This Week in the ASAM Weekly

Addiction is a lived experience and the “distress related to discrepancies between desired and actual social connections” is a significant part of that. In a national study of US veterans, those with problematic substance use (PSU) were over 60% more likely to experience loneliness than those without (Journal of Addiction Medicine). In a commentary on problematic pornography use, the author goes beyond addiction-based dimensions and considers the role of early maladaptive schemas, for which loneliness is a common experience (International Journal of Mental Health and Addiction).

But loneliness is also an experience of how the individual relates to a group. Family members affected by addiction often develop coping strategies to manage disordered family connections which they carry into adulthood as various forms of stress (European Journal of Psychotraumatology). Even rat models have shown how social rank modulates the reward signals and executive control involved in methamphetamine use, but interestingly enough, it happens only in males (Nature Neuroscience).

These social connections drive how one reacts to the group which ultimately impacts the individual’s well-being. Narrative messages are a persuasive way to influence group members, and as with smoking cessation, threats and fear improve efficiency by evoking negative emotions toward an object (Tobacco Control). But negative emotions toward the self can exacerbate unhealthy behaviors. For all the criticisms one might have of WeightWatchers, it actually helped combat the loneliness of obesity by facilitating a therapeutic third space (New York Times).

When we lose that third space, we lose the group that filled it, and loneliness follows. This happened during the pandemic, contributing to a spike in overdose deaths which is only now returning back to “normal” (ABC). But with such drastic cuts at the federal level, we’re risking a relapse, or worse (Journal of Addiction Medicine). That’s why more than 320 mental health and addiction experts wrote a letter to congressional leaders urging them to protect vital substance use and mental health services, concluding with, “Millions of Americans are depending on you” (New York Times).

And they are not alone.

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

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Applications to join the editorial team for the Behavioral Addictions Volume of the Fourth Edition of The ASAM Criteria are now being accepted until May 30, 2025. For more information and to apply, please click below.

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Lead Story

Loneliness Among US Veterans With Problematic Substance Use: Results From the National Health and Resilience in Veterans Study

Journal of Addiction Medicine

Loneliness is a major public health concern, especially among individuals with problematic substance use (PSU), but little research has focused on vulnerable groups like US military veterans. This study, using data from the National Health and Resilience in Veterans Study, found that nearly half of veterans with PSU (47.4%) experience clinically significant loneliness. Factors contributing to loneliness included being unmarried, higher psychological distress (depression and PTSD), a history of suicide attempts, physical disability, smaller social networks, and lower purpose in life and optimism. The analysis highlighted that depressive and PTSD symptoms had the strongest impact on loneliness, followed by social network size and sense of purpose. Furthermore, veterans with depressive symptoms who had a strong sense of purpose were less likely to feel lonely. The study underscores the need for strategies targeting psychological distress, fostering social connections, and enhancing purpose to help alleviate loneliness in this population.

Research and Science

Effects of legal access versus illegal market cannabis on use and mental health: A randomized controlled trial 🔓

Addiction

This two-arm, parallel group, open-label, randomized controlled trial assessed the effects of public health-oriented cannabis access versus the illegal market on cannabis use and mental health outcomes in adult users. Conducted in Basel-Stadt, Switzerland, 378 participants were randomly assigned to either access legal cannabis through regulated pharmacies or continue using the illegal market. After 6 months, results showed a slight reduction in cannabis misuse in the legal access group, particularly among those who also used other drugs. However, no significant changes were found in mental health symptoms or overall substance use. The findings suggest that legal cannabis access may help reduce cannabis use and related harms, especially for users of other substances.

The dynamics of stress experiences of students with relatives with addiction problems: a longitudinal qualitative study 🔓

European Journal of Psychotraumatology

For this qualitative study, researchers interviewed university students who had a family member with addiction problems . The interviews, which took place annually over 3 years, assessed levels of stress and factors that increased or relieved stress. The 24 students were an average of 22.5 years old and had a total of 95 relatives with addiction problems. Physical or verbal aggression, experienced or witnessed, was one source of stress as were incidents or accidents involving a relative. The relative’s receiving treatment and recovery reduced stress; however, relapse caused a sharp increase. Those insulted and belittled had damaged self-esteem and fear of failure with tasks at school or work and developed maladaptive perfectionism. Support from a trusted individual, either personal or professional, reduced stress. One-third of study participants were diagnosed with PTSD.

Efficacy and safety of psilocybin for the treatment of substance use disorders: A systematic review

Neuroscience and Biobehavioral Reviews

This is a systematic review of the literature on psilocybin for treatment of substance use disorders (SUDs). There were 7 studies on alcohol (AUD), 5 on tobacco (TUD), and 1 each on opioids and cocaine. Studies on AUD showed reductions in drinking days and drinking problems, and an increase in abstinence. One study correlated hallucinogen intensity with improved outcomes. An MRI study showed normalization of brain activity associated with AUD. In a study of TUD, 67% were abstinent at 12 months and 60% at 30 months. A study correlated a mystical experience with improved outcome. The few studies of other substances were inconclusive. Adverse events included 2 of anxiety requiring medication and 1 of brief (15 min) suicidal ideation. Results were significantly improved when psychotherapy accompanied the psilocybin. The authors conclude that psilocybin shows promise for AUD and TUD, but further studies are needed.

Tobacco control messages for individuals who use both cigarettes and e-cigarettes: a randomised trial comparing biomarker outcome with cessation experience narratives

Tobacco Control

This study included 487 adults who used both e-cigarettes and combustible cigarettes. Participants were shown 1 of 2 written first-person narratives designed to increase motivation to quit. The biomarker narrative discussed the effect of quitting on reducing compounds such as nitrosamines, aromatic hydrocarbons, and volatile organic compounds. The cessation experience narrative gave information and advice on how to quit. The biomarker narrative generated significantly more negative emotions and fewer positive emotions than the cessation experience narrative. The biomarker narrative also produced larger increases in motivation to quit than the cessation experience narrative. The changes in motivation were mediated by negative emotions and not by positive emotions.

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The First 100 Days: The Trump Administration and Changes to Addiction Policy 🔓

Journal of Addiction Medicine

In this commentary, author Regina LaBelle, JD, assesses the Trump Administration’s current drug policy strategy that includes structural and personnel changes, budget cuts, and reductions in data collection. The Trump Administration plans to merge several US Department of Health and Human Services (HHS) subagencies — including SAMHSA — along with consolidating the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Institute of Mental Health (NIMH). The Administration has severely cut HHS staffing and expertise, for example, terminating the work group overseeing the National Survey on Drug Use and Health (NSDUH), and is targeting many grant programs that fund state addiction services. A most detrimental consequence could come from budgetary cuts to Medicaid, one of the primary payors for addiction treatment. The author stresses this is an inflection point for the US approach to addiction and advises those who work in the addiction field to pay close attention.

Social rank modulates methamphetamine-seeking in dominant and subordinate male rodents via distinct dopaminergic pathways

Nature Neuroscience

Social status can significantly impact predisposition to developing substance use disorder, but little is known about the underlying neural mechanisms. In a rat model, dominant male rats exhibited less methamphetamine (METH)-seeking, while subordinate male rats exhibited high METH-seeking. Dominant rats also exhibited denser mesocortical dopaminergic projections while subordinate rats exhibited increased dopamine (DA) functions in mesolimbic pathways. In addition, lesions of the mesocortical regions in dominant rats resulted in increased METH-seeking, while activation of the mesocortical pathways in subordinate rats resulted in decreased METH-seeking. The authors suggest these findings support potential novel therapies using neuromodulation and advancements in cognitive behavioral therapy.

Integrating Cognitive and Psychodynamic Perspectives on Problematic Pornography Use: A Commentary on Vieira et al. (2025)

International Journal of Mental Health and Addiction

This commentary examines problematic pornography use (PPU) through an integrative lens, incorporating cognitive and psychodynamic perspectives. While cognitive models highlight the role of early maladaptive schemas in reinforcing compulsive pornography use as a maladaptive coping strategy, psychodynamic frameworks emphasize the impact of attachment trauma and unmet psychological needs in shaping compulsive engagement with pornography. By synthesizing these perspectives, the author underscores the necessity of an integrated clinical approach to PPU that addresses both maladaptive cognitive patterns and deeper emotional vulnerabilities. The author also advocates for interventions that integrate cognitive and psychodynamic therapy to foster deeper psychological transformation and the development of healthier relational and emotional regulation capacities for individuals suffering from PPU.

In the News

WeightWatchers Got One Thing Very Right

The New York Times