The ASAM Weekly for August 18, 2026

This exploratory case study identifies barriers, facilitators, and implementation needs during the phases of implementation of a virtual SUD clinic offering low-barrier medications for opioid use disorder (MOUD) across the state of Texas. From January 2022 to September 2023, researchers conducted 10 individual and 11 group periodic reflections with 16 individuals (including clinic leadership, operation staff, and providers) to evaluate implementation activities, clinic processes, and events during the rollout of the virtual clinic. In the preparation phase, participants emphasized the importance of strong leadership, effective workforce and technology infrastructure, staff training, and mission alignment. During implementation, participants highlighted the need for strong interprofessional communication, continuous reflection and evaluation, and medication supply chain management, as well as the challenge of workforce turnover. In the sustainment phase, participants identified a need for diversified funding and intentional growth.

Chronic alcohol use and acute stress disrupt emotion regulation and behavioral inhibition, but individual variability suggests underlying mechanisms of vulnerability and resilience. Using a conditioned inhibition paradigm, researchers assessed Long Evans rats with prior alcohol exposure and/or stress on fear and reward cue discrimination alongside corticolimbic interneuron markers. While all animals eventually learned cue distinctions, females with combined alcohol and stress exposure showed impaired suppression of fear when inhibitory cues were present. Behavioral resilience or vulnerability corresponded to distinct patterns of parvalbumin- and protein kinase C-δ (PKCδ)-expressing interneuron network organization, highlighting sex-specific effects and neural correlates of inhibitory control.

Gambling in older adults represents an emerging but still under-recognized mental health concern. A systematic review of studies involving adults aged ≥55 years with gambling were identified. Commonly identified correlates to gambling-related problems included loneliness, reduced social support, financial difficulties, male gender, stressful life events, and early gambling initiation. Gambling was frequently reported as a recreational activity, but could become maladaptive when used as a strategy to regulate negative emotions or cope with social isolation. Psychiatric comorbidity, particularly depression and anxiety, was frequently observed in clinical and high-risk samples. Evidence regarding psychological interventions remains limited but suggests potential benefits.

DNA methylation (DNAm) increases with age as well as with various environmental and psychosocial exposures, such as tobacco, social stress, chronic inflammation, and toxins. Various epigenetic clocks have been developed that use DNAm at genomic sites to estimate epigenetic age acceleration (EAA). This study used individuals’ (n=2276) data from a health interview conducted in Indiana with saliva analyzed for DNAm. The 11% that were assessed to be intermediate to high risk for SUD had EAA 21% faster than chronological age. The 20% who smoked daily had EAA 10% faster than chronological age. Vaping alone had no significant EAA. Illicit opioid use had EAA 3.6% faster, however the effect was reduced by about half when controlled for the effects of smoking. The researchers conclude that substance use is associated with accelerated biological aging and call for research on the mechanisms.

Researchers conducted a longitudinal cohort study evaluating healthy aging, particularly examining substance use among those 50–70 years of age in Australia. Researchers found significant rates of substance use, with 85.2% reporting current alcohol use and 52.4% screening positive for possible problematic alcohol use. In addition, 3.7% reported current cannabis use, 8.7% reporting tobacco use, and 5.5% reported other current non-medical substance use (3.7% sedatives, 0.9% stimulants, and 0.9% other psychoactive substances). Researchers also found that 12.7% had moderate or severe anxiety and 16.4% had moderate or severe depression. These findings demonstrate vulnerabilities in this population and the necessity for clinicians to identify and address substance use, particularly alcohol use, in an aging population.