The ASAM Weekly for August 4, 2026

The 2025 National Survey on Drug Use and Health (NSDUH) shows encouraging trends among adolescents and young adults with broad declines across past-month nicotine, alcohol, and marijuana use, and binge drinking, as well as reduced rates of substance use disorders, major depressive episodes, and suicidality.

Conversely, troubling overall increases occurred in past-month nicotine vaping and marijuana use, past-year use of marijuana and hallucinogens, and past-year marijuana use disorder. Interestingly, it is important to point out that these increases are driven by use among adults aged 26 or older. For each of these indicators, use among adults 26 or older all increased whereas use among youth 12 to 17 and young adults aged 18 to 25 either declined or remained stable.

Furthermore, while youth mental health improved, suicide indicators among adults aged 26-49 and 50+ rose between 2021 and 2025. These findings highlight the importance of ensuring a lifespan approach to suicide prevention and mental health promotion and treatment initiatives, including incorporating age-related changes in physical abilities and social environments into prevention strategies.

There is evidence that alcohol consumption may be linked to cognitive function—potentially protective at low amounts and negative effects at higher amounts—but results of prior studies have been mixed. Researchers conducted a systematic review and dose-response meta-analysis to assess association between alcohol consumption and cognitive function including minimal cognitive impairment. Researchers identified a weak inverted J-shaped association, but the test for non-linearity was not statistically significant. Overall, researchers found a significant inverse association between heavy alcohol intake (≥67 g/day) and cognitive function. In stratified analysis accounting for baseline cognition, alcohol intake of ≥28 g/day was associated with lower cognitive function. The researchers did not find a significant protective association at low or moderate alcohol consumption levels.

Recent findings raise concern that certain high-risk patterns of prenatal alcohol use in the US may be increasing. This repeated cross-sectional analysis examined trends and correlates of current alcohol use, binge drinking, and heavy drinking among pregnant individuals in the US from 2011 to 2024. Researchers found that during this period the prevalence of current alcohol use, binge drinking, and heavy drinking each increased, with possible stabilization in more recent years but no clear reversal of overall upward trends. Because no amount of alcohol is established as safe during pregnancy, these increases across all drinking patterns are concerning.

Medications for opioid use disorder (MOUD) are still underutilized among those with OUD and cost can be a significant barrier. Twelve states have a prescription cap policy and researchers assess if that policy is associated with a difference in MOUD use and continuity. Researchers defined treatment discontinuity as at least a 7-day gap in medications in a 180-day follow-up period. Patients in states with caps were more likely to experience treatment gaps (RR=1.12) for any MOUD, buprenorphine (RR=1.07), and methadone (RR=1.34). Of note, the researchers also found that residence in a state with caps was associated with fewer treatment gaps. The authors do suggest the lower number of treatment gaps may be reflective of lower likelihood of re-engagement in treatment.

Researchers performed a systematic literature review to investigate insomnia in people with OUD. A total of 37 studies met inclusion criteria. Using the Insomnia Severity Index, the prevalence of insomnia in OUD ranged from 21% to 88% (mean 53%). Using the Pittsburgh Sleep Quality Index, the prevalence of insomnia in OUD ranged from 70% to 83%. Sedative-hypnotics produced limited sleep benefits and regular benzodiazepine use was strongly associated with overdose (91% vs 9.1%, p=.001). However, insomnia itself was a predictor of relapse and overdose. Other commonly used treatments include antidepressants, anticonvulsants, and mood stabilizers. Mirtazapine increased sleep efficiency. There is recent evidence that orexin receptor antagonists may improve sleep and not adversely affect OUD outcomes.

There is evidence that severe floods are associated with anxiety, depression, PTSD, and suicide. This study included 219 rural counties in Appalachia, 118 of which had severe floods between 2000 and 2017. Counties had similar overdose deaths (ODDs) initially; however, severe flooding increased a county's ODDs by 28% over the next 1-2 years, and they remained elevated for up to a decade. This increase in ODDs was worse among individuals with less than a high school education and in economically distressed counties. ODDs were attributed to decreased access to SUD treatment, recovery services (eg, 12-step groups), and harm reduction services. Disruptions in drug supply resulted in increased instability in drug potency and contaminants. Interruptions in water supply resulted in the use of creek water to inject drugs, resulting in increased infections. Flooding is predicted to increase, and these results may help mitigate the risk of ODDs.

This is a quasi-experimental nonrandomized trial looking at community-level interventions to prevent opioid overdoses across 1,667 city blocks in Philadelphia with high overdose rates from January 2019 to December 2021. Interventions examined were community trash pickups, vacant lot cleanups, and abandoned house remediation. When examined in aggregate, the interventions were associated with a reduction in fatal opioid overdoses but not nonfatal overdoses. Abandoned house remediation was significantly associated with a reduction in both fatal and nonfatal opioid overdose rates.

This is a retrospective case series of three adults with cocaine use disorder treated with naltrexone to prevent opioid overdose. All three patients had a history of unintentional fentanyl exposure, and two had a prior nonfatal opioid-involved overdose. Both oral and extended-release intramuscular formulations of naltrexone were prescribed. Two of the three patients had co-occurring alcohol use disorder and were prescribed oral naltrexone, with eventual transition to intramuscular naltrexone. One did not have a history of alcohol use disorder and was prescribed intramuscular naltrexone. All patients in the series tolerated naltrexone well, remained engaged in care, and experienced no additional opioid-involved overdoses.