good research questions about substance abuse

206 Substance Abuse Essay Topics + Examples

Writing a paper about addiction to drugs and alcohol is your chance to explore the substance abuse risk factors, experiences, treatment options, and prevention. Need catchy substance abuse research topics? You’re at the right place! StudyCorgi has plenty of essay and research topics on drug abuse, alcohol, and other psychoactive substances.

💊 7 Substance Abuse Essay Topics

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• Drug Abuse among Teenagers Causes and Effects
• Drug and Alcohol Abuse among Young People
• Substance Abuse Literature Review
• Prevention of Substance Abuse
• Substance Abuse and Addiction Treatment: The Humanistic Theory
• Drug Abuse and Theories Explaining It
• Alcohol and Drug Abuse in the Workplace
• Drug and Substance Abuse: Sociological Causes and Explanations It is normal to think that drug and substance abuse affects only consumers. However, it also affects various aspects of society.
• Substance Abuse Disorder in “The Breaking Bad” Film The series that is built on substance abuse disorders is Breaking Bad, directed by Vince Gilligan. Walter White turns to producing and selling methamphetamine.
• Substance Abuse Prevention in Adolescence Parents and school administrations should implement measures of stopping substance abuse as the first step in safeguarding the future of the next generation.
• The Link Between Drug Abuse and Corruption This paper discusses that drug abuse and corruption deserve attention. It introduces causes and reasons for drug abuse and corruption.
• Adolescent Drug Abuse, Their Awareness and Prevention This essay provides a critique of an article written by Chakravarthy, Shah, and Lotfipour about adolescent drug abuse prevention interventions.
• Victimless Crimes: Drug Abuse and Sex Work This work’s primary objective is to research and analyze victimless crimes, namely drug abuse and sex work, from the viewpoint of criminology.
• Drug Abuse Relation to the Violent Behavior Various groups of drugs greatly vary and relate to violence in different ways. Any person with heavy drug habits may act negatively and involve in violent acts punishable by law.
• Substance Abuse: The Cause of Social Problems Substance abuse is a contributing factor to social problems but cannot be said to be the one that is most responsible.
• Psychotherapy and Counseling for Drug Abuse Treatment Drugs are the biggest vice of humanity, along with the mental and moral deviations, horrible diseases of modern times, social neglect and abuse it causes and goes along with.
• Drug Abuse and Its Effects on Families Because of the lack of control that a substance abuse patient has over their actions, families of the people that develop chemical dependency are under constant threat.
• Drug Abuse and Alcohol-Related Crimes in Adolescents The current paper focuses on the topic of drug abuse and alcohol-related crimes among teenagers, showing that substances remain the most notable factor in juvenile crime.
• Predatory Crime Causation and Substance Abuse Problems Substance abuse problems, as the causes of deviant behavior, are a subject of study in biosocial criminological theories.
• Drug Abuse in Homeless Community The number of homeless people is continuously increasing, creating a severe threat to a country’s general well-being.
• Substance Abuse and Impact on the Family This report will investigate the background, impact on personal lives, and cultural perspectives of the critically dangerous opioid epidemic in the United States due to substance abuse of legal medications.
• Juvenile Drug Abuse Problems Analysis This essay describes the problem of juvenile drug use and applies the relevant delinquency theory. Additionally, the interventions or programs to fix the issue will be highlighted.
• Substance Abuse Among Adolescents Substance abuse and addiction are rampant within the adolescent age. Children abuse substances due to peer pressure, poor parenting, and lack of sufficient sensitization.
• Drugs and Substance Abuse in College: Effects and Treatments The paper will give a review of a treatment approach to drug abuse and describe the effects of substance abuse on a person who is in college.
• Social Factors of Substance Drug Abuse Substance abuse refers to the pattern of continued use, despite adverse consequences. Socio determinants of substance abuse imply social factors that affect the outcome of drugs.
• Substance Abuse Counselling: Current Trends substance abuse is one of the major problems which have seized most individuals in the United States. It is a problem for all sets of the population.
• Personal Relationship With Alcohol Abuse Given that alcohol abuse affects myriad families, ruining people’s health and harming social life, it is still a sensitive and critical issue to consider.
• Parental Substance Abuse: Negative Impact on Child Development The researchers focus on the negative impact of parental substance abuse on child development, leading to addiction problems when these children become teenagers or young adults.
• Assessment of Clients with Substance Abuse Up-to-date medicine struggles with treating humans’ bodies and spirit as sometimes spending more attention to the first aspect lead to an increase in human addictions.
• The Theme of Drug Abuse in Egan’s Book In her novel “A Visit from the Goon Squad”, Jennifer Egan discusses a number of problems of modern society. Among them is the problem of drug abuse.
• Genetic and Environmental Factors Causing Alcoholism and Effects of Alcohol Abuse The term alcoholism may be used to refer to a wide range of issues associated with alcohol. Simply put, it is a situation whereby an individual cannot stay without alcohol.
• The Problems of Substance Abuse in Homeless Veterans The problem of homelessness often affects the most vulnerable segments of society, among them veterans. This group also experiences excessive alcohol consumption.
• Drug Misuse, Abuse, and Their Factors Addiction is a recurrent, chronic disorder characterized by compulsive substance seeking and use despite harmful consequences.
• Substance Abuse Issues in Modern Society Substance abuse entails using illicit drugs, prescription or over-the-counter pharmaceuticals, or alcohol for reasons besides those medically intended or at excessive levels.
• The Factors Which Determine Substance Abuse Substance addiction is a disease that affects the patient’s behavior and physical well-being. It is associated with mood modification and chemical intoxication.
• How Does Substance Abuse in Utero Affect a Child?
• Does Substance Abuse Cause Mental Disorders?
• How Do Nature and Nurture Influence Substance Abuse?
• Does Substance Abuse Treatment Make a Difference for Child Welfare Case Outcomes?
• How Does Parenting Affect Teen Substance Abuse?
• What Is the Effect of Substance Abuse on an Individual and Society?
• How Does Substance Abuse Affect the Community?
• What Are the Causes and Effects of Substance Abuse?
• How Do Psychologists Define and Explain Substance Abuse?
• What Are the Social Problems That Are Caused by Substance Abuse?
• How Can Substance Abuse Addicts Benefit From Art Therapy and Spiritual Nourishment?
• What Are the Main Environmental Factors That Influence Substance Use and Abuse?
• How Does Substance Abuse Influence Youngsters?
• Does Substance Abuse Impact Conception?
• How Does Substance Abuse Affect the Family Unit?
• What Birth Defects Are Caused by Substance Abuse?
• How Has Substance Abuse Become a Worldwide Public Health Problem?
• Does Substance Abuse Affect Academic Performance?
• How Does Poverty Lead to Substance Abuse?
• What Are the Causes of Substance Abuse During Adolescence?
• How Does Substance Abuse Affect an Individual’s Social Life?
• Are There Strategies for the Prevention and Control of Substance Use and Abuse?
• How Can We Prevent Substance Abuse Among Youth?
• Why Is It Important to Talk About Substance Abuse?
• How Can Substance Abuse Be Addressed and Reduced?
• Drug Abuse in the United States’ Social Context Drug abuse is one of the problems affecting people in the United States. Society has contributed to the continued misuse of drugs today, through bad parenting or the environment.
• Developments in Global Tobacco and Alcohol Policy WHO reports that about 8 million people die from smoking every year. Tobacco is a major cause of the emergence and development of multiple complications such as cancer, heart disease.
• Substance Abuse Relapse among Women For substance abuse relapse among women, it is the issue of resumption of females to substance abuse after they have recovered from using such drugs.
• Substance Abuse and Preventive Measures The paper analyzes socio-economic and health issues for families, communities, and nations caused by psychoactive substances abuse.
• Substance Abuse and Its Promotion in Advertisement Substance abuse is very common in the world, and lately, the general populace has perceived substance abuse mentally as one of the vital questions facing almost all countries.
• Personality and Substance Abuse This article looks at personalities of frequent substance users, experimenters, and non-users from the point of view of social psychology.
• Drug Abuse and Its Impact on Creativity The boosting effect of drugs on creativity is a myth because changes in thinking are a brain reaction to a narcotic that is temporary yet severe.
• National Association for Alcoholism and Drug Abuse Counselors This paper will consider the fourth principle of the organization’s ethical code, which reads: “Working in a culturally diverse world.”
• Impaired Nurses: Substance Abuse Treatment Many organizations are more likely to provide impaired nurses with substance abuse treatment rather than with punishment that is considered to be a less effective approach.
• Cognitive-Behavioral Therapy for Social Anxiety and Substance Abuse Mark is a student who suffers from social anxiety and alcohol abuse problems. The assessment regime is needed to identify the cause of Mark’s substance abuse.
• Drug Abuse Case: Jenny G This paper present the case of drug abuse. Jenny G., a 48-year-old recovering IV drug abuser, presents with general malaise, anorexia, abdominal pain, and slight jaundice.
• Interprofessional Health Promotion Resources: Substance Abuse in Adults Available interventions, risks, and factors contributing to substance abuse in adults will be discussed in the present paper.
• Fear Appeal in Anti-Drug Abuse Public Campaign The problem of prescription drug abuse has become a crucial concern for Florida residents. The public campaign proposes raising awareness about the dangers of prescription drugs.
• Substance Abuse: Environmental Influences and Biology Substance abuse is not a new problem the human society faces. This paper examines different ways biological and environment influences interact and affect drug taking behavior.
• Crisis of Chemical Dependence: Drug Abuse Drug abuse mainly begins during teenage. The first part of this essay discusses social and cultural determinants of substance abuse. The second part focuses on the dynamics of addiction.
• Drug Abuse During Pregnancy: Policy Options Heated discussions on whether or not drug abuse during pregnancy should be illegal due to the potential risks to the developing fetus or child persist.
• How Does Substance Abuse Affect Mental Health in High School? The paper states that the number of students who begin to try drugs has increased. The reasons may be a banal interest to try something new in their life.
• Leadership in Drug Abuse Program Development Within the context of a potential intervention for drug abuse, the roles and competencies of leaders are the primary emphasis of this paper.
• The CAGE Substance Abuse Screening Tool Issues The paper states that the CAGE Assessment has a high rate of false positives, which can lead to individuals being wrongly accused of drug abuse.
• The Experience of Substance Abuse in Homeless Veterans The problem of homelessness often affects the most vulnerable segments of society, one of them being veterans. This particular group also experiences significant issues.
• Aspects of Substance Abuse Group Counselling The paper discusses the substance abuse counseling group. It is based on minimizing the substance abuse cases that are among the youth.
• Substance Abuse in Population and How to Address It Substance abuse is one of the issues in the population that affect not only the people who conduct the abuse but those around them as well.
• Parental Alcohol Abuse as a Family Issue Parental alcohol abuse is a serious problem in the community that impacts not only one individual but spreads to different social units.
• Substance Abuse and Its Financial Dimension The purpose of this paper is to explore substance use as a healthcare finance issue and review its significance with regard to healthcare policy.
• The Drug Abuse Problem in Indiana Drug usage is one of Indiana’s most serious societal problems, affecting the state’s health, economy, behavioral, and criminal elements.
• Substance Abuse in Media: Godfather of Harlem In the Godfather of Harlem film directed by Chris Brancato and Paul Eckstein, the character meets two criteria of the DSM-5 qualifying signs and symptoms.
• Overcoming the Drug Abuse Addiction The use of narcotic drugs brings irreparable harm to health and diminishes the quality of life. Opioid abuse is a predominant problem that continues to be a concern.
• The Problems of Drug Misuse and Abuse and Their Management This research aims to determine the best ways to prescript drugs, the importance of drug interactions, and the potential dangers of drug abuse.
• Drug Prescription Issues and Abuse This paper aims to determine the best ways to prescript drugs, the importance of drug interactions, and the potential dangers of drug abuse.
• Drug Abuse Demographics in Prisons Drug abuse, including alcohol, is a big problem for the people contained in prisons, both in the United States and worldwide.
• Elderly Health and Substance Abuse Relationship The topics chosen for this scientific paper are elderly health and social care and alcohol and substance abuse.
• Pandemic’s Impact on Mental Health & Substance and Alcohol Abuse While substance use disorder can impose mental health challenges on those who consume drugs, COVID-19 affects the psychology of all humankind.
• Challenges of Treating Substance Abuse in Homeless Population Substance abuse remains among the major problems the health care industry is facing, also in developed countries.
• Drug Abuse at the Workplace and a Policy to Address It In this proposal, a policy to address worker substance abuse and addiction, will be discussed, with both its major goals and potential benefits being outlines.
• Alcohol Abuse and Self-Management Program The main self-management program for a high school student with alcohol addiction is to set long-term and intermediate goals, and the development of a reward system.
• What are the commonly abused drugs among students?
• How does peer pressure affect students’ drug abuse?
• What are the gender and socioeconomic differences in students’ substance abuse?
• How does drug abuse influence the overall campus environment?
• What are the psychological and behavioral effects of drug abuse on students?
• What is the link between the accessibility of drugs on campus and student drug abuse?
• How does stress affect the development of student substance abuse?
• How does social support impact students’ susceptibility to drug abuse?
• Does the use of random drug testing reduce student substance abuse rates?
• What are the long-term consequences of student drug abuse?
• Substance Abuse Counseling Practices The main statistic of the research is that trauma in childhood is an indispensable part of the substance abuse experience.
• Alcohol Abuse: Causes and Solutions Alcohol abuse remains one of the key healthcare concerns around the globe, not least because addicts do not purely injure their own health.
• Substance Abuse Experience and Treatment Substance abuse is a major issue that can affect an addicted person’s life profoundly. Furthermore, it has a strong impact on those around this individual.
• Personalized Substances Abuse Assessment The paper discusses the fact that the client was addicted to marijuana and methamphetamine, and she realized that this addiction changed her life for the worse.
• Substance Abuse Treatment in Pembroke Pines City Pembroke Pines is a beautiful suburban city close to Miami. Unfortunately, the town is infamous due to the high number of people suffering from substance abuse.
• Substance Abuse Addiction: Guide for Colleagues in the Workplace If a colleague exhibits an addictive behavior, there is need to handle the situation properly and professionally to ensure better productivity after addressing the issue.
• Types of Drugs and Types of Domestic Abuse Correlation Understanding that the consumption of particular drugs causes physical changes is essential in ascertaining the probability of a specific type of domestic violence.
• Prescription Drug Abuse Problem Providing access to prescription drugs is among the key tasks that the modern healthcare system should fulfill to increase recovery rates.
• Substance Abuse and Its Social Determinants The paper argues that substance abuse is intensely predisposed by relational, domestic, and communal changing aspects.
• Substance Abuse: Determinants, Widespread Use, Financial Costs, Defense Mechanism Substance abuse is also referred to as drug abuse. Substance abuse has been defined as the harmful use of both prescription and illicit drugs.
• Substance Abuse and Its Effect on the Community This paper discusses how substance abuse contributes to teen pregnancy, HIV, domestic violence, child abuse, and how the epidemiological problem has affected the entire community.
• The Availability of Recovery High Schools in Overcoming Substance Abuse The article by Deborah Yaffe, titled “Recovery High Schools Make Dent in Teen Substance Abuse,” was published in District Administration journal in 2019.
• Anti-Drug Abuse Act of 1986: Crack vs. Cocaine Sentencing Disparity The Anti-Drug Abuse Act of 1986 imposes disproportionate sentences for offenders convicted of using or possessing crack and powder cocaine.
• Researching of Pregnancy and Alcohol Abuse In order to address the issue of alcohol abuse during pregnancy, the interprofessional team should consider the current trends and recommendations on maternal alcohol consumption
• Accessory Plus Incorporated’s Drug Abuse Case In the case of Accessory Plus Incorporated, the issue of drug abuse has been suspected. However, there is no policy framework for the company to deal with the case.
• The Link Between Culture and Substance Abuse Drugs and substance abuse have become a very important element of youth culture as time goes by. The abuse of drugs has become a normal trend among the youths.
• Adolescent Males With Depression: Poly-Substance Abuse Depression is the most crucial aspect that makes young males indulge in poly-substance abuse. There are various ways in which male adolescents express their depression.
• Prescription Drug Abuse as a Community Health Issue Consumption of prescription drugs in a manner that has not been prescribed by the doctor is an outstanding community health issue. This can be more harmful than people understand.
• Crime Trends: Drug Abuse in Adults and Juveniles One notes a mixed trend in the different crimes over the years. Drug abuse, for example, increased steadily from the 1970s in both the adult and juvenile populations.
• Substance Abuse Problem Analysis This essay explores substance abuse and its general impact on society and on individuals. Substance abuse has been a major concern for all governments over the last century.
• Substance Abuse: Alcohol and Drugs in the Movie “Ray” The movie “Ray” by Taylor Hackford. In “Ray,” the issue of substance abuse helps understand the problems that a person faces when dealing with addiction.
• Treatment of Substance Abuse Problems among Adolescents The study involves an examination of the effective treatment models utilized in the treatment of substance abuse problems among adolescents.
• Substance Abuse among Black Women Aged 22-55 in Miami Substance abuse in black women who are aged between 25 and 55 years is rarely considered an issue of major concern and it is often relegated to the background.
• Substance Abuse Therapy Positive and Negative Outcomes The indispensable role played by substance abuse therapists, in providing rehabilitative measures to curb this drug abuse scourge.
• Drug Abuse in Correction Facilities The purpose of this article is to consider the problem of drug abuse in correctional facilities, as well as to suggest possible solutions to this problem.
• Adolescents With a Substance Abuse Issue Treatment The study is a review of the current treatment modalities employed in management of substance abuse among adolescents.
• Costs and Effects of Substance Abuse There are a number of factors of social, economic, environmental, biological and psychological factors that are recognized as the most common determinants of substance abuse
• Substance Abuse in the Young People Substance abuse refers to unsafe or hazardous use of substances that are psychoactive. Such substances may include alcohol or illicit drugs.
• Substance Abuse Among African American Women in Miami The purpose of this paper is to discuss substance abuse among African American women aged 25-55 years living in Miami.
• Impact of Alcohol Abuse on Breast Cancer Risk in Women This paper will examine the effects of alcohol abuse on the development of breast cancer in women to uncover its devastating consequences.
• Alcohol Abuse: External and Internal Perspectives This paper will examine the social costs of alcohol abuse problems, in particular, the external rise of violence and the private stigma surrounding addiction.
• The Drug Courts: The Question of Drug Abuse Drug abuse is one of the most prevalent crimes in the world. It is a concern for both local governments and international organizations.
• Alcohol Abuse as It Pertains to High Risk Families The main objections of the promotion and prevention program are to ensure reduced substance abuse among young people to protect their health.
• Community Health: Prescription Drug Abuse The rising access to frequently abused prescription drugs via the internet has created public anxieties within the healthcare system in the United States.
• Family Involvement in Substance Abuse Cases The family systems theory underlies eight interconnected concepts, which purport to highlight the source of different conflicts and other emotional problems within the family.
• Health Issue Analysis: Prescription Drug Abuse Prescription drug abuse is a rapidly growing epidemic that spreads worldwide. Various national and international health organizations research this field.
• The Link Between Cultural Family and Substance Abuse The paper identifies the prevalence, correlates, and negative implications of substance abuse among African American women.
• Substance Abuse and Health Care Cost for Employers: A Review of the Literature Substance abuse is a condition that can be prevented and treated. Substance abuse disorders impose huge financial costs to both the employer and the society at large.
• Dealing With Alcohol Abuse in Adolescents This research evaluates how the public can be incorporated in developing effective interventions aimed at dealing with alcohol abuse and binge drinking among youth.
• The Drug Abuse in the U.S. Navy: The Problem Analysis The purpose of this report is to capture drug abuse in the U.S. Navy and to analyze some of the measures that the Naval Criminal Investigative Service (NCIS) has put in place.
• OxyContin as a Legitimate Drug and a Drug of Abuse OxyContin is the brand name used to sell the extended-release form of oxycodone, it describes a semi-synthetic prescription opioid used to manage severe pain.
• Substance Abuse in Low-Income Community Cocaine abusers become heroin-addicted fifteen times more, whereas people with addiction to prescription drugs are forty times more likely to shift to heroin abuse.
• Hispanic Community: Alcohol & Substance Abuse Among the Female Gender Population This study will focus on alcohol and substance abuse among the female gender population proportion (12-20 years and 25-45 years) in the Hispanic community in California.
• Adolescence Substance Abuse: Over The Counter Inhalants And Cough Syrup Over-the-counter drugs, commonly known as OTC, refer to the prescription of drugs that are not meant for medical use.
• Drug Abuse Factors: Substance Use Disorder The various reasons for the abuse of opioids, alcohol, and nicotine account for the challenge in research and treatment.
• Substance Abuse Problem in the Miami City Community In Miami City, teenagers are at a particularly high risk of developing alcohol use disorder. More efforts should be implemented into screening and surveying this at-risk.
• White Collar Crime, Corporate Crime and Substance Abuse A single corporate crime can cause harm to many people. The fiscal impact of white-collar crimes significantly surpasses those of blue-collar offenses.
• Drug Abuse and Addiction: Risk Factors People with drug abuse issues have enhanced motivation to take drugs, increased probability of reacting to stress, emotional dysregulation, and impaired self-control.
• Linking Obamacare Policy, Substance Abuse, and Mental Health Obamacare, or The Affordable Care Act, is one of the most prominent health care policies in the United States because disputes over its advantages and disadvantages last for years.
• The Relations Between Drug Abuse and Criminal Justice The purpose of this article is to use conflict theory to analyze how race, class, and gender affect drug abuse and crime in the United States.
• Drug and Alcohol Abuse in Organizations The purpose of this paper is to analyze the impact of drugs and alcohol on the behavior of the employees and the relationships between business owners and their subordinates.
• Drug Abuse: Impaired American Society The history of American society as far as drug abuse is concerned has had a dark past where drugs and alcohol were considered a lifestyle.
• The Issue of Drug Abuse in the Community of Kinsburg This paper aims to research the community of the city of Keansburg, located in the state of New Jersey and its issue of substance abuse.
• Adolescent Drug Abuse: Diagnosis and Cultural Awareness The paper examines the effect of amphetamine on human and, as a consequence, the development of mental illness, namely, mood disorder.
• The Problem of Prescription Drug Abuse in the United States Prescription drug abuse is a serious health concern that causes an overdose crisis in the United States. There are determinants such as social, economic, and healthcare-related issues.
• A Health Issue Analysis: Prescription Drug Abuse Prescription drug abuse is one of the acutest problems of healthcare systems in the USA. In the past decade, the rate of deaths due to prescription drug overdose grew by 142%.
• Substance Abuse Among Teenagers: Factors and Causes This study seeks to investigate the impact of gender, family structure, parental influence, and peer pressure on teenagers’ alcohol use.
• Drug Abuse and Drug Addiction and Various Policies Related to Drugs The harm reduction policy is concerned with reducing or minimizing the risks that are accrued to drug abuse in various societies.
• Drug Abuse and Crime Correlation The correlation between drug use and crimes go, most prisoners said they commit crimes for obtaining money for drugs, so drugs are the motivation.
• Family Violence and Substance Abuse Substance abuse does not only affect the individuals but its consequences spill over to the society especially the community and also the work places.
• Drug Addiction: The Problem of Xanax Abuse and Its Consequences Xanax as a drug can be very addictive and difficult to stop and it is very important for anyone using the drug to be cautious and follow the instructions that are provided.
• Alcohol Abuse Among Students: Reforming College Drinking A large number of works are devoted to the problem of alcohol abuse among students. One of them is Drinking in College: Rethinking a Social Problem by George Dowdall.
• The Impacts of Substance Abuse on Pregnancy The consequences of substance abuse on pregnancy are very diverse: both physiological and psychological and there are many specific aspects which have not been fully discussed.
• Personal Issues: Marriage, Obesity, and Alcohol Abuse The actions of every person have a particular impact on society and its development, and this impact is sometimes underestimated.
• Drug Abuse Among Teenagers Before analyzing the causes of addiction among teenagers, we have to look at this issue from sociological point of view.
• Substance Abuse, Lack of Treatment, Prejudice and Incarceration – A Community Health Problem Substance abuse and poor mental health form some of the biggest concerns of society. People of all ages especially the young are influenced by substance abuse.
• Substance Abuse Prevention and Effective Prevention Programs Substance abuse is a maladaptive pattern of drug or alcohol use that leads to clinical impairment or distress. Substance abuse is manifested in failure to fulfill adaptation at work, school, or home.
• Substance Abuse Effects on Person and Community Substance abuse is a well-documented problem that can lead to numerous complications on a personal, family, community, and national level.
• Alcohol Abuse: the Economist Approach To an economist, the problem of alcohol abuse is viewed as an externality in both consumption and production. The value to consumers is greater than the value to society.
• The Alcohol Abuse Treatment Among the Elderly This paper delves into the issue of alcohol abuse among the elderly, its potential implications, the origin of the problem, and methods to resolve the issue.
• Alcohol Abuse’ Treatment Among the Elderly This research focuses on finding the best treatment for the problem of alcohol abuse among the elderly as it may pose serious health problems.
• Drug and Alcohol Abuse Treatment Effectiveness The production and consumption of drugs is a core challenge in the modern world. It is the reason why there is an increased need for treatment of people affected by drug addiction.
• The Treatment of Alcohol Abuse of the Elderly This paper delves into the issue of alcohol abuse among the elderly, its potential implications, and examines what the current methods utilize to resolve the issue.
• The Treatment of Alcohol Abuse among the Elderly Alcohol abuse among the elderly is an issue that has raised concern among medical practitioners and society in general.
• Substance Abuse and Frustration Relationships A report released by the Harvard health institute indicated that substance abuse is high among frustrated individuals.
• Drug Abuse Treatment in Nursing Jenny G., a 48-year-old recovering IV drug abuser, presents with general malaise, anorexia, abdominal pain, and slight jaundice. She is currently staying in a women’s shelter and looking for a job.
• Substance Abuse Versus Addiction When abuse of psychoactive substances is regularly repeated, dependence syndrome develops a person begins to crave the drug or alcohol more.
• Caring for Vulnerable Population: Substance Abuse Substance abuse is a rampant problem in the current society despite the availability of information regarding the consequences of drug abuse.
• Teenage Drug and Substance Abuse It is crucial for governments, not just the U.S., where teenage drug and substance abuse are on the rise, but also other countries, to establish mechanisms that can help to fight the menace.
• Drug Abuse Among Homeless People in Miami This paper aims to better assess the disaster of drug abuse among homeless people in Miami, and develop ways to counter this issue.
• Drug Abuse, HIV/AIDS, and Songs on Social Issues Drug abuse and HIV/AIDS are some of the major social issues affecting society today. Songs have been used in raising awareness about social issues that affect the world.
• Female Drug Abuser’s Recovery Care Plan A woman is an IV drug abuser. The laboratory tests reveal elevated alanine aminotransferase and antibody-positive for Hepatitis C and Hepatitis B.
• Substance Abuse in Reducing Frustration Frustration usually co-occurs with substance abuse. The research question is whether substance abuse can reduce frustration.
• Contingency Management for Patients With Substance Abuse Contingency management is a behavioral treatment for patients with substance abuse problems. This work discusses methods of treatment and contingency management.
• Substance Abuse Disorder Causes, Syptoms, Types Substance abuse – illicit, prescriptive, or licit drugs – has been linked to multiple chronic behavioral and psychotic disorders.
• Mental Health and Substance Abuse in Obamacare The Affordable Care Act (ACA) offered an opportunity to improve healthcare for people with mental illnesses. The implementation of new regulations required certain payment reform.
• Substance Abuse Treatment and Domestic Violence The histories of child abuse and neglect form the present behavior of a person a define his administering treatment needs regarding the fact of whether a person was sexually or emotionally abused.
• Substance Abusers Alcoholics – Psychology Alcoholics suffer from a distinct physical yearning to take alcohol past their capability to manage it, irrespective of every law of common sense.
• Minimizing Prescription Drug Abuse in Oklahoma Over the past few years, the rates of prescription drug abuse in Oklahoma have grown impressively. The issue must be addressed by raising awareness via modern media.
• Substance Abuse: How Much Is Enough? Drug and substance abuse is caused by many factors that include environmental, age, race and ethnicity, gender, sexual orientation, income level and socioeconomic class
• Social Cultural Determinants of Substance Abuse This paper presents a discussion on the social cultural determinants of substance abuse. It also addresses the dynamics of addiction and the mechanisms that are cope with challenges that arise.
• How do genetic factors contribute to one’s susceptibility to substance abuse?
• What is the impact of substance abuse on brain development in adolescents?
• How do co-occurring mental health disorders affect substance abuse treatment outcomes?
• What are the long-term physical health consequences of prolonged substance abuse?
• How does substance abuse affect family relationships?
• What are the economic costs of substance abuse?
• How do healthcare professionals’ attitudes affect substance abuse treatment quality?
• How does substance abuse affect occupational performance?
• What are the unique challenges of LGBT people in accessing substance abuse treatment?
• How do drug laws affect substance abuse rates?

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• A Research Guide
• Research Paper Topics
• 40 Drug Abuse & Addiction Research Paper Topics

40 Drug Abuse & Addiction Research Paper Topics

Drug Abuse and Sociology

Drug abuse and medicine, drug abuse and psychology.

• Drug abuse and the degradation of neuron cells
• The social aspects of the drug abuse. The most vulnerable categories of people
• Drugs and religion. Drug abuse as the part of the sacred rituals
• Chronic Lymphocytic Leukemia
• Drug abuse as the part of human trafficking and as psychological defence of victims
• Reversible and irreversible consequences of drug abuse
• Drug abuse and minors
• Ethnic and cultural traditions that may lead to drug abuse
• Medical marijuana. Can legalizing it lead to drug abuse?
• The ethical questions of abusing painkiller drugs or other drugs that ease the state of a person
• The “club culture”. May it enhance the danger of drug abuse?
• Preventing drug abuse. Mandatory examination or voluntary learning: what will help most?
• The abstinence after the drug abuse. Rehabilitation and resocialization of the victims of it
• The harm done by drug abuse to the family and social relations
• The types of drugs and the impact of their abuse to the human body
• The positive effects of drugs. May they be reached without drawbacks of drug abuse?
• Alcoholics Anonymous, similar organisations and their role in overcoming the dependency
• Is constant smoking a drug abuse? Quitting smoking: government and social decisions
• Exotic addictions: game addiction, porn addiction etc. Do they have the effects similar to drug abuse?
• Substance abuse during pregnancy and before conceiving. What additional harm it causes?
• The correlation between drugs and spreading of HIV/AIDS
• Drug abuse and crime rates
• History of drug abuse. Opium houses, heroin cough syrup and others
• Drunk driving and drunk violence. The indirect victims of alcohol abuse
• The social rejection of the former drug abusers and the way to overcome it
• The main causes of drug abuse in the different social groups
• Drug abuse and mental health
• LGBTQ+ and drug abuse
• The development of drug testing. The governmental implementation of it
• Geniuses and drug abuse. Did drugs really helped them to create their masterpieces?
• Shall the laws about drug abuse be changed?
• Health Care Information Technology
• Drug abuse and global health throughout the 20-21 centuries
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Vol. XXVIII, No. 4, Summer 2012

Eight Questions for Drug Policy Research

By Mark A. R. Kleiman , Jonathan P. Caulkins , Angela Hawken , Beau Kilmer

The current research agenda has only limited capacity to shrink the damage caused by drug abuse. Some promising alternative approaches could lead to improved results.

Drug abuse—of licit and illicit drugs alike—is a big medical and social problem and attracts a substantial amount of research attention. But the most attractive and most easily fundable research topics are not always those with the most to contribute to improved social outcomes. If the scientific effort paid more attention to the substantial opportunities for improved policies, its contribution to the public welfare might be greater.

The current research agenda around drug policy concentrates on the biology, psychology, and sociology of drugtaking and on the existing repertoire of drug-control interventions. But that repertoire has only limited capacity to shrink the damage that drug users do to themselves and others or the harms associated with drug dealing, drug enforcement, and drug-related incarceration; and the current research effort pays little attention to some innovative policies with substantial apparent promise of providing improved results.

At the same time, public opinion on marijuana has shifted so much that legalization has moved from the dreams of enthusiasts to the realm of practical possibility. Yet voters looking to science for guidance on the practicalities of legalization in various forms find little direct help.

All of this suggests the potential of a research effort less focused on current approaches and more attentive to alternatives.

The standard set of drug policies largely consists of:

• Prohibiting the production, sale, and possession of drugs
• Seizing illicit drugs
• Arresting and imprisoning dealers
• Preventing the diversion of pharmaceuticals to nonmedical use
• Persuading children not to begin drug use
• Offering treatment to people with drug-abuse disorders or imposing it on those whose behavior has brought them into conflict with the law
• Making alcohol and nicotine more expensive and harder to get with taxes and regulations
• Suspending the drivers’ licenses of those who drive while drunk and threatening them with jail if they keep doing it

With respect to alcohol and tobacco, there is great room or improvement even within the existing policy repertoire for example, by raising taxes), even before more-innovaive approaches are considered. With respect to the currently illicit drugs, it is much harder to see how increasing or slightly modifying standard-issue efforts will measurably shrink the size of the problems.

The costs—fiscal, personal, and social—of keeping half a million drug offenders (mostly dealers) behind bars are sufficiently great to raise the question of whether less comprehensive but more targeted drug enforcement might be the better course. Various forms of focused enforcement offer the promise of greatly reduced drug abuse, nondrug crime, and incarceration. These include testing and sanctions programs, interventions to shrink flagrant retail drug markets, collective deterrence directed at violent drug-dealing organizations, and drug-law enforcement aimed at deterring and incapacitating unusually violent individual dealers. Substantial increases in alcohol taxes might also greatly reduce abuse, as might developing more- effective treatments for stimulant abusers or improving the actual evidence base underlying the movement toward “evidence-based policies.”

These opportunities and changes ought to influence the research agenda. Surely what we try to find out should bear some relationship to the practical choices we face. Below we list eight research questions that we think would be worth answering. We have selected them primarily for policy relevance rather than for purely scientific interest.

1) How responsive is drug use to changes in price, risk, availability, and “normalcy”?

The fundamental policy question concerning any drug is whether to make it legal or prohibited. Although the choice s not merely binary, a fairly sharp line divides the spectrum of options. A substance is legal if a large segment of he population can purchase and possess it for unsupervised “recreational” use, and if there are no restrictions on who can produce and sell the drug beyond licensing and routine regulations.

Accepting that binary simplification, the choice becomes what kind of problem one prefers. Use and use-related problems will be more prevalent if the substance is legal. Prohibition will reduce, not eliminate, use and abuse, but with three principal costs: black markets that can be violent and corrupting, enforcement costs that exceed those of regulating a legal market, and increased damage per unit of consumption among those who use despite the ban. (Total use related harm could go up or down depending on the extent to which the reduction in use offsets the increase in harmfulness per unit of use.)

The costs of prohibition are easier to observe than are its benefits in the form of averted use and use-related problems. In that sense, prohibition is like investments in prevention, such as improving roads; it’s easier to identify the costs than to identify lives saved in accidents that did not happen.

We would like to know the long-run effect on consumption of changes in both price and the nonprice aspects of availability, including legal risks and stigma. There is now a literature estimating the price elasticity of demand for illegal drugs, but the estimates vary widely from one study to the next and many studies are based on surveys that may not give adequate weight to the heavy users who dominate consumption. Moreover, legalization would probably involve price declines that go far beyond the support of historical data.

Furthermore, as Mark Moore pointed out many years ago, the nonprice terms of availability, which he conceptualized as “search cost,” may match price effects in terms of their impact on consumption. Ye t those effects have never been quantitatively estimated for a change as profound as that from illegality to legality. The decision not to enforce laws against small cannabis transactions in the Netherlands did not cause an explosion in use; whether and how much it increased consumption and whether the establishment of retail shops mattered remain controversial questions.

This ignorance about the effect on consumption hamstrings attempts to be objective and analytical when discussing the question of whether to legalize any of the currently illicit drugs, and if so, under what conditions.

2) How responsive is the use of drug Y to changes in policy toward drug X?

Polydrug use is the norm, particularly among frequent and compulsive users. (Most users do not fall in that category, but the minority who do account for the bulk of consumption and harms.) Therefore, “scoring” policy interventions by considering only effects on the target substance is potentially misleading.

For example, driving up the price of one drug, say cocaine, might reduce its use, but victory celebrations should be tempered if the reduction stemmed from users switching to methamphetamine or heroin. On the other hand, school based drug-prevention efforts may generate greater benefits through effects on alcohol and tobacco abuse than via their effects on illegal drug use. Comparing them to other drug-control interventions, such as mandatory minimum sentences for drug dealers, in terms of ability to control illegal drugs alone is a mistake; those school-based prevention interventions are not (just) illicit-drug–control programs.

But policy is largely made one substance at a time. Drugs are added to schedules of prohibited substances based on their potential for abuse and for use as medicine. Reformers clamor for evidence-based policies that rank individual drugs’ harmfulness, as attempted recently by David Nutt, and ban only the most dangerous. Ye t it makes little practical sense to allow powder cocaine while banning crack, because anyone with baking soda and a microwave oven can convert powder to crack.

Considerations of substitution or complementarity ought to arise in making policy toward some of the so-called designer drugs. Mephedrone looks relatively good if most of its users would otherwise have been abusing methamphetamine; it looks terrible if in fact it acts as a stepping stone to methamphetamine use. But no one knows which is the case.

Marijuana legalization is in play in a way it has not been since the 1970s. Various authors have produced social-welfare analyses of marijuana legalization, toting up the benefits of reduced enforcement costs and the costs of greater need for treatment, accounting for potential tax revenues and the like.

Yet the marijuana-specific gains and losses from legalization would be swamped by the uncertainties concerning its effects on alcohol consumption. The damage from alcohol is a large multiple of the damage from cannabis; thus a 10% change, up or down, in alcohol abuse could outweigh any changes in marijuana-related outcomes.

There is conflicting evidence as to whether marijuana and alcohol are complements or substitutes; no one can rule out even larger increases or decreases in alcohol use as a result of marijuana legalization, especially in the long run.

Marijuana legalization might also influence heavy use of cocaine or cigarette smoking. But again, no one knows whether that effect would be to drive cocaine or cigarette use up or down, let alone by how much. If doubling marijuana use led to even a 1% increase or decrease in tobacco use, it could produce 4,000 more or 4,000 fewer tobacco related deaths per year, far more than the (quite small) number of deaths associated with marijuana.

This uncertainty makes it impossible to produce a solid benefit/cost analysis of marijuana legalization with existing data. That suggests both caution in drawing policy conclusions and aggressive efforts to learn more about cross-elasticities among drugs prone to abuse.

3) Can we stop large numbers of drug-involved criminal offenders from using illicit drugs?

Many county, state, and federal initiatives target drug use among criminal offenders. Ye t most do little to curtail drug use or crime. An exception is the drug courts process; some implementations of that idea have been shown to reduce drug use and other illegal behavior. Unfortunately, the resource intensity of drug courts limits their potential scope. The requirement that every participant must appear regularly before a judge for a status hearing means that a drug court judge can oversee fewer than 100 offenders at any time.

The HOPE approach to enforcing conditions of probation and parole, named after Hawaii’s Opportunity Probation with Enforcement, offers the potential for reducing use among drug-involved offenders at a larger scale. Like drug courts, HOPE provides swift and certain sanctions for probation violations, including drug use. HOPE starts with a formal warning that any violation of probation conditions will lead to an immediate but brief stay in jail. Probationers are then subject to regular random drug testing: six times a month at first, diminishing in frequency with sustained compliance. A positive drug test leads to an immediate arrest and a brief jail stay (usually a few days but in some jurisdictions as little as a few hours in a holding cell). Probationers appear before the judge only if they have violated a rule; in contrast, a drug court judge participates in every status review. Thus HOPE sites can supervise large numbers of offenders; a single judge in Hawaii now supervises more than 2,000 HOPE probationers.

In a large randomized controlled trial (RCT), Hawaii’s HOPE program greatly outperformed standard probation in reducing drug use, new crimes, and incarceration among a population of mostly methamphetamine-using felony probationers. A similar program in Tarrant County, Texas (encompassing Arlington and Fort Worth), appears to produce similar results, although this has not yet been verified by an RCT, as has a smaller-scale program (verified by an RCT) among parolees in Seattle. Reductions in drug use of 80%, in new arrests of 30 to 50%, and in days behind bars of 50% appear to be achievable at scale. The last result is the most striking; get-tough automatic-incarceration policies can reduce incarceration rather than increasing it, if the emphasis is on certainty and celerity rather than severity.

The Department of Justice is funding four additional RCTs; those results should help clarify how generalizable the HOPE outcomes are. But to date there has been no systematic experimentation to test how variations in program parameters lead to variations in results.

Hawaii’s HOPE program uses two days in jail as its typical first sanction. Penalties escalate for repeated violations, and the 15% or so of participants who violate a fourth time face a choice between residential treatment and prison. No one is mandated to undergo treatment except after repeated failures. The results suggest that this is an effective design, but is it optimal? Would some sanction short of jail for the first violation—a curfew, home confinement, or community service—work as well? Are escalating penalties necessary and if so, what is the optimal pattern of escalation? Is there a subset of offenders who ought to be mandated to treatment immediately rather than waiting for failures to accumulate? Should cannabis be included in the list of drugs tested for, as it is in Hawaii, or excluded? How about synthetically produced cannabinoids (sold as “Spice”) and cathinones (sold as “bath salts”), which require more complex and costly screening? Would adding other services to the mix improve outcomes? How can HOPE be integrated with existing treatment-diversion programs and drug courts? How can HOPE principles best be applied to parole, pretrial release, and juvenile offenders?

Answering these questions would require measuring the results of systematic variation in program conditions. There is no strong reason to think that the optimal program design will be the same in every jurisdiction or for every offender population. But it’s time to move beyond the question “Does HOPE work?” to consider how to optimize the design of testing-and-sanctions programs.

4) Can we stop alcohol-abusing criminal offenders from getting drunk?

Under current law, state governments effectively give every adult a license to purchase and consume alcohol in unlimited quantities. Judges in some jurisdictions can temporarily revoke that license for those with an alcohol-related offense by prohibiting drinking and going to bars as conditions of bail or probation. However, because alcohol passes through the body quickly, a typical random-but-infrequent testing regiment would miss most violations, making the revocation toothless.

In 2005, South Dakota embraced an innovative approach to this problem, called 24/7 Sobriety. As a condition of bail, repeat drunk drivers who were ordered to abstain from alcohol were now subject to twice-a-day breathalyzer tests, every day. Those testing positive or missing the test were immediately subject to a short stay in jail, typically a night or two. What started as a five-county pilot program expanded throughout the state, and judges began applying the program to offenders with all types of alcohol-related criminal behavior, not just drunk driving. Some jurisdictions even started using continuous alcohol-monitoring bracelets, which can remotely test for alcohol consumption every 30 minutes. Approximately 20,000 South Dakotans have participated in 24/7—an astounding figure for a state with a population of 825,000.

The anecdotal evidence about the program is spectacular; fewer than 1% of the 4.8 million breathalyzer tests ordered since 2005 were failed or missed. That is not because the offenders have no interest in drinking. About half of the participants miss or fail at least one test, but very few do so more than once or twice. 24/7 is now up and running in other states, and will soon be operating in the United Kingdom. As of yet there are no peer-reviewed studies of 24/7, but preliminary results from a rigorous quasi-experimental evaluation suggest that the program did reduce repeat drunk driving in South Dakota. Furthermore, as with HOPE, there remains a need to better understand for whom the program works, how long the effects last, the mechanism(s) by which it works, and whether it can be effective in a more urban environment.

Programs such as HOPE and 24/7 can complement traditional treatment by providing “behavioral triage.” Identifying which subset of substance abusers cannot stop drinking on their own, even under the threat of sanctions, allows the system to direct scarce treatment resources specifically to that minority.

Another way to take away someone’s drinking license would be to require that bars and package stores card every would be to require that bars and package stores card every buyer and to issue modified driver’s licenses with nondrinker markings on them to those convicted of alcohol-related crimes. This approach would probably face legal and political challenges, but that should not discourage serious analysis of the idea.

There is also strong evidence that increasing the excise tax on alcohol could reduce alcohol-related crime. Duke University economist Philip Cook estimates that doubling the federal tax, leading to a price increase of about 10%, would reduce violent crime and auto fatalities by about 3%, a striking saving in deaths for a relatively minor and easy-to-administer policy change. There is also evidence that formal treatment, both psychological and pharmacological, can yield improvements in outcomes for those who accept it.

There is also strong evidence that increasing the excise linked. Among people with drug problems who are also crimtax on alcohol could reduce alcohol-related crime. Duke Uni- inally active, criminal activity tends to rise and fall with drug versity economist Philip Cook estimates that doubling the consumption. Reductions in crime constitute a major benfederal tax, leading to a price increase of about 10%, would efit of providing drug treatment for the offender population, reduce violent crime and auto fatalities by about 3%, a strik- or of imposing HOPE-style community supervision. ing saving in deaths for a relatively minor and easy-to-ad- Reducing drug use among active offenders could also minister policy change. There is also evidence that formal shrink illicit drug markets, producing benefits everywhere, treatment, both psychological and pharmacological, can yield from inner-city neighborhoods wracked by flagrant drug improvements in outcomes for those who accept it.

5) How concentrated is hard-drug use among active criminals?

Literally hundreds of substances have been prohibited, but the big three expensive drugs (sometimes called the “hard” drugs)—cocaine, including crack; heroin; and methamphetamine— account for most of the societal harm. The serious criminal activity and other harms associated with those substances are further highly concentrated among a minority of their users. Many people commit a little bit of crime or use hard drugs a handful of times, but relatively few make a habit of either one. Despite their relatively small numbers, those frequent users and their suppliers account for a large share of all drug-related crime and violence.

The populations overlap; an astonishing proportion of those committing income-generating crimes, such as robbery, as opposed to arson, are drug-dependent and/or intoxicated at the time of their offense, and a large proportion of frequent users of expensive drugs commit income-generating crime. Moreover, the two sets of behaviors are causally linked. Among people with drug problems who are also criminally active, criminal activity tends to rise and fall with drug consumption. Reductions in crime constitute a major benefit of providing drug treatment for the offender population, or of imposing HOPE-style community supervision.

Reducing drug use among active offenders could also shrink illicit drug markets, producing benefits everywhere, from inner-city neighborhoods wracked by flagrant drug dealing to source and transit countries such as Colombia and Mexico.

A back-of-the envelope calculation suggests the potential size of these effects. The National Survey on Drug Use and Health estimates users in the household population. The Arrestee Drug Abuse Monitoring Program measures the rate of active substance use among active offenders (by self-report and urinalysis). Two decades ago, an author of this article (Kleiman) and Chris Putala, then on the Senate Judiciary Committee staff, used the predecessors of those surveys to estimate that about three-quarters of all heavy (morethan-weekly) cocaine users had been arrested for a nondrug felony in the previous year.

Applying the Pareto Law’s rule of thumb that 80% of the volume of any activity is likely to be accounted for by about 20% of those who engage in it—true, for example, about the distribution of alcohol consumption—suggests that something like three-fifths of all the cocaine is used by people who get arrested in the course of a typical year and who are therefore likely to be on probation, parole, or pretrial release if not behind bars.

Combining that calculation with the result from HOPE that frequent testing with swift and certain sanctions can shrink (in the Hawaii case) methamphetamine use among heavily drug-involved felony probationers by 80%, suggests that total hard-drug volume might be reduced by something like 50% if HOPE-style supervision were applied to all heavy users of hard drugs under criminal-justice supervision. No known drug-enforcement program has any comparable capability to shrink illicit-market volumes.

By the same token, HOPE seems to reduce criminal activity, as measured by felony arrests, by 30 to 50%. If frequent offenders commit 80% of income-generating crime, and half of those frequent offenders also have serious harddrug problems, such a reduction in offending within that group could reduce total income-generating crime by approximately 15 to 20%, while also decreasing the number of jail and prison inmates.

The Kleiman and Putala estimate was necessarily crude because it was based on studies that weren’t designed to measure the concentration of hard-drug use among offenders. Unfortunately, no one in the interim has attempted to refine that estimate with more precise methods (for example, stochastic-process modeling) or more recent data.

6) What is the evidence for evidence-based practices?

Many agencies now recommend (and some states and federal grant programs mandate) adoption of prevention and treatment programs that are evidence-based. But the move toward evidence-based practices has one serious limitation: the quality of the evidence base. It is important to ask what qualifies as evidence and who gets to produce it. Many programs are expanded and replicated on the basis of weak evidence. Study design matters. A review by George Mason University Criminologist David Weisburd and colleagues showed that the effect size of offender programs is negatively related to study quality: The more rigorous the study is, the smaller its reported effects.

Who does the evaluation can also make a difference. Texas A&M Epidemiologist Dennis Gorman found that evaluations authored by program developers report much larger effect sizes than those authored by independent researchers. Yet Benjamin Wright and colleagues reported that more than half of the substance-abuse programs targeting criminal-justice programs that were designated as evidence-based on the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Registry of Evidence Based Programs and Practices (NREPP) include the program developer as evaluator. Consequently, we may be spending large sums of money on ineffective programs. Many jurisdictions, secure in their illusory evidence base, could become complacent about searching for alternative programs that really do work.

We need to get better at identifying effective strategies and helping practitioners sort through the evidence. Requiring that publicly funded programs be evaluated and show improved outcomes using strong research designs—experimental designs where feasible, well-designed historicalcontrol strategies where experiments can’t be done, and “intent-to-treat” analyses rather than cherry-picking success by studying program completers only—would cut the number of programs designated as promising or evidence-based by more than 75%. Not only would this relieve taxpayers of the burden of supporting ineffective programs, it would also help researchers identify more promising directions for future intervention research.

The potential for selection biases when studying druginvolved people is substantial and thus makes experimental designs much more valuable. Small is key. It avoids expense, and equally important, it avoids champions with bruised egos. It is difficult to scale back a program once an agency becomes invested in the project. Small pilot evaluations that do show positive outcomes can then be replicated and expanded if the replications show similarly positive results.

7) What treats stimulant abuse?

Science can alleviate social problems not only by guiding policy but also by inventing better tools. The holy grail of such innovations would be a technology that addresses stimulant dependence.

The ubiquitous “treatment works” mantra masks a sharp disparity in technologies available for treating opiates (heroin and oxycodone) as opposed to stimulants (notably cocaine, crack, and meth). A variety of so-called opiate-substitute therapies (OSTs) exist that essentially substitute supervised use of legal, pure, and cheap opiates for unsupervised use of street opiates. Methadone is the first and best-known OST, but there are others. A number of countries even use clinically supplied heroin to substitute for street heroin.

OST stabilizes dependent individuals’ chaotic lives, with positive effects on a wide range of life outcomes, such as increased employment and reduced criminality and rates of overdose. Sometimes stabilization is a first step toward abstinence, but for better and for worse the dominant thinking since the 1980s has been to view substitution therapy as an open-ended therapy, akin to insulin for diabetics. Either way, OST consistently fares very well in evaluations that quantify social benefits produced relative to program costs.

There is no comparable technology for treating stimulant dependence. This is not for lack of trying. The National Institute on Drug Abuse has invested hundreds of millions of dollars in the quest for pharmacotherapies for stimulants. Decades of work have produced many promising advances in basic science, but with comparatively little effect on clinical practice. The gap between opiate and stimulant treatment technologies matters more in the United States and the rest of the Western Hemisphere, where stimulants have a large market, than in the rest of the world, where opiates remain predominant.

There are two reactions to this zero-for-very-many batting average. One is to redouble efforts; after all, Edison tried a lot of filament materials before hitting on carbonized bamboo. The other is to give up on the quest for a chemical that can offset, undo, or modulate stimulants’ effects in the brain and pursue other approaches. For example, immunotherapies are a fundamentally different technology inasmuch as the active introduced agent does not cross the blood-brain barrier. Rather, the antibodies act almost more like interdiction agents, but interdicting the drug molecules between ingestion and their crossing the blood-brain barrier rather than interdicting at the nation’s border.

There is evidence from clinical trials showing that some cognitive-behavioral therapies can reduce stimulant consumption for some individuals. Contingency management also takes a behavioral rather than a chemical approach, essentially incentivizing dependent users to remain abstinent. The stunning finding is that, properly deployed, very small incentives (for example, vouchers for everyday items) can induce much greater behavioral change than can conventional treatment methods alone.

The ability of contingency management to reduce consumption, and the finding that even the heaviest users respond to price increases by consuming less, profoundly challenge conventional thinking about the meaning of addiction. They seem superficially at odds with the clear evidence that addiction is a brain disease with a physiological basis. Brainimaging studies let us see literally how chronic use changes the brain in ways that are not reversed by mere withdrawal of the drugs. So just as light simultaneously displays characteristics of a particle and a wave, so too addiction simultaneously has characteristics of a physiological disease and a behavior over which the person has (at least limited) control.

8) What reduces drug-market violence?

Drug dealers can be very violent. Some use violence to settle disputes about territory or transactions; others use violence to climb the organizational ladder or intimidate witnesses or enforcement officials. Because many dealers have guns or have easy access to them, they also sometimes use these weapons to address conflicts that have nothing to do with drugs. Because the market tends to replace drug dealers who are incarcerated, there is little reason to think that routine drug-law enforcement can reduce violence; the opposite might even be true if greater enforcement pressure makes violence more advantageous to those most willing to use it.

That raises the question of whether drug-law enforcement can be designed specifically to reduce violence. One set of strategies toward this end is known as focused deterrence or pulling-levers policing. These approaches involve lawenforcement officials directly communicating a credible threat to violent individuals or groups, with the goal of reducing the violence level, even if the level of drug dealing or gang activity remains the same. Such interventions aim to tip situations from high-violence to low-violence equilibria by changing the actual and perceived probability of punishment; for example, by making violent drug dealing riskier, in enforcement terms, than less violent drug dealing.

The seminal effort was the Boston gun project Ceasefire, which focused on reducing juvenile homicides in the mid-1990s. Recognizing that many of the homicides stemmed from clashes between juvenile gangs, the strategy focused on telling members of each gang that if anyone in the gang shot someone (usually a member of a rival gang) police and prosecutors would pull every lever legally available against the entire gang, regardless of which individual had pulled the trigger. Instead of receiving praise from colleagues for increasing the group’s prestige, the potential shooter now had to deal with the fact that killing put the entire group at risk. Thus the social power of the gang was enlisted on the side of violence reduction. The results were dramatic: Youth gun homicides in Boston fell from two a month before the intervention to zero while the intervention lasted. Variants of Ceasefire have been implemented across the country, some with impressive results.

An alternative to the Ceasefire group-focused strategy is a focus on specific drug markets where flagrant dealing leads to violence and disorder. Police and prosecutors in High Point, North Carolina, adopted a focused-deterrence approach, which involved strong collaborations with community members. Their model, referred to as the Drug Market Intervention, involved identifying all of the dealers in the targeted market, making undercover buys from them (often on film), arresting the most violent dealers, and not arresting the others. Instead, the latter were invited to a community meeting where they were told that, although cases were made against them, they were going to get another chance as long as they stopped dealing. The flagrant drug market in that neighborhood, as David Kennedy reports, vanished literally overnight and has not reappeared for the subsequent seven years. The program has been replicated in dozens of jurisdictions, and there is a growing evidence base showing that it can reduce crime.

A third approach recognizes the heterogeneity in violence among individual drug dealers. By focusing enforcement on those identified as the most violent, police can create both Darwinian and incentive pressures to reduce the overall violence level. This technique has yet to be systematically evaluated. This seems like an attractive research opportunity if a jurisdiction wants to try out such an approach.

An especially challenging problem is dealing-related violence in Mexico, now claiming more than 1,000 lives per month. It is worth considering whether a Ceasefire-style strategy might start a tipping process toward a less violent market. Such a strategy could exploit two features of the current situation: The Mexican groups make most of their money selling drugs for distribution in the United States, and the United States has much greater drug enforcement capacity than does Mexico. If the Mexican government were to select one of the major organizations and target it for destruction after a transparent process based on relative violence levels, U.S. drug-law enforcement might be able to put the target group out of business by focusing attention on the U.S. distributors that buy their drugs from the target Mexican organization, thereby pressuring them to find an alternative source. If that happened, the target organization would find itself without a market for its product.

If one organization could be destroyed in this fashion, the remaining groups might respond to an announcement that a second selection process was underway by competitively reducing their violence levels, each hoping that one of its rivals would be chosen as the second target. The result might be—with the emphasis on might—a dramatic reduction in bloodshed.

Whatever the technical details of violence-minimizing drug-law enforcement, its conceptual basis is the understanding that in established markets enforcement pressure can have a greater effect on how drugs are sold than on how much is sold. So violence reduction is potentially more feasible than is greatly reducing drug dealing generally.

Drug policy involves contested questions of value as well as of fact; that limits the proper role of science in policymaking. And many of the factual questions are too hard to be solved with the current state of the art: The mechanisms of price and quantity determination in illicit markets, for example, have remained largely impervious to investigation. Conversely, research on drug abuse can provide insight into a variety of scientifically interesting questions about the nature of human motivation and self-regulation, complicated by imperfect information, intoxication, and impairment, and engaging group dynamics and tipping phenomena; not every study needs to be justified in terms of its potential contribution to making better policy. However, good theory is often developed in response to practical challenges, and policymakers need the guidance of scientists. Broadening the current research agenda away from biomedical studies and evaluations of the existing policy repertoire could produce both more interesting science and more successful policies.

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• Published: 28 May 2022

A qualitative study exploring how young people perceive and experience substance use services in British Columbia, Canada

• Roxanne Turuba 1 , 2 ,
• Anurada Amarasekera 1 , 2 ,
• Amanda Madeleine Howard 1 , 2 ,
• Violet Brockmann 1 , 2 ,
• Corinne Tallon 1 , 2 ,
• Sarah Irving 1 , 2 ,
• Steve Mathias 1 , 2 , 3 , 4 , 5 ,
• Joanna Henderson 6 , 7 ,
• Kirsten Marchand 1 , 4 , 5 , 8 &
• Skye Barbic 1 , 2 , 3 , 4 , 5 , 8  

Substance Abuse Treatment, Prevention, and Policy volume  17 , Article number:  43 ( 2022 ) Cite this article

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Substance use among youth (ages 12–24) is troublesome given the increasing risk of harms associated. Even more so, substance use services are largely underutilized among youth, most only accessing support when in crisis. Few studies have explored young people’s help-seeking behaviours to address substance use concerns. To address this gap, this study explored how youth perceive and experience substance use services in British Columbia (BC), Canada.

Participatory action research methods were used by partnering with BC youth (under the age of 30) from across the province who have lived and/or living experience of substance use to co-design the research protocol and materials. An initial focus group and interviews were held with 30 youth (ages 12–24) with lived and/or living experience of substance use, including alcohol, cannabis, and illicit substances. The discussions were audio-recorded, transcribed verbatim, and analyzed thematically using a data-driven approach.

Three main themes were identified and separated by phase of service interaction, starting with: Prevention/Early intervention , where youth described feeling unworthy of support; Service accessibility , where youth encountered many barriers finding relevant substance use services and information; and Service delivery , where youth highlighted the importance of meeting them where they are at, including supporting those who have milder treatment needs and/or do not meet the diagnosis criteria of a substance use disorder.

Conclusions

Our results suggest a clear need to prioritize substance use prevention and early interventions specifically targeting youth and young adults. Youth and peers with lived and/or living experience should be involved in co-designing and co-delivering such programs to ensure their relevance and credibility among youth. The current disease model of care leaves many of the needs of this population unmet, calling for a more integrated youth-centred approach to address the multifarious concerns linked to young people’s substance use and service outcomes and experiences.

Substance use initiation is common during adolescence and young adulthood [ 1 ]. In North America, youth (defined here as aged 12–24) report the highest prevalence of substance use compared to older age groups [ 2 , 3 ], alcohol being the most common (youth 15–19: 57%; youth 20–24: 83%), followed by cannabis (youth 15–19: 19%; youth 20–24: 33%), and illicit substances (youth 15–19: 4%; youth 20–24: 10%) [ 2 ]. High rates of substance use among youth are worrisome given the ample evidence linking early onset to an increased risk of developing a substance use disorder (SUD) and further mental health and psychosocial problems [ 4 , 5 , 6 ]. Youth are also more likely to use more heavily and in riskier ways than adults, making them especially vulnerable to substance use related harms [ 2 , 7 ]. For example, polysubstance use is more common and increasing among youth [ 8 , 9 , 10 ], which has been associated with an increase in youth overdose hospitalizations [ 11 ]. Substance use is also associated with several leading causes of death among youth (e.g., suicide, unintentional injury, violence) [ 12 , 13 ], demonstrating an urgent need to provide effective substance use services to this population.

Current evidence-based recommendations to address substance use issues among youth include a range of comprehensive services, including family-oriented treatments, behavioural therapy, harm reduction services, pharmacological treatments, and long-term recovery services [ 14 , 15 , 16 , 17 ]. Like with adults, these services should be tailored based on young people’s individual needs and circumstances and should consider concurrent mental health disorders which are common among youth who use substances [ 3 , 15 , 18 ]. Merikangas et al. [ 18 ] reported rates of co-occurring mental health disorders as high as 77% among a community sample of youth with a SUD diagnosis. Regardless of precedence, both mental health and SUD can have exacerbating effects on each other if not treated, highlighting the importance of early diagnosis and early access to care [ 19 ]. However, current practices utilizing an integrative approach to diagnose and treat SUD and concurrent mental health disorders have yet to be widely implemented [ 20 , 21 , 22 ]. Further, the current substance use service landscape has been largely designed to treat SUD in adult populations [ 17 ], who often require more intensive treatment compared to youth [ 15 ].

Literature suggests that there are differences between how youth and adults perceive and present substance use issues, suggesting different approaches may be needed to address substance use concerns [ 15 ]. For example, youth have shorter substance use histories and therefore often express fewer negative consequences related to their substance use, which may reduce their perceived need for services [ 15 ]. Further, the normalization of substance use among younger populations and the influence of peers and family members may also play a factor in reducing young people’s ability to recognize problems that arise due to their substance use [ 9 , 23 ]. Confidentiality concerns may also prevent youth from accessing services when needed [ 23 ]. Youth are therefore unlikely to access substance use services before they are in crisis. The 2019 National Survey on Drug Use and Health [ 24 ] reported that only 7.2% of youth ages 12–25 who were identified as needing specialized substance use treatment (defined as substance use treatment received at a hospital (inpatient), rehabilitation facility (inpatient or outpatient), or a mental health centre) accessed appropriate services and that 92% of youth did not feel they needed to access specialized services for substance use. In 2020, the percentage of youth who received specialized treatment dropped to 3.6 and 98% of youth did not perceive the need for it [ 3 ], demonstrating the exacerbating effects the pandemic has had on young people’s service trajectory and experiences.

Although help-seeking behaviours to address mental health concerns among youth have been explored [ 25 , 26 ], few studies have been specifically designed to explore young people’s experiences with substance use services. Existing evidence has largely focused on the experiences of street entrenched youth and youth who specifically use illicit substances (e.g., opioids, heroin, fentanyl) ([ 1 , 27 , 28 , 29 , 30 ], (Marchand K, Fogarty O, Pellat KM, Vig K, Melnychuk J, Katan C, et al: “We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth, Under review)), which remains an important research focus, but may not be representative of those who have milder treatment needs. As such, this qualitative study aims to understand how youth perceive and experience substance use services in British Columbia (BC) more broadly. This study also explored young people’s recommendations to improving current models of care to address substance use concerns.

Study design & setting

This study is part of the Building capacity for early intervention: Increasing access to youth-centered, evidence-based substance use and addictions services in BC and Ontario project, which aims to create youth-informed substance use training for peer support workers and other service providers working within an integrated care model. The project is being led by Foundry Central Office and the Youth Wellness Hubs Ontario (YWHO), two youth integrated health service hubs in BC and Ontario respectively. As part of this project, the BC project team conducted a qualitative research study, entitled The Experience Project , to support the development of substance use training. This paper focuses on this BC study, which follows standards for reporting qualitative research (SRQR) [ 31 ].

In May 2020, we applied participatory action research (PAR) methods [ 32 , 33 ], by partnering with 14 youth (under the age of 30) throughout the course of the project, who had lived and/or living experience of substance use and lived in BC. Youth advisors were recruited through social media and targeted outreach (i.e., advisory councils from Indigenous-led organizations and rural and remote communities) in order to engage a diverse group of young people. A full description of our youth engagement methods has been described elsewhere (Turuba R, Irving S, Turnbull H, Howard AM, Amarasekera A, Brockmann V, et al: Practical considerations for engaging youth with lived and/or living experience of substance use as youth advisors and co-researchers, Under review). British Columbia has a population of approximately 4.6 million people, 88% of which reside within a metropolitan area; only 12% live in rural and remote communities across a vast region of land. Nationally, BC has been disproportionately impacted by the opioid crisis, counting 1782 illicit drug overdose deaths in 2021 alone, 84% of which were due to fentanyl poisoning [ 34 ]. Although more than half of BC’s population reside in the Metro Vancouver area, rates of illicit drug overdose deaths are similar across all health regions [ 34 ].

The youth partners formed a project advisory which co-created and revised the research protocol and materials. The initial focus group questions were informed by Foundry’s Clinician Working Group, based on what Foundry clinicians wanted to know about youth who use substances and how best to support them. The subsequent interview guide was developed based on the focus group learnings and debriefing sessions with the project youth advisory (see Data Collection section below). Three advisory members were also hired as youth research assistants to support further research activities including data collection, transcription, and analysis.

Participants

Participants were defined as youth between the ages of 12–24 who had lived and/or living experience of substance use (including alcohol, cannabis, and/or illicit substance use) in their lifetime and lived in BC. Substance use service experience was not a requirement as we wanted to understand young people’s perception of services and barriers to accessing them. Youth were recruited through Foundry’s social media pages and targeted advertisements. Organizations serving youth across the province were contacted about the study and asked to share recruitment adverts with youth clients. Organizations were identified by our youth advisors and Foundry service teams from across the province in order to recruit a geographically diverse sample of youth. This included mental health services, child and family services, social services, crisis centres, youth shelters, harm reduction services, treatment centres, substance use research partners, community centres, friendship centres, schools, and youth advisories. Interested youth contacted the research coordinator (author RT) to confirm their eligibility. Youth under the age of 16 required consent from a parent or legal guardian and gave their assent in order to participate, while youth ages 16–24 consented on their own behalf. Verbal consent was obtained from participants/legal guardians over the phone or Zoom after being read the consent form, prior to the focus group/interview. A hard copy of their consent form was signed by the research coordinator and sent to the participant/legal guardian for their records.

Data collection

Data collection began in November 2020 until April 2021. An initial semi-structured 2-h focus group with 3 youth (ages 16–24) was facilitated by 2 trained research team members, including a youth research assistant with lived/living experience. A peer support worker was also available for further support. The focus group discussion highlighted youth participants’ multifarious experiences with substance use services and the variety of substances used, which led us to change our data collection methods to individual in-depth interviews. Two interview guides were developed based on the focus group learnings to reflect the different range of service experiences. Interviews questions were reviewed and modified with the project youth advisory. Semi-structured interviews were held with 27 youth participants, which were facilitated by 1–2 members of the research team and lasted 30-min to an hour. In an effort to promote a safe and inclusive space for youth to share their experiences, participants were given the option to request a focus group/interview facilitator who identified as a person of color if preferred. The focus group/interviews began with introductions and the development of a community agreement to ensure youth felt safe to share their experiences. Participants were also sent a demographic survey to fill out prior to the focus group/interview, which was voluntary and not a requirement for participating in the qualitative focus group/interview. Due to the COVID-19 pandemic, the discussions were conducted virtually over Zoom. Participants were provided with a $30 or $50 honoraria for taking part in an interview or focus group, respectively.

Data analysis

The focus group and interviews were audio-recorded, transcribed verbatim, and analyzed thematically using NVivo (version 12) following an inductive approach using Braun and Clarke’s six step method [ 35 ]. The research coordinator led the analysis and debriefed regularly with author KM, who has extensive experience with qualitative health research in substance use [ 36 , 37 ]. The transcripts were read multiple times and initial memos were taken. A data driven approach was used to generate verbatim codes and identify themes. Meetings were also held with the youth research assistants to discuss the data and review and refine the themes to strengthen the credibility and validity of the findings, given their role as facilitators and their lived/living experience with substance use. This included selecting supporting quotes to highlight in the manuscript and conference presentations.

We interviewed a total of 30 youth participants. Socio-demographics, substance use patterns and service experiences are listed in Table  1 . Participants’ median age was 21 and primarily identified as women (55.6%) and white/Caucasian (66.7%). Most youth had used multiple substances in their lifetime and over the past 12-months, with alcohol being the most common, followed by marijuana/cannabis, psychedelics, amphetamines (e.g., MDMA, ecstasy) and other stimulants, non-prescription or illicit opioids, depressants, and inhalants. More than half (55.6%) had some post-secondary education and almost all participants were either in school and/or employed (94.4%). Seventy-five percent of participants had experience accessing substance use services.

Three overarching themes of youths’ substance use service perceptions and experiences were identified (see Fig.  1 ). These themes were specific to the phase of service interaction youth described, given that they were all at different phases of their substance use journeys and had different levels of interaction with substance use services. For example, some youth had never accessed substance use services but described their perceptions of services based on the information available to them, while others described specific service interactions they had. The themes were therefore separated by phase of service interaction, starting with 1. Prevention/Early intervention, where youth describe feeling unworthy of support; 2. Service accessibility, where youth encounter many barriers finding relevant services and information; and 3. Service delivery, where youth highlight the importance of meeting them where they are at.

Overarching themes describing young people’s experiences with substance use services

Prevention/early intervention: youth feel unworthy of support

Many youth described feeling unworthy of health and social services, especially when they did not identify as having a SUD. Young people’s perception of SUD typically revolved around the use of “ harder substances”, which participants defined as heroin, crack cocaine, intravenous drugs, and being in crisis situations, such as being homeless or at risk of an overdose. Youth perceived that most services were geared towards this population and therefore not for them. Many described suffering from “ imposter syndrome ” fearing that they would be taking space away from others who needed it more or judged by services providers for accessing services they did not ‘need’:

“...that idea that you could go get help for your drug use without it – without you being some stereotype of an addict, right?... like there’s different severities of addiction, or you could not have an addiction but also still have some sort of issue related to substance use that should be dealt with. I think my biggest fear as a person with anxiety, through all aspects of accessing health care, is that...I am gonna go to the doctor and they’re going to say ‘Oh my god what an idiot, she doesn’t need to be here, I’m just going to give her something to shut her up’.”

Youth described feeling embarrassed or afraid of how people in the community (including friends, family, and service providers), would react to their substance use, not wanting to disappoint anyone or be stereotyped as an “ addict ”, a “ bad person ” or a “ criminal ”. Alternately, some youth were simply not ready to change their substance use behaviours and assumed this would be expected of them if they reached out for support. As one participant described: “A lot of people are under the idea that if they tell people about their problems, they’re just going to ship them off somewhere, and the only form of recovery is abstinence based, which is not at all helpful and way too intimidating.”

Youth also felt that substance use adverts were often irrelevant to their experiences, and that public health messaging was polarizing and unconvincing:

“I feel like maybe there could be a larger conversation about how drugs are fun, and we should stop – like that’s the thing, if everyone pretends that they’re not and that it’s all bad – that’s why people don’t believe you, they don’t believe what you’re saying, right? Drugs are really fun, that’s why they’re dangerous. That’s why people have addiction problems. They’re really fun until they’re not.”

“I think if they had signs that spoke more to the average college student who is maybe getting black out every weekend or popping zanies...instead I’m hearing about a 40-year old who’s been using hard drugs for like 20 years”.

Further, youth described how marijuana/cannabis and stimulant use were often disregarded, which are commonly used among youth and young adults [ 24 ]. For example, participants described the lack of recognition marijuana/cannabis has as being an addictive substance for some people, which invalidated their experiences. Hence, youth struggled to understand when their substance use “hit a threshold of bad enough to bother public health services” and therefore often only reached out for support when in crisis: “What stopped me from accessing services after this initial attempt was me just second-guessing that I actually had an issue ”.

Youth expressed wanting more information about the neuroscience of addiction, and how to differentiate between substance use, abuse, and disorder to reduce feelings of shame and increase their ability to identify when they should reach out for support. Youth also appreciated learning that substances affect people differently, which validated their experiences : “I learned that it’s very different for everyone....and I was like ‘Oh, I didn’t think there was anybody like me’. So it was this amazing thing, learning that I’m not the only high schooler struggling with this.”

Youth were more likely to reach out to friends for support; however, participants reported that the normalization of substance use among youth meant peers often did not take issues seriously and therefore could not be an effective source of support long-term. This also strengthened participants’ self-doubt about whether their issues warranted support from health and social services, often delaying accessing to care.

Service accessibility: youth encounter many barriers finding substance use services and information “zero to 100”

When youth were ready to access services and information for their substance use, they encountered many barriers. Youth expressed not knowing what services and supports were available, or which services they would benefit from: “It seems like through my searching, it’s either you can get counselling, or you can reach out for people – to health professionals to chat with on a hotline. Or it goes from zero to 100 where you have to get admitted to a rehab treatment program.”

Youth expressed a lack of available information about substance use and services and identified a need to reach those who were not already actively accessing services. This included advertising about different service options in schools, coffee shops, bars, and social media. “I would’ve never went up and asked somebody about it [information about substance use services] or looked it up on the internet. That just wasn’t an interest at all.... I feel like it’s got to be in schools where you can just plain and broad see it in the office or have school counsellors talk about it.” Youth also wanted more information provided in schools about the long-term effects of different substances, harm reduction, and how lifestyle choices and emotional regulation can play a role in substance use behaviours.

Having information more widely available was also identified to “ help break the stigma” by increasing people’s awareness about substance use and available supports. Youth often had to research information independently, which had its own barriers. This included not knowing what to look for or where to start, a lack of information about services listed on service websites, requiring further research through phone calls and emails, and a lack of service options available. As one youth described:

“When I saw people talking about their problems on social media...it just made me realize there’s so much other treatments out there that are just very simple. Like, you can honestly learn breathing techniques...or like cognitive behavioural therapy or all these other things...I guess for people to be able to talk about it – people don’t really see what is cognitive behavioural therapy online, you have to search it up yourself. But for some companies being able to express what it is, express what their services are, it would be able to give an idea to some people.”

When trying to access services, youth described encountering other challenges, including long wait times, challenges getting to appointments (e.g., lack of transportation), limited hours of operation, and a lack of services available, including a lack of affordable services, especially for specialized care (e.g., service providers specializing in substance use, LGBTQ2S+, etc.). A lack of referrals between services was also a barrier to receiving care, placing the responsibility on the youth to reconnect with care, which required them to continuously retell their story. Youth also felt like service providers tended to withhold information about service options based on their level of perceived need, which was often inaccurate, and thus, felt they needed to appear more in crisis to receive more options:

“They [service providers] will withhold certain information from you based on what your need is, because I feel like they try to assess people, and they place them on a sliding scale of like, “Who needs one more?” Which is why I didn’t really like that because … a lot of… supports only became available to me after I had been in the hospital, when I feel like I would’ve benefitted from the support even more, like beforehand.”

Service delivery: importance of meeting youth where they are at

For youth who accessed substance use services, their care experiences varied widely depending on their interactions with their service providers, with some who “ genuinely listened ” and “ took their time to make a connection ”, while others were described as “ uncompassionate ” and ‘ don’t really understand what I’m going through’ . Youth wanted to be “ treated with the same respect and dignity like anyone ” but described being treated like children, as though they were being “ lectured by a parent ” or treated as though incapable of making good decisions for themselves. Youth described “ not being taken seriously” and their issues often “ pushed aside” for not fitting a certain “ stereotype ”. For example, one participant expressed: “I was a really good student, I had a really good home life, and everything was, on the outside, literally perfect. And there was kind of that stigma around “You don’t have any problems, why would you have problems?”.” This strengthened youths’ perceptions that substance use services were not for them and prevented them from accessing further support. As one youth described their experience after an overdose:

“When they had asked me my age and I had told them my age, they were like, ‘Oh my goodness. What are you doing?’ And it was just a random nurse. It wasn’t actually anyone trained, but I just felt like, ‘Wow. Maybe I should go home’. Even though I really needed to be there, it was just hard to not get up and run.”

Youth recognized the importance of crisis-oriented services; however they expressed that “the goal should be preventing crisis rather than just helping people when they get there.” This implied taking youth’s concerns at face value, regardless of how service providers perceived their situation:

“Yeah, I guess assuming that people are asking for help because they really need it, and because... people that are good at holding it together, that have extreme privilege, that look like they’re healthy and making it work, they’re still accessing services for a reason and maybe to include more of a preventative mind frame in their model of care in the sense that, this person may be not be at their worst right now, and that’s actually wonderful that they’re here before that happens, so let’s take this seriously and try to work with them before, you know, they look like they need help.”

Having a service provider who took additional steps to support them, such as providing rides, meeting them in more casual settings, and checking in with them regularly, made youth feel genuinely cared for and increased their likelihood of returning. As one youth described:

“I found that they checked in a lot and it made me feel like they actually cared. You know what I mean? It’s not like just because I’m not there in that moment seeing them... Sometimes, I’d get a text or a phone call being like, “Hey, what are you doing? I haven’t you seen in a while.” You know what I mean? And I had a period of time with the counsellor that I was seeing that I literally ignored her calls for 2 months and [she] was still calling me and leaving voice mails. Even though I wasn’t answering and speaking to her, I still felt like, "Wow, she actually gives a shit. She's still trying to communicate and be there even though I’m not putting the same effort back.”

Being able to connect with someone of similar age, gender, and race/ethnicity generally made it easier for youth to relate to their service provider, however this varied and highlighted the importance of providing youth with options to choose from. Youth described being more comfortable talking to someone who could relate to them and had their own lived experiences. Hearing about similar experiences helped youth feel “ normal ” and validated. This came in the form of peer support, friends, support groups, and online forums such as Reddit and Facebook groups. However, some youth described hesitancy accessing peer support services given that peers may not have received any formal substance use training. Meanwhile, some youth assumed their problems would not compare to the lived experiences of peer support workers, and therefore did not see its value. As one youth described “Hearing [about] other people’s problems...[it] reminds me that other people have gone through wars and made it out of wars, which is like, would be comforting for some people, but for me, makes me feel like [I should] “get over it”.”

Youth desired a holistic approach to care, where all aspects of their life were considered rather than solely focusing on their substance use. As one participant describes: “It wasn’t just substance abuse going on for me, so programs kind of like CBT again, it kind of helps you deal with emotions no matter what way you choose to cope...I think just more effort to get to the root of the problem instead of just trying to stop the symptom.” Focusing on accomplishments rather than abstinence was important, as abstinence was not always young people’s objective for accessing services. Setting more attainable and flexible goals also reduced pressures associated with potential relapses, which were often a source of shame. Having providers who rejected the “ all or nothing approach ” made youth feel more confident and comfortable admitting setbacks.

Addressing mental health concerns was also a priority for most youth, many for whom it had been the primary reason for their service visit. “When I started talking about my mental health as a factor in substance abuse rather than two different things...once I figured out what works for me...and that [mental health] was more stable, everything fell into place after that.” Other factors youth wanted service providers to consider included traumatic experiences, parental substance use, school and work stress, social pressures, and relationship issues. Youth also found it helpful when service providers helped them build recovery capital, including helping them meet their basic needs, recommending school and employment programs, and finding activities and healthy habits. As one youth described “We talked about lots of different ways to cope and things that do not necessarily have anything to do with my substance use, such as eating habits and exercising and study habits when I’m in school. Those really impact me. When those are going well, then it is easier for me to heal from my substance use.”

Youth experience many challenges engaging with existing substance use services in BC as they are currently delivered. Participants in our study described their perceptions towards substance use and their experiences trying to navigate services, and they reflected on multi-level barriers associated with accessing information and support. Throughout these discussions, youth described how the crisis-oriented state of the current health care system leaves many of their needs unmet, calling for a more youth-centred and driven preventative and early intervention approach for diverse youth across BC.

In accordance with the Canadian Drugs and Substances Strategy [ 38 ], all three themes demonstrate a clear need to prioritize substance use prevention and early intervention specifically targeting youth. Youth are in the early phase of substance use, which presents a critical opportunity to reduce potential related harms, including SUDs. However, many existing prevention programs and early interventions have shown limited effectiveness in reducing substance use and associated harms among youth [ 39 ], and very few youths receive evidence-based substance use prevention and education [ 40 , 41 ]. Hanley et al. [ 41 ] reported only 35% of schools in the United States used evidence-based programing, and that only 14% used evidence-based strategies as their primary source of programming. Programs like D.A.R.E. are still being used [ 42 ], which focus on the potential negative consequences associated with substance use to deter young people from using, rather than acknowledging their place in society [ 43 , 44 ]. This approach fails to acknowledge that youth often use substances for enjoyment and social benefits, rather than solely responding to distress [ 44 , 45 ], leading to unconvincing public health messages that fail to resonate with youth.

Following the principles of the Canadian Standards for Community-Based Youth Substance Abuse Prevention [ 46 ], substance use prevention and education should be informed by youth to ensure messaging is relevant to their experiences and is effective in providing youth with the tools needed to make informed decisions about substance use. Moffat et al. [ 47 ] reported that involving youth in prevention efforts helped develop public health recommendations about cannabis that were less ambiguous and stimulated productive conversations among youth about the associated risks. A systematic review on the involvement of youth in substance use prevention efforts also reported that these practices increased youths’ knowledge about substance use and supported the development of prevention interventions that were specifically tailored to the needs of the community [ 48 ].

Youth participants also highlighted the benefits of hearing from peer experiences and advocated for more opportunities for peers to talk in schools. Although there has been increasing evidence supporting the effectiveness of peer-led programs in reducing substance use and associated harms, peers remain largely underutilized in substance use prevention efforts [ 49 , 50 ]. These findings underline the importance of reducing stigma and discrimination against people who use substances, so that peers can be actively engaged in programs design and delivery. However, the findings from this study also indicates that youth may worry about peers invalidating their own experiences through self-disclosure, highlighting the different preferences among youth. This also suggests that the purpose of self-disclosure may need to be better conveyed to youth as a tool to help build common humanity and trust rather than the focus of peer roles.

The study also highlighted that preventative efforts are not only important in school settings but should also be applied in other healthcare settings. As youth from this study explained, services should address the motivations for using substances from a holistic perspective rather than trying to treat substance use alone, requiring an individualized approach. Concurrent mental health disorders, including internalizing (e.g., anxiety, depression) and externalizing disorders (e.g., attention deficit hyperactivity disorder, conduct disorder) are common among youth and are often linked to substance use issues, highlighting the importance of diagnosing and treating substance use and mental health concerns simultaneously [ 22 , 51 ]. However, our results emphasized that the current fragmented state of the healthcare system makes this approach challenging for young people and their families. As many youths access the healthcare system for reasons other than substance use concerns, substance use screening and brief interventions need to occur in a variety of health care settings, accompanied with proper staff training. This approach has been proven to be effective in reducing substance use and violence among youth by screening for substance use in schools, emergency departments, and primary care settings among high-risk youth [ 52 ]. However, this study suggests that substance use screening should be applied more broadly and intentionally integrated as youth may not present external signs of problematic substance use and may not feel comfortable bringing it up unless explicitly asked or in crisis. Providing service providers with training on how to provide culturally safe care to youth who use substances is imperative for this approach to be effective and maintain trusting relationships with youth, given young people’s fears of being stigmatized and judged when accessing services [ 53 , 54 ].

There has been increasing evidence supporting the benefits of an integrated approach to address substance use and mental health concerns among youth, which would facilitate the early identification of possible substance use issues [ 21 ]. Although several barriers can impede the implementation of such services (e.g., organizational-level barriers, distinct health financing systems, and having to train providers in multiple disciplines) [ 54 ], this model of care has been successfully implemented in Australia (Headspace) [ 55 ], Ireland (Jigsaw) [ 56 ], and Canada (Foundry, Youth Wellness Hubs Ontario, ACCESS Open Minds, and YouthCAN Impact) [ 21 , 57 ]. This framework has the potential to increase service provider awareness about the complexities associated with substance use and facilitate the delivery of a wide range of services to support recovery, such as primary care, financial assistance, supportive housing, employment, education, and family support. Given youths’ hesitancy to discuss substance use issues with health care providers, this framework should also integrate peer support services to provide youth with a relatable point of contact to discuss issues without fear of judgment or negative consequences [ 21 ]. Although peer support has been associated with positive treatment outcomes [ 58 ], this study suggests that these services need to be better integrated and conveyed to youth who may benefit.

The service accessibility barriers described by youth in this study reflect the undeniable need to increase the service system’s capacity to provide substance use services. These barriers are consistent with other Canadian studies [ 26 , 59 , 60 ], including a study conducted with youth in urban, rural, and remote Ontario [ 59 ] who described a general lack of substance use services available, low service awareness by youth, and a lack of coordination and collaboration between services. Family members in this study validated these challenges as they described trying to navigate the system for and/or with their young person, which was further substantiated by caregivers trying to navigate youth opioid treatment services in BC (Marchand KM, Turuba R, Katan C, Brasset C, Fogarty O, Tallon C, et al: Becoming our young people’s case managers:Caregivers’ experiences, needs, and ideas for improving opioid use treatments for young people using opioids, Under review). Given the increasing harms associated with the opioid crisis [ 7 ], coordinated efforts across all levels of government and multiple sectors are imperative to improving young people’s access to substance use services and create space, not only for youth in dire need of these services, but for those trying to address substance use concerns proactively.

This study had several limitations. Participants were recruited through Foundry social media channels and targeted advertisements, therefore youth who had access to a phone or a computer and followed mental health and/or substance use organizations were more likely to hear about the study. Consequently, our sample mainly included youth who were actively employed and in school and living in stable living environments. Yet, similar accessibility barriers are described by street-entrenched youth in Ontario [ 27 ] and British Columbia [ 30 ], including long wait times and difficulties seeking support due to stigma, as well as negative experiences with abstinent-based approaches, highlighting young people’s desire for holistic care regardless of substance use patterns. Although we tried to recruit through several health and social services across the province, the COVID-19 pandemic likely limited organizations’ capacity to support with local promotion. Further, we were only able to recruit 1 youth between the ages of 12–15, likely due to our inability to recruit through schools and need for parental consent, which hindered our ability to identify potential differences in substance use service perceptions and experiences between adolescents and young adults. Given the important life transitions that occur between adolescence and young adulthood, future studies exploring these differences are important as different prevention and early intervention approaches may be warranted. Exploring how perceptions and experiences differ across communities could also be an important consideration for future research to better understand how geographic location, including urban and rural differences, impacts young peoples’ access to services. Despite these limitations, the findings of this study have important implications in the way we co-design and deliver substance use services to youth. They also have important considerations for policy makers who are considering how to shape substance use services for diverse youth in their jurisdictions.

This study highlights the many challenges youth experience when engaging with substance use services and emphasizes a need for a more preventative approach. The lack of integration and capacity among service providers to provide substance use services implies that youth who have milder treatment needs and/or do not meet the diagnosis criteria of SUD often do not have access to adequate substance use service interventions. Research, health service, and policy efforts should focus on substance use prevention and early interventions to address young people’s concerns before they are in crisis and increase their ability to perceive the need to reach out for support. Moving forward, it is critical that diverse youth and peers with lived and/or living experience be involved in these efforts, including the co-design of new services and evaluation of impact of prevention and early intervention services, including quality improvement efforts. Intentional, sustained investment in youth substance use services will optimize the health outcomes and experiences of young people across BC, transformation that young people can no longer patiently wait for.

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available due to the potential for identifying participants but are available from the corresponding author on reasonable requests.

Abbreviations

British Columbia

Drug Abuse Resistance Education

3,4-Methylenedioxymethamphetamine

• Participatory action research

Substance use disorder

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Acknowledgements

The Experience Project is grateful to have taken place on the ancestral lands of many different Indigenous Nations and Peoples across what we now call British Columbia. We are also very grateful to the Youth4Youth Advisory Committee who supported the research and the participants who shared their experiences and insights with us.

The Experience Project has been made possible through the financial contributions of Health Canada under their Substance Use and Addiction Program. The views herein do not necessarily represent the views of Health Canada. Author Kirsten Marchand is supported by a Michael Smith Foundation for Health Research/Centre for Health Evaluation & Outcome Sciences Research Trainee award and author Skye Barbic by a Scholar grant funded by the Michael Smith Foundation for Health Research.

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All authors contributed to the conception and design of the Experience Project. Authors RT, AA, AH, VB and CT collected the data and RT, AA, AH, VB and KM contributed to the analysis and interpretation of the data. All authors contributed to the manuscript and approved the submitted version.

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Turuba, R., Amarasekera, A., Howard, A.M. et al. A qualitative study exploring how young people perceive and experience substance use services in British Columbia, Canada. Subst Abuse Treat Prev Policy 17 , 43 (2022). https://doi.org/10.1186/s13011-022-00456-4

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209 Substance Abuse Essay Topic Ideas & Examples

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• Social Media Impact on Drug Abuse Thus, social media platforms definitely contribute to the misuse of various drugs by romanticizing their consumption and making “social drug use” acceptable among users.
• Drug and Alcohol Abuse For along time now, drug and alcohol abuse in the society has been a problem that affects the youth and the society at large. This paper highlights the problems of drug abuse and alcohol drinking […]
• Drug Abuse and Current Generation Drug abuse also breeds an array of behavioral problems among young people, which may affect their suitability to fit in the society.
• Consequences of Drug Abuse The endless stream of drugs, obtainable to the individuals with little or no restrictions, poses a serious inquiry. When assessing the advantages of using pharmaceutical drugs, it is essential to consider the severity of health […]
• Drug Abuse & Its Effects on Families Focusing on the family seems to be by far, the most known and effective way of finding a solution with regards to the “war on drugs” since it more promising to end the vicious cycle […]
• Drug and Substance Abuse Many experts consider addiction as a disease as it affects a specific part of the brain; the limbic system commonly referred to as the pleasure center.
• Teenage Drug Abuse in the United States The problem of teenage drug abuse inflicts a threat to the future society and health state of the overall population in the United States.
• Drug Abuse in Adolescents and Its Causes Scientific research shows that the development factors for adolescent drug abuse are not limited to a set of three to five causes, but are usually linked to the integration of destructive environmental conditions.
• Merton’s Argument of Deviance: The Case of Drug Abuse The most prominent example in support of Merton’s argument in relation to drug abuse is that cultural and social circumstances play a crucial role in defining people’s desire to engage in drug use.
• Drug and Alcohol Abuse Among Young People It is evident among drinkers that, when the BACs are low they develop a feeling of elation and when it rises, a feeling of friendliness begins to develop.
• Underage Drinking and Teen Alcohol Abuse However, due to low legal driving age in America, many teenagers are prone to the risk of driving under the influence of alcohol than in other countries.
• Substance Abuse and Crime Logically, it is still not possible to prove the theories that correspond to criminal behaviour studies and consequently the correctness and relevancy of the theories vary in application depending on the strain of the situation, […]
• The Formative Evaluation: Program of Addressing Drug Abuse in Schools The proposed program sought to educate students about the challenges of drug abuse, its impacts on academic performance, and the best techniques to avoid the vice.
• Why Marilyn Monroe Was Addicted to Substance Abuse In terms of Marilyn Monroe’s problem, addiction to substance abuse is dependent on the number of times the substance involved is consumed during each day, the number of days in a week or month, and […]
• Drug Abuse in Lake County, California The topic of drug abuse is essential for discussion due to the need to develop strategies to prevent and minimize the dangerous consequences of drug abuse in different regions.
• Community Intervention Practices Against Drug Abuse The key features that result in successful community-based intervention on drug abuse are integrated for effectiveness and efficiency. On the other hand, drug abuse refers to the consumption of substances that elicit particular feelings and […]
• Drug Abuse and Prevention Strategies When specialists deal with preventative factors, they pay attention to both mental and physical ways to resist the drug. The symbiosis of these procedures is exceptionally efficient in terms of the drug rehabilitation process when […]
• Drug Abuse in High School and College With respect to social work and the problem of substance abuse, research has been carried out in terms of investigating the relationship between drug abuse and poverty, the effects of drug abuse on the society.
• Substance Abuse in Women Towards the end of the 20th century, most of the studies focusing on substance abuse focused on the needs of men.
• Drug Abuse Among the Youth Essentially, this case study will allow the evaluation of the prevailing cases of drug abuse among the youth. In this regard, the pain and peer pleasure cannot be persevered to allow an explicit cure of […]
• Music Analysis: Drug Abuse in Music So in this song the artist is also lamenting the dangers of drugs and the theme of the music is one that advocates against tackling the problem with issues of drug abuse by arguing the […]
• Substance Abuse. Drinking by Caroline Knapp She starts consuming alcohol in her early teens and became a regular drinker by the age of sixteen. During the misery stage, her thoughts and imaginations were immersed in a bottle of alcohol.
• Impact of Drug Abuse on Adolescent Development Therefore, it is important for counselors to consider these stages to help them address the issue of substance abuse among adolescents. In the habitual stage, most adolescents take drugs to help them modify their moods.
• Reasons Behind Youth’s Engagement to Drug Abuse in the 21st Century Although youths in the 21st century engage in drug abuse due to several factors, it suffices to declare factors such as the rising unemployment status, peer pressure, and their hiked tendency to copy their parents’ […]
• Drug Abuse as a Social Problem This poses as problem to the society because many of the people who are unemployed will resort to different ways of seeking money and pleasure.
• Connection Between Substance Abuse and Personality The behavior of forty people of the former group and forty people of the latter were examined. Researchers report about the changes of behavior and even personality in substance abusers.
• Evaluation of the Empirical Literature on Personality Types and Substance Abuse Hence, to shed light on why certain people are more predisposed to addiction than others, it is necessary to have a solid grasp of the relationship between personality and substance usage.
• Attachment and Substance Abuse: Literature Review The inequality in treatment and hospitalization of individuals with substance use disorders, based on their race and ethnicity, is one of the frequent issues that is regularly reiterated.
• The Effects of Substance Abuse Due to the drastic change in physical, mental, and social health of people with drug misuse problems, illicit drug use must be actively prevented an addressed by offering people with drug misuse issues rehabilitation options […]
• Drug Abuse and Its Psychological Effects The purpose of this paper is to explore in more depth the psychological effects of addiction on the family and inner circle of the addict.
• Drug Abuse, Aggression and Antisocial Behavior The use of abusive drugs can cause anger in people because of the effect they have on the brain. An example of how alcohol can cause aggression in a person is that it impairs an […]
• Policies for Pregnant Women With Drug Abuse Thus, out of all the offered policies, financial support for therapy is the best one, as it motivates prevention and treatment, which, in turn, causes the improvement of this situation.
• Substance Abuse Screening (SBIRT) in New York City In this way, it is possible to observe the rise in the use of substance abuse every year. Drug addiction is a disease that is difficult to treat and leads to the death of the […]
• Drug and Alcohol Abuse Among Teenagers The thesis statement is: “Conviction is a better way to reduce drug and alcohol addiction among teenagers in the United States”.
• Alcohol and Drug Abuse in Canada Therefore, it contributes as a central factor in the essence of the character, and it is crucial to understand the core definition and the elements that foster the ideology.
• Mitigating Drug Abuse in Pine View School The inclusion of professionals in the fields of health care, counseling, and drugs is expected to promote the delivery of desirable results.
• 12 Steps Programs for Substance Abuse Treatment Despite some debates about the effectiveness of 12 steps programs in the long term, the latter can become a decent addition to other therapeutic approaches in creating a safe environment to develop a stable abstention […]
• Drug Abuse and Its Negative Effects This paper aims to highlight what the field of psychology says about the negative effects of drugs and why people continue using despite the consequences. The main effect is that it creates a memory of […]
• Substance Abuse: The Harm Reduction Strategies The primary reason proposed for the continued use of harm reduction approaches is to aid victims dealing with the stress of side effects of substance abuse and gradually motivate them to stop the behavior.
• Statistics of Substance Abuse Among College Students Descriptive statistics were employed in the study to examine the data and spot trends in substance abuse among college students. Descriptive statistics were employed in the study to examine the data and spot trends in […]
• Prevention Programs: Drug Abuse Resistance Education This program focuses on handling peer pressure among youths, a crucial cause of drug abuse in the country. The program is also grounded on sound research, which offers the critical elements vital to handling the […]
• Substance Abuse: Harm Reduction Strategies Secondly, providing Nila with a kit for safer inhalation, including glass stems, screens, chopsticks, and mouthpieces, is recommended to reduce the risks of sharing smoking supplies with her acquaintances.
• Alcohol Abuse: Causes, Symptoms, Prevention, and Treatment Alcohol can additionally be the cause of brain damage manifested in the form of impairments in executive functioning, for example, weakening of visuospatial function and working memory.
• The Impact of Substance Abuse on the Brain This paves the way for the medications to bind to the neurons and begin working. Even though the structure of these medications is similar to that of natural neurotransmitters, they do not stimulate neurons in […]
• Substance Use and Abuse Among Adolescents Illicit substance consumption is a national problem Substance abuse causes violence Substance abuse is a burdens on families Some scholars call for evidence-based practice in prevention and intervention Substance use among family members Lack […]
• Students With Substance Abuse Problems This work is a plan of two important steps: identification of the student using substances and assistance in the process of weaning from substances.
• Substance Abuse and Overdose: Causes and Solutions In addition to the losses of their lives, the damage can also be found in the lack of economic input and loss of productivity due to drugs.
• Substance Abuse and Driving Under Influence The list of felonies consists of possession of substances, possession of ammunition with marijuana and the distribution of substances. This way, a person would be able to enhance their well-being and the state of mental […]
• Drug Abuse Among Homeless Young Adults in New Jersey The reason why young adults in New Jersey get involved in drugs and alcohol after becoming homeless is to manage their situations in an attempt to attain the tentative pleasure of life despite their problems. […]
• Substance Abuse in Teenagers The essay presents the issues and the causes of substance abuse among adolescents. Despite significant legislative and social communication efforts in the field, the prevalence of drug use remained relatively unchanged for the commonly used […]
• Substance Abuse Disorder in Latinos Their research showed, that Latinos are reluctant to undergo SUD treatment, unlike the Whites and Blacks. Personal stigmatization: this is simple, Latinos were afraid, that asking for treatment will prove that they are “losers” or […]
• Substance Abuse: Drug and Alcohol Treatment National Association of Addiction Treatment Providers: Concentrates on ethical interventions Provides integrated treatment approach Offers cognitive-behavioral methods Reinforces the value of family support Recognizes addiction as a complex issue Prohibits discrimination
• Personal Experience of Substance Abuse and Healing Nonetheless, I am proud that this episode of Xanax abuse stays in the past and willing to share my knowledge with the suffering people who are now in the same pernicious situation as I was […]
• Personal Relationship With Substance Abuse I realized during the treatment that my addiction was out of my control, and I never admitted that I have one. Now I admit that a healthy diet and sport is the only right way […]
• Health Education Activity Planner for Patients Vulnerable to Substance Abuse Problems The critical objective of the assessment is to improve the health status and prevent further damage from using drugs in regard to the infections and viruses the group is prone to having.
• Alcohol Abuse and Effective Prevention Technique The original presentation and this extended exploration for it discuss the community structure, the essence of the problem and the theory and practice behind the SBIRT approach.
• Substance Abuse in African American Women In particular, there is a lack of investigations devoted to the substance abuse of African American women. To sum up, there are various premises and outcomes for African American women involved in substance abuse.
• Substance Abuse Impact on Intimate Relationships Moreover, children are reported to suffer in such families, which is especially serious due to the ongoing process of their personality formation.
• Media Influence on Alcohol Abuse Consequently, many people are likely to watch the advert, and the ad can increase consumption of the product and limit the fight against alcohol problems.
• Substance Abuse: The Main Causes First and foremost, when it comes to external influence, the person tends to be a victim of other people’s intentions to start taking substances.
• Drug Abuse Effects on Health and Nervous System These numerous damages severely affect the quality of the brains work and the health of the nervous system. While discussing the effects of drug addiction, it is essential to notice that it has a devastating […]
• Substance Abuse Crisis and Public Policy Response The Comprehensive Addiction Resources Emergency and Excellence in Mental Health and Addiction Treatment Expansion Acts are public health policy responses to the United States’ substance abuse crisis.
• Assistance to Queens Residents With Substance Abuse This information shows that the issue of substance abuse poses a serious threat to the health of residents of Queens county.
• Drug Abuse. “Nine Years Under” Book by Sheri Booker The book is thought provoking and important because it allows representing the difficult social situation and the problems of gang violence and drugs in the United States from the personal point of view.
• Substance Abuse: Prevention Strategies and National Benchmarks Still, this desire to get away from problems by means of substances instead of making effort to improve an individual’s environment contributed to the evolution of the challenge of substance abuse into a real public […]
• White Deer Run and Colonial House: Substance Abuse Treatment Facilities The inpatient care of the facility is characterized by a 90-day program and this is a holistic treatment that requires clients to attend Alcoholics or Narcotics Anonymous meetings daily.
• Alcoholism, Domestic Violence and Drug Abuse Kaur and Ajinkya researched to investigate the “psychological impact of adult alcoholism on spouses and children”. The work of Kaur and Ajinkya, reveals a link between chronic alcoholism and emotional problems on the spouse and […]
• Families Recovery From Substance Abuse The first goal is to help families that are working to recover from substance abuse to develop social support in their efforts to change.
• Co-Occurring Disorders: Description, Examples of Disorders and Substances Abused Therefore, in understanding these illnesses, it is essential first to describe them in-depth and identify examples to assess and relate the issues that arise in treatment.
• Substance Abuse Disorders and PTSD The concept indicates that people who have PTSD are at higher risk of substance abuse and consequently substance disorders due to the tendency to consume alcohol and use drugs to deal with stress.
• Fundamental Determination of Substance Abuse and Addiction and Their Difference Due to the difference in regularity and intensity of drug absorption, substance abuse and addiction can be correctly separated from another so that there is a concrete measure that identifies an abuse and an addiction […]
• The Small Group for Substance Abuse To make more informed recommendations based on the survey conducted among students, it is important to retrieve more data on the number of surveyed students to assess the applicability and feasibility of the results.
• Drugs and Substance Abuse Within the City of Melbourne This team project involves assessing the drug and substance abuse problem in the City of Melbourne as a community that is an important administrative centre of Victoria.
• Monitoring the Future: National Survey Results on Drug Use National survey results on drug use obtained by Monitoring the Future have a significant value to the development of various approaches with regard to the prevention of drug abuse.
• Social Work Related to Alcohol and Substance Abuse The social work of this setting offers services to understand the current point of clients and identify the directions to improve their behaviors.
• Substance Abusers – Opioids The potential for addiction to opioids like heroin and prescription medications for short-term pain relief, such as methadone, is high.
• Moderate Alcohol Abuse as DSM–IV–TR Diagnosis The DSM-IV-TR diagnosis in this case is a moderate alcohol abuse ), which requires a minimum of four symptoms as specified in the DSM.
• The Health Issues Associated With Drug Abuse It is therefore imperative to develop strategies for health promotion to reduce the number of teenagers, the most at-risk family member when it comes to drug abuse.
• Alcohol and Substance Abuse There has been “no definitive treatment strategy for alcohol-related intervention with homeless individuals”. Some of the most successful interventions or programs to help homeless individuals with alcohol and substance abuse include the following: Providing both […]
• Socio-Cultural Determinants of Substance Abuse The term ‘substance abuse’ refers to continued use of drugs which is irresistible to the abuser. It is worth noting that substance abuse has serious implications to the abusers’ lives.
• Fentanyl – Drug Profile and Specific and Drug Abuse The drug has the effect of depressing the respiratory center, constricting the pupils, as well as depressing the cough reflex. The remainder 75% of fentanyl is swallowed and absorbed in G-tract.
• Cases of Drug Abuse Amongst Nursing Professionals It is noteworthy that at the top of the information, the date posted is Monday, February 14, 2011, yet against the information, the date is February 11, 2011.
• Alcohol or Substance Abuse: Diagnostic and Statistical Manual Criteria one deals with tolerance which states that tolerance is a need to consume large amounts of alcohol in order to achieve intoxication, and it is the diminished effect that the substance abuser experiences with […]
• The Treatment of Drug Abuse Any medical practitioner treating a drug abuse patient has to be careful in many aspects, like: He has to be careful on the issue that if the addiction has effected the brain of the patient.
• Alcoholism and Depression: Intervention Strategies The intention of the research paper is to assess if indeed there is an association between alcoholism as manifested by Jackson, and a case of depression.
• The Substance Abuse and Mental Health Services Administration’s Center Substance abuse and mental health services administration has a well-established principle of collaborating with public and private partners so as to provide the most effective services to the needy people within the society.
• Substance Abuse and America’s Prison Population The Juvenile program offers an opportunity for the community to prevent the young people stay away from criminal behavior and efficiently rehabilitate the young wrongdoers.
• Substance Abuse Effects on Society in the USA Excessive usage of these substances leads to one becoming addicted to the substance and therefor has adverse effects on the user and the society at large.
• Alcohol Abuse, Behaviour, and Types of Personalities Personality type is a process that assists in the determination of people’s behavior; it however assists in the classification of people into distinct category types.
• Helping People With Substance Abuse Orlando Recovery Center Drug and Alcohol Rehab The drug and alcohol rehab center contain quality care and health recovery programs tailored to those suffering from substance abuse addictions. Drug Addiction Now aims to provide the […]
• Substance Abuse Impact on Brain Development and Cognitive Functioning The paper aims to examine the reasons why people get addicted to a substance from their psychological and biological perspectives and the effects of substance abuse on the brain, memory, personality, and behavior.
• Drug Courts and Detoxification: Approach to Drug Abuse Treatment However, since 1989, the US federal system has been providing the majority of drug abusers with proper treatment or education with the help of a drug court option.
• Case Management for Substance Abuse Treatment The approach promotes the use of informal helping networks, which is central for case managers, according to the US Department of Health and Human Services.
• Adolescent Substance Abuse, Addiction, and Dependence And while overall statistics show a decrease in the number of unique and persistent cases of substance abuse in Western countries in general and in the US in particular, this problem is still extremely urgent.
• Drug Abuse in Adolescents Aged 15-19 Years Old: A Public Health Menace In addition, the objectives of the paper are as follows: the first aim is to analyze the collected data and produce a review of the information.
• Addressing Drug and Substance Abuse in Melbourne The role of nursing staff in the City of Melbourne will be analysed in relation to the engagement in community outreach and the work on eliminating dangerous consequences for the target population.
• Drug Abuse and Addiction Holimon has succeeded in reviving some of her family relations, and she is still putting a lot of effort to get ahead in this area to the fullest extent possible.
• Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
• Christian Based Outreach Programs Role for the Intervention of Teenage Substance Abuse Counseling is therefore of utmost importance to the addict in view of the challenges that alcohol and drug abuse presents in their lives.
• Sports as a Solution to Youth Substance Abuse: Dr. Collingwood’s View His comments made me realize that it would be unwise by the end of the day for any parent to leave their children under the mercy of the media where they learned that doing drugs […]
• Intervention Techniques Focusing Drug Abuse and Alcoholism A technique of Family Intervention needs the concern, care and supremacy of love to penetrate the denial and start the treatment.
• Depression, Substance Abuse and Suicide in Elderly While significant body of research has been devoted to the study of depression in elderly, little attention has been paid to the investigation of substance abuse, emotional instability, burden feelings, and depression.
• Substance Abuse and Domestic Violence: Comprehensive Discussion Substance abuse refers to the misuse of a drug or any other chemical resulting in its dependence, leading to harmful mental and physical effects to the individual and the wellbeing of the society.
• How Teenagers Can Avoid Becoming Alcohol Abusers Drinking a glass of wine or a can or two of beer during a social event is acceptable and does not impair the physical ability and senses of a person.
• Substance Abuse: Mandated Treatment Setting Once they are admitted into the treatment programs, the doctors need to deal with not only the requirements stated for the patients but have to broaden their area of services and meet the difficult needs […]
• Drug and Alcohol Abuse: A Comprehensive Research Study First, it is necessary to indentify the age groups, most inclined to drug and alcohol addiction, and ascertain the major reasons for it. The research should discuss the problem of addiction from various standpoints therefore […]
• Prescription Drug Abuse Among Teens: Fault of Decision-Making Drug and alcohol abuse is a common problem around the world and teenagers are mainly facing this problem of decision making and behavior.
• Social Work: Women & Power and Substance Abuse The issues of MICA substance abuse are rather significant, and their high rates among women can be explained by the fact the women are afraid of power as understood in the widest sense of the […]
• Substance Abuse: Inpatient Rehabilitation Her parents were alcoholics so that by the time she was fourteen, she already had her first smoke and by the time she got a little older, she was drinking alcohol.
• Critical Issues in Education: Drug Abuse and Alcoholism For this case, the ministry concerned has a very hard task of ensuring there are no critical issues that are left unsolved that relate to education, failure to which will affect the performance of students […]
• Military Substance Abuse Issue Analysis Military substance abuse, therefore, refers to the people working in the department of defense and in one way or the other are overindulging themselves in drug abuse or rather depending on a drug or chemical […]
• Substance Abuse and Community Nursing In the past the failure of properly addressing the problem and scientifically developing and applying the treatment for substance abusers caused many to believe that substance abuse disorders do not respond to any psychological interventions.
• Certification in Substance Abuse Counseling Therefore, the presence of tolerance to alcohol is clear from the interview. In summary, the assessment generated substantial evidence that the client has a problematic pattern of alcohol use leading to clinically significant impairment or […]
• Substance Abuse in Elderly Patients in Rural Areas The problem of substance abuse has been observed in the rural setting among aging adults for a while, mostly due to the lack of a sustainable strategy for prescribing opioid medications and the absence of […]
• Substance Abuse Among Aging Adults in Rural Areas Moreover, the increase in financing of healthcare services for aging rural patients will be needed to introduce medications of greater quality that do not cause as a complex and rapidly developing dependency as first-generation opioids.
• Comorbidity of Substance Abuse and Mental Illness, Associated Complications, and Approaches to Care The authors have found that the highest comorbidity is between S.A.and schizophrenia, and the lowest was in S.A.and depressive illness. Thus, it is viable to conclude that the incidence of mortality is alarmingly higher in […]
• Substance Abuse in Older Adults In conclusion, the problem of substance abuse among older adults involves various triggers such as health issues related to the aging process and lesser access to health care.
• Substance Abuse Among Nurse Practitioners The purpose of this term paper is to analyze the nature of substance abuse among nurses and examine various arguments, principles, and perspectives that different stakeholders can consider to address this ethical issue.
• Substance Abuse: 12-Step Facilitation Program The clients are to be asked to give an example of how people can be powerless and relate to the issue by reflective upon the circumstances that made them feel powerless in the past.
• Substance Abuse Trends in the United States Also notable is that the prevalence of substance abuse in the general population in the U.S.for persons aged 12 years and older was 14.
• Reducing the Alcohol Abuse Among the Youth This paper includes a brief discussion of two possible ways to improve the problem and the justification for the use of one of the options.
• The DARE (Drug Abuse Resistance Education) Program’s Effectiveness While evaluating the effectiveness of the DARE program analysis in accordance with the methodologies and evaluation criteria used, the given assessments refer to various methods of the analysis of participants, as well as various data […]
• Alcohol Abusers and Their Psychological Treatment The aim of these sessions is to resolve the internal conflict within the clients in order to assist in the making of informed decisions by these individuals concerning their behavior.
• Substance Abuse in the US Military System Perhaps the real cause of the tendency of the soldiers to engage in substance abuse and the persistence of the problem is the detachment from military authorities at the end of service.
• Depression and Drug Dependence Treatment and Support She states that her father was the main person who was able to give the right pieces of advice and she was not afraid of making the wrong decision.
• Drug Abuse and Dependence: Insights from Clients and Professionals If either the client or the professional wishes to determine the extent to which an individual is dependent on drugs, the only thing he or she would have to do is read the individual’s behavior.
• Biopsychosocial Experience in Drug Abuse Treatment There has to be a preventive strategy in every intervention procedure to avoid the occurrence of a disease. I find the course of treatment in this intervention beneficial for the creation of the needed preventive […]
• Alcohol & Substance Abuse and Medication Treatment In the case of descriptive research, the research findings and recommendations are expected to be congruent with the researcher’s hypotheses coupled with proving and adding knowledge to the question.
• Understanding Disorders: Biological, Emotional, Cognitive, and Behavioral Perspectives These components are concerned with the various aspects of the body such as genetics and the functioning of the endocrine system.
• Alcohol Abuse, Depression and Human Trafficking Patterson and Jeste point out that the high prevalence of alcohol abuse will increase in the future. Besides, Hanna indicates that domestic trafficking of girls in the US is a complex phenomenon to understand because […]
• Treatments for Alcohol Abuse in the Military It is also notable that the use of illicit drugs and alcohol is not high among military professionals in comparison with the other members of the society. Stress and the nature of the working environment […]
• Primary Diagnosis: Substance Abuse The factors defining the occurrence of drug use disorders include genetic predisposition and increased sensitivity of reward receptors in the brain, as well as the widespread availability of drugs, i.e, frequent prescription of opioid analgesics […]
• Addictive Behavior Programs and Drug Abuse Trends The involvement of stakeholders is an essential condition for the effectiveness of this model of work and its results, and all the roles should be allocated in accordance with the capabilities of the program’s participants.
• Substance Misuse in American Youth: A Socio-Cultural Analysis The paper analyzes studies regarding some of the most widespread types of substances, as well as discusses the role of the rap culture in the growing number of young addicts in the U.S.
• Mental Health Issues and Substance Abuse: Dual Diagnosis The prevention of the development of addictions is achieved through the integration of the client into the community and neutralisation of the stressors that can lead to drug or alcohol misuse.
• Social Behaviour as a Science: Drug Abuse in Youth Thus, the application of social psychology to the phenomenon of youth drug abuse helps to explain how social factors impact the prevalence of and risk for drug abuse.
• Substance Abuse in Fear and Loathing in Las Vegas The protagonists constantly increase the dose of the hallucinogen, which leads to “a quantitative increase in the effects of the experience”.
• Substance Abuser’s Mental Health Risks in 3D Model When it comes to the use of opioids, there are also a number of dangers associated with it, such as engaging in delinquent or violent behaviors, which may be a risk for X, who already […]
• Alcohol Abuse for Military-Connected It should also be pointed out that in the earlier conversation Wilson expressed interest in transferring to a base that would be closer to home and revealed his intention to terminate service in order to […]
• Financial Planning for Drug Abuse Prevention in Virginia Estates Therefore, the first preferred sources for the program are the County Commission and the Alabama Department of Corrections. The program can be financed by the Montgomery County Commission in the short term and Alabama Department […]
• Addressing the Drug Abuse in Parolees and Probationers The aim of the program is to address the drug abuse in parolees and probationers during their probations and decrease the use of drugs in them.
• Substance Abuse: Screening and Assessment Tools CIDI-SAM is a structured and standardized interview, which is used in the assessment of substance use and abuse. Then a set of questions is given to all the respondents and answers analyzed.
• Problem of Drug Abuse in Schools The research worked on the hypothesis that the treatment would reduce or result in the total cessation of drug use, and better relations with family and friends.
• Substance Abuse Advocacy in Des Moines Community According to Lee, Kim, and Kim, the Oklahoma bombing, and the series of criminal activities that preceded the attack were largely attributed to the drug abuse among the youth.
• Youth Drug Abuse Among, Education, and Policies Although drug abuse encompasses improper use of drugs disregarding the prescriptions of medical practitioners, the principal challenges of drug abuse occasion from abuse of drugs such as cocaine, heroin, and marijuana.
• Prescription Drug Abuse in the United States The combination of Ibuprofen and acetaminophen are effective for the patients, who want to reduce and control the level of pain.
• Drug Use Among Parolees and Probationers: A Comprehensive Plan To reduce drug use in probationers and the probability of a new crime, the approach to drug testing needs to be changed.
• Drug Addiction: Stages, Theories, and Psychological Treatment Stress is laid on access to education and the distribution of social wealth. Because social inequality is a common problem, those affected by it are under the risk of becoming drug addicts.
• Substance Abuse Symptoms in the Workplace Generally, substance abuse by employees in a workplace is more likely to be disruptive as it will negatively affect the productivity of the employees.
• Children of Alcoholics and Substance Abusers The presence of an alcoholic or substance abuser is a family that leaves an imprint on the relationships inside and outside of a family, as well as on the child development and the mental health […]
• Substance Abuse Disorders and Their Factors This essay focuses on a brief overview related to substance abuse disorders with a specific reference to the case of Betty Ford.
• Personality Alteration and Substance Abuse The objective of the paper was to assess the empirical research on the current knowledge on possible causes of drinking incentives amongst young adults Later in adolescence and transiting to adulthood, the study identified that […]
• Employees of Substance Abuse Treatment Facility Needs The first step is to understand the unique needs of the targeted population. The tool will also identify the major gaps affecting the wellbeing of different workers.
• Substance Abusers’ Clinical Treatment According to the author of this article, understanding the past, present, and future of substance abuse treatment is quite important to a social worker.
• Economic Tools: The Alcohol Abuse Problem Solving The four elements of an economic way of thinking are the use of assumptions, isolating variables, thinking at the margin, and the response of rational people to incentives.
• Young Adulthood and Substance Abuse The impacts of drug abuse are not felt by the individual youth only; they are also felt at a family and societal level. The earlier the diagnosis and discovery of a drug abuse, the higher […]
• Substance Abuse Treatment With this in mind, it should also be said that some assessment tool should be created for Sampson to be able to determine whether he has any symptoms of depression or not.
• Reasons for Substance Abuse On the same note, young people are likely to copy what other people in society are doing. As a result, the majority of people tend to stick to this behavior, thinking their ways of lives […]
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The 10 Most Common Questions About Addiction

It is estimated that 1 in 10 individuals experience an alcohol or drug addiction at some point in their life.  When other addictions such as gambling addiction, technology addiction, food addiction, or other common forms of addiction are taken into account the statistic of those suffering from an addiction increases substantially.  Although someone you know likely experiences some form of an addiction, addictions continue to be stigmatized and are a seldom discussed topic among family and friends.  Addiction all too often lacks basic understanding and education in our soceity, and common myths continue to circulate.  Below are some of the most common questions and answers about addiction.

What is Addiction?

Addiction occurs when an individual continues to engage in a behavior with difficulty stopping or moderating.  Addiction involves compulsive engagement in the behavior, such as drinking alcohol or gambling.  The compulsive nature of an addiction surfaces as a result of rewarding stimulation in the brain, and a subsequent desire for the brain to crave that stimulation in order to induce pleasure.  Addiction also often involves obsessive psychological preoccupation with getting, using, and recovering from the addictive substance or behavior.

A common cornerstone of addiction is continued engagement in the addictive behavior despite adverse consequences such as career problems, deterioration of relationships, legal issues, financial troubles, or health concerns, among many other negative impacts.  Another common component of addiction involves tolerance, meaning that over time an individual requires more of the substance or behavior in order to produce the same desired pleasurable effects.  Addiction also often involves withdrawal, meaning that when an individual is not engaged in their substance use or behavioral addiction they experience psychological or physiological withdrawal symptoms.  Such symptoms vary from person to person as well as between various forms of addiction.

What is a Substance Use Disorder and What is the Difference Between an Addiction and a Dependence?

In the field of substance use and addiction there are many terms that are commonly used. For example, among addiction therapists and other addiction specialists the term regularly used to classify someone with an addiction to alcohol or drugs is “substance use disorder,” or more specifically may be “alcohol use disorder” if the addiction is to alcohol or “stimulant use disorder” if the addiction is to Adderall, etc.  The term “substance use disorder” was updated from older terms such as “substance abuse” and “substance dependence.

The term used by addiction professionals for gambling addiction is “gambling disorder.”  Other addictions, such as gaming addiction, cryptocurrency addiction, social media addiction and other addictions are not officially recognized as a disorder by the American Psychiatric Association and are currently left out of the Diagnostic Statistical Manual that is used by addiction professionals to render a clinical diagnosis.  This is not to say that such behaviors are not problematic nor that individuals with such addictions are not deserving of treatment, but rather serves as a continued area of research among medical and addiction professionals.

Nonetheless, addictions are widespread and have a far-reaching impact beyond substance use disorder and gambling disorder.  Two terms commonly used to discuss various problematic behaviors are addiction and dependence.  The difference between addiction and dependence can be difficult to understand, and some may even use the words interchangeably.  The term dependence is most notably used to refer to a physical dependence or physical reliance, most notably characterized by tolerance and withdrawal.

The term addiction is usually used to also include a psychological component, such as a mental obsession or preoccupation with a behavior.  An individual can be physically dependent to a substance, such as opiates for example, but may not have breached the mental component of addiction.  Such individuals are able to detox from their substance and not think about it thereafter once the substance is out of their body.

Why Do People Become Addicted?

There is not one reason why an individual becomes addicted, and anyone can become addicted to anything. However, two primary factors that may make someone vulnerable to become addicted are environmental factors and genetic factors.  Environmental variables include a home environment in which there is trauma, abuse, or addictive behaviors occurring; a living environment in which drugs, alcohol or other addictions are readily available and taking place; friends, family members or other peer influences of individuals who are addicted or regularly engage in problematic behaviors; social acceptance of problematic behaviors; or a culture that generally accepts addiction.  Genetic variables include a family history of mental health or addiction.

Aside from genetic and environmental risk factors, there are other variables that may make someone at higher risk of developing an addiction.  Underlying mental health issues such as anxiety or depression certainly can make individuals at higher risk of developing an addiction.  A history of physical, sexual, or emotional abuse or other trauma can also be a risk factor for addiction.  Also, the earlier someone begins to engage in a problematic behavior the more likely they are to develop an addiction to that behavior.

What Is The Worst Addiction?

The term addiction is most commonly used in relation to substance dependence such as alcohol addiction, cocaine addiction, Adderall addiction, and other such drug addictions, but it is also used in regard to behavioral addictions such as gambling addiction, technology addiction, porn addiction, sex addiction, food addiction and other such addictions.  Furthermore, there are subcategories of addictions, so for example types of gambling addiction may involve sports betting, poker, cryptocurrency addiction, or day trading addiction.  A technology addiction may involve social media addiction, internet addiction, phone addiction or gaming addiction.

Addiction comes in many different forms, and there is no “worse” addiction.  Yes, there are more deadly addictions.  For example, an addiction to alcohol or heroin is more deadly and dangerous than an addiction to video games.  However, all addictions can have a substantial negative impact on the individual suffering from the addiction, and impact them and their loved ones in a variety of ways from their mental health to physical health to spiritual health to financial health to relational health and every which way in-between.   Instead of asking what type of addiction is the worst, one should be asking how the addiction is negatively impacting their life and the life of their loved ones.

Can You Get Addicted if You Do It Just Once?

This question is often posed for drug addiction.  While just one use of a substance contributes to chemical changes in the brain, one does not become addicted or dependent after one use.  However, after one use an individual may experience a sense of pleasure that they want to feel again, and the habitual nature of addiction can begin to take effect after continued use.  Some individuals may also be at higher risk of addiction, for example, if they have an underlying mental health issue or if there is a history of addiction in their family.

This question is also often posed with the question, “Is marijuana addictive?”  The answer is yes.  Although marijuana is a natural substance, it does not mean that it is harmless nor does it mean that it is not addictive.  Marijuana can change brain chemistry and take over the pleasure center of the brain in the same way as other drugs, and is especially dangerous for the development of the adolescent and young adult brain.

Another common question in this line of questioning is, “Are prescription drugs safe?”  Before answering this question, it is important to always discuss your medication regiment with your prescribing doctor and to take medication safely as prescribed.  That being said, prescription drugs can be highly addictive, especially Opioids such as Oxycodone or Oxycontin, Benzodiazepines such as Xanax, Klonopin or Ativan, and Amphetamines such as Adderall.

How Do You Know If Someone Is Addicted?

Addiction comes in many different severities, and can be classified as mild, moderate or severe.  An individual may not fit into the box of having an alcohol use disorder or an addiction to alcohol, but they may be a binge drinker or problem drinker.  In other words, they may on occasion be unable to control their alcohol use or their alcohol use may occasionally cause problems in their life.  If alcohol, drugs, gambling, TikTok, gaming or other behaviors are causing a problem in your life or a loved one’s life then it should be enough to recognize that there is a problem that needs to be addressed.

If you answer yes to any of the below questions, your relationship with an addictive substance or addictive behavior is something you should take a closer look at.

• Have you had times when you ended up engaging in your behavior more, or longer, than you intended?
• Have you more than once wanted to cut down or stop your behavior, or tried to, but couldn’t?
• Have you spent a lot of time engaging in your behavior or spent time recovering from the aftereffects of your behavior?
• Have you wanted to engage in your behavior so badly you couldn’t think of anything else?
• Have you found that engaging in your behavior often interfered with taking care of your home or family? Or caused career troubles? Or Financial Problems?
• Have you continued to engage in your behavior even though it was causing trouble with your family or friends?
• Have you given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to engage in your behavior?
• Have you continued to engage in your behavior even though it was making you feel depressed or anxious or adding to another health problem?
• Have you had to engage in your behavior much more than you once did to get the effect you want? Have you increased the frequency, duration or quantity of use or engagement in the behavior?
• Have you found that when you stopped engaging in your behavior for hours or days you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, irritability, agitation, depression, sweating, or other unwanted psychological or physiological symptoms?

Can Addiction Lead to Mental Health Disorders?

Yes.  Addiction can lead to a variety of mental health concerns including depression and anxiety as well as other psychological problems.  In some instances, such as with alcohol or drugs, mental health issues can be induced while under the influence of the substance or in other cases the mental health issues may continue to persist long-term.

Mental health issues can also serve as an underlying issue that existed prior to the addiction, and therefore can sometimes be a “chicken or the egg” scenario in which one is not certain if the mental health issue contributed to the addiction or if the addiction contributed to the mental health issue.  In both cases it is important that the addiction and the mental health concerns are both addressed in treatment.  

Is Addiction Treatable?

There is no cure for addiction, but addictions are treatable.  In other words, an addiction can go into remission when an individual has abstained from their addictive behavior for some time, but there can be a recurrence. Individuals with a history of addiction will always be vulnerable to relapse, and unfortunately relapse rates for addictive disorders are quite high.  Depending on the type of addiction, the severity of the addiction, and the history of the individual’s relationship with their addiction there are moderation management approaches, and many individuals are able to live a thriving life while moderating their addictive behavior.  In other cases, and more widely accepted by the addiction recovery community and addiction specialists, are abstinence-based approaches to recovery involving complete abstinence from the addictive behavior.

Addictions are treated in various settings such as medical detox clinics, inpatient rehabilitation centers, and outpatient rehabilitation centers.  Some individuals choose to work privately with an addiction therapist, addiction psychiatrist, or addiction recovery coach (sober coach).  Common methods of treatment involve various behavioral therapeutic approaches such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Motivational Interviewing (MI), or Rational Emotive Behavior Therapy (REBT), among many other forms of therapy.  Medication can also play an important role in recovery in curbing withdrawal symptoms, curbing cravings, and addressing underlying mental health concerns.  There are also mutual help groups available such as Alcoholics Anonymous, SMART Recovery, Refuge Recovery, Gamblers Anonymous and many other twelve-step programs that are specific to the addiction.

What Do I Do If My Loved One Is Addicted?

Addictions are chronic, progressive and can be fatal, so it is always recommended that individuals encourage their loved ones to get help for their addiction if they are unable to stop on their own.  If your loved one is in denial about their addiction or if they are unwilling to get help, then an intervention may be needed.  There are different forms of intervention, but most commonly involve gathering loved ones to help encourage the addicted individual to seek out some form of help for their addiction.  During the intervention process loved ones may be expected to express their love and concern for the individual and set boundaries that they are going to hold with the addicted individual should that individual choose not to get help.  Lastly, it is also important for loved ones to seek out their own source of support regardless of if the addicted individual seeks out help or not.  Such forms of help for loved ones can be with a family therapist who specializes in addiction, family therapy, or mutual help groups such as Al-Anon, Gam-Anon, or SMART Recovery Family & Friends.

To learn more about the impact of addiction on loved ones, please read “ The Impact of Alcoholism and Addiction on Family, and How to Protect Yourself .”

How Can I Support Someone with an Addiction?

It is not your job to get a person sober or to get them to stop destroying their life via their addictive behavior; your job is to take care of yourself.  If your loved one is ready and willing to receive help or is in recovery, you can serve as a great source of strength and support.  Some healthy behaviors you can implement are to actively listen, express empathy, set healthy boundaries, reduce environmental triggers, encourage healthy habits, role-model healthy behaviors, and educate yourself about addiction.  For more information on supporting someone struggling with addiction, please read “ 10 Tips For How To Support Someone In Recovery From Addiction .”

For more information on New York City addiction treatment and to find the best addiction counselor in NYC, or for general therapy and mental health counseling, or to inquire about Family Addiction Specialist’s private concierge sober coach Manhattan, recovery coach Manhattan, sober companion Manhattan, Manhattan addiction therapy services and/or our Manhattan teletherapy services (online therapy/virtual therapy) for drug addiction, alcohol addiction, gambling addiction, or digital addiction and technology addiction, as well as our Manhattan hypnosis services in New York City please contact our undisclosed therapy office location in the Upper East Side of NYC today at (929) 220-2912.

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Co-occurring substance abuse and mental health problems among homeless persons: Suggestions for research and practice

Douglas l. polcin.

a Alcohol Research Group , Public Health Institute , USA

Communities throughout the U.S. are struggling to find solutions for serious and persistent homelessness. Alcohol and drug problems can be causes and consequences of homelessness, as well as co-occurring problems that complicate efforts to succeed in finding stable housing. Two prominent service models exist, one known as “Housing First” takes a harm reduction approach and the other known as the “linear” model typically supports a goal of abstinence from alcohol and drugs. Despite their popularity, the research supporting these models suffers from methodological problems and inconsistent findings. One purpose of this paper is to describe systematic reviews of the homelessness services literature, which illustrate weaknesses in research designs and inconsistent conclusions about the effectiveness of current models. Problems among some of the seminal studies on homelessness include poorly defined inclusion and exclusion criteria, inadequate measures of alcohol and drug use, unspecified or poorly implemented comparison conditions, and lack of procedures documenting adherence to service models. Several recent papers have suggested broader based approaches for homeless services that integrate alternatives and respond better to consumer needs. Practical considerations for implementing a broader system of services are described and peer-managed recovery homes are presented as examples of services that address some of the gaps in current approaches. Three issues are identified that need more attention from researchers: (1) improving upon the methodological limitations in current studies, (2) assessing the impact of broader based, integrated services on outcome, and (3) assessing approaches to the service needs of homeless persons involved in the criminal justice system.

Homelessness in the U.S. has been a significant problem for decades and communities have struggled to find solutions. On any given night in 2013, over 600,000 persons in the U.S. were homeless ( National Alliance to End Homelessness, 2014 ). The public health implications of homelessness are significant and include syndemic interactions that exacerbate substance abuse, health problems, HIV risk, and mental health symptoms ( Fitzpatrick-Lewis et al ., 2011 ; Kertesz, Crouch, Milby, Cusimano, & Schumacher, 2009 ; Larimer et al ., 2009 ). Mortality rates among homeless persons are more than three times that of persons with some type of housing ( O'Connell, 2005 ).

Homelessness is associated with increased risk to be involved in the criminal justice system. A variety of papers document high rates of homelessness for offenders leaving state prisons ( Petersilia, 2003 ) and local jails ( Freudenberg, Daniels, Crum, Perkins, & Richie, 2005 ; Petteruti & Walsh, 2008 ). Once they are homeless, these individuals are at increased risk to reengage in illegal activities that result in re-incarceration ( Greenberg & Rosenheck, 2008 ). Lack of stable housing also leaves individuals vulnerable to being victims of crime such as physical and sexual assault ( Gaetz, 2006 ).

There have been increases in funding for homeless services in recent years and it appears to be having a beneficial effect ( National Alliance to End Homelessness, 2014 ). Between 2012 and 2013, overall homelessness in the U.S. decreased by 3.7%, although there was significant variation among individual states. Funding has increased for a variety of housing programs, including emergency shelters, permanent housing, and specialized Veteran's Administration programs. As funding increases, service providers, researchers, and local governments debate about what types of services to increase.

Although studies vary, research consistently shows over a third of individuals who are homeless experience alcohol and drug problems (e.g., Gillis, Dickerson, & Hanson, 2010 ) and up to two-thirds have a lifetime history of an alcohol or drug disorder ( Robertson, Zlotnick, & Westerfelt, 1997 ). The relationship between homelessness and substance abuse is complex, with studies suggesting that substance use can be both a cause and consequence of homelessness ( National Coalition for the Homeless, 2009 ). Until recently, few services addressed the needs of substance abusing homeless persons who were not motivated to address their substance use. In addition, even when homeless individuals were motivated to address substance abuse problems, access to the variety of services needed were lacking. Notably lacking has been successful integration of substance abuse treatment, permanent stable housing, and related services such as mental health.

This paper begins with a brief description of two approaches addressing co-occurring substance abuse and homelessness, Housing First and linear. Next, we highlight how reviews of the homeless services literature have reached mixed and inconsistent conclusions about the effects of services for this population and we point out a variety of methodological weaknesses that limit the confidence of research findings. The paper then describes several recent papers calling for broader based, flexible, and integrated service delivery to homeless persons (e.g., Corporation for Supportive Housing & National Council for Behavioral Health, 2014 ; Paquette & Winn, 2015 ). We add to this literature by suggesting that peer-managed alcohol and drug recovery homes could play a greater role in the mix of services offered to homeless persons, particularly those who are motivated to pursue abstinence and have some period of stability in the community. Practical considerations for improved service integration are presented along with suggestions for research that can strengthen the empirical base for integrated, broader based services.

Models for assisting homeless individuals with substance abuse

Two prominent models have emerged in response to the need for housing for persons with co-occurring substance abuse and unstable housing: linear and Housing First. The linear approach ( Kertesz et al ., 2009 ; Ridgway & Zipple, 1990 ) emphasizes abstinence from substances as an explicit goal. Substance abuse treatment is an integral first step to eventually obtaining permanent stable housing. Thus, stable housing is an end goal. In contrast, Housing First takes the view that provision of subsidized and in some cases free housing should occur first ( Tsemberis, Gulcur, & Nakae, 2004 ). While case management services are sometimes offered to residents, Housing First emphasizes a “low threshold” with personal choice about whether to address substance abuse and mental health problems. Housing First programs provide permanent housing largely without conditions, either in decentralized apartments or larger, congregant facilities. The accepting tone of this approach may be particularly helpful to persons who are chronically homeless (longer than one year) and persons with chronic psychiatric conditions such as schizophrenia ( Padgett, Gulcur, & Tsemberis, 2006 ). In addition, the Housing First approach serves as an alternative to formal treatment for persons who have had negative experiences.

Research on Housing First

A variety of studies support both Housing First and linear models. Kertesz et al . (2009) reviewed outcomes for both models and concluded they evidenced different strengths. When individuals with mental health and substance abuse problems enter Housing First programs and are provided subsidized or free housing without requirements, such as completing treatment or abstinence from drugs, retention is excellent (e.g., Collins, Malone, & Clifasefi, 2013 ; Tsemberis et al ., 2004 ). However, findings for other outcomes are mixed or not well studied, particularly substance abuse problems. For example, some studies reporting favorable outcomes (e.g., Padgett et al ., 2006 ; Padgett, Stanhope, Henwood, & Stefancic, 2011 ) did not assess important measures of drinking, such as days of heavy drinking and drinking-related problems. The definition of heavy drugs in these studies was a very low threshold: any drug use four or more times over a six-month assessment period. In the Home Chez Soi study of Housing First in Canada, Kirst, Zerger, Misir, Hwang, and Stergiopoulos (2015) used two individual items from the Addiction Severity Index (ASI) Alcohol Scale to assess alcohol outcome rather than the ASI scaled scores. No rationale was provided. Another example of questionable measures among Housing First studies was the use of a dichotomous measure of treatment attendance to assess the effect of treatment on outcome. Attendance was defined as any treatment during the last month (even a single session) versus no treatment (e.g., Collins, Malone, & Larimer, 2012 ).

There have also been concerns about inclusion and exclusion criteria. Some studies did not specify substance abuse inclusion criteria that would ensure substance abuse problems existed among the residents at the time they entered the study (e.g., Tsemberis et al ., 2004 ). In this scenario, no differences in substance abuse outcomes between study conditions might be the result of limited room for improvement among individuals in both groups rather than equivalent effectiveness of interventions. A different type of problem is the use of a single group design of participants who entered Housing First with high rates of alcohol problems. Here, the improvements noted over time could be due to regression to the mean or ceiling effects (e.g., Collins, Malone, Clifasefi, et al. , 2012 ). Finally, Kertesz et al . (2009) questioned the appropriateness of some of the “usual care” comparison conditions, many of which were unspecified aggregate conditions, limited by underfunding, and lacking evidence-based interventions. In recent analyses of data from the Home Chez Soi study (e.g., Kirst et al ., 2015 ; Stergiopoulos et al ., 2015 ), there was very little information about the treatment as usual (TAU) condition, including services received or offered. Especially important, there is nothing about the availability of housing for the TAU group. We do know the Housing First condition received subsidized and in some cases free housing. The potential effects of offering subsidized housing as part of the TAU condition were unknown.

Research on linear approaches

While formal substance abuse treatment programs that are part of the linear approach to homelessness have been studied for many years and have demonstrated consistent albeit moderate effectiveness (National Institute on Drug Abuse, 2012), there have been serious problems with retention. A majority of persons in formal treatment programs do not complete treatment ( Ball, Caroll, Canning-Ball, & Rounsaville, 2006 ; Palmer, Murphy, Piselli, & Ball, 2009 ). Tsemberis et al . (2004) suggested many homeless individuals, particularly those with significant mental health disorders, are unwilling or unable to comply with linear model requirements such as engaging in treatment and maintaining abstinence from drugs and alcohol. Relative to Housing First, most studies have shown the linear models yield significantly lower retention rates ( Kertesz et al ., 2009 ).

An area of strength in linear housing models is they have been shown to have favorable substance abuse outcomes. For example, using a state-of-the-art, abstinent contingent housing and treatment approach known as the Birmingham model, Milby, Schumacher, Wallace, Freedman, and Vuchinich (2005) showed that abstinent contingent housing had better cocaine outcomes than non-abstinent contingent housing. The review of homeless studies by Hwang, Tolomiczenko, Kouyoumdjian, and Garner (2005) concluded that a variety of substance abuse and mental health interventions can help homeless individuals, but specific types of interventions do not show superior efficacy. However, a serious problem for linear programs is they often lack stable, permanent housing options for individuals who complete treatment even though the model calls for provision of permanent housing as part of the continuum or care. Even when individuals in linear service models achieve abstinence, they are vulnerable to relapse and reoccurrence of homelessness if they are not able to find permanent housing ( Kertesz et al ., 2009 ).

Systematic reviews of homeless services studies

Systematic reviews of the homeless services literature have reached inconsistent conclusions. For example, Rog et al . (2014) assessed studies of permanent supportive housing for homeless persons with mental illness and substance abuse and concluded permanent supportive housing was associated with reduced homelessness, increased housing tenure, and deceased hospitalizations. Compared to other housing models (e.g., those requiring abstinence or engagement in treatment), consumer satisfaction among residents in permanent supportive housing was higher. However, Hwang et al . (2005) concluded that studies assessing the independent effect of subsidized housing alone on substance abuse, physical health, and mental health were inconsistent. Their conclusions suggested that provision of case management to homeless persons with substance abuse problems was important regardless of whether supportive housing was provided. A good example of combined Housing First and intensive case management or Assertive Community Treatment is the Home Chez Soi study in Canada ( Kirst et al ., 2015 ; Polvere, Macnaughton, & Piat, 2013 ; Stergiopoulos et al ., 2015 ). Fitzpatrick-Lewis et al . (2011) reviewed 84 studies on the effectiveness of housing services for homeless people with substance abuse issues or other concurrent disorders (e.g., mental illness). They indicated provision of housing was associated with increased housing tenure and decreased substance use, relapse, and health services utilization. However, they also concluded that abstinent dependent housing was more effective in achieving abstinence than non-abstinence dependent housing or no housing.

Permanent housing services, such as Housing First, have been identified as “best practices” by the Substance Abuse and Mental Health Service Administration, the U.S. Department of Housing & Urban Development, and the U.S. Conference of Mayors ( Corporation for Supportive Housing & National Council for Behavioral Health, 2014 ; Kertesz et al ., 2009 ). Although Housing First has enjoyed widespread popularity, a recent review by Waegemakers Schiff and Schiff (2014) concluded political support was more the basis for popularity than scientific evidence that met best practices criteria. Of particular note is the fact that 11 of the 18 studies reviewed used data from one site in New York City (Pathways to Housing). In addition, many studies had inadequate procedures for selecting appropriate participants and lacked measures to assess services delivered. The authors concluded there were favorable results for Housing First studies overall, but methodological problems resulted in weak reliability and generalizability.

Considerations for research

Taken together, systematic reviews show some degree of support for Housing First and linear approaches, but they also clearly illustrate the need for more research before we can make definitive conclusions. There is a need for research procedures and measures that are more rigorous. For example, confidence in research findings would be improved with more consistent use of standardized assessment instruments to assess substance use, mental health problems, and services received. In particular, inspection of clinical records to determine current or past substance use and mental health disorders, which has been used in some of these studies, is methodologically weak. When the term dual diagnosis is used, we need to be clear about disorders that were included and excluded as well as their severity.

There is also a need for studies to better clarify intervention and comparison conditions. When a term such as “usual care” is used it needs to be specified. What services are included in usual care? How accessible are the services? What services do participants actually receive? For example, Kertesz et al . (2009) noted that linear models of care are designed to provide permanent housing arrangements after individuals comply with treatment and abstinence requirements. However, treatment providers do not typically control housing subsidies and therefore treatment does not always lead to housing, even when the treatment is effective. Rog et al . (2014) addressed the lack of clarity about services received in terms of fidelity. Although they focused primarily on inadequate fidelity for assessing adherence to permanent housing models, fidelity problems are arguably worse in terms of measuring fidelity to comparison conditions.

Although most of the literature reviews on homeless services call for more studies using randomized designs, there are potential downsides to this approach. In a paper on residential recovery homes for persons with alcohol and drug disorders, Polcin (in press) pointed out that randomization eliminates self-determination of services received. The process of selecting a recovery home and being offered admission by a program sets the stage for subsequent recovery experiences. Because consumer choice and empowerment about receipt of housing and other services is central to the Housing First model there are concerns about generalization of results when using randomized designs. In addition, the sample of persons who are willing to be randomized to where they live for months or even years may be different from self-selected samples one individuals choosing to enter housing conditions.

An alternative to randomized designs is to use pre–post naturalistic designs where outcomes between groups of individuals receiving different service models are compared over time. Although naturalistic designs cannot be used to show causality, they have the advantage of mirroring real world conditions and that increases generalization of study findings. In addition, there are ways to strengthen these designs to increase confidence about their effects. Examples include the use of multivariate models that parse out the relative effects of influential variables that can confound intervention effects, matching designs that compare outcomes for similar individuals in intervention and comparison conditions, and propensity score matching, which controls for covariates that predict receiving an intervention versus not receiving it ( Polcin, in press ).

A final issue that needs more attention is how community stakeholders experience homeless services. If housing models are to expand and meet the current need for housing among the homeless, there will need to be significant political and popular support. Not in my back yard (NIMBY) has been the term used to describe opposition to housing and other services in community settings. Lee, Tyler, and Wright (2010) noted that federal initiatives to address homelessness have been offset to some extent at the local level by NIMBY resistance to housing services in suburban areas and by the enactment of “quality of life” ordinances that criminalize homeless people's basic survival behaviors. However, relatively few papers addressing homeless services have addressed strategies to overcome NIMBY resistances. For example, where possible, it would be helpful to document community support for homeless services as well as understand resistances in more detail. Studies of stakeholder views about abstinence-based recovery homes for persons with substance use disorders have shown strong neighborhood support as well as support from local government (e.g., Jason, Roberts, & Olson, 2005 ; Polcin, Henderson, Trocki, Evans, & Wittman, 2012 ). Resistances to recovery homes tended to come from persons unfamiliar with them. Among a number of strategies suggested was more interaction between recovery home residents and stakeholder groups. However, it is unclear to what extent these findings and suggestions can generalize to homeless services, particularly centralized Housing First programs where service providers view substance use as a personal choice. Among neighbors of recovery houses there was strong support for the requirement that residents remain abstinent from drugs and alcohol ( Polcin et al ., 2012 ).

Integrated service delivery

Gillis et al. (2010) suggested there is enormous heterogeneity among homeless persons' needs and preferences. For example, Polvere et al . (2013) found most persons enrolled the Housing First condition in the Home Chez Soi study had positive experience, but a subgroup felt socially isolated in the decentralized apartments. Homeless persons also vary by needs, which can range from mild to severe mental health, medical, and substance abuse problems. They also can vary in terms of risk for HIV infection and involvement in the criminal justice system. Moreover, there is heterogeneity in the level of motivation to address these problems. Some homeless persons recognize their problems and are receptive to services that might be helpful. Others are unaware or want to deal with problems on their own.

The heterogeneous characteristics of homeless persons support the use of a flexible, multidimensional approach to service delivery rather than one focusing on a single model ( Corporation for Supportive Housing & National Council for Behavioral Health, 2014 ; Paquette & Winn, 2015 ). For example, for homeless persons with co-occurring substance abuse who have no desire to quit using substances and no criminal justice mandate requiring treatment Housing First might be the best approach. There may be few other options for them. Because these individuals frequently present service needs for substance abuse, mental health, and other problems, Housing First approaches that provide on-site case management that can connect them with the types of services they need is important (e.g., Stergiopoulos et al ., 2015 ).

Homeless individuals who are motivated to address their substance abuse issues should typically be referred to a treatment program because research shows treatment is effective for many individuals, including those who are homeless ( Hwang et al ., 2005 ; National Institute on Drug Abuse, 2012). However, seriously lacking in many linear approaches is the permanent housing service after completion of treatment. As Kertesz et al . (2009) noted, treatment providers do not typically control housing subsidies and therefore treatment does not always lead to housing, even when the treatment is effective. Therefore, an issue that providers should consider when determining referrals for homeless persons with substance abuse problems is the availability of permanent housing after treatment is completed.

Although there is currently widespread support for resident centered approaches that emphasize consumer readiness and choice (e.g., Tsemberis et al ., 2004 ), we need to recognize that some homeless persons are mandated to receive treatment by the criminal justice system. Typically, criminal justice systems require abstinence among offenders with alcohol or drug problems and therefore refer these individuals to abstinence-based treatment programs. For them, motivation is often based on a desire to avoid incarceration rather than to address alcohol or drug use. This does not necessarily bode poorly for treatment outcome. Among the larger population of substance abusers, those coerced into treatment through the criminal justice system have fared as well as those entering voluntarily (National Institute on Drug Abuse, 2012).

Despite their criminal justice status, persons coerced into treatment or abstinent contingent housing through the criminal justice system have some degree of choice. First, they can opt for criminal justice sanctions rather than enter treatment. Second, they often have choices about programs to which they can apply. Finally, the programs are typically not obligated to accept individuals, which results in some degree of mutual selection. The limitation of Housing First for these individuals is that the criminal justice system typically mandates abstinence, which is inconsistent with the Housing First approach.

Korcha and Polcin (2012) pointed out there is a need for more research targeting outcomes for the growing numbers of individuals being released from incarceration, particularly in California where large numbers of ex-offenders are reentering communities. They suggested that peer-managed recovery homes, which are described in detail below, may be good options for many of these individuals. Because they do not mandate abstinence, Housing First services typically receive fewer referrals from the criminal justice system. Although few studies have addressed Housing First approaches for criminal justice offenders, one study did assess outcomes for Housing First residents with a history of misdemeanor crimes. Individuals in the sample apparently did not have a criminal justice mandate requiring services (i.e., Clifasefi, Malone, & Collins, 2013 ). Consistent with a variety of studies in the substance abuse field, the single group design showed that longer retention in the program resulted in better criminal justice outcomes. It would be interesting to assess outcomes of criminal justice referrals to Housing First without a mandate for abstinence, if a criminal justice jurisdiction would be willing to agree to such a condition.

Residential recovery homes for homeless persons

Overlooked in most of the current debates about services for homeless persons with co-occurring substance abuse is the potential role of residential recovery homes. These facilities serve a variety of persons with substance abuse disorders and represent a range of settings, some of which are unstructured and peer managed and others that are managed by professionals who provide on-site services ( National Association of Recovery Services, 2012 ). Most recovery homes emphasize a “social model” philosophy of recovery that emphasizes peer support for abstinence and involvement in 12-step recovery programs ( Polcin, Mericle, Howell, Sheridan, & Christensen, 2014 ). However, Mericle, Miles, Cacciola, and Howell (2014) noted that some recovery homes in Philadelphia included a variety of on-site services (e.g., counseling and medical care) in addition to peer support. Recent papers specifically targeting housing for the homeless (e.g., Corporation for Supportive Housing & National Council for Behavioral Health, 2014 ; Paquette & Winn, 2015 ) have supported an enhanced role for recovery residences. However, they are not appropriate for all homeless persons. Particularly contraindicated are individuals who do not wish to abstain from substances and those with severe and persistent mental illness. Nevertheless, Paquette and Winn (2015) suggested that including recovery homes in the mix of potential housing services is a positive response to calls for increased consumer choice in selection of services.

Recovery homes that offer a relatively higher degree of structure and on-site services, such as some of the houses described by Mericle et al . (2014) in Philadelphia, can be entry points for some persons into homeless service systems, particularly those who are motivated to live in an alcohol- and drug-free environment. However, one of the pitfalls of some of these facilities is that they offer time-limited lengths of stay and lack provision of permanent housing once residents reach the maximum length of time in the residence.

Peer-managed recovery homes

Expansion of two types of peer-managed recovery homes could help address the need for permanent sober housing: California Sober Living Houses (SLHs) ( Polcin, 2009 ; Polcin & Henderson, 2008 ) and Oxford Houses ( Jason, Olson, & Foli, 2008 ). Peer-managed recovery homes are resources for persons who have established some stability in the community and who are motivated to maintain an abstinence-based lifestyle. The individuals who enter these homes are typically not chronically homeless (longer than one year) or persons with chronic and severe mental illness (e.g., schizophrenia and other persistent psychotic disorders). The reason for this is that peer-managed homes require a level of autonomy and stability that is not often characteristic of individuals who are chronically homeless or suffering from severe mental illness. However, this does not mean that housing and psychiatric problems are not prevalent issues. In studies of SLHs, only 36% of the entering residents indicate they have stable housing at the time they enter ( Polcin, Korcha, Bond, & Galloway, 2010a ; Polcin, Korcha, Bond, & Galloway, 2010b ). In one study of an urban SLH program over a third (35%) indicated homeless or shelter was their typical living situation the past six months ( Polcin et al ., 2010a ). In a different sober living program, a majority (52%) indicated they were marginally or temporarily housed, examples of which included staying with friends or leaving incarceration with no stable place to stay ( Polcin et al ., 2010b ). Majer, Jason, Ferrari, and North (2002 ) studied Oxford Houses in St. Louis and reported that half had a history of homelessness. Similarly, psychiatric symptoms are issues in peer-managed recovery homes even though there were few persons with chronic, severe disorders such as schizophrenia. For example, Polcin, Korcha, and Bond (2015) found the average level of psychiatric severity in a sample of 245 SLH residents was similar to that of persons attending outpatient treatment for mental health symptoms.

Although peer-managed recovery homes do not offer formal services on-site, residents are free to pursue whatever professional services they need in the community and most homes encourage or require residents to be involved in 12-step recovery groups such as Alcoholics Anonymous. Some SLHs are targeted as “step down” homes where individuals can live after they complete a residential treatment program. In addition, some outpatient treatment programs have opened SLHs as alcohol- and drug-free living arrangements for individuals enrolled in outpatient treatment. However, most California SLHs and all Oxford Houses are freestanding facilities not associated with formal treatment.

Unlike formal treatment or Housing First approaches, the residents themselves typically pay most of the costs through earned income, family resources, or government subsidies, such as general assistance or social disability insurance. Because residents share living arrangements, the rental costs per person tend to be affordable. However, persons with no stable income, family support, or government subsidy may not be able to meet their financial obligations. As long as residents are able to meet financial obligations and comply with house expectations (e.g., abstinence), they can remain as long as they like. Relapse typically results in the resident leaving the home for some minimal period of time, but they typically can reenter if assessed as motivated to reestablish abstinence. Learning from relapses is viewed as an important part of recovery. Thus, these settings offer the potential for long-term and even permanent housing with very little cost to state and local governments.

Studies of sober living and Oxford Houses have revealed favorable longitudinal outcomes on measures of alcohol, drug, employment, and legal problems ( Jason et al ., 2008 ; Polcin et al ., 2010a , 2010b ). These studies used established, psychometrically sound instruments, such as the ASI (McLellan et al ., 1992), the Brief Symptom Inventory (Derogatis & Melisaratos, 1983), and the Diagnostic Interview Schedule ( Robbins, Cottler, & Keating, 1989 ). To enhance generalization of study findings, few inclusion/exclusion criteria were used.

None of the sober living and Oxford House studies specifically targeted recruitment of homeless persons. However, research on broad samples of residents that included significant numbers of persons with a history of homeless has yielded favorable outcomes. For example, in a study of 53 residents of Oxford Houses in St. Louis, half of the sample had a history of homelessness ( Majer et al ., 2002 ). Six-month outcomes showed 42% continued to reside in the houses and 27% left the houses on good term. In a study of 55 residents in SLHs in California over one-third indicated their primary living situation during the past six months was homeless or living in a shelter and another 16% indicated their primary housing was criminal justice incarceration ( Polcin et al ., 2010a ). Six months after entry into the SLHs, residents showed significant improvement in terms of substance use, arrests, and employment. Importantly, these improvements were maintained at 18 months even though most residents had left the homes by that point.

Integration of peer-managed recovery homes into broad based services

Peer-managed recovery homes such as California SLHs and Oxford Houses have the potential to play unique roles within linear and Housing First models. Within linear models, they can be housing resources for previously homeless persons completing residential treatment or places for them to reside while they attend outpatient programs ( Polcin et al ., 2010a ). Kertesz et al . (2009) pointed out that the lack of permanent housing is a common gap in linear systems of care. Peer-managed recovery homes have the potential to fill that gap because residents are free to stay as long as they wish. Because recovery homes require alcohol and drug abstinence and encourage or mandate attendance at 12-step groups, they provide an approach that is consistent with most treatment programs. In this way, recovery homes emphasize concepts and practices that are familiar to residents and reinforcing of their treatment experiences. For individuals who found treatment to be helpful, this consistency adds to the therapeutic value.

Peer-managed homes can also compliment Housing First approaches to homelessness. For example, once stabilized in a Housing First apartment some individuals may decide at some point to quit their substance use. However, if they reside in an environment that tolerates substance use, pursuing that goal might be difficult. Living in a recovery home environment might be a much more effective way of responding to the individual's needs at that point and therefore should be available. Conversely, when individuals in recovery homes are not able or willing to comply with requirements for abstinence Housing First should be a readily available alternative to homelessness. In this manner there would be a cross referral process based on resident needs rather than competition between the two approaches.

One of the obstacles to peer-managed recovery homes is cost. Currently, most individuals in Oxford Houses and California SLHs pay rent using earned income or family resources. In a limited number of cases, the criminal justice system will pay for several months of rent but subsequently will expect the resident to pay costs. In low-income urban areas, some residents are able to pay costs using social security disability or general assistance. However, these homes are often not ideal because to make them affordable the homes serve a large numbers of residents per square footage and multiple residents share bedrooms. There is no clear rationale why one type of permanent housing is subsidized by government funding (Housing First) and one is not (recovery homes). Ensuring the availability and affordability of peer-managed recovery homes within Housing First and linear models of care would contribute important services currently lacking: permanent, abstinent-based housing that draws primarily on peer support as the active ingredient for successful recovery.

Researchers and practitioners frequently debate about the most appropriate service models for homeless persons with co-occurring substance abuse. However, a variety of weaknesses in the methods that have been used to study homeless services suggests caution when pointing to empirical research supporting different models. To improve the evidence base for systems of care for homeless persons with substance use disorders there needs to be closer attention to measurement of the characteristics of homeless persons, specification of inclusion and exclusion criteria that help focus studies on specific problems, and assessment of the types of services participants receive within different models. Although randomized designs have the advantage of showing causality, they can entail problems with generalization to the real world conditions of homeless persons, such as the typical ways they access services. This paper urges researchers to consider a wide array of research designs to address different aspects of homeless services.

Although several recent papers (e.g., Corporation for Supportive Housing & National Council for Behavioral Health, 2014 ; Paquette & Winn, 2015 ) have called for broader based service delivery systems that integrate Housing First and linear models, little has been done to integrate these models in community practice. This paper has described ways these two models complement each other and ways that practitioners could implement broader based, integrated approaches that respond better to individual needs. Homeless persons often move through different periods of motivation ranging from a desire to receive help to address their problems to simply receiving help for basic needs such as food and shelter. Current service systems for the homeless have not been sufficiently flexible to respond to these changes.

Currently, when criminal justice offenders are leaving incarceration and have a mandate to receive services, they typically are referred to programs that require abstinence from alcohol and drugs. This procedure is understandable given the consistent association between substance use and crime and relatively favorable outcomes for offenders in abstinence-based treatment programs. However, peer-based recovery homes could play stronger roles in providing long-term abstinent housing as part of the endpoints for linear-based service systems. Although the Housing First principle of supporting abstinence as one option for residents is not generally consistent with criminal justice requirements mandating abstinence for all ex-offenders, it would be interesting to assess illegal activities and arrests among Housing First residents without mandated abstinence.

Absent in most of the debates about services for homeless persons with co-occurring substance abuse is the potential role of peer-managed recovery homes, such as California SLHs and Oxford Houses. Most of these facilities require a level of functional and financial independence that is frequently lacking among persons who are chronically homeless or suffering from severe mental illness. However, they have the potential to fill existing service gaps for both Housing First and linear models. Within Housing First models, they can be an important referral resource when residents receiving permanent housing subsidies decide they wish to attempt abstinence. Many Housing First environments are not suitable for persons attempting abstinence because they allow substance use among residents and are unlikely to have the social support often necessary to support abstinence. In linear service systems, peer-managed recovery homes can provide permanent housing after inpatient treatment, during concurrent outpatient care, or after residence in a more structured, professionally staffed recovery home. The potential impact of peer-managed recovery homes on linear service systems is high because lack of permanent, affordable housing that maintains the gains made in treatment has been a serious and widespread problem within linear systems.

Disclaimer statements

Contributors Dr. Polcin is the sole author of this paper.

Funding National Institutes of Health.

Conflicts of interest No conflicts of interest.

Ethics approval No data were collected for this paper. Ethical approval not required.

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E-cigarettes are the most commonly used tobacco product among U.S. youth. No tobacco products, including e-cigarettes, are safe, especially for children, teens, and young adults. Learn more about e-cigarette use among youth.

• In the United States, youth use e-cigarettes, or vapes, more than any other tobacco product. 1
• No tobacco products, including e-cigarettes, are safe, especially for children, teens, and young adults. 2
• Most e-cigarettes contain nicotine, which is highly addictive. Nicotine can harm the parts of an adolescent's brain that control attention, learning, mood, and impulse control. 2
• E-cigarette marketing, the availability of flavored products, social influences, and the effects of nicotine can influence youth to start or continue vaping. 3 4
• Most middle and high school students who vape want to quit. 5
• Many people have an important role in protecting youth from vaping including parents and caregivers, educators and school administrators, health care providers, and community partners.
• States and local communities can implement evidence-based policies, programs, and services to reduce youth vaping.

E-cigarette use among U.S. youth

In 2023, e-cigarettes were the most commonly used tobacco product among middle and high school students in the United States. In 2023: 6

• 550,000 (4.6%) middle school students.
• 1.56 million (10.0%) high school students.
• Among students who had ever used e-cigarettes, 46.7% reported current e-cigarette use.
• 1 in 4 (25.2%) used an e-cigarette every day.
• 1 in 3 (34.7%) used an e-cigarette on at least 20 of the last 30 days.
• 9 in 10 (89.4%) used flavored e-cigarettes.
• Most often used disposable e-cigarettes (60.7%) followed by e-cigarettes with prefilled or refillable pods or cartridges (16.1%).
• Most commonly reported using the following brands: Elf Bar, Esco Bars, Vuse, JUUL, and Mr. Fog.

Most middle and high school students who vape want to quit and have tried to quit. 5 In 2020:

• 63.9% of students who currently used e-cigarettes reported wanting to quit.
• 67.4% of students who currently used e-cigarettes reported trying to quit in the last year.

Most tobacco use, including vaping, starts and is established during adolescence. There are many factors associated with youth tobacco product use . These include:

• Tobacco advertising that targets youth.
• Product accessibility.
• Availability of flavored products.
• Social influences.
• Adolescent brain sensitivity to nicotine.

Some groups of middle and high school students use e-cigarettes at a higher percentage than others. For example, in 2023: 6

• More females than males reported current e-cigarette use.
• Non-Hispanic multiracial students: 20.8%.
• Non-Hispanic White students: 18.4%.
• Hispanic or Latino students: 18.2%.
• Non-Hispanic American Indian and Alaska Native students: 15.4%.
• Non-Hispanic Black or African American students: 12.9%.

Many young people who vape also use other tobacco products, including cigarettes and cigars. 7 This is called dual use. In 2020: 8

• About one in three high school students (36.8%) who vaped also used other tobacco products.
• One in two middle school students (49.0%) who vaped also used other tobacco products.

E-cigarettes can also be used to deliver other substances, including cannabis. In 2016, nearly one in three (30.6%) of U.S. middle and high school students who had ever used an e-cigarette reported using marijuana in the device. 9

• Park-Lee E, Ren C, Cooper M, Cornelius M, Jamal A, Cullen KA. Tobacco product use among middle and high school students—United States, 2022 . MMWR Morb Mortal Wkly Rep. 2022;71:1429–1435.
• U.S. Department of Health and Human Services. E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon General . Centers for Disease Control and Prevention; 2016. Accessed Feb 14, 2024.
• Apelberg BJ, Corey CG, Hoffman AC, et al. Symptoms of tobacco dependence among middle and high school tobacco users: results from the 2012 National Youth Tobacco Survey . Am J Prev Med. 2014;47(Suppl 1):S4–14.
• Gentzke AS, Wang TW, Cornelius M, et al. Tobacco product use and associated factors among middle and high school students—National Youth Tobacco Survey, United States, 2021 . MMWR Surveill Summ. 2022;71(No. SS-5):1–29.
• Zhang L, Gentzke A, Trivers KF, VanFrank B. Tobacco cessation behaviors among U.S. middle and high school students, 2020 . J Adolesc Health. 2022;70(1):147–154.
• Birdsey J, Cornelius M, Jamal A, et al. Tobacco product use among U.S. middle and high school students—National Youth Tobacco Survey, 2023 . MMWR Morb Mortal Wkly Rep. 2023;72:1173–1182.
• Wang TW, Gentzke AS, Creamer MR, et al. Tobacco product use and associated factors among middle and high school students—United States, 2019 . MMWR Surveill Summ. 2019;68(No. SS-12):1–22.
• Wang TW, Gentzke AS, Neff LJ, et al. Characteristics of e-cigarette use behaviors among US youth, 2020 . JAMA Netw Open. 2021;4(6):e2111336.
• Trivers KF, Phillips E, Gentzke AS, Tynan MA, Neff LJ. Prevalence of cannabis use in electronic cigarettes among U.S. youth . JAMA Pediatr. 2018;172(11):1097–1099.

Smoking and Tobacco Use

Commercial tobacco use is the leading cause of preventable disease, disability, and death in the United States.

For Everyone

Health care providers, public health.

If you’re living with a drug or mental health problem, here’s where to look for help

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Fatal overdoses in the U.S. fell for the first time in five years in 2023 , according to preliminary estimates recently released by the Centers for Disease Control and Prevention, but UCLA researcher Joseph Friedman warns that the new findings should not be interpreted to mean that the nation’s drug and mental health crises are abating.

Friedman has analyzed “deaths of despair” that result from overdose, suicide and liver disease due to alcoholism and found that while death rates for white Americans have dipped, rates have risen in recent years among people of color in the U.S., especially among Native and Black Americans. Illegal opioids such as fentanyl have ravaged Black and low-income communities in Los Angeles .

While it’s difficult to pinpoint the exact reasons behind substance abuse or suicide, Friedman as well as other experts in addiction medicine and mental health say racial inequality, economic distress and historical trauma have aggravated those problems in marginalized communities.

If you or someone you know needs immediate help for a mental health, substance-use or suicidal crisis, call or text 988, or chat online by visiting the suicide and crisis line’s website . For mental health resources and referrals, call the Los Angeles County Department of Mental Health’s Help Line 24/7 at ( 800) 854-7771 .

Here are other organizations that offer information, counseling and support services:

Are ‘deaths of despair’ really more common for white Americans? A UCLA report says no

Many believe white Americans suffer higher rates of premature death from addiction, overdoses and mental health. Researchers say that’s false.

May 21, 2024

Nakeya Fields, a licensed clinical social worker in Pasadena, founded the Black Mental Health Task Force , a coalition that brings together mental health professionals, clients, nonprofits, community organizations, educators and others in California to raise awareness about mental wellness. Her Therapeutic Play Foundation offers activities designed to improve resilience and coping skills through creative arts, play and sports. It provides individual, couples, group and family therapy for Black, Latinx, LGBTQ+ and other members of marginalized populations.

The American Indian Counseling Center , a division of the Los Angeles County Mental Health Department, offers crisis intervention, 24/7 intensive mental health services and counseling for all ages, as well as physician consultations for medications and referrals to culturally relevant support groups. Call (562) 402-0677 and ask to speak with the on-duty worker.

United American Indian Involvement’s behavioral health program provides outpatient substance use disorder treatment and mental health services to American Indians and Alaska Natives living throughout Los Angeles County. Visit the website or call (213) 202-3970.

Melanin and Mental Health offers an online network of Black and brown mental healthcare providers that is searchable by geographic area, issue type and treatment sought. It’s also possible to filter results by therapists’ racial background and specialty, as well as by insurance carrier.

The Black Mental Health Alliance offers confidential referrals to culturally competent mental health professionals who are in its database of licensed therapists.

Painted Brain advocates for mental wellness in underserved L.A. communities by offering self-care, relaxation and therapeutic art and play sessions, support groups and trainings for mental health professionals. As part of its peer-led model, many of the staff have experienced mental health issues themselves. Its community center and art space is located at 5980 W. Pico Blvd. in Los Angeles.

The Los Angeles LGBT Center offers individual, couples, family, group therapy and psychiatric care, as well as support for people struggling with substance use. The center has locations in West Hollywood, at Mi Centro in East L.A., at its Trans Wellness Center near MacArthur Park and in South L.A.’s Leimert Park neighborhood.

The Community Health Project Los Angeles provides services to people who use drugs by way of a harm-reduction approach that emphasizes offering clean needles as well as education on how to respond to an overdose.

More to Read

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May 15, 2024

Deadly overdoses stopped surging among L.A. County homeless people. Narcan could be why

May 9, 2024

How L.A. County is trying to remake addiction treatment — no more ‘business as usual’

April 23, 2024

Tyrone Beason is a reporter for the Los Angeles Times who writes about America through the lenses of race and culture. He previously covered the 2020 presidential election. Before joining the paper in 2019, the Kentucky native spent nearly 25 years at the Seattle Times covering the Pacific Northwest. Follow him on Instagram @tyrone_california and Twitter @tyrone_beason.

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Frequently Asked Questions

What is the National Institute on Drug Abuse (NIDA)? What does NIDA do?

The National Institute on Drug Abuse (NIDA) is a federal scientific research institute and the world’s largest funder of biomedical research on drug use and addiction. NIDA’s mission is to advance science on drug use and addiction and to apply that knowledge to improve individual and public health. NIDA is one of 27 Institutes and Centers that comprise the National Institutes of Health, part of the U.S. Department of Health and Human Services.

NIDA supports and conducts a wide range of preclinical, clinical, and population-level research to address key questions about drug use and health. NIDA then disseminates key findings of the research it supports to the public, health professionals, researchers, policymakers, and other stakeholders. Learn more about NIDA’s priority research areas outlined in the  2022-2026 NIDA Strategic Plan .

Founded in 1974, NIDA has been directed by  Nora D. Volkow, M.D. , since 2003. Learn more about NIDA’s organization and activities on the  About NIDA  page.

How does NIDA fund research?

Part of the National Institutes of Health and the U.S. Department of Health and Human Services, NIDA is a publicly funded federal research institute. NIDA funds meritorious and innovative biomedical research projects that support its mission. NIDA’s mission is to advance science on drug use and addiction and to apply that knowledge to improve individual and public health.

Find more information on NIDA research opportunities, initiatives, and policies at the  NIDA Grants and Funding  page. Find more information on NIH research opportunities, initiatives, and policies—including instructions on how to apply for funding—at the  NIH Grants and Funding  site.

Where can I find substance use treatment or other medical help for myself or a loved one?

NIDA is a biomedical research organization and does not provide personalized medical advice, treatment, counselling, or referral services.

• IN AN EMERGENCY:  If you or someone you know is experiencing severe symptoms or is in immediate danger, please seek immediate medical attention by calling 911 or visiting an emergency department. Poison control can be reached at 1-800-222-1222 or  poison.org .
• NEED SUPPORT NOW?  If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat  988lifeline.org  to reach the 988 Suicide & Crisis Lifeline. 988 connects you with a trained crisis counselor who can help.
• FIND TREATMENT:  For referrals to substance use and mental health treatment programs, call the Substance Abuse and Mental Health Services Administration National Helpline  1-800-662-HELP (4357)  or visit  FindTreatment.gov .
• For other personal medical advice, please speak to a health care provider. Find more health resources on  USA.gov .

The emergency and referral resources listed above are available to individuals located in the United States and are not operated by the National Institute on Drug Abuse (NIDA). Information provided by NIDA is not a substitute for professional medical care.

How can I participate in a clinical trial?

NIDA supports studies taking place around the world and conducts clinical research studies at its Intramural Research Program in Baltimore, Maryland. Learn more about participating in  NIDA-funded or conducted clinical trials .

How can I stay updated on NIDA news and activities?

• Sign up for  NIDA email updates  based on your interests (Educator & Youth Resources, Medical Professional Resources, Research Professional Resources, News & Events, and more).
• Follow NIDA on  Twitter ,  Facebook ,  LinkedIn , and  YouTube .
• Discover the latest updates on NIDA research on the  News and Events  page and on  Nora’s Blog .

Where can I find more information about drugs and addiction?

• Explore drug use and addiction topics related to NIDA research on NIDA’s  Research Topics  web portal.
• Explore resources for health professionals from  NIDAMED .
• Learn more about  Overdose Prevention  from the Department of Health and Human Services.
• Learn more about substance use treatment, prevention, recovery support, and related services from the  Substance Abuse and Mental Health Services Administration .
• Learn more about the health effects of alcohol and alcohol use disorder from the  National Institute on Alcohol Abuse and Alcoholism .
• Learn more about the approval and regulation of prescription medicines from the  Food and Drug Administration .
• Learn more about efforts to measure, prevent, and address public health impacts of substance use from the  Centers for Disease Control and Prevention .
• Learn more about controlled substance law and regulation enforcement from the  Drug Enforcement Administration .
• Learn more about policies impacting substance use from the  Office of National Drug Control Policy .

What employment, training, and volunteer opportunities does NIDA offer?

• Find currently open positions and learn more about  Working at NIDA .
• Learn more about  Careers at the NIDA Intramural Research Program .
• Find additional  Research Training and Career Development  information for careers in substance use research and addiction medicine.
• Explore  Health Professions Education  resources from NIDAMED to access training opportunities, including CME and CE activities.
• Learn more about volunteering opportunities and other  Public Involvement with NIH .

How can I find support for my project?

NIDA funds meritorious and innovative biomedical research projects that support its mission to advance science on drug use and addiction and to apply that knowledge to improve individual and public health. Find more information on NIDA research opportunities, initiatives, and policies at the  NIDA Grants and Funding  page. Find more information on NIH research opportunities, initiatives, and policies—including instructions on how to apply for funding—at the  NIH Grants and Funding  site. For questions about specific funding opportunity announcements, please contact the listed program official.

For more information about funding for public health programs, see the  U.S. Centers for Disease Control and Prevention Grants  page. For additional federal funding opportunities for programs related to substance use, see the  Substance Abuse and Mental Health Services Administration Grants  page.

Where can I find statistics related to substance use?

For the latest findings and statistics from NIDA research, please visit NIDA’s  News and Events  page. For more information on drug overdose death statistics, please visit the  Overdose Death Rates  page or explore information from the  National Center for Health Statistics  at the Centers for Disease Control and Prevention. For general national data on substance use, you may visit the official website of the  National Survey on Drug Use and Health (NSDUH)  from the Substance Abuse and Mental Health Services Administration (SAMSHA).

Where can I find publications and educational materials on drug use and addiction? Does NIDA mail printed materials?

You can explore a variety of information on substance use and addiction by visiting NIDA’s  Research Topics  page. Additional educational materials for students can be found on NIDA’s  Parents and Educators  page.

While NIDA does not create or distribute printed materials, some digital and print-friendly  NIDA Publications  are available. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers delivery of select printed materials on drug use and addiction through the  SAMSHA Store .

Where can I find screening tools and other resources for patient care? Do I need NIDA’s permission to use them in a training or clinical study?

Explore validated  Screening Tools  and related resources from NIDAMED. Additional assessment tools may be found on  NIDA’s Research Data, Measures and Resources  page. Unless otherwise specified, NIDA-developed screening and assessment tools—including the Tobacco, Alcohol, Prescription medications, and other Substance (TAPS) Tool—are in the public domain, and permission is not required to use them. Citation of the source is appreciated.

Where can I find data from NIDA-supported studies and related research resources?

Explore research data sharing resources, policies, and related tools on  NIDA’s Research Data, Measures and Resources  page. For further data related to specific published study results, please reach out directly to the corresponding author.

Who maintains the NIDA website?

The NIDA web site at nida.nih.gov is maintained by the NIDA  Office of Science Policy and Communications (OSPC) . For technical problems with the NIDA website,  contact the NIDA Webmaster .

Do I have permission to use, reproduce or share a NIDA webpage, publication, graphic or video?

Unless otherwise specified, written NIDA materials are in the public domain and may be reproduced in their entirety without permission from NIDA. Citation of the source is requested.

Many multimedia products (including photographs, illustrations, and videos) featured on the NIDA site are not in the public domain and may not be used without permission. Please send questions about the use of specific multimedia products to  [email protected] .

Where can I find information about National Drug and Alcohol Facts Week®?

Participate in  National Drug and Alcohol Facts Week®  (NDAFW) and help share facts about drugs, alcohol, and addiction in your community. If your organization is interested in hosting a local event or promotional activity, visit  Learn About NDAFW . If you have further questions, please contact  [email protected] .

Where can I find information for a school project?

Explore information by topic in NIDA’s  Research Topics  web portal and find educational resources on the  Parents and Educators  page. For scientific literature on substance use, you may consider searching  PubMed , a tool provided by the National Library of Medicine.

I (or my organization) have produced content that may be of interest. Can NIDA please post or share it?

Thank you for your interest. As a federal scientific research agency, NIDA only accepts guest blog posts or articles from other federal agencies and organizations with which we have formal partnerships.

Can NIDA assist me with interpreting or disputing the results of a drug screen?

NIDA is a biomedical research organization and does not provide personal medical advice, legal consultation, or medical review services to the public. While NIDA-supported research may inform the development and validation of drug screening technologies, NIDA does not manufacture, regulate or distribute laboratory or at-home drug screening products. The  U.S. Food and Drug Administration (FDA)  regulates most of these products in the United States. Those with concerns about drug screening results may consider reaching out to the drug screening program or a qualified health care professional. For more information on workplace drug screening, please visit the Substance Abuse and Mental Health Services Administration (SAMSHA)  Division of Workplace Programs website .

Can NIDA assist me with a substance-related legal problem?

NIDA is a biomedical research organization and does not provide personal legal consultation or typically provide expert witnesses. Information provided by NIDA is not a substitute for professional legal help. For more information on finding legal help, explore  Legal Aid  resources from USA.gov. 

Can I report a suspected crime to NIDA?

NIDA is a biomedical research organization and does not enforce laws or process reports of suspected illegal activity related to drug trafficking, sales, or use. Regarding these concerns, you may consider contacting local law enforcement or the  U.S. Drug Enforcement Administration . For more information on laws and legal issues, visit  USA.gov .

How can I contact NIDA?

If your question was not answered in this FAQ, please  Submit a Question or Comment here . For additional contact information, please visit  Contact Us .