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The ASAM Weekly for February 3, 2026
This Week in the ASAM WeeklyAddiction is (also) a disease of attention. Alcohol imagery contributes to alcohol use but it has become incredibly difficult to measure the effect now that so much of our attention has moved online (Addiction). On the flip side, people who pay a lot of attention to life online are finding themselves addicted to complex algorithms and suing Big Tech because of it (The Associated Press). Marketing is a tool that can capture people's attention. Big Tobacco knows this well and is reinventing itself with an evidence-based and slightly ironic marketing campaign: nicotine pouches are the safer alternative to tobacco (The Associated Press). But not all marketing has the intended effect; “never use alone” started off as a good idea but might have brought the wrong kind of attention to harm reduction (The Guardian). (Speaking of attention…while we’ve got yours, apply to be the next ASAM Weekly Editor in Chief before time runs out.) Attention is also necessary for treating addiction. The guideline for tapering benzodiazepines was developed with close attention paid to the patient experience (Journal of Addiction Medicine). Practitioners at treatment facilities should pay closer attention to the medications for AUD (MAUD) treatment gap (JAMA Network Open). And we will always need politicians to pay attention, support the work we do, and pass legislation, like the Cure Hepatitis C Act of 2025 (JAMA Network Open). Nicholas Athanasiou, MD, MBA, DFASAM Apply to be the ASAM Weekly Editor in Chief! ASAM Weekly, with a circulation of 70,000 readers, is conducting a search for a new Editor in Chief (EIC). The EIC will serve a 1-year term from July 1, 2026, to June 30, 2027, with the option to renew for additional years. Benefits and compensation offered. ASAM Needs Your Expertise ASAM’s Clinical Practice Guideline Methodology and Oversight Subcommittee (CPG-MOS) is seeking additional volunteers to join the group. The CPG-MOS provides advice and guidance for the implementation of ASAM’s CPG methodology. Members with an understanding of GRADE methodology and CPG development are encouraged to apply. For more information or to apply, click here. Lead Story Medication Availability for Alcohol Use Disorder in Substance Use Disorder Treatment Facilities 🔓 JAMA Network Open This study examined the availability of medications for alcohol use disorder (MAUD) in SUD treatment facilities (SUDTF) from 2017 to 2023. Data were obtained from SAMHSA’s Mental Health and Addiction Treatment Tracking Repository. The percentage of counties with a SUDTF offering MAUD increased from 34% in 2017 to 50% in 2021. This increase leveled out between 2021 and 2023, perhaps related to the pandemic. Counties with an MAUD-offering facility were more likely to be metropolitan (57% vs 25%, p<.001) with substantially more population (mean 220,100 vs 26,650, p<.001) and fewer uninsured residents (8.5% vs 10.7%, p<.001). The authors call for policies supporting MAUD-offering facilities, particularly in underserved counties. Research and Science Comparing the accuracy of artificial intelligence models to detect alcohol in video images Addiction The advent of smart phones, social media, and streaming platforms has made it difficult to track depictions of alcohol and alcohol use in videos. In addition, there is evidence of a link between viewing depictions of alcohol and its consumption and that streaming platforms contain more depictions of alcohol than traditional media. Given these circumstances, researchers tested 3 artificial intelligence models and their ability to accurately identify depictions of alcohol in various media. Researchers found that the zero-shot learning Large Language and Vision Assistant (ZSL-LLaVA) model worked well and provides a potential way to track depictions of alcohol in media, thus informing public health interventions. Addiction Biology This study measured the effect on alcohol use disorder (AUD) recovery of continuous theta-burst stimulation (cTBS), a form of transcranial magnetic stimulation where pulses are delivered at theta rhythm (5 hertz). Participants (16 active, 12 sham) received 10 cTBS (or sham) treatments over 2 weeks. Neural activation provoked by alcohol cues was measured before and after cTBS treatment using fMRI. The active cTBS group showed reduced relapse risk over the following year (HR=0.21). The sham group had a progressive increase in alcohol cue reactivity after (sham) treatment that was not seen in the active group. The authors suggest that in early abstinence the brain becomes increasingly sensitized to alcohol cues and that this was suppressed by the cTBS treatment. The change in neural activation was able to predict relapse in 79% of patients. The authors conclude that cTBS treatment decreased risk of relapse by reducing craving-related neural activity. Journal of General Internal Medicine This New York-based retrospective study compared outcomes for inpatients with a diagnosis of opioid use disorder (OUD) who received medication for OUD (MOUD) to those who did not receive MOUD, with a primary outcome of patient-directed discharge. Admissions of patients with OUD who were not on MOUD prior to admission (n=5,542) were included in the study, which took place from January 2016 to December 2022. Researchers found that admissions receiving inpatient MOUD were significantly less likely to result in a patient-directed discharge (11.9% vs 14.4%). Additionally, admissions receiving MOUD were significantly more likely to receive a discharge prescription for buprenorphine (8.6% vs 1.2%), as well as a buprenorphine prescription within 60 days of hospital discharge (5.5% vs 1.1%). JAMA Network Open This open-label, randomized, parallel-group clinical trial compared mobile telemedicine for Hepatitis C treatment with enhanced usual care. The trial ran from April 2022 to September 2024 in rural counties of New Hampshire and Vermont. Participants (n=150) were randomized to either mobile telemedicine care (MTC), which brought HCV treatment directly to patients via mobile van, or enhanced usual care in which a mobile team provided care navigation and referral to an HCV treatment provider. Both groups received sterile syringes and other harm reduction services. Participants in the MTC arm had higher rates of treatment initiation (57.3% vs 26.7%) and higher rates of viral clearance at 12 weeks (37.3% vs 18.7%). Learn More A Long-acting Naltrexone Implant (iSTEP-N) for Opioid Use Disorder: First-in-Human Phase I Trial 🔓 Journal of Addiction Medicine iSTEP-N is a novel, bioresorbable, subcutaneous implant designed to release naltrexone for 6–12 months after a single procedure and improve adherence. This single-center, randomized, double-blind, placebo-controlled, single-ascending-dose trial was also a first-in-human study which evaluated the safety and pharmacokinetics of iSTEP-N. At the 9.6 g dose, iSTEP-N provided sustained therapeutic naltrexone exposure for 12 weeks with a favorable safety profile, while releasing less than one-fourth of its drug content. Further studies will evaluate longer-term exposure, safety, and clinical feasibility in individuals with opioid use disorder.  Benzodiazepine Tapering: A Marathon, Not a SprintJournal of Addiction Medicine While benzodiazepines can have benefits, they also carry risks, including dependence, withdrawal (including protracted withdrawal), and benzodiazepine use disorder. In this commentary, the authors discuss the core of recent guidelines for benzodiazepine use and tapering, noting risks and benefits should be discussed with each new prescription, tapering should be patient centered and, because response can vary significantly between patients, should start slow (5%-10% reduction in dose). The authors also highlight other considerations, including benzodiazepine use in persons with substance use disorders, co-occurring psychiatric conditions, and transitioning to long-acting benzodiazepines. Finally, the authors highlight some of the research gaps, including strategies to prevent and treat protracted withdrawal, valid withdrawal scales, and long-term outcomes if phenobarbital is used for tapering. Standardizing Opioid Treatment Program Performance in the Era of Medicaid Reform 🔓 JAMA Network Open This invited commentary reviewed a national cohort study which analyzed over 500,000 methadone treatment episodes across more than 1,300 opioid treatment programs using Medicaid data from 2018 to 2023. The author developed an adjusted retention metric at 30, 90, and 180 days, revealing significant variation in patient retention (median 30-day retention 65.1%) even after accounting for case mix. This reliable, scalable measure offers a foundation for evaluating program performance, informing quality improvement, and advancing equity in opioid use disorder care, underscoring retention as a key indicator of treatment success and system accountability. In the News Opinion | Why Is My Son Being Left to Die on the Streets? The New York Times FDA considers whether Zyn can be marketed as safer than cigarettes🔓 The Associated Press CDC seeks to block ‘never use alone’ messaging used by overdose prevention groups🔓 The Guardian Social media companies face landmark trial over youth addiction claims🔓 The Associated Press Inside the rise and fall of Opvee, Indivior's nasal overdose antidote STAT The Conversation |