Key Points

  • Federal data from 2025 found that more than 80% of people with substance use disorders received no medical treatment at all, and an NPR investigation published August 6, 2026 documented that most U.S. clinicians actively avoid offering the FDA-approved medications proven to reduce cravings and prevent overdoses for both alcohol and opioid use disorders.
  • Medical school and nursing school training gaps are a structural driver: most programs still do not teach addiction care as a core part of practice, which means each generation of clinicians enters the field without the skills or confidence to treat these patients.
  • A large randomized clinical trial published July 7, 2026 in the Annals of Internal Medicine found that about half of patients with chronic pain were able to reduce their opioid dose by at least half within a year; adding cognitive behavioral therapy did not change that completion rate.
  • That trial enrolled patients without moderate-to-severe opioid use disorder and is not a study of addiction treatment. Dr. Sylvie Stacy cautions that applying these results to patients seeking help for opioid addiction could route them into dose-reduction programs that do not match their clinical needs.
  • In a sub-analysis of the same trial, patients who tapered while receiving CBT had a 54% lower rate of opioid withdrawal symptoms compared to those who tapered without behavioral support, which is clinically meaningful even when the primary outcome did not differ between groups.
  • Researchers at the University of Pennsylvania found that nearly 30% of almost 7,000 patients who used stimulants experienced a heart attack, stroke, or heart failure within three years, and built the first cardiovascular risk calculator designed specifically for people who use cocaine or methamphetamine, using a three-year window rather than the standard 10 to 30 years.

Addiction News Weekly Episode 1.14

In This Episode:

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction, recovery, and public health. This week is about the questions worth asking.

An NPR investigation on why most clinicians avoid treating addiction, a large trial on opioid tapering that is being widely misread, and a new tool built because the standard way of measuring heart risk was giving people who use stimulants a dangerously reassuring answer.

Most U.S. Clinicians Still Don’t Treat Addiction

We start with the most uncomfortable finding this week. An NPR investigation published on August 6, 2026 found that most U.S. clinicians actively avoid providing addiction treatment and that the majority do not offer the medications shown to work for alcohol and opioid use disorders.1

Addiction correspondent Brian Mann reviewed the existing research and interviewed more than a dozen medical experts. He set that against new federal data showing that in 2025, more than 80% of people with substance use disorders received no help at all.1 The explanation experts gave is historical rather than clinical. For decades, addiction was treated as a moral failing or criminal matter, and surveys of medical professionals show that same stigma inside the health system.

Robert DeForde of Shatterproof described two overlapping problems. Some clinicians do not want these patients in their practices, and some do not believe the FDA-approved medications will help. DeForde is in recovery himself and said he has encountered that bias from his own doctors.

Underneath the attitudes is a structural problem that may matter more. Most U.S. medical and nursing schools still do not teach addiction care as a core part of practice, so new clinicians keep entering the field without the skills to treat these patients. The gap does not close as older cohorts retire.

Effective medications exist for both alcohol and opioid use disorder, with decades of evidence between them. If a clinician declines to discuss medications, that is reason to get a second opinion, not a verdict on whether treatment could help you. Ask a program whether it prescribes medication on-site, whether it continues after discharge, and whether anyone on staff holds addiction medicine credentials.

What the Stanford Opioid Tapering Trial Actually Found

Our second story is a large, randomized trial that is being read the wrong way. Researchers from Stanford University School of Medicine and colleagues randomly assigned 562 adults with chronic pain across 11 U.S. sites, publishing July 7, 2026 in the Annals of Internal Medicine.2 All three groups received patient-centered opioid tapering with close monitoring.

One group added cognitive behavioral therapy for chronic pain, one added a self-management program, and one tapered alone. Success meant cutting the daily dose by at least half within a year without pain getting worse. Tapering alone reached 50.9%, and adding CBT reached 48.6%.

Here is Rehab.com Chief Medical Officer Dr. Sylvie Stacy with her take.

It’s easy to read a headline about opioids and assume that it applies directly to the type of patients that I see every single day, which are those with an addiction, but that’s not actually what this trial tested. This study is about chronic pain populations reducing prescribed opioid doses under medical supervision. These individuals did not have opioid addictions. The finding here was that the addition of therapy didn’t change the success rate of that opioid taper.

The reason this article could get misinterpreted is that tapering a prescription and treating a substance use disorder are really two different clinical services with distinct standards of care. When those get blurred in referral networks or in marketing materials, patients looking for help with opioid use disorder could potentially get routed into dose reduction programs that might not always match their needs. Anyone with a substance use disorder or someone who is treating a substance use disorder needs to know that behavioral therapy remains a really important element of effective care.

Something notable the data does show us in this study is that about half of the participants cut their dose significantly over a year without their pain getting worse. In my experience, many, many patients taking opioids are fearful about getting their dose lowered because they are concerned it will lead to more suffering, like withdrawal symptoms and pain. And very relevant to individuals with addictions is that in a sub-analysis of this study, the group that tapered while receiving cognitive behavioral therapy actually had a 54% reduction in the incidence of opioid withdrawal symptoms compared to the group that tapered their dose without therapy.

So structured psychosocial intervention didn’t change the taper finish rate, but it seems to have made the process considerably more tolerable. So if you’re a patient seeing a doctor who wants to talk about tapering your opioid dose or you’re a prescriber starting to taper one of your patient’s opioids, it’s entirely reasonable to ask what role behavioral support will play and weigh that into your decision-making along with the tapering schedule and the dosing plan. For patients with chronic pain, even without an opioid addiction, the added therapy does have a place, especially in managing withdrawal symptoms.

The First Heart Risk Calculator Built for Stimulant Users

Our last story is about a risk standard medicine has been measuring wrong. Researchers at the University of Pennsylvania reported that nearly 30% of almost 7,000 patients who used stimulants had a heart attack, stroke, or heart failure within three years.3 That pushed the team to build the first heart disease risk calculator designed specifically for people who use cocaine or methamphetamine.3

The problem with existing tools is the mismatch. Most estimate risk over 10 to 30 years using populations that included very few stimulant users. Dr. Rebecca Arden Harris said that hands clinicians the wrong picture. A low 10-year score looks reassuring for a patient in their 40s, while the real danger arrives much sooner, often in their 30s, through blood pressure spikes, coronary artery spasms, and dangerous heart rhythms.

The Penn team built their model around a three-year window and kept it simple enough for a routine visit. It requires no blood tests, which matters because people who use stimulants often receive fragmented care and lab results are frequently missing from their records.4

Dr. Sean Hennessy called it a proof of concept rather than a substitute for clinical judgment. It was developed in a single mid-Atlantic health system and still needs testing elsewhere.

What is actionable now does not depend on the tool reaching your clinic. If you are researching treatment for cocaine or methamphetamine use, ask how a program handles physical health alongside substance use. Ask what medical services are available on-site and how the program handles someone who arrives with untreated high blood pressure.

Conclusion

Three stories with three questions. Does this provider actually treat addiction or only refer it elsewhere? Is this program tapering a prescription or treating a substance use disorder? And does anyone here look at the rest of my health and not just the substance?

None of this week’s problems were problems of knowledge. The medications exist and they do work. About half of the patients in the Stanford trial cut their dose without more pain. And a research team found a measurement failure and fixed it. The problem was whether anyone asked. So, ask.

If you or someone you love is looking for treatment, Rehab.com lists thousands of verified centers across the country and free, confidential support is available anytime through the SAMHSA National Helpline at 1-800-662-4357. And if you are in crisis, you can call or text 988 at any time.

Those are the top stories in the news. For more, visit Rehab.com. We will be back next week. I’m Kay, and thank you for listening.

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Sources in This Episode

  1. Mann B. Most U.S. Doctors Avoid Treating Patients With Addiction, Leaving Millions Vulnerable. NPR. Published August 6, 2026. https://www.npr.org/2026/08/06/nx-s1-5918040/most-u-s-doctors-avoid-treating-patients-with-addiction-leaving-millions-vulnerable. Accessed September 1, 2026.
  2. Darnall BD, Perez L, Kao MC, et al. Patient-Centered Prescription Opioid Tapering Methods: A Randomized Clinical Trial. Ann Intern Med. Published July 7, 2026. doi:10.7326/ANNALS-25-04784.
  3. Harris RA, Wang F, Bilker WB, et al. Three-Year Cardiovascular Risk Prediction Among People Who Use Cocaine or Methamphetamine. Drug Alcohol Depend Rep. Published June 22, 2026. doi:10.1016/j.dadr.2026.100459.
  4. Stark K. People Who Use Stimulants Face Hidden Heart Risks, Penn Study Finds. Penn LDI. Published August 18, 2026. https://ldi.upenn.edu/our-work/research-updates/people-who-use-stimulants-face-hidden-heart-risks-penn-study-finds/. Accessed September 1, 2026.