The ASAM Weekly for November 10, 2026

This quasi-experimental difference-in-differences study including almost 62 million enrollee-years assessed the association between online sports betting legalization and behavioral health care use. Researchers found that online sports betting legalization was associated with an increase in the probability of people with employer-sponsored health insurance having a prescription fill or outpatient visit related to depression or anxiety. Associations were more precise and robust for men than women, and legalization was not associated with changes in prescriptions or outpatient visits for a substance use disorder. Results suggest state legalization of online sports betting was associated with measurable increases in mental health care use and may increase strain on the behavioral health system.

This survey-based study examined the acceptability of opioid vaccines among a national sample of 442 individuals who reported using opioids in the last 6 months. Participants were randomized to receive a survey using different terminology to describe opioid vaccines (“vaccines” vs “long-acting medications”) and different amounts of explanatory background material. Participants were more likely to express willingness to use a “long-acting medication” (60.7%) than a “vaccine” (45.1%). The most preferred duration of action for a blockade-based treatment was 6 months to one year, rather than longer periods of time. Fentanyl was the most popular preferred target for blockade. Side effects were the most commonly reported concern, with additional concerns around cost, safety, effectiveness, and unwanted blockade of analgesia.

Medications for opioid use disorder (MOUD) are often underutilized in residential treatment centers but could provide a crucial opportunity to improve access and uptake. Researchers conducted a simulation model to assess 4 scenarios: (1) Status quo, (2) Improved MOUD – all centers offer MOUD, (3) Improved MOUD with linkage – linkage provided for those discharged on MOUD, and (4) Improved MOUD with extended linkage – linkage provided to all patients at discharge. All 3 improved MOUD scenarios increased person-time on MOUD and prevented overdose deaths compared to status quo. “Improved MOUD with extended linkage” was the preferred strategy with a 151% increase in person-time on MOUD and prevention of 15 overdose deaths per 10,000 individuals in a closed cohort. In addition, this strategy resulted in an incremental cost-effectiveness ratio of $40,195 per quality-adjusted life-years.

This retrospective observational study used a national de-identified linked laboratory and medical and pharmacy claims database to examine polysubstance use among patients with OUD based on urine drug testing (UDT) results. Included were 143,108 adults (ages 18-64) diagnosed with OUD with at least one opioid UDT between December 2017 and May 2024, with a total of 747,801 UDTs during the study period. Of the patients, 77.7% had a positive UDT for prescription opioids and 50.8% had a positive UDT for synthetic opioids. In addition, 70.8% had a positive UDT for a non-opioid substance; of these, marijuana (46.0%) was most common, followed by cocaine (29.7%), methamphetamine (28.3%), and alcohol (22.5%).

Researchers assessed use of addiction consult services (ACS) and MOUD among reproductive-aged women and pregnant women with OUD hospitalized in 2021 and 2022. Overall, a consult order was placed for 52.5% of eligible patients and 55.9% received MOUD. Consult orders were less likely to be placed for women admitted to obstetrics than other departments (aOR=0.31) and for Black women versus White women (aOR=0.42). Black women were also less likely to receive MOUD (aOR=0.25). The authors note these findings highlight the need to address inequities and improve collaboration between obstetrics and ACS but did also recognize patients admitted to obstetrics may already have treatment plans upon admission given higher rates of MOUD among pregnant women.

This study compared motor development of infants (at 3-4 weeks) born to mothers on opioid replacement therapy (ORT), mothers using alcohol or drugs (AOD), and controls. Infant motor function was assessed using the Motor Optimality Score - Revised (MOS-R). Studies have shown that early motor scores can predict later cognitive dysfunction. The MOS-R score was lower in the ORT group than the control group (p=.005) and lower in the AOD group than the control group (p<.001). There was no difference between the ORT and AOD groups (p=.95). The Alberta Infant Motor Scale (AIMS) measures postural control and was similar in the ORT and AOD groups, and both groups scored significantly lower than the control group. Using the AIMS score, the odds of atypical motor development were elevated in both the ORT group (OR=14.1) and the AOD groups (OR=12.8). The authors conclude that both the ORT and AOD groups had reduced motor behavior and may be at risk for neurodevelopmental impairment.

This study included patients (n=60) who met ICD-10 criteria for alcohol dependence or harmful use and who completed a 7-week inpatient treatment program in the Czech Republic. Treatment was based on group psychotherapy combining cognitive-behavioral therapy, motivational techniques, and 12-step elements. Continuous one-year abstinence occurred in 38% of patients and an additional 8% had a single, brief lapse. Almost all (94%) of the relapses occurred in the first 6 months, a high-risk period. Mortality was 6.5%, with all deaths following a relapse. Higher disease severity (Addiction Severity Index European Version) correlated with shorter time to relapse (p=.001). Quality of life measures were significantly improved at both 6- and 12-month follow-ups, indicating inpatient treatment improved psychosocial function in addition to substance use.

This comparative effectiveness study of 24,643 patients across 754 US hospitals examined if the initiation of phenobarbital was associated with a shorter hospital length of stay compared with diazepam in patients admitted for alcohol withdrawal syndrome. Researchers found that initiation of phenobarbital on the day of admission was not associated with differences in hospital length of stay or invasive mechanical ventilation use. These findings suggest near therapeutic equivalence between phenobarbital and diazepam for alcohol withdrawal syndrome and support the need for comparative clinical trials.