AUD medications and postsurgery opioids: The latest

Topiramate's use as a treatment for alcohol use disorder (AUD) is not a new idea, Bankole Johnson, M.D. (now of ondansetron fame; see ADAW, March 25, April 1), reviewed it many times (see ADAW, Oct. 15, 2007; Feb. 11, 2008; June 16, 2008; Nov. 3, 2008; June 7, 2010; Jan. 31, 2011; Feb. 24, 2014). But a comprehensive review published recently in the Journal of Addiction Medicine is concise. While not approved by the Food and Drug Administration for AUD, topiramate can be prescribed off‐label, and should be considered as a treatment for the condition, according to Ajay Manhapra, M.D., and colleagues in the article, “Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review.” Like ondansetron and other possible AUD medications, including those that are approved (like acamprosate and naltrexone), topiramate doesn't work for everyone. But pharmacogenetic testing may help identify those who are likely to respond, according to the review. In addition, there are early studies indicating it could be used to treat cocaine and nicotine use disorder, as well as behavioral addictions.     

Names in the News

Bankole A. Johnson, M.D., DSc., until March 26 chairman of the board of directors of Adial Pharmaceuticals, is now chief medical officer of the company, which is about to start a Phase 3 clinical trial of AD04 (low‐dose ondansetron) for alcohol use disorder (see ADAW, March 25). Johnson will also leave his position as chair of the Department of Psychiatry at the University of Maryland. “I am delighted to join the senior management team of Adial as we work toward our goal of developing the leading addiction company,” Johnson said in a press statement March 26.     

Alcoholism starts in youth,so it should be screened for

Alcohol use disorder (AUD) — what used to be called alcoholism, but a condition which by definition is sometimes used to apply to everyone who drinks alcohol and is underage — is not a disease of adults only. It starts in childhood, and that's why Scott E. Hadland, M.D., and colleagues argue for screening in the February issue of Pediatrics.     

Underage drinking and the role of parents

Last week's article on underage drinking and DWIs touched on the role of parents in helping to prevent both (see “Binge drinking in 12th grade predicts DWIs, blackouts and ‘extreme’ binge drinking,” ADAW, Feb. 3, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32610 ). The article was based on a study published in Pediatrics, co‐authored by Ralph W. Hingson, Sc.D., M.P.H., director of the Division of Epidemiology and Prevention Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Last week, Hingson, who presented on underage drinking at the annual leadership meeting of Community Anti‐Drug Coalitions of America (CADCA), also explained more about the role of parents. “Parents do have an influence over whether and how much their children drink,” he told us. For example, if a parent binge drinks, their children will be twice as likely to binge drink — and to have alcohol use disorder.     

Medical cannabis physician decries lack of education

“This is all new to them.” That's how David G. Ostrow, M.D., Ph.D., vice president of the American Academy of Cannabinoid Medicine (AACM), describes medical cannabis, which has actually been legal in some states for many years. It was the precursor to recreational cannabis, but it's not the same thing. Patients with real medical problems ask their doctors about it — and their doctors don't know what to say.     

Psychodynamic therapy for SUD: Counselor's view

First of all, psychodynamic psychotherapy as treatment for substance use disorder (SUD) works. Ian McLoone, lead therapist with the Alltyr Clinic in Minneapolis, knows that firsthand — he's in recovery from heroin addiction and is in it himself. And despite the fact that addiction therapists aren't taught psychodynamic theory or psychoanalytic psychotherapy in graduate school, where cognitive behavioral therapy (CBT), motivational interviewing (MI) and, to a lesser degree, 12‐Step facilitation are stressed, he became interested in it mainly because of his employer, Mark Willenbring, M.D., a psychiatrist and former medical director of the National Institute on Alcohol Abuse and Alcoholism. We talked to McLoone for this story as a follow‐up to our article on the self‐medication hypothesis of addiction, for which we interviewed its developer, Ed Khantzian, M.D. (see “Psychodynamic psychotherapy: When it helps people in recovery,” ADAW, June 22, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32756 ).     

Sublocade: Why a placebo arm?

In a time when people are dying from illicit fentanyl overdoses, why would a trial for a new medication to treat opioid use disorder — a formulation of buprenorphine, already proven to be safe and effective in oral form — include a placebo arm? This was the question asked by many when the results of Indivior's trial for Sublocade, a buprenorphine injection that lasts a month, were published last month in The Lancet (see ADAW, Feb. 25). The trial results were what led to Sublocade's approval by the Food and Drug Administration (FDA) for the treatment of opioid use disorder more than a year ago (see ADAW, Dec. 11, 2017).     

As HIPAA changes loom,patients demand continued confidentiality for SUD records

In last week's issue, we wrote about the plans by the federal Department of Health and Human Services (HHS) to weaken the Health Insurance Portability and Accountability Act (HIPAA), citing regulatory burdens and the need for information‐sharing (see ADAW, Jan. 21). The plans, detailed in a request for information (RFI) issued Dec. 12, throw a wrench into the plans by the “make 42 CFR Part 2 like HIPAA” movement, which would erase the federal confidentiality regulation protecting substance use disorder (SUD) treatment records by watering it down to HIPAA standards. Now, with even HIPAA seeming too burdensome, the need is even greater to protect the consent provision of 42 CFR Part 2 — which is basically all that's left after the Substance Abuse and Mental Health Services Administration (SAMHSA) allowed information‐sharing for the vague “health care operations” without consent last year (see ADAW, Jan. 8, 2018). Last week, H. Westley Clark, M.D., J.D., dean's executive professor at Santa Clara University and former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, made this abundantly clear in his comments to ADAW.     

AN EXPERIMENTAL TEST OF THE PERSISTENCE OF GENDER‐BASED STEREOTYPES

This paper experimentally investigates the role of gender‐based stereotypes in the forecasting of risk attitudes. Subjects predict the gamble choice of target subjects in one of three treatments: (1) Visual—the predictor can only observe the target; (2) Information—the predictor has individuating information about the targets' response to two statements from a risk‐preference survey; and (3) Combined—the predictor both observes the targets and has the targets' two responses to the risk‐preference survey. Our results suggest that stereotypes play a considerable role in forming predictions about others' risk attitudes and that these stereotypes persist even when individuating information is available. (JEL C91, D8, J16)     

Is Partner Violence Worse in the Context of Control?

M. P. Johnson’s (1995) proposal that there are two qualitatively distinct types of intimate partner violence—intimate terrorism and situational couple violence—has been an influential explanation for disparate findings on sex symmetry in domestic violence. This study examines whether this typology increases our ability to explain variations in the negative outcomes of partner violence as compared with the use of a continuous measure of violence. This study also considers whether the use of control to differentiate between types of violence helps to explain the negative consequences of partner violence. The results, based on analyses of data on 4,575 married women from National Violence Against Women survey, indicate mixed support for Johnson’s argument for a qualitative distinction between IT and SCV.     

Gendered Divisions of Fertility Work: Socioeconomic Predictors of Female Versus Male Sterilization

Domestic labor researchers have examined a multitude of duties disproportionately performed by women, yet the responsibility associated with navigating a couple's fertility—fertility work—has been overlooked. Using data from the 2006–2010 National Survey of Family Growth (N = 1,415), the author examined how racial and socioeconomic factors affect the division of contraceptive fertility work among married and cohabiting women who rely on either their partners' vasectomies or their own sterilizations. Drawing theoretical connections between fertility work and housework, resource‐ and gender‐based perspectives were used to assess whether women's or their partners' characteristics are stronger predictors of sterilization type, and whether women's absolute or relative education level has a greater impact. Findings suggest that White and socioeconomically privileged women are more likely to have vasectomized partners than disadvantaged women. Male partners' characteristics were more closely associated with sterilization type than women's characteristics, lending greater support for the gender‐based hypotheses.     

THE HABIT OF GIVING

Many charitable organizations believe it is worthwhile to solicit very small donations, particularly from young people, because these gifts form a habit of giving which leads to larger donations in the future. Indeed, there is some evidence of a positive correlation between giving when young and giving when old. However, such a correlation, by itself, does not constitute evidence of habit formation. Using data on alumni contributions to a university, we assess whether the correlation is due to habit formation—true state dependence—or to unobservable factors such as affinity to the school. We further examine whether habits form by the mere act of giving or based on the amount given. We implement an instrumental variables approach using the fact that performance of the school's athletic teams and solicitation by one's former roommates generate shocks to giving while young that are plausibly uncorrelated with giving when older. There is strong evidence of habit formation on the extensive margin, but not in the amount given. This finding has important implications for fundraising strategies, charities' accounting practices, and tax policy. (JEL D64, D91, D12)     

Addiction telemedicine comes into its own with COVID‐19

Telepsychiatry, telemental health, telepsychology, teletherapy — whatever you call it, it is now required in the era of the COVID‐19 pandemic. “We should be doing it immediately; the more, the better,” said Robert Caudill, M.D., a member of the American Psychiatric Association's Committee on Telepsychiatry. “It's exploded in the past week, obviously,” he told ADAW in a Zoom interview on March 23. But he thinks it should be the norm.     

Is counseling ‘required’ with medications to treat opioid use disorder?

In “No Strings Attached: More Opioid Addicts Get Meds Without Talk Therapy,” an article by Beth Schwartzapfel of the Marshall Project published in USA Today May 9 ( https://www.usatoday.com/story/news/investigations/2019/05/09/opioid‐crisis‐drugs‐no‐therapy/1131110001/ ), both sides were excellently reported. Kenneth B. Stoller, M.D., longtime methadone researcher from Johns Hopkins, was quoted as saying that medications without any talking is “selling patients short.” Some Twitter participants immediately charged that Stoller was kicking patients off medication if they weren't participating in counseling (which he doesn't do and the article doesn't say he does), and a protracted debate on Mother's Day led us to ask Stoller himself — who does not tweet — to respond. We copied and pasted the comments so he could see them. His response is below. (To see the Twitter thread, go to https://twitter.com/ADAWnews/status/1127175604959436800 .)     

Onslaught against 42 CFR Part 2 continues in Congress

With the opposition of the American Medical Association (AMA) last fall, any moves in Congress and the federal government to weaken the patient consent provisions of 42 CFR Part 2, the regulation protecting the confidentiality of substance use disorder (SUD) treatment records, were stopped in their tracks — and in the nick of time (see ADAW, Oct. 1, 2018; Oct. 15, 2018). But the groups promoting the complete abandonment of 42 CFR Part 2, replacing it with the Health Insurance Portability and Accountability Act, which itself is targeted for at least partial destruction (see ADAW, Jan. 21, Jan. 28, Feb. 25), are back. There's a new push to try to overhaul 42 CFR Part 2.     

IS PHYSICAL INVESTMENT THE KEY TO CHINA'S GROWTH MIRACLE?

This paper applies Jones' test for the empirical validity of AK‐type models to the Chinese economy over the period 1952–2006 (Jones C. I., Quarterly Journal of Economics, 110, 1995a, 495–525). We aim to establish whether large permanent movements in the physical investment rate cause permanent movements in output growth. The evidence indicates that the one‐sector AK model cannot be rejected. We also find that augmenting the model to allow for transitional dynamics—via imbalances in factor endowments, structural transformation, and R&D‐based technology transfer—does a better job in describing China's growth dynamics than the basic AK model. (JEL C22, O41, O47)     

Appropriations update: DOJ and ONDCP now funded

President Trump has signed the Consolidated Appropriations Act of 2019, which funds the agencies that weren't funded in last fall's spending bill, which included the Department of Health and Human Services. In particular, for ADAW readers, the spending bill signed Feb. 15 includes the Department of Justice (DOJ), the Office of National Drug Control Policy (ONDCP), and the Food and Drug Administration, which weren't funded before due to the government shutdown.     

Changes in Relationship‐Specific Attachment in Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT; Johnson, The practice of emotionally focused couple therapy (1st/2nd edition). Brunner‐Routledge, New York, 2004) is an effective treatment of relationship distress (Johnson et al., Clinical Psychology: Science and Practice, 1999; 6, 67). However, less is known about EFT's impact on couples' relationship‐specific attachment bond. Using hierarchical linear modeling with a sample of 32 couples, we examined session‐by‐session changes in couples' relationship‐specific attachment anxiety and avoidance and pre‐ to posttherapy changes in their relationship‐specific attachment behaviors. Couples significantly decreased in relationship‐specific attachment avoidance, and those who completed a blamer softening significantly decreased in relationship‐specific attachment anxiety. Couples' attachment behavior significantly increased toward security. Finally, session‐by‐session decreases in relationship‐specific attachment anxiety and avoidance were significant associated with increases in relationship satisfaction across sessions. These results provide empirical support for the attachment‐based assumptions of EFT. Video abstract accessible by clicking here