Substance use and abuse, with its associated health consequences, is a major public health problem. Substance use disorders (SUDs) include dependencies on alcohol, illicit and prescription drugs, and nicotine. SUDs have substantial negative consequences on Veterans' mental and physical health, work performance, housing status, and social function.
SUD can develop in individuals who use alcohol or other addicting drugs in harmful quantities. According to the VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders, about 9 percent of Americans over age 18 have a non-tobacco SUD, and about 1 in 4 Americans will develop a non-tobacco SUD over the course of a lifetime.
According to the Centers for Disease Control and Prevention (CDC), SUDs represent the leading cause of death in the United States. Excessive alcohol use alone leads to about 88,000 premature deaths each year.
In service members and Veterans, SUD commonly co-occurs with and complicates other conditions or issues. These conditions or issues may be health-related, such as other mental health conditions. They may also be societal, such as homelessness, criminal justice involvement, or unemployment.
Among Iraq and Afghanistan Veterans who were first-time users of VA health care between Oct. 15, 2001, and Sept. 30, 2009, SUD diagnoses were associated with being male, being under 25 years of age, and having been exposed to combat. Of those with a SUD diagnosis, 55 to75 percent also received a diagnosis for posttraumatic stress disorder (PTSD) or depression.
VA began researching SUDs in the 1940s, through studies on the characteristics of alcoholics that took place at the Northport, New York, VA Medical Center. In the late 1960s and early 1970s, VA collaborated with the White House's Special Action Office for Drug Abuse Prevention in a comparison trial of two different types of methadone, a drug still used in treating heroin addicts.
In 1971, Dr. Marcus Rothschild of the New York VA Medical Center received VA's William S. Middleton Award for outstanding scientific contributions and achievements in the areas of biomedical and bio-behavioral research relevant to Veterans' health care. Rothschild received the award for his research on the pathological biochemistry of the liver in alcoholism and liver disease.
Also in 1971, Dr. Charles P. O'Brien of the Corporal Michael E. Crescenz VA Medical Center in Philadelphia and the University of Pennsylvania founded and became director of the Center for Studies of Addiction. At the center, VA and University of Pennsylvania researchers work to advance knowledge on the nature of addiction and the best ways to relieve this illness.
In the 1980s, O'Brien and his colleagues discovered a new way to treat alcoholism, by providing alcoholic patients with a drug called naltrexone, which had previously been used only for treating addiction to heroin and other opioids. In a study published in 1992, the team found that after three months of treatment, patients receiving naltrexone had fewer relapses to heavy drinking and reported less craving for alcohol and less pleasure when they did drink compared with those receiving a placebo. Based on the team's work, the FDA approved naltrexone for treating alcohol dependence in 1995.
In 1977, Dr. Charles Lieber of the Bronx VA Medical Center received the Middleton Award for his work on the toxicity of alcohol, and the pathogenesis (the manner of development of a disease) of fatty liver and cirrhosis (scarring of the liver) in man and nonhuman primates.
VA researchers were integral in demonstrating the relationship between smoking and lung cancer. Later, other VA researchers developed the nicotine patch (see the section on smoking cessation below).
VA supports a broad portfolio of research looking at substance abuse prevention, screening, and treatment. Some researchers are looking at treatment-seeking patterns: why and when Veterans ask for help—and why many don't. Treatment strategies, including cognitive behavioral strategies and Web-based approaches, are also being studied.
Other researchers are working to identify the most effective therapies for co-morbid disorders, such as depression and PTSD, and attempting to determine if early intervention improves outcomes. Still others are focusing on how readjustment issues relate to substance abuse.
The department offers treatments for substance use problems throughout its health care system. A list of VA treatment programs can be found here.
A Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) group is working to promote value and access in VA's SUD services. The group is doing so by validating and refining quality metrics; evaluating and disseminating low-cost, high impact innovations; and promoting patient and provider knowledge about evidence-based treatment for SUDs.
Primary care vs. specialty care treatment—In 2014, VA researchers in Philadelphia published the results of a study finding that a 26-week primary care intervention is just as effective as specialty outpatient treatment for treating alcohol dependence.
The study enrolled 163 Veterans and randomly assigned them to primary care treatment or specialty treatment groups. Those receiving primary care treatment were offered medicine and psychosocial support, delivered in person and by phone.
The researchers found that Veterans in the primary care treatment group were more than five times as likely to complete all 26 weeks. Overall abstinence rates were the same between groups, and the primary care group had a smaller percentage of days with heavy drinking.
HIV, alcohol, and memory—Researchers at the Palo Alto Health Care System conducted a study, published in 2014, that found that human immunodeficiency virus (HIV)-infected patients who had problematic levels of alcohol use also had problems with their memory, both in terms of their ability to recall facts and their activity memory (recalling what they did yesterday.) Memory impairment is tied to chronic problem drinking for all populations, but little research has focused on how drinking affects HIV patients in particular, and how their overall health care might suffer.
The HIV-related symptoms of the 172 patients with alcohol problems who were studied were also more severe than those of other patients. The research team concluded that integrated care for HIV and alcohol use disorders is important, and that routine alcohol and cognitive screenings may improve health outcomes among HIV-infected patients.
Counseling for 'hazardous drinkers'—A research team at the VA Pittsburgh Healthcare System is conducting a study to determine the efficacy of providing counseling for Veterans who don't meet the threshold for an alcohol use disorder but who score positive on a screening tool for hazardous drinking. The goal is to help them make positive changes in their lifestyle and phase out their unhealthy alcohol use.
The Veterans' drinking problems were identified during stays at the VA Pittsburgh Healthcare System. Some of the 320 Veterans in the study are receiving individual change plans to reduce or eliminate their drinking while still in the hospital, and are also receiving follow-up afterward. Others are receiving only general attention to their health status and information about healthy lifestyles. Still others are getting a limited amount of counseling on alcohol abuse.
Alcohol and liver disease—Scientists know that alcohol itself can directly damage liver cells. A 2016 study by researchers at the VA San Diego Healthcare System and the University of California reported evidence that alcohol is harmful to the liver for a second reason—it allows gut bacteria to migrate to the liver promoting alcohol-induced liver disease.
According to the research team, alcohol appears to impair the body's ability to keep microbes in check. When barriers break down, bacteria that don't normally colonize the liver end up there—and this bacterial migration promotes alcohol liver disease.
The team is now working on strategies that can restore the body's defenses against microbes.
Vaccine may fight meth addiction—Researchers at the Michael E. DeBakey VA Medical Center in Houston and Baylor College of Medicine found, in 2013, that a vaccine to combat methamphetamine (meth) addiction is effective and safe in mice—a preliminary step toward possible human clinical trials.
The research team gave mice three doses of the vaccine. Four weeks after the second dose, vaccinated and non-vaccinated mice were tested with different methamphetamine amounts. Mice that were not vaccinated showed changes in their movement patterns that could be attributed to meth addiction. Vaccinated mice showed much less of an effect. They also did not develop a positive conditioned response to receiving methamphetamine, whereas non-vaccinated mice did become conditioned.
Recently, the Portland VA and Oregon Health and Science University founded the Methamphetamine Abuse Research Center, dedicated to developing effective prevention and treatment approaches to meth abuse. Researchers here are focusing on understanding the mechanisms and genetics of meth addiction.
Levels of cannabis use among Veterans—For more than 30 years, cannabis (better known as marijuana) has been the most widely used illicit substance in the United States. According to the National Institutes for Drug Abuse, there were 19.8 million current users of cannabis in the United States in 2013, about 7.5 percent of people aged 12 or older. That number is up from 14.5 million (5.8 percent) in 2007.
In a study published in 2012, Palo Alto VA researchers found that the prevalence of cannabis use disorder in VA patients increased nearly 60 percent between 2002 and 2009, from 0.66 percent of the total patient population to 1.05 percent. Rates of other substance use disorder diagnoses within VA increased to a much smaller degree.
Although rates of cannabis use disorder among VA patients have increased dramatically, they remain significantly lower than the rates in the general U.S. population. The researchers also found that states with laws allowing for the legal use of cannabis for medicinal purposes had significantly higher rates of cannabis use disorder diagnoses than others in 2002, 2008, and 2009.
Marijuana and lung disease—Marijuana, a preparation of the hemp plant that is used both as a recreational drug and as medicine, is commonly smoked to get a "high." However, some sick people, especially cancer patients, can use it to relieve their pain.
In 2014, researchers from the Central Arkansas Veterans Healthcare System in Little Rock and the University of Arkansas reviewed recent studies on the controversial drug and its ties to lung diseases. They determined that smoking marijuana is not as bad as smoking cigarettes when it comes to lung disease.
They found a clear linkage between marijuana use and chronic bronchitis and large airway inflammation, conditions that make breathing difficult. However, they found no links to emphysema, a chronic disease in which the air sacs in the lungs are gradually damaged, and only weak, if any, links to lung cancer.
The researchers concluded, however, that there is unequivocal evidence that habitual or regular marijuana use is not harmless, and that doctors should caution patients about possible lung damage from regular heavy marijuana use.
A previous study, published in 2012 by researchers at the Birmingham, Ala., VA Medical Center, the University of Alabama, and the University of California, San Francisco, found that marijuana does not impair lung function, at least not in the doses inhaled by the majority of users. The team even found that some marijuana smokers could blow air in and out slightly better than those who did not smoke at all.
The investigators tested the lung function of 5,115 young adults over the course of 20 years, starting in 1985. They found that marijuana use was almost as common as cigarette smoking in the sample, and that the average user smoked marijuana about two to three times a month, while the average cigarette smoker smoked eight cigarettes a day.
VA researchers have long been involved in documenting the relationship between smoking and cancer. In 1956, Dr. Oscar Auerbach of the East Orange, New Jersey, VA Medical Center found that smoking for three years caused major changes in the lungs of animals that were taught to inhale cigarettes—and that many developed cancer. Auerbach was later a participant in the first Surgeon General's report, published in 1964, which explained the harmful effects of smoking to America and the world.
Development of the nicotine patch—In 1984, VA Research made a major contribution toward helping Veterans and others quit smoking through the development of the nicotine transdermal patch. The patch transfers nicotine into the bloodstream to reduce cravings for the substance.
Successful counseling method—In 2016, a team led by researchers from the VA New York Harbor Healthcare System and the New York University School of Medicine found that specialized counseling delivered by telephone may be more effective than state quit lines to help smokers in mental health care to kick the habit.
The study looked at 522 Veterans with mental health issues, 270 of whom received specialized counseling that incorporated motivational interviewing, problem-solving therapy and cognitive behavioral therapy. The other 307 Veterans were referred to their local quit lines.
The team found that the specialized counseling yielded a quit rate of 26 percent at six months, versus 18 percent for the state quit lines.
Varenicline and buproprion do not appear to increase neuropsychiatric risk—Varenicline (sold as Chantix) and buproprion (sold as Wellbutrin and Zyban) are prescription medications used to treat nicotine addiction.
A 2016 study by VA researchers in Hines, Ill.; Bedford, Massachusetts; and Pittsburgh, along with researchers from the U.S. Food and Drug Administration and two universities, found that these medications do not appear to increase the incidence of serious neuropsychiatric illnesses such as depression, schizophrenia, or bipolar disorder when compared with placebo.
Participants in the study were more than 8,000 adults aged 18-75 who smoked more than 10 cigarettes a day and were motivated to stop smoking. About half (4,116) had a history of a past or current stable psychiatric condition. For 9 to12 weeks, some received varenicline, some buproprion, some a nicotine patch, and others a placebo.
The participants were assessed to see whether they had any moderate to severe neuropsychiatric events during their treatment, and at a follow-up visit 9 to24 weeks after the treatment ended. The researchers checked for episodes of agitation, aggression, panic, anxiety, or suicidal ideation.
The team found that while there were more adverse events reported in the group that previously had psychiatric disorders, there was no significant increase in the incidence of such events in the groups receiving any of the four kinds of treatment.
Varenicline was more effective in helping people stop smoking than bupropion, nicotine patches, or placebo. Bupropion was about as effective as nicotine patches, and both were more effective than placebo.
QuitNet study—In a four-year study, researchers at the Durham VA Medical Center looked at Web-based methods of quitting smoking as an alternative to clinic-based programs, which are often poorly attended. They examined QuitNet, a website launched 10 years ago, which offers chat rooms, advice from experts, medication tips, buddy match-ups, and other tools to support smokers in their quest to stop smoking.
The researchers provided half of the 400 Veterans involved in the study with premium memberships in QuitNet, and compared their quit rates over a four-year period with those of Veterans enrolled in a clinic at the Durham VA geared toward helping returning Veterans quit smoking. The study team expects to publish the results in late 2016.
Lung cancer screening issues—A 2015 study by researchers with the VA Puget Sound Health Care System and the University of Seattle found that lung cancer screening can have the unintended consequence of lowering smokers' motivation to quit.
The team studied 37 current smokers who were offered lung cancer screening by their primary care physician during 2014. After the screening, the smokers were interviewed by the research team. The team found nearly half of those interviewed found some reason to believe that just being screened meant that they did not need to stop smoking.
Some told the researchers that undergoing the test had the same benefit as stopping smoking, even when precancerous lung nodules were found. Others felt that being able to return for additional screenings would protect them, and still others felt that a cancer-free screening test indicated that they were among the lucky ones who would avoid the harms of smoking.
All of these assumptions are false—as is the assumption many study participants had that lung cancer was the only potentially lethal effect of smoking. The team suggested that counseling for smokers should target these and other rationalizations some people use to avoid quitting.
Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus. Medications that fall within this class include hydrocodones, such as Vicodin; oxycodones, such as OxyContin and Percocet; morphine, such as Kadian and Aviza; codeine; and related drugs.
Taken as prescribed, opioids can be used to manage pain safely and effectively. When abused, however, even a single large dose can cause severe respiratory depression and death. Regular or longer-term use and abuse of opioids can lead to physical dependence, and in some cases addiction.
Opioids are prescribed at high and increasing rates in the United States. From 2004 to 2012, opioid receipt among VA outpatients increased by nearly 77 percent. As of 2012, some 33 percent of Veterans in VA care received opioids for pain management.
Opioids are important in helping people manage their pain, but the long-term effectiveness of opioid therapy for chronic pain is untested.
Opioid use is also associated with a number of serious risks, including death from unintentional overdose, suicide, accidents related to sedation, and interactions with other medications. VA has developed a clinical practice guideline for opioid therapy for constant pain. The guideline outlines practices designed to reduce the risks and increase the effectiveness of opioid therapy.
Who prescribes opioids?—Most prescriptions for opioid painkillers are made by the broad swath of U.S. general practitioners, not by a limited group of specialists, according to a 2015 study by researchers at the Palo Alto VA Health Care System and Stanford University School of Medicine.
The research team examined Medicare prescription drug claim data for 2013, and found that while the top 10 percent of opioid prescribers account for 57 percent of all opioid prescriptions, this prescribing pattern is comparable to that found in the Medicare data for prescribers of all drugs.
The team's findings contrast with previous studies by others that indicated the high levels of prescribing opioids in the United States is the result of a small population of prolific prescribers operating out of corrupt pill mills. According to the authors of the new study, efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective.
Benzos and overdose deaths—In another study published in 2015, researchers with VA, the Alpert Medical School at Brown University, and the University of Michigan Medical School found that nearly half of 2,400 Veterans who died from a drug overdose between 2004 and 2009 while they were receiving opioids for pain were also receiving benzodiazepines, known as benzos for short. These are common medications for the treatment of anxiety, insomnia, and alcohol withdrawal.
The risk of overdose death for Veterans receiving both opioids and benzodiazepines was four times greater than for those receiving opioids alone. In addition, Veterans receiving higher doses of benzodiazepines while concurrently receiving opioids were at greater risk of overdose death than those on lower doses of benzodiazepines. According to the study's lead researcher, prescribing benzodiazepines to patients taking opioids for pain is "quite common," and therefore the team's findings are "deeply troubling."
Opioids and depression—While opioids may cause short-term improvements in mood, their long-term use brings the risk of new-onset depression, according to a study published in 2016 by a team of researchers from VA and several academic institutions. The study looked at more than 107,000 patients from VA, Baylor Scott & White Health (BSWH), and the Henry Ford Health System (HFHS). The patients were new opioid users, ages 18 to 80, who did not have a diagnosis of depression when they began taking their medication.
Twelve percent of the VA patients, 9 percent of the patients from BSWH, and 11 percent of the HFHS sample experienced new-onset depression after using opioid analgesics. The research team speculated that the findings may be explained by the possibility that using opioids for more than 30 days can lead to changes in neuroanatomy, and low testosterone.
Opioid doses and risk of suicide—Researchers with the Serious Mental Illness Treatment Resource and Evaluation and the Center for Clinical Management Research at the VA Ann Arbor Healthcare System, along with colleagues from the University of Michigan, reported in 2016 that Veterans receiving the highest doses of opioid painkillers were more than twice as likely to die by suicide, compared with those receiving the lowest doses.
The research team looked at nearly 124,000 Veterans who received VA care in 2004 and 2005. All had non-cancer chronic pain and received prescriptions for opioids. Using the National Death Index, the researchers identified 2,601 patients who died by suicide before the end of 2009.
They found that the suicide risk rose as dose increased. The researchers could not tell, however, whether there was a direct causal link between the pain medications and suicide risk. Instead, the high doses may be a marker for other factors that drive suicide, including unresolved severe chronic pain.
Peptide-based painkiller—In 2016, researchers at the Southeast Louisiana Veterans Health Care System and Tulane University announced that they have developed a painkiller that is as strong as traditional painkillers like morphine, but that has fewer side effects and less potential for addiction.
The team compared several engineered variants of the neurochemical endorphin, which is found naturally in the body, to morphine to measure their effectiveness and side effects. These peptide-based drugs target the same pain-relieving opioid receptor as morphine.
In a study, the new drug produced longer pain relief without substantially slowing breathing in rats. A similarly potent dosage of morphine produced significant respiratory depression. The new drug also did not produce significant impairment of motor coordination, as does morphine, and it appears not to be addictive in rats. The rats also were not more tolerant of the drug over time, which lessens the likelihood that it will be abused in humans, and reduces the chance of an overdose.
Behavioral therapy as a pain-relief alternative—VA's Care Management for the Effective Use of Opioids (CAMEO) trial is a randomized clinical trial now underway at the Richard L. Roudebush VA Medical Center in Indianapolis to compare pharmacological pain relievers with behavioral approaches such as cognitive behavioral therapy for the relief of chronic lower back pain.
The study is comparing the two interventions' effects on pain intensity, function, and other pain-relevant outcomes at 6 and 12 months. The study will also compare their cost-effectiveness.
Naloxone vs. opioids—Another ongoing study is comparing the use of the drug buprenorphine/naloxone (BUP/NX) with patients currently on morphine equivalents whose pain is being poorly controlled.
BUP/NX is used to treat opioid addiction both in physicians' offices and by prescription. It may be a safer alternative to escalating opioid doses if the transition to using it can be managed successfully and if it reduces patients' pain, two aspects of clinical care that have not previously been rigorously studied.
Opioid Safety Initiative—In 2011, the Minneapolis VA Health Care System began developing an Opioid Safety Initiative (OSI). OSI was designed to decrease high-risk opioid prescribing practices, and to improve the safety of opioid prescribing while providing high-quality pain care for Veterans.
A 2015 study found that OSI, which emphasizes patient education, close patient monitoring with frequent feedback, and the use of complementary and integrative medicine practices such as acupuncture and behavior therapy, can produce dramatic results.
The Minneapolis researchers found that, from 2011 through 2014, the number of Veterans prescribed more than 200 morphine-equivalent milligrams worth of opioids decreased from 342 to 65. Overall, the number of unique pharmacy patients who received at least one opioid prescription decreased by almost 1,000 and the number of Veterans receiving oxycodone dropped from 292 to 3.
"Promoting Value and Access in VA's Substance Use Disorder Services" is one of 10 "CREATE" programs recently funded by VA Research. The CREATE acronym stands for "Collaborative Research to Enhance and Advance Transformation and Excellent." The program involves groups of coordinated research projects conducted in a focused area by independent, collaborating investigators and VA clinical or operations partners. The studies within each CREATE group address distinct but complementary areas of investigation. They work synergistically to advance knowledge and care on behalf of VA patients.
The CREATE on substance use disorders includes four projects:
SUD Treatment and Staffing Handbook Implementation: Impact on Patient Outcome is designed to produce quick answers to critical questions about how to fund substance use disorder treatment services and whether staffing levels influence patient outcomes. Web-based Intervention to Reduce Alcohol Use in Veterans with Hepatitis C is a multi-site, randomized clinical trial of a self-administered web-based brief alcohol intervention to reduce alcohol consumption in Veterans with hepatitis C. It is important because the VA Office of Public Health considers improving these patients' access to quality alcohol treatment among its highest priorities. Improving Quality of Addiction Treatment Quality Measures aims to validate 41 newly-developed measures of addiction treatment quality. Finally, Telemonitoring to Improve Substance Use Disorder Treatment after Detoxification is a multi-site, randomized clinical trial that will look at telephonic monitoring and support intervention to improve care transitions and outcomes among Veterans who have received detoxification for substance use disorders.
Gray-matter loss across mental health conditions—A 2015 study by researchers at the VA Palo Alto Healthcare System and Stanford University identified a common pattern across a spectrum of psychiatric disorders widely perceived to be quite distinct.
The research team analyzed 193 peer-reviewed papers that contained magnetic resonance images of the brains of 7,381 patients diagnosed with schizophrenia, bipolar disorder, depression, addiction, obsessive-compulsive disorder, or anxiety.
They found a loss of gray matter (the darker tissue of the brain and spinal cord, consisting mainly of nerve cell bodies and branching dendrites) in three separate brain structures—the left and right anterior insula, and the dorsal anterior cingulate.
These structures are part of a larger network in the brain associated with higher-level executive functions such as concentrating in the face of distractions, multitasking or task switching, planning and decision-making, and inhibition of counterproductive impulses.
Gray matter loss in the three brain structures was similar across patients with different psychiatric conditions, according to the researchers. The findings call into question the longstanding tendency to distinguish psychiatric disorders chiefly by their symptoms rather than their underlying brain pathology.
Prevalence of cannabis use disorder diagnoses among veterans in 2002, 2008, and 2009. Bonn-Miller MO, Haris AH, Trafton JA. Psychol Serv. 2012 Nov;9(4):404-16. Results indicated that the prevalence of cannabis use disorder diagnoses within VA has increased more than 50 percent (from 0.66 to 1.05 percent) over the past seven years. Psychol Serv. 2012 Nov;9(4):404-16.
A vaccine against methamphetamine attenuates its behavioral effects in mice. Shen XY, Kosten TA, Lopez AY, Kinsey BM, Kosten TR, Orson FM. Succinyl-methamphetamine-keyhole limpet hemocyanin carrier protein (SMA-KLH) attenuates the ability of methamphetamines to support place conditioning and reduces or delays its locomotor effects. Drug Alcohol Depend. 2013 Apr 1;129(1-2):41-8.
A randomized clinical trial of alcohol care management delivered in Department of Veterans Affairs primary care clinics versus specialty addiction treatment. Oslin DW, Lynch KG, Malsto SA, Lantinga LJ, McKay JR, Possemato K, Ingram E, Wierzbicki M. Treatment for an alcohol use disorder can be delivered effectively within primary care, leading to greater rates of engagement in treatment and greater reductions in heavy drinking. J Gen Intern Med. 2014 Jan;29(1):162-8.
Identification of a common neurobiological substrate for mental illness. Goodkind M, Eickhoff SB, Oathes DJ, Jiang Y, Chang A, Jones-Hagata LB, Ortega BN, Zaiko YV, Roach EL, Korgaonkar MS, Grieve SM, Galatzer-Levy I, Fox PT, Etkin A. A meta-analysis of 193 peer-reviewed papers identified a common pattern of loss of gray matter in three brain structures across a spectrum of psychiatric disorders that are widely perceived to be distinct. JAMA Psychiatry. 2015 Apr:72(4):305-15.
Opioid dose reduction in a VA health care system—implementation of a primary care population-level initiative. Westanmo A, Marshall P, Jones E, Burns K, Krebs EE. VA's Opioid Safety Initiative was associated with a substantial reduction in high-dose opioid prescribing. Pain Med, 2015 May;16(5):1019-26.
Alcohol brief intervention for hospitalized Veterans with hazardous drinking; Protocol for a 3-arm randomized controlled efficacy trial. Broyles LM, Wieland ME, Confer AL, DiNardo MM, Kraemer KL, Hanusa BH, Youk AO, Gordon AJ, Sevick MA. Description of a methodologically rigorous trial of alcohol brief intervention for hospitalized Veterans who screen positive for unhealthy alcohol use. Addict Sci Clin Pract. 2015 May 13;10:13.
Benzodiazepine prescribing patterns and deaths from drug overdose among US Veterans receiving opioid analgesics: case-cohort study. Park TW, Saltz R, Ganoczy D, Ilgen MA, Bohnert AS. Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose. BMJ, 2015 Jun 10;350:h2698.
Attitudes and perceptions about smoking cessation in the context of lung cancer screening. Zeliadt SB, Heffner JL, Sayre G, Klein DE, Simons C, Williams J, Reinke LF, Au DH. Health care professionals should be aware that the opportunity for early detection of lung cancer may be interpreted as a way of avoiding the harms of smoking. JAMA Intern Med. 2015 Sep;175(9):1530-7. 12;370(24):2265-75
Prescription opioid duration, dose, and increased risk of depression in 3 large patient populations. Scherrer JF, Salas J, Copeland LA, Stock EM, Ahmedani BK, Sullivan MD, Burroughs T, Schneider FD, Bucchols KK, Lustman PJ. Patients and practitioners should be aware that opioid analgesic use of longer than 30 days imposes risk of new-onset depression. Ann Fam Med, 2016 Jan;14(1):54-62.
Electronic cigarettes induce DNA strand breaks and cell death independently of nicotine in cell lines. Yu V, Rahimy M, Korrapati A, Xuan Y, Zou AE, Krishnan AR, Tsui T, Aguilera JA, Advani S, Crotty Alexander LE, Brumund KT, Wang-Rodriguez J, Ongkeko WM. E-cigarette vapor, both with or without nicotine, is cytotoxic to epithelial cell lines and is a DNA strand break-inducing agent. Further assessment of the potential carcinogenic effects of e-cigarette vapor is urgently needed. Oral Oncol. 2016 Jan;52:58-65.
Opioid dose and risk of suicide. Ilgen MA, Bohnert AS, Ganoczy D, Bair MJ, McCarthy JF, Blow FC. The risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid doses as a marker of an elevated risk for suicide. Pain, 2016 Jan 5. (Epub ahead of print.)
Electronic cigarette inhalation alters innate immunity and airway cytokines while increasing the virulence of colonizing bacteria. Hwang JH, Lyes M, Sladewski K, Enany S, McEachern E, Mathew DP, Dae S, Moshensky A, Bapat S, Pride DT, Ongkeko WM, Crotty Alexander LE. E-cigarettes may be toxic to airway cells, suppress host defenses, and promote inflammation over time, while also promoting virulence of colonizing bacteria. J Mol Med (Berl). 2016 Jan 25. (Epub ahead of print.)
A comparison of neuropsychiatric adverse events during early treatment with varenicline or a nicotine patch. Cunningham FE, Hur K, Dong D, Miller DR, Zhang R, Wei X, McCarren M, Mosholder AD, Graham DJ, Aspinall SL, Good CB. Use of varenicline for smoking cessation was not associated with a detectable increase compared with nicotine patches in hospitalization for any mental health outcomes. Addiction. 2016 Jan 30. (Epub ahead of print.)
Distribution of opioids by different types of Medicare prescribers. Chen JH, Humphreys K, Shah NH, Lembke A. Most prescriptions for opioid painkillers are made by the broad swath of U.S. general practitioners, not by a limited group of specialists. JAMA Intern Med. 2016 Feb 1;176(2):259-61.
Intestinal REG3 lectins protect against alcoholic steatohepatitis by reducing mucosa-associated microbiota and preventing bacterial translocation. Wang L, Fouts DE, Starkel P, Hartmann P, Chen P, Llorente C, DePew J, Moncera K, Ho SB, Brenner DA, Hoper LV, Schnabel B. Alcohol appears to impair control of mucosa-associated microbiota, and subsequent breach of the mucosal barrier facilitates progression of alcoholic liver disease. Cell Host Microbe, 2016 Feb 10; 19(2):227-39.
Telephone smoking-cessation counseling for smokers in mental health clinics: a patient-randomized controlled trial. Rogers ES, Smelson DA, Gillespie CC, Elbel B, Poole S, Hagedorn HJ, Kalman D, Krebs P, Fang Y, Wang B, Sherman SE. A specialized counseling intervention was more effective at helping patients quit than transfer to a state quit-line. Am J Prev Med. 2016 April;50(4):518-27.
Endomorphin analog analgesics with reduced abuse liability, respiratory depression, motor impairment, tolerance, and glial activation relative to morphine. Zadina JE, Nilges MR, Morgenweck J, Zhang X, Hackler L, Fasold MB. Endomorphin analogs could provide gold standard pain relief but with remarkably safer side effect profiles compared to opioids like morphine. Neuropharmacology. 2016 Jun:105:215-27.