Alcohol screening in primary healthcare services, including Aboriginal Community Controlled Health Organisations, may encounter barriers. These include time constraints, competing health priorities and sensitivities about the topic. Digital tools like the Grog App, validated in population settings, offer potential opportunities to overcome these barriers. We conducted a three-round Delphi study to gain consensus on items to include in a digital alcohol screening tool for Aboriginal and Torres Strait Islander people accessing primary healthcare services ('Grog Check'). Twelve Australian health experts, of whom a majority were Aboriginal or Torres Strait Islanders (67%, n = 8/12), evaluated the clinical importance of potential items (consensus level: 80%). Panellists had expertise in drug and alcohol, primary care, addiction medicine and Indigenous health. Half of the 42 questions, relating to 24 items, reached consensus. Panellists agreed that the screening tool should be brief and culturally relevant. Of the 24 items, there was consensus on 17 including pregnancy, episodic drinking, harms and dependence. Panellists agreed on asking individuals about worries from their own drinking but were divided on asking about worries from others' drinking. There was consensus to ask about dependence, but no agreement if everyone should be asked or only high-risk individuals. Panellists endorsed including a 'cheat-sheet' to guide clinicians on interpretating results and next steps. We identified questions for a digital alcohol screening tool (Grog Check). This app has the potential to support clinicians and enable safer ways for Aboriginal and Torres Strait Islander people to describe their drinking in primary healthcare settings.

Patients with alcohol use disorder (AUD) frequently initiate their recovery by first completing treatment in an inpatient withdrawal management unit, but many are not connected to ongoing care after discharge. We sought to evaluate the correlation between the use of medications for AUD (MAUD) on confirmed linkage to care. We conducted a retrospective review of every patient admitted for alcohol withdrawal management to an American Society of Addiction Medicine Level IV unit for intensive inpatient withdrawal management from September 2021 to November 2022 to evaluate whether initiation or continuation of MAUD was associated with confirmed linkage to ongoing post-discharge addiction treatment. Data were collected via the institution's electronic health record (EHR). Confirmed linkage was defined as having confirmation in the EHR for attending the planned follow-up appointment within 30 days of discharge. Statistically significant differences in unadjusted analyses were included in a logistic regression model to account for confounders. There were 312 unique patient encounters. Fifty-three (17%) had their linkage confirmed, and 127 (40.7%) were discharged on MAUD. Among MAUDs, only extended-release naltrexone (XR-NTX) was associated with a greater likelihood of linkage (28.3% vs 10.8%, P = .001). In adjusted analyses, those receiving XR-NTX (adjusted odds ratio [aOR] 2.7, 95% confidence interval [CI] 1.3-5.6, P = .009) and drinks per drinking day prior to admission (aOR 0.96, 95% CI 0.92-0.99, P = .016) remained significant predictors of linkage to care. XR-NTX may enhance post-discharge care linkage. Further research is warranted to examine the potential role of MAUDs in improving AUD-related outcomes after the completion of inpatient treatment.

Current approaches to preventing drug-related harms remain suboptimal. This review describes components of a systems innovation framework for addiction care designed to address escalating drug-related harms and fragmented service delivery through a multidisciplinary, ecosystem-driven approach. Innovative approaches to addiction medicine are needed that integrate clinical research with entrepreneurial execution to address three priority areas of need: real-time risk mitigation using digital phenotyping and wearable biosensors for overdose detection; precision surveillance utilizing AI-informed data ecosystems and wastewater analysis; and next-generation therapeutics, including neuromodulation and nanotechnology-driven drug delivery. This creates an innovative "biopsychotechnological" treatment paradigm that moves beyond traditional clinical boundaries. This framework provides a roadmap for transitioning addiction care from reactive clinical and risk management to innovative and proactive precision medicine. For research, it necessitates a shift toward interdisciplinary validation of "biopsychotechnological" models that bridge bench science and community implementation. For clinical practice, this framework offers a blueprint for integrating real-time biosensing and advanced therapeutics into patient care, promising to reduce mortality and support sustainable recovery through ecosystem-informed and individualized care.

In October 2025, the Alabama Poison Information Center and local addiction medicine providers identified a cluster of cases involving liquid products marketed as containing kava associated with opioid-like withdrawal symptoms. Kava is not typically associated with physical dependence, raising concern for opioid-active substances. Five unique retail products were submitted for laboratory analysis. Three underwent quantitative ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) testing for kavalactones, kratom alkaloids, and related semisynthetic derivatives, with additional screening for 260 substances. Two products underwent qualitative gas chromatography-mass spectrometry (GC-MS) testing for mitragynine and kavalactones. Qualitative GC-MS detected both mitragynine and kavalactones in one product, while another contained mitragynine with no detectable kavalactones. Quantitative UPLC-MS/MS identified both kavalactones and kratom alkaloids in three products, with mitragynine pseudoindoxyl predominating at concentrations of 0.16-0.21 mg per bottle. Detection of kratom alkaloids and related semisynthetic derivatives in products labeled as kava may explain the observed opioid-like withdrawal. Mitragynine pseudoindoxyl, which has greater opioid activity than mitragynine and 7-hydroxymitragynine, was identified as the predominant kratom-related compound. Unrecognized exposure to opioid-active kratom compounds may occur through products marketed as kava, highlighting the need for improved surveillance and increased awareness.

The traditional division of clinical psychiatry in Germany comprises general psychiatry, geriatric psychiatry and addiction medicine. It is important to know how factors such as age, gender, length of stay, comorbidities and concomitant medication have developed in these areas in order to understand future care needs. The billing system (abbreviated as "PEPP") unique to Germany was introduced in 2018 and brought structural changes to psychiatric care. This study focuses on a retrospective, longitudinal observation in general psychiatry, describes developments, and examines the impact of the PEPP reimbursement system on length of stay and coding of diagnoses in general psychiatry. The Evangelische Stiftung Tannenhof operates a specialist hospital for psychiatry, psychotherapy, psychosomatics and neurology with a compulsory care area containing 580,000 inhabitants. Data from the hospital information system was analysed in a descriptive manner. A total of 61,385 inpatient cases from general psychiatry belonging to the ICD-10 diagnosis groups F2, F3, F4 and F6 were included. Demographic data, length of stay and the development of psychiatric main and somatic secondary diagnoses as well as medication prescriptions were analysed. The gender distribution and age structure in general psychiatry remained largely constant between 2005 and 2022. The number of cases increased continuously and the length of stay decreased continuously. The main diagnoses from the general psychiatry group remained relatively stable with the affective disorders group being the largest. The total number of psychiatric and somatic medications prescribed increased progressively, especially the share with somatic indications. During the COVID-19 pandemic, Z diagnoses were frequently assigned as secondary diagnoses. The retrospective analysis of patient data in general psychiatry between 2005 and 2022 shows that the age structure and main diagnoses have remained relatively stable. In contrast, the increase in the prescription of medication and somatic secondary diagnoses is an important development that emphasises the need for increased training and interdisciplinary collaboration in the care of psychiatric patients.

A randomized controlled trial of stepped treatment to reduce unhealthy alcohol use in patients with chronic liver disease.

Alcohol consumption remains an independent risk factor for recurrent presentations of alcohol-associated acute pancreatitis (AAP). Although there are recognised guidelines for alcohol use disorder (AUD), there are no recommendations on targeting alcohol cessation to reduce recurrence of AAP in guidelines for acute pancreatitis. This study describes the uptake of the Addiction Medicine Unit (AMU), a specialist consultative service, in patients with AAP presenting to a tertiary hospital. Retrospective cohort with all inpatients with AAP at a large multisite tertiary health service in Melbourne, Australia from May 2022 to May 2024. Demographics, AUD diagnosis and recommended interventions from the AMU were obtained from medical records. There were 231 patients across 314 admissions with AAP identified with a high prevalence of AUD (91.8%). Referral to AMU occurred in 56.7% of admissions, predominantly among those with AUD (93.8%), with a tendency to refer patients with higher weekly alcohol intake (P = 0.024). The AMU recommended outpatient counselling services to assist with detoxification and rehabilitation in 40.4%, both pharmacological and outpatient interventions in 37.6% and medications alone in 21.9% of admissions. Over the 2-year period, 54 (23.4%) patients were readmitted with AAP. The adjusted analysis did not demonstrate reduced readmission with AAP associated with AMU review. There is a substantial missed opportunity for specialist addiction medicine input in this cohort. AAP should be considered a sentinel alcohol-related hospital presentation, and the observed referral gap identifies an opportunity for more systematic addiction medicine assessment, pharmacotherapy initiation and linkage to longitudinal care.

The morbidity, mortality, and costs associated with untreated substance use disorder (SUD) in hospitals are substantial. In 2017 alone, $13 billion was spent on medical costs associated with SUD care in hospitals and emergency departments (EDs). However, SUD often goes unaddressed during hospital and ED encounters despite the existence of effective treatments. In 2024, the American Society for Addiction Medicine (ASAM) initiated a consensus development process to update The ASAM Criteria standards for general hospital settings. These standards outline the capabilities all hospitals are recommended to meet to enable effective care for SUD. The development process included convening an expert Task Force, evidence review and synthesis, formal consensus development, field review, and approval through ASAM's Quality Improvement Council. The Task Force defined 7 core competencies for hospital and ED-based SUD care: (1) identification, engagement, and approach to patient care, (2) intoxication and withdrawal management, (3) overdose and post-overdose care, (4) initiation and continuation of addiction medications, (5) assessment and management of common co-occurring conditions, (6) linkage to ongoing SUD care, and (7) risk reduction. The Task Force used these competencies to define consensus standards within The ASAM Criteria service characteristic domains including setting, staff, support systems, assessment and treatment planning, services, and documentation. Rapidly evolving evidence demonstrates the importance and feasibility of providing SUD care in hospitals. These consensus standards aim to coalesce the field around a common set of expectations for meeting the needs of patients with SUD.

Methadone in community pharmacies: A mixed methods study of board-certified addiction medicine physician and addiction psychiatrist perspectives.

The 2024 American Society of Addiction Medicine and American Academy of Addiction Psychiatry Clinical Practice Guideline includes a conditional recommendation for long-acting methylphenidate as a pharmacologic option for amphetamine-type stimulant use disorder, including methamphetamine use disorder. Although this recommendation is conditional and based on low-certainty evidence, it reflects an evolving consideration of pharmacologic treatment approaches for methamphetamine use disorder and raises questions regarding clinical implementation, particularly given the schedule II regulatory status of methylphenidate and the associated oversight and risk considerations. In this commentary, we review the guideline's recommendation in the context of real-world prescribing challenges, including clinical safety considerations, monitoring requirements, and potential implications for equitable access. We highlight the absence of established behavioral readiness or engagement frameworks to guide the initiation and continuation of schedule II stimulant medications for methamphetamine use disorder. To address this gap, we describe an approach adapted from prior work in office-based buprenorphine treatment. This 5-domain framework-adherence, abstinence progress, attendance, alternative activities, and accessing support-offers a structured method for integrating behavioral engagement into patient selection and ongoing monitoring when considering prescribing a psychostimulant for stimulant use disorders. By emphasizing objective, transparent engagement metrics alongside pharmacologic decision-making, such a framework may help support safety, accountability, and a more equitable application of an emerging treatment option.

Substance use disorders (SUDs) are the leading causes of both global mortality and morbidity, and alcohol, nicotine, and opioids account for most of this burden. Existing pharmacotherapies are only moderately effective, have inconsistent compliance and regular relapse, and therefore, new treatment modalities are required. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), which have been licensed to treat type 2 diabetes and obesity, have emerged as potential therapeutic candidates for SUDs due to their central action on neural reward circuits. GLP-1 receptors are expressed in mesolimbic regions, and preclinical studies show decreases in drug use, suppression of nucleus accumbens efflux of dopamine, and inhibition of relapse-like behaviors in models of alcohol, nicotine, and opioids. Early clinical findings, particularly those from semaglutide, indicate reductions in both alcohol and cigarette consumption, although the results remain inconsistent and are limited by small sample size. Subgroup analysis and observational findings suggest that GLP-1RAs may have potentially larger effects in individuals with obesity and metabolic disease, which could also be due to metabolic modes of action. In opioid use disorder, evidence is currently limited to animal models but demonstrates comparable efficacy to established therapies. Collectively, GLP-1RAs represent an emerging and mechanistically novel therapeutic option for SUDs. Future research should prioritize large-scale randomized controlled trials, patient stratification, and long-term safety assessments to define their potential role as adjunct or standalone treatments in addiction medicine.

Emergency Departments Need to Train and Hire More Sub-Specialists in Addiction Medicine.

About 1 in 10 adults in the United States report having used benzodiazepines in the past year. These medications carry substantial risks, including falls, cognitive impairment, overdose, and death, particularly when combined with alcohol or opioids. The American Society of Addiction Medicine, in collaboration with 9 other professional societies, has issued recommendations on when and how to taper and discontinue benzodiazepines. The authors of this article summarize important points from the guideline, aimed at all who provide long-term benzodiazepine prescriptions.

Kratom (Mitragyna speciosa) is increasingly used in the United States as a dietary supplement for pain, mood regulation, and opioid withdrawal. Its alkaloids, mitragynine and 7-hydroxymitragynine (7-OH), demonstrate μ-opioid receptor activity, with 7-OH exhibiting substantially greater opioid-like potency than mitragynine. There are concerns from the US Food and Drug Administration (FDA) regarding dependence and adverse effects. Purified 7-OH products may bypass metabolic pathways and deliver disproportionately strong opioid effects compared with natural kratom preparations, increasing the risk of dependence. Despite these concerns, 7-OH remains federally unscheduled, though listed as a "Drug of Concern" by the DEA. Although there is no standardized clinical guidance, buprenorphine has been used to manage kratom and 7-OH withdrawal with varying initiation strategies. To describe the clinical course and outcomes of buprenorphine initiation among patients with problematic 7-OH use, focusing on initiation timing, dosing strategies, and symptom monitoring. Retrospective chart review of patients treated at a low-barrier telehealth addiction medicine clinic between April and October 2025. Nine patients with purified 7-OH product use (as opposed to kratom use) met the inclusion criteria. The mean age was 33.5 years; 7 patients were identified as male. Low-dose initiation was used in 6 cases and standard initiation in 3 cases. Successful initiation and stabilization occurred in 88.9%, with no precipitated withdrawal or adverse events. Symptom improvement was reported in 8 of the total cases at a median 6-week follow-up. Buprenorphine initiation for problematic 7-OH use was feasible, well tolerated, and associated with symptom improvement, supporting development of pragmatic clinical approaches for this emerging substance use disorder.

EASL position paper on preclinical models of steatotic liver disease.

Substance dependence is a significant health problem and major cause of preventable disease worldwide. Addiction Medicine (AM) specialists play an important role across numerous countries in the management and treatment of individuals with problematic substance use. However, there is currently a shortage of Fellows of the Australasian Chapter of Addiction Medicine (AChAM), with many reaching retirement age. This study aimed to inform AM attraction initiatives by identifying motivations, concerns, and suggestions for promoting the specialisation from the perspectives of current Fellows and Trainees. Twenty-two semi-structured interviews were undertaken with AChAM Fellows (n = 12) and Trainees (n = 10) across Australasia (Australia and New Zealand). Participants were asked about their motivations to specialise, concerns around specialising and suggestions for increasing the number of AM specialists. Transcripts were subject to qualitative data analysis and organised around an established four-factor framework for career choice. All participants had followed a General Practitioner entry pathway. Seventeen different types of motivating factors were identified across four domains. For most, motivations included relationships with patients, support and encouragement from colleagues and supervisors, and an interest in AM. Concerns for specialisation were largely centred around generalist deskilling and pay reduction during training years. As many participants discovered AM in a serendipitous way, suggestions to grow the workforce are focused on increasing awareness and clinical placements. This was the first study to consider Australasian General Practitioners' motivations, concerns and attraction suggestions regarding AM specialisation. It identified a wide range of factors motivating General Practitioners across Australasia to specialise in AM, with limited concerns. To grow the workforce, there is a need for targeted promotional strategies that increase AM awareness while also addressing the motivations and concerns identified in this study.

As of 2026, physicians must complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited addiction medicine fellowship to seek addiction medicine board certification. While the ACGME has developed general goals and objectives, they also allow for curricular flexibility. Little is known, however, about how individual programs meet these requirements. To describe how addiction medicine fellowship training programs meet ACGME requirements, including commonalities and innovative curricular and education strategies. In 2025, 5 experts in addiction education developed a survey tool to capture comparisons of addiction medicine fellowship curricula. The principal investigator (R.S.) sent this survey via e-mail to 104 addiction fellowship program directors; responses were kept anonymous and not linked to individual programs. Data were analyzed using quantitative descriptive statistics and inductive and deductive thematic analysis. Forty-seven of 104 program directors (45%) completed the survey. Program directors described both shared elements and unique features of their curricula, reflecting differences in program settings, available community resources, specialty focus, faculty diversity and expertise, and patient population. There is a wide array of curricula that meet addiction medicine fellowship ACGME requirements. Future research and efforts should describe individual programs' curricula in more depth to support new and existing programs in growing and improving their programs to suit the growing demand for diverse practices in addiction medicine and to recruit fellows with aligned interests.

BackgroundSubstance use disorder (SUD) remains a major public health crisis in the United States, with significant challenges in treatment access, retention, and workforce capacity. SUD care teams, including addiction medicine physicians and peer recovery coaches (PRCs), support patients receiving SUD treatment but face heavy workloads and burnout. Artificial intelligence (AI) innovations, particularly large language model (LLM)–based chatbots, may extend PRC support and provide patients with on-demand recovery support between clinic visits and PRC contacts. However, evidence on their development, feasibility, acceptability, and usability in addiction services remains limited.ObjectiveThis study describes the development, feasibility, acceptability, and usability of an AI-powered health coaching chatbot (Suzy) designed to support patients in SUD recovery.MethodsA total of 2 clinicians, 5 researchers, and 2 technology developers led a small, multiphase pilot study. In the formative phase, they conducted focus groups and qualitative in-depth interviews with 12 health care professionals and 8 patients with substance use histories to specify chatbot functions and develop a rule-based chatbot. In phase 2, they conducted usability testing of the rule-based chatbot with 8 patients who reported substance use and completed standardized tasks, surveys, and qualitative interviews. Measures included the System Usability Scale (SUS), Net Promoter Score (NPS), and Single Ease of Use Question (SEQ). In phase 3, they developed an LLM-based chatbot co-designed and fine-tuned with PRCs and other SUD experts.ResultsRule-based chatbot functions included craving management, appointment reminders, resource referrals, care team contacts, and goal setting. Usability task testing supported feasibility. In this small pilot sample, quantitative and qualitative feedback indicated acceptability and usability, with an average SUS score of 93 (benchmark 68), an NPS of 63 (benchmark 35), and a mean SEQ score of 6.5/7. Patients valued Suzy’s approachable, nonjudgmental language and features that promoted accountability, self-monitoring, and 24/7 availability, while emphasizing that chatbots should supplement but not replace human support. The LLM-based chatbot development emphasized information accuracy, safety escalation protocols to mitigate risks of inappropriate chatbot responses, human-in-the-loop features, and expanded conversational flexibility and personal tailoring.ConclusionsIn this pilot study, a rule-based chatbot designed to support SUD care demonstrated feasibility, usability, and acceptability. LLM-based chatbot development required more robust safety and emergency reporting features, while offering more patient-responsive conversational functions. By providing on-demand coaching, referrals, and reminders, Suzy may extend the reach of care teams, alleviate provider burden, and enhance patient engagement. Additional work is needed to understand how to best integrate Suzy into patients’ recovery journeys to ensure human support remains accessible and prioritized. LLM evaluation was based on expert testing and safety review. Clinical effectiveness, including the impact on substance use, was not evaluated. Next steps include evaluating the LLM chatbot in real-world settings with larger samples and assessing its efficacy in reducing substance use.

Occupational medicine (OM) is a small field in Canada. Due to various routes of entry, accurate depictions of the field are challenging and have been conducted twice previously. To assess the profile of OM practice in Canada and distinguish between subgroups of interest (by years of practice and training routes). A 66-item survey was distributed by three national and four provincial organizations with OM physician members, asking about demographic information, qualifications and education, and characteristics of practice, duties and compensation. 107 surveys were received. More than half (52%) of respondents declared being >55 years old, and 67% identified as male. Eighteen per cent reported having specialist credentials in OM, while the majority reported other backgrounds, and nearly 25% had no formal qualifications in OM. Those with >15 years of work in OM were more likely to be specialists, have a graduate degree relevant to OM and have core duties related to addiction medicine, workplace health and safety (e.g. training, hygiene evaluation) and leadership duties. Compared to respondents with no formal training, those with formal training were more likely to report adequate education in OM and more likely to work in management/administrative roles. This is the first survey to seek input from a broad variety of OM-focused organizations in Canada. While the field is ageing overall, other demographic changes and newer pathways to certification show a change in the landscape from previous surveys.

Organizational perspectives on barriers and facilitators to an integrated care model for opioid use disorder and serious injection-related infections