This Week in the ASAM Weekly

It wasn’t long ago that we showcased an article about the wasp’s incredible ability to metabolize alcohol and the implications of this for humans. This week we return with a focus on Drosophila. The research-ready fruit fly has allowed for important discoveries in addiction, but the insect’s bitter distaste for cocaine has made it difficult to develop a fruit fly model for cocaine use disorder—until now (The Journal of Neuroscience).

Some animals, it seems, also have a liking for music, but they lack something universally human—the groove phenomenon. This drive to drum, sing, and dance in groups is closely linked with reward, and a new study finds that individuals with SUD seem to demonstrate a higher dance affinity to more complicated beats (Proceedings of the National Academy of Sciences). If we combine that with the benefits of acute aerobic exercise, then it becomes apparent that movement can be a healing process for people with addictions (Drug and Alcohol Dependence).

Oftentimes humans, and other animals alike, seek out experiences that are much more than just physical; whether that may be an elder’s intoxication from cannabis (JAMA Network Open), a billionaire taking psychedelics on way to the White House (The New York Times), or a young man experiencing the slippery slope of gambling (USA Today), studying animals has helped us better understand what it means to be human.

This is especially true in the case of love, which is seemingly universal for many animals and, many believe, built on an addiction network. It is this network that is becoming increasingly vulnerable to technology and the reason many are worried about stories of chatbots exploiting “I love you” (The New York Times) or “therapy” bots encouraging relapse (Futurism). Advanced technologies like AI have the potential to harm people in ways we haven’t seen before, and yet there is still something important we need to learn from these technologies that we haven’t from animal models—what it means to be not human.

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM; John A. Fromson, MD; Jack Woodside, MD

Lead Story  

Bitter sensing protects Drosophila from developing experience-dependent cocaine consumption preference

The Journal of Neuroscience

Cocaine use disorder (CUD) is a highly heritable condition for which there are no effective treatments. Testing the many human genetic variants linked to CUD requires a cost-effective, genetically tractable model. This study showed that bitter-sensing neurons prevent cocaine self-administration in Drosophila. Disrupting Drosophila bitter perception enables a model for experience-dependent cocaine preference. The findings underscore the potential of Drosophila as a crucial tool for identifying the genetic mechanisms underlying CUD, aiding in the discovery of new therapeutic targets, and contributing to the development of effective treatments for this highly heritable disease.

Research and Science 

Benefits of Acute Aerobic Exercise to Ameliorate Craving and Risky Decision-Making in Individuals with Methamphetamine Use Disorder 

Drug and Alcohol Dependence

Male subjects (n=30) undergoing rehabilitation for methamphetamine use disorder (MUD) at a facility in China had craving and decision-making measured shortly after 20 minutes of moderate-intensity aerobic exercise (75%-80% of HRmax) and, in a separate session, after 20 minutes of rest. A session of moderate-intensity aerobic exercise significantly reduced craving (p<0.01). The aerobic exercise also improved risky decision-making and myopic decision-making (choosing immediate reward without considering long-term consequences), both (p<0.05). However, aerobic exercise did not improve a measure of risk-taking behavior. The authors suggest moderate-intensity aerobic exercise may reduce the risk of relapse in MUD.

Cannabis Use Among Older Adults 🔓

JAMA Network Open

The authors conducted a cross-sectional study of a VHA cohort of patients aged 65-84 to assess cannabis use and cannabis use disorder (CUD) and potential associated factors. Overall, 58.2% of veterans reported ever using cannabis, with 10.3% reporting past 30-day use. Among those who reported ever using cannabis, 28.9% reported having used it for a medical reason, most commonly pain (56.4%). Factors associated with past 30-day use included age 65-75, tobacco use, other substance use, financial hardship, and living in a state where recreational use was legal. Among those with past 30-day use, 36.3% met criteria for CUD and were more likely to be younger than 76, have anxiety, and have deficits in activities of daily living. Given the relatively high rates of cannabis use and CUD, the authors support screening for older veterans.

Carcinogen reduction in a randomized controlled study comparing e-cigarette provision to assessment only among people with serious mental illness who smoke

Drug and Alcohol Dependence

People with serious mental illness (SMI) have high smoking rates and low quit rates. Participants (n=240) with SMI (47% schizophrenia, 52% bipolar disorder) with no current desire to quit were randomized to receive either electronic nicotine delivery systems (ENDS) or usual care (control). The ENDS group, asked to replace their cigarette use with ENDS, reduced their cigarette use by 59% and exhaled carbon monoxide (CO) by 36% compared to 6% and 9% for controls. NNAL (a metabolite of the tobacco-specific carcinogen nitrosamine) was significantly lower at 4 weeks in the ENDS group compared to controls (p<0.02), but the effect diminished at 8 weeks (p<0.07). Reductions in exhaled CO strongly correlated with reductions in NNAL. The authors conclude that ENDS provided short-term harm reduction, but behavioral support may help sustain the benefit.

Initiating Injectable Buprenorphine in People Hospitalized With Infections 🔓

JAMA Network Open

This randomized clinical trial of 171 adults with infections and opioid use disorder (OUD) assessed if initiating long-acting buprenorphine (LAB) with infectious disease (ID) management (ID-LAB) for hospitalized persons with OUD and infection improves receipt of medications for OUD (MOUD) 12 weeks after randomization. Researchers found that there was no difference in the proportion who received MOUD at 12 weeks between the ID-LAB (59%) and treatment as usual (54%) arms. These findings suggest that patient preference and shared decision-making should guide which formulation of MOUD is started during hospitalization for infections in patients with OUD. 

Learn More 

Pharmacokinetics of Oral and Extended-release Naltrexone in Pregnant and Lactating Individuals and their Infants 

Journal of Addiction Medicine

Naltrexone may be an option for treatment of opioid use disorder (OUD) and alcohol use disorder (AUD) during pregnancy, but little is known about its pharmacokinetics. In this study, researchers assessed oral and extended-release (XR) naltrexone levels at multiple time points during pregnancy, at delivery in mother and infant, and 1 month post-delivery in breastmilk and infant. Naltrexone was identified across dosing intervals for both oral and XR formulations during pregnancy, but levels were low at the end of XR formulation dosing period. Naltrexone was also detectable in infant post-delivery consistent with transplacental transfer and in breastmilk 28 days post-partum with low levels detected in the breastfeeding infant. These findings do suggest dosing intervals for XR naltrexone may need to be increased to maintain therapeutic levels during pregnancy. 

Individuals with substance use disorders experience an increased urge to move to complex music 🔓 

Proceedings of the National Academy of Sciences

Substance use disorders disrupt the brain’s dopamine system, which is key to movement, reward, and music perception, specifically the pleasurable urge to move to music, called groove. This study examined how long-term cocaine and heroin use, which lowers dopamine levels, affects the experience of groove. Researchers found that drug users preferred music with high rhythmic and harmonic complexity more than nonusers did, while responses to moderate complexity were similar. This pattern is different from other dopamine-related conditions like Parkinson’s disease. The results suggest that drug users need more intense, complex stimuli to activate their reward system, supporting the idea that reduced dopamine raises the threshold for non-drug rewards.

Time-Specific Predictors of E-Cigarette and Cigarette Use Trajectory Classes From Preadolescence to Late Adolescence (2013–2020) of the Population Assessment of Tobacco and Health (PATH) Study 🔓

Journal of Adolescent Health

Researchers evaluated e-cigarette and cigarette use in adolescents across 7 years of the Population Assessment of Tobacco and Health (PATH) Study to assess changes in use patterns and predictors of those changes. The authors examined patterns of use over time, identifying 5 classes of e-cigarette use and 4 classes of cigarette use. Daily social media use and advertising exposure were associated with susceptibility and initiation of e-cigarettes in young adolescents. In addition, having friends that used, a low perception of harm, and other substance use were all associated with trajectories of both e-cigarette and cigarette use. The authors suggest these factors should be addressed in targeted intervention and prevention strategies, including regulation limiting advertisement. 

In the News 

On the Campaign Trail, Elon Musk Juggled Drugs and Family Drama

The New York Times

What a ‘Perfect’ SUD Care Model Would Actually Look Like 🔓

Behavioral Health Business

Why GLP-1s like Ozempic should be available over the counter 🔓

Reason

Sports betting addictions are surging. Young men are unprepared. 🔓

USA Today

Opinion | Love Is a Drug. A.I. Chatbots Are Exploiting That.

The New York Times

What Will Happen to Opioid and Drug Overdose Deaths after CDC Cuts? 🔓

Scientific American

Therapy Chatbot Tells Recovering Addict to Have a Little Meth as a Treat 🔓

Futurism