Prior Substance Use Research Articles

Substance use and menopausal symptoms among people with and without HIV in the US, 2008-2020.

The aim of the study is to assess associations between substance use and menopausal symptoms among US people living with and without HIV in a longitudinal cohort. We analyzed self-reported menopausal symptoms and substance use from biannual Women's Interagency HIV Study (WIHS) visits from 2008-2020. Substance use since the last visit or lifetime cumulative use included tobacco, alcohol, marijuana, crack/cocaine, and opioids. Logistic regression quantified associations between each substance use and menopausal symptom frequency (vasomotor, mood, and musculoskeletal), adjusting for other substance use, HIV status, demographics, comorbidities, and trauma. A total of 1,949 participants contributed early perimenopausal, late perimenopausal, or postmenopausal study visits. Across reproductive-aging stages, based on menstrual history, and among participants with and without HIV, participants reported frequent vasomotor (range 22-43%), mood (18-28%), and musculoskeletal (25-34%) symptoms. Many reported ever using tobacco (72%), heavy alcohol (75%), marijuana (73%), crack (50%), and opioids (31%). Current heavy alcohol use (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.10-1.37), cumulative marijuana use (OR: 1.15, 95% CI: 1.01-1.32), and cumulative tobacco use (OR: 1.06, 95% CI: 1.01-1.12) were associated with a higher frequency of vasomotor symptoms; current heavy alcohol use (OR: 1.20, 95% CI: 1.04-1.39) and current opioid use (OR: 1.13; 95% CI: 1.01-1.25) were associated with mood symptoms; and current opioid use (OR: 1.11, 95% CI: 1.00-1.23) was associated with musculoskeletal symptoms. All other associations were found to be null. Current and prior substance use may independently affect symptoms experienced during the menopausal transition and may indicate potential to benefit from additional intervention and referral to menopause specialty care.

Creatine monohydrate use is prospectively associated with muscle dysmorphia symptomatology

This study aimed to determine the prospective association between creatine monohydrate use and muscle dysmorphia symptomatology among adolescents and young adults in Canada. Data from 912 adolescents and young adults from the Canadian Study of Adolescent Health Behaviors were analyzed. Creatine monohydrate use in the past 12 months was assessed at Wave 1, and muscle dysmorphia symptomatology was measured using the Muscle Dysmorphic Disorder Inventory (MDDI) at Wave 1 and Wave 2. The prospective associations between creatine monohydrate use and the MDDI total score and subscale scores were determined using linear regression analyses. Regression analyses controlled for relevant demographic identifiers, prior substance use, and the corresponding Wave 1 MDDI variable. Creatine monohydrate use at Wave 1 was prospectively associated with both total muscle dysmorphia symptomatology (B 1.34, 95 % CI 0.27, 2.42) and greater Appearance Intolerance (B 0.52, 95 % CI 0.02, 1.03) at Wave 2. Importantly, these findings were independent of prior muscle dysmorphia symptomatology, lifetime anabolic-androgenic steroid use, lifetime cigarette use, and frequency of alcohol use. Creatine monohydrate is commonly used among adolescents and young adults. Findings from this study are among the first to document that creatine monohydrate use may be a risk factor for the development of muscle dysmorphia symptomatology among adolescents and young adults. Health and mental health care professionals may consider assessing for both creatine monohydrate use and muscle dysmorphia symptomatology among adolescents and young adults.

Psychopathy, psychological distress, and treatment history among perpetrators of intimate partner femicide, homicide, and other violent crimes in Buenos Aires, Argentina

Intimate partner femicide—the killing of women based on their gender by their former or current partners—is a global long-standing manifestation of violence against women. Despite the enactment of femicide-specific laws in Latin America, femicide rates have remained relatively constant throughout the last decade. Often perpetrators are pathologized as suffering from mental illness, yet the data on their mental health status is still relatively unknown. Thus, more research is needed to understand the extent of poor mental health among these individuals. The purpose of this study was to compare levels of psychopathy, psychological distress, and treatment history among an all-male sample of intimate partner femicide perpetrators, male-male homicide perpetrators, and offenders convicted of other violent crimes in Buenos Aires, Argentina. This study utilized a cross-sectional survey based on data derived from a two-stage sampling strategy. The questionnaire included two standardized instruments for the measurement of psychopathy (revised Psychopathy checklist and the Levenson Self-Report Psychopathy scale) and one for general distress (Spanish version of 12-item General Health Questionnaire). The final sample included 205 prisoners including 68 intimate partner femicide perpetrators, 73 homicide perpetrators, and 64 individuals convicted of other violent crimes. There were no significant differences across these groups based on their socio-demographic characteristics. Participants did not differ in terms of their psychopathology; however, femicide perpetrators were statistically more likely to experience psychological distress. In addition, femicide perpetrators self-reported more prior episodes of mental and substance use treatments. The findings of increased psychological distress and prior mental health and substance use treatment among femicide perpetrators suggest that there may be missed opportunities for femicide prevention within the public health subspecialties of mental health and substance use disorders. This study suggests that femicide perpetrators likely require distinctive interventions, including self-assessments and harm mitigation tactics, to prevent their potential for femicide perpetration.

Latent Trajectories of Persistence of Cannabis Use Across Four Decades in 329 Men From the San Diego Prospective Study.

These analyses use data from a 40-year prospective study to extend information into the sixth and seventh decades of life regarding latent trajectory classes of cannabis use and predictors of those classes. Data from the San Diego Prospective Study were analyzed for 329 men of European and Hispanic ethnicity who had used cannabis at about age 23 at study entry (Time 1) and who were interviewed about every 5 years through about age 60 to 70. Latent classes of cannabis use trajectories were evaluated using latent class growth analyses, baseline predictors of class membership were determined, and significant predictors of each class were established using logistic regression analyses. Four latent classes were identified ranging from 12.5% with cannabis use at every follow-up to 25.8% with no use after Time 1. Eight of 14 Time 1 predictors differed significantly across the trajectory classes, including five (age, marital status, religious identity, intensity of cannabis use, and sensation seeking) that significantly contributed to regression analyses when all significant predictors were considered together. Forty-two percent of participants continued using cannabis long-term, including one in eight who used it at every follow-up. Predictors of continued use and identification of those most likely to stop required gathering information on a range of demographic, prior substance use, and personality characteristics. Considering the potential enhanced dangers of cannabis use in later life, the high rate of continued use over four decades implies that clinicians should ask all older patients about recent cannabis use, especially if they had used it in their 20s.

Brain activation in response to art-based tasks using diverse materials based on the Expressive Therapy Continuum (ETC)

This study investigated the relationship between art creation and brain function using functional near-infrared spectroscopy (fNIRS) via a portable NIRSIT device, focusing on the frontal lobe’s oxygen saturation changes during art activities. Authorized by the Institutional Review Board of Seoul Women’s University, the research involved 26 healthy participants aged 20 to 29, without prior mental, medical, or substance use issues. They engaged in four art tasks, separated by rest periods, to monitor pre- and post-task brain activity through fNIRS scans.The research unfolded in two phases: initially, it analyzed brain activity based on the Expressive Therapies Continuum (ETC) framework, comparing different art mediums; next, it then examined differences between drawing on paper and on a digital tablet.Findings indicated unique activation patterns in various brain regions—including the Ventrolateral Prefrontal Cortex (VLPFC), Orbitofrontal Cortex (OFC), Dorsolateral Prefrontal Cortexes (DLPFC), and the parietal cortex—highlighting a notable increase in the Left Frontopolar and Orbitofrontal Cortexes during paper drawing compared to tablet drawing. These results provide insights into how different art mediums influence neural activation, particularly showing enhanced activity in regions linked to empathy and feedback in paper-based tasks. It clearly suggests that different art materials significantly influence varying brain region activation, highlighting the importance of art medium and art-making in art therapy in enhancing cognitive and emotional functions.By examining changes in frontal lobe oxygen saturation via diverse art activities grounded in the ETC framework, this study contributes to understanding art therapy’s neurological impact on cognitive and emotional functions. It offers evidence-based guidance for art therapists on selecting materials that meet therapeutic objectives. The study’s limitations include a small sample size that may affect the generalizability of the findings and the exclusive use of NIRSIT focusing on the frontal cortex, potentially neglecting the involvement of other brain regions like the temporal and parietal cortexes in art activities. Future research should therefore consider expanding the sample size and employing comprehensive neuroimaging techniques.

Patient-Physician Sex Discordance and "Before Medically Advised" Discharge from Hospital: A Population-Based Retrospective Cohort Study.

Patient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with "before medically advised" hospital discharge (BMA discharge; commonly known as discharge "against medical advice"). To evaluate whether patient-physician sex discordance is associated with BMA discharge. Retrospective cohort study using 15years (2002-2017) of linked population-based administrative health data for all non-elective, non-obstetrical acute care hospitalizations from British Columbia, Canada. All individuals with eligible hospitalizations during study interval. Exposure: patient-physician sex discordance. BMA discharge (primary), 30-day hospital readmission or death (secondary). We identified 1,926,118 eligible index hospitalizations, 2.6% of which ended in BMA discharge. Among male patients, sex discordance was associated with BMA discharge (crude rate, 4.0% vs 2.9%; adjusted odds ratio [aOR] 1.08; 95%CI 1.03-1.14; p = 0.003). Among female patients, sex discordance was not associated with BMA discharge (crude rate, 2.0% vs 2.3%; aOR 1.02; 95%CI 0.96-1.08; p = 0.557). Compared to patient-physician sex discordance, younger patient age, prior substance use, and prior BMA discharge all had stronger associations with BMA discharge. Patient-physician sex discordance was associated with a small increase in BMA discharge among male patients. This finding may reflect communication gaps, differences in the care provided by male and female physicians, discriminatory attitudes among male patients, or residual confounding. Improved communication and better treatment of pain and opioid withdrawal may reduce BMA discharge.

Prior psychiatric morbidity and differential psychopharmacological treatment patterns: Exploring the heterogeneity of bipolar disorder in a nationwide study of 9594 patients.

Individuals with bipolar disorders (BD) have heterogenic pre-onset illness courses and responses to treatment. The pattern of illness preceding the diagnosis of BD may be a marker of future treatment response. Here, we examined associations between psychiatric morbidity preceding the diagnosis of BD and pharmacological treatment patterns in the 2 years following diagnosis. In this register-based study, we included all patients with a diagnosis of BD attending Danish Psychiatric Services between January 1, 2012 and December 31, 2016. We examined the association between a diagnosis of substance use disorder, psychosis (other than schizophrenia or schizoaffective disorder), unipolar depression, anxiety/OCD, PTSD, personality disorder, or ADHD preceding BD and pharmacological treatment patterns following the diagnosis of BD (lithium, valproate, lamotrigine, antidepressants, olanzapine, risperidone, and quetiapine) via multivariable Cox proportional hazards regression adjusted for age, sex, and year of BD diagnosis. We included 9594 patients with a median age of 39 years, 58% of whom were female. Antidepressants, quetiapine, and lamotrigine were the most commonly used medications in BD and were all linked to prior depressive illness and female sex. Lithium was used among patients with less diagnostic heterogeneity preceding BD, while valproate was more likely to be used for patients with prior substance use disorder or ADHD. The pharmacological treatment of BD is linked to psychiatric morbidity preceding its diagnosis. Assuming that these associations reflect well-informed clinical decisions, this knowledge may inform future clinical trials by taking participants' prior morbidity into account in treatment allocation.

Symptom Trajectories of Youth in Live-In Treatment Facilities Before, During and After the COVID-19 Pandemic

ABSTRACT COVID-19 and contagion mitigation efforts forced health care workers to very quickly develop and implement new policies aimed at reducing virus transmission. Such safety measures, while helping to reduce COVID-19 may result in decreased therapeutic effectiveness. We examined the impact of COVID-19, as well as several individual differences on the mental and behavioral health trajectories of 176 youths residing in several live-in treatment centers (M age = 15.30 years). Longitudinal data were collected at Intake, Discharge and 6-months post treatment, with timepoints spanning before and after COVID-19 lockdown. We observed an interaction between COVID-19 and prior substance use; youth who reported drug or alcohol use in the 30 days prior to Intake had worse treatment trajectories compared to those without prior use, but only when treatment started before lockdown mandates were implemented. For youth who entered treatment after lockdown had started, there was no difference in treatment outcomes between those with and without prior substance use. We also found an effect of family functioning whereby youth with more adaptive family functioning had better treatment trajectories. Practical implications are discussed.

Distribution of intranasal naloxone to potential opioid overdose bystanders in Sweden: effects on overdose mortality in a full region-wide study

ObjectivesDistribution of take-home naloxone is suggested to reduce opioid-related fatalities, but few studies have examined the effects on overdose deaths in the general population of an entire community. This study...

Substance Use Disorder and Suicidal Ideation in Rural Maryland

Background Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland. Methods The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender. Results Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation. Conclusions The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.

Access to Rehabilitation After Hospitalization for Traumatic Brain Injury: A National Longitudinal Cohort Study in Sweden

Background Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear. Objective To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors. Method We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15 880 TBI patients ≥18 years hospitalized ≥3 days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n = 1366; most severe), grade II (n = 5228), and grade III (n = 9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients ≥65 years) during the hospital stay, and/or within 1 year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors. Results Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81). Conclusion Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.

Is there a gender paradox in the association between conduct problems and cannabis use? A cohort-study among Swedish adolescents.

Conduct problems (CP) predict cannabis use prospectively but the research is mixed as to whether this association is stronger among girls. A stronger association among girls would suggest a 'gender paradox' as both CP and cannabis use is less common in this group. This study aimed to assess whether the longitudinal association between CP and cannabis use in Swedish adolescents is stronger among girls. Data from two waves of a nationally representative cohort study of Swedish adolescents born in 2001 were used. Baseline measurements were collected in 9th grade (at age 15-16) and follow-up measures at 11th grade (at age 17-18). CP at baseline were significantly associated with cannabis use at follow-up adjusted for hyperactivity problems, emotional problems, socio-demographics, parental monitoring, school grades and truancy at baseline (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06-1.24) but not when also adjusting for substance use at baseline. Boys were more likely to have used cannabis during the past year, even when controlling for prior substance use (OR 2.29, 95% CI 1.76-2.98). The association between CP and cannabis use was significantly weaker for boys (OR 0.83, 95% CI 0.72-0.95 in the fully adjusted model). The predicted probability of cannabis use was stable at 0.13 for boys across levels of CP, but ranged from 0.05 to 0.16 for girls. The longitudinal association between CP and cannabis use was stronger among girls. The findings are indicative of a 'gender paradox' in the association between CP and cannabis use.

Substance Use among Emerging Adults during the COVID-19 Pandemic: A Review through the Lens of Sustainable Development Goals.

Public health initiatives, including lockdowns to reduce the spread of COVID-19, have resulted in societal stressors like loneliness, job loss, and economic collapse linked to worsening mental health outcomes, such as depression, anxiety, and coping-related substance use. The various psychosocial stressors caused by the pandemic have potentially led to the increased use of substances across the globe, particularly among emerging adults. The current study summarises the literature on substance use among emerging adults during the COVID-19 pandemic. The terms "coronavirus", "COVID-19", "substance use", "substance abuse", "drug use", drug abuse", "emerging adults", and "young adults" were all used in different combinations throughout the search, using the Scopus, PubMed, and JSTOR databases. Using this method, a total of 28 English-language citations published between 2020 and 2023 were obtained. Following a study of the articles mentioned above, 16 papers were removed. The remaining 12 papers were included in this review. Even though substance use dropped when COVID-19 lockdowns began, it rose when restrictions were removed, particularly among those with prior substance use. Studies related to mental health need to assess substance use, as many emerging adults use substances to cope with distress, including isolation and loneliness, which are part of the current mental health crisis among emerging adults.

A Longitudinal Analysis of Monthly Changes in Substance Use in Relation to Negative Consequences From Alcohol and Cannabis Use in a Community Sample of Young Adults.

Experiencing negative substance use consequences may deter future use, alter patterns of substance use (e.g., substituting one substance for another, combining substances), or point to a sustained pattern of engaging in heavy or frequent use. We used monthly data to examine relationships between negative alcohol and cannabis use consequences experienced in one month and changes in use the following month. Data were from 508 individuals (59% female; ages 18-23 years at enrollment) who were surveyed monthly for 2 years and used both alcohol and cannabis during the study period. Multilevel models assessed within-person associations between monthly fluctuations in substance-related negative consequences and the next month's substance use (i.e., typical drinks per week, cannabis use frequency, and simultaneous alcohol and cannabis/marijuana [SAM] use), controlling for the prior month's substance use. Positive associations were found between alcohol consequences and the following month's alcohol use and between cannabis consequences and subsequent cannabis use, although only the cannabis association was statistically significant. There was little evidence of effects of cannabis consequences on the next month's alcohol use or alcohol consequences on the next month's cannabis use. Cannabis consequences had a positive and statistically significant association with the next month's SAM use. Within-substance positive associations were strongest for physical alcohol consequences and cannabis consequences of low motivation, memory problems, and trouble breathing. Experiencing negative cannabis use consequences predicted more frequent cannabis use and greater chance of SAM use 1 month later. Results point to negative consequences, along with prior use, indicating risk for future use.

Factors associated with use of opioid rescue medication after surgery

BackgroundOpioid exposure after surgery increases risk of persistent opioid use. Here, we characterize at-home use of opioid rescue medication during 1–2 days after outpatient surgery (N=270) in a postoperative opioid-sparing...

Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors.

Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD. This narrative review captures a subset of recent advances in the field targeting the literature on patients' risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. To reduce OUD, providers should evaluate both the individual patient's risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.

The relationship between victimization and vaping results from monitoring the future

Previous studies found a positive relationship between prior violent victimization experience and substance use among adolescents based on general strain theory. However, there is limited knowledge on the link between violent victimization and vaping, which is a relatively new method of substance use. Therefore, the current study applies general strain theory to examine the relationship between violent victimization and vaping. Three types of vaping, nicotine, marijuana, and flavor only, are examined in correlation with violent victimization, utilizing data from the 2019 cohort of the Monitoring the Future study (MTF). The findings suggest that students with violent victimization experience are more likely to engage in vaping. Also, students with stronger negative emotions, weaker social bonds, and more unstructured time with peers are more likely to vape. The current study provides empirical evidence on using general strain theory to explain vaping behavior among students. Applicable policies are also discussed.

Mediating the Worst of Both Worlds Effect with Facets of Criminal Thought Process: Moral Neutralization, Cognitive Impulsivity, and Their Interaction

ABSTRACT The Worst of Both Worlds (WBW) hypothesis holds that prior offending and substance use in combination is significantly more likely to lead to antisocial behavior than either prior offending or prior substance use alone. In an effort to better understand the mechanisms behind the WBW effect, we performed a causal mediation analysis in which moral neutralization and cognitive impulsivity served as mediators of the WBW-delinquency relationship in a group of 845 (406 boys, 439 girls) early adolescents. We then tested the indirect effect for each pathway using longitudinal data and bias-corrected bootstrapped confidence intervals. Results showed that moral neutralization, but not cognitive impulsivity or the neutralization x impulsivity interaction, mediated the relationship between WBW and delinquency. These findings indicate that moral neutralization may play a salient role in the WBW effect by linking offending-substance comorbidity to future antisocial behavior. There is a need for additional research, however, to ascertain how and why comorbid criminal offending and substance use/abuse link specifically to moral neutralization, whereas there appears to be no connection between crime-substance comorbidity and cognitive impulsivity.

A Systematic Review of Intravenous Psychoactive Drug Use among Adolescent Females

Background: In the twenty-first century, female adolescents’ use of intravenous psychoactive substances has become widespread worldwide. For instance, statistics show that 155 and 250 million people between the ages of 15-64 used intravenous psychoactive drugs as of 2008. Examples of intravenous psychoactive drugs taken by people with 15-64 include; Amphetamines, non-prescribed psychoactive prescription drugs, cannabis, cocaine, and opiates. As a result of the preceding, the use of intravenous psychoactive drugs among Female adolescents is a common phenomenon in the 21st century. Aim: To undergo a systematic review on IV psychoactive drugs use, prevalence, causes and effects among adolescent females. Design: A systematic review. Data Sources: Systematic search for worldwide published literature from databases like google scholar, Emerald, PubMed, and science-direct. Study Eligibility Criteria: Articles that are published in English, primary research and studies published within the last 10 (ten) years (2013-2023). Results: From the 2000 published papers that was found, 1700 publications were screened out owing to duplicate data. In addition, 60 publications were eliminated because they did not have appropriate information for this current study, and 200 papers were eliminated because of erroneous information. For being overly shallow, 29 publications were ignored. In the end, this study included 11 (eleven) publications. Conclusion: Worldwide, there is a high prevalence of female adolescents using intravenous psychoactive drugs. The causes include feelings of helplessness following family separation, poor academic performance, a physical environment, prior substance use, recreational alternatives, socialisation issues, and inadequate organisational support. Cardiovascular illness, psychological diseases like anxiety, dependency, mood, and psychosis disorders, as well as various Hormonal Contraceptives, are all consequences of intravenous psychoactive drug use among female teenagers (HC). According to this study, more Motivational Enhancement Therapy (MET), family counselling, and cognitive-behavioural therapy should be used to free female adolescents from the shackles of intravenous psychoactive substance use.

'Let Others Love You Back to Health': The Role of Performance-based Support Groups for People in Recovery.

Peer support groups have become widely utilized among those in recovery from problematic substance use. Yet, these peer-based programs vary and research examining their effectiveness has yielded mixed results. Relatively less is known about the impacts of arts-based peer recovery programs. Some research suggests that theatre may offer a powerful tool to address biopsychosocial changes among individuals in recovery. To explore the role of arts-based peer support programs, we draw on qualitative interviews with performers in two arts-based recovery programs. Our findings suggest that arts-based peer recovery programs may aid individuals in recovery in four main ways. Performing allowed participants to build relationships with others in recovery, channel experiences creatively while challenging stigma, foster confidence and recovery-identity formation, aiding participants in working through emotional impacts of prior substance use. These findings support emerging scholarship examining the role of performance in challenging stereotypes about substance use to aid those in recovery.