Against this backdrop, a research team at Maryland Treatment Centers in Baltimore, working with colleagues at Johns Hopkins University School of Medicine, has adapted a behavioral intervention called Youth Opioid Recovery Support, or YORS, for adolescents aged 13 to 17. The intervention had already shown large effects on medication adherence in young adults aged 18 to 28 across multiple pilot trials since 2018, but it had never been tested in younger adolescents, nor in patients taking sublingual buprenorphine, the dissolvable tablet under the tongue that is by far the most common medication choice among youth. The new pilot, published in Frontiers in Adolescent Medicine, also took a broader view of success than previous work. Rather than measuring only medication adherence and opioid use, the researchers explored recovery capital, a framework describing the accumulated resources across financial, human, social, and community dimensions that support a person’s recovery. For adolescents, these resources include stable housing, school engagement, sober friendships, supportive family, and access to peer recovery groups.

The study enrolled 11 adolescents seeking treatment for opioid use disorder from inpatient or outpatient addiction programs in central Maryland between April 2024 and January 2025. Each participant nominated a family member or support person to serve as a treatment significant other, and 10 such adults, all parents, joined the trial. The design was a 16-week uncontrolled feasibility pilot, meaning there was no comparison group and the goal was to establish whether the adapted intervention could be delivered successfully and whether adolescents and families found it acceptable. The sample was diverse and clinically severe: participants were primarily African American and Hispanic, mostly male, with a mean age of 15.8 years, smoking fentanyl as their primary route of opioid use, and relying on public insurance. Their first opioid use occurred at a mean age of 14.3 years, and more than a quarter reported a lifetime overdose.

YORS is built on four core components, each designed to strip away the barriers that typically cause adolescents to fall out of medication treatment. The first is low-barrier access to medication: there was no requirement to attend counseling sessions in order to receive prescriptions, medications were prescribed in flexible supplies of one to four weeks, and free rideshare transportation was offered for injection visits or pharmacy pickups. Research staff monitored refills, coordinated medication visits, and offered same-day appointments outside regular business hours. The second component is motivational incentives, in which participants earned cash gift cards verified for taking their medication, with schedules totaling up to 200 dollars for injectable adherence or 208 dollars for daily sublingual buprenorphine over the 16 weeks. Incentives were dispensed only when adherence was confirmed through medical records, direct observation, or a trained support person.

The third component is assertive outreach and therapy. Every adolescent was assigned a YORS therapist for individual sessions, family sessions, and frequent contact by text and phone. Staff contacted patients weekly and support persons at least biweekly, with sessions flexible enough to accommodate school schedules, and maintaining engagement treated as the top priority even when patients declined formal sessions. The fourth component is family involvement: each adolescent and their designated support person created a written treatment agreement with the therapist to set goals and expectations, revisited in monthly family sessions, supplemented by education and coaching on opioid use disorder, coping skills, peer support, and weekly family support groups. The intervention was layered on top of usual care, which consisted of completing an acute inpatient stay where applicable and referral to continuing outpatient services.

The primary outcome was self-reported days of medication adherence, assessed biweekly with the timeline follow-back interview method. Participants averaged 78.7 days of adherence, or 70.3 percent of the 112-day intervention period, with missing days conservatively imputed as non-adherent. When calculated only across days with available self-report data, adherence reached 92.4 percent. Six of the 11 participants reported adherence above 90 percent, well over the 80 percent threshold conventionally considered good medication adherence, while the remaining participants ranged from 25 to 53 percent, producing a strikingly bimodal distribution. On the secondary outcome of opioid use, participants reported use on only 4.8 percent of days with available data, and nine of the 11 participants, or 81.8 percent, reported complete opioid abstinence across the intervention. Urine drug screen data collected as a validity check flagged only one discordance, in which a participant self-reported two abstinent weeks contradicted by a positive screen in the first month.

Feasibility signals were strong. The trial exceeded its enrollment target of eight adolescents with 11 enrollments, and reached 90.9 percent of its goal for enrolling a support person for each participant. All intervention components were implemented with variable uptake: 72.7 percent of adolescents completed at least one individual therapy session, averaging 3.3 sessions, while 72.7 percent of patient-family dyads completed at least one family session, averaging 1.2. Staff averaged 47.9 days of outreach per dyad across the intervention, and the average incentive dispensed was 93.64 dollars, roughly 46 percent of the total possible, on par with dispensation rates commonly reported in the contingency management literature. Session attendance was low, which the authors attribute to the model’s flexible principle of accommodating whatever level of care patients will accept while persistently reengaging them, and to the high volume of shorter impromptu contacts through calls, texts, and check-ins that supplemented scheduled care.

Acceptability ratings were uniformly high among the seven adolescents and five support persons who completed satisfaction surveys. Every participant with prior treatment experience rated YORS as better than previous treatment, and all adolescents described the outreach level as the right amount. Adolescents rated the helpfulness of components on a 10-point scale: having a support person involved scored a perfect 10, low-barrier access to medication 9.7, cash incentives 9.4, relapse prevention medication 8.4, individual therapy 8.3, frequent calls and texts 8.3, and family sessions 7.3. Support persons rated components similarly, with low-barrier access and support person involvement both at 10, and frequent calls and texts at 9.6. Adolescents reported mean satisfaction of 8.9 out of 10 with their family member’s involvement in recovery, while support persons reported 9.0 satisfaction with their loved one’s recovery.

The exploratory recovery capital indicators showed promising pre-to-post signals, though the authors caution these were not validated measures and missing data reached 36 percent for adolescents and 50 percent for support persons. Among the seven participants with complete data, two reported homelessness in the past year at baseline, but only one reported homelessness during the intervention. Five of seven were in school or employed at baseline; all seven were in school or employed at week 14. None attended self-help groups at intake, but four, or 57.1 percent, attended at least one group by follow-up, with two attending regularly. Five of seven reported at least one lifetime arrest at baseline, yet only one arrest occurred during the intervention and no participant was charged with a new offense. Both adolescents and support persons rated family involvement in recovery above 9 on a 10-point scale. Three psychiatric hospitalizations occurred during the trial, classified as unrelated to the intervention by the principal investigator and an independent data safety monitoring board.

The authors emphasize that this small, uncontrolled pilot cannot establish efficacy, and its limitations are substantial: no randomization, no validated adolescent recovery capital measure, reliance on self-report with 20 percent missing opioid use data suggesting the use rate may be underestimated, exclusion of non-English speakers despite a largely Hispanic sample, and a fixed rather than escalating incentive schedule for daily medication. The trial was also not pre-registered. Still, the bimodal adherence pattern offers a concrete research question for future work, since understanding what distinguishes adolescents who thrive under the model from those who struggle could guide targeted improvements. The team calls for adequately powered randomized trials, cultural adaptations for Spanish-speaking families, longer intervention durations, and the development of validated recovery capital measures for adolescents, a gap experts in the field have highlighted. If confirmed, the findings would suggest that a family-centered, low-barrier, persistently assertive treatment model can help a critically underserved population not only stay on medication but begin building the resources that make recovery durable.

Subject of Research: Behavioral treatment and recovery capital in adolescents with opioid use disorder

Article Title: Targeting recovery capital for adolescents through treatment for opioid use disorder: a pilot expansion of the Youth Opioid Recovery Support intervention

Article References: Taylor, L., Wenzel, K., Mallik-Kane, K., Pfeltz, C., Massie, E., Davis, K., Lavorato, L., & Fishman, M. (2026). Targeting recovery capital for adolescents through treatment for opioid use disorder: a pilot expansion of the Youth Opioid Recovery Support intervention. Frontiers in Adolescent Medicine, 4, Article 1720332. https://doi.org/10.3389/fradm.2026.1720332

Image Credits: AI Generated

DOI: 10.3389/fradm.2026.1720332

Keywords: adolescents, opioid use disorder, Youth Opioid Recovery Support, medication adherence, buprenorphine, recovery capital, family involvement, motivational incentives, assertive outreach, pilot trial, Frontiers in Adolescent Medicine, addiction treatment

The study, led by Jessica A. Chen and Emily C. Williams of the University of Washington and VA Puget Sound Health Care System, examined monthly treatment patterns among more than 110,000 veterans diagnosed with opioid use disorder between March 2018 and February 2022. Published in Addiction Science & Clinical Practice, the research drew on 48 monthly cohorts extracted from national electronic health records, covering outpatients aged 18 and older with a past-year opioid use disorder diagnosis. The team tracked receipt of any medication for opioid use disorder, including methadone, buprenorphine, and naltrexone, and then examined methadone and buprenorphine separately to see how each medication’s use changed over time and across racial and ethnic groups.

The analytical design was deliberately granular. Rather than comparing a single pre-pandemic year with a single pandemic year, the researchers constructed 48 consecutive monthly cohorts, allowing them to trace trends with unusual precision across the entire 2018 to 2022 window. The primary outcome was receipt of any medication for opioid use disorder in a given month. Secondary analyses split the picture by medication type, because methadone and buprenorphine are delivered through very different channels: methadone is dispensed only through federally regulated opioid treatment programs with strict supervision requirements, while buprenorphine can be prescribed by office-based clinicians and carried in a patient’s pocket.

At the start of the study window, the system looked remarkably equitable on the surface. In March 2018, non-Hispanic Black and non-Hispanic White veterans with opioid use disorder received any medication for opioid use disorder at nearly identical rates, 27.3 percent and 27.8 percent respectively. Hispanic Black patients started at 28.0 percent, essentially matching Hispanic White patients at 28.4 percent and Hispanic patients who were neither Black nor White at 27.0 percent. Four years later, that parity had eroded. By February 2022, 35.0 percent of non-Hispanic White patients were receiving medication, compared with only 29.3 percent of non-Hispanic Black patients. Among Hispanic patients, the same pattern emerged: Hispanic Black patients stood at 26.2 percent, while Hispanic White and Hispanic neither Black nor White patients had climbed to 33.2 percent and 33.7 percent respectively.

The medication-specific numbers reveal where the divergence originated. Buprenorphine receipt increased after the pandemic began, but the increase was strikingly unequal. Non-Hispanic White patients rose from 27.9 percent to 29.8 percent receiving buprenorphine, while non-Hispanic Black patients moved only from 13.9 percent to 15.5 percent and Hispanic Black patients from 11.6 percent to 15.1 percent. In other words, White veterans were roughly twice as likely as Black veterans to receive buprenorphine at both the start and the end of the study period, and the pandemic-era expansion of prescribing did little to narrow that chasm.

Methadone told the opposite story. Receipt of methadone declined after the pandemic began for every group, yet Black patients remained far more dependent on it than White patients. Non-Hispanic Black patients fell from 17.4 percent to 14.4 percent receiving methadone, and Hispanic Black patients from 17.1 percent to 11.9 percent, while non-Hispanic White patients declined only from 6.6 percent to 5.5 percent. The result is a persistent structural pattern: Black veterans with opioid use disorder were more than twice as likely as White veterans to be on methadone, the medication tied to daily clinic visits and rigid dispensing schedules, and far less likely to be on buprenorphine, the medication most compatible with ordinary life, employment, and privacy.

Why does this split matter clinically? Buprenorphine and methadone are both full-strength opioid agonist treatments that reduce overdose mortality and improve retention in care, but they impose different burdens. Methadone traditionally requires daily attendance at a specialized clinic, which can be difficult for people with inflexible jobs, unreliable transportation, or childcare responsibilities. Buprenorphine, by contrast, can be prescribed in routine medical settings and taken at home. When pandemic policies loosened methadone dispensing rules and eased buprenorphine initiation, the expectation was that both medications would reach more people, particularly those historically excluded. The VHA data show that overall access did expand, but the expansion accrued disproportionately to White patients, leaving the underlying hierarchy of treatment untouched.

The study’s authors are careful to frame the findings as descriptive rather than causal. The analysis documents trends in receipt by race and ethnicity across the pre-pandemic and pandemic periods; it does not identify the specific mechanisms that produced the widening gaps. Still, the implications are pointed. Pandemic-related policy changes were intended to expand access to medications for opioid use disorder, the researchers conclude, but their benefits may not have been equitably distributed across racial and ethnic groups. Improving equity, they argue, may require targeted approaches to reduce barriers to both buprenorphine and methadone, rather than assuming that broad flexibilities will lift all boats.

The research also carries methodological significance for how health systems monitor equity. By disaggregating Hispanic patients into Hispanic Black, Hispanic White, and Hispanic neither Black nor White subgroups, the study avoided treating Hispanic veterans as a monolithic category and surfaced disparities that aggregate statistics would conceal. Hispanic Black patients, for example, ended the study period with the lowest medication receipt of any subgroup examined, a finding invisible in analyses that collapse all Hispanic patients together. The work was supported by the National Institute on Drug Abuse and was informed by consultation from groups of veterans with lived and living experience of opioid use, including the Veterans’ Opioid Use disorder Inequities CommitteE and the Research with Expert Advisors on Drug Use panel.

For a health system caring for a population at elevated risk of fatal overdose, the message is sobering. The VHA is the largest integrated healthcare system in the United States, and its electronic health records offer one of the few national windows into how treatment patterns actually shifted when prescribing rules changed. The data show that between 2018 and 2022, the share of White veterans receiving buprenorphine grew while the share of Black veterans receiving methadone shrank, and the two trends combined to leave Black patients with less access to the most flexible, most widely available treatment option. As policymakers consider making pandemic-era flexibilities permanent, the study suggests that flexibility alone is not enough; without deliberate attention to who actually receives each medication, the same structural inequities will persist, and the promise of expanded opioid treatment will remain unevenly fulfilled.

Subject of Research: Racial and ethnic inequities in receipt of methadone and buprenorphine for opioid use disorder in the Veterans Health Administration before and after COVID-19

Article Title: Trends in receipt of methadone vs. buprenorphine by race/ethnicity before and after COVID-19 (2018–2022): a Veterans Health Administration study

Article References: Chen, J. A., Dunn, J. A., Maskey, P., Austin, E. J., Durland, M. L., Ravi, V., Warth, A., Brooks, J., Marshall, S., van Draanen, J., Jones-Smith, J., & Williams, E. C. (2026). Trends in receipt of methadone vs. buprenorphine by race/ethnicity before and after COVID-19 (2018–2022): a Veterans Health Administration study. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00730-x

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00730-x

Keywords: opioid use disorder, medications for opioid use disorder, methadone, buprenorphine, health disparities, Veterans Health Administration, COVID-19, race and ethnicity, veterans, addiction treatment, health policy, Trends

The research team, led by investigators at Rutgers School of Public Health and Columbia University, focused on four of the most serious bacterial infections associated with injection drug use: skin and soft tissue infections, osteomyelitis, infective endocarditis, and central nervous system abscesses. These conditions represent a spectrum of severity, from painful tissue infections that may require surgical drainage to life-threatening heart valve infections and brain abscesses that demand weeks of intravenous antibiotics. All of them share a common thread in the context of the ongoing drug overdose crisis, in which contaminated injection practices introduce bacteria into the bloodstream and deep tissues, creating infections that frequently require prolonged hospitalization.

Methodologically, the study is a retrospective cohort analysis designed to produce nationally representative estimates. The researchers applied survey weights to the Nationwide Readmission Database, a federal dataset that captures readmissions across state lines and allows analysts to track patients who move between hospitals, a critical feature given that many patients with substance use disorders receive care at multiple institutions. After weighting, the analysis encompassed 392,984 index admissions of adults hospitalized with a primary diagnosis of one of the four target infections. Each admission was classified into one of four exposure groups based on ICD-10-CM diagnostic codes: neither disorder, opioid use disorder only, stimulant use disorder only, or co-occurring opioid and stimulant use disorders.

The demographic profile of the cohort underscores how deeply these infections intersect with an aging population of people who inject drugs. The mean age of hospitalized patients was 58.8 years, 57.1 percent were male, and 46.9 percent carried Medicare coverage, a striking figure for a population often assumed to be younger and uninsured. Within the cohort, 4.5 percent of admissions involved opioid use disorder alone, 3.9 percent involved stimulant use disorder alone, and 2.4 percent involved both disorders simultaneously. The overall unplanned readmission rates were 4.3 percent within seven days of discharge and 12.48 percent within thirty days, meaning roughly one in eight patients returned to the hospital within a month of being sent home.

After statistical adjustment for patient and hospital characteristics, the central finding emerged clearly: having opioid use disorder, stimulant use disorder, or both was associated with higher odds of both seven-day and thirty-day unplanned all-cause readmission compared with patients who had neither disorder. This pattern held across the short and slightly longer follow-up windows, suggesting that the elevated risk is not confined to the immediate post-discharge period but persists through the first month, when patients are typically transitioning from intravenous antibiotics in the hospital to oral regimens or outpatient infusion therapy.

Perhaps the most clinically provocative result concerns the co-occurring group. Patients diagnosed with both opioid and stimulant use disorders showed higher odds of readmission than those with opioid use disorder alone, although the authors note that this particular comparison did not reach statistical significance in their models. The direction of the effect is nonetheless consistent with a growing body of literature on polysubstance use, which suggests that people who use multiple drug classes experience compounded medical and social vulnerabilities. Stimulants such as methamphetamine and cocaine can drive frequent injection episodes, cardiovascular strain, and erratic engagement with care, while opioids contribute to overdose risk and withdrawal-related treatment disruption. When both disorders are present, the pathways back to the hospital may multiply.

The mechanisms behind these associations are likely multifactorial, and the study’s design cannot fully disentangle them. Patients with untreated opioid use disorder may leave the hospital against medical advice to avoid withdrawal, cutting short antibiotic courses for infections like endocarditis that require weeks of therapy. Others may be discharged without linkage to medications for opioid use disorder such as buprenorphine or methadone, returning to injection practices that seed new infections at old or new sites. Social factors, including housing instability, lack of transportation to follow-up appointments, and stigma within healthcare settings, can compound the pharmacological challenges. Readmissions in this population may also reflect non-infectious causes, including withdrawal, overdose, and complications of untreated chronic disease, since the study measured all-cause readmission rather than infection-specific recurrence.

For the authors, the implications point squarely toward integrating addiction treatment into inpatient infection care. Hospitalization for a serious bacterial infection represents a rare moment of sustained contact between this population and the healthcare system, often the longest period of stability a patient experiences in months. Evidence from other fields suggests that initiating medications for opioid use disorder during hospital admission, combined with warm handoffs to community-based treatment, can reduce subsequent opioid use and improve retention in care. The new findings extend the logic to infectious diseases practice, where hospitals have historically treated the infection and discharged the patient without addressing the underlying substance use disorder that produced it.

The study carries important caveats that shape how its results should be interpreted. Diagnostic codes for substance use disorders depend on clinician documentation, and undercoding is common, particularly for stimulant use disorder, which may mean some exposed patients were misclassified as unexposed and the true associations could be stronger than estimated. The all-cause readmission outcome cannot distinguish between returns driven by infection relapse and those driven by other acute events. As with any database study, residual confounding by severity of illness, social determinants of health, and treatment intensity remains possible. The authors also relied on the 2022 database year, and patterns of drug use and hospital practice continue to evolve rapidly, meaning the estimates represent a snapshot of a dynamic epidemic.

Even with those limitations, the scale of the analysis gives its central message considerable weight. Nearly 400,000 weighted hospitalizations for injection-related bacterial infections in a single year, with one in eight patients readmitted within thirty days, describes an enormous and largely preventable burden on patients, families, and the healthcare system. The finding that opioid and stimulant use disorders independently elevate short-term readmission risk reframes these disorders not as peripheral social issues but as central clinical drivers of infectious disease outcomes. As the authors conclude, embedding addiction medicine within inpatient infectious disease care, from bedside initiation of treatment to structured post-discharge linkage, could transform the hospital stay from a revolving door into a genuine turning point for one of the most vulnerable populations in American medicine.

Subject of Research: The association between opioid and stimulant use disorders and unplanned hospital readmission after injection drug use-related bacterial infections

Article Title: The impact of co-occurring opioid and stimulant use disorders on unplanned readmissions among patients hospitalized with bacterial infections

Article References: Hu, J., Blair, N., Mauro, P. M., Samples, H., Bushnell, G., Yin, M. T., & Shiau, S. (2026). The impact of co-occurring opioid and stimulant use disorders on unplanned readmissions among patients hospitalized with bacterial infections. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14321-3

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14321-3

Keywords: opioid use disorder, stimulant use disorder, bacterial infection, hospital readmission, injection drug use, infective endocarditis, osteomyelitis, polysubstance use, addiction treatment, Nationwide Readmission Database, infectious diseases, public health

The findings reveal a striking mismatch between where women carry the heaviest burden of alcohol problems and where treatment facilities offer services designed for their needs. Estimated state-level prevalence of AUD among women ranged from approximately 6 to 13 percent, well above and below the national average of 8 percent among women. All six New England states exceeded the national average, as did several states in the West and the Midwest, while prevalence was generally lower across southern states. At the extremes, an estimated 6.2 percent of women in Utah had AUD compared with 12.7 percent of women in Washington, DC. More than 40 percent of addiction treatment facilities nationwide did not offer women-specific treatment at all, and services targeted toward women were disproportionately unavailable in many of the very states where estimated AUD prevalence among women was higher than average.

The study was funded by the National Institute on Alcohol Abuse and Alcoholism and conducted by researchers from Boston University School of Public Health, Columbia University Mailman School of Public Health, and Boston Medical Center’s Grayken Center for Addiction. The team used publicly available national and state-level data to estimate the prevalence of AUD among women in each state, the prevalence of addiction treatment facilities offering women-specific services in 2024, and the proportion of facilities with these specialized services per 10,000 adult women with AUD. This approach allowed the researchers to compare, for the first time, not just how many women struggle with alcohol in each state, but how well the local treatment infrastructure is equipped to serve them.

Senior author Dr. Maureen Stewart, research associate professor of health law, policy & management at Boston University School of Public Health, emphasized that the rising toll of alcohol on women coincides with persistently low treatment engagement. Women are drinking more and experiencing significant health consequences from alcohol use, she noted, while alcohol treatment rates remain abysmally low. She pointed to evidence that alcohol treatment programs tailored to women’s needs have achieved greater success in reducing substance use and mental health symptoms than programs lacking these services. Knowing which states have the greatest burden of AUD among women yet lack access to appropriate treatment, she argued, can help direct resources efficiently and reduce the barriers that prevent women from getting help.

The researchers attribute the geographic pattern of AUD among women to a combination of factors rather than any single cause. Alcohol taxes and other alcohol policies, cultural differences in attitudes toward drinking, persistent stigma surrounding AUD, and uneven availability of AUD healthcare all likely contribute to the disproportionate burden observed in New England, the Midwest, and the West relative to southern states. Coauthor Dr. Rachel Sayko Adams, also a research associate professor of health law, policy & management at Boston University, said that women’s estimated burden of alcohol use disorder varied substantially from state to state, and that these differences highlight the importance of understanding local needs when shaping prevention efforts and designing treatment programs that are accessible and responsive to women.

The availability of specialized services proved to be the study’s most sobering finding. Among nearly 14,000 alcohol treatment facilities for adults across the nation, only 58.5 percent offered women-specific programming. Twenty-three states and Puerto Rico had fewer than 10 facilities offering women-specific treatment per 10,000 women with AUD. In states with a higher estimated prevalence of AUD among women, most treatment facilities had below-average availability of critical services such as trauma therapy, intimate partner violence support, and transportation assistance. Less than half of all treatment facilities offered telehealth services, an accommodation the researchers note could be especially valuable for women who lack reliable transportation or who struggle with stigma or other fears associated with seeking in-person treatment.

Childcare emerged as perhaps the most glaring gap of all. In 2024, only 4.6 percent of addiction treatment facilities provided childcare, even though caring responsibilities are one of the most persistent obstacles keeping women out of treatment. Study lead author Sage Feltus, a research associate in the Department of Health Law, Policy & Management at Boston University, explained that women are more likely to be the primary caregivers of their children, and that parenting women may find it difficult to obtain reliable, affordable, and trustworthy childcare in their communities while they participate in lifesaving AUD treatment. Supporting women’s recovery, the researchers argue, means providing concrete solutions to the childcare barrier and the other practical obstacles women face when trying to enter care.

The study arrives amid shifting cultural norms in which alcohol use among women has become widely accepted and normalized in daily life, despite substantial evidence that even moderate drinking places women at greater risk of developing breast cancer, liver disease, suicidal ideation, and reproductive health complications. In previous work, the same research team found that women without children by age 35 were at highest risk for binge drinking and AUD, but that 35-year-old women with children also remained at increased risk, possibly influenced by the proliferation of messaging on social media and in popular culture that embraces drinking as a form of stress relief and enjoyment. Dr. Adams observed that despite the well-established health risks of drinking, popular culture often presents alcohol as a way for women to celebrate or unwind, and that women need clear information about alcohol-related health risks alongside access to treatment that is responsive to their needs.

To close the gap between need and availability, the researchers outlined several actions states can take, particularly in the regions where the burden is greatest. They recommend incentivizing treatment facilities to provide childcare and telehealth services, and requiring health plans to cover alcohol treatment services and medications. The latter may be a necessary mandate: a previous analysis by the team found that fewer than half of Medicaid managed care plans provide all AUD medications approved by the Food and Drug Administration. The team also recommends that primary care offices and mental health facilities screen for and treat AUD, since women with AUD are more likely to seek treatment for co-occurring mental health conditions in those settings than at dedicated addiction treatment facilities.

The study was coauthored by Dr. Katherine Keyes, professor of epidemiology and Susan Lasker Brody Professor of Population Mental Health at Columbia University; Dr. Jake Morgan, research assistant professor of health law, policy & management at Boston University School of Public Health; and Dr. Miriam Harris, primary care addiction specialist at Boston Medical Center. The research was supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number R01AA029821, and the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. As women’s drinking continues to climb and the historical gender gap in alcohol-related harm closes, the study makes clear that the map of who needs help and the map of where tailored help exists do not currently align, and that closing that distance will require deliberate policy choices at the state level.

Subject of Research: State-level variation in alcohol use disorder prevalence among women and the availability of women-specific addiction treatment services in the United States

Article Title: Many states with higher burden of alcohol use disorder among women have fewer treatment facilities tailored to their needs

Article References: Many states with higher burden of alcohol use disorder among women have fewer treatment facilities tailored to their needs. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: alcohol use disorder, women's health, addiction treatment, health services research, childcare barriers, telehealth, state health policy, binge drinking, New England, Boston University School of Public Health, NIAAA, Substance Use & Addiction Journal

The scale of the problem ibogaine might address is enormous. In the United States alone, 2022 estimates counted 29.5 million people with alcohol use disorder, 63.9 million current nicotine users, 6.1 million with opioid use disorder, and 3.2 million with stimulant use disorder. Existing pharmacotherapies, such as methadone, buprenorphine, and naltrexone for opioid dependence or nicotine replacement for smoking, help some patients, but relapse remains common and there is currently no FDA-approved drug therapy for stimulant use disorder at all. Against this backdrop, the idea of a single-dose treatment that can interrupt opioid withdrawal and suppress cravings has an obvious appeal, and it is precisely this claim that has driven ibogaine’s unusual journey through science, subculture, and regulation.

That journey began long before modern pharmacology. Indigenous Pygmy hunter-gatherer populations in equatorial Africa observed frenzied behavior in animals eating iboga root and adopted low doses to boost endurance and suppress appetite during hunts. The plant later became central to the Bwiti spiritual tradition, where it is used in ceremonies aimed at communication with ancestral spirits and personal insight, a practice that continues today. Western science caught up in 1901, when two independent groups isolated ibogaine from the root bark. The compound was marketed in France as the stimulant Lambarene from 1939 until its withdrawal in 1966 over adverse effects, and a 1913 report by Mexican physician Enrique O. Aragón had already documented its use against alcoholism.

The modern anti-addiction story traces to 1962, when Howard Lotsof, a 19-year-old with a heroin habit, ingested ibogaine and found his cravings eliminated. He and several peers reportedly sustained abstinence for around six months afterward. Lotsof went on to found NDA International and secure a series of US patents between 1985 and 1992 covering rapid methods for interrupting narcotic, cocaine, alcohol, nicotine, and polydrug dependency syndromes. The FDA approved clinical trials in 1993, initiated at the University of Miami under molecular biologist Debora Mash, but after an unexpected fatality in the Netherlands in 1995, the National Institute on Drug Abuse declined to fund further human trials. Treatment clinics nonetheless spread to Mexico, the Netherlands, Panama, St. Kitts, and elsewhere, operating in a largely unregulated medical subculture.

Pharmacologically, ibogaine is unlike most other psychedelics. Where psilocybin and LSD act primarily through serotonin receptors, ibogaine is a multi-target agent, a profile the review’s authors describe through the concept of matrix pharmacology. Ibogaine and its metabolite noribogaine act as weak antagonists at mu opioid receptors and agonists at kappa opioid receptors, moderate competitive antagonists at NMDA glutamate receptors, and noncompetitive inhibitors of the serotonin transporter, with noribogaine more potent at the latter. Ibogaine also binds sigma receptors and antagonizes alpha3beta4 nicotinic acetylcholine receptors in the habenulo-mesolimbic pathway, a circuit strongly implicated in drug dependence. Recent work has added vesicular monoamine transporter 2 and the organic cation transporter 2 to the target list. After oral ingestion, ibogaine peaks in plasma at around two hours and is mostly cleared within 24 hours, but CYP2D6-mediated conversion to noribogaine, which has a half-life of 24 to 49 hours, extends the drug’s biological activity considerably.

Perhaps the most striking recent finding concerns neuroplasticity. Ibogaine acts as a psychoplastogen, promoting structural and functional remodeling of neural circuits through cortical glutamate release and the BDNF-TrkB-mTORC1 signaling cascade. In mice, ibogaine’s effects on plasticity outlast those of ketamine or psilocybin, holding open a critical period of adult learning for several weeks rather than days. This prolonged window may allow the brain to decouple drug cues from reward and form healthier behavioral patterns, which could explain why a single administration appears to produce effects lasting weeks to months. Preclinical studies also show that ibogaine and noribogaine increase expression of glial cell line-derived neurotrophic factor in the ventral tegmental area, a change associated with lasting reductions in alcohol intake and cocaine seeking in animal models.

The clinical evidence, while encouraging, comes almost entirely from observational studies, open-label trials, and case reports, with no randomized controlled trials of ibogaine itself published to date. In opioid use disorder, an open-label study of 191 individuals found significant reductions in withdrawal symptoms and cravings at discharge and one-month follow-up, and a twelve-month observational follow-up reported an approximately 80 percent decrease in Addiction Severity Index scores, with 87.5 percent of participants testing negative for opioids at three months and 75 percent at twelve months. A systematic review covering 24 studies and more than 700 participants supports reductions in withdrawal and craving. Evidence for stimulant and nicotine use disorders rests largely on preclinical models, where ibogaine and analogues reduce cocaine, methamphetamine, and nicotine self-administration in rodents, while a small alcohol use disorder pilot of nine participants, only five of whom completed, showed reduced drinking frequency alongside concerning adverse effects.

Safety is the elephant in the room. Ibogaine inhibits the hERG potassium channel in cardiac muscle, prolonging the QT interval and elevating the risk of torsades de pointes, a potentially lethal arrhythmia. In one observational study at a relatively low dose of 10 milligrams per kilogram, all but one patient developed QT prolongation and half exceeded 500 milliseconds, a threshold associated with substantially elevated risk. A case report documented torsades de pointes at a QT interval of 714 milliseconds after an estimated dose of 65 to 70 milligrams per kilogram. A systematic review identified 19 fatalities between 1990 and 2008, with autopsies in 14 cases revealing predominantly pre-existing cardiovascular disease. Neurological effects add further concern: ataxia and tremors are common acutely, and rat studies show dose-dependent degeneration of cerebellar Purkinje cells at 50 milligrams per kilogram and above, although this has not been observed in humans. At high doses ibogaine produces an intense oneirogenic, dream-like state involving vivid autobiographical memory retrieval, which the review links to possible memory reconsolidation mechanisms but which also carries psychiatric risks, including reported cases of mania.

These limitations have galvanized a medicinal chemistry effort to design safer iboga derivatives. Noribogaine, the primary metabolite, has an oral toxicity in mice roughly 2.4-fold lower than ibogaine and has been tested in ascending-dose studies in healthy volunteers and opioid-dependent patients, though it still produced dose-dependent QTc prolongation requiring cardiac monitoring. The semi-synthetic analogue 18-methoxycoronaridine retains anti-addictive efficacy against morphine, cocaine, alcohol, and nicotine in animals while avoiding the tremors and Purkinje cell loss seen with ibogaine, and has reached phase 1 safety evaluation. Even more striking is tabernanthalog, a non-hallucinogenic derivative that promotes neural plasticity, reduces heroin- and alcohol-seeking in mice, and shows roughly a 100-fold reduction in hERG channel inhibition. A newer class of oxa-iboga alkaloids, including oxa-noribogaine, showed no pro-arrhythmic activity in human cardiomyocytes while outperforming both ibogaine and noribogaine in suppressing opioid self-administration in rats.

The regulatory landscape is shifting rapidly. In the United States, where ibogaine remains a Schedule I substance, Texas Governor Abbott signed legislation in June 2025 authorizing state funding for clinical ibogaine research, and several other states have followed. An April 2026 executive order directed the FDA and Drug Enforcement Administration to build a clinical trial pipeline for psychedelic therapies, and the FDA has approved a phase 1 trial of noribogaine hydrochloride for alcohol use disorder. A Stanford study in veterans also suggested that magnesium co-administration may attenuate ibogaine-induced QT prolongation. The review’s authors caution, however, that the field still lacks standardized dosing protocols, large controlled trials, and demographically diverse study populations, and that treatment costs of roughly 4,500 to 15,000 dollars far exceed the per-diem costs of methadone or buprenorphine. Whether ibogaine, or one of its engineered descendants, can finally translate from African ritual and underground clinics into an approved medicine will depend on the trials now beginning to take shape.

Subject of Research: Therapeutic potential and safety of the psychedelic alkaloid ibogaine for treating substance use disorders

Article Title: Ibogaine for Substance Use Disorders

Article References: Anwar, A. I., Hegazi, A.-R. A., Sawaya, M. F., Nelson, J. R., Lashley, A. E., Gatti, J. M., Pham, K. M., Hachem, I. A., McNulty, M. E., Lewis, D. S., Murnane, K. S., & Kaye, A. D. (2026). Ibogaine for Substance Use Disorders. Advances in Therapy. https://doi.org/10.1007/s12325-026-03814-x

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03814-x

Keywords: ibogaine, substance use disorders, opioid use disorder, psychedelics, noribogaine, neuroplasticity, cardiotoxicity, QT prolongation, tabernanthalog, 18-methoxycoronaridine, addiction treatment, Tabernanthe iboga

The study, part of a clinical trial registered on ClinicalTrials.gov as NCT 05118204, was designed to test strategies for starting buprenorphine during medical hospitalization. Buprenorphine is a partial opioid agonist that is considered one of the most effective medications for treating opioid use disorder, and it is also used for chronic pain management. Clinical guidelines increasingly encourage hospitals to initiate the medication before discharge, because patients who leave the hospital without treatment face elevated risks of overdose and readmission. Yet in practice, identifying which hospitalized patients might benefit from buprenorphine remains a major operational challenge, one that the Bronx team set out to address systematically.

Recruitment for the trial took place between October 2022 and October 2024 at two urban teaching hospitals. The research team built an automated electronic health record algorithm that generated a daily list of patients with likely opioid misuse or opioid use disorder. The idea was straightforward: rather than relying on busy clinicians to notice which patients might be candidates for addiction treatment, the algorithm would continuously scan hospital records and surface potentially eligible individuals. This approach reflects a broader trend in implementation science, in which health systems attempt to use their existing data infrastructure to close well-documented gaps between evidence and practice.

The scale of the screening effort was enormous. Over the two-year recruitment window, the algorithm produced 9,140 records for screening. Of those, 8,534 records, or 93 percent, were excluded during preliminary manual review of the electronic health record. In other words, for every record that advanced beyond the first stage of screening, more than thirteen were set aside. Staff members conducted this manual review to confirm whether the algorithm’s flags were accurate, a labor-intensive process that the authors acknowledge as a central limitation of the approach. The algorithm successfully identified patients who were potentially eligible for buprenorphine, but its precision was low enough that substantial human effort was required to separate true candidates from false positives.

From that initial pool of 9,140 records, only 434 patients were deemed potentially eligible for buprenorphine treatment. That figure alone illustrates how narrow the funnel becomes at each stage. But the steepest drop came next: of those 434 potentially eligible patients, only 43 agreed to be assessed for the trial. The remaining patients either declined assessment or could not be evaluated, and when patients were not assessed, research assistants documented the reasons using pre-specified categories. This attrition at the consent stage is particularly significant, because it suggests that the barriers to buprenorphine initiation are not solely technical or logistical. They are also deeply human, rooted in patient concerns and the stigma that continues to surround both addiction and its treatment.

Among the 43 patients who agreed to assessment, 29 were found to be eligible for the trial, and 23 ultimately enrolled and started buprenorphine. Taken together, that represents a 5 percent initiation rate among the pool of potentially eligible patients. The authors frame this outcome as evidence that while automated surveillance can identify candidates, the pathway from identification to treatment is fraught with attrition. Each step of the process, from algorithmic flagging to manual chart review to patient outreach to eligibility assessment to enrollment, loses a substantial proportion of the people who might benefit from the medication. The final yield of 23 patients across two years of screening underscores how much work remains to make hospital-based buprenorphine initiation routine.

The report’s conclusions point in two directions at once. On the technical side, the authors suggest that improving the precision of the screening algorithm, for example through artificial intelligence applications, could better identify patients who are genuinely eligible for buprenorphine. Machine learning models trained on richer clinical data might reduce the 93 percent exclusion rate at the manual review stage, freeing research and clinical staff to focus their outreach on patients who are truly candidates. The study’s own keyword list includes artificial intelligence, and the authors clearly view computational refinement as a promising avenue for future work. Better algorithms would not eliminate the need for human judgment, but they could dramatically reduce the burden of reviewing thousands of records to find a few hundred relevant ones.

On the human side, the authors are equally direct: patient concerns and potential stigma regarding buprenorphine present ongoing obstacles to uptake. Even when the system successfully identified a potentially eligible patient, fewer than one in ten agreed to be assessed. This finding resonates with a large body of addiction research showing that misconceptions about medication-assisted treatment, fear of being labeled as having a substance use disorder in the medical record, and ambivalence about starting buprenorphine during an acute hospitalization all suppress engagement. The study’s design, which included documenting pre-specified reasons when patients were not assessed, reflects an effort to characterize these barriers systematically rather than simply counting losses.

The trial was funded by the National Institutes of Health under award RM1DA055437 and was approved by the Einstein Institutional Review Board under protocol 2021-13311. Informed consent was obtained from all individuals who participated in the clinical trial, and the screening data reported here include individuals who were assessed for eligibility but did not enroll. The authors declare no competing interests, and the article is published open access under a Creative Commons Attribution 4.0 license, making the full screening dataset description available to any research team attempting similar surveillance-based recruitment. The corresponding author is Aaron D. Fox, and the author team includes collaborators from the Peer Network of New York and Kelly S. Ramsey Consulting, bringing peer and clinical expertise to the research.

For hospitals and health systems grappling with the overdose crisis, the report offers both a caution and a roadmap. The caution is that simply deploying an automated screening tool will not, by itself, translate into widespread buprenorphine initiation; the Bronx experience shows that even a well-resourced trial with dedicated staff achieved a 5 percent initiation rate among potentially eligible patients. The roadmap lies in the study’s dual diagnosis of the problem: algorithms need to be more precise, and the clinical encounter needs to be better designed to address patient concerns and reduce stigma. As health systems increasingly turn to electronic health record surveillance and artificial intelligence to identify candidates for addiction treatment, this brief report provides a rare, transparent accounting of what such efforts actually look like on the ground, complete with the attrition that most publications leave unreported. The gap between 9,140 flagged records and 23 treatment initiations is precisely the kind of number that should shape the next generation of hospital-based addiction care.

Subject of Research: Screening and recruitment for in-hospital buprenorphine initiation in patients with opioid use disorder

Article Title: Brief report on screening data from a randomized controlled trial of in-hospital buprenorphine initiation strategies

Article References: Haber, A., Sanchez-Fat, G., Buonora, M., Sabado, A., Ghiroli, M., Deng, Y., Khalid, L., Torres-Lockhart, K. E., Reyes, M., Ramsey, K. S., Starrels, J. L., & Fox, A. D. (2026). Brief report on screening data from a randomized controlled trial of in-hospital buprenorphine initiation strategies. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00731-w

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00731-w

Keywords: buprenorphine, opioid use disorder, hospitalization, electronic health records, screening, randomized controlled trial, addiction treatment, stigma, artificial intelligence, chronic pain, implementation science, clinical trial recruitment

The core engineering insight is deceptively simple: increase the surface area of the needle and you amplify everything the needle does. Electrochemical anodic oxidation achieves this by placing the stainless-steel needle—typically SUS304, an alloy of iron, chromium, and nickel chosen for its biocompatibility and electrochemical stability—as the anode in an electrolyte cell. In the widely used protocol, an ethylene glycol-based solvent containing 0.5 weight percent ammonium fluoride and a small amount of deionized water serves as the electrolyte, with carbon paper acting as the cathode. As voltage is applied, metal ions released from the needle surface react with hydroxide ions to form oxides of iron, chromium, and nickel. In most anodizing conditions these oxide films are dense, but fluoride ions selectively dissolve 20 to 50 percent of the growing film, carving out a nanoporous architecture instead.

Getting the porosity right depends on a delicate balance of processing parameters. Fluoride concentrations that are too low fail to generate sufficient pores, while excessive concentrations trigger structural collapse through over-etching. Ethylene glycol, with its high viscosity, helps optimize oxide growth rates and improve structural alignment compared with aqueous electrolytes. Voltage proved equally decisive: experiments measuring surface area by both methylene blue dye adsorption and Brunauer–Emmett–Teller analysis found that 30 volts maximized the nanoporous surface area, achieving a BET value of 0.0328 square meters per gram. Above 40 volts, the needles simply broke. At the optimum, the effective surface area of a needle increased up to twentyfold compared with a conventional smooth needle, with pores ranging from 1.0 to 2.6 micrometers in diameter and oxide layer thickness growing from roughly 693 nanometers after five minutes of anodization to 4.25 micrometers after 25 minutes.

These porous surfaces serve as ideal substrates for a second modification strategy: electrodeposition of noble metal nanoparticles. By applying an external current or voltage to reduce metal ions in solution onto the porous framework, researchers can control particle size, density, and distribution with considerable precision. Silver, gold, and platinum nanoparticles deposited on anodized needles produced average particle diameters of 32.9, 57.7, and 49.3 nanometers respectively, each conferring distinct advantages. Silver’s dense, small particles deliver high conductivity and antibacterial properties; gold’s uniform distribution enhances biocompatibility and biomolecule binding, suiting drug delivery and biosensing applications; and platinum’s larger, sparser particles offer superior heat resistance and electrochemical stability for long-term stimulation environments. Together, the deposited nanoparticles can expand the effective reaction area of a needle by tens of times, transforming it from a passive stimulation tool into a functional bioelectrode.

The therapeutic consequences of this surface engineering are striking. In a rat model of inflammatory pain induced by complete Freund’s adjuvant, nanoporous needles inserted at the ST36 acupoint—located over the tibialis anterior muscle—generated significantly greater rotational torque and withdrawal resistance than conventional needles, a reflection of the enhanced needle grasp phenomenon in which tissue winds around the rotating shaft. Histological analysis confirmed the mechanical story: subcutaneous connective tissue thickness increased from 58.0 to 339.2 micrometers and muscle layer thickness from 524.7 to 942.7 micrometers after porous needle treatment. Functionally, the porous needles extended meaningful analgesia to roughly two hours, compared with only 30 to 60 minutes for conventional needles, and ten days of repeated treatment produced cumulative reductions in mechanical hypersensitivity. The authors suggest that amplified mechanical stimulation may boost local adenosine release, activate transient receptor potential channels such as TRPV1, and intensify crosstalk between subcutaneous fibroblasts and peripheral nerve endings, while observed collagen fiber realignment may further prolong antinociceptive signaling.

Perhaps most provocatively, the modified needles show promise against substance use disorders. In animal studies, porous needle acupuncture at HT7—a point on the inner wrist crease—significantly reduced cocaine-induced hyperlocomotion in rats, with the effect persisting far longer than that achieved by thicker conventional needles. Against ethanol withdrawal, nanoporous needle treatment reduced tremors more effectively than conventional acupuncture as measured by automated force-transducer monitoring, and elevated plus maze testing revealed anxiolytic effects during withdrawal. When different electrode types were compared—conventional, porous, and porous needles sensitized with silver, gold, or platinum—the silver-sensitized variant performed best, increasing open-arm exploration time by 20 percent relative to the unsensitized porous group. This hints that noble-metal-enhanced charge transfer may synergize with acupuncture-induced stimulation in brain regions governing anxiety and reward, offering a possible low-cost, surgery-free neuromodulation strategy for addiction.

The cancer data add another dimension. In a chemically induced rat model of colorectal cancer, porous needle acupuncture reduced aberrant crypt foci, an early warning sign of tumorigenesis, most markedly when treatment was delivered at HT7 rather than the SI5 acupoint on the wrist. Genetic analysis showed the porous needles reversed a greater number of cancer-related transcriptional changes than conventional needles. In late-stage disease, repeatedly treated animals bore fewer and smaller tumors and displayed lower circulating levels of carcinoembryonic antigen, a standard colorectal cancer biomarker. Immunohistochemical staining revealed reduced beta-catenin expression in treated tissues, suggesting suppression of the Wnt/beta-catenin signaling pathway, a major driver of colon cancer progression. Notably, acupoint selection mattered as much as needle type, underscoring that clinical optimization will require attention to both device engineering and anatomical targeting.

Beyond therapy, the engineered needles are emerging as serious candidates for neural interfacing. Conventional neural electrodes face an uncomfortable trade-off: larger surfaces yield better signal-to-noise ratios but inflict more tissue damage, while miniaturized electrodes are gentler but suffer high impedance. Porous needle electrodes dissolve this dilemma. Electrochemical impedance spectroscopy showed smaller semicircle diameters in Nyquist plots for porous needles, indicating lower charge transfer resistance, and local field potential signals in the 1 to 49 hertz range—associated with motor cortex activity—were captured more reliably than with conventional electrodes, while noise in the 59 to 61 hertz band was significantly reduced. Because the porous architecture interlocks with surrounding tissue, electrode stability improves over time, and the stainless-steel platform can be fabricated cheaply and reproducibly. Previous biocompatibility work in dermal and subcutaneous applications, along with evidence that nanoscale pores promote protein adsorption and cellular integration, strengthens the case for chronic implantation.

Remarkably, the same properties that make these needles good neural electrodes also make them viable electrocatalysts. In alkaline potassium hydroxide solutions, anodized porous needles exhibited lower charge transfer resistance and enhanced current density for the oxygen evolution reaction compared with conventional polished electrodes, with a Tafel slope of 67.6 millivolts per decade indicating favorable catalytic kinetics. The hydrogen evolution reaction proved more demanding, requiring noble metal coatings such as silver nanoparticles, though even then performance remains below standard catalysts, highlighting a clear optimization target in particle size and coating homogeneity. Cross-sectional electron microscopy revealed conical nanopores between 0.81 and 1.92 micrometers in diameter and 0.51 to 1.33 micrometers deep, topography that improves wettability and ion transport—the very parameters that govern water-splitting efficiency. The implication is that defective or waste acupuncture needles could be repurposed as low-cost electrochemical materials, improving economic efficiency across their lifecycle.

The review’s authors, led by Su-Il In of the Daegu Gyeongbuk Institute of Science and Technology, are candid about the field’s limitations. Most studies rest on rodent models with few human trials, and research has concentrated narrowly on pain, addiction, and cancer-related symptoms. Fabrication has likewise stagnated around a single ammonium fluoride–ethylene glycol–water electrolyte recipe, leaving the morphological consequences of alternative chemistries largely unexplored. Their prescription is systematic optimization of anodization conditions, functionalization with photothermal agents, semiconducting nanomaterials, or biosensitive coatings, and large-scale clinical validation. If those steps succeed, the two-thousand-year-old acupuncture needle may complete an extraordinary journey—from ritual instrument to precision medicine platform, bioelectronic interface, and component of sustainable energy technology.

Subject of Research: Surface engineering of acupuncture needles for biomedical and electrochemical applications

Article Title: Nanostructured acupuncture needles: recent progress in surface engineering and biomedical and electrochemical applications

Article References: Lee, J., Park, J., Park, S., Kim, H., & In, S.-I. (2025). Nanostructured acupuncture needles: recent progress in surface engineering and biomedical and electrochemical applications. Advances in Industrial and Engineering Chemistry, 1(1), Article 35. https://doi.org/10.1007/s44405-025-00037-6

Image Credits: AI Generated

DOI: 10.1007/s44405-025-00037-6

Keywords: acupuncture needles, electrochemical anodization, nanoporous surfaces, noble metal nanoparticles, neural electrodes, local field potential, pain management, addiction treatment, colorectal cancer, oxygen evolution reaction, hydrogen evolution reaction, surface engineering

The authors draw on a targeted, non-systematic review of the literature to document what clinicians and researchers have long observed: mental health difficulties can drive young people toward substance use, and substance use can, in turn, precipitate or worsen mental health disorders. Yet the commentary notes that this bidirectional relationship is frequently recognized only in hindsight, after a young person is already in treatment for one condition or the other. By the time the interplay becomes visible, opportunities for earlier, more effective intervention may have been lost, and the course toward a full co-occurring disorder may already be set.

Central to the authors’ argument is the developmental vulnerability of the adolescent brain. Neuroimaging and longitudinal studies cited in the commentary show that the prefrontal cortex, which governs impulse control, decision-making, and emotional regulation, continues to mature well into the mid-twenties. The limbic circuits that mediate reward and emotional reactivity, however, develop earlier, creating a period in which emotional distress is intense while regulatory capacity is still under construction. This mismatch helps explain why anxiety, depression, trauma, and attention-deficit/hyperactivity disorder frequently precede or coincide with the initiation of alcohol, cannabis, nicotine, and other substance use during the teenage years.

The self-medication hypothesis features prominently in the evidence the authors synthesize. Studies of posttraumatic stress disorder and problematic alcohol use, along with epidemiological reviews of mood and anxiety disorders, indicate that many young people begin using substances not primarily for pleasure but to manage unbearable internal states. Research on reasons for first cannabis use, for example, links coping-motivated initiation to heavier subsequent consumption and elevated risk of first-episode psychosis. High-potency delta-9-tetrahydrocannabinol products have been associated in systematic reviews with adverse mental health outcomes, and large cohort studies have documented increased risks of depression, bipolar disorder, and psychosis following cannabis use disorder in youth and young adults.

The reverse pathway is equally well documented. Prospective research shows that adolescent substance use can alter neurodevelopmental trajectories and increase vulnerability to internalizing symptoms, suicidality, and psychiatric comorbidity. Data from national surveys, including the Youth Risk Behavior Survey and the National Survey on Drug Use and Health, reveal that high school students who use substances report substantially higher rates of suicidal thoughts and co-occurring psychiatric conditions. In other words, the arrow of causation runs in both directions, and the commentary stresses that prevention and treatment systems must be designed with that bidirectionality in mind rather than addressing one condition at a time.

Despite this robust evidence base, services for young people remain fragmented. Mental health providers often lack training and confidence in addressing substance use, while addiction treatment programs frequently are not equipped to manage depression, trauma, or anxiety. Screening practices reflect the same divide: many pediatric, school-based, and primary care settings screen for one domain but not the other, or refer young people to separate agencies whose records and treatment plans never converge. The commentary argues that this separation creates missed opportunities at every stage, from prevention education that ignores emotional drivers of use to treatment planning that fails to account for the psychiatric function a substance may be serving.

The authors point to models demonstrating that integration is practical and cost-effective. Evidence-based outpatient behavioral treatments for adolescent substance use updated through 2023, along with integrated treatment frameworks for co-occurring depression and substance use disorder, show that combined interventions improve engagement and outcomes. The American Society of Addiction Medicine’s criteria for adolescents and guidance from the Substance Abuse and Mental Health Services Administration already call for co-occurring competent care, yet implementation continues to lag behind the evidence. School connectedness interventions, trauma-informed prevention models, and alternatives to punitive school responses for substance-related infractions, such as curriculum-based approaches tested in pragmatic clinical trials, illustrate concrete entry points for earlier identification.

The commentary also highlights the importance of listening to young people themselves. Studies of adolescents’ reasons for substance use show that these motivations are not trivial; they are clinically meaningful predictors of treatment response and outcome. A young person who uses cannabis to quiet intrusive trauma memories needs a different intervention than one who drinks socially at parties. Qualitative research with adults and adolescents in substance misuse treatment confirms that many recognized only later how strongly their addiction and mental health difficulties reinforced each other, underscoring the cost of systems that fail to ask about both domains from the outset.

For policymakers, the authors frame integrated, co-occurring competent care as a matter of both scientific fidelity and fiscal prudence. Preventing the escalation from experimentation to disorder, and from a single condition to a co-occurring one, reduces downstream demand on emergency departments, criminal justice systems, and long-term treatment services. The commentary calls on prevention professionals, educators, clinicians, and policymakers to embed dual-domain screening in schools, primary care, and behavioral health settings, to train the workforce in the interplay between mental health and substance use, and to fund service models in which the same team addresses both conditions simultaneously.

Ultimately, the message of the commentary is one of urgency tempered by optimism. The science of adolescent brain development, the epidemiology of co-occurring conditions, and the clinical evidence on integrated treatment all converge on the same conclusion: mental health and substance use are two faces of the same set of vulnerabilities during youth, and systems that treat them separately will continue to miss the young people who need help most. What remains is the institutional will to translate an evidence base that has been accumulating for decades into everyday practice across the settings where young people live, learn, and seek care.

Subject of Research: Integrated prevention and treatment of co-occurring substance use and mental health disorders in adolescents

Article Title: Advancing an Integrated Approach to Prevention, Early Identification, and Intervention for Youth with Co-Occurring Substance Use and Mental Health Challenges

Article References: Banach, O., & Richter, L. (2026). Advancing an Integrated Approach to Prevention, Early Identification, and Intervention for Youth with Co-Occurring Substance Use and Mental Health Challenges. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01717-3

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01717-3

Keywords: adolescent mental health, substance use disorder, co-occurring disorders, integrated care, prevention, early identification, self-medication, cannabis, screening, school-based intervention, addiction treatment, public health policy