Top 7 Addiction Treatment Developments of 2023

It was an eventful year in addiction treatment and addiction psychiatry. Here’s what stood out most to me.

More people are entering addiction treatment when they need it most: straight from the ER

Far too many people suffer a non-lethal overdose, are brought to the ER, receive treatment, and then get released days or even hours later. These patients are sometimes in active withdrawal when they leave the hospital and thus are at maximum risk of relapse. They often do exactly that, and the addiction cycle continues.

At long last, this is now changing in many parts of the country. Where I’m based in north Florida, some systems are in place whereby many who come into the ER suffering from a drug or alcohol event can speak to a peer counselor or case manager who can help them get into treatment right away. This is a critical advancement, and it is saving lives.

The stigma of addiction continues to recede

More people than ever now understand that opioid addiction and other addictions are treatable brain diseases, not evidence of bad character or moral weakness. The scientific evidence has proven this time and again, and people are hearing that message. As a result, the you’re-a-bad-person stigma around addiction keeps dropping—and clearly did so in 2023.

A big reason is that people are simply talking about addiction more, and they’re more open about their struggles. Celebrities, athletes, and people from all walks of life are sharing their stories. This reinforces the point that addiction can happen to anyone. So, let’s stop demonizing people for having a mental illness and help them get the treatment they deserve.

The people at the 988 suicide and crisis lifeline are saving lives

July 2023 marked the one-year anniversary of the 988 Suicide and Crisis Lifeline. One year in, licensed counselors had answered nearly five million calls, texts, and online chat messages. These caring counselors are trained to de-escalate a crisis, provide emotional support, and connect callers to follow-up resources.

Several enhanced services were added in 2023, including:

• More counselors (demand is high).
• An LGBTQ+ subnetwork for adults under 25.
• A Spanish language text option.
• Enhanced online chat.

The Lifeline’s website at 988lifeline.org also offers helpful resources as well as inspiring stories of hope and recovery.

Ultrasound may be the next frontier in addiction treatment

In 2023, researchers continued to look at low-intensity focused ultrasound as a way to treat people with opioid use disorder (OUD). Unlike the use of magnetic fields or electric current, ultrasound can target areas deeper inside the brain that are associated with addiction. It’s also completely noninvasive.

The FDA has already approved ultrasound to treat tremors associated with Parkinson’s, and clinical trials are continuing into 2024 that use ultrasound to treat people with OUD. Addiction experts believe the day may be coming when people can wear a portable ultrasound device that delivers needed intervention to the brain in real-time.

Excessive social media use mimics addiction—and can be self-treated

During 2023, a trend gained steam, mostly among young people: the use of so-called “dumb phones” that do next to nothing except allow you to call and text people. This “digital detoxing” movement is led mainly by people worrying about spending time on social media and the damaging content available there.

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As an addiction psychiatrist, I’m all for this self-help trend. It’s clear that excessive smartphone/social media use mimics addiction in many ways, including the harmful effects it may have on young people’s developing brains. It also increases a person’s risk of depression, anxiety, and eating disorders, including anorexia and binge-eating disorder.

Cannabis use disorder increases the risk of schizophrenia, especially among young men

Young men with cannabis (marijuana) use disorder have a significantly increased risk of developing schizophrenia, according to a 2023 study published in the journal Psychological Medicine.

Researchers found strong evidence of an association between cannabis use disorder (CUD) and schizophrenia among men and women, but the association was much stronger among young men. Study authors estimate that as many as 30% of schizophrenia cases among men aged 21-30 might have been prevented if CUD was not present.

Medications for opioid use disorder remain vastly underused

An estimated 2.5 million people aged 18 years or older in the U.S. had opioid use disorder (OUD) in 2021. Yet, only one in five (22%) received medications to treat it, according to an August 2023 study in JAMA Network Open. For Black individuals, women, the unemployed, and those living in rural areas, the medication use rate was lower still. These results show once again that buprenorphine, methadone, and naltrexone (the three main OUD medications) continue to be vastly underused in the fight against OUD.

Why is this? Often, it’s a case of people not being able to afford the medications out-of-pocket (they’re expensive). Other times, health insurance doesn’t cover them. Also, many people can’t access the medications because they live too far from a health clinic or because their primary care doctor either isn’t licensed to prescribe the medication or isn’t trained in addiction medicine.

My take: Medications for opioid use disorder are some of the most powerful tools we have, with the important caveat that they’re not appropriate for everyone (no medication is). For those who would benefit from these medications, we need to do everything we can to make them more accessible and more affordable.