Quality & Science

ASAM Weekly Archive

William Haning, MD, DFASAM, DFAPA 


Bill Haning is a Professor of Psychiatry at the John A. Burns School of Medicine, University of Hawaii, who directs neuroscience education for the medical students and is the Program Director, Addiction Psychiatry/Addiction Medicine. A Director of the American Society of Addiction Medicine, he also serves as Chair of the Examination Committee for Addiction Psychiatry, American Board of Psychiatry and Neurology. He is the current Chair of ASAM’s Publications Council.

Question for the editor? Email pubs@ASAM.org

  • 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