High Risk For Substance Abuse Research Articles

The Phenomenon Of Bullying Among Teenagers In A Thematic Hadith Perspective

Bullying has serious and long-term effects on adolescents. Victims of bullying have a higher risk of experiencing physical and psychosomatic problems such as headaches, stomachaches, and sleep problems. They are also at higher risk of internalizing problems such as anxiety and depression in young adulthood and middle adulthood. Bullying can also have a negative impact on both the victim and the bully. It can lead to physical injury, social and emotional distress, self-harm, and even death. Teens who bully others have a higher risk of drug abuse, academic problems, and experiencing violence in adolescence and adulthood. The issue of bullying becomes a big problem if it is not addressed. It is important to prevent bullying and provide support to those who are victims. The object of this research material is a case of bullying according to the hadith themes. This study uses a qualitative approach by applying the thematic method. The results of this study show that the themes of hadith can be formulated in the theoretical framework of the phenomenon of bullying in adolescents. The discussion of this study explains that bullying is not relevant to the teachings of Islam

Adverse Childhood Experiences and Mental Health in an Adolescent Partial Hospital Program

ABSTRACT Childhood adversity has been associated with myriad physical, emotional, and mental health symptoms across the lifespan, including higher risk for substance abuse, depression, suicidal ideation, and premature mortality. The current study evaluates the association between cumulative adverse childhood experiences and mental health distress at admission and discharge in an adolescent partial hospital program. Data were collected from 157 adolescents through clinical assessments administered during admission and discharge procedures (Youth Outcomes Questionnaire Self-Report (YOQ-SR), Treatment Support Measure (TSM), and Center for Youth Wellness Adverse Childhood Experiences Questionnaire Teen (CYW ACE-Q Teen)). Regression analyses were conducted to assess how cumulative ACEs predict admission mental health distress (Intrapersonal Distress, Critical Items, and Total Score) as well as mental health distress at discharge, above and beyond other clinically relevant factors. While ACEs significantly predicted overall distress at admission (p = .026), there were no other significant associations between ACEs and outcomes at admission, nor ACEs and any outcomes at discharge. This suggests experiences of adversity may not hinder or influence outcomes over the course of treatment in this setting. Experiences of adversity were highly endorsed in this sample; thus, further understanding of experiences of trauma and resilience in acute treatment settings is a critical area for future research to improve interventions for adolescents. Abbreviations: ACE(s): Adverse Childhood Experience(s); ACE-Q: Adverse Childhood Experience Questionnaire; APHP: Adolescent Partial Hospitalization Program; LOS: Length of Stay; NSSI: Non-Suicidal Self-Injury; PHP: Partial Hospitalization Program; Y-OQ: Youth Outcome Questionnaire; Y-OQ-SR: Youth Outcome Questionnaire Self-Report; TSM: Treatment Support Measure

11.17 Melancholic Depression in the Adolescent Patient

This poster aims to review risk factors, clinical patterns, diagnostic workup, and available treatments in melancholic depression in the adolescent patients. A qualitative literature review was conducted. A search was conducted in the PubMed database using “melancholic depression” AND “adolescent,” yielding 62 results. After eliminating unrelated articles, 15 articles were reviewed. Adolescents with depressive disorders are at high risk for substance abuse, legal problems, exposure to negative life events, physical illness, early pregnancy, poor life, and psychosocial functioning. Compared with patients with nonmelancholic depression, patients with melancholic depression have a higher depression score and overall illness severity score, suicidal ideation, and behavior. In adults, melancholic patients were more likely to be male and older in age. They were also more severely depressed, had a higher frequency of depressive episodes, and had shorter episode duration when compared to atypical and nonmelancholic patients. Adolescents compared to children can have more melancholic symptoms. Melancholic patients have poorer performance compared to nonmelancholic depressed patients when it comes to tasks that include verbal and visual memory, executive function, sustained attention and span, and psychomotor speed. Melancholic features are found to be more frequent in the inpatient setting as opposed to the outpatient setting and are more likely to occur in those with psychotic features. A meta-analysis that was performed comparing atypical depression and melancholic depression as a predictor of therapeutic outcome of CBT did not find any indication that either of these types can be a significant outcome moderator. Research data suggest that the presence of melancholia predicts a poor response to psychotherapy and a relatively good response to antidepressants and ECT. There is a limited amount of data focused on the melancholic depression subtype, specifically in adolescent patients. There may be potential benefit in more research on this topic and approaching melancholic depression as a separate entity than typical and atypical subtypes, particularly with focus on adolescents. This would also include further research on treatment specific for melancholic depression.

Implications of Tamarkoz on stress, emotion, spirituality and heart rate

Perceived stress among university students is a prevalent health issue directly correlated with poor academic performance, poor sleep quality, hopelessness, compromised physical and mental health, high risk of substance abuse, and suicidal ideation. Tamarkoz, a Sufi meditation, may reduce the impact of stressors to prevent illness among students. Tamarkoz is the art of self-knowledge through concentration and meditation. It is a method of concentration that can be applied to any task. The method is said to discipline the mind, body, and emotions to avoid unintended distractions. Therefore, it can be used in daily life activities, such as studying, eating, driving, de-stressing or in Sufism, seeking self-knowledge. This study was an 18-week quasi-experimental design with pre-intervention, post-intervention and follow-up assessments in the experimental group, a wait-list control, and a third group that utilized the campus health center’s stress management resources. Participants, university students, had no prior exposure to Tamarkoz, and there were no statistically significant differences among groups on baseline measurements. Using a generalized linear mixed model, significant increases in positive emotions and daily spiritual experiences, and reductions in perceived stress and heart rate were found in the experimental group compared to the other two groups. Tamarkoz seems to show some advantages over the usual stress management resources offered by a student health center.Trial registration: ClinicalTrials.gov Protocol Registration Date: (03/04/2018); ClinicalTrials.gov ID: NCT03489148.

Adolescent access to health services in fragile and conflict-affected contexts: The case of the Gaza Strip

BackgroundEnjoyment of physical and mental health is not only recognized as a human right but also as an integral part of development, as reflected in Sustainable Development Goal 3 – to ensure healthy lives and promote well-being for all at all ages. The rapid physical and psychosocial changes that take place during adolescence have a strong influence on the rest of a person’s life course, so investments in adolescent health services constitute a unique opportunity to reap inter-generational dividends. Yet the evidence base on adolescents’ access to health services, particularly in conflict-affected contexts, remains thin. This article explores adolescents’ access to health services in the Gaza Strip, and their experiences and perceptions of those services.MethodsThe article draws on mixed methods research in the Gaza Strip conducted in 2016 and 2017 as part of the Gender and Adolescence: Global Evidence research programme. Data were collected from 240 male and female adolescents combining in-depth interviews, focus group discussions and a tablet-based survey. This study also draws on a participatory action pilot project engaging 12 boys and 23 adolescent girls aged 15–19 years old.ResultsThe findings underscore that gender norms—especially those pertaining to adolescent girls’ sexual purity––shape adolescent health in multiple ways. Girls face increasing restrictions on their mobility, leaving them with limited opportunities for leisure or exercise, socializing with peers or seeking health services and information. Adolescent boys in Gaza do not face the same restrictions, but given the multiple political, economic and familial stressors, they are at high risk of substance abuse including smoking and involvement in peer violence. Moreover, our findings suggest that a range of socioeconomic, cultural and structural barriers prevent adolescents in Gaza from accessing quality and appropriate health care. Study participants cited the main challenges being an absence of preventive adolescent health initiatives and limited information on sexual and reproductive health, as well as drug shortages, high treatment costs, and inappropriate interactions with service providers.ConclusionsThe article highlights the importance of designing and implementing conflict-sensitive and age- and gender-appropriate adolescent services and information and promoting preventive services targeted at adolescents.

Youth, poverty, and interpersonal violence: a recipe for PTSD

Substantial efforts have focused on physical rehabilitation to help speed the recovery process post-trauma. Despite intensive physical therapy, many trauma patients never return to their pre-injury status. This finding suggests...

Opioid training development: Cultivating nurse competence through education.

Mental illness and substance use have become areas of concern throughout society. One of the greatest concerns affecting the United States is the increased prevalence of opioid use and accidental overdose. The opioid epidemic not only impacts adults, it also affects the nation's most vulnerable youth. Children and adolescents are at high risk for substance abuse due to multiple risk factors including negative life events, family dysfunction, and parental substance abuse. Pediatric nurses must be prepared to care for children and families who experience opioid addiction and overdose. The aim of the quality improvement project was to improve the skill set of nurses working with children and adolescents with substance use disorders (SUDs) in a pediatric psychiatric hospital. Nurses attended a 2-hr workshop focused on nursing interventions related to SUD utilizing Orlando's Nursing Theory and Brief Intervention Therapy. Following the workshop, nurses reported their perceived competence in caring for individuals at risk for or identified with SUD increased. The workshop appeared to be effective in increasing nurses' competence and confidence if working with youth and their families dealing with substance use issues.

4100 Chronic Pain in Refugee Torture Survivors

OBJECTIVES/GOALS: An estimated 87% of torture survivors, or 27 million people globally, suffer from chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation, placing vulnerable individuals at higher risk of drug abuse, and increasing healthcare expenditures. We hypothesized that the novel application in torture survivors of a validated pain screen can supplement the UNIP and improve its sensitivity for pain from approximately 15% to 90%, as compared to the reference standard. METHODS/STUDY POPULATION: In this prospective, blind comparison to gold standard study, 25 patients who survived torture by World Medical Association definition first received the standard evaluation protocol for torture survivors (United Nations Istanbul Protocol, UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory Short Form, BPISF) followed by a non-invasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. RESULTS/ANTICIPATED RESULTS: Providers using only the UNIP detected and treated pain in a maximum of 16% of patients as compared to 85% of patients who were diagnosed with pain by the reference standard. When employed, the validated pain screen had a sensitivity of 100% [95% CI: 72% - 100%] and a negative predictive value of 100%, as compared to a sensitivity of 24% [95% CI: 8% - 50%] and negative predictive value of 19% by the index test. The difference in the sensitivity of the UNIP as compared to the BPISF was significant, with p < 0.001. DISCUSSION/SIGNIFICANCE OF IMPACT : These data indicate that the current global standard assessment of torture survivors, the United Nations Istanbul Protocol, should be supplemented by the use of a validated pain screen to increase the accuracy of chronic pain diagnosis. This would change the standard medical assessment of 70.8 million people globally, a number that continues to rise by nearly 45,000 people each day. ClinicalTrials.gov protocol number NCT03018782.

Problematic Alcohol and Drug Use Is Associated with Low Self-Directedness and Cooperativeness

Background: Personality traits, such as self-directedness (SD) and cooperativeness (CO), may be indicative of problematic alcohol and/or drug use. Objectives: The aim of this study was to quantify the association of substance use with SD and CO in a large cohort of adolescents. Method: A total of 6,917 individuals (58% women) at the age of 18 who had filled in the Alcohol Use Disorder Identification Test (AUDIT) and Drug Use Disorder Identification Test (DUDIT), and the SD and CO scales from the Temperament and Character ­Inventory, as part of the Child and Adolescent Twin study in Sweden were included in the analyses. Results: High AUDIT scores (>15) were found in 2.4% of the population and high DUDIT scores (>7) in 1.2% of the population. Total score on the AUDIT was negatively correlated (p < 0.001) with SD (r = –0.18) and CO (r = –0.15), as well as total DUDIT with SD (r = –0.11) and CO (r = –0.08). The risk of high AUDIT (>15) and DUDIT (>7) was highest for those with a low (1 standard deviation below mean) SD score (ORs 4.1 and 4.5, p < 0.001) and a low CO score (ORs 3.5 and 4.5, p < 0.001). However, at 1 standard deviation above mean, no association between alcohol or drug use and SD or CO was seen. Using SD and CO scores to predict AUDIT >15 or DUDIT >7 yielded a sensitivity between 62.4 and 71.3% and a specificity between 64.9 and 70.4%. Conclusions: Personality traits of low SD and CO are associated with increased alcohol and drug use. These findings support the notion that personality traits can be used to identify individuals at high risk of substance abuse.

Prevalence of Substance Abuse (Tobacco, Alcohol, Narcotics and Psychotropic Drugs) and Its Relationship to Family Factors in Pre-university Male Students in Shiraz 2017-2018.

Teenagers are valuable resources in communities and they are faced with multiple risk factors. Factors such as family attachment, devotion to family, parent's educational level, and parental support are the protective factors against high-risk behaviors. The purpose of this study was to determine the prevalence of drug use among pre-university students and its relationship with familial factors. 1000 Fourth grade high-school male students were randomly selected during 6months in four districts of Shiraz City during 2017-2018. 14% of the participants were current smokers, 13.5% had a history of alcohol consumption, and 1% used psychotropic drugs, respectively. Moreover 59% of the participants who had consumed alcohol were cigarette smokers as well. 4.5% of them used all the three substances such as alcohol, tobacco and psychotropic drugs. Children whose parents do not set clear regulations or do not control their children are at higher risk of drug abuse.

Opioids for cancer pain: A growing quandary: Opioid prescriptions for cancer-related pain are facing greater scrutiny amid the nation's spiraling epidemic.

Opioids for cancer pain: A growing quandary: Opioid prescriptions for cancer-related pain are facing greater scrutiny amid the nation's spiraling epidemic.

A Preventive Approach to the Risk of Substance Abuse in Medical Personnel with Migraine: A Case Report

Background: Substance abuse as a major social and medical problem can be job-dependent. Objectives: Among various occupations, medical personnel have greater access to narcotic drugs, leading to mood, behavior, and occupational disorders and ultimately death due to lack of control. Methods: The present study reported a death of medical personnel with migraines owing to colleagues' inattention to substance abuse. Results: The case was a 44-year-old man with 24 years of clinical experience, good social relationship, no symptoms of psychiatric disorder, an expert in the field of anesthesiology, and a popular manager among hospital colleagues. Diagnosed with migraine headaches one year ago, he worked for several treatment centers. According to some reports, he showed ataxia in some cases due to the exacerbated headache. Additionally, ataxia and drowsiness after a headache attack were not considered the cause of drug abuse so that they were always attributed to the disease. Eventually, in a shift, he had a respiratory failure and then died of the overdose or non-control of fentanyl abuse. Conclusion: Medical personnel with migraine are at high risk of substance abuse in therapeutic settings. Therefore, it is suggested that periodic and intangible examinations be conducted for medical personnel, especially those with migraines in the field of substance abuse, and preventive counseling be provided.

Tobacco Product Use Among Lesbian, Gay, and Bisexual Adolescents.

Sexual minority youth face health disparities and a high risk of substance abuse. This study sought to fully characterize the disparity of tobacco use and risk factors in this high-risk subpopulation. Using data from the 2015 Youth Risk Behavior Survey, the current use of various tobacco products (cigarettes, smokeless tobacco, cigars, and e-cigarettes) was compared according to sex and distinct sexual identities (lesbian, gay, bisexual, and unsure). Heterosexual/straight adolescents served as the control group. Of 14 703 respondents, 88.8% were heterosexual/straight, 2.0% were lesbian or gay, 6.0% were bisexual, and 3.2% were unsure about their sexual identity. Sexual minorities had a higher prevalence of tobacco product use than their heterosexual/straight counterparts. Sex had a significant effect on the disparities of tobacco use. Lesbian and bisexual girls had higher odds of reporting current use of any tobacco product, cigarettes, cigars, and e-cigarettes than did straight girls, whereas sexual minority boys had similar smoking behaviors compared with straight boys. Substance use, including marijuana use, drinking, and binge drinking, was significantly associated with any tobacco use. Tobacco use differs among subgroups of sexual minority youth, with lesbians and bisexual girls having a higher prevalence of tobacco use than their straight peers. Heterogeneity of tobacco use across distinct sexual identity groups underscores the need to develop evidence-based tobacco control strategies for sexual minority youth.

Drug-caused deaths in Australian medical practitioners and health-care professionals.

There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent. Retrospective cohort study. The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner. A total of 404 drug-caused deaths reported to an Australian coroner between 2003 and 2013 involving HCPs (including medical practitioners, paramedics, nurses, dentists, psychologists, pharmacists and veterinarians). χ2 tests and descriptive statistics were used to examine relationships. The primary outcome measures were drug type and intent. Covariates included occupation type, mental illness and self-harm. Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group [confidence interval (CI)=42.21-58.79]. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) (CI=92.15-109.85). Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression (CI=33.48-44.12). Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians (χ2(7) =237.391). A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases. Between 2003 and 2013, Australian health-care professionals averaged 37 deaths per year attributed to drug toxicity, with a mortality rate of nearly five deaths per 1000 employed HCPs. Drug-caused deaths among HCPs in Australia commonly involve females in their mid-40s, with a diagnosis of mental illness, personal and professional stress and the intent to self-harm.

Two-stage model for time varying effects of zero-inflated count longitudinal covariates with applications in health behaviour research.

This study proposes a two-stage approach to characterize individual developmental trajectories of health risk behaviors and delineate their time-varying effects on short-term or long-term health outcomes. Our model can accommodate longitudinal covariates with zero-inflated counts and discrete outcomes. The longitudinal data of a well-known study of youth at high risk for substance abuse are presented as a motivating example to demonstrate the effectiveness of the model in delineating critical developmental periods of prevention and intervention. Our simulation study shows that the performance of the proposed model improves as the sample size or number of time points increases. When there are excess zeros in the data, the regular Poisson model cannot estimate either the longitudinal covariate process or its time-varying effect well. This result, therefore, emphasizes the important role that the proposed model plays in handling zero-inflation in the data.

Mental health, anthropometry and blood pressure among adolescents living in slums of Nashik, India

Background: Both hypertension and depression are common disorders and obesity is on the rise in low and middle-income countries. Because early life changes may prove to be precursors to the development of diseases in adult, assessing the mental and physical health of younger population is crucial. This study aimed to determine the association between blood pressure, mental health and anthropometric status of adolescents from urban slums in Nashik, India. Methods: A cross-sectional observational study was conducted among eligible adolescents during November 2010 and April 2011 in two randomly selected slums of Nashik, Maharashtra, India. A total of 545 adolescents were selected from 276 households. Data on socio-demographic indicators, anthropometry, blood pressure, mental wellbeing, and addictions were collected using pretested structured questionnaires by house visits. Mental wellbeing was examined using the General Health Questionnaire with 12 items (GHQ-12). A higher score indicates more-optimal mental wellbeing. Linear mixed effects models were used to analyse the data. Results: Girls had better mental wellbeing scores than boys. Adolescents with low mental wellbeing score had higher percentage of stunting (22%) compared to high scores. The factors associated significantly with systolic blood pressure (SBP) were age, mid mental wellbeing score, stunting, and thinness. For diastolic blood pressure (DBP), sex, high mental wellbeing score, and father's education were, in addition, also significant. When moving from the low to mid mental wellbeing score, SBP and DBP decreased and the same was observed for high score. The prevalence of prehypertension was 20%. Conclusion: The findings showed that the adolescents do run a higher risk of substance abuse, health-related problems and higher SBP and DBP if there is an evidence of distress. It brings into focus the importance of mental health management in adolescents.

The Effectiveness of Group Assertiveness Training on Happiness in Rural Adolescent Females With Substance Abusing Parents.

Background:Parental substance abuse confronts children with a variety of psychological, social, and behavioral problems. Children of substance abusing parents show higher levels of psychiatric disorders including anxiety and depression and exert lower levels of communication skills. Weak social skills in this group of adolescents put them at a higher risk for substance abuse. Many studies showed school based interventions such as life skill training can effective on future substance abusing in these high risk adolescences.Materials and Methods:The participants consisted of 57 middles schools girls, all living in rural areas and having both parents with substance dependency. The participants were randomly assigned to intervention (n=28) and control (n=29) groups. The data were collected before and six weeks after training in both group. The intervention group received eight sessions of group assertiveness training. Participants were compared in terms of changes in scores on the Oxford Happiness Questionnaire and the Gambrills-Richey Assertion Inventory.Results:The total score for happiness change from 43.68 ±17.62 to 51.57 ±16.35 and assertiveness score changed from 110.33±16.05 to 90.40±12.84. There was a significant difference in pretest-posttest change in scores for intervention (7.89±4.13) and control (-2.51±2.64) groups; t (55) =2.15, p = 0.049. These results suggest that intervention really does have an effect on happiness and assertiveness.Conclusion:Determining the effectiveness of these school based interventions on other life aspects such as substance abuse calls for further study on these rural adolescent girls.

The Prevalence and Pattern of Social Drug Abuse Among Students of Rift Valley University College, Bishoftu Campus, 2014, Bishoftu, Ethiopia

Background: Social drug include all substances and chemicals that act in the central nervous system, leaving the individual dependent upon prolonged use. College students are at higher risk of substance abuse. Since this is a serious problem to the individual users, the community and the country as whole, this problem has to be researched. Objectives: To determine the prevalence and pattern of social drug abuse among students of RVUC, Bishoftu campus. Methods: A cross sectional study was conducted on a sample of 356 students that are selected by employing conventional sampling procedure. Results: A total of 356 students were participated in the study. The response rate was 97.7%. One hundred eighty eight (54.0%) of the respondents were males, 168(48.3%) in the age group of 21-25 years, 176(50.6%) Oromo, 196(56.3%) Orthodox and 164(47.1%) of the students were from second year. The overall life time and current prevalence of social drug use among the study subjects were 156(44.8%) and 136(39.1%) respectively. The life time prevalence of alcohol drinking, khat use and cigarette smoking among the study participants were 40.2%, 35.6% and 18.4% respectively. Similarly, the current prevalence of alcohol drinking, khat chewing and cigarette smoking were 35.6%, 29.9% and 14.9% respectively. The most common reason for social drugs abuse among university students were to for relaxation with friends 84(53.8%), peer pressure 72(46.2%) and to get relief from stress 56(35.9%) respectively. Conclusion: The study has identified that substance abuse is a serious problem among RVUC student. The commonly abused substances were alcohol, khat, and cigarette in descending order. Most of the students started substances abuse during their High school and preparatory study period. This study indicates that adolescents and youths should be educated about the problem of abusing social drugs and higher institutions should teach their students about the health risks and socioeconomic problems associated with substances abuse.

Potential Psychological Factors Associated with High Risk for Cannabis Abuse: Evidence from Multiple Logistic Regression

The aim of the present study was to provide a list of psychological variables likely to explain cannabis abuse among adolescents and young adults based on the following psychological risk factors: anxiety, depression, difficulty in describing feelings, difficulty in identifying feelings, and external oriented thought. The analysis was based on the multiple logistic regression technique; the step-wise procedure showed that only anxiety, depression, and difficulty in describing feelings were retained in the final model. Following this, additive versus interactive models under different assumptions between the three independent variables were also assessed. The key findings of this study are twofold: (a) anxiety was revealed to be the primary risk factor for cannabis abuse and (b) no interaction between the aforementioned factors proved to be significantly informative in explaining high risk cannabis abuse. Findings were discussed in the context of the current knowledge of the relationship between anxious and depressive symptoms and higher risk of substance abuse and dependence.

Increasing Cultural Awareness and Sensitivity: Effective Substance Treatment in the Adult Lesbian Population

In the United States, lesbians are the subject of discrimination due to homophobic practices. Within the realm of substance abuse, there are disparities in substance use and treatment. Literature was reviewed to assess factors that contribute to lesbian substance abuse and effective treatment modalities that provide positive outcomes for this population. Literature suggested several reasons for a lesbian's higher risk for substance abuse including social stigma, discrimination, difficulty with identity development, and obstacles in relationship acceptance by society. Literature points to the importance of cultural competency and gay affirmative substance abuse treatment practitioners when working with lesbian clients. Recommendations for substance abuse practitioners are presented.