has become a trope, investing it with a spiritual value that makes the endless and fervent buying-and-giving-and-receiving-and-exchanging seem somehow a little sacred. But that misses the point. The gifts in such seasons are not those by us to spiritual entities, but from them to us. We give thanks to you, the readers for guiding our shared patients to a place of sustained relief.
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  • News December 16, 2019

    Editorial Comment 12/17/19: Amphetamine use disorder and medication approaches

    A December 11 article by Coffin et al. in JAMA Psychiatry suggests efficacy for the use of mirtazapine in management of methamphetamine use disorder, as well as some positive effect upon high-risk sexual behavior. The article particularly stirred up interest among one large group of addiction specialists, stimulating a high baud-rate exchange both pro/con.
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  • News December 10, 2019

    Editorial Comment 12/10/19: Tinker, tailor, soldier, spy. Doctor, detective, toxicologist, felon?

    High-activity antiretroviral therapy (HAART) first arrived in 1993, comprised of a variety of agents active against human immunodeficiency virus (HIV). These included fusion inhibitors, integrase inhibitors, protease inhibitors, NNRTIs and both nucleoside and nucleotide reverse transcriptase inhibitors.
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  • News December 3, 2019

    Editorial Comment 12/3/19: AIDS & Addiction (World AIDS Day)

    High-activity antiretroviral therapy (HAART) first arrived in 1993, comprised of a variety of agents active against human immunodeficiency virus (HIV). These included fusion inhibitors, integrase inhibitors, protease inhibitors, NNRTIs and both nucleoside and nucleotide reverse transcriptase inhibitors.
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  • News November 25, 2019

    Editorial Comment 11/26/19: It pays to shop early

    Inserted here is a link to a RAND Corporation offering, a free downloadable text of 295 pages… It is provocatively entitled, “The Future of Fentanyl and Other Synthetic Opioids.” It is the closest I will have to a Thanksgiving gift for you.
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  • News November 19, 2019

    Editorial Comments 11/19: Preface to Thanksgiving Week

    Although September is Recovery Month, among those in recovery that part of the calendar most venerated and most feared is this interval of November-January. For here coincide holidays and inaugurations, periods of revelry and of reverie, rehabilitation and regrets. While the season is a less official celebration of recovery, it is certainly more visceral. Continuing the past two weeks’ characterizations of addiction and recovery, it is right to give examples of both those with and without the disease, “Donna” and Ahmed, who serve those with it.
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  • News November 12, 2019

    Editorial Comments: On Meth 2.0; and for Veterans’ Day

    Methamphetamine: The USA Today piece below (“Cheap and powerful ‘meth 2.0’…”) seeks to build a case for response to an ostensibly new addiction threat, from methamphetamine (MA). It is not clear that the author demonstrates a difference between the MA in circulation three decades ago and that currently available; or between the effects then and now.
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  • News November 5, 2019

    Editorial Comment 11/5: Willingness vs. willfulness

    In 2003, I found myself back in uniform at the beginning of another war. Part of that time was spent in Manama, the capital of Bahrain, in comparatively safe, even comfortable circumstances. It was, moreover, a sufficiently urban setting that some peculiarly Western institutions found homes there. There were two meetings of Alcoholics Anonymous weekly, both bracketing the weekend with its holy days, one hosted by a hospital, the other by a church not so distant from the hospital.
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  • News October 28, 2019

    Editorial Comment 10/29: On Recovery Speakers:

    Role models and accomplishments in recovery have provided guidance to those who were ambivalent, assurances to those who were desperate, and a validation of shared human experience to those who felt alone, since the beginning of Alcoholics Anonymous (AA). In fact, this is not unique to AA; the Temperance Movement and its predecessors relied heavily on personal testimonials to achieve authenticity, or at least the appearance of authenticity. Reasoning from the abstract may be satisfying for a teacher but is seldom of much use to the pupil; even less so when the pupil is cognitively impaired. To reason more from example or even by analogy requires real skill from the teacher. It is translation at its best. Translation is, after all, movement of the un-comprehended into the realm of understanding.
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  • News October 22, 2019

    Editorial Comment 10/22: Contagion Control and National Addiction Treatment Week

    As noted, the interval 21-27 October is National Addiction Treatment Week. Initiated by the American Society of Addiction Medicine in 2017, its aim is to annually rekindle a conversation regarding the origins, characterization, diagnosis, and treatment of addiction disorders (http://treataddictionsavelives.org/about/ ). The style of such an event is familiar to us all: the effort to bring about a national understanding of an epidemic illness and its human devastation was most recently memorably evident in the AIDS epidemic.
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  • News October 15, 2019

    Editorial Comment 10/15: The struggle for balance and National Addiction Treatment Week; “Mindful Drinking”

    In the April 2019 issue of National Geographic magazine on cities (https://www.nationalgeographic.com/magazine/2019/04/ ), the segment on Singapore asks the important question of social control versus autonomy: what are we willing to give up for security? I submit this just as an analogy in considering the measures for treating addiction.
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  • News October 7, 2019

    Editorial Comment 10/8: Graduate education

    Readership attention is invited to the opioid use disorder education requirement proposal (The Journal of Law, Medicine & Ethics), below. The follow-up question is whether such a proposal is sufficiently broad.
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  • News September 30, 2019

    Editorial Comment 10/1: What isn’t here

    In psychiatric residency training, there is an admonition that every supervisor makes to the trainee, at some point: listen for what isn’t being said. There are various interpretations of this – one is simply, “Look for what history you have omitted.” Another, less obvious translation is to listen for what has been either concealed or repressed.
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  • News September 23, 2019

    Editorial Comment 9/24: Ms. Penny Mills, EVP & CEO

    This about a graceful but unwanted departure. This past week, Penny Mills, Executive Vice President and Chief Executive Officer of the American Society of Addiction Medicine, announced her wish to retire in June of 2020. She will conclude her 10th year with us having done all that we could want and more, more even that we had wit to ask. With characteristic professional commitment, she has provided us fully 9 months in which she will aid in the selection of a successor.
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  • News September 16, 2019

    Editorial Comment 9/17: Acquiring perspectives and communicating perspectives

    In context with the lead article, The Future of Fentanyl and Other Synthetic Opioids (RAND), consider examining a text edited by David F. Musto, One Hundred Years of Heroin (Auburn House 2002). Cited in several national conference presentations in the past year, it is a compilation of 14 articles dovetailed to form a coherent history of the archetypal opioid of misuse.
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  • News September 9, 2019

    Editorial Comment 9/10: Susceptible populations

    Two of the articles discussed relate directly to the US incarcerated population. This invites commentary on how we may best serve them. Citizens and former citizens in our prisons exceed 2.3 million in 2019, with 11 million spending some time in jails over the year. Of these, a reliable estimate of those with substance use disorders still wants determining but certainly exceeds 50%.
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  • News September 3, 2019

    Editorial Comment 9/3: Tools of the (drug) trade

    The creative intelligence is ethically neutral. It can confer therapeutic benefit or lethality with equal facility. The moral compass of its owner determines the direction of its effect: in its most mundane form we encounter it during our brighter patients’ justifications for drug or alcohol use.
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  • News August 26, 2019

    Editorial Comment 8/27: Efficacy claims

    When we began the present format for the ASAM Weekly, it was to improve access to recently-arriving news in the addiction medicine field. Judging by the subscription rate and similar factors (e.g., click-rate, email comments), we have enjoyed some success. But there are obstacles to assigning the correct treatment to the illness that become apparent in publications advancing either pharmacotherapies or nonpharmacologic therapies. One of these is in the area of trustworthiness.
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  • News August 20, 2019

    Editorial Comment 8/20: Accepting the things we cannot change, changing the things we can

    In the interval since last week's editorial, I received a number of suggested community recovery options. I'm a little cautious about opening this up to a listing or inventory of all programs, community and otherwise. But whether such an inventory belongs in the pages of ASAM Weekly is less relevant than whether there should be such an inventory, somewhere. ASAM makes no endorsement, direct or inferred, of any of the programs, and particularly not of those that have some commercial underpinnings (with reference to the Therapeutic Communities examples provided last week; which, just as TCs generally, may have no-cost or externally-supported components).
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  • News August 12, 2019

    Editorial Comment 8/13: More on alternate choices

    In the interval since last week's editorial, I received a number of suggested community recovery options. I'm a little cautious about opening this up to a listing or inventory of all programs, community and otherwise. But whether such an inventory belongs in the pages of ASAM Weekly is less relevant than whether there should be such an inventory, somewhere. ASAM makes no endorsement, direct or inferred, of any of the programs, and particularly not of those that have some commercial underpinnings (with reference to the Therapeutic Communities examples provided last week; which, just as TCs generally, may have no-cost or externally-supported components).
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  • News August 5, 2019

    Editorial Comment 8/6: The other community recovery groups

    I discussed the various cultures of both addiction and recovery from addiction this past week, at the International Doctors in Alcoholics Anonymous (IDAA) conference in Knoxville, Tennessee. Most of the topic was dedicated to the conceptual utility of a cultural model in providing effective interventions and structured treatment for addictions. But it also offered an opportunity to look briefly at what else is available, in addition to twelve-step programs, as community mutual assistance organizations. Such knowledge is an ethical and professional imperative.
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  • News July 30, 2019

    Editorial Comment 7/30: Medicine beyond pharmacotherapy

    This week’s emphases are dominantly on social interventions: season as an indicator for prevention, the parenting role and punishment, telemedicine (2 times), care for the caregiver (resident duty hours caps). In the article below addressing seasonal onset of drug misuse (Palamar J. et al.), the authors conclude that possibly more effort should be put into prevention methods prior to the onset of summer. This may be so, although it begs the question of whether publicity-centered interventions have value, seasonal or otherwise. From the sidelines, having heard very many AA & NA testimonials regarding the onset of drug or alcohol use, the most frequently-named culprits have been boredom, drug availability, and peer induction.
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  • News July 22, 2019

    Editorial Comment 7/23: Oaths

    Our medical school introduced 77 new students this week, culminating in a White Coat Ceremony. This may not be fully familiar to readers, but it’s nothing more than a robing-ceremony. Students are provided and cloaked with a short clinical coat, given a stethoscope and a book of Oslerian aphorisms, and congratulated on making it through the gauntlet. All this takes place before their parents, friends, sometimes spouses or intended spouses, possibly some bank loan officers, and not uncommonly the mentors who induced them to stay the course. It concludes in the assembly reciting the Oath of Hippocrates, mindful of the fact that they are not doctors, yet; but that the tenets of the Oath still apply as students.
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  • News July 15, 2019

    Editorial Comment 7/16: On editing

    My editorial this week was superseded over the course of the weekend. It became clear that consultation was needed, and in a profession that is founded on the consultative process, that is no light matter. So I put it to bed. Therapeutic coma, if you will. That left me with a brain full of dendritic tangles, from which I despaired of summoning any inspiration; and this caused me to pick up a book. I have an original copy of Benjamin Rush’s “Medical Inquiries and Observations upon the Diseases of the Mind,” published in 1812. To read it is to wonder at times if Dr. Rush was not being facetious in addressing certain topics.
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  • News July 8, 2019

    Editorial Comment 7/9: The law and addiction medicine

    Please look to the last link and edit, a question of crime vs. misconduct in the California penal system. The issue tried relates to possession of cannabis in a controlled or special setting. In this instance, the inmates who were originally convicted may be seen as having committed a type of status offense, similar to when a minor consumes alcohol or violates curfew. This judgment must have been exasperating to both sides of the aisle, prosecution and defense, and entertaining to the gallery.
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  • News July 1, 2019

    Editorial Comment 7/2: Memes

    A link to a BuzzFeed piece on addiction memes is included below, in which the work of Timothy Kavanagh is reviewed by journalist Derek Garner. The memes do not require editorial interpretation by me, but because of the potentially inflammatory nature of the material, it seemed wisest for me to take advantage of this editorial spot occurring at the top of the Weekly’s front page.
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  • News June 25, 2019

    Editorial Comment 6/25: “Susceptibles” and addiction injury

    Apart from the discussion of the Pennsylvania Society of Addiction Medicine's efforts to improve access to buprenorphine, legislatively, the topics this week focus on the needs of women, the newborn, and adolescents.
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  • News June 17, 2019

    Editorial Comment 6/18: Novel opio-mimetics

    The claim associated with the linked article in Journal of Neuroinflammation warrants special attention this week. A novel opioid under investigation is described as being less subject to specific adverse properties associated with morphine, notably aggravation of acute pain over the long term and initiation of a chronic nociceptive state. The principle underlying this transition to chronicity is postulated as inflammatory, a contention that has been increasingly supported.
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  • News June 7, 2019

    Editorial Comment 6/11: Final response, contribution of volume and frequency to the diagnosis of alcohol use disorder (AUD)

    In last week’s ASAM Weekly (04 June 2019), Dr. Raymond Anton and co-authors replied to a guest editorial by Dr. Stuart Gitlow, in reference to a Clinical Psychiatry News 21 February report from the December 2018 meeting of the American Academy of Addiction Psychiatry (AAAP). As is customary in an exchange of letters, Dr. Gitlow’s response is provided below, in conclusion:
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  • News June 4, 2019

    Editorial Comment 6/4: Rebuttal to guest editorial

    (Dr. Stuart Gitlow’s guest editorial, titled “End-point in AUD Treatment” and posted 26 February 2019, followed comments reported from Dr. Raymond Anton and colleagues in the December 2018 AAAP meeting, in Clinical Psychiatry News dated 21 February.) Response to Dr. Gitlow regarding use of the WHO risk drinking reduction to guide medication-based treatments. In a recent guest editorial, Dr. Stuart Gitlow expresses some concerns about a proposed new AUD clinical trial efficacy outcome measure based upon reductions in World Health Organization (WHO) risk drinking levels. The editorial suggests more broadly that “reductions in alcohol use” are not an adequate measure of recovery from AUD, as they may reflect only a reduction in symptoms (that is alcohol related pathology).
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  • News May 28, 2019

    Editorial Comment 5/28: Memorial Day; Sublocade and Brixadi

    For the years that I have been with the Weekly, I have been grateful to the ASAM staff leadership for observing Memorial Day. It is one day that I’ve always taken more seriously than those associated explicitly with other historical events. Mention of it here has particular significance, given the long association of alcohol use with military service.
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  • News May 20, 2019

    Editorial Comment 5/21: Fear

    Even for this periodical, the variety of topics included today is unusual. The We Rise project in the Los Angeles, alcohol use in pregnancy, the impact of psychostimulants on opioid use and mortality rates, alcoholism and emotional responsiveness, major national policy initiatives, and the adverse effects of early discontinuation of opioids in those on long-term management are among these. A week seldom goes by without this periodical including a piece that reflects the concerns of physicians about governmental restrictions placed on either opioid analgesia or pharmacologic management of opioid addiction; so noting that frequency leads to the following overview.
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  • News May 13, 2019

    Editorial Comment 5/14: Pending legislation relating to buprenorphine prescribing limits

    Sessi Kuwabara Blanchard, in last week’s issue of Filter, an online journal emphasizing public policy in the realm of drug use and addiction, describes Congressional initiatives relating to buprenorphine prescribing limits. Before opening the link, please know that while Filter has several intelligently written and apparently well-researched articles displayed, it is of uncertain provenance: no editorial or financial support information, no editorial objectives, no history.
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  • News May 6, 2019

    Editorial Comment 5/7: Graduations

    All around us during this last month of spring are the phenomena of emergence: graduations, convocations, celebrations. Students complete some phase of their education and are reminded by high-minded pedants that they are just about to enter another phase of it.
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  • News April 29, 2019

    Editorial Comment 4/30: A Recovery Without Joy

    Decades ago, as an older resident in a second career, I met with a 17-year-old Chinese-Hawaiian-Filipino male in the emergency room of a large acute-care hospital. He will be “Kyle”. He was agitated and acknowledged intense anxiety. The basis for his evaluation was his inability to communicate coherently, plus his acknowledgment that he was experiencing auditory hallucinations.
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  • News April 22, 2019

    Editorial Comment 4/23: Holidays and holy days

    Nick – Dr. Athanasiou – prompted me to recall that 4/20, or April 20th, is the date celebrated by many in honor of cannabis consumption. Bracketed by Good Friday and by Easter, it would seem an unlikely competitor for the attentions of the Christian faithful, and we will similarly Passover other religious references. But with the nation's attention so preoccupied with how best to become intoxicated, “420” and the legal status of marijuana seemed a right topic for attention.
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  • News April 16, 2019

    Hyperkatifeia | 4.16.19

    On Friday 05 April, the Annual ASAM Scientific Conference included two plenary sessions titled, “Big Ideas.” At the latter of these were Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA); and Dr. George Koob, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Both provided brief presentations to serve as take-off points for a colloquium hosted by Dr. Kelly Clark, then President of ASAM.
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  • News April 6, 2019

    Journeys | 4.9.2019

    Journey 1: The Staff, Senior Editor, and Editor-in-Chief of the ASAM Weeklyare honored to announce the digest’s bronze award in the category of best E-Newsletter, from The American Society of Healthcare Publication Editors (ASHPE). We have shared the task leading to this point for three years. Journey 2:
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  • News April 1, 2019

    Numbers | 4.2.2019

  • News March 26, 2019

    Addiction Education, all strata | 3.26.2019

  • News March 19, 2019

    Alcohol consumption volume as a criterion for AUD | 3.19.2019

  • News March 12, 2019

    Values and the purpose of the FDA | 3.12.2019

  • News March 5, 2019

    The physician as sponsor | 3.5.2019

  • News February 25, 2019

    Guest Editorial Comment: End-point in AUD Treatment

  • News February 19, 2019

    Opioid use in pregnancy – Treatment as encompassing more than the drug-user and the interval of pregnancy | 2.19.2019

  • News February 11, 2019

    Editorial Comment: Cannabis for treatment of Opioid Use Disorder (OUD) | 2.12.2019

  • News February 4, 2019

    Sorry, Professor McLuhan. It’s not the medium. It really is the (neurotransmitter) message. | 2.5.2019

  • News January 29, 2019

    Continuity in all matters | 1.29.2019

  • News January 22, 2019

    Chronic disease paradigm, again | 1.22.2019

  • News January 14, 2019

    Inclemency | 1.15.2019

  • News January 7, 2019

    Evolution of the field | 1.8.2019

  • News December 25, 2018

    Tobacco Lite | 2.6.2018

  • News December 25, 2018

    Crime and Punishment, minus crime. | 6.26.2018

  • News December 25, 2018

    Greetings Readers | 12.25.2018

  • News December 18, 2018

    Public Recovery | 5.1.2018

  • News December 18, 2018

    Safe Injection Sites (SIS) | 9.4.2018

  • News December 18, 2018

    Final common pathways (5/8/2018)

  • News December 18, 2018

    Cannabis in the management of opioid use disorder (2/20/2018)

  • News December 17, 2018

    A full deck (12/18/2019)

  • News December 10, 2018

    Disclosures and Influence

  • News December 3, 2018

    Recovery; and death

  • News November 27, 2018

    T.K.Li, MD, d. 18 November 2018

  • News November 19, 2018

    Reminiscence and nostalgia

  • News November 12, 2018

    GUEST COMMENT: NIDA Science Seeks Solutions to the Opioid Crisis

  • News November 5, 2018

    Addiction as Learning Disorder

  • News October 29, 2018

    1) Content development in ASAMW. 2) Hospitalizations related to amphetamine use.

  • News October 22, 2018

    Addiction Policy and Unintended Consequences

  • News October 15, 2018

    Management of Alcohol Withdrawal | 10.16.2018

  • News October 8, 2018

    Ethanol deprivation & mood | 10.9.2018

    In the lead full-text article correlating symptoms of PTSD with risky or problem alcohol consumption (Posttraumatic Stress Disorder Symptom Association With Subsequent Risky and Problem Drinking Initiation), there is a direct association made between the finding of irritability and at-risk drinking. While the study is designed to examine PTSD in the context of alcohol use, it manages to reemphasize a finding that all addiction clinicians are familiar with, the prominence of irritability, mood reactivity and dysphoria, among those who engage in at-risk drinking. The timing for this finding came just as the U.S. Senate was compelled to examine the implications of a drinking history for a high level of executive function.
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  • News October 1, 2018

    Euphony | 10.2.2018

    Most practitioners will be in receipt of the Surgeon General's Spotlight on Opioids, released September 19. I have included the direct link below, along with a comment from ASAM leadership including President Dr. Kelly Clark. Additionally, I have included the link to the full length report, Facing Addiction in America, the 413 page comprehensive
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  • News September 18, 2018

    The ASAMW Survey - foreword (9.18.2018)

  • News September 13, 2018

    Recovery Month