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The ASAM Weekly for July 22nd, 2025

This Week in the ASAM Weekly

There is speculation that psychedelic medicine could get a boost from the current administration—not long after the FDA did not approve MDMA-assisted therapy (MedPage Today). Contingency management, on the other hand, could face some challenges in the current political climate, even though it’s the most effective treatment for an illness that has no FDA-approved medications (New York Times). It also has (virtually) no side effects.

This is notable because side effects can often come with conflicting data. Cognitive decline has been associated with several medications but now it might be more clearly a concern with gabapentin (Regional Anesthesia and Pain Medicine). In fact, concerns with gabapentin have been growing enough over the years that some states moved to schedule it as a controlled substance, only to see their intervention backfire (International Journal of Drug Policy).

Such incongruence is not uncommon when evaluating the impact of any substance. There has been a substantial movement behind medical marijuana for some time, even though the evidence doesn’t support its efficacy (Journal of Addiction Medicine). And even though modern science has enlightened us about the harms of alcohol, we likely needed it to evolve as a society (Humanities and Social Sciences Communications).

Maybe then a healthy dose of open-minded skepticism can help make sense of things. We know that a treatment gap persists in addiction medicine, and we know that primary care is an important part of closing that gap (JAMA Internal Medicine). But if fewer than 10% of primary mental health outpatient facilities offer medications for alcohol use disorder (AUD), shouldn’t we be paying more attention to the treatment gap in mental health (JAMA Network Open)?

This might sound like speculation, but a treatment gap this big is usually a problem with stigma, not knowledge. 

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

Lead Story

Did alcohol facilitate the evolution of complex societies? ðŸ”“

Humanities and Social Sciences Communications

This study tested the “drunk” hypothesis, which claims that alcohol promoted social bonding and cooperation, aiding the rise of complex societies. Using data from 186 non-industrial societies, researchers found a modest positive link between indigenous alcoholic beverages and political complexity, even after controlling for ancestry, environment, and agriculture. Results suggest traditional fermented alcohols provided social benefits that helped societal evolution. However, other factors like agriculture and religion were likely stronger drivers of complexity than alcohol consumption alone.

Research and Science

Vaporized Nicotine Products for Smoking Cessation Among People Experiencing Social Disadvantage: A Randomized Clinical Trial  

Annals of Internal Medicine

This randomized trial examined whether vaporized nicotine products (VNPs) are more effective than gum or lozenge nicotine replacement therapy (NRT) for smoking cessation among socially disadvantaged adults in Australia. A total of 1,045 daily smokers receiving government pensions were assigned to 8 weeks of either VNPs or NRT, with text-message support. At 7 months, the 6-month continuous abstinence rate was 28.4% for VNP users versus 9.6% for NRT users, showing VNPs’ superiority. Adverse events were fewer in the VNP group. VNPs offer a promising cessation option for socially disadvantaged smokers. 

Risk of dementia following gabapentin prescription in chronic low back pain patients

Regional Anesthesia and Pain Medicine

Gabapentin is commonly prescribed for chronic pain, particularly neuropathy, but there has been some question about potential increased risk of dementia. Prior studies have resulted in conflicting findings, so the authors used the TriNetX national database to assess association between gabapentin prescribing for patients diagnosed with chronic pain and diagnosis of dementia and mild cognitive impairment (MCI) within 10 years. Overall, 6+ gabapentin prescriptions were associated with increased risk of both dementia (RR=1.29) and MCI (RR=1.85). When stratified by age group, there was no significant difference in dementia or MCI among those 18-34, but there was an increased risk in all other age groups. In addition, the authors found those who received 12+ prescriptions compared to those who received 3-11 prescriptions had a higher incidence of dementia (RR=1.40) and MCI (RR=1.65).  

Clinical Decision Support System for Primary Care of Opioid Use Disorder:
A Randomized Clinical Trial

JAMA Internal Medicine

Primary care physicians report reluctance to provide medication for opioid use disorder (MOUD), so this study evaluated a clinical decision support system (CDSS) embedded in the electronic health record to see if it could improve diagnosis and treatment for OUD in primary care clinics. While the study did not find an increase in OUD diagnosis, there was an increase in naloxone prescribing (OR=1.76) and MOUD prescribing or referral to OUD treatment (OR=1.48). There was not an increase in median days covered by MOUD in 90 days post intial visit. The authors pose that the CDSS could improve access to MOUD in primary care settings.

Changing Trends in Nonmedical Gabapentin Use Among a Cohort of Rural Appalachian People Who Use Drugs: A Longitudinal Study Over the Time Period of Scheduling Changes in Kentucky

International Journal of Drug Policy

This is a secondary analysis of a study of people who used drugs in rural Kentucky (n=503) from 2008 to 2020. In mid-2017, Kentucky became the first state to classify gabapentin as Schedule V. In 2008 none of the participants reported nonmedical gabapentin use. By the final interview, reported nonmedical gabapentin use had risen to 56%, passing opioids to become the most prevalent substance used in this group. The greatest rate of increase occurred between 2013 and early 2017 and continued to increase after it was scheduled in mid-2017. During the same period opioid use decreased from 99% to 54% of participants. There was also a significant increase in the use of methamphetamine. Prior to being scheduled gabapentin was reportedly obtained by 55% of participants from regulated sources (prescribed); this decreased to 35% after scheduling. In conclusion, in Kentucky there was a dramatic increase in nonmedical gabapentin use between 2008 and 2020 and the scheduling of gabapentin in 2017 did not reverse this trend. 

Learn More

Alcohol Use Disorder Treatment Availability at Mental Health Treatment Facilities ðŸ”“

JAMA Network Open

Among adults with mental illness, 18.9% have co-occurring AUD, but only 8% receive treatment and under 2% get medications for AUD (MAUD). MAUD reduces drinking and harms, and remission improves when both conditions are treated. This study analyzed 2023 US data from 6,572 facilities, comparing mental health-only and combined mental health and substance use disorder (SUD) centers. While most mental health facilities offered SUD treatment, only 10% provided MAUD versus 41.5% in combined centers. Limited MAUD access may stem from staffing, knowledge, and resource gaps, suggesting integrated care could improve treatment availability.

Prevalence of Congenital Heart Defects Among Children With and Without Diagnosed Fetal Alcohol Spectrum Disorders, 2016-2022 

Drug and Alcohol Dependence

This study of congenital heart defects (CHD) and fetal alcohol spectrum disorder (FASD) used insurance claims data for 9 million children enrolled in Medicaid and 11 million children enrolled in commercial insurance. In the Medicaid group 0.05% had FASD and 5.2% of these had CHD, compared to children without FASD where 1.0% had CHD. In the commercial insurance group 0.01% had FASD and 3.0% of these had CHD, compared to children without FASD where 0.6% had CHD. The degree that FASD increased the odds of CHD was similar for both insurance groups. Prenatal smoking exposure was not a likely cause of the increased odds of CHD in children with FASD. 

Cannabis and Cannabinoids for Treating Pain: What Are the Data?

Journal of Addiction Medicine

The authors of this commentary discuss the current evidence, which they note is limited, for use of cannabis and cannabinoids to treat pain. They highlight concerns that public perception does not match current evidence and that the potency of cannabis has increased in recent years, potentially increasing the risk of serious health consequences such as psychosis. Currently, there are no FDA-approved cannabis or cannabinoid formulations for treatment of pain, and additional and rigorous research is needed. Further, if a formulation is approved, FDA approval is generally narrow and applies to specific formulations for specific conditions and is not in line with the current commonly held concept of “medical marijuana.”  â€¯