The Last Straw: Sudden Shifts in Substance Use During the First 6 Months After Prison Release

Adolescents who attend special education for behavioural problems (SEB) and adolescents who live in a residential youth care institution (RYC) are characterised by behavioural disorders and problematic family backgrounds and have an increased risk for substance use. Though it is likely that the high rates of substance use in SEB/RYC settings might be inherent to the risk profile of these adolescents, little is known about the actual role the risk profile has in explaining substance use. The present study examined the extent to which the elevated risk of substance use in SEB/RYC can be explained by high levels of individual, family, and peer risk indicators that are known to characterise their risk profile. Self-report questionnaires from 531 adolescents in RYC (50 % male; mean age 14.7) and 603 adolescents in SEB (81 % male; mean age 14.1) were compared with information from 1,905 adolescents attending special education for students with learning disabilities (SEL) (56 % male; mean age 14.1). Results show that adolescents in SEB/RYC reported higher levels of daily smoking, weekly alcohol consumption, cannabis and hard drug use, as well as greater prevalence of individual, family and peer factors. Though individual, family and in particular peer risk indicators all explain some of the variance in substance use, the differences between adolescents in SEB/RYC compared with SEL remained significant and substantial, with the exception of heavy alcohol consumption. These findings suggest that deviant peer affiliation, in particular, plays a role in explaining high substance use levels in SEB/RYC and those factors relevant to the residential settings and special education schools might also contribute to substance use in these high-risk groups.

Substance use is a leading cause of burden of disease worldwide. Selective prevention programs can help reduce the development of problematic substance use and disorders. To examine effects of a selective, personality-targeted substance use prevention program on alcohol, cannabis, tobacco, nonmedical opioid, and illicit polysubstance use among adolescents with elevated levels of personality traits associated with frequent and risky substance use. This prespecified secondary analysis of a cluster-randomized clinical trial assessed the effectiveness of a personality-targeted cognitive-behavioral intervention (PreVenture) in reducing substance use during adolescence. Participants included grade 7 students attending 31 secondary schools in the Greater Montreal Area, Canada (2012-2013 school year), who screened as having elevated levels of anxiety sensitivity, hopelessness, impulsivity, or sensation seeking. Schools were randomized to either the intervention (15 schools) or the control group (16 schools). Data were analyzed in January to March 2025. Schools delivered a 2-session, personality-targeted group-based cognitive-behavioral intervention designed to help students recognize, challenge, and manage personality-specific emotions, behaviors, and cognitions associated with substance use in adolescence. Self-reported frequency of alcohol, cannabis, smoking tobacco, nonmedical use of opioids, and illicit polysubstance use were measured by the Detection of Alcohol and Drug Problems in Adolescents. A total of 3861 students from 31 schools were screened; 1669 students (847 [50.7%] female; mean [SD] age, 12.83 [0.47] years) were at elevated risk of substance use and included in the intention-to-treat sample. The 31 schools were randomized, with 16 schools with 964 students in the control group and 15 schools with 705 students in the intervention group. Multilevel bayesian mixed-effects models indicated that students in the intervention group had slower increases in the frequency of alcohol (odds ratio [OR], 0.92; 95% credible interval [CrI], 0.85-1.00), cannabis (OR, 0.75; 95% CrI, 0.66-0.86), tobacco smoking (OR, 0.79; 95% CrI, 0.70-0.96), and illicit polysubstance use (OR, 0.56; 95% CrI, 0.35-0.89) over 4 years. Effects did not differ by sex. This secondary analysis of a cluster-randomized clinical trial found that personality-targeted interventions protected against the escalation in substance use during adolescence, with similar effects for males and females. ClinicalTrials.gov Identifier: NCT01655615.

BackgroundWomen of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment.ObjectiveIn this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age.MethodsWe used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app’s usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women’s reactions to the app.ResultsA total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as “at-risk” for substance use disorders contacted the free treatment clinic for further evaluation.ConclusionsThe mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change.

High school youth have an elevated risk of substance use. Some substances (e.g., inhalants, MDMA/Ecstasy [3,4-methylenedioxymethamphetamine]) used by youth are overlooked or grouped in an "other" category. Compared with other racial/ethnic groups, American Indian (AI) youth may be at higher risk of using these substances. The purpose of this study is to examine the prevalence and patterns of use of other substances among youth living on or near reservations. This study uses data from Our Youth Our Future, a national probability sample survey of substance use among reservation-based youth (n = 14,769), to examine prevalence rates of use across sex (51% male), AI identity (61% AI), and their intersection within seven geographic regions of the United States. Results indicate that AI youth largely did not endorse other substance use at significantly higher rates than non-AI youth. However, in two regions, they held higher odds of using any other substance than non-AI participants. In the Southeast and Northwest, AI youth were less likely to use prescription opioids and over-the-counter cold medicines than non-AI youth, respectively. Notable effects for sex emerged, such that males in the Southwest were more likely to use inhalants, hallucinogens, and tranquilizers than female participants. Participants in the Southern Plains reported the highest prevalence of other substance use. Although the overall risk of using other substances is similar between AI and non-AI youth in many regions, differences in use patterns by AI identity and sex can help target prevention and intervention efforts.

Escalation and Initiation of Younger Adolescents’ Substance Use: The Impact of Perceived Peer Use

Adolescents exposed to traumatic events, including physical and sexual abuse, are at higher risk of developing problematic substance use behaviours. This study investigates associations between traumatic experiences and trajectories of substance use in adolescence and young adulthood, focusing in particular on differences in neuroendocrine and subjective stress reactivity as potential explanatory mechanisms. Using data from the TRacking Adolescents' Individual Lives Survey (TRAILS) (N = 715), we assessed whether traumatic experiences up to age 16 were associated with differences in acute neuroendocrine stress reactivity (in terms of heart rate (HR), high-frequency heart rate variability (HF-HRV), pre-ejection period (PEP), and cortisol reactivity), as well as subjective stress reactivity, assessed in the context of a standardized stress test conducted around age 16. We then analysed whether these stress reactivity measures predicted substance use trajectories (tobacco, alcohol, and cannabis) from around age 16 to around age 22. Results showed that traumatic experiences increased the risk of following trajectories characterized by an early initiation and escalation of tobacco, alcohol, and cannabis use (vs. no use or low use trajectories). Traumatic experiences were additionally associated with a higher probability of belonging to cannabis use trajectories characterized by consistently relatively low levels of use (vs. no use) or a later escalation of use in young adulthood. Regarding mechanisms, blunted neuroendocrine stress reactivity, but not subjective stress reactivity, was inconsistently linked to trajectories of higher substance use. However, differences in acute stress reactivity did not contribute to associations between traumatic experiences and substance use trajectories, as associations between traumatic experiences and acute stress reactivity were absent. Our findings emphasize the need to explore mechanisms beyond acute stress reactivity that may explain the association between trauma and adolescent and young adult substance use.

Background: Adolescents with a history of maltreatment and child welfare involvement are at elevated risk for substance use, but few studies have focused on exogenous correlates (e.g., neighborhood, family, and peer characteristics) of substance use in this population. The current cross-sectional study explored associations between exogenous risk and protective factors and past-year substance use. Methods: Self-reported data were collected from 249 youth (Mage = 13.95 years, SD = 0.67) who had experienced maltreatment and had an open child welfare case. Results: Almost one-third of the sample reported any substance use in the past year. In the full sample, community violence exposure and deviant peer affiliations were found to be risk factors for past-year substance use. For females, community violence exposure and deviant peer affiliations were risk factors for substance use, while affiliation with prosocial peers was a protective factor. For males, community violence exposure and living at home (vs. in out-of-home care) were risk factors for substance use. Parental monitoring and school connectedness were not related to substance use, suggesting that these protective factors are less salient in this sample. Conclusions: Findings suggest that focusing on modifiable intervention targets (e.g., discouraging affiliations with deviant peers), providing mental health treatment for violence exposure, and addressing broader contextual risk factors are promising directions for substance use prevention efforts for this vulnerable population of youth.

Chronic pain is a significant global health problem that affects millions of people globally and in the US which can sometimes lead to unhealthy coping mechanisms such as substance use. This case–control study aimed to examine the relationship between chronic pain and substance use using data from the National Health and Nutrition Examination Study (NHANES). Descriptive analysis and logistic regression models were used to compare the odds of substance use in individuals according to a history of ongoing (≥ 6 weeks) or chronic pain (≥ 3 months). A total of 980 individuals were included in the analysis. Among them, 87.4% reported no substance use, 10.2% single substance use, and 2.3% polysubstance use. Compared with 19.33% of non-substance users, 23.36% of single substance users and 39.21% of polysubstance users reported current ongoing pain (p-value: 0.04). Examining the association between substance use and chronic pain revealed that polysubstance users had a significantly higher risk of having current or a history of ongoing pain or a history of chronic pain compared to non-users, with adjusted odds ratios (aORs) ranging from 2.28 (95% CI 2.27–2.29) to 6.30 (95% CI 6.28–6.32). Single substance users also faced increased risk, with aORs from 1.19 (95% CI 1.18–1.20) to 2.14 (95% CI 2.13–2.15). These results highlight the elevated risk of substance use associated with chronic pain, particularly elevated risk of polysubstance use, after adjustments for demographic, socioeconomic, and mental health factors. These findings emphasize the need for targeted interventions addressing chronic pain to potentially mitigate substance use risks.

Objective: Prior research shows that college athletes have higher rates of substance use, especially alcohol, than do college students who are not involved in athletics. To augment the literature, the author sought to determine which sports/teams are at the greatest risk for substance use. Participants: The author used data from the 1999 Harvard School of Public Health College Alcohol Study, a national survey of college and university students in the United States. Methods: A series of chi-square and logistic regression models examined variation in substance use among college athletes on the basis of sport/team affiliation. Results: Findings indicated that male hockey and female soccer athletes were the most likely to report substance use and that male basketball and cross-country/track athletes reported lower levels of substance use. Conclusion: There is variation in substance use on the basis of sport/team affiliation, and future researchers should examine why certain groups of athletes have higher rates of substance use.

This study examined substance use rates and related background factors among adolescents in special education (SE) and in residential youth care institutions (RYC). Information on substance use from 531 adolescents in RYC, 603 adolescents in SE for students with behavioral problems (SEB) and 1,905 adolescents in SE for students with learning disabilities (SEL) was compared with information from 7,041 adolescents who attended mainstream education. Results show that substance use rates are particularly high among adolescents in RYC and in SEB. For example, 22% of the 12–13 years old in RYC and 16% in SEB was a daily smoker compared with 1% of their counterparts in mainstream education. Background factors, including age, ethnic background and family situation, partly explained the differences in substance use between mainstream education on the one hand and SE and RYC on the other hand, but differences between the groups remained substantial and significant. Several interaction effects were found in the relation between SE/RYC and substance use that were all in line with the risk paradox: some subgroups that are normally at lower risk for problem behavior are at higher risk when they are subjected to high-risk indicators. The elevated risk of substance use among adolescents in RYC/SE was in some cases particularly marked for those who would normally be at lower risk for substance use (girls in SEB for heavy alcohol drinking and cannabis use, ethnic minority adolescents and adolescents with a stable family situation in RYC for respectively heavy weekly alcohol drinking and daily use of tobacco). Results of this study have important implications for health education and intervention programs for adolescents in RYC and SE.

We aimed to describe temporal changes in substance use among HIV-infected pregnant women in the United States from 1990 to 2012. Data came from two prospective cohort studies (Women and Infants Transmission Study and Surveillance Monitoring for Antiretroviral Therapy Toxicities Study). Women were classified as using a substance during pregnancy if they self-reported use or had a positive biological sample. To account for correlation between repeated pregnancies by the same woman, generalized estimating equation models were used to test for temporal trends and evaluate predictors of substance use. Over the 23-year period, substance use among the 5451 HIV-infected pregnant women sharply declined; 82% of women reported substance use during pregnancy in 1990, compared with 23% in 2012. Use of each substance decreased significantly (P < 0.001 for each substance) in an approximately linear fashion, until reaching a plateau in 2006. Multivariable models showed substance use was inversely associated with receiving antiretroviral therapy. Among the subset of 824 women with multiple pregnancies under observation, women who used a substance in their previous pregnancy were at elevated risk of substance use during their next pregnancy (risk ratio, 5.71; 95% confidence interval, 4.63-7.05). A substantial decrease in substance use during pregnancy was observed between 1990 and 2012 in two large US cohorts of HIV-infected women. Substance use prevalence in these cohorts became similar to that of pregnant women in the general US population by the mid-2000s, suggesting that the observed decrease may be due to an epidemiological transition of the HIV epidemic among women in the United States.

Risk and protective factors for alcohol, marijuana, and cocaine use among child welfare-involved youth

Marijuana use is increasing among adults and often co-occurs with other substance use; therefore, it is important to examine whether parental marijuana use is associated with elevated risk of substance use among offspring living in the same household. To examine associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse. This cross-sectional study used survey data from the 2015 through 2018 National Surveys on Drug Use and Health (NSDUH), which provide nationally representative data on adolescents or young adults living with a parent (the mother or the father). Annual average percentages were based on survey sampling weights. Final analyses were conducted September 21 through 23, 2019. Parental marijuana use status. Offspring self-reported use of marijuana, tobacco, or alcohol or misuse of opioids. Survey respondents included 24 900 father-offspring or mother-offspring dyads sampled from the same household. Among mothers living with adolescent offspring, 8.2% (95% CI, 7.3%-9.2%) had past-year marijuana use, while 7.6% (95% CI, 6.2%-9.2%) of mothers living with young adult offspring had past-year marijuana use. Among fathers living with adolescent offspring, 9.6% (95% CI, 8.5%-10.8%) had past-year marijuana use, and 9.0% (95% CI, 7.4%-10.9%) of fathers living with young adult offspring had past-year marijuana use. Compared with adolescents whose mothers never used marijuana, adjusted relative risk (ARR) of past-year marijuana use was higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.3; 95% CI, 1.1-1.6; P = .007), less than 52 days of past-year marijuana use (ARR, 1.7; 95% CI, 1.1-2.7; P = .02), or 52 days or more of past-year marijuana use (ARR, 1.5; 95% CI, 1.1-2.2; P = .02). Compared with young adults whose mothers never used marijuana, adjusted risk of past-year marijuana use was higher among those whose mothers had lifetime (without past-year) marijuana use (ARR, 1.4; 95% CI, 1.1-1.7; P = .001), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.0-2.3; P = .049), or 52 days or more of past-year marijuana use (ARR, 1.8; 95% CI, 1.3-2.5; P = .002). Compared with adolescents whose fathers never used marijuana, adolescents whose fathers had less than 52 days of past-year marijuana use were more likely to use marijuana (ARR, 1.8; 95% CI, 1.2-2.7; P = .006). Compared with young adults whose fathers never used marijuana, young adults whose fathers had 52 days or more of past-year marijuana use were more likely to use marijuana (ARR, 2.1; 95% CI, 1.6-2.9; P < .001). Compared with their peers whose parents never used marijuana and after adjusting for covariates, the adjusted risk of past-year tobacco use was higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.3; 95% CI, 1.0-1.6; P = .03), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.0-2.1; P = .04), or 52 days or more of past-year marijuana use (ARR, 1.6; 95% CI, 1.1-2.3; P = .03); adolescents whose fathers had lifetime marijuana use (ARR, 1.5; 95% CI, 1.1-1.9; P = .004) or 52 days or more of past-year marijuana use (ARR, 1.8; 95% CI, 1.2-2.7; P = .006); young adults whose mothers had lifetime marijuana use (ARR, 1.2; 95% CI, 1.0-1.4; P = .04); and young adults whose fathers had 52 days or more of past-year marijuana use (ARR, 1.4; 95% CI, 1.0-1.9; P = .046). Compared with their peers whose parents had no past marijuana use and after adjusting for covariates, risk of past-year alcohol use was higher among adolescents whose mothers had lifetime marijuana use (ARR, 1.2; 95% CI, 1.1-1.4; P = .004), less than 52 days of past-year marijuana use (ARR, 1.5; 95% CI, 1.2-1.9; P = .002), or 52 days or more of past-year marijuana use (ARR, 1.3; 95% CI, 1.0-1.7; P = .04). After adjusting for covariates, parental marijuana use was not associated with opioid misuse by offspring. In this cross-sectional study, parental marijuana use was associated with increased risk of substance use among adolescent and young adult offspring living in the same household. Screening household members for substance use and counseling parents on risks posed by current and past marijuana use are warranted.

Using data from a regional census survey of high school students, we compared substance use patterns between transgender and cisgender students, and students who did not know if they are transgender (DKT). Data from more than 23,000 youth from 26 high schools were used to compare alcohol-related behaviors, marijuana use, and non-medical use of prescription drugs (NMUPD) between these three groups. We also examined differences in substance use behaviors between these groups by grade. Results show that transgender students have significantly higher odds of engaging in most types of substance misuse behaviors including problem drinking, current marijuana use, and NMUPD, compared to cisgender students. DKT students have significantly higher odds of engaging in problem drinking, and NMUPD compared to cisgender students. Furthermore, differences in some substance use behaviors between transgender and cisgender students are greater among students in earlier grades compared to later grades; though this was not the case when comparing cisgender students to DKT students. Results highlight the elevated risk of substance use among transgender youth—especially during early high school years, and students who are not sure about their gender identity. Implications about the need for targeted and early prevention efforts for this vulnerable population are discussed.

Intervention for marijuana using, court-involved non-incarcerated youth