Category: From Newswise – Addiction

Newswise — UCLA Health investigators are leading a new, six-city trial of injectable buprenorphine for treatment of methamphetamine use disorder in adults who also use opioids. This is the first study to investigate the drug’s efficacy in treating the two co-addictions simultaneously.

While buprenorphine has been used to treat opioid use disorder since 2002, there are currently no FDA-approved treatments for methamphetamine use disorder or methamphetamine use disorder together with opioid co-use.

The first-of-its-kind trial, available locally at the UCLA Health Vine Street Clinic, is a 12-week randomized, double-blind, placebo-controlled study. UCLA hopes to enroll 61 of the 246 participants to be recruited nationwide over the next two years.

The study is designated for those with moderate to severe methamphetamine use disorder coupled with mild opioid use disorder or opioid misuse. It is funded by the National Institute on Drug Abuse, part of the National Institutes of Health, and the Helping to End Addiction Long Term Initiative, or NIH HEAL Initiative. 

“There is strong rationale for evaluating buprenorphine as a treatment for methamphetamine and opioid co-use, and we are hopeful that the long-acting formulation of the medication will offer a viable recovery option for people living with this condition,” said Shoptaw, who participated in a previous New England Journal of Medicine study that showed a similar combination of medications — the injectable opioid antagonist naltrexone and the oral antidepressant bupropion — was effective in reducing methamphetamine use among adults with moderate to severe methamphetamine use disorder compared to placebo.

To be considered for the study, participants must be seeking treatment for methamphetamine use disorder and opioid co-use, be 18-65 in age, and be able to attend twice-weekly outpatient clinic visits. The trial evaluates patients with twice-weekly urine drug screens as well as self-reported frequency of methamphetamine and opioid co-use.

In addition to the UCLA Vine Street Clinic, participating institutions include: University of Texas Southwestern Medical Center, CODA, Alameda Health System Highland Hospital, Oklahoma State University Center for Health Sciences, and University of Washington Harborview Medical Center.

For more information this UCLA Vine Street Clinic-based study, call (323) 461-3106 or email [email protected]

###

Research reported in this press release is supported by the Clinical Trials Network at the National Institute on Drug Abuse, part of the National Institutes of Health, under award UG1DA020024. Additional support was provided by the NIH HEAL Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, is an aggressive, trans-NIH effort to speed scientific solutions to stem the national opioid public health crisis. Launched in April 2018, the initiative is focused on improving prevention and treatment strategies for opioid misuse and addiction, and enhancing pain management. For more information, visit: https://heal.nih.gov

What: Researcher at Washington University School of Medicine in St. Louis will discuss the study which involved a sleeping aid known as suvorexant that is already approved by the Food and Drug Administration (FDA) for insomnia, hints at the potential of sleep medications to slow or stop the progression of Alzheimer’s disease.

When: April 21st, 2PM EST

Where: Live Events Zoom Room (link will be given once you register)

Who: Dr. Brendan P. Lucey, MD -Associate Professor of Neurology, Section Head, Sleep Medicine

Researcher’s info:

Brendan Lucey is associate professor of neurology and Sleep Medicine Section head. Born and raised in Burlington, Vermont, he received his undergraduate degree at the University of Vermont and his medical degree from the Johns Hopkins University School of Medicine. Following medical school, Lucey completed his neurology residency at Washington University and a clinical neurophysiology fellowship at Brigham and Women’s Hospital. From 2008-2012, Lucey was on active duty in the U.S. Air Force and then joined the Department of Neurology at Washington University.

Lucey’s current research interests are in sleep, aging and Alzheimer’s disease. His lab focuses on studying the potential of sleep interventions to prevent or delay the onset of Alzheimer’s disease. Using lumbar catheters, he investigates how sleep affects different markers of Alzheimer’s disease changes in the brain such as amyloid-beta and tau. Lucey is also interested in whether or not sleep changes may be non-invasive markers for Alzheimer’s disease progression.

Media Register to Attend Here

Newswise — U.S. middle and high schools with the most students taking prescription stimulants to treat ADHD also had, overall, the highest percentage of students who misused prescription stimulants within the past year.

The University of Michigan-led study highlights a significant association between ADHD stimulant therapy in schools and prescription stimulant misuse, said Sean Esteban McCabe, U-M professor of nursing and principal investigator on the study. 

At some schools, 25% or more of kids reported misusing prescription stimulants in the past year—meaning they used the medication without a doctor’s orders or nonmedically, e.g., for recreation or to stay awake. 

Key takeaway: Wide variation in stimulant misuse among schools

This is the first large study to examine the prevalence of prescription stimulant misuse and correlating factors in U.S middle and high schools, McCabe said. Stimulant misuse among schools ranged from 0% to 25%, with some outliers that were higher. Other findings include:

• Students in schools with the highest rates of stimulant therapy for ADHD had a 36% higher risk of misusing prescription stimulants
• In schools with 12% or more students treated with prescription stimulants for ADHD, 8% of students reported misusing prescription stimulants 
• In schools with 6% or fewer students taking prescription stimulants for ADHD, 0-4% reported misusing prescription stimulants. 
• Other characteristics of schools with higher misuse: higher proportion of highly educated parents; located in non-Northeastern regions and suburbs; more white students; medium levels of binge drinking; and schools surveyed from 2015-2020

“I can tell you that a student’s experience will be different at a school with no peers who misuse stimulants versus a school where 1 in 4 peers misuse stimulants,” said McCabe, director of the U-M Center for the Study of Drugs, Alcohol, Smoking and Health. 

McCabe said the wide variation in misuse means individual schools should assess their own students for substance misuse behaviors rather than rely on existing data collected elsewhere. 

Stimulant therapy is highly effective; risk for misuse can be reduced 

Stimulant therapy for ADHD has increased in the last two decades. Prescription stimulants are one of  the most widely shared prescription drugs among teens, and the most misused prescription drug among teens. 

“Prescription stimulant therapy for ADHD does help millions of people, including in my own family, and students, friends and colleagues,” McCabe said. “It’s critical to balance the need for access to these medications while reducing the risk for misuse. This is more important than ever with the increases in prescribing.” 

Medication-sharing among teens is a big reason kids who aren’t on stimulant therapy have access to prescription stimulants, but it’s not the only factor, McCabe said. Some schools in the study with little or no stimulant therapy still had misuse. Parents can take steps to prevent medication sharing: 

• In middle school, start talking to kids about managing their medications
• Role play so kids know how to respond if asked to share medications 
• Always store controlled substances in a lockbox and monitor pill counts 
• Make sure schools have safe storage and dispensing policies, and ask about prevalence of misuse
• Contact prescriber immediately if you detect misuse

Other recent U-M studies show associations between stimulant therapy and misuse 

One paper found that students who had used both stimulant and nonstimulant medications for ADHD were more likely to misuse prescription stimulants, or to use cocaine or methamphetamine, in the past year, compared to students who reported never using stimulant or non-stimulant therapy. 

Another paper found that kids diagnosed early with ADHD, who started stimulant therapy early and were treated longer, had lower odds of later stimulant misuse compared to those who started therapy later and for a shorter duration. 

These two studies and the current study used data collected between 2005 and 2020 by Monitoring the Future, a large survey of trends in legal and illicit drug use among American students in 8th, 10th and 12th grades. Not all studies used the same data sets.

The findings, appearing in JAMA Network Open, were supported by the National Institute on Drug Abuse at the National Institutes of Health and the U.S. Food and Drug Administration.

Study (available when embargo lifts): Prescription stimulant medical and nonmedical use among US secondary school students (DOI: 10.1001/jamanetworkopen.20238707)

Newswise — A stop smoking mobile app that senses where and when you might be triggered to light up could help people quit – according to University of East Anglia research.

Quit Sense is the world’s first Artificial Intelligence (AI) stop smoking app which detects when people are entering a location they used to smoke in. It then provides support to help manage people’s specific smoking triggers in that location.

Funding for the Quit Sense app has come from the National Institute for Health and Care Research (NIHR) and the Medical Research Council.

A study published today shows how the new app helped more smokers to quit than people who were only offered online NHS support.

The team hope that by helping people manage trigger situations, the new app will help more smokers to quit.

Lead researcher Prof Felix Naughton, from UEA’s School of Health Sciences, said: “We know that quit attempts often fail because urges to smoke are triggered by spending time in places where people used to smoke. This might be while at the pub or at work, for example.

“Other than using medication, there are no existing ways of providing support to help smokers manage these types of situations and urges as they happen.

Dr Chloë Siegele-Brown, from the University of Cambridge and who built the app, said: “Quit Sense is an AI smartphone app that learns about the times, locations and triggers of previous smoking events to decide when and what messages to display to the users to help them manage urges to smoke in real time.

Prof Naughton added: “Helping people attempting to quit smoking to learn about and manage these situations is a new way of increasing a smoker’s chances of quitting successfully.”

The research team carried out a randomised controlled trial involving 209 smokers who were recruited via social media.

They were sent links by text message to access their allocated treatment – all participants received a link to NHS online stop smoking support but only half received the Quit Sense app in addition.

Six months later, the participants were asked to complete follow-up measures online and those reporting to have quit smoking were asked to post back a saliva sample to verify their abstinence.

Prof Naughton said: “We found that when smokers were offered the Quit Sense app, three-quarters installed it and those who started a quit attempt with the app used it for around one month on average.

“We also found that four times more people who were offered the app quit smoking six months later compared to those only offered online NHS support.”

The research team note that one limitation of this relatively small scale study was that less than half of the people who reported quitting smoking returned a saliva sample to verify that they had quit smoking. And more research is needed to provide a better estimate of the effectiveness of the app.

Health Minister Neil O’Brien said: “Technology and smartphones have a role to play in driving down smoking rates, which is why I’ve set out our plans to explore the use of QR codes in cigarette pack inserts to take people to stop-smoking support.

“Making better use of technology – alongside the world’s first national ‘swap to stop’ scheme and financial incentives for pregnant women alongside behavioural support – will help us to meet our smokefree ambition by 2030, reduce the number of smoking-illnesses needing to be treated, and cut NHS waiting times.”

This study was led by the University of East Anglia in collaboration with researchers from the University of Cambridge, the Norwich Clinical Trials Unit, the University of Nottingham, King’s College London, University College London, and Imperial College London.

‘An automated, online feasibility randomised controlled trial of a Just-In-Time Adaptive Intervention for smoking cessation (Quit Sense)’ is published in the journal Nicotine and Tobacco Research.

ENDS

Newswise — High levels of the body’s own cannabinoid substances protect against developing addiction in individuals previously exposed to childhood maltreatment, according to a new study from Linköping University in Sweden. The brains of those who had not developed an addiction following childhood maltreatment seem to process emotion-related social signals better.

Childhood maltreatment has long been suspected to increase the risk of developing a drug or alcohol addiction later in life. Researchers at Linköping University have previously shown that this risk is three times higher if you have been exposed to childhood maltreatment compared with if you have not, even when accounting for confounds from genetics and other familial factors.

“There’s been a lot of focus on addiction as a disease driven by a search for pleasure effects and euphoria, but for many it has more to do with the drugs’ ability to suppress negative feelings, stress sensitivity, anxiety and low mood. Based on this, we and other researchers have had a theory that if affected in childhood, the function of the brain’s distress systems is altered, and that this may contribute to addiction risk in adulthood,” says Markus Heilig, professor and director of the Center for Social and Affective Neuroscience, CSAN, at Linköping University and consultant at the Psychiatric Clinic of the University Hospital in Linköping.

Endocannabinoids, i.e. the body’s own cannabis-like substances, are an interesting player in this context. The endocannabinoid system plays an important part in regulating reactions to stress and discomfort. Recent research suggests that this endogenous system may function as a stress buffer.

The researchers behind the study, published in Molecular Psychiatry, aimed to investigate possible mechanisms behind susceptibility or resilience to developing substance use disorder later in life after exposure to childhood maltreatment. One difficulty in research is that people who develop problems later in life tend to overreport negative life experiences when questioned about earlier events. The researchers therefore used psychiatric care registers of children and young people having been treated for traumatic childhood experiences to find study participants with objectively and prospectively documented exposure. The study included about 100 young adults divided into four equal sized groups: individuals that had been exposed to childhood maltreatment and had developed an addiction, individuals that had been exposed but had not, individuals that had not been exposed but had developed an addiction, and individuals who had neither been exposed nor developed an addiction. The researchers measured endocannabinoid levels in participants’ blood and carried out several experiments to test stress reactions. The participants’ brains were also scanned using magnetic resonance imaging, MRI, while their reactions to social stimuli were tested.

It turned out that one group stood out compared to the other three: the group that had experienced childhood maltreatment but had not later developed an addiction. The researchers refer to this group as ‛resilient’. In comparison with the other groups, this group showed increased function of the endocannabinoid system as well as different brain activity. Surprisingly, the resilient group differed most from the control group, which had not been exposed to childhood maltreatment, nor had any addictions.

 Faced with emotional social stimuli, the resilient group showed higher activity in three areas of the brain. Two of these areas are part of a brain network that focuses attention and cognitive abilities on what is important at the moment and modifies individuals’ behaviour according to the situation at hand. The third area of the brain is in the frontal lobe and is associated with regulating emotions. This area communicates extensively with other areas in the brain that process emotions. In comparison with other animals, humans have a well-developed frontal lobe that regulates impulses and emotions, for instance by suppressing fear impulses in situations where fear is not relevant.

­“Increased activity in certain areas of the brain in the resilient group, which had not developed an addiction despite childhood maltreatment, may be linked to a more adaptive way of reacting to emotional social information. We can see that also in a resting state they show increased communication between the frontal lobes and other parts of the brain, which could indicate that this group has better emotional regulation,” says Irene Perini, staff scientist at CSAN at Linköping University.

A question this discovery raises is whether the resilient group had a high endocannabinoid system function from the outset, or whether they were better able to activate the system in response to stress, thereby avoiding long-term consequences of childhood maltreatment. Because of its cross-section nature, this is not possible to determine from the present study.

The study was funded by, among others, the Swedish Research Council, Knut and Alice Wallenberg Foundation, Region Östergötland, Linköping University, Systembolaget’s Alcohol Research Council and the Brain & Behaviour Research Foundation NARSAD Young Investigator Grant. It was carried out by Markus Heilig’s research group at CSAN. Irene Perini is the lead author together with Leah Mayo, previously with CSAN at LiU, and currently professor at the University of Calgary in Canada.

BYLINE: Jacqueline Mitchell

Newswise — BOSTON – There were more than 100,000 reported deaths from opioid overdoses in 2021, according to the Centers for Disease Control and Prevention. Methadone treatment remains one of the most reliable means of treating opioid use disorder, with success rates reportedly ranging from 60 to 90 percent for patients who stick with the long-term regimen. Adherence, though, remains a challenge.

In a novel randomized clinical trial published in JAMA Network Open, senior author Ted J. Kaptchuk at Beth Israel Deaconess Medical Center (BIDMC), lead author Annabelle Belcher, PhD, of the University of Maryland School of Medicine, and colleagues tested whether using open-label placebo could increase the efficacy of methadone treatment for people undergoing care for opioid use disorder. The researchers found that participants who knowingly received placebo pills in addition to standard-of-care methadone treatment were significantly more likely to remain in treatment than participants who received methadone treatment alone. Participants who received placebo pills also reported better sleep quality.

“The clinical implications of our intervention have great potential impact, as retention in treatment is a serious challenge for the field of addiction medicine,” said Belcher. “We’ve demonstrated it’s feasible to administer a placebo in addition to standard-of-care methadone in a community-based opioid treatment setting without adding a significant burden to clinic procedures, and the low-cost, low-risk nature of this intervention could provide an appealing strategy to target early methadone treatment adherence.”

It has long been assumed that deception or concealment is necessary for placebo effects – i.e. “tricking” a patient to believe an inert pill contains active medication. But, a growing body of evidence in randomized controlled trials with irritable bowel syndrome, chronic low back pain, cancer-related fatigue, migraine and other conditions has demonstrated no such deception is necessary for placebo treatment to alleviate symptoms. Additionally, conditioning study participants to placebos by having them pair the placebo with an active medication – thereby potentially associating the placebo with a relief in symptoms that may be caused by the active drug – has also been shown to treat symptoms of insomnia, ADHD, post-surgical pain, and more.

For this two-arm, open-label, single-blind randomized controlled trial, 131 newly enrolled adult patients seeking treatment for moderate-to-severe opioid use disorder (OUD) at an academically affiliated community opioid treatment program were recruited. All participants were informed of the possible benefits of open-label placebo and conditioning. The research team also described the neurobiological and psychological mechanisms of placebo effects and conditioning in lay terms and in a routine, supportive setting. Then, participants were randomized either to receive treatment-as-usual or treatment-as-usual plus conditioned open-label placebo (microcrystalline cellulose pills).

While the participants were aware that they were taking a placebo pill, the clinical addiction care team was unaware as to which participants were in the treatment-as-usual or treatment-plus-placebo groups and the trial altogether to avoid any unconscious differential treatment. All participants were seen at weeks two, four, eight, and 12 after the initial enrollment and underwent the same outcome assessments. Those in the placebo group were not provided with any additional information about placebos or the rationale of the study beyond what was provided at the baseline meeting.

Researchers assessed patients’ 90-day methadone dose, treatment retention, self-reported drug use, withdrawal, craving, quality of life, and sleep quality. Contrary to the researchers’ expectations, the conditioned open-label placebo had no impact on the 90-day methadone dose. However, participants treated with open-label placebo were significantly more likely to remain in treatment; 78 percent of the placebo-treated group stayed with the program compared to 61 percent of the methadone-only group. The placebo group also reported better sleep quality. No statistically significant differences were found in any other outcome measures.

“Implementing a unique combination of two methods to harness the placebo effect – open-label placebo and pharmacological conditioning – we found a significant difference in the group’s 90-day retention rates, demonstrating that placebo treatment can provide valuable benefits and still adhere to ethical norms of informed consent,” said Kaptchuk, director of the Program in Placebo Studies and the Therapeutic Encounter at BIDMC and professor of medicine at Harvard Medical School. “Previous assumptions that placebo treatment needs concealment or deception to ‘work’ are not true. Additionally, there is growing evidence that open-label placebo demonstrates similar neurotransmitter engagement to double-blind and deceptive placebos. It is important to note that a patient-clinician relationship is an important component of open-label placebo.”

Co-authors included Thomas O. Cole, MA, Emerson M. Wickwire, PhD, Aaron D. Greenblatt, MD, William Wooten, MS, and Lawrence Magder, PhD, and Eric Weintraub, MD, of University of Maryland, School of Medicine; Ebonie Massey, MA, Amy S. Billing, MSSA, Michael Wagner, PhD, and Eric D. Wish, PhD, of Center for Substance Abuse Research (CESAR), University of Maryland; David H. Epstein, PhD, of Real-world Assessment, Prediction, and Treatment Unit, National Institute on Drug Abuse Intramural Research Program (NIDA-IRP/NIH); Stephen W. Hoag, PhD, of University of Maryland, School of Pharmacy; Luana Colloca, MD, of University of Maryland School of Nursing; and John Rotrosen, MD, of NYU Grossman School of Medicine.

This work was supported by the Foundation for the Science of the Therapeutic Encounter; the University of Maryland MPowering the State Opioid Use Disorders Initiative; the University of Maryland, Baltimore, Institute, for Clinical & Translational Research (ICTR); the National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA) (grant number 1UL1TR003098.)

Please see the publication online for a complete list of disclosures.

About Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center is a leading academic medical center, where extraordinary care is supported by high-quality education and research. BIDMC is a teaching affiliate of Harvard Medical School, and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.

Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,800 physicians and 36,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.

# # #

Newswise — INDIANAPOLIS—A multi-disciplinary team of Indiana University researchers is focusing their efforts on a growing public health concern: binge and “high-intensity” drinking—extreme drinking behaviors that are increasingly prevalent among college-age adults.

The researchers, who are part of the Indiana Alcohol Research Center, recently received a five-year, $8.65 million grant renewal from the National Institute on Alcohol Abuse and Alcoholism to support this work.

Established in 1987, the Indiana Alcohol Research Center (IARC) is housed at IU School of Medicine and led by director David Kareken, PhD, a professor of neurology at the school. The center’s broad mission is to study the behavioral and neurobiological risks for alcohol use disorder.

“The IARC begins its eighth consecutive funding cycle by continuing its long tradition of multi-disciplinary collaboration across animals and humans to better understand the neurobiological and behavioral risks for developing alcohol use disorder,” Kareken said. “We believe that our combined diverse methods and perspectives are best suited to studying a problem of both great importance and complexity.”

Cristine Czachowski, PhD, a professor of psychology at the School of Science at IUPUI, and Christopher Lapish, PhD, a professor of anatomy, cell biology and physiology at IU School of Medicine, serve as the center’s deputy director and scientific director, respectively.

“The center provides researchers like me—those studying rodent models of behavior—valuable interactions with colleagues (and friends) who work on the clinical side,” Czachowski said. “The crosstalk between disciplines, and across many departments, keeps us at the top of our game with regard to the latest findings and focused on the human experience of alcohol use disorder.”

Working as a team across basic and clinical research, center faculty will work to determine how inherited and acquired behavioral and neurobiological vulnerabilities predispose people to more intense patterns of drinking, with a particular emphasis on factors that lead to faster initial rates of drinking and a proclivity for sustained high intake.

“Our ability to measure how brain function is altered in alcohol use disorder is rapidly improving,” Lapish said. “This is true for humans and rodent models of the disorder. Our hope is that we can find similarities across the species, which, in turn, will facilitate new treatments.”

The researchers will also work with the community, schools, health care providers and state policy makers in providing education about the science, prevention, and treatment of alcohol use disorder.

This funding renewal is the Indiana Alcohol Research Center’s eighth consecutive five-year grant from the National Institute of Alcohol Abuse and Alcoholism since its founding. Over the past three decades, center researchers and their collaborators have played key roles in studying alcohol use disorder heritability—showing differing genetic and environmental influences across the disorder’s developmental timeline.

Their animal and human research models are also used worldwide in alcohol-related research. Center researchers conceived, and continue to refine, the “Computer-assisted Alcohol Infusion System,” an intravenous alcohol administration research method that permits exquisite experimental control over an individual’s level of alcohol exposure—a technique employed in human research laboratories around the world. The center’s animals—rats and mice selectively bred by the IARC to prefer alcohol—are similarly used throughout the world to help understand inherited risk.

Other Indiana Alcohol Research Center project and core resource leaders include IU School of Medicine’s Martin Plawecki, MD, PhD; Frederic (Woody) Hopf, PhD; Tamika Zapolski, PhD; and Karmen Yoder, PhD; and the IUPUI School of Science’s Marian Logrip, PhD; Nicholas Grahame, PhD; Melissa Cyders, PhD; and Stephen Boehm, PhD. Collaborating scientists include researchers at IU School of Medicine, the School of Science at IUPUI, the IU School of Public Health-Bloomington, and Purdue University.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

Newswise — WINSTON-SALEM, N.C. – April 4, 2023 – The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH), has awarded Wake Forest University School of Medicine a renewal grant of $8 million over five years for research on alcohol use disorder.

With the support of the grant, the Wake Forest Translational Alcohol Research Center will build upon a highly productive translational alcohol research program that was established with prior support from the NIH.

According to the NIAAA, more than 140,000 people die from alcohol-related causes each year in the U.S., and an estimated 15 million people have alcohol use disorder.

“Our center’s primary research focus is understanding what makes people vulnerable to alcohol use disorder,” said Jeffrey L. Weiner, Ph.D., professor of physiology and pharmacology at Wake Forest University School of Medicine and the center’s director.

The center seeks to identify behavioral adaptations and brain mechanisms that contribute to vulnerability and resilience to alcohol use disorder. For example, one ongoing study seeks to understand how abstinence alters craving and brain network connectivity in risky drinkers. And a recent study, published in the Journal of Neurosurgery, analyzed chemical fluctuations in the brain in patients with alcohol use disorder.

Researchers are also examining brain network dynamics associated with hazardous drinking by analyzing a dataset from the National Consortium on Alcohol and Neurodevelopment in Adolescence, a longitudinal study that is collecting brain imaging and alcohol consumption history from adolescents over eight years. 

“There’s a lot of research on the role of genetics in alcohol addiction, but we’re learning more about how environmental factors such as early-life adversity, poverty and childhood stress have a huge influence on the brain and its susceptibility to neuropsychiatric disorders including alcohol use disorder,” Weiner said. “Our hope is that our research will lead to evidence-based therapies for those who are most at risk.” 

Newswise — A new University of California study shows long-term success when health care providers make electronic referrals (e-referrals) for their patients to California’s tobacco quitline. The paper was published today in the journal Nicotine & Tobacco Research.

Quitlines offer free help to stop tobacco use. They typically double the chances that a person stays quit for good.

Tobacco is the leading cause of preventable disease, disability and death in the United States. Quitting significantly reduces these risks. However, until this study was conducted, there had been little research about the real-world implementation, maintenance, and outcomes of e-referrals to quitlines. The study is the first collaboration of its kind to be conducted by all five University of California health systems.

“Even though the five UC health systems are under the umbrella of UC Health, they each are independent, which is why the implementation benefited from a whole-systems approach, taking into account the different IT systems and clinical workflows,” said Elisa Tong, lead author of the study and UC Davis co-leader of CA Quits.

Tong is also an internist and medical director of the Stop Tobacco Program at UC Davis Health. She said that including both outpatient and inpatient settings is important for offering and sustaining e-referrals to patients. The study showed that patients referred by providers had similar quit rates as people who called the quitline seeking help.

Method and results

In 2013, UC Davis Health was the first health system to implement an e-referral to the California quitline, now known as Kick it California. Beginning in 2014, the UC-wide project UC Quits worked with inpatient, outpatient, and nursing champions to scale up quitline e-referrals from one to five UC health systems. This also included UC San Francisco, UC Irvine, UC Los Angeles, and UC San Diego.

Data on e-referred patients and quitline callers were collected April 2014-March 2021. Analysis of referral trends and cessation outcomes was conducted in 2021-2022.

Of the more than 20,000 patients referred, the quitline contacted 47.1%; 20.6% of those completed the intake process. Data collected showed 15.2% requested counseling and 10.9% received the cessation help. In a sample randomly selected for follow-up, patients e-referred by their UC providers were as likely as general quitline callers to attempt quitting (68.5% vs. 71.4%), quit for 30 days (28.3% vs. 26.9%) and quit for six months (13.6% vs. 13.9%).

The study supports the broad implementation of tobacco quitline e-referrals across health care settings and finds that modifying electronic health records systems and clinical workflows will enable and encourage e-referrals.

If implemented and maintained appropriately, the study showed that e-referrals will improve patient care, make it easier for clinicians to support patients in quitting, and increase the number of patients using evidence-based treatment.

“More health systems can use electronic referral systems to link with the quitline and collaborate on systems changes,” said Shu-Hong Zhu, UC San Diego co-leader of CA Quits and co-author. “Establishing and maintaining electronic referrals is an important way to ensure patients who are trying to stop smoking are set up for success.”

Acknowledgements

Other authors included Shu-Hong Zhu, Christopher M. Anderson, Mark V. Avdalovic, Alpesh N. Amin, Allison L. Diamant, Timothy W. Fong, Brian Clay, Robert El-Kareh, Sujatha Sankaran, Catherine Bonniot, Carrie A. Kirby, Antonio Mayoral, and Linda Sarna.

Funding was supported by the UC Center for Health Quality and Innovation, with additional support secured from Tong from the Tobacco-Related Disease Research Program (#28CP-0039HS). Kick It California is funded by the California Department of Public Health, First 5 California and the Centers for Disease Control and Prevention.