The ASAM Weekly for March 24, 2026
This Week in the ASAM Weekly
Periodically, criticism of the “addiction is a brain disease” model (ABDM) pops up in the news media. The headline or even the lead often indicate a radical new perspective, and yet these perspectives often seem less about the science of addiction and more about the limits of language (Vox).
One of the main critiques of ABDM is that calling addiction a brain disease (or a disease at all) is too simplistic. But there is nothing simple about the paradigm shift occurring around dopamine or its role in attention, working memory, and social behaviors. Some experts are even advocating for more complexity, taking it beyond the “feel good”/addiction chemical of the brain (Nature). Also, one shouldn’t deny the complex role of genetics, especially when scientists are able to pinpoint the role of specific MicroRNA in modulating opioid reward systems (Translational Psychiatry).
Another critique of ABDM is that addiction would be better labeled as a behavioral disorder—one in which drug use has gone wrong. That’s essentially how the DSM-5 defines it. But also, addiction is frequently comorbid with other behavioral disorders, and the more severe the addiction, the more severe the comorbidity, usually (Substance Use and Misuse).
Sometimes, critics of ABDM can go a little deeper or be a little more nuanced, for example, by stating ABDM does not do enough to address self-harm. We do need to better screen for suicidality as evidence shows that suicidal intent might precede more than half of all opioid overdoses (Journal of Addiction Medicine).
A less often noted but more recent critique of ABDM is about cravings and their causes: for example, withdrawal, psychological pain, or even identity crisis. But if we consider how opioid cravings in pregnant individuals improve with injectable buprenorphine, then it becomes hard to ignore the brain’s opioid receptors (JAMA Internal Medicine).
One of the most common critiques of ABDM is the need to better humanize the definition of addiction. SAMHSA’s definition of recovery seems to do this with four interrelated domains—health, home, purpose, and community—that represent a holistic model of well-being (Scientific Reports). Even how we measure recovery in polysubstance use is getting more qualitative and better at incorporating Quality of Life factors (Harm Reduction Journal).
The list could go on—of critiques and examples, counterexamples, and commonalities. In the end, addiction is not bound by language, but the human brain is. So let’s give all our brains a little break and agree upon a definition that comes with a little more flexibility:
Addiction is a(n) (existential) brain disease (The ASAM Weekly).
Thanks for reading,
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM · John A. Fromson, MD · Sarah Messmer, MD, FASAM · Jack Woodside, MD
2026 Addiction Medicine Research Priorities
ASAM is requesting your input on which areas of addiction clinical practice are most in need of further research. This input will be shared with federal research agencies, including the National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Agency for Healthcare Research and Quality (AHRQ), and the Food and Drug Administration (FDA). We are also planning a listening session called “Bridging the Gap Between Science and Clinical Practice” with federal research agency representatives at the ASAM 57th Annual Conference.
PROVIDE INPUTIf you have any questions, please email Radhika Sagar, OTR/L, MOT, Clinical Algorithm Analyst, at [email protected]. Thank you!
Join the ASAM Criteria Task Group on Interoperable Data Standards
ASAM is seeking experts to serve on this Task Group, which will help define and recommend approaches for integrating interoperable data standards into ASAM tools and resources for substance use disorder (SUD) assessment and treatment planning.
Interested? Apply here to learn more.
Lead Story
Addiction
This study used a microsimulation model of methamphetamine use behavior among individuals with methamphetamine use disorder (MethUD) to assess the cost-effectiveness of contingency management (CM) for MethUD. Both 12-week and 24-week CM programs were modeled, using a maximum incentive of $750/patient, per SAMHSA guidelines. The model simulation was run for a cohort of 10,000 individuals with MethUD and looked at lifetime cost. Compared to no treatment, the model predicted an estimated net gain of 0.70 quality-adjusted life years (QALYs) per person at a cost of $6,850/QALY for a 12-week program, with an incremental cost-effectiveness ratio (ICER) of $9,830/QALY. For a 24-week program, the benefit was 0.81 QALYs at a cost of $10,000, yielding an ICER of $12,312/QALY. This suggests that both durations of CM for MethUD are highly cost-effective, even at the maximum level of incentives.
Call for Volunteers! ASAM is looking for volunteers to write mock clinical cases for patients in jail or prison, and those reentering the community. Contributors will be mentioned in The ASAM Criteria®, Fourth Ed., Volume 3: Correctional Settings and Community Reentry. Applications accepted until April 17, 2026.
To learn more and apply click here.
Research and Science
Harm Reduction Journal
This remote cross-sectional study introduces the concept of proportion of remission (PrR) that provides a more granular and nuanced measure of recovery in individuals with a history of two or more substance use disorders (polySUD) and investigates its association with various Quality of Life (QoL) domains. It also reports on individual SUD’s contribution to QoL. PrR was significantly positively associated with environmental, psychological, and social QoL, after adjusting for covariates. Across SUDs, individuals not in remission exhibited significantly lower QoL compared to those in remission, with stimulants having the largest effect sizes. The authors propose a novel construct of polySUD recovery: proportion of remission. The results indicate the potential of PrR to capture gradual improvements in quality of life and reflect recovery progress.
JAMA Internal Medicine
This study is an open-label noninferiority randomized clinical trial of extended-release (ER) vs sublingual (SL) buprenorphine for opioid use disorder (OUD) in pregnancy through 12 months postpartum. From July 2020 to October 2024, 140 pregnant individuals between 6 to 30 weeks gestational age were randomized to receive either SL or ER buprenorphine across 13 peripartum OUD treatment sites. ER buprenorphine was found to be noninferior to SL buprenorphine. Participants on ER buprenorphine had higher rates of illicit opioid abstinence during pregnancy but they were similar postpartum between groups. The ER buprenorphine group had fewer serious adverse events during pregnancy and postpartum. There were no significant differences in infant neonatal opioid withdrawal syndrome (NOWS) treatment or duration of infant hospitalization between groups.
Substance Use and Misuse
Polysubstance use (PolySU) is common among people seeking alcohol and other drug (AOD) treatment and peaks among young people, decreasing after age 25. Researchers assessed PolySU among persons aged 12–25 in outpatient or residential AOD treatment and identified three PolySU profiles: 1) extended-range PolySU (moderate-risk profile across all substances), 2) high-risk opiate use with extended-range PolySU (high-risk opioid profile with moderate-risk across all other substances), and 3) moderate-range PolySU (moderate-risk or low-risk profile across substances). Researchers noted profile 2 was associated with homelessness, recent hospitalization, lower rates of employment or school, and psychosis. Profiles 1 and 2 were associated with being in residential treatment; risky behavior including overdose; depression; and anxiety.
Scientific Reports
Students in the National College Health Assessment who reported they had been diagnosed and/or treated for an SUD (n=1,816) completed a survey to assess SAMHSA’s four domains of recovery: health, home, purpose, and community. Each domain was scored on a scale of 0 to 100 and the four domain scores averaged for an overall score. In this group, 19% received no treatment, 3% medication only, 50% therapy only, 21% therapy and medication, 4% were part of a 12-step program, and 5% other treatment. Those in a 12-step program had the highest overall score (73 vs 66 for the entire group) as well as the highest score in each of the four domains, while the no treatment group had the lowest overall score (64). The overall score for medication only was 65, therapy only 65, therapy and medication 68, and other treatment 67. Significantly better recovery outcomes were seen with 12-step programs and combined medication and therapy.
Learn More
Translational Psychiatry
Using a luciferase reporter assay, this study discovered that repeated morphine administration decreases the expression of MicroRNA (miR)-132/212 in the ventral tegmental area (VTA) and induces a concurrent upregulation of the dopamine transporter (DAT). It also found that the DAT coding gene, SLC6A3 mRNA 3’UTR, is a direct target of miR-132/212. These miRNAs negatively regulated both mRNA expression and protein levels of DAT in vitro. The findings uncover a regulatory mechanism wherein miR-132/212 modulates morphine-induced reward behavior by fine-tuning DAT expression at the posttranscriptional level, providing a potential therapeutic target of rewarding effects.
Drug and Alcohol Dependence
Researchers from university departments of communication and computer science used machine learning and large language models, such as ChatGPT-40, to analyze visual and text content in 27,242 Facebook social media ads for cannabis in 2021 and 2022. They found that warm hues and the colors red, yellow, and orange increased engagement. Visual food cues (candies, chocolate, etc) were found in 18% of ads and increased comments, shares, and likes. In tobacco ads food cues attract adolescents and food cues in cannabis ads warrant regulation. Claims of health benefits appeared in 47% of ads; these claims typically included stress relief, improved sleep, and the suggestion that cannabis is part of a wellness lifestyle. Mentions of potential risks were rare.
Journal of Addiction Medicine
Suicide by opioid overdose has more than doubled since 2017, but current suicide risk screening tools may be inadequate to identify those at risk. In this commentary the authors review some of the unique risks associated with opioid use disorder (OUD) and the need for a new screening tool that accounts for these factors. Persons with OUD have increased risks of comorbid psychiatric disorders and chronic pain, which put them at increased risk for suicide. OUD is also associated with negative emotional states including dysphoria and anhedonia in withdrawal periods. The authors note current screening tools fail to detect history of intentional overdose as patients often don’t report these as suicide attempts and may not always recognize their intent as suicide.
In the News
- Drug addiction is not a moral failing or a brain disease. It’s more complex. Vox
- Advancing Science-Based Responses to Polydrug Use: Highlights from the 2026 Informal Scientific Network Meeting 🔓 United Nations Office on Drugs and Crime
- Dopamine takes a hit: how neuroscience is rethinking the ‘feel-good’ chemical 🔓 Nature
- Gen Z is drinking less alcohol. Why these NJ students stay sober NorthJersey.com
- Smoking rates are at a historic low. You’re not hearing about it from the government STAT
- March Madness and the rise of prediction markets 🔓 Deseret News
- Maker of Device To Treat Addiction Withdrawal Seeks Counties’ Opioid Settlement Cash 🔓 KFF Health News
- African states hike gambling taxes as addiction soars, and industry fights back 🔓 Reuters