New Research and Insights into Substance Use Disorder
Addictions to alcohol, illicit drugs and other substances remain a serious threat: According to the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, from April 2020 to April 2021, nearly 92,000 people in the U.S. fatally overdosed on drugs — the single highest reported death toll during a 12-month period. The National Center for Drug Abuse Statistics has deemed the situation “a public health emergency.” All groups ages 15 and older experienced a rise in these grim statistics, intensified by the use of fentanyl.
Currently, substance use disorder affects more than 20 million Americans ages 12 and over. These numbers are troubling, says Johns Hopkins neuroscientist and addiction researcher Andrew Huhn, “but with a multifaceted approach, people with substance use disorders can recover.”
Drawing from his background in neuroscience and behavioral pharmacology, Huhn identifies risk factors for relapse and medication strategies — bolstered by supervised withdrawal and counseling — to improve treatment outcomes. “My research focuses on understanding the human experience of substance use disorder,” he says, noting that medications for opioid overdose, withdrawal and addiction “are safe, effective and continue to save lives.”
Now, thanks to a recent collaboration with Ashley Addiction Treatment, a residential treatment center in Havre de Grace, Maryland, Huhn, Kelly Dunn and colleagues are combining efforts to identify patients likely to benefit from supervised withdrawal or opioid maintenance therapy. The goal is to expand treatment options to improve health care for people with the condition. “Relapse remains common, but a subset of patients have done well,” says Dunn.
Concurrently, Huhn, Dunn and colleagues are building a research database based on the Trac9 program, which charts patients’ progress in real-time through technology, such as a tablet or phone — as well as alerting clinicians to a relapse and the need for intervention. They are also using wearable devices to monitor sleep and cardiovascular outcomes, and a smart phone application to track each time a patient notes having successfully ignored a craving for alcohol or a drug. Much of this research takes place at Behavioral Pharmacology Research Unit, located on the Johns Hopkins Bayview Medical Center campus.
Their published work includes studies showing a greater need for treatment of older adults with alcohol and opioid use disorders. Two additional studies have garnered national attention, both on how fentanyl use affects the treatment of opioid use disorder. Much of the illicit opioid supply in the U.S. is mixed with fentanyl, leading to a recent surge in fentanyl-related overdose deaths.
Yet another study showed promise in the use of a sleep medication to improve opioid withdrawal outcomes. Researchers in Huhn’s lab continue to glean insights from neuroimaging, ambulatory monitoring in real time, and repeated measures of behaviors.
Greg Hobelmann, the CEO of Ashley, who trained at Johns Hopkins and is a part-time faculty member, chairs an elective at the Ashley facility in addictions psychiatry. He, along with Eric Strain and Huhn are building infrastructure that includes intake data on every patient, as well as outcomes data when people complete the Ashley program — and for the year that follows. Biospecimens will also be included in the project, for studies in areas such as genetics.
“The biggest and most exciting thing is being able to create predictive models of relapse risk and then create strategies to improve those outcomes,” says Huhn. Jimmy Potash, director of the Johns Hopkins Department of Psychiatry and Behavioral Sciences couldn’t agree more. “This will be a powerful platform for discovery of better approaches to treating addiction,” he says. “I’m eager to see it — and our relationship with Ashley Addiction — move forward.”
Despite enduring challenges in addictions psychiatry, Huhn is hopeful. “We have the ability to continue collecting data and to test hypotheses,” he says. “It’s the kind of stuff we hope will turn into a game-changer, similar to what has happened in cancer and heart disease treatments. We build research into the treatment and let that guide our approach to care.”
Learn about a web-based education intervention to reduce opioid overdose, Low-Cost Intervention Reduces Risk of Opioid Overdose.