articles

Which Drug Epidemic Is Next: Meth, Psychedelics, Mushrooms? 

KEY POINTS:

• Current data and historical trends indicate that while the opioid epidemic may be reaching a plateau, stimulant misuse—particularly involving methamphetamine and cocaine—is emerging as the next critical concern.
• CDC reports show a 17% reduction in overdose fatalities between July 2023 and July 2024, underscoring the effectiveness of targeted interventions and harm-reduction strategies.
• However, this progress is tempered by a parallel rise in deaths linked to polysubstance use, including speedballing and concurrent stimulant intake.
• Simultaneously, the increasing use of psychedelics such as psilocybin, MDMA, and LSD reflects evolving patterns in recreational and therapeutic drug consumption that merits closer clinical and research scrutiny.

Teens and Counterfeit Death Pills

KEY POINTS:

• Rising Adolescent Overdose Mortality: Drug overdose has emerged as the third leading cause of death among individuals under the age of 19 in the United States. This alarming statistic reflects a significant public health emergency requiring increased vigilance, early identification, and prompt intervention by pediatric and behavioral health providers.
• Lethality of Counterfeit Medications: Adolescents are particularly vulnerable to the dangers posed by counterfeit pills, which are often illicitly manufactured to mimic prescription medications such as alprazolam (Xanax), amphetamine-dextroamphetamine (Adderall), or oxycodone (OxyContin). These pills frequently contain high-potency synthetic opioids, including illicitly manufactured fentanyl, placing users at heightened risk for unintentional overdose and death—even with a single exposure.
• Gaps in Screening and Treatment Access: One of the most significant barriers to managing opioid use disorder (OUD) in adolescents is the widespread absence of standardized screening, diagnostic evaluation, and treatment referral within pediatric and school-based health settings. Addressing this gap is critical to ensuring timely identification and evidence-based care.
• Public Health Messaging and Clinical Awareness: The “One Pill Can Kill” campaign underscores the lethality of counterfeit medications and is designed to raise public and clinical awareness of the overdose risks posed by even a single encounter with a contaminated pill. Clinicians are urged to incorporate this messaging into prevention strategies, family education, and treatment planning.

Cannabis Use Disorders in Teens and Adults

KEY POINTS:

• Cannabis use disorder (CUD) is a clinically recognized condition with significant behavioral and functional consequences; adolescents represent a particularly vulnerable population.
• Rates of CUD are rising both in the United States and internationally, a trend attributed in part to the proliferation of ultra-high-potency cannabis products.
• Contemporary methods of cannabis consumption—such as dabbing—expose users to substantially elevated levels of tetrahydrocannabinol (THC), increasing the risk of dependence, cognitive impairment, and adverse psychiatric outcomes.

The Many Risks of Cannabis and High-Dose THC

KEY POINTS:

• The escalating potency of Δ9-tetrahydrocannabinol (THC) in contemporary cannabis products is associated with heightened concerns regarding short- and long-term health outcomes.
• Experts in addiction medicine and neuroscience continue to highlight the potential impact of high-THC cannabis on neurodevelopment, particularly during adolescence—a critical window for cognitive and emotional maturation.
• Advances in endocannabinoid system research offer promising avenues for the development of novel therapeutic interventions targeting cannabis use disorder, as well as related conditions such as sleep dysregulation and chronic pain.

Ketamine Use Disorder Is on the Rise

KEY POINTS:

• Emergence of Ketamine Use Disorder (KUD): Ketamine use disorder is increasingly recognized as a distinct and emerging addictive condition. While historically underappreciated in clinical settings, rising patterns of compulsive use, tolerance, and withdrawal symptoms have prompted greater attention to its diagnostic and therapeutic implications.
• Dual Identity as Therapeutic Agent and Substance of Misuse: Ketamine is classified by the World Health Organization as an essential medicine due to its anesthetic and analgesic properties. However, its growing nonmedical use—particularly in recreational and self-medication contexts—has been associated with significant health risks, including urological, cognitive, and psychiatric complications.
• Development of Diagnostic Tools for KUD: In response to increasing clinical encounters with ketamine misuse, researchers have proposed diagnostic criteria and screening questions to aid in the identification of ketamine use disorder. These tools are designed to align with DSM-5 substance use disorder frameworks and can assist both clinicians and patients in recognizing problematic patterns of use.

The Best Way to Treat Alcohol Use Disorder (AUD)

KEY POINTS:

• Although alcohol use disorder (AUD) is highly prevalent, fewer than 2% of individuals with AUD receive pharmacologic treatment approved by the U.S. Food and Drug Administration, highlighting a substantial gap in care.
• Clinical evidence supports the safety and efficacy of disulfiram when administered under supervision, with improved adherence linked to better abstinence outcomes.
• Naltrexone, available in both oral and extended-release injectable formulations, functions by attenuating the reinforcing effects of alcohol and opioids through μ-opioid receptor antagonism, thereby reducing relapse risk.
• Integrated approaches that combine pharmacotherapy with behavioral interventions and peer support (e.g., Alcoholics Anonymous) have demonstrated superior efficacy compared to single-modality treatments.

Calls to Reassess Cannabis Risks: New Research Reported

KEY POINTS:

• Cannabis has long been perceived by the public as a relatively benign substance; however, evolving evidence has challenged this assumption.
• Recent peer-reviewed literature has drawn attention to a range of adverse outcomes associated with cannabis use, particularly in relation to high-potency products and early initiation.
• Increasingly, clinicians and researchers are observing associations between cannabis use and elevated risks of depressive symptoms, emergency department presentations, suicidality, and the development of cannabis use disorder (CUD).

Zyn Nicotine Pouch Products Get FDA Approval for Adults

KEY POINTS: 

• Zyn nicotine pouches are positioned in the marketplace as a “cleaner” alternative to combustible tobacco and vaping products, containing nicotine without tobacco leaf or combustion byproducts.
• Although perceived by some as lower risk, Zyn remains a highly addictive product; its slower buccal absorption compared to inhaled nicotine may reduce peak plasma levels, but dependence potential persists.
• Certain high-strength formulations of Zyn deliver up to 6 mg of nicotine per pouch—an amount that can approximate the nicotine yield of multiple combustible cigarettes, raising concerns about sustained neurochemical impact and potential gateway effects, particularly among adolescents and nicotine-naïve individuals.

The Good News About Overdose Deaths in the U.S.

KEY POINTS:

• As of February 2025, the Centers for Disease Control and Prevention (CDC) reported a nearly 24% reduction in drug overdose mortality in the United States—a notable shift in the trajectory of the opioid crisis and broader substance use landscape.
• Specifically, overdose fatalities declined from approximately 112,000 between October 2022 and September 2023 to 87,000 during the corresponding period in 2023–2024, suggesting meaningful progress in harm-reduction efforts.
• This decline is attributed in part to increased access to naloxone, the expansion of telehealth services, and broader implementation of evidence-based treatments such as medication-assisted treatment (MAT), which together have enhanced reach News Flash:  Increased Numbers of Children Poisoned by Fentanyland continuity of care for individuals with substance use disorders.

News Flash: Increased Numbers of Children Poisoned by Fentanyl

KEY POINTS:

• Recent analyses indicate a marked increase in the severity of pediatric fentanyl poisonings between 2015 and 2023, reflecting a growing threat to child health and safety.
• More than one-third of these cases were either unintentional or involved documented life-threatening outcomes, underscoring the vulnerability of children to opioid exposure.
• Amid the proliferation of counterfeit pills adulterated with fentanyl, comprehensive harm reduction and prevention strategies must explicitly address pediatric populations to mitigate further morbidity and mortality.

What We Can Learn from Celebrity Addictions

KEY POINTS:

• Public figures and celebrities are often regarded as cultural influencers and aspirational role models, particularly among youth and media consumers.
• Robert Downey Jr. battled heroin and cocaine addiction for years, leading to multiple arrests and nearly a year in prison in 1999. After turning his life around in the early 2000s, he rose to fame as Iron Man and became one of Hollywood’s top earners.
• Jamie Lee Curtis struggled with a decade-long addiction to prescription painkillers and alcohol, even stealing pills from loved ones. She achieved sobriety in 1999 and later won an Oscar in 2023 for Everything Everywhere All at Once.
• Bradley Cooper overcame alcoholism after a self-destructive period in his 20s. He’s been sober since 2004 and credits it with saving his career, now starring in major films like A Star is Born and Maestro.
• Public figures can shape societal views on drugs and sobriety. While some inadvertently glamorize substance use (e.g., speedballing, cannabis), others inspire recovery. High-profile deaths and habits—like Amy Winehouse’s alcohol overdose and pop culture’s embrace of marijuana—have raised awareness, for better or worse.
• High-profile struggles with addiction and substance-related mortality have contributed to broader societal awareness of the dangers associated with drug misuse and the complexity of substance use disorders (SUDs).
• Conversely, stories of celebrities achieving sustained recovery underscore the potential efficacy of comprehensive treatment approaches—including rehabilitation programs—and serve to destigmatize help-seeking behaviors.

The New Amphetamine Crisis

KEY POINTS:

• Amphetamines were widely prescribed in the mid-20th century for indications such as weight loss, fatigue, and depressive symptoms, prior to the emergence of clinical and regulatory concerns regarding their misuse and addictive potential.
• By 2023, data indicated that 6.6% of U.S. adults were using prescription amphetamines indicated for attention-deficit/hyperactivity disorder (ADHD); while many were appropriately diagnosed, a subset engaged in nonmedical use, highlighting ongoing challenges in monitoring and risk mitigation.
• Contemporary patterns of misuse have been observed among high-performing professionals—particularly in sectors such as technology and finance—who may use ADHD medications off-label in pursuit of enhanced cognitive or occupational performance, raising ethical and clinical concerns about stimulant diversion and neuroenhancement.

Spring Break 2025: College Binge Drinking in Context

KEY POINTS:

• Large-scale longitudinal studies indicate a downward trend in alcohol misuse among high school and college-aged individuals, reflecting the potential impact of public health initiatives and shifting social norms.
• Despite this encouraging data, contemporary media portrayals—particularly around events such as spring break 2025—continue to emphasize high levels of alcohol consumption among young adults, potentially reinforcing risky behavioral stereotypes.
• While overall rates of hazardous drinking have declined in collegiate settings, episodic heavy drinking and associated harms persist, warranting continued clinical vigilance and culturally responsive prevention strategies.

Are You a Chocoholic? The Good News…

KEY POINTS:

• Cocoa, a key component of dark chocolate, has been associated with anti-inflammatory properties and potential benefits for cognitive function, mood regulation, and behavior, as evidenced in emerging nutritional neuroscience research.
• Bioactive compounds found in chocolate—such as theobromine and phenylethylamine—interact with neurochemical pathways involved in reward processing, particularly through dopaminergic activation.
• These neurobiological effects may contribute to the development of craving, hedonic eating, and reduced dietary self-regulation, potentially triggering compulsive consumption patterns in vulnerable individuals.
• Episodic memory traces related to highly palatable, energy-dense foods are encoded within the hippocampus, reinforcing reward-driven eating behaviors and intensifying perceived cravings, especially under stress or emotional duress.

Getting High the Cali Sober Way

KEY POINTS:

• “California Sober” beverages represent a growing category of alcohol-free products designed to produce calming or euphoric effects, appealing to individuals who abstain from alcohol but seek similar experiential outcomes.
• In jurisdictions where legally permitted, some of these alternative beverages are infused with tetrahydrocannabinol (THC) or cannabidiol (CBD), introducing psychoactive or therapeutic properties that may influence mood, cognition, and behavior.
• Several formulations also include adaptogens—botanical compounds purported to modulate stress responses—although empirical evidence supporting their efficacy remains limited and warrants further investigation.

Naltrexone Is the Ozempic for Alcoholism

KEY POINTS:

• Naltrexone, an FDA-approved μ-opioid receptor antagonist, is undergoing renewed clinical attention for its potential in treating substance use disorders, paralleling recent enthusiasm surrounding medications such as semaglutide (Ozempic).
• Although prior studies have demonstrated the efficacy of naltrexone in reducing cravings and relapse in alcohol and opioid use disorders, adherence and uptake in clinical populations have historically been suboptimal.
• Emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, may attenuate alcohol consumption—prompting calls for direct comparative studies with agents like naltrexone to better inform pharmacotherapeutic strategies.

Clubbing in Virtual Reality

KEY POINTS:

• “VR clubbing” refers to the practice of attending immersive, virtual dance environments via head-mounted display technology; these events often span extended durations and simulate real-world nightlife experiences.
• Preliminary observational data and anecdotal reports suggest that some individuals engaging in virtual clubbing use psychoactive substances, including ketamine, lysergic acid diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA)—to enhance sensory immersion and emotional euphoria.
• The phenomenon of extended virtual engagement, sometimes described as “digital benders” or VR binges, can persist for several consecutive days, raising concerns about dissociative symptoms, circadian disruption, and potential behavioral dysregulation among high-frequency users.

Women With Alcohol Use Disorder Have a Different Disease

KEY POINTS:

• Due to lower gastric and hepatic alcohol dehydrogenase activity, women metabolize ethanol less efficiently than men, resulting in higher peak blood alcohol concentrations and increased physiological toxicity at comparable intake levels.
• Neurobiological studies reveal that women exhibit unique neuroimmune signaling and heightened stress-related neural circuitry in the context of alcohol exposure—factors that may contribute to sex-specific vulnerability to alcohol use disorder (AUD).
• Despite these biological distinctions, the majority of pharmacologic trials for AUD have historically enrolled predominantly male participants, highlighting the urgent need for sex-specific research to guide the development of tailored therapeutics and precision treatment strategies.

Abused Drugs and Trends We’re Up Against in the U.S.

KEY POINTS:

• Over the past decade, the United States has witnessed a sustained rise in overdose mortality driven by the combined use of opioids and stimulants, reflecting an increasingly complex and lethal substance use landscape.
• Distinct geographic patterns have emerged, with fentanyl-cocaine co-involvement predominating in the Eastern U.S., while fentanyl-methamphetamine combinations are more prevalent in Western regions—posing regionally specific clinical challenges.
• The dynamic and unpredictable nature of drug adulteration—often involving potent agents such as fentanyl analogs, local anesthetics, xylazine, and veterinary sedatives like medetomidine—continues to exacerbate overdose risk, complicate treatment response, and hinder toxicologic surveillance.

Where Is the Anti-Fentanyl Truth Campaign?

KEY POINTS:

• The Truth Initiative is widely recognized for its evidence-based success in reducing youth tobacco use through strategic public messaging and the deliberate de-normalization of tobacco industry practices.
• Public health experts have advocated for the application of similar stigmatization strategies targeting high-risk behaviors such as fentanyl use and “speedballing” (co-administration of opioids and stimulants via smoking or injection), aiming to counteract normalization and reduce initiation.
• Concerningly, there is growing evidence that a subset of users—particularly those with repeated exposure—have become desensitized to the risks associated with fentanyl, cocaine, methamphetamine, and injection practices, indicating an urgent need for innovative harm reduction messaging and behavioral interventions.

Reducing Personal Shame and Stigma Heps with Recovery

KEY POINTS:

• Reducing stigma and addressing internalized shame are essential components in enhancing an individual’s willingness to initiate and engage in treatment for substance use disorders.
• The recovery process is inherently non-linear, requiring a flexible, patient-centered approach characterized by sustained support, clinical perseverance, and adaptability over time.
• Sustained recovery extends beyond the cessation of substance use—it involves emotional maturation, identity development, and the cultivation of a purpose-driven, values-oriented life.
• Lapses and relapses are recognized as clinical features of substance use disorders and should be met with compassion, accountability, and an emphasis on re-engagement, rather than punitive responses.

Finally! Some Good News About U.S. Drug Overdose Deaths

KEY POINTS:

• Modest Decline in Opioid-Related Mortality: National data indicate a decrease in opioid overdose deaths from 84,181 in 2022 to 81,083 in 2023. While this represents a positive shift, the overall burden remains substantial and underscores the need for sustained intervention and surveillance efforts.
• Rising Mortality from Stimulant-Involved Overdoses: In contrast to the decline in opioid-related deaths, overdose fatalities involving methamphetamine and cocaine continued to rise in 2023. These increases reflect the growing complexity of polysubstance use and the limitations of opioid-centric treatment models.
• Disproportionate Global Burden: Although the United States comprises only 4% of the global population, it accounts for approximately 20% of all drug overdose deaths worldwide. This stark disparity highlights systemic vulnerabilities in prevention, treatment access, and harm reduction infrastructure.
• Illicitly Manufactured Fentanyls as a Primary Driver: An estimated 70% of U.S. overdose deaths in 2023 involved illegally manufactured fentanyls (IMFs), including fentanyl analogs such as carfentanil. These synthetic opioids continue to dominate the illicit drug supply and are frequently implicated in both fatal and nonfatal overdoses across all regions.

GLP-1s may interrupt the attachment and even desire to consume not only food but also drugs of abuse.

KEY POINTS:

• Neurocircuitry of Palatability and Food Reward: Gustatory stimuli, particularly those associated with highly processed, energy-dense foods, engage mesolimbic reward pathways in the brain. This activation parallels mechanisms observed in substance use disorders, suggesting overlapping neurobiological substrates underlying compulsive consumption behaviors.
• Pharmacologic Advancements in Obesity Management: Glucagon-like peptide-1 (GLP-1) receptor agonists—such as semaglutide (Ozempic) and tirzepatide (Mounjaro)—have demonstrated significant efficacy in treating obesity through appetite regulation, delayed gastric emptying, and modulation of central reward mechanisms.
• Potential Impact on Substance Use and Craving Pathways: Emerging evidence indicates that GLP-1 receptor agonists may attenuate not only hyperphagia and hedonic eating but also reduce cravings for substances of abuse. These findings support the hypothesis that GLP-1 pathways influence shared dopaminergic circuitry implicated in both food and drug reinforcement, potentially positioning these agents as therapeutic candidates in broader addiction frameworks.

“Neuromodulation in Addiction Treatment”

KEY POINTS:

• Emerging Role of Neuromodulation in Addiction Treatment: Neuromodulation represents a promising frontier in the management of substance use disorders (SUDs), offering non-pharmacologic strategies to modulate dysfunctional neural circuitry associated with compulsive substance use.
• Transcranial Magnetic Stimulation (TMS) as a Pioneering Modality: TMS was the first neuromodulatory technique to receive regulatory approval for use in addiction treatment. By delivering targeted magnetic pulses to specific cortical regions, TMS has demonstrated efficacy in reducing cravings and enhancing executive control among individuals with SUDs.
• Focused Ultrasound Neuromodulation and Craving Attenuation: Early clinical investigations suggest that low-intensity focused ultrasound may reduce craving intensity in individuals with opioid and other substance use disorders. This modality enables precise targeting of deep brain structures implicated in reward processing and craving regulation.
• Targeting Core Neurobehavioral Circuits: Neuromodulation interventions engage brain regions critical for decision-making, inhibitory control, and reward valuation—particularly the dorsolateral prefrontal cortex, anterior cingulate cortex, and striatal pathways. Modifying activity within these networks may restore functional balance and reduce relapse risk.

“Medical” Marijuana and Chronic Pain”

KEY POINTS:

• Perceived Analgesic Effects and Patient Beliefs: While some patients report symptom relief from cannabis use—particularly in the context of chronic pain—robust, high-quality evidence remains limited and inconclusive. Patient-reported outcomes often reflect perceived benefit, though placebo effects and individual variability must be considered in clinical assessment.
• Public Health Consequences of Expanded Access: The increased availability of both regulated and illicit cannabis products has coincided with a rise in adverse outcomes. These include higher rates of emergency department visits, psychiatric presentations, accidental ingestion in pediatric populations, and impaired driving. Concerns voiced by public health and addiction experts regarding commercialization, potency escalation, and youth access have begun to manifest in population-level data.
• Epidemiology of Cannabis Use Disorder (CUD): CUD is currently the most rapidly growing substance use disorder in the United States. Prevalence is rising particularly among adolescents and young adults, with increased daily or near-daily use, high-potency THC products, and early onset of use contributing to addiction vulnerability and psychiatric comorbidity.
• Clarifying Terminology in Clinical Contexts: The terms cannabis and marijuana are often used interchangeably, yet they carry important distinctions in medical and legal discourse. “Cannabis” refers broadly to the plant genus and all its constituent compounds, while “marijuana” is typically used to describe cannabis products that contain psychoactive concentrations of delta-9-tetrahydrocannabinol (THC), the compound primarily responsible for intoxication and addiction risk.

Extreme Drinking on Holidays and Special Occasions High-intensity drinking on Christmas, New Year’s, and other events.

KEY POINTS:

• Holiday-Associated Surge in Alcohol Consumption: Alcohol intake typically doubles among adults during celebratory events such as New Year’s Eve, substantially increasing the incidence of alcohol-related harm including impaired driving, domestic violence, and emergency room presentations.
• Prevalence and Consequences of High-Intensity Drinking: High-intensity alcohol use—defined as consumption well beyond standard binge thresholds—is relatively common during holidays and is linked to acute adverse outcomes, including blackouts, traumatic injuries, emergency department visits, and exacerbation of psychiatric symptoms.
• Lethality of Alcohol Poisoning: Rapid ingestion of large quantities of alcohol over a short time can result in alcohol poisoning, a potentially fatal condition characterized by respiratory depression, hypothermia, and loss of consciousness. Clinicians should remain vigilant during peak risk periods.
• January 1st as a Marker of Elevated Alcohol-Related Mortality: Epidemiologic data consistently identify January 1st as the calendar day with the highest incidence of alcohol-related deaths annually, underscoring the need for targeted preventive messaging, early intervention, and harm reduction strategies during this period.

“Top Findings on Addiction in 2024”

KEY POINTS.

• Shifting Patterns in Opioid-Related Mortality: While intravenous opioid overdoses have declined in some regions, mortality associated with alternative routes of administration—such as smoking—and high-risk behaviors like speedballing (opioid-stimulant co-use) continues to rise. These trends reflect the evolving nature of polysubstance use and underscore the need for adaptive harm reduction strategies.
• Clinical Significance of Non-Fatal Overdoses: Non-fatal opioid overdoses are not benign events. Hypoxic episodes resulting from respiratory depression can lead to lasting neurological injury, including cognitive impairment and motor dysfunction. These incidents should be treated as critical intervention points for initiating comprehensive care.
• Psilocybin and Neuroplasticity: Psilocybin, a serotonergic psychedelic compound, has been shown to induce widespread but reversible alterations in brain functional connectivity. These changes are associated with enhanced neuroplasticity and may have therapeutic implications for mood, anxiety, and substance use disorders, though further research is warranted to establish long-term safety and efficacy.
• Ibogaine as a Novel Therapeutic for Trauma and Brain Injury: Preliminary studies suggest that ibogaine, a psychoactive alkaloid derived from the Tabernanthe iboga plant, may offer neuropsychiatric benefits for individuals with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). In a recent study of U.S. Special Operations veterans, ibogaine treatment was associated with significant reductions in PTSD symptoms, depression, and functional impairments. While promising, these findings require replication in controlled clinical trials to assess safety, especially given ibogaine’s known cardiotoxicity.

Teenage Abuse of Cough Medicines and Promethazine

KEY POINTS:

• Underrecognized Prevalence of Medication Misuse Among Adolescents: Nonmedical use of prescription and over-the-counter (OTC) medications by adolescents may be more widespread than current surveillance data suggest. Such behavior is often underreported, especially when involving easily accessible OTC products, and may not be identified through routine substance use screenings.
• Dextromethorphan (DXM) as a Misused Dissociative Agent: DXM, a common antitussive ingredient found in cough and cold preparations, is frequently misused by adolescents seeking dissociative or hallucinogenic experiences. At supratherapeutic doses, DXM acts on N-methyl-D-aspartate (NMDA) receptors, eliciting effects similar to those of ketamine or phencyclidine (PCP), and may pose significant psychiatric and neurologic risks.
• Rising Co-Misuse with Promethazine: Recent toxicological alerts and anecdotal reports highlight a growing trend among adolescents to combine DXM with promethazine, an antihistamine with sedative and anticholinergic properties. This combination may amplify central nervous system depression and increase the potential for adverse events including respiratory compromise, delirium, and impaired cognition.

California Sober or Abstinences

KEY POINTS:

• Defining the “California Sober” Paradigm: The term “California sober” (or “Cali sober”) generally refers to a lifestyle in which individuals abstain from certain substances—typically alcohol and opioids—while continuing to use other perceived “less harmful” substances such as cannabis or psychedelics. This approach reflects a broader movement toward personalized harm reduction rather than complete abstinence.
• Alternative Recovery Framework Post-Treatment or Overdose: For some individuals, particularly those with prior overdose experiences or dissatisfaction with abstinence-only models such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), “California sober” is positioned as a more attainable or acceptable form of recovery. It is often framed as a pragmatic response to rigid sobriety definitions that may not align with individual values or experiences.
• Clinical and Ethical Considerations: Experts continue to examine the validity and limitations of “California sober” as a sustainable recovery strategy. Central to this discourse are concerns about cognitive distortion—specifically the distinction between hope for control and actual loss of control indicative of addiction relapse. Clinicians must evaluate whether such approaches support long-term recovery or risk perpetuating cycles of dependence under the guise of moderation.

Abused Drugs and Trends We’re Up Against in the U.S.

KEY POINTS:

• Decade-Long Escalation in Overdose Mortality: Over the past ten years, the United States has experienced a sustained increase in overdose deaths involving opioids and stimulants. This trend reflects the growing complexity of polysubstance use and the evolving potency of the illicit drug supply.
• Geographic Variability in Drug Combinations: Distinct regional patterns have emerged in the co-use of opioids and stimulants. In the Eastern U.S., the combination of cocaine and illicitly manufactured fentanyl is a predominant driver of overdose fatalities, whereas in the Western U.S., methamphetamine-fentanyl co-use is more prevalent. These patterns necessitate region-specific prevention and treatment strategies.
• Toxic Adulterants and Unpredictable Drug Composition: The illicit drug supply is increasingly contaminated with pharmacologically active adulterants, including local anesthetics (e.g., lidocaine), veterinary sedatives such as xylazine, and alpha-2 agonists like medetomidine. These substances complicate overdose presentations, reduce the efficacy of standard reversal agents like naloxone, and contribute to atypical toxidromes and treatment resistance.

Drugs of Abuse Cause Addiction Through Effects on the Brain

KEY POINTS:

• Dopaminergic Alterations Across Substances of Abuse: Decades of neuroscientific research confirm that all major classes of addictive substances induce measurable alterations in dopamine signaling pathways, particularly within mesolimbic and mesocortical circuits. These changes disrupt the brain’s reward, motivation, and reinforcement systems and are implicated in the transition from voluntary use to compulsive drug-seeking behavior.
• Mechanistic Insights into Addictive Processes: Scientific advances over the past 50 years have substantially expanded our understanding of how substances of abuse generate pleasure, modulate learning and memory circuits, and promote maladaptive reinforcement. This knowledge base has elucidated the neuroadaptive processes underlying tolerance, withdrawal, and relapse vulnerability.
• Addiction as a Chronic Brain Disease: Addiction is now widely recognized as a chronic, relapsing disorder with neurobiological underpinnings. This paradigm shift is supported by integrative research across disciplines—encompassing neuroanatomy, molecular and cellular biology, pharmacology, and functional neuroimaging—which together have established addiction as a disease state characterized by durable alterations in brain structure and function.

The 10 Most Common Myths About Addiction

KEY POINTS:

• Addiction Is a Treatable Medical Condition: Public and even professional misconceptions persist that addiction is untreatable or that individuals with strong moral character are somehow immune. Evidence-based interventions—including pharmacotherapy, psychotherapy, and integrated care—demonstrate that substance use disorders (SUDs) are chronic, relapsing conditions that can be effectively managed, particularly with early and sustained treatment.
• The Fallacy of “Hitting Rock Bottom”: The notion that individuals must reach a crisis point before initiating recovery is not supported by clinical evidence. Intervening early in the course of substance misuse—much like with any progressive illness—leads to better outcomes and reduced risk of long-term harm. Waiting for escalation delays access to care and increases the potential for medical, legal, and social complications.
• High Prevalence of Co-Occurring Disorders: Comorbidity between psychiatric disorders and SUDs is common and clinically significant. Individuals with mental health diagnoses such as depression, anxiety disorders, post-traumatic stress disorder (PTSD), or bipolar disorder are at elevated risk for substance misuse, and vice versa. Integrated treatment approaches that address both conditions concurrently yield the most effective outcomes.

The Concerning Emergence of “Gas Station Heroin”

KEY POINTS:

• Tianeptine and Regulatory Evasion: Commonly referred to as “gas station heroin,” tianeptine is a tricyclic antidepressant developed for depression but never approved for medical use in the United States. Despite its opioid-like activity at the mu-opioid receptor, it is marketed as a dietary supplement or nootropic, exploiting regulatory loopholes that allow its sale in convenience stores and online platforms.
• Addictive Potential and Adverse Outcomes: At supratherapeutic doses, tianeptine produces euphoria, sedation, and dependence, with withdrawal symptoms resembling those of classical opioids. Poison control centers have reported a dramatic rise in tianeptine-related exposures, including cases of respiratory depression, seizures, and intensive care admissions.
• Synthetic 7-Hydroxymitragynine (7-OH) Misrepresentation: Products labeled as kratom extracts may contain synthetic 7-OH, a highly potent mu-opioid receptor agonist up to 30 times stronger than morphine. These substances are often falsely marketed as natural kratom derivatives, misleading consumers and increasing the risk of overdose, dependence, and respiratory compromise.
• Clinical and Public Health Implications: Both tianeptine and synthetic 7-OH products represent significant challenges for clinicians due to their unregulated status, high abuse potential, and lack of detection in standard toxicology screens. Increased awareness, early identification, and advocacy for regulatory oversight are essential to mitigate harm and guide appropriate intervention.

Obesity Actually Changes Your Brain

KEY POINTS:

• Dopaminergic Dysregulation in Obesity: Neuroimaging studies have demonstrated that individuals with obesity exhibit a reduction in striatal dopamine D2 receptor availability. This alteration is associated with diminished reward sensitivity and may contribute to compensatory overeating as individuals seek to restore hedonic balance through excessive food intake.
• Somatotopic Structural Changes Reinforcing Hyperphagia: Structural brain alterations have been identified in somatosensory regions representing the oral and facial areas, including the mouth, lips, and tongue. These changes are hypothesized to reinforce maladaptive eating patterns by increasing attentional salience and sensorimotor responsiveness to food-related stimuli.
• Impact of Western Dietary Patterns on Neural Plasticity: Chronic consumption of high-fat, high-sugar diets—hallmarks of the Western dietary pattern—has been shown to remodel central reward and regulatory circuits. This neuroplastic shift promotes habitual overconsumption and impairs homeostatic control mechanisms.
• GLP-1 Receptor Agonists and Neurocircuitry Modulation: Emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists not only regulate peripheral appetite signals but may also modulate central neural circuits involved in reward processing, impulse control, and motivation. These agents may partially reverse obesity-associated brain changes, supporting their role as both metabolic and neuropsychiatric interventions.

Is Sugar Really “Poison”?

KEY POINTS:

Certainly—here is a revised version in an academic and clinically relevant tone, tailored for physicians, therapists, and behavioral health professionals:

• Public Health Framing of Sugar Consumption: In a recent public statement, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. referred to sugar as “poison,” invoking the toxicological principle that “the dose makes the poison” to underscore the health risks associated with excessive sugar intake. His remarks reflect growing concern over the role of added sugars in the rising prevalence of metabolic and neuropsychiatric disorders.
• Neuroadaptive Changes and Dietary Behavior: Emerging evidence suggests that chronic consumption of high-sugar diets may induce neuroplastic changes in brain regions governing reward, impulse control, and homeostatic regulation. These alterations can reinforce maladaptive eating behaviors, reduce dietary restraint, and contribute to compulsive food-seeking patterns—particularly in individuals with obesity.
• Obesity-Related Brain Responsiveness to Food Cues: Neuroimaging studies have demonstrated that individuals with obesity exhibit heightened activation in brain regions associated with gustatory processing and reward anticipation in response to food-related stimuli. This increased responsivity may perpetuate overeating and complicate behavioral interventions aimed at dietary modification.

Why Language of Key Self-Help Groups Works

KEY POINTS:

• Therapeutic Use of Language in Recovery Communities: Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) employ structured language, slogans, and metaphors as core components of their recovery framework. These linguistic tools serve not only to convey shared experience but also to reinforce behavioral change, promote cognitive reframing, and support relapse prevention.
• Behavioral Science Behind “One Day at a Time”: The widely used phrase “one day at a time” reflects a behavioral strategy rooted in present-focused coping and incremental goal setting. This approach aligns with evidence-based relapse prevention models that emphasize short-term behavioral targets to reduce overwhelm and enhance self-efficacy.
• The “Cucumber-to-Pickle” Metaphor and Neurobiological Correlates: A frequently cited metaphor in 12-step circles likens the irreversible transformation of a cucumber into a pickle to the neuroadaptive changes associated with addiction. This analogy resonates with neuroscientific findings that chronic substance use induces lasting alterations in brain circuitry, particularly in reward, motivation, and executive function systems.
• The Big Book as a Cognitive-Behavioral Resource: The foundational text of AA, commonly referred to as the “Big Book,” contains numerous sayings and metaphors that function as cognitive anchors. These narrative devices facilitate insight, normalize struggle, and provide accessible frameworks for understanding the chronic and relapsing nature of addiction. Clinicians may find value in exploring these elements to better understand the mechanisms by which 12-step programs support recovery.

March 2025 Sports Gambling Madness

KEY POINTS:

• Prevalence of Sports Wagering in the General Population: In 2025, an estimated 68 million U.S. adults—approximately one in four—intended to participate in March Madness betting, collectively wagering $15.5 billion. This level of engagement reflects the growing normalization of gambling behaviors, particularly in association with major sporting events.
• Clinical Criteria for Gambling Disorder: Gambling disorder is recognized as a behavioral addiction in the DSM-5, characterized by persistent and recurrent maladaptive gambling behavior. Core diagnostic features include compulsivity, impaired control, development of tolerance, preoccupation with gambling, and withdrawal-like symptoms in the absence of gambling opportunities.
• Digital Platforms and Accessibility: The proliferation of smartphone technology, online gambling platforms, in-play betting options, and targeted marketing via social media has dramatically increased accessibility and frequency of gambling behaviors. These digital innovations are particularly associated with high-risk patterns of impulsive and compulsive gambling, especially among younger populations.
• Implications for Screening and Intervention: The expanding digital ecosystem of gambling necessitates routine screening in clinical settings, including primary care, psychiatry, and adolescent medicine. Clinicians should be aware of the unique features of online gambling—including its continuous nature and dissociation from tangible currency—and integrate behavioral interventions that address both psychological drivers and technological facilitators of gambling-related harm.

Go Ahead, Drink your Coffee

KEY POINTS:

• Protective Associations with All-Cause Mortality: A robust body of epidemiological literature—comprising over 50 cohort and population-based studies—demonstrates that regular consumption of moderate amounts of coffee is associated with a reduction in all-cause mortality. Benefits have been observed across diverse populations and appear to extend to both caffeinated and decaffeinated coffee.
• Caffeine Content Variability and Clinical Awareness: A standard cup of caffeinated coffee typically contains between 80 to 120 mg of caffeine, though actual amounts vary based on preparation method, bean type, and serving size. Importantly, decaffeinated coffee often retains measurable caffeine content—sometimes upwards of 10–20 mg per cup—which may be clinically relevant for sensitive individuals or those advised to limit stimulant exposure.
• Caffeine as a Mildly Dependence-Producing Agent: While caffeine can lead to physiological dependence and withdrawal symptoms—such as headache, fatigue, and irritability—it is not associated with the compulsive use patterns, neurotoxicity, or behavioral dysregulation characteristic of high-risk stimulants (e.g., amphetamines, cocaine). From a clinical standpoint, caffeine use rarely requires formal intervention but warrants discussion in cases of sleep disturbance, anxiety exacerbation, or cardiovascular sensitivity.

5 Common False Beliefs About Drug Use, Users, and Addiction

KEY POINTS:

• Barriers to Timely Treatment: Misconceptions and Evidence Disregard: Widespread societal misconceptions—such as viewing addiction as a moral failing or personal weakness—continue to impede early intervention. Additionally, the underutilization of research-informed practices delays treatment initiation and contributes to poorer long-term outcomes. Promoting scientific literacy among providers and the public is essential to dismantle stigma and facilitate timely care.
• Enduring Consequences of Substance Use: The use of addictive substances is associated with a broad array of long-lasting harms spanning physical health deterioration (e.g., cardiovascular, hepatic, and neurological damage), mental health complications, social disruption, and impaired relational functioning. These impacts often persist long after acute intoxication subsides, underscoring addiction’s chronic and relapsing nature.
• Urgency of Youth-Focused Prevention Efforts: Adolescents and young adults represent a high-risk population for initiating substance use, with early exposure linked to elevated risk for lifelong addiction, psychiatric comorbidities, and impaired neurodevelopment. Despite this vulnerability, prevention initiatives targeting youth remain underfunded relative to treatment expenditures. Robust investment in school- and community-based prevention programs is both evidence-based and cost-effective.

Detoxing From Dopamine from Fast Food to Pornography to AI, We’re Drowning in Dopamine

KEY POINTS:

• Neurobiological Balance Between Reward and Aversion: The human brain operates under a dynamic equilibrium between hedonic (pleasurable) and dysphoric (pain-related) signaling systems. This regulatory balance, often described in terms of allostasis, allows for adaptive responses to environmental stimuli and maintains emotional homeostasis.
• Consequences of Repeated Hedonic Overstimulation: Chronic over engagement in highly rewarding behaviors—such as substance use, compulsive eating, gambling, or digital media consumption—can result in downregulation of dopamine receptors and diminished sensitivity to naturally occurring rewards. This neuroadaptive process, often referred to as “reward system desensitization,” increases vulnerability to addiction by promoting compulsive behavior and anhedonia.
• Dopamine Fasting and Neural Reset Hypotheses: Emerging behavioral strategies such as “dopamine fasting”—involving temporary abstinence from reinforcing activities—are thought to reduce stimulus-induced neuroadaptation and may facilitate a partial restoration of baseline dopaminergic tone. While largely theoretical and requiring further empirical validation, this concept aligns with broader clinical practices of behavioral withdrawal and stimulus control in addiction treatment.

Grading the Progress of National Initiatives on the Opioid Crisis

KEY POINTS:

• Strategic Framework Development in 2016: In response to escalating opioid-related morbidity and mortality, leading public health and addiction experts outlined comprehensive strategies in 2016 aimed at curbing the opioid epidemic. These included evidence-based prevention, treatment expansion, supply chain regulation, and harm reduction approaches.
• Policy and Programmatic Innovations: Following this roadmap, numerous federal, state, and local initiatives were launched. These efforts encompassed expanded access to medications for opioid use disorder (MOUD), prescription drug monitoring programs (PDMPs), naloxone distribution, provider education, and integration of behavioral health services into primary care.
• Measurable Reductions in Opioid-Related Harms: Preliminary outcomes indicate that several of these interventions have yielded tangible public health benefits. These include declines in prescription opioid availability, increased initiation of MOUD, reduced overdose fatalities in select jurisdictions, and a growing national emphasis on recovery-oriented systems of care.

Easing End-of-Life Care With Shrooms

KEY POINTS:

• Efficacy in Alleviating Psychological Distress: Since 2016, a growing body of randomized controlled trials and clinical studies has demonstrated that psilocybin, when administered in a controlled therapeutic setting, significantly reduces anxiety, depression, and existential distress in patients facing terminal illness. These effects are often sustained for months following a single or limited number of sessions.
• Facilitation of Transcendent and Meaning-Making Experiences: Psilocybin reliably induces altered states of consciousness characterized by a sense of unity, transcendence, and emotional catharsis. These so-called “mystical-type experiences” are strongly correlated with therapeutic outcomes, including enhanced acceptance of mortality and improved psychological well-being.
• Neuroplasticity and Disruption of Maladaptive Cognitive Patterns: Neuroimaging and clinical data suggest that psilocybin modulates activity in the default mode network and promotes neural flexibility. This “rebooting” effect may help loosen entrenched patterns of rumination, fear of death, and depressive cognition, thereby restoring adaptive emotional processing.

The Current State of the Polydrugs Use Epidemic

KEY POINTS:

• Polydrug Use as the Defining Feature of the Current Epidemic: The United States is now experiencing the “Fourth Wave” of the opioid overdose crisis, characterized by widespread and escalating patterns of polysubstance use. Unlike earlier waves driven by prescription opioids, heroin, or fentanyl alone, this phase is marked by the concurrent use of multiple substances—often involving combinations of opioids, stimulants, and sedatives—which significantly increases overdose risk.
• High Co-Positivity Rates in Fentanyl-Positive Patients: A 2024 analysis of over 4 million urine drug test results revealed that 93% of individuals who tested positive for fentanyl also had additional substances present in their system. This finding underscores the pervasiveness of polysubstance use and the limitations of single-substance treatment models.
• Youth and Event-Based Risk Environments: A recent study found that 87% of music festival attendees reported plans to use substances during events, with polydrug use being common. These findings highlight the need for targeted harm reduction strategies in high-risk social settings, particularly among adolescents and young adults.
• 2010 and 2022, unintentional overdose deaths in the U.S. quadrupled, with the majority involving multiple substances. This trend reflects the increasing lethality of the illicit drug supply and the urgent need for comprehensive, multi-substance overdose prevention and treatment approaches.

Overdose Survivors: Medical and addiction Challenges

KEY POINTS:

• Prevalence of Addiction Among Older Adults: Contrary to common misconceptions, substance use disorders (SUDs) are not limited to younger populations. More than 2 million adults aged 65 and older in the United States are currently living with an SUD—a number expected to rise with demographic shifts and evolving substance use patterns.
• Alcohol and Prescription Misuse as Leading Diagnoses: Alcohol use disorder (AUD) remains the most prevalent SUD among older adults, followed by the nonmedical use of prescription medications, including opioids, benzodiazepines, and sedative-hypnotics. Age-related changes in pharmacokinetics and pharmacodynamics further amplify the risks associated with substance misuse in this population.
• Overdose as a Critical Clinical Marker: In older adults, an overdose should be viewed as a sentinel event indicating significant underlying pathology. Beyond its acute medical consequences, overdose signals heightened vulnerability and often precipitate long-term physical, cognitive, and functional decline. Timely intervention following an overdose is essential for both prevention and recovery planning.
• Medication-Assisted Treatment (MAT) and Relapse Vulnerability: Medication-assisted treatments—such as buprenorphine, methadone, or extended-release naltrexone—are highly effective in reducing opioid-related mortality when maintained over time. However, discontinuation of MAT is frequently associated with relapse and increased risk of fatal overdose, highlighting the importance of continuity of care and long-term treatment engagement in older patients.

A Vaccine Against Fentanyl!

KEY POINTS:

• Persistent Challenges in SUD Treatment Outcomes: Despite significant progress in the development of pharmacologic and behavioral interventions for substance use disorders (SUDs), relapse and overdose remain prevalent. These outcomes underscore the need for novel adjunctive therapies that can enhance long-term recovery and reduce mortality.
• Vaccine-Based Approaches Informed by Preclinical Research: Over the past five decades, animal models have played a pivotal role in advancing vaccine technologies aimed at treating SUDs. These studies have laid the groundwork for immunotherapies that target specific substances by eliciting antibodies to neutralize their psychoactive effects before they reach the brain.
• Anti-Fentanyl Vaccine as a Potential Breakthrough: A promising anti-fentanyl vaccine has emerged from this body of research, designed to generate antibodies that bind fentanyl in the bloodstream and prevent its central nervous system penetration. Preclinical studies have demonstrated efficacy in blocking fentanyl’s euphoric and respiratory-depressant effects, with human trials anticipated in the near future.
• Decades of Scientific Investment: The development of this vaccine reflects over 36 years of sustained interdisciplinary research, integrating immunology, pharmacology, and addiction neuroscience. While not yet approved for clinical use, the vaccine represents a potentially transformative tool in combating the ongoing fentanyl-driven overdose crisis.

Not So Pretty in Pink Cocaine

KEY POINTS:

• Polysubstance Composition and Unpredictability: Commonly referred to as “pink cocaine,” “tusi,” or “tucibi,” this substance is not a single chemical entity but rather a variable mixture of psychoactive compounds. Laboratory analyses have identified combinations including ketamine, MDMA (ecstasy), methamphetamine, fentanyl, xylazine, and other novel synthetic drugs. The lack of standardization renders each batch pharmacologically unpredictable and significantly increases the risk of adverse effects and overdose.
• Cultural Appeal and Misleading Nomenclature: Despite its name, pink cocaine rarely contains cocaine or the psychedelic 2C-B, from which its nickname is derived. The pink coloration—achieved through food dye—is a marketing tactic aimed at enhancing visual appeal, particularly among young adults in nightlife settings. The drug’s association with elite party scenes and celebrity culture, including reported use at events linked to public figures such as Sean “Diddy” Combs, has contributed to its glamorization and rising popularity.
• Clinical and Public Health Concerns: The unpredictable composition of pink cocaine poses serious clinical challenges. Users may experience a wide range of effects—from euphoria and hallucinations to respiratory depression, seizures, and cardiac arrest—depending on the substances present. The co-ingestion of stimulants and depressants within a single dose further complicates management and increases the likelihood of toxic interactions.

Teen and Young Adult Abuse of Nitrous Oxide

KEY POINTS:

• Decline in Traditional Substance Use Among Adolescents: Recent national surveys indicate a sustained decrease in adolescent use of conventional substances such as tobacco, alcohol, cannabis, and other drugs. This trend may reflect the success of public health campaigns, regulatory efforts, and shifting cultural norms surrounding substance use.
• Surge in Recreational Hallucinogen Use: In contrast, there has been a notable rise in the recreational use of hallucinogens among teens, including psilocybin, LSD, and dissociative agents. These substances are often perceived as “natural” or therapeutic, despite their potential to disrupt neurodevelopment and precipitate psychiatric symptoms during adolescence—a critical period for brain maturation.
• Nitrous Oxide Misuse as a Maladaptive Coping Strategy: The increasing use of nitrous oxide (“laughing gas”) by adolescents may represent a maladaptive response to unmet mental health needs, including anxiety, depression, and trauma. Easy accessibility, social media promotion, and the perception of safety contribute to its appeal, despite risks of neurological damage, vitamin B12 deficiency, and cardiovascular complications.
• Therapeutic Exploration of Nitrous Oxide in Psychiatry: Paradoxically, nitrous oxide is also under investigation as a rapid-acting intervention for treatment-resistant depression. Clinical trials have demonstrated that low-dose administration can produce significant antidepressant effects, potentially through modulation of glutamatergic neurotransmission and neuroplasticity mechanisms. This duality underscores the importance of clinical context, dosing, and supervision in distinguishing therapeutic use from recreational misuse.

Life or Death (Updated December 19, 2024) 

KEY POINTS:

• Stigma toward alcohol, drug and especially OUDs, exceeds that of other mental health conditions.
• Stigmatizing language used to describe people with SUDs matter, causes shame and delays their access to clinical care. 
• Even emergency and primary-care doctors do not want to treat people with drug addictions. 

Key Addiction Points You Need to Know 

KEY POINTS:

• Adolescent drug experimentation can cause changes in their developing brains. 
• The U. S’s efforts have concentrated on saving lives now, by reversing opioid drug overdosages, but other strategies are necessary. 
• All drugs like opioids target the brain’s pleasure system, causing brain changes.

Ask the Expert: Yale University Addiction Expert Brian Fuehrlein, M.D., Ph.D. (Updated February 28, 2024)

KEY POINTS:

• Do not wait! Substance Use Disorder treatment can start in the emergency room. 
• Opioid use disorder patients start and stop buprenorphine, relapse, and overdose. 
• Naloxone, Buprenorphine, Methadone can work but we need new, more effective treatment options. 

Speedballing: The Current Fourth Wave of the Overdose Crisis (Updated March 8, 2024)

KEY POINTS:

• The opioid crisis has moved from oxycontin to heroin to fentanyl and now is in its fourth wave. 
• The fourth wave is Speedballing, opioids plus cocaine or methamphetamine, is increasingly prevalent and killing users. 
• We have methadone, naltrexone, buprenorphine but cocaine and methamphetamine usually require residential treatment.

Ask Jean Lud Cadet, M.D. The National Institute on Drug Abuse Methamphetamine and Cocaine Expert (Updated March 12, 2024)

KEY POINTS:

• The amount/frequency of methamphetamine use determines risks of a brain injury.  
• Treatment for methamphetamine use disorders are difficult and can be lengthy. 
• Epigenetic discoveries may help us understand how an occasional drug abuser’s brain is reorganized by a substance use disorder. 

Addicted to Food (Updated July 29, 2025) 

KEY POINTS:

• Nicole Avena, Mark Gold, and Bart Hoebel at Princeton showed that sugar, high fructose corn syrup, and highly processed foods change the brain and behavior like drugs of abuse.  
• The obese brain is activated by how foods taste, and highly processed foods are particularly attractive. 
• Some medications effectively treat obesity, especially GLP-1 drugs such as Ozempic and Mounjaro, may interrupt the attachment and even desire to consume not only food but also drugs of abuse. 

Dual Diagnosis: When Substance Abuse and Psychiatric Issues Collide (Updated April 5, 2025) 

KEY POINTS:

• Many people have a substance use disorder (SUD) and serious psychiatric issues at the same time. 
• Experts and the public have struggled with whether drugs cause psychiatric illness or vice versa. 
• Sexual, physical, or emotional traumatic events in childhood increase risks for co-occurring disorders. 
• Carrie Fisher and Matthew Perry may have self-medicated over distress, or SUDs, triggering psychiatric illnesses. 
• Co-occurring disorders have taken a toll on celebrities and regular folk alike.

Ibogaine: A Possible Cure for Addiction and Traumatic Brain Injury (Updated July 24, 2025)

KEY POINTS:

• Researchers have found that ibogaine can reverse drug withdrawal and can end drug craving for some people. 
• The late Nolan Williams, Stanford University psychiatrist, has shown that Ibogaine can improve symptoms of traumatic brain injury and also PTSD. 
• Psychedelic medications like LSD, psilocybin, ibogaine, and others are being tested for safety and efficacy for various psychiatric conditions. 

Genetics and Addiction: What We’ve Learned (Updated April 18, 2024) 

KEY POINTS:

• New research offers insights into numerous addiction-related genes. 
• Alcohol use disorder (AUD) has been studied for years, starting with twin studies comparing identical or fraternal twins and their risk for AUD and adoption studies comparing adopted children to their birth parents. These studies demonstrated that the heritability of alcohol dependence is up to 60%. 
• Twenty-two percent of adults in the United States have at least one biological parent with alcohol use disorder (AUD). The odds of lifetime AUD are 2.5 times higher for the offspring of one AUD parent and 4.4 times higher for the offspring of two AUD parents, as compared to children of non-AUD parents. 
• Genetics helps doctors provide individualized advice and patients to make personalized medicine choices. 

America’s Favorite, Weed, Comes with Big Health Risks (Updated August 26, 2025)

KEY POINTS:

• Psychosis is an increasing risk of today’s strong marijuana. 
• Many people do not know that regular marijuana use may carry serious health risks, especially for the young. 
• Young adults and teens can develop an addiction to weed and become psychotic. 
• No medication is FDA-approved for treating cannabis use disorder. 
• One cannabis-induced psychotic episode ups the risk of developing bipolar disorder or schizophrenia by 50%. 

The Reality of Teens and Weed (October12, 2024) 

KEY POINTS:

• The risks and consequences of marijuana use for young adults.  
• Millions of teenagers in the United States use marijuana or “Weed.”  
• Young people who are depressed are more likely to use marijuana, but it can make their depression worse.  
• The adult SUD and overdose crisis has its roots in teen and young adults’ use that targets and changes brains.  

How Exercise Helps Us Fight Depression and Addiction (Updated July 7, 2025)   

KEY POINTS:

• Exercise helps substance abusers detoxify from drugs and reduce drug cravings.  
• While drugs can change the brain, exercise can reverse these and allow for new connections.  
• Aerobics and other vigorous exercise regimens are anti-depressants, help too with anxiety and sleep problems.  
• Exercise is safe and effective, and especially helpful in long-term recovery from substance use disorders.  

Psilocybin: Potential Psychedelic Treatment for Depression (Updated April 25, 2025)

KEY POINTS:

• “Magic” psilocybin mushroom use has risen sharply across all age groups.  
• Research by Joshua Siegel, M.D., Ph.D. and others have shown is a potential new treatment for depression.  
• Psychedelic research on LSD, psilocybin, ibogaine, and others is ongoing at Harvard/MGH, Yale, Washington University, Stanford, University of Texas, Mt Sinai and more.  
• Magic Mushrooms have been used by indigenous people for thousands of years. 

Naltrexone for Both Alcohol and Opioid Use Disorders (May 23, 2024)  

KEY POINTS:

• Naltrexone (ReVia, Trexan, Vivitrol) may be a wonder drug but getting patients to take it is a challenge.  
• Alcohol use disorders and opioid use disorders may be two DSM diagnoses but share Naltrexone as an effective treatment suggesting important commonalities.  
• Yale’s Dr. Rajita Sinha has data showing that gender matters in alcohol effects on the brain and craving and also appears to determine Naltrexone, Antabuse, Acamprosate –AUD medication treatment responses. 

The Fentanyl Death Crisis in America (June 4, 2024)

KEY POINTS:

• Fentanyl has replaced synthetic opioids like oxycontin and heroin.  
• Fentanyl is the major threat causing overdose deaths in the United States.  
• Fentanyl is the major factor in overdose deaths, and some are unknowingly taking fentanyl and dying.  
• Fentanyl smoking is contributing to overdose and speedballing deaths. 

The New Fentanyl and Speedballing Crisis of 2024 (June 6, 2024)

KEY POINTS:

• Fentanyl in counterfeit pills or smoked alone or with methamphetamine are causing overdose deaths.  
• The naïve users, fentanyl smokers, and speedballers are at elevated risk of overdose.  
• Death by fentanyl is greater in people with Depression, heart disease, or liver disease. 

Increasing Acceptance of Behavioral Addictions as Real (June 12, 2024) 

KEY POINTS:

• Yale’s Marc Potenza, M.D., PhD.  helps us understand the APA’s DSM-5 breakthrough in recognizing gambling disorder.  
• DSM-5 includes internet gaming disorder (IGD) as a behavioral addiction needing further study.  
• Petros Levounis, M.D. former APA President has written about Behavioral Addictions including pornography, food, and sex addictions.  
• Experts believe behavioral addictions will eventually be recognized, helping destigmatize these diagnoses.

The Zombie Drugs- xylazine and medetomidine (Updated April 7, 2025) 

KEY POINTS:

• Drug Cartels additives to street fentanyl are changing the opioid crisis, complicating opioid The animal tranquilizer xylazine increases opioid effects and is a newer drug of abuse.  
• Zombie Users do not know their fentanyl is laced with xylazine or medetomidine.  
• Alpha-2 agonists like xylazine are peripheral vasodilators and lower blood pressure can result in dangerously low blood pressure and heart rate, compromising end-organ and peripheral perfusion, resulting in harm to the brain, heart, kidneys, and extremities.  
• Fentanyl plus xylazine complicates emergency overdose treatment. 

Here’s What a Massive New NIH Addiction Study Found (June 21, 2024) 

KEY POINTS:

• Naloxone, Narcan, Nalmefene are essential for life saving overdose reversal.  
• Medication Assisted Treatment with methadone and 5-year outcomes appear to have been a better strategy than the community approach. need support and reporting.  
• Prevention is safe, 100% effective when it works, an underfunded and complementary addiction strategy. 

Fentanyl Overdoses May Cause Brain Injury (Updated November 1, 2024) 

KEY POINTS:

• Identifying oxygen-deprivation brain injury can improve addiction treatment.  
• With Narcan available many more opioid overdoses are reversed, and lives are saved, but some suffer brain damage from oxygen deprivation.  
• Head injury evaluation is important because an overdose by itself can cause brain injury but people who use drugs have accidents and fights too.  
• Take a detailed history of overdoses, loss of consciousness, and reversal with Narcan.  
• Fentanyl overdoses are like loss of consciousness by drowning or injury. GLP-Time is of the essence in hypoxia, brain injury, and resulting problems with memory and concentration. 

Why Can’t U.S. Doctors Prescribe Methadone for Opioid Use Disorder? (Updated October 18, 2024)

KEY POINTS:

• Many addiction experts support wider methadone access. 
• People taking methadone are roughly 60% less likely to die of opioid overdoses.  
• Methadone, a proven detoxification medication, as part of methadone maintenance therapy (MMT), is an effective long-term treatment for people with opioid use disorders (OUDs). 
• Methadone is not available by prescription, but it has been available in Canada since 1963, Great Britain since 1968, and Australia since 1970. 

The Origins and Promise of Methadone Maintenance Treatment (Updated September 2, 2024)

KEY POINTS:

• 400,000 people in the United States are treated with methadone yearly for opioid use disorder. 
• Methadone treatment for heroin addicts was spearheaded by the pioneering work of Vincent Dole, M.D., and Marie Nyswander, M.D., and researcher Mary Jeanne Kreek, M.D. 
• Herbert Kleber, M.D. Charles O’Brien, MS, Ph.D., and Tom McLellan, Ph.D., helped solidify methadone’s role as a safe and effective treatment for OUDs. 

Smoking Hard Drugs Is Now Killing Many Users (Updated November 1, 2024) 

KEY POINTS:

• Smoking may seem dramatically safer than injecting, but the ease of use, novel combinations, and use of the most dangerous and addictive drugs—methamphetamine, cocaine, fentanyl—make smoking extremely dangerous. 
• Most people believe that smoking major drugs like heroin, fentanyl, methamphetamine, or cocaine is much safer than injecting the drug. 
• A sudden shift in drug overdose deaths is tied to smoking meth, fentanyl, more. 
• The CDC reports that the percentage of overdose deaths with evidence of injection decreased from 22.7 percent of deaths to 16.1 percent, while the percentage of overdose deaths with evidence of smoking increased from 13.3 percent to 23.1 percent.

The Origins and Promise of Methadone Maintenance Treatment (Updated September 2, 2024)

KEY POINTS:

• 400,000 people in the United States are treated with methadone yearly for opioid use disorder. 
• Methadone treatment for heroin addicts was spearheaded by the pioneering work of Vincent Dole, M.D., and Marie Nyswander, M.D., and researcher Mary Jeanne Kreek, M.D. 
• Herbert Kleber, M.D. Charles O’Brien, MS, Ph.D., and Tom McLellan, Ph.D., helped solidify methadone’s role as a safe and effective treatment for OUDs. 

A Front-Row Change Agent of the Drug Epidemic (Updated August 19, 2024)

KEY POINTS:

• Dupont has published more than 400 journal articles and 15 books, most recently Chemical Slavery: Understanding Addictions and Stopping the Drug Epidemic (2018). 
• Dr. Tom McLellan and DuPont’s study of nearly 1,000 drug-addicted physicians closely monitored for five years showed treatment works or can work and what is possible for the rest of the population. Seventy-eight percent recovery.  
• Robert DuPont, M.D. a former White House Drug Czar and Founding Director of NIDA developed and treated more than 15,000 heroin addicts and reported the D.C. crime rate plummeted by 50%, in a direct correlation. 
• He reports that it is rarely just one drug abused by most problematic substance users. And that is particularly true of individuals who die from drug overdoses. 

Ending Smoking or Vaping (Updated December 17, 2024)

KEY POINTS:

• Most people who smoke cigarettes (and many who vape) want to end their habit. 
• Chantix or Varenicline produces higher cigarette smoking quit rates than bupropion or nicotine patches.
• At least 11 million people use e-cigarettes, there are no approved medication options to help them stop. 
• Varenicline is safe and effective for cessation of e-cigarette use in a recent study. 

Targeting Teens to Vape (Updated December 25, 2024)

KEY POINTS:

• Electronic cigarettes (e-cigarettes), also known as e-cigs, vapes, vape pens, and electronic nicotine delivery systems (ENDS), are very popular among adolescents.  
• One of the scariest aspects of vaping is that many teenagers and young adults think it is so much healthier than smoking cigarettes. 
• Cigarette smokers or nicotine vapers often smoke or vape cannabis as well. Many marijuana concentrate users prefer the e-cigarette/vaporizer because it is smokeless, sometimes odorless, and easy to conceal.

Heading Off Alcohol Use Disorder (Updated August 1, 2024)

KEY POINTS:

• Most people who smoke cigarettes (and many who vape) want to end their habit. 
• Chantix or Varenicline produces higher cigarette smoking quit rates than bupropion or nicotine patches.
• At least 11 million people use e-cigarettes, there are no approved medication options to help them stop. 
• Varenicline is safe and effective for cessation of e-cigarette use in a recent study. 

Just Say No to Alcohol? (Updated August 13, 2025)

KEY POINTS:

• Current U.S. alcohol guidelines are being reevaluated as new data details medical risks of alcohol use. 
• Recent surveys indicate that 29.5 million people ages 12 years and older had an AUD in the past year in the United States. 
• Credible estimates contend that more than 178,000 people die from excessive alcohol use each year in the U.S. 
• Alcohol consumption increased dramatically during the Covid pandemic. 
• Alcohol consumption guidelines are being revised in light of risks and consequences of use.

An Addiction Medicine Pioneer (Updated July 20, 2024)

KEY POINTS:

• “Dr. Dave,” Smith the father of community-based addiction medicine. 
• David E. Smith, M.D., started the Haight Ashbury Free Clinic- the first free medical clinic for problem drug users in the United States. 
• “Dr. Dave” is considered one of the founders of modern addiction medicine. 
• He is known for his addiction journal, treatment protocols, and treating the whole person and family. 
• Dr. Dave worries about the strength, tobacco-like business model, and effects of marijuana on adolescents.

What We Know About Kratom (Updated May 30, 2025) 

KEY POINTS:

• Kratom alkaloids differ from heroin as they have opioid plus serotonergic, adrenergic, and other effects. 
• Scientists are trying to separate the constituents of Mitragyna speciosa Korth leaves to find new medicines. 
• Natural Kratom leaves, the alkaloid 7-Hydroxymitragynine is only present in extremely small amounts—around 0.01% to 0.04% of the total alkaloid content.  
• Commercial “7-Hydroxymitragynine” products contains very highly elevated 7-Hydroxymitragynine  marketed as “7-OH” products, these include chewable tablets, concentrates, extracts, edible materials and even beverages. 

Methamphetamine Is a Major Drug Threat in the U.S. (Updated December 27, 2024)

KEY POINTS:

• Researchers are trying but no medication is FDA approved for methamphetamine use disorder or overdose. 
• In a new wave of overdoses, it is clear the USA faces a speedballing, fentanyl and methamphetamine overdose crisis. 
• Methamphetamine abuse and overdoses are on the rise. 
• Methamphetamine plus Fentanyl in pills, smoke, or i.v. use cause the majority of deaths.

Food for Thought: Exploring Cravings and Compulsions (July 10, 2024)

KEY POINTS:

• Centers for Disease Control and Prevention (CDC) says 42 percent of adults in the United States are obese. 
• Dependence on sugar and ultra-processed foods can cause dangerous health issues. 
• Nicole Avena, Ph.D., and author of Sugarless, is a research pioneer who broke the code on a central cause of overweight and obesity in the United States: food addiction. 
• Avena says about 20 percent of adults and 15 percent of kids and adolescents crave ultra-processed foods.

The Surprising Dangers Modern Seniors Face (Updated June 6, 2025)

KEY POINTS:

• Increasing suicide, loneliness, pain, substance abuse, and STIs reported among older Americans.  
• Stanford University Professor Keith Humphreys, told me, “Our research showed the rate of drug-involved suicides among older Americans has increased by 60% since 2001. This should be a major concern for older people as well as their doctors. 
• Self-medication of undiagnosed and untreated depression with alcohol, benzodiazepines, and marijuana is common among older adults. These substances often fail to provide relief and may worsen depression, adding a new problem, addiction, to depression.

The Bright and Dark Sides of Ketamine (Updated June 17, 2025)

KEY POINTS:

• Ketamine, a Schedule III substance, is FDA-approved for induction and maintenance of general anesthesia. 
• Yale Psychiatry’s Dr. John Krystal and colleagues demonstrated that low-dose ketamine produced rapid, significant antidepressant effects in patients.  
• Esketamine (Spravato) nasal spray s-ketamine is FDA-approved as a novel, rapid-acting way to treat depression. It works.  
• At-home, unsupervised injection of the drug is surging due to online “clinics” spawned by the pandemic. 

Which Drug Epidemic Is Next: Meth, Psychedelics, Mushrooms? (Updated December 28, 2024)

KEY POINTS:

• Current data and historical trends indicate that while the opioid epidemic may be reaching a plateau, stimulant misuse—particularly involving methamphetamine and cocaine—is emerging as the next critical concern. 
• CDC reports show a 17% reduction in overdose fatalities between July 2023 and July 2024, underscoring the effectiveness of targeted interventions and harm-reduction strategies. 
• However, this progress is tempered by a parallel rise in deaths linked to polysubstance use, including speedballing and concurrent stimulant intake. 
• Simultaneously, the increasing use of psychedelics such as psilocybin, MDMA, and LSD reflects evolving patterns in recreational and therapeutic drug consumption that merits closer clinical and research scrutiny.

Teens and Counterfeit Death Pills (Updated September 27, 2024)

KEY POINTS:

• Rising Adolescent Overdose Mortality: Drug overdose has emerged as the third leading cause of death among individuals under the age of 19 in the United States. This alarming statistic reflects a significant public health emergency requiring increased vigilance, early identification, and prompt intervention by pediatric and behavioral health providers. 
• Lethality of Counterfeit Medications: Adolescents are particularly vulnerable to the dangers posed by counterfeit pills, which are often illicitly manufactured to mimic prescription medications such as alprazolam (Xanax), amphetamine-dextroamphetamine (Adderall), or oxycodone (OxyContin). These pills frequently contain high-potency synthetic opioids, including illicitly manufactured fentanyl, placing users at heightened risk for unintentional overdose and death—even with a single exposure. 
• Gaps in Screening and Treatment Access: One of the most significant barriers to managing opioid use disorder (OUD) in adolescents is the widespread absence of standardized screening, diagnostic evaluation, and treatment referral within pediatric and school-based health settings. Addressing this gap is critical to ensuring timely identification and evidence-based care. 
• Public Health Messaging and Clinical Awareness: The “One Pill Can Kill” campaign underscores the lethality of counterfeit medications and is designed to raise public and clinical awareness of the overdose risks posed by even a single encounter with a contaminated pill. Clinicians are urged to incorporate this messaging into prevention strategies, family education, and treatment planning.

Cannabis Use Disorders in Teens and Adults (Updated January 29, 2025)

KEY POINTS:

• Cannabis use disorder (CUD) is a clinically recognized condition with significant behavioral and functional consequences; adolescents represent a particularly vulnerable population. 
• Rates of CUD are rising both in the United States and internationally, a trend attributed in part to the proliferation of ultra-high-potency cannabis products. 
• Contemporary methods of cannabis consumption—such as dabbing—expose users to elevated levels of tetrahydrocannabinol (THC), increasing the risk of dependence, cognitive impairment, and adverse psychiatric outcomes.

The Many Risks of Cannabis and High-Dose THC (Updated November 5, 2025)

KEY POINTS:

• The escalating potency of Δ9-tetrahydrocannabinol (THC) in contemporary cannabis products is associated with heightened concerns regarding short- and long-term health outcomes. 
• Experts in addiction medicine and neuroscience continue to highlight the potential impact of high-THC cannabis on neurodevelopment, particularly during adolescence—a critical window for cognitive and emotional maturation. 
• Advances in endocannabinoid system research offer promising avenues for the development of novel therapeutic interventions targeting cannabis use disorder, as well as related conditions such as sleep dysregulation and chronic pain.

 Ketamine Use Disorder Is on the Rise (Updated November 9, 2024)

KEY POINTS:

• Emergence of Ketamine Use Disorder (KUD): Ketamine use disorder is increasingly recognized as a distinct and emerging addictive condition. While historically underappreciated in clinical settings, rising patterns of compulsive use, tolerance, and withdrawal symptoms have prompted greater attention to its diagnostic and therapeutic implications. 
• Dual Identity as Therapeutic Agent and Substance of Misuse: Ketamine is classified by the World Health Organization as an essential medicine due to its anesthetic and analgesic properties. However, its growing nonmedical use—particularly in recreational and self-medication contexts—has been associated with significant health risks, including urological, cognitive, and psychiatric complications. 
• Development of Diagnostic Tools for KUD: In response to increasing clinical encounters with ketamine misuse, researchers have proposed diagnostic criteria and screening questions to aid in the identification of ketamine use disorder. These tools are designed to align with DSM-5 substance use disorder frameworks and can assist both clinicians and patients in recognizing problematic patterns of use.

The Best Way to Treat Alcohol Use Disorder (AUD) (Updated August 10, 2025)

KEY POINTS:

• Although alcohol use disorder (AUD) is highly prevalent, fewer than 2% of individuals with AUD receive pharmacologic treatment approved by the U.S. Food and Drug Administration, highlighting a substantial gap in care. 
• Clinical evidence supports the safety and efficacy of disulfiram when administered under supervision, with improved adherence linked to better abstinence outcomes. 
• Naltrexone, available in both oral and extended-release injectable formulations, functions by attenuating the reinforcing effects of alcohol and opioids through μ-opioid receptor antagonism, thereby reducing relapse risk. 
• Integrated approaches that combine pharmacotherapy with behavioral interventions and peer support (e.g., Alcoholics Anonymous) have demonstrated superior efficacy compared to single-modality treatments.

Calls to Reassess Cannabis Risks: New Research Reported (Updated June 11, 2025)

KEY POINTS:

• Cannabis has long been perceived by the public as a relatively benign substance; however, evolving evidence has challenged this assumption. 
• Recent peer-reviewed literature has drawn attention to a range of adverse outcomes associated with cannabis use, particularly in relation to high-potency products and early initiation. 
• Increasingly, clinicians and researchers are observing associations between cannabis use and elevated risks of depressive symptoms, emergency department presentations, suicidality, and the development of cannabis use disorder (CUD).

Zyn Nicotine Pouch Products Get FDA Approval for Adults (Updated August 2, 2025)

KEY POINTS:

• Zyn nicotine pouches are positioned in the marketplace as a “cleaner” alternative to combustible tobacco and vaping products, containing nicotine without tobacco leaf or combustion byproducts. 
• Although perceived by some as lower risk, Zyn remains a highly addictive product; its slower buccal absorption compared to inhaled nicotine may reduce peak plasma levels, but dependence potential persists. 
• Certain high-strength formulations of Zyn deliver up to 6 mg of nicotine per pouch—an amount that can approximate the nicotine yield of multiple combustible cigarettes, raising concerns about sustained neurochemical impact and potential gateway effects, particularly among adolescents and nicotine-naïve individuals.

The Good News About Overdose Deaths in the U.S. (Updated May 14, 2025)

KEY POINTS:

• As of February 2025, the Centers for Disease Control and Prevention (CDC) reported a nearly 24% reduction in drug overdose mortality in the United States—a notable shift in the trajectory of the opioid crisis and broader substance use landscape. 
• Specifically, overdose fatalities declined from approximately 112,000 between October 2022 and September 2023 to 87,000 during the corresponding period in 2023–2024, suggesting meaningful progress in harm-reduction efforts. 
• This decline is attributed in part to increased access to naloxone, the expansion of telehealth services, and broader implementation of evidence-based treatments such as medication-assisted treatment (MAT), which together have enhanced reach News Flash: Increased Numbers of Children Poisoned by Fentanyland continuity of care for individuals with substance use disorders.

News Flash: Increased Numbers of Children Poisoned by Fentanyl (Updated March 11, 2025)

KEY POINTS:

• Recent analyses indicate a marked increase in the severity of pediatric fentanyl poisonings between 2015 and 2023, reflecting a growing threat to child health and safety. 
• More than one-third of these cases were either unintentional or involved documented life-threatening outcomes, underscoring the vulnerability of children to opioid exposure. 
• Amid the proliferation of counterfeit pills adulterated with fentanyl, comprehensive harm reduction and prevention strategies must explicitly address pediatric populations to mitigate further morbidity and mortality.

What We Can Learn from Celebrity Addictions (Updated April 21, 2025) 

KEY POINTS:

• Public figures and celebrities are often regarded as cultural influencers and aspirational role models, particularly among youth and media consumers. 

• • Robert Downey Jr. battled heroin and cocaine addiction for years, leading to multiple arrests and nearly a year in prison in 1999. After turning his life around in the early 2000s, he rose to fame as Iron Man and became one of Hollywood’s top earners. 
  • Jamie Lee Curtis struggled with a decade-long addiction to prescription painkillers and alcohol, even stealing pills from loved ones. She achieved sobriety in 1999 and later won an Oscar in 2023 for Everything Everywhere All at Once. 
  • Bradley Cooper overcame alcoholism after a self-destructive period in his 20s. He’s been sober since 2004 and credits it with saving his career, now starring in major films like A Star is Born and Maestro. 
  • Public figures can shape societal views on drugs and sobriety. While some inadvertently glamorize substance use (e.g., speedballing, cannabis), others inspire recovery. High-profile deaths and habits—like Amy Winehouse’s alcohol overdose and pop culture’s embrace of marijuana—have raised awareness, for better or worse. 

• High-profile struggles with addiction and substance-related mortality have contributed to broader societal awareness of the dangers associated with drug misuse and the complexity of substance use disorders (SUDs). 
• Conversely, stories of celebrities achieving sustained recovery underscore the potential efficacy of comprehensive treatment approaches, including rehabilitation programs—and serve to destigmatize help-seeking behaviors. 

The New Amphetamine Crisis (Updated April 4, 2025)

KEY POINTS:

• Amphetamines were widely prescribed in the mid-20th century for indications such as weight loss, fatigue, and depressive symptoms, prior to the emergence of clinical and regulatory concerns regarding their misuse and addictive potential. 
• By 2023, data indicated that 6.6% of U.S. adults were using prescription amphetamines indicated for attention-deficit/hyperactivity disorder (ADHD); while many were appropriately diagnosed, a subset engaged in nonmedical use, highlighting ongoing challenges in monitoring and risk mitigation. 
• Contemporary patterns of misuse have been observed among high-performing professionals—particularly in sectors such as technology and finance—who may use ADHD medications off-label in pursuit of enhanced cognitive or occupational performance, raising ethical and clinical concerns about stimulant diversion and neuroenhancement.

Spring Break 2025: College Binge Drinking in Context (April 3, 2025)

KEY POINTS:

• Large-scale longitudinal studies indicate a downward trend in alcohol misuse among high school and college-aged individuals, reflecting the potential impact of public health initiatives and shifting social norms. 
• Despite this encouraging data, contemporary media portrayals—particularly around events such as spring break 2025—continue to emphasize high levels of alcohol consumption among young adults, potentially reinforcing risky behavioral stereotypes. 
• While overall rates of hazardous drinking have declined in collegiate settings, episodic heavy drinking and associated harms persist, warranting continued clinical vigilance and culturally responsive prevention strategies.

Are You a Chocoholic? Good News… (Updated April 18, 2025)

KEY POINTS:

• Cocoa, a key component of dark chocolate, has been associated with anti-inflammatory properties and potential benefits for cognitive function, mood regulation, and behavior, as evidenced in emerging nutritional neuroscience research. 
• Bioactive compounds found in chocolate—such as theobromine and phenylethylamine—interact with neurochemical pathways involved in reward processing, particularly through dopaminergic activation. 
• These neurobiological effects may contribute to the development of craving, hedonic eating, and reduced dietary self-regulation, potentially triggering compulsive consumption patterns in vulnerable individuals. 
• Episodic memory traces related to highly palatable, energy-dense foods are encoded within the hippocampus, reinforcing reward-driven eating behaviors and intensifying perceived cravings, especially under stress or emotional duress.

Getting High the Cali Sober Way (Updated May 5, 2025)

KEY POINTS:

• “California Sober” beverages represent a growing category of alcohol-free products designed to produce calming or euphoric effects, appealing to individuals who abstain from alcohol but seek similar experiential outcomes. 
• In jurisdictions where legally permitted, some of these alternative beverages are infused with tetrahydrocannabinol (THC) or cannabidiol (CBD), introducing psychoactive or therapeutic properties that may influence mood, cognition, and behavior. 
• Several formulations also include adaptogens—botanical compounds purported to modulate stress responses—although empirical evidence supporting their efficacy remains limited and warrants further investigation.

Naltrexone Is the Ozempic for Alcoholism (Updated May 29, 2025) 

KEY POINTS:

• Naltrexone, an FDA-approved μ-opioid receptor antagonist, is undergoing renewed clinical attention for its potential in treating substance use disorders, paralleling recent enthusiasm surrounding medications such as semaglutide (Ozempic). 
• Although prior studies have demonstrated the efficacy of naltrexone in reducing cravings and relapses in alcohol and opioid use disorders, adherence and uptake in clinical populations have historically been suboptimal. 
• Emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, may attenuate alcohol consumption—prompting calls for direct comparative studies with agents like naltrexone to better inform pharmacotherapeutic strategies. 

Clubbing in Virtual Reality (Updated May 9, 2025)

KEY POINTS:

• “VR clubbing” refers to the practice of attending immersive, virtual dance environments via head-mounted display technology; these events often span extended durations and simulate real-world nightlife experiences. 
• Preliminary observational data and anecdotal reports suggest that some individuals engaging in virtual clubbing use psychoactive substances, including ketamine, lysergic acid diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA)—to enhance sensory immersion and emotional euphoria. 
• The phenomenon of extended virtual engagement, sometimes described as “digital benders” or VR binges, can persist for several consecutive days, raising concerns about dissociative symptoms, circadian disruption, and potential behavioral dysregulation among high-frequency users. 

Women With Alcohol Use Disorder Have a Different Disease (Updated June 13, 2025)

KEY POINTS:

• Due to lower gastric and hepatic alcohol dehydrogenase activity, women metabolize ethanol less efficiently than men, resulting in higher peak blood alcohol concentrations and increased physiological toxicity at comparable intake levels. 
• Neurobiological studies reveal that women exhibit unique neuroimmune signaling and heightened stress-related neural circuitry in the context of alcohol exposure—factors that may contribute to sex-specific vulnerability to alcohol use disorder (AUD). 
• Despite these biological distinctions, the majority of pharmacologic trials for AUD have historically enrolled predominantly male participants, highlighting the urgent need for sex-specific research to guide the development of tailored therapeutics and precision treatment strategies. 

Abused Drugs and Trends We’re Up Against in the U.S. (Updated July 2, 2025)  

KEY POINTS:

• Over the past decade, the United States has witnessed a sustained rise in overdose mortality driven by the combined use of opioids and stimulants, reflecting an increasingly complex and lethal substance use landscape. 
• Distinct geographic patterns have emerged, with fentanyl-cocaine co-involvement predominating in the Eastern U.S., while fentanyl-methamphetamine combinations are more prevalent in Western regions—posing regionally specific clinical challenges. 
• The dynamic and unpredictable nature of drug adulteration—often involving potent agents such as fentanyl analogs, local anesthetics, xylazine, and veterinary sedatives like medetomidine—continues to exacerbate overdose risk, complicate treatment response, and hinder toxicologic surveillance. 

Where Is the Anti-Fentanyl Truth Campaign? (Updated June 25, 2025)

KEY POINTS:

• The Truth Initiative is widely recognized for its evidence-based success in reducing youth tobacco use through strategic public messaging and the deliberate de-normalization of tobacco industry practices. 
• Public health experts have advocated for the application of similar stigmatization strategies targeting high-risk behaviors such as fentanyl use and “speedballing” (co-administration of opioids and stimulants via smoking or injection), aiming to counteract normalization and reduce initiation. 
• Concerningly, there is growing evidence that a subset of users—particularly those with repeated exposure—have become desensitized to the risks associated with fentanyl, cocaine, methamphetamine, and injection practices, indicating an urgent need for innovative harm reduction messaging and behavioral interventions.

Reducing Personal Shame and Stigma Helps with Recovery (June 11, 2025)

KEY POINTS:

• Reducing stigma and addressing internalized shame are essential components in enhancing an individual’s willingness to initiate and engage in treatment for substance use disorders. 
• The recovery process is inherently non-linear, requiring a flexible, patient-centered approach characterized by sustained support, clinical perseverance, and adaptability over time. 
• Sustained recovery extends beyond the cessation of substance use—it involves emotional maturation, identity development, and the cultivation of a purpose-driven, values-oriented life. 
• Lapses and relapses are recognized as clinical features of substance use disorders and should be met with compassion, accountability, and an emphasis on re-engagement, rather than punitive responses. 

 Finally! Some Good News About U.S. Drug Overdose Deaths (Updated February 7, 2025)

KEY POINTS:

• Modest Decline in Opioid-Related Mortality: National data indicate a decrease in opioid overdose deaths from 84,181 in 2022 to 81,083 in 2023. While this represents a positive shift, the overall burden remains substantial and underscores the need for sustained intervention and surveillance efforts. 
• Rising Mortality from Stimulant-Involved Overdoses: In contrast to the decline in opioid-related deaths, overdose fatalities involving methamphetamine and cocaine continued to rise in 2023. These increases reflect the growing complexity of polysubstance use and the limitations of opioid-centric treatment models. 
• Disproportionate Global Burden: Although the United States comprises only 4% of the global population, it accounts for approximately 20% of all drug overdose deaths worldwide. This stark disparity highlights systemic vulnerabilities in prevention, treatment access, and harm reduction infrastructure. 
• Illicitly Manufactured Fentanyls as a Primary Driver: An estimated 70% of U.S. overdose deaths in 2023 involved illegally manufactured fentanyls (IMFs), including fentanyl analogs such as carfentanil. These synthetic opioids continue to dominate the illicit drug supply and are frequently implicated in both fatal and nonfatal overdoses across all regions.

Neuromodulation in Addiction Treatment” (Updated January 18, 2025)

KEY POINTS:

• Emerging Role of Neuromodulation in Addiction Treatment: Neuromodulation represents a promising frontier in the management of substance use disorders (SUDs), offering non-pharmacologic strategies to modulate dysfunctional neural circuitry associated with compulsive substance use. 
• Transcranial Magnetic Stimulation (TMS) as a Pioneering Modality: TMS was the first neuromodulatory technique to receive regulatory approval for use in addiction treatment. By delivering targeted magnetic pulses to specific cortical regions, TMS has demonstrated efficacy in reducing cravings and enhancing executive control among individuals with SUDs. 
• Focused Ultrasound Neuromodulation and Craving Attenuation: Early clinical investigations suggest that low-intensity focused ultrasound may reduce craving intensity in individuals with opioid and other substance use disorders. This modality enables precise targeting of deep brain structures implicated in reward processing and craving regulation. 
• Targeting Core Neurobehavioral Circuits: Neuromodulation interventions engage brain regions critical for decision-making, inhibitory control, and reward valuation—particularly the dorsolateral prefrontal cortex, anterior cingulate cortex, and striatal pathways. Modifying activity within these networks may restore functional balance and reduce relapse risk.

 Finally! Some Good News About U.S. Drug Overdose Deaths (Updated February 7, 2025)

KEY POINTS:

• Modest Decline in Opioid-Related Mortality: National data indicate a decrease in opioid overdose deaths from 84,181 in 2022 to 81,083 in 2023. While this represents a positive shift, the overall burden remains substantial and underscores the need for sustained intervention and surveillance efforts. 
• Rising Mortality from Stimulant-Involved Overdoses: In contrast to the decline in opioid-related deaths, overdose fatalities involving methamphetamine and cocaine continued to rise in 2023. These increases reflect the growing complexity of polysubstance use and the limitations of opioid-centric treatment models. 
• Disproportionate Global Burden: Although the United States comprises only 4% of the global population, it accounts for approximately 20% of all drug overdose deaths worldwide. This stark disparity highlights systemic vulnerabilities in prevention, treatment access, and harm reduction infrastructure. 
• Illicitly Manufactured Fentanyls as a Primary Driver: An estimated 70% of U.S. overdose deaths in 2023 involved illegally manufactured fentanyls (IMFs), including fentanyl analogs such as carfentanil. These synthetic opioids continue to dominate the illicit drug supply and are frequently implicated in both fatal and nonfatal overdoses across all regions.

Medical” Marijuana and Chronic Pain” (Updated February 6, 2025)

KEY POINTS:

• Perceived Analgesic Effects and Patient Beliefs: While some patients report symptom relief from cannabis use—particularly in the context of chronic pain—robust, high-quality evidence remains limited and inconclusive. Patient-reported outcomes often reflect perceived benefit, though placebo effects and individual variability must be considered in clinical assessment. 
• Public Health Consequences of Expanded Access: The increased availability of both regulated and illicit cannabis products has coincided with a rise in adverse outcomes. These include higher rates of emergency department visits, psychiatric presentations, accidental ingestion in pediatric populations, and impaired driving. Concerns voiced by public health and addiction experts regarding commercialization, potency escalation, and youth access have begun to manifest in population-level data. 
• Epidemiology of Cannabis Use Disorder (CUD): CUD is currently the most rapidly growing substance use disorder in the United States. Prevalence is rising particularly among adolescents and young adults, with increased daily or near-daily use, high-potency THC products, and early onset of use contributing to addiction vulnerability and psychiatric comorbidity. 
• Clarifying Terminology in Clinical Contexts: The terms cannabis and marijuana are often used interchangeably, yet they carry important distinctions in medical and legal discourse. “Cannabis” refers broadly to the plant genus and all its constituent compounds, while “marijuana” is typically used to describe cannabis products that contain psychoactive concentrations of delta-9-tetrahydrocannabinol (THC), the compound primarily responsible for intoxication and addiction risk. 

Extreme Drinking on Holidays and Special Occasions High-intensity drinking on Christmas, New Year’s, and other events. (Updated December 26, 2024) 

KEY POINTS:

• Holiday-Associated Surge in Alcohol Consumption: Alcohol intake typically doubles among adults during celebratory events such as New Year’s Eve, substantially increasing the incidence of alcohol-related harm including impaired driving, domestic violence, and emergency room presentations. 
• Prevalence and Consequences of High-Intensity Drinking: High-intensity alcohol use—defined as consumption well beyond standard binge thresholds—is relatively common during holidays and is linked to acute adverse outcomes, including blackouts, traumatic injuries, emergency department visits, and exacerbation of psychiatric symptoms. 
• Lethality of Alcohol Poisoning: Rapid ingestion of large quantities of alcohol over a short time can result in alcohol poisoning, a potentially fatal condition characterized by respiratory depression, hypothermia, and loss of consciousness. Clinicians should remain vigilant during peak risk periods. 
• January 1st as a Marker of Elevated Alcohol-Related Mortality: Epidemiologic data consistently identify January 1st as the calendar day with the highest incidence of alcohol-related deaths annually, underscoring the need for targeted preventive messaging, early intervention, and harm reduction strategies during this period. 

“Top Findings on Addiction in 2024” (Updated January 26, 2025) 

KEY POINTS:

• Shifting Patterns in Opioid-Related Mortality: While intravenous opioid overdoses have declined in some regions, mortality associated with alternative routes of administration—such as smoking—and high-risk behaviors like speedballing (opioid-stimulant co-use) continues to rise. These trends reflect the evolving nature of polysubstance use and underscore the need for adaptive harm reduction strategies. 
• Clinical Significance of Non-Fatal Overdoses: Non-fatal opioid overdoses are not benign events. Hypoxic episodes resulting from respiratory depression can lead to lasting neurological injury, including cognitive impairment and motor dysfunction. These incidents should be treated as critical intervention points for initiating comprehensive care. 
• Psilocybin and Neuroplasticity: Psilocybin, a serotonergic psychedelic compound, has been shown to induce widespread but reversible alterations in brain functional connectivity. These changes are associated with enhanced neuroplasticity and may have therapeutic implications for mood, anxiety, and substance use disorders, though further research is warranted to establish long-term safety and efficacy. 
• Ibogaine as a Novel Therapeutic for Trauma and Brain Injury: Preliminary studies suggest that ibogaine, a psychoactive alkaloid derived from the Taberna the iboga plant, may offer neuropsychiatric benefits for individuals with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). In a recent study of U.S. Special Operations veterans, ibogaine treatment was associated with significant reductions in PTSD symptoms, depression, and functional impairments. While promising, these findings require replication in controlled clinical trials to assess safety, especially given ibogaine’s known cardiotoxicity. 

Teenage Abuse of Cough Medicines and Promethazine (Updated February 27, 2025) 

KEY POINTS:

• Underrecognized Prevalence of Medication Misuse Among Adolescents: Nonmedical use of prescription and over-the-counter (OTC) medications by adolescents may be more widespread than current surveillance data suggest. Such behavior is often underreported, especially when involving easily accessible OTC products, and may not be identified through routine substance use screenings. 
• Dextromethorphan (DXM) as a Misused Dissociative Agent: DXM, a common antitussive ingredient found in cough and cold preparations, is frequently misused by adolescents seeking dissociative or hallucinogenic experiences. At supratherapeutic doses, DXM acts on N-methyl-D-aspartate (NMDA) receptors, eliciting effects similar to those of ketamine or phencyclidine (PCP), and may pose significant psychiatric and neurologic risks. 
• Rising Co-Misuse with Promethazine: Recent toxicological alerts and anecdotal reports highlight a growing trend among adolescents to combine DXM with promethazine, an antihistamine with sedative and anticholinergic properties. This combination may amplify central nervous system depression and increase the potential for adverse events including respiratory compromise, delirium, and impaired cognition.

California Sober or Abstinences (Updated April 18, 2025)

KEY POINTS:

• Defining the “California Sober” Paradigm: The term “California sober” (or “Cali sober”) generally refers to a lifestyle in which individuals abstain from certain substances—typically alcohol and opioids—while continuing to use other perceived “less harmful” substances such as cannabis or psychedelics. This approach reflects a broader movement toward personalized harm reduction rather than complete abstinence. 
• Alternative Recovery Framework Post-Treatment or Overdose: For some individuals, particularly those with prior overdose experiences or dissatisfaction with abstinence-only models such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), “California sober” is positioned as a more attainable or acceptable form of recovery. It is often framed as a pragmatic response to rigid sobriety definitions that may not align with individual values or experiences. 
• Clinical and Ethical Considerations: Experts continue to examine the validity and limitations of “California sober” as a sustainable recovery strategy. Central to this discourse are concerns about cognitive distortions specifically the distinction between hope for control and actual loss of control indicative of addiction relapse. Clinicians must evaluate whether such approaches support long-term recovery or risk perpetuating cycles of dependence under the guise of moderation.

Abused Drugs and Trends We’re Up Against in the U.S. (July 2, 2025) 

KEY POINTS:

• Decade-Long Escalation in Overdose Mortality: Over the past ten years, the United States has experienced a sustained increase in overdose deaths involving opioids and stimulants. This trend reflects the growing complexity of polysubstance use and the evolving potency of the illicit drug supply. 
• Geographic Variability in Drug Combinations: Distinct regional patterns have emerged in the co-use of opioids and stimulants. In the Eastern U.S., the combination of cocaine and illicitly manufactured fentanyl is a predominant driver of overdose fatalities, whereas in the Western U.S., methamphetamine-fentanyl co-use is more prevalent. These patterns necessitate region-specific prevention and treatment strategies. 
• Toxic Adulterants and Unpredictable Drug Composition: The illicit drug supply is increasingly contaminated with pharmacologically active adulterants, including local anesthetics (e.g., lidocaine), veterinary sedatives such as xylazine, and alpha-2 agonists like medetomidine. These substances complicate overdose presentations, reduce the efficacy of standard reversal agents like naloxone, and contribute to atypical toxidromes and treatment resistance.

Drugs of Abuse Cause Addiction Through Effects on the Brain (June 19, 2025) 

KEY POINTS:

• Dopaminergic Alterations Across Substances of Abuse: Decades of neuroscientific research confirm that all major classes of addictive substances induce measurable alterations in dopamine signaling pathways, particularly within mesolimbic and mesocortical circuits. These changes disrupt the brain’s reward, motivation, and reinforcement systems and are implicated in the transition from voluntary use to compulsive drug-seeking behavior. 
• Mechanistic Insights into Addictive Processes: Scientific advances over the past 50 years have substantially expanded our understanding of how substances of abuse generate pleasure, modulate learning and memory circuits, and promote maladaptive reinforcement. This knowledge base has elucidated the neuroadaptive processes underlying tolerance, withdrawal, and relapse vulnerability. 
• Addiction as a Chronic Brain Disease: Addiction is now widely recognized as a chronic, relapsing disorder with neurobiological underpinnings. This paradigm shift is supported by integrative research across disciplines—encompassing neuroanatomy, molecular and cellular biology, pharmacology, and functional neuroimaging—which together have established addiction as a disease state characterized by durable alterations in brain structure and function.

The 10 Most Common Myths About Addiction (Updated December 25, 2024) 

KEY POINTS:

• Addiction Is a Treatable Medical Condition: Public and even professional misconceptions persist that addiction is untreatable or that individuals with strong moral character are somehow immune. Evidence-based interventions—including pharmacotherapy, psychotherapy, and integrated care—demonstrate that substance use disorders (SUDs) are chronic, relapsing conditions that can be effectively managed, particularly with early and sustained treatment. 
• The Fallacy of “Hitting Rock Bottom”: The notion that individuals must reach a crisis point before initiating recovery is not supported by clinical evidence. Intervening early in the course of substance misuse—much like with any progressive illness—leads to better outcomes and reduced risk of long-term harm. Waiting for escalation delays access to care and increases the potential for medical, legal, and social complications. 
• High Prevalence of Co-Occurring Disorders: Comorbidity between psychiatric disorders and SUDs is common and clinically significant. Individuals with mental health diagnoses such as depression, anxiety disorders, post-traumatic stress disorder (PTSD), or bipolar disorder are at elevated risk for substance misuse, and vice versa. Integrated treatment approaches that address both conditions concurrently yield the most effective outcomes.

The Concerning Emergence of “Gas Station Heroin” (June 3, 2025) 

KEY POINTS:

• Tianeptine and Regulatory Evasion: Commonly referred to as “gas station heroin,” tianeptine is a tricyclic antidepressant developed for depression but never approved for medical use in the United States. Despite its opioid-like activity at the mu-opioid receptor, it is marketed as a dietary supplement or nootropic, exploiting regulatory loopholes that allow its sale in convenience stores and online platforms. 
• Addictive Potential and Adverse Outcomes: At supratherapeutic doses, tianeptine produces euphoria, sedation, and dependence, with withdrawal symptoms resembling those of classical opioids. Poison control centers have reported a dramatic rise in tianeptine-related exposures, including cases of respiratory depression, seizures, and intensive care admissions. 
• Synthetic 7-Hydroxymitragynine (7-OH) Misrepresentation: Products labeled as kratom extracts may contain synthetic 7-OH, a highly potent mu-opioid receptor agonist up to 30 times stronger than morphine. These substances are often falsely marketed as natural kratom derivatives, misleading consumers and increasing the risk of overdose, dependence, and respiratory compromise. 
• Clinical and Public Health Implications: Both tianeptine and synthetic 7-OH products represent significant challenges for clinicians due to their unregulated status, high abuse potential, and lack of detection in standard toxicology screens. Increased awareness, early identification, and advocacy for regulatory oversight are essential to mitigate harm and guide appropriate intervention.

Obesity Actually Changes Your Brain (May 19, 2025) 

KEY POINTS:

• Dopaminergic Dysregulation in Obesity: Neuroimaging studies have demonstrated that individuals with obesity exhibit a reduction in striatal dopamine D2 receptor availability. This alteration is associated with diminished reward sensitivity and may contribute to compensatory overeating as individuals seek to restore hedonic balance through excessive food intake. 
• Somatotopic Structural Changes Reinforcing Hyperphagia: Structural brain alterations have been identified in somatosensory regions representing the oral and facial areas, including the mouth, lips, and tongue. These changes are hypothesized to reinforce maladaptive eating patterns by increasing attentional salience and sensorimotor responsiveness to food-related stimuli. 
• Impact of Western Dietary Patterns on Neural Plasticity: Chronic consumption of high-fat, high-sugar diets—hallmarks of the Western dietary pattern—has been shown to remodel central reward and regulatory circuits. This neuroplastic shift promotes habitual overconsumption and impairs homeostatic control mechanisms. 
• GLP-1 Receptor Agonists and Neurocircuitry Modulation: Emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists not only regulate peripheral appetite signals but may also modulate central neural circuits involved in reward processing, impulse control, and motivation. These agents may partially reverse obesity-associated brain changes, supporting their role as both metabolic and neuropsychiatric interventions.

Is Sugar Really “Poison”? (May 6, 2025) 

KEY POINTS:

Certainly—here is a revised version in an academic and clinically relevant tone, tailored for physicians, therapists, and behavioral health professionals: 

• Public Health Framing of Sugar Consumption: In a recent public statement, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. referred to sugar as “poison,” invoking the toxicological principle that “the dose makes the poison” to underscore the health risks associated with excessive sugar intake. His remarks reflect growing concern over the role of added sugars in the rising prevalence of metabolic and neuropsychiatric disorders. 
• Neuroadaptive Changes and Dietary Behavior: Emerging evidence suggests that chronic consumption of high-sugar diets may induce neuroplastic changes in brain regions governing reward, impulse control, and homeostatic regulation. These alterations can reinforce maladaptive eating behaviors, reduce dietary restraint, and contribute to compulsive food-seeking patterns—particularly in individuals with obesity. 
• Obesity-Related Brain Responsiveness to Food Cues: Neuroimaging studies have demonstrated that individuals with obesity exhibit heightened activation in brain regions associated with gustatory processing and reward anticipation in response to food-related stimuli. This increased responsivity may perpetuate overeating and complicate behavioral interventions aimed at dietary modification.

Why Language of Key Self-Help Groups Works (May 11, 2025) 

KEY POINTS:

• Therapeutic Use of Language in Recovery Communities: Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) employ structured language, slogans, and metaphors as core components of their recovery framework. These linguistic tools serve not only to convey shared experience but also to reinforce behavioral change, promote cognitive reframing, and support relapse prevention. 
• Behavioral Science Behind “One Day at a Time”: The widely used phrase “one day at a time” reflects a behavioral strategy rooted in present-focused coping and incremental goal setting. This approach aligns with evidence-based relapse prevention models that emphasize short-term behavioral targets to reduce overwhelm and enhance self-efficacy. 
• The “Cucumber-to-Pickle” Metaphor and Neurobiological Correlates: A frequently cited metaphor in 12-step circles likens the irreversible transformation of a cucumber into a pickle to the neuroadaptive changes associated with addiction. This analogy resonates with neuroscientific findings that chronic substance use induces lasting alterations in brain circuitry, particularly in reward, motivation, and executive function systems. 
• The Big Book as a Cognitive-Behavioral Resource: The foundational text of AA, commonly referred to as the “Big Book,” contains numerous sayings and metaphors that function as cognitive anchors. These narrative devices facilitate insight, normalize struggle, and provide accessible frameworks for understanding the chronic and relapsing nature of addiction. Clinicians may find value in exploring these elements to better understand the mechanisms by which 12-step programs support recovery.

March 2025 Sports Gambling Madness (Updated April 7, 2025)

KEY POINTS:

• Prevalence of Sports Wagering in the General Population: In 2025, an estimated 68 million U.S. adults—approximately one in four—intended to participate in March Madness betting, collectively wagering $15.5 billion. This level of engagement reflects the growing normalization of gambling behaviors, particularly in association with major sporting events. 
• Clinical Criteria for Gambling Disorder: Gambling disorder is recognized as a behavioral addiction in the DSM-5, characterized by persistent and recurrent maladaptive gambling behavior. Core diagnostic features include compulsivity, impaired control, development of tolerance, preoccupation with gambling, and withdrawal-like symptoms in the absence of gambling opportunities. 
• Digital Platforms and Accessibility: The proliferation of smartphone technology, online gambling platforms, in-play betting options, and targeted marketing via social media has dramatically increased accessibility and frequency of gambling behaviors. These digital innovations are particularly associated with high-risk patterns of impulsive and compulsive gambling, especially among younger populations. 
• Implications for Screening and Intervention: The expanding digital ecosystem of gambling necessitates routine screening in clinical settings, including primary care, psychiatry, and adolescent medicine. Clinicians should be aware of the unique features of online gambling, including its continuous nature and dissociation from tangible currency—and integrate behavioral interventions that address both psychological drivers and technological facilitators of gambling-related harm.

Go Ahead, Drink your Coffee (updated April 6, 2025) 

KEY POINTS:

• Protective Associations with All-Cause Mortality: A robust body of epidemiological literature—comprising over 50 cohort and population-based studies—demonstrates that regular consumption of moderate amounts of coffee is associated with a reduction in all-cause mortality. Benefits have been observed across diverse populations and appear to extend to both caffeinated and decaffeinated coffee. 
• Caffeine Content Variability and Clinical Awareness: A standard cup of caffeinated coffee typically contains between 80 to 120 mg of caffeine, though actual amounts vary based on preparation method, bean type, and serving size. Importantly, decaffeinated coffee often retains measurable caffeine content—sometimes upwards of 10–20 mg per cup—which may be clinically relevant for sensitive individuals or those advised to limit stimulant exposure. 
• Caffeine as a Mildly Dependence-Producing Agent: While caffeine can lead to physiological dependence and withdrawal symptoms—such as headache, fatigue, and irritability, it is not associated with the compulsive use patterns, neurotoxicity, or behavioral dysregulation characteristic of high-risk stimulants (e.g., amphetamines, cocaine). From a clinical standpoint, caffeine use rarely requires formal intervention but warrants discussion in cases of sleep disturbance, anxiety exacerbation, or cardiovascular sensitivity.

5 Common False Beliefs About Drug Use, Users, and Addiction (Updated March 4, 2025)

KEY POINTS:

• Barriers to Timely Treatment: Misconceptions and Evidence Disregard: Widespread societal misconceptions—such as viewing addiction as a moral failing or personal weakness—continue to impede early intervention. Additionally, the underutilization of research-informed practices delays treatment initiation and contributes to poorer long-term outcomes. Promoting scientific literacy among providers and the public is essential to dismantle stigma and facilitate timely care. 
• Enduring Consequences of Substance Use: The use of addictive substances is associated with a broad array of long-lasting harms spanning physical health deterioration (e.g., cardiovascular, hepatic, and neurological damage), mental health complications, social disruption, and impaired relational functioning. These impacts often persist long after acute intoxication subsides, underscoring addiction’s chronic and relapsing nature. 
• Urgency of Youth-Focused Prevention Efforts: Adolescents and young adults represent a high-risk population for initiating substance use, with early exposure linked to elevated risk for lifelong addiction, psychiatric comorbidities, and impaired neurodevelopment. Despite this vulnerability, prevention initiatives targeting youth remain underfunded relative to treatment expenditures. Robust investment in school- and community-based prevention programs is both evidence-based and cost-effective. 

Detoxing From Dopamine from Fast Food to Pornography to AI, We’re Drowning in Dopamine (November 25, 2025)

KEY POINTS:

• Neurobiological Balance Between Reward and Aversion: The human brain operates under a dynamic equilibrium between hedonic (pleasurable) and dysphoric (pain-related) signaling systems. This regulatory balance, often described in terms of allostasis, allows for adaptive responses to environmental stimuli and maintains emotional homeostasis. 
• Consequences of Repeated Hedonic Overstimulation: Chronic over engagement in highly rewarding behaviors—such as substance use, compulsive eating, gambling, or digital media consumption—can result in downregulation of dopamine receptors and diminished sensitivity to naturally occurring rewards. This neuroadaptive process, often referred to as “reward system desensitization,” increases vulnerability to addiction by promoting compulsive behavior and anhedonia. 
• Dopamine Fasting and Neural Reset Hypotheses: Emerging behavioral strategies such as “dopamine fasting”—involving temporary abstinence from reinforcing activities—are thought to reduce stimulus-induced neuroadaptation and may facilitate a partial restoration of baseline dopaminergic tone. While largely theoretical and requiring further empirical validation, this concept aligns with broader clinical practices of behavioral withdrawal and stimulus control in addiction treatment. 

Grading the Progress of National Initiatives on the Opioid Crisis (January 31, 2025)

KEY POINTS:

• Strategic Framework Development in 2016: In response to escalating opioid-related morbidity and mortality, leading public health and addiction experts outlined comprehensive strategies in 2016 aimed at curbing the opioid epidemic. These included evidence-based prevention, treatment expansion, supply chain regulation, and harm reduction approaches. 
• Policy and Programmatic Innovations: Following this roadmap, numerous federal, state, and local initiatives were launched. These efforts encompassed expanded access to medications for opioid use disorder (MOUD), prescription drug monitoring programs (PDMPs), naloxone distribution, provider education, and integration of behavioral health services into primary care. 
• Measurable Reductions in Opioid-Related Harms: Preliminary outcomes indicate that several of these interventions have yielded tangible public health benefits. These include declines in prescription opioid availability, increased initiation of MOUD, reduced overdose fatalities in select jurisdictions, and a growing national emphasis on recovery-oriented systems of care.

The Current State of the Polydrug Use Epidemic (December 2, 2024)

KEY POINTS:

• Polydrug Use as the Defining Feature of the Current Epidemic: The United States is now experiencing the “Fourth Wave” of the opioid overdose crisis, characterized by widespread and escalating patterns of polysubstance use. Unlike earlier waves driven by prescription opioids, heroin, or fentanyl alone, this phase is marked by the concurrent use of multiple substances—often involving combinations of opioids, stimulants, and sedatives—which significantly increases overdose risk. 
• High Co-Positivity Rates in Fentanyl-Positive Patients: A 2024 analysis of over 4 million urine drug test results revealed that 93% of individuals who tested positive for fentanyl also had additional substances present in their system. This finding underscores the pervasiveness of polysubstance use and the limitations of single-substance treatment models. 
• Youth and Event-Based Risk Environments: A recent study found that 87% of music festival attendees reported plans to use substances during events, with polydrug use being common. These findings highlight the need for targeted harm reduction strategies in high-risk social settings, particularly among adolescents and young adults. 
• 2010 and 2022, unintentional overdose deaths in the U.S. quadrupled, with the majority involving multiple substances. This trend reflects the increasing lethality of the illicit drug supply and the urgent need for comprehensive, multi-substance overdose prevention and treatment approaches.

Overdose Survivors: Medical and addiction Challenges (December 4, 2024)

KEY POINTS:

• Prevalence of Addiction Among Older Adults: Contrary to common misconceptions, substance use disorders (SUDs) are not limited to younger populations. More than 2 million adults aged 65 and older in the United States are currently living with an SUD—a number expected to rise with demographic shifts and evolving substance use patterns. 
• Alcohol and Prescription Misuse as Leading Diagnoses: Alcohol use disorder (AUD) remains the most prevalent SUD among older adults, followed by the nonmedical use of prescription medications, including opioids, benzodiazepines, and sedative-hypnotics. Age-related changes in pharmacokinetics and pharmacodynamics further amplify the risks associated with substance misuse in this population. 
• Overdose as a Critical Clinical Marker: In older adults, an overdose should be viewed as a sentinel event indicating significant underlying pathology. Beyond its acute medical consequences, overdose signals heightened vulnerability and often precipitate long-term physical, cognitive, and functional decline. Timely intervention following an overdose is essential for both prevention and recovery planning. 
• Medication-Assisted Treatment (MAT) and Relapse Vulnerability: Medication-assisted treatments—such as buprenorphine, methadone, or extended-release naltrexone—are highly effective in reducing opioid-related mortality when maintained over time. However, discontinuation of MAT is frequently associated with relapse and increased risk of fatal overdose, highlighting the importance of continuity of care and long-term treatment engagement in older patients.

A Vaccine Against Fentanyl! (October 21, 2024)

KEY POINTS:

• Persistent Challenges in SUD Treatment Outcomes: Despite significant progress in the development of pharmacologic and behavioral interventions for substance use disorders (SUDs), relapse and overdose remain prevalent. These outcomes underscore the need for novel adjunctive therapies that can enhance long-term recovery and reduce mortality. 
• Vaccine-Based Approaches Informed by Preclinical Research: Over the past five decades, animal models have played a pivotal role in advancing vaccine technologies aimed at treating SUDs. These studies have laid the groundwork for immunotherapies that target specific substances by eliciting antibodies to neutralize their psychoactive effects before they reach the brain. 
• Anti-Fentanyl Vaccine as a Potential Breakthrough: A promising anti-fentanyl vaccine has emerged from this body of research, designed to generate antibodies that bind fentanyl in the bloodstream and prevent its central nervous system penetration. Preclinical studies have demonstrated efficacy in blocking fentanyl’s euphoric and respiratory-depressant effects, with human trials anticipated in the near future. 
• Decades of Scientific Investment: The development of this vaccine reflects over 36 years of sustained interdisciplinary research, integrating immunology, pharmacology, and addiction neuroscience. While not yet approved for clinical use, the vaccine represents a potentially transformative tool in combating the ongoing fentanyl-driven overdose crisis.

Not So Pretty in Pink Cocaine (November 8, 2025) 

KEY POINTS:

• Polysubstance Composition and Unpredictability: Commonly referred to as “pink cocaine,” “tusi,” or “tucibi,” this substance is not a single chemical entity but rather a variable mixture of psychoactive compounds. Laboratory analyses have identified combinations including ketamine, MDMA (ecstasy), methamphetamine, fentanyl, xylazine, and other novel synthetic drugs. The lack of standardization renders each batch pharmacologically unpredictable and significantly increases the risk of adverse effects and overdose. 
• Cultural Appeal and Misleading Nomenclature: Despite its name, pink cocaine rarely contains cocaine or the psychedelic 2C-B, from which its nickname is derived. The pink coloration—achieved through food dye—is a marketing tactic aimed at enhancing visual appeal, particularly among young adults in nightlife settings. The drug’s association with elite party scenes and celebrity culture, including reported use at events linked to public figures such as Sean “Diddy” Combs, has contributed to its glamorization and rising popularity. 
• Clinical and Public Health Concerns: The unpredictable composition of pink cocaine poses serious clinical challenges. Users may experience a wide range of effects—from euphoria and hallucinations to respiratory depression, seizures, and cardiac arrest—depending on the substances present. The co-ingestion of stimulants and depressants within a single dose further complicates management and increases the likelihood of toxic interactions.

Teen and Young Adult Abuse of Nitrous Oxide (August 11, 2025)

KEY POINTS:

• Decline in Traditional Substance Use Among Adolescents: Recent national surveys indicate a sustained decrease in adolescent use of conventional substances such as tobacco, alcohol, cannabis, and other drugs. This trend may reflect the success of public health campaigns, regulatory efforts, and shifting cultural norms surrounding substance use. 
• Surge in Recreational Hallucinogen Use: In contrast, there has been a notable rise in the recreational use of hallucinogens among teens, including psilocybin, LSD, and dissociative agents. These substances are often perceived as “natural” or therapeutic, despite their potential to disrupt neurodevelopment and precipitate psychiatric symptoms during adolescence—a critical period for brain maturation. 
• Nitrous Oxide Misuse as a Maladaptive Coping Strategy: The increasing use of nitrous oxide (“laughing gas”) by adolescents may represent a maladaptive response to unmet mental health needs, including anxiety, depression, and trauma. Easy accessibility, social media promotion, and the perception of safety contribute to its appeal, despite risks of neurological damage, vitamin B12 deficiency, and cardiovascular complications. 
• Therapeutic Exploration of Nitrous Oxide in Psychiatry: Paradoxically, nitrous oxide is also under investigation as a rapid-acting intervention for treatment-resistant depression. Clinical trials have demonstrated that low-dose administration can produce significant antidepressant effects, potentially through modulation of glutamatergic neurotransmission and neuroplasticity mechanisms. This duality underscores the importance of clinical context, dosing, and supervision in distinguishing therapeutic use from recreational misuse.

Is Hallucinogen Dependence or Use Disorder Real? (August 13, 2025) 

KEY POINTS:

• Low Physical Dependence Potential: Preclinical and clinical research suggests that classic psychedelics such as psilocybin and LSD exhibit minimal risk for physical dependence or withdrawal symptoms. 
• Psychological and Behavioral Risks: Despite low physical addiction potential, these substances may contribute to hallucinogen use disorder, psychological dependence, acute anxiety reactions, panic episodes, and in some cases, the emergence or exacerbation of psychotic symptoms. 
• Public Health Concerns: Trends in decriminalization, unsupervised self-medication, and concurrent use with other substances (polysubstance use) are raising significant concerns among healthcare professionals regarding safety, misuse, and long-term outcomes.

Ending Tobacco and Nicotine Addiction (August 8, 2025) 

KEY POINTS:

• Increased Prevalence Among Individuals with Mental Illness: Research consistently shows that individuals experiencing depression and other psychiatric disorders have a higher likelihood of cigarette use compared to the general population. 
• Approved Nicotine Replacement Therapies (NRTs): The FDA has approved several NRT modalities—including transdermal patches, gum, lozenges, nasal sprays, and inhalers—as effective interventions for managing nicotine dependence associated with cigarette smoking. 
• Vaping as a Harm Reduction Strategy: While electronic nicotine delivery systems (ENDS), such as vaping, have been proposed as a harm-reduction alternative for adult smokers, ongoing concerns remain regarding their long-term safety, efficacy, and potential for continued nicotine dependence. 
• Pharmacologic Treatment Efficacy: Varenicline (Chantix) is currently regarded as the most effective pharmacologic agent for smoking cessation, demonstrating superior outcomes in reducing both cigarette and nicotine vaping use.

Thousands of Clinics Treat Patients with Ketamine. Are they Safe? (August 1, 2025) 

KEY POINTS:

• Rapid Expansion of Ketamine Treatment Centers: A growing number of clinics across the country are offering ketamine—primarily via intravenous administration—as a treatment for various psychiatric conditions, including depression, anxiety, and PTSD. 
• Off-Label Use and Regulatory Ambiguity: Many of these clinics operate within a regulatory gray area, utilizing ketamine for psychiatric indications that have not received formal FDA approval. This raises concerns about consistency in clinical protocols and patient safety. 
• Lack of Standardized Oversight: Unlike FDA-approved uses of ketamine, these clinics are not required to adhere to federal guidelines or implement the patient protections typically mandated in regulated treatment settings. This absence of oversight may pose risks related to dosing, monitoring, and follow-up care.

On the Horizon: Intravenous Ketamine for Suicidal Depression (September 4, 2025)

KEY POINTS:

• In 2023, the United States recorded 49,316 suicide deaths, averaging one death every 10.7 minutes. Suicide remains the 11th leading cause of death nationally and the second leading cause among individuals aged 10–34.  
• Survivors of suicide attempts frequently report immediate regret, highlighting the importance of timely intervention and the potential reversibility of suicidal crises.  
• Intravenous ketamine is emerging as a promising treatment for acute suicidal ideation in depression, with rapid onset of action and significant reductions in suicidal thoughts observed within hours of administration. Clinical trials have demonstrated ketamine’s efficacy in treatment-resistant depression, with some studies showing remission of suicidal ideation in over 60% of patients within three days.

Illicit Drugs are Rarely What They Seem (August 19, 2025) 

KEY POINTS:

• Adulteration is a longstanding and pervasive feature of illicit drug markets, affecting substances such as cocaine, methamphetamine, and heroin. These drugs are frequently cut with pharmacologically active agents to increase bulk, mimic effects, or facilitate administration. 
• The emergence of illicitly manufactured fentanyl (IMF) in the U.S. drug supply has significantly escalated overdose deaths over the past decade. Initially introduced as an adulterant in heroin, fentanyl has now largely supplanted heroin in many regions due to its potency and ease of production.  
• A concerning new trend involves the adulteration of IMF with local anesthetics—commonly referred to as “-caines,” including lidocaine and procaine. These additives can produce atypical overdose presentations, such as numbness, agitation, hallucinations, and seizures, and may complicate treatment with naloxone.

Magic Mushroom, Teens, and Young Adults (November 14, 2024) 

KEY POINTS:

• Psilocybin use has surged among adolescents and young adults, with past-year use increasing by 44% in individuals aged 18–29 and poison center calls rising by 317% among teens between 2019 and 2023. This trend coincides with growing public interest in psychedelic therapies and state-level decriminalization efforts. 
• Psilocybin, the psychoactive compound in hallucinogenic mushrooms, remains a Schedule I controlled substance under federal law, despite its exploration in clinical research for conditions such as depression and PTSD. 
• Emergency departments and poison control centers are increasingly managing adverse events linked to psilocybin, including seizures, cardiovascular symptoms, and toxic reactions from mislabeled or contaminated mushroom products.  
• Emerging research suggests psilocybin disrupts normal brain wave patterns and neural communication, particularly in the anterior cingulate cortex—a region critical for emotional regulation and cognitive control. These disruptions may pose heightened risks to the developing brain, potentially leading to long-term neuropsychiatric consequences.

Methamphetamine is a Major Drug Threat in the U.S. (December 27, 2024)

KEY POINTS:

• Methamphetamine abuse continues to rise in the United States, contributing to a growing public health crisis. Between 2015 and 2019, frequent methamphetamine use increased by 66%, and methamphetamine use disorder (MUD) rose by 62%. 
• Overdose deaths involving methamphetamine have escalated sharply, particularly due to its co-use with synthetic opioids. In recent years, over 70% of stimulant-related deaths have involved fentanyl, often through contamination or intentional mixing in pills, smoke, or intravenous use. 
• The combination of methamphetamine and fentanyl is now a leading cause of overdose fatalities, reflecting the emergence of a fourth wave in the overdose epidemic characterized by polysubstance use.  
• Despite the severity of methamphetamine use disorder, no FDA-approved medications currently exist for its treatment or for reversing overdose. However, a recent NIH-sponsored trial showed that a combination of injectable naltrexone and oral bupropion significantly improved outcomes in individuals with moderate to severe MUD, offering a promising direction for future therapies.

March 2025 Sports Gambling Madness (April 7, 2025) 

KEY POINTS:

• An estimated 68 million Americans—approximately one in four adults—planned to wager $15.5 billion on the 2025 NCAA March Madness tournament, reflecting the rapid normalization and expansion of sports gambling in the U.S.  
• Gambling disorder is a recognized behavioral addiction, defined by persistent and recurrent gambling behavior that leads to significant impairment or distress. Diagnostic criteria include compulsive gambling, impaired control, tolerance, withdrawal, and continued behavior despite adverse consequences. 
• The proliferation of smartphone apps, online betting platforms, in-play wagering, and social media marketing has dramatically increased access to gambling, particularly among young adults. These technologies facilitate impulsive betting behaviors and are associated with higher rates of gambling disorder.

Moderate or “safe” Alcohol Consumption: True or Oxymoron (August 8, 2025)

KEY POINTS:

• The U.S. Surgeon General has issued a new advisory emphasizing the established link between alcohol consumption and cancer. Alcohol is now recognized as a preventable carcinogen, contributing to approximately 20,000 cancer-related deaths annually in the United States. 
• Alcohol is causally associated with multiple cancer types, including breast, liver, esophageal, and colorectal cancers. Even low to moderate consumption increases risk, challenging long-held assumptions about the safety of moderate drinking. 
• While some studies have suggested that moderate alcohol use may be associated with neutral or slightly improved lifespan compared to abstinence, these findings are increasingly scrutinized due to confounding variables such as socioeconomic status and misclassification of former heavy drinkers. 
• Pharmacological harm-reduction strategies are gaining traction, particularly with agents like naltrexone, an opioid antagonist approved for alcohol use disorder, and GLP-1 receptor agonists such as semaglutide, which have shown promise in reducing alcohol consumption by modulating reward pathways and appetite regulation.

Understanding Problematic Social Media Use in Adolescents (August 27, 2025

KEY POINTS:

• Problematic social media use (PSMU) reflects behavioral addiction patterns: It extends beyond a desire for social connection and mirrors compulsive engagement similar to other addictive disorders, with potential implications for emotional regulation and cognitive functioning. 
• High usage alone is not indicative of pathology: The clinical concern lies in the functional impairment caused by social media use—such as disrupted sleep, academic decline, interpersonal conflict, or mood disturbances—not merely the frequency of engagement. 
• Adolescents increasingly form emotionally significant digital relationships: Some youth demonstrate dependence on AI-driven platforms for emotional support and decision-making, which may interfere with the development of healthy coping mechanisms and therapeutic alliances.

“Gas Station Weed”:  Delta-8 and Delta-10 THC (June 26, 2025) 

KEY POINTS:

• Synthetic and semi-synthetic cannabinoids—including Delta-8-THC and Delta-10-THC—can exhibit psychoactive potency equal to or greater than traditional cannabis. These compounds are increasingly implicated in psychiatric symptoms, including psychosis, agitation, and cognitive impairment, especially among youth. 
• Delta-8-THC use among adolescents is rising and strongly associated with emergency department visits. Poison control data reveal thousands of pediatric exposures, with symptoms ranging from confusion and vomiting to seizures and coma. One fatality was directly attributed to Delta-8 toxicity. 
• Products like Delta-8, Delta-9, K2, and Spice are often marketed as “safe” or “legal” alternatives to marijuana, yet they are frequently mislabeled, unregulated, and contaminated. Their packaging and advertising often target youth, contributing to widespread misconceptions about safety and risk. 
• Unlike cannabidiol (CBD), which is non-intoxicating, Delta-8-THC and Delta-10-THC are psychoactive substances. Their use has been linked to addiction profiles similar to cannabis use disorder, with tolerance, withdrawal, and psychosocial impairment documented in case reports.

Are Girls the New Potheads? (August 29, 2025) 

KEY POINTS:

• Recent epidemiological data reveal a gender reversal in adolescent cannabis use: For the first time in five decades of national surveillance, female high school students now report higher rates of marijuana use than their male peers. This shift is particularly pronounced in grades 8, 10, and 12. 
• Cannabis vaping is a key driver of increased use among adolescent girls: Girls are more likely than boys to vape marijuana across all grade levels, with vaping perceived as more discreet and socially acceptable. This trend may reflect both biological sensitivity to THC and psychosocial factors such as mood regulation and body image concerns. 
• Vape marketing and social media content disproportionately target and influence female adolescents: Packaging aesthetics (e.g., pastel colors, fruity flavors) and influencer-driven content on platforms like TikTok have been shown to increase the likelihood of cannabis initiation and dual use (nicotine and cannabis) among teen girls.

Generation K for Ketamine Use Disorders (August 2, 2025)

KEY POINTS:

• Ketamine, though not classified as an opioid, demonstrates addiction potential in clinical settings. Chronic use has been associated with tolerance, withdrawal symptoms, and compulsive patterns of use, particularly among adolescents and young adults. 
• Recreational ketamine use is rising sharply among Generation Z, with social media platforms like TikTok contributing to its normalization. This demographic—sometimes referred to as “Generation K”—is increasingly exposed to ketamine-related content that trivializes its risks, despite a 650% increase in ketamine-related deaths since 2015. 
• Ketamine’s pharmacological effects involve both NMDA receptor antagonism and interaction with the opioid system. These dual mechanisms contribute to its dissociative, analgesic, and antidepressant properties, but also raise concerns about misuse and neuropsychiatric side effects with repeated exposure.

Highest Drug-Taking Risks (July 12, 2025)

KEY POINTS:

• Polysubstance use is now the predominant driver of drug overdose mortality: The majority of overdose deaths in the U.S. involve multiple substances, with combinations of synthetic opioids (e.g., fentanyl) and stimulants (e.g., cocaine or methamphetamine) accounting for a significant and growing proportion of fatalities. 
• The co-use of fentanyl with stimulants is fueling the “fourth wave” of the overdose crisis: This lethal combination is increasingly common and presents unique challenges for clinical management, including atypical presentations and reduced responsiveness to naloxone. 
• High-risk drug combinations are frequently used in nightlife and festival settings: Substances such as MDMA, ketamine, cocaine, and synthetic stimulants are commonly consumed at raves and music festivals, often in unpredictable mixtures. These environments amplify risks due to dehydration, hyperthermia, and impaired judgment. 
• “CK” (Calvin Klein) is a modern iteration of the speedball concept: This combination of a stimulant (typically cocaine) and a dissociative anesthetic (ketamine) produce synergistic effects that can mask intoxication, increase cardiovascular strain, and elevate the risk of overdose, psychosis, and behavioral dysregulation.

Do Ritalin and Psychostimulants Actually Improve Thinking and Learning? (July 27, 2025)

KEY POINTS:

• Exciting research shows that Methylphenidate (Ritalin) does more than just manage ADHD symptoms—it plays a powerful role in reducing self-harm, accidental injuries, motor vehicle crashes, and even criminal behavior. 
• When introduced before adolescence in individuals diagnosed with ADHD, MPH has been linked to a lower risk of developing substance use disorders later in life. However, it is important to note that early use in those without ADHD may carry different risks—highlighting the importance of accurate diagnosis and personalized care. 
• What makes MPH truly remarkable is how it mimics the brain’s natural neurochemical rhythms, helping the brain feel rested, regulated, and ready to function at its best. 

Hooked on Screens (July 1, 2025) 

KEY POINTS:

• The adolescent mental health landscape is facing a new and urgent challenge: behavioral addiction to smartphones, social media, and video games. Groundbreaking longitudinal research reveals that it is not the amount of screen time that matters—it is the compulsive, distress-driven use that poses the greatest psychiatric risk. 
• In a cohort of over 4,000 U.S. youths tracked from ages 9 to 14, researchers found that addictive patterns of screen use—marked by loss of control, emotional reliance, and withdrawal-like symptoms—were strongly linked to anxiety, depression, and suicidal ideation and behavior. 
• Adolescents with high or increasing trajectories of addictive use were two to three times more likely to experience suicidal thoughts or attempts compared to their peers with low addictive use. 
• This emerging evidence calls for a paradigm shift in clinical practice: away from simply monitoring screen time and toward identifying behavioral addiction markers—such as compulsive engagement, emotional dysregulation, and impaired functioning. These patterns mirror DSM-5 criteria for gambling disorders and may benefit from interventions rooted in addiction medicine, including CBT, motivational interviewing, and structured support systems. 
• Mental health professionals are uniquely positioned to lead this shift—by integrating digital behavior assessments into routine care, educating families, and advocating for nuanced, personalized approaches to screen use.

Hope for Depression and Other Diagnoses with Psychedelics (July 31, 2025) 

KEY POINTS:

• The field of mental health is entering a transformative era, with psychedelic-assisted therapies gaining momentum across clinical trials for major depression, anxiety, PTSD, and beyond. These studies are not fringe science—they’re rigorous, FDA-reviewed investigations that are reshaping our understanding of psychiatric care. 
• In a groundbreaking development, a Phase 3 clinical trial of psilocybin (COMP360) for treatment-resistant depression has reported statistically and clinically significant improvements in symptom severity compared to placebo. 
• This marks a historic milestone—the first time a classic psychedelic has reached this level of clinical validation. 
• What makes psilocybin so promising? It appears to reboot the brain’s functional connectivity, disrupting rigid, maladaptive patterns and allowing for greater cognitive flexibility and emotional processing. 
• These changes may help patients reframe entrenched beliefs, reduce rumination, and enter a more adaptive and resilient mental state. 
• As the evidence base grows, mental health professionals are called to engage with this paradigm shift—educating themselves, preparing for integration into practice, and advocating for safe, ethical, and evidence-based psychedelic care.

Treating Anorexia or Bulimia Nervosa and Substance Use Disorders (August 5, 2025)

KEY POINTS:

• Eating disorders (EDs) remain among the most challenging psychiatric conditions to treat—especially when complicated by substance use. Alarmingly, up to 50% of individuals with EDs also struggle with alcohol or illicit drug use, a dual diagnosis that significantly increases morbidity and complicates recovery. Despite the severity of anorexia nervosa (AN) and bulimia nervosa (BN), no FDA-approved medications currently exist for their treatment. 
• In this therapeutic vacuum, patients often turn to cannabis and psychedelics as forms of self-medication, seeking relief from emotional distress and rigid thought patterns. But hope is on the horizon. Psilocybin-assisted therapy is emerging as a promising intervention for individuals with EDs, particularly those with treatment-resistant anorexia and binge eating disorders. Early-phase clinical trials have shown that psilocybin may enhance cognitive flexibility, reduce compulsive behaviors, and improve emotional regulation. 
• In a recent trial at UC San Diego, 90% of participants with anorexia ranked their psilocybin session among the most meaningful experiences of their lives, with notable improvements in body image and quality of life. Meanwhile, a Phase II trial at the University of Florida reported an 80% reduction in binge eating episodes following psilocybin-assisted psychotherapy. 
• These findings suggest that psychedelics may offer a novel neurobiological reset, helping the brain break free from entrenched patterns and enter a more adaptive, resilient state. As research progresses, mental health professionals are encouraged to stay informed, advocate for rigorous safety protocols, and prepare for the integration of psychedelic therapies into clinical practice.

Molly (aka MDMA and Ecstasy) Today (August 18, 2025) 

KEY POINTS:

• MDMA (3,4-methylenedioxymethamphetamine) is not just a party drug—it’s an entactogen, a compound that uniquely fosters emotional openness, empathy, and deep interpersonal connection. These properties have made it a compelling candidate for psychotherapy-enhancement, especially in the treatment of post-traumatic stress disorder (PTSD). 
• Despite positive Phase 3 trial results showing rapid and durable symptom relief in treatment-resistant PTSD, the FDA advisory panel in June 2024 voted against approval, citing concerns about trial methodology and long-term safety. This decision has sparked intense debate across the psychiatric and research communities. 
• Yet the momentum is far from lost. Congressional leaders, veterans’ organizations, and federal agencies are actively championing MDMA’s therapeutic potential. The VA has launched its first psychedelic research initiative in over 50 years, and bipartisan support continues to grow for integrating MDMA-assisted therapy into veteran care. This is a pivotal moment for mental health professionals: to engage with science, advocate for rigorous standards, and prepare for a future where psychedelic-assisted therapies may redefine trauma care.

New Research into Cocaine’s Damaging Effects on the Heart (July 19, 2025)  

KEY POINTS:

• New data reveal a dramatic surge in cardiovascular mortality linked to stimulant use, particularly involving methamphetamine and cocaine. Between 2014 and 2023, stimulant-related cardiovascular deaths rose by over 10% annually, with methamphetamine-associated deaths increasing nearly 14% per year. This trend stands in stark contrast to the relatively stable rates of overall cardiovascular mortality. 
• The danger escalates when alcohol is combined with stimulants. Co-use of alcohol with cocaine or methamphetamine significantly amplifies cardiovascular toxicity, increasing the risk of arrhythmias, myocardial injury, and sudden death. The formation of cocaethylene, a toxic metabolite produced when alcohol and cocaine are used together, has been shown to raise the risk of sudden death by up to 25-fold compared to cocaine alone. 
• A large cohort study involving nearly 30 million individuals found that both methamphetamine and cocaine use were independently associated with increased risk of ventricular arrhythmias and all-cause mortality, especially among younger adults and women. 
• Given these findings, routine cardiovascular screening should be a priority for individuals with known or suspected stimulant use, particularly those who also consume alcohol. High-sensitivity troponin assays and targeted cardiac evaluations may help detect subclinical myocardial injury, even in the absence of overt heart disease. Mental health clinicians are uniquely positioned to lead this charge—by integrating cardiovascular risk assessments into addiction treatment protocols and collaborating with cardiology to ensure comprehensive care.

Exercise for Addictions, Depression, and Anxiety (September 2, 2025)

KEY POINTS:

• If exercise were a pill, it would be the most powerful and widely prescribed medicine on the planet. 
• Post-detox, the brain’s reward system is fragile—leaving patients vulnerable to relapse and anhedonia. 
• Regular physical activity helps recalibrate the brain, reducing risks tied to addiction, mood disorders, cardiovascular health, and overall medical complications.

Smoking and Vaping in People with Substance Use Disorders (September 7, 2025) 

KEY POINTS:

• Tobacco often flies under the radar in alcohol-focused treatment programs, yet it is the deadliest addiction of all. 
• More people in recovery die from smoking-related diseases than from alcohol or drug use itself. 
• Helping patients quit smoking does not just save lives, it strengthens recovery outcomes across the board.

Use, Misuse, and Addiction to Anabolic Steroids (September 15, 2025) 

KEY POINTS:

• The global market for testosterone and its herbal/vitamin-based “boosters” is booming—worth $1B to $3.7B and growing. 
• Synthetic testosterone is known to enhance libido, confidence, energy, mood, and lean muscle mass—all factors closely tied to mental health and overall vitality. 
• Its use is expanding rapidly among men, women, and athletes, driven by its performance-enhancing and mood-elevating effects. 

Kitty Flipping: Ketamine and MDMA Stimulant Combinations (September 21, 2025) 

KEY POINTS:

• A growing underground practice known as “kitty flipping”—mixing ketamine with MDMA—is raising alarms in major cities like Miami, where ketamine-related deaths are on the rise. 
• While ketamine has therapeutic potential, its safety depends entirely on proper medical supervision in hospitals, clinics, or physician offices. 
• This trend underscores the urgent need for clinical oversight, public education, and mental health advocacy to prevent misuse and protect lives.

Gene Therapy Offers New Hope for Huntington’s Disease Patients (September 29, 2025)

KEY POINTS:

• Huntington’s disease (HD) often masquerades as psychiatric or substance use disorder sometimes for years—before motor symptoms emerge, leading to frequent misdiagnosis. 
• History repeats itself: Folk legend Woody Guthrie and his mother were both institutionalized with psychiatric labels before HD was understood. 
• Hope on the horizon: A groundbreaking gene therapy trial has shown a 75% slowing in disease progression—with cognitive function preserved. 

Why Someone’s “Drug of Choice” Matters (October 7, 2025)

KEY POINTS:

• A person’s drug of choice often reflects more than a desire to feel good—it is a way to feel normal.
• This insight aligns with the late Harvard psychiatrist Edward J. Khantzian’s self-medication hypothesis, which reframes substance use as an attempt to manage deep psychological distress. 
• With over half of individuals with substance use disorders also experiencing co-occurring mental health conditions, integrated treatment is not just beneficial—it is essential. 

Rethinking Medication Treatment for Opioid Use Disorders (October 15, 2025

KEY POINTS:

• Evolving Drug Landscape: The transition from heroin to fentanyl—and now to increasingly dangerous polydrug use—has dramatically escalated the risk of fatal overdoses. 
• Treatment Gap: Despite the crisis, most adults with opioid use disorder (OUD) either do not recognize their need for treatment or are not being offered it, leaving a critical gap in care. 
• Evidence-Based Lifesaving Therapies: Long-term use of methadone or buprenorphine is not just effective—it’s transformative. These medications reduce suffering, prevent overdose deaths, and lay the foundation for lasting recovery.

Move over Xanax? New Research on LSD Offers Hope for Anxiety (October 20, 2025) 

KEY POINTS:

• In a recent study it is revealed that with a higher dose of LSD, patients suffering from anxiety saw significant reductions in their anxiety symptoms—with effects lasting up to 12 weeks.  
• Remarkably, these benefits occurred without psychotherapy, suggesting LSD may have standalone therapeutic potential. Patients tolerated the treatment well, with psychedelic effects requiring only brief observation on the first day. 
• The LSD treatment was tolerated well, although psychedelic effects were monitored on the first day. This research opens exciting possibilities for non-traditional, fast-acting interventions in anxiety treatment. 

Weed, THC, Car Crashes, and Fatalities (October 10, 2025) 

KEY POINTS:

• 42% of drivers in fatal crashes tested positive for THC, according to an American College of Surgeons coroner study.  
• THC significantly impairs coordination, visual processing, and attention—effects that can last for hours after use.  
• The risks skyrocket with high-potency THC, vaping, or combining cannabis with alcohol or other substances. 

Pre–addiction Intervention Could Save Lives (November 3, 2025) 

KEY POINTS:

We screen early for hypertension, type 2 diabetes, and cancer—why not addiction? 

• Pre-addiction thinking empowers early intervention, breaks through denial, and promotes a harm-reduction mindset. 
• Delaying treatment increases risk and contradicts both outcomes research and ethical care standards. 
• It is time to shift the paradigm: early engagement saves lives.

Can Psychedelics Help with Alcohol Use Disorder? (November 7, 2025)

KEY POINTS:

• Global Burden: Alcohol Use Disorder (AUD) affects approximately 280 million individuals and accounts for 5% of global mortality.  
• Historical Context: Interest in psychedelic-assisted treatment for AUD dates back to the 1950s, despite its current perception as novel.  
• Current Research: Psilocybin shows promise in clinical trials for several psychiatric conditions, but not yet for AUD.

Is Cannabis Medicine? (December 5, 2025)

KEY POINTS:

• Public Support: Most Americans favor legalization of cannabis for medical use.  
• Evidence Gap: Despite thousands of studies, cannabis and cannabinoids remain unproven for most therapeutic indications.  
• Research Evolution: Investigators are revising study designs—drawing lessons from ketamine approvals and prior failures—to improve rigor and clinical relevance. 

Medicinal cannabis benefits fall short of expectations; new JAMA study finds

Even Millionaire Pro Athletes Can Be Addicted Gamblers – Illegal gambling and game (and micro-event) fixing (November 20, 2025) 

KEY POINTS:

• Behavioral Risk in Professional Sports: Gambling, cryptocurrency trading, and day trading are emerging as addictive behaviors among professional athletes.  
• Prevalence and Criminal Involvement: Recent cases include athletes implicated in illegal gambling schemes linked to organized crime.  
• Historical Context: The last major addiction crisis in professional sports—drug misuse—was mitigated through systematic drug testing; similar preventive strategies may be needed for gambling-related disorders. 

Is Cannabis Medicine? 

KEY POINTS:

• Public support in the United States is high for the legalization of cannabis for medical use.  
• However, despite thousands of studies, most proposed medical indications for cannabis and cannabinoids remain unproven.  
• Current evidence does not support the use of cannabis for the treatment of psychiatric disorders or substance use disorders.  
• In response to prior methodological limitations and informed by recent regulatory pathways such as ketamine approval, cannabis researchers are adapting study designs to more rigorously evaluate therapeutic potential.

Tea or Coffee? Choosing Between These Wellness Drinks (June 4, 2025) 

KEY POINTS:

• Tea Consumption: Associated with reduced all-cause mortality and increased years lived free of major illness.  
• Coffee Consumption: Linked to lower all-cause mortality and decreased incidence of type 2 diabetes, chronic liver disease, Parkinson’s disease, and certain cancers.  
• Combined Intake: Tea and coffee offer distinct health benefits; incorporating both may optimize protective effects.

More Cannabis, Less Alcohol–In Studies and in Real Life (November 30, 2025) 

KEY POINTS:

• Cannabis and Alcohol Reduction: First causal evidence indicates that smoking cannabis/THC decreases alcohol consumption.  
• Substitution Trend: >50% of surveyed individuals report replacing alcohol with cannabis at least weekly.  
• High-Potency THC Beverages: Drinks containing 50–100 mg THC are increasingly common in multiple states.  
• Cannabinoid Hyperemesis Syndrome (“Scromiting”): Severe vomiting and agitation from high-dose cannabis use are driving more emergency department visits.

Stock Options, and Cryptocurrency Trading Disorders (November 26, 2025) 

KEY POINTS:

• Financial Risk Behaviors: Activities such as gambling, cryptocurrency trading, and day trading involve wagering on uncertain outcomes, often resulting in financial loss.  
• Prevalence: Approximately 8% of individuals engaged in financial markets meet diagnostic criteria for problem gambling.  
• Clinical Parallels: Cognitive distortions—such as overconfidence and illusion of control—observed in stock trading disorder mirror those seen in gambling disorder. 

Cocaine is Back! (October 15, 2025)

KEY POINTS:

• Lessons from the prior cocaine epidemic have largely been forgotten.  
• CDC reports a significant rise in U.S. overdose deaths involving stimulants.  
• Cocaine-related overdose mortality nearly doubled over 5 years—from 4.5 to 8.6 per 100,000. 

Methamphetamine Use is Growing Among Fentanyl Users (October 29, 2025)

KEY POINTS:

• Methamphetamine use and overdose are now a nationwide concern, not limited to the West Coast.  
• Synthetic methamphetamine and fentanyl increasingly replace plant-derived cocaine and heroin in highly reinforcing “speedball” combinations.  
• No FDA-approved pharmacologic treatments exist for cocaine or methamphetamine overdose or use disorder. 

Early Cannabis Use Poses Risks to Physical and Mental Health (October 31, 2025) 

KEY POINTS:

• Early cannabis initiation in teens is linked to increased utilization of mental and physical health services in young adulthood.  
• Adolescents who start cannabis use early experience higher rates of injuries, poisoning, respiratory issues, and other health complications compared to non-users.  
• Five-year data reinforce prevention messaging:  
• Best advice: Avoid cannabis use during adolescence. 
• Next best: Delay initiation as long as possible. 

Stimulant ADHD Meds Work Differently Than Experts Assumed (January 2, 2026) 

KEY POINTS:

• Methamphetamine use and overdose are now a nationwide concern, not limited to the West Coast.  
• Synthetic methamphetamine and fentanyl increasingly replace plant-derived cocaine and heroin in highly reinforcing “speedball” combinations.  
• No FDA-approved pharmacologic treatments exist for cocaine or methamphetamine overdose or use disorder. 

Cannabis and Alcohol in Pregnancy

KEY POINTS:

• Alcohol: No amount, timing, or type of alcohol is safe during pregnancy.  
• Cannabis: Prenatal cannabis exposure is associated with low birth weight, fetal growth restriction, preterm birth, higher NICU admission rates, and increased risk of perinatal mortality.  
• Guidance: Individuals who are pregnant, breastfeeding, or planning pregnancy should abstain from both alcohol and cannabis. 

Yoga Speeds Recover in People with Opioid Use Disorder 

KEY POINTS:

• Emerging evidence indicates that yoga may accelerate recovery during opioid use disorder (OUD) treatment, with associated reductions in anxiety, sleep disturbance, and pain.  
• Mind–body practices—including breathwork, meditation, and yoga—are already incorporated into some addiction treatment programs.  
• Notably, the first randomized clinical trial now provides empirical support for yoga as an adjunctive intervention during OUD detoxification and ongoing treatment.

Very Different Psychiatric Diagnoses Share Common Genes

KEY POINTS:

• A crossdisorder genomics study published in Nature this year, identified that based on shared genetic liability major psychiatric conditions could be grouped together.  
• Fourteen common psychiatric disorders were organized into five genetically overlapping clusters.  
• Notably, alcohol, cannabis, opioid, and nicotine use disorders clustered together, supporting their classification as a genetically related brainbased disorder. 

Shock in Fentanyl Supply leads to Dramatic Drop in Deaths

KEY POINTS:

• Since the onset of the opioid epidemic in 1999, drug overdoses have resulted in more than one million deaths in the United States.  
• Following years of steady increases, opioidrelated mortality has recently declined sharply.  
• This reduction appears linked to disruptions in the illicit fentanyl supply rather than sustained improvements in treatment or prevention.  
• Despite this decline, synthetic substances—particularly fentanyl and methamphetamine—continue to drive high rates of addiction and overdose mortality.

Drug-Induced Nodding-Not a Nice Nap

KEY POINTS:

• Nonfatal drug overdoses are estimated to affect at least one million individuals annually in the United States. 
• A particularly highrisk opioidrelated state, commonly referred to as “nodding,” involves fluctuating levels of consciousness and respiratory compromise.  
• Repeated overdoses, nearoverdoses, and episodes of nodding are associated with hypoxic brain injury, which may result in persistent memory deficits and behavioral changes.

Psychedelics, Plasticity, and Addicted Brains

KEY POINTS:

• Psychedelic compounds are being investigated for addiction treatment due to their capacity to disrupt and reorganize maladaptive brain networks.  
• Addiction is increasingly conceptualized as a disorder characterized by cognitive rigidity, compulsive repetition, and entrenched neural patterns.  
• Among psychedelics, psilocybin is the most commonly misused, with an estimated 11 million U.S. adults reporting nonmedical use in the past year.

Smoking Fentanyl, Cannabis, Methamphetamine, or Tobacco

KEY POINTS:

• Primary users are not the only ones affected by inhaled drug particles and aerosols and these particles and fumes can persist in indoor environments.  
• Evidence indicates that secondhand opioid smoke contaminates indoor air, resulting in involuntary exposure.  
• Consequently, nonusing individuals—including children, pregnant people, and other adults—may test positive for drugs following second and thirdhand exposure. 

AA and NA Were Right: Spirituality Decreases Addictions 

KEY POINTS:

• An estimated 48.5 million individuals in the United States meet diagnostic criteria for alcohol or other substance use disorders.  
• Research indicates that engagement in spiritual practices is associated with improved outcomes in recovery from alcohol, marijuana, and other drug use disorders. 
• For individuals who identify spirituality as meaningful, integrating these practices may enhance both prevention and recovery efforts. 

Carfentanil Was an Elephant Sedative – Now It’s Human Drug Problem 

KEY POINTS:

• Originally developed as a largeanimal immobilizing anesthetic, carfentanil has now been detected in illicit drug supplies across at least 37 U.S. states.  
• Its effects are approximately 100 times more potent than fentanyl and 10,000 times more potent than morphine, substantially increasing overdose risk.  
• CDC surveillance data indicate a sevenfold increase in carfentanilinvolved overdose deaths between early 2023 and mid2024.  
• While naloxone (Narcan) remains effective in reversing carfentanil overdoses, repeated dosing and extended clinical monitoring are often required due to its extreme potency and duration of effect.

What is the most Addictive Drug? Science May Have Some Answers

KEY POINTS:

• Alcohol and nicotine account for the greatest overall populationlevel harm, while opioids, methamphetamine, and cocaine demonstrate the highest addictive potential.  
• Cocaine and other addictive substances actively reinforce their own use by strengthening drugassociated reward learning and memory.  
• Once these drugrelated associations are encoded within neural circuitry, they become highly persistent and resistant to reversal.  
• At the molecular level, ΔFosB serves as a shared transcriptional marker of enduring circuit adaptations across cocaine and multiple other addictive substances. 

A Global Glut in Cocaine Shocks the World 

KEY POINTS:

• Global cocaine production has reached unprecedented levels, accompanied by record seizures, escalating health consequences, and rising mortality.  
• In the United States, cocaine now contributes to nearly onethird of overdose deaths, often in combination with synthetic opioids.  
• In response, enforcement efforts have intensified, with a focus on disrupting maritime trafficking routes and targeting cartel leadership to reduce supply and downstream harms. 

Opioid Overdose Damages Oxygen-Sensitive Brain Cells

KEY POINTS:

• Emerging evidence indicates that opioid use disorder (OUD) reduces cerebral oxygen availability, leading to neuronal injury.  
• Rather than directly exerting neurotoxic effects, opioids produce persistent brain changes primarily through hypoxia resulting from respiratory depression.  
• Biologically, opioid overdose initiates a hypoxicischemic cascade comparable to that observed in neardrowning events. 

Young/Middle-Aged Drug Users Risk Stroke

KEY POINTS:

• A large population based study encompassing approximately 100 million individuals has identified a significant association between stroke risk and use of cocaine, methamphetamine/amphetamine, and cannabis.  
• Among adults under age 55, amphetamine and methamphetamine use is associated with nearly a threefold increase in stroke risk, with cocaine showing similarly elevated risk. Notably, substance use disorders represent the most common predisposing factor for stroke in individuals under age 35. 

From Mushroom Trip or Cosmic Ride to Therapeutic Healing 

KEY POINTS:

• Emerging evidence indicates that opioid use disorder (OUD) reduces cerebral oxygen availability, leading to neuronal injury.  
• Rather than directly exerting neurotoxic effects, opioids produce persistent brain changes primarily through hypoxia resulting from respiratory depression.  
• Biologically, opioid overdose initiates a hypoxicischemic cascade comparable to that observed in neardrowning events. 

Fibromyalgia, Pain, and Substance Use Disorders

KEY POINTS:

• Fibromyalgia affects an estimated 4–10 million individuals in the United States, and chronic pain lasting longer than three months impacts more than 60 million people overall.  
• Selfmedication with opioids, cannabis, and alcohol poses particular risk in chronic pain populations.  
• This vulnerability is especially pronounced in fibromyalgia, a nociplastic pain condition in which dysregulated central painprocessing pathways overlap with neural circuits implicated in addiction.

GLP-1 Anti-Obesity Rx and Alcohol Substance Use Disorders

KEY POINTS:

• As early as classical Greek medicine, Hippocrates emphasized the central role of the gut in health, a concept increasingly revisited in modern neuroscience.  
• Contemporary evidence suggests that GLP1 receptor agonists (e.g., semaglutide) reduce intake of food, alcohol, and cocaine and may have therapeutic relevance for behavioral addictions.  
• Notably, GLP1 receptors are expressed in mesolimbic brain regions implicated in reward processing and substancerelated reinforcement.

Craving Drives Bad Decisions, Relapse, and Drug Use

KEY POINTS:

• Craving is not simply a symptom of addiction but a central neurobehavioral process that drives compulsive use, relapse vulnerability, and disease persistence.  
• Craving alters decision-making by recalibrating reward valuation, risk assessment, and reinforcement learning within cortico–striatal and limbic circuits.  
• Both conscious and nonconscious craving states induce durable changes in brain networks that sustain substance use, compulsive behavior, and relapse risk.

insurances