Opparounds

Evaluating Reduced Use and Abstinence as Outcomes in Pharmacotherapy Trials for Stimulant Use Disorder: A Meta-Analysis of 12 Randomized Controlled Trials

Amin-Esmaeili M, Farokhnia M, Mojtabai R, Leggio L, Johnson RM, Susukida R · JAMA Psychiatry · June 2026

This one-stage individual-participant meta-analysis pooled 2,000 participants across 12 NIH-sponsored multisite RCTs of pharmacotherapy for cocaine or methamphetamine use disorder, all arms also receiving cognitive behavioral therapy. Rather than scoring outcome as abstinence-or-failure, the authors also scored a "reduced use" outcome against each patient's own baseline.

Across the pooled sample, 31.2% achieved reduced use versus only 13.3% who reached full abstinence, and effect sizes for reduced use were consistently larger than for abstinence across the same medications. Pooled treatment effects were not statistically significant for either outcome overall, but cabergoline showed a positive signal specifically for reduced cocaine use (Cohen h = 0.35).

Read the paper →  doi:10.1001/jamapsychiatry.2026.1092

Predicting Premature Treatment Termination in Inpatient Psychotherapy: A Machine Learning Approach

Engstler M, Lutz W, Schwartz B, Jennissen S, Friederich HC, Dinger U · Psychotherapy Research · July 2026

Researchers followed 2,017 patients at a German psychosomatic inpatient unit and built random-forest models to flag, at intake, who would leave treatment early for therapy-related reasons (rupture, disengagement, a sense it "wasn't working") rather than practical ones like insurance or discharge logistics. Overall, 12.1% dropped out for therapy-related reasons.

A model built only from routine intake paperwork caught 29% of these at-risk patients. Adding a single self-report questionnaire at admission raised detection to 59%, while still correctly clearing 80% of patients who went on to complete treatment. The single strongest predictor in either model wasn't a symptom score — it was simply whether the patient filled out the self-report measure at intake at all.

Read the paper →  doi:10.1080/10503307.2026.2710330

The SSRI-NSAID bleeding interaction isn't about the stomach lining — it's about platelets that can't make more serotonin

Platelets don't synthesize serotonin; they load it from circulating plasma through SERT and release it on activation to drive local vasoconstriction and aggregation at a wound. SSRIs block that same reuptake transporter in platelets that they block in neurons — and because a platelet's lifespan is roughly 7 to 10 days, the effect doesn't reverse until the whole population turns over. Bleeding risk builds over the first one to two weeks of treatment and doesn't fully resolve until about 10 days after stopping the drug.

Alone, SSRIs roughly double upper-GI bleed risk (odds ratio ~1.7-2.4 across studies). Add an NSAID and the risk isn't additive, it's multiplicative — pooled estimates put the combination's odds ratio in the 6-to-12 range versus NSAID alone. SNRIs and clomipramine share the mechanism through the same transporter; bupropion and mirtazapine largely don't. The practical move: any patient on chronic NSAIDs, aspirin, or an anticoagulant who starts an SSRI/SNRI is a candidate for routine PPI co-prescription, especially if older or with a prior GI bleed — not a one-time counseling point to forget after visit one.

Activate the here-and-now before you illuminate it — reversing the order wastes the data

In group therapy, the group's real power isn't insight about outside relationships — it's that members' behavior toward each other, right now, is genuine data rather than a report about someone. Yalom split the leader's job into two separate moves: first activate the here-and-now (steer the group away from "there-and-then" storytelling and toward what members are actually doing to each other in the room), then illuminate it (help the group examine the interaction that just happened and connect it to patterns outside).

The mistake advanced trainees make is skipping straight to illumination — naming a dynamic before the group has actually lived it. An interpretation offered before the interaction has been allowed to unfold intellectualizes the very affect you needed the group to generate. Sequence is the technique: let the moment happen first, name it second.