Problematic Substance Use Research Articles

The “Cycle” of HIV: Limits of Personal Responsibility in HIV Vulnerability Among Transgender Adolescents and Young Women in Lima, Peru

Globally, transgender women (TW) face a high burden of the HIV epidemic. In Peru, HIV prevalence among TW rises at age 25, indicating a need to understand HIV vulnerability as adolescents reach adulthood. The life course of TW is often marked by abuse, discrimination and poverty fueled by transphobic stigma. Approaches to the HIV epidemic among TW and adolescents emphasize problem behaviors such as unprotected sex and substance. However, there has been a call for HIV research and interventions to understand and leverage community strengths. This qualitative study utilized a transgender-oriented, strength-based, intersectional and feminist approach to understand the strengths and protective health behaviors among 17 transgender adolescents and young women (TAYW) age 16–24 in Lima, Peru. Most participants re-located to Lima from the Amazon due to familial rejection, and engaged in obligatory sex work. TAYW demonstrated self-knowledge, motivation for education, efforts to secure employment, strong community networks, legal advocacy, avoiding problem substance use, HIV knowledge and condom use. However, strengths were impeded by multi-level barriers such as familial physical abuse, educational discrimination, and sexual assault which led to increased HIV vulnerability. We created a conceptual model of the “cycle” of HIV to describe the limits of personal responsibility within a vulnerable community denied access to family, education, employment and human rights. We recommend researchers, clinicians and public health workers follow the lead of TAYW at the frontlines of the HIV epidemic, and support beloved communities and enabling environments which may permit protective behaviors to mitigate HIV vulnerability.

Burden and satisfaction with social support in families with a history of problematic substance use or dementia – a comparison

BackgroundLiving in a family with a history of problematic substance use or dementia is a major stressful experience for family members and results often in an impaired health condition. Seeking and receiving social support has been emphasized as a major resource while coping with this stress. However, especially family members of people with problematic substance use often refrain from help-seeking. This paper examines whether (1) family members of problematic substance users are more physically and psychologically distressed than caregivers of people with dementia, and (2) whether and to what extent differences are mediated by satisfaction with perceived professional and private social support.MethodsTwo samples of family members of people with a chronic disease (problematic substance use (n = 221), dementia (n = 322)) completed self-administered questionnaires on burden, quality of life and social support. Physical distress was assessed using the Giessen Subjective Complaints List, psychological distress using the Center for Epidemiological Studies Depression Scale and anxiety symptoms using the Hospital Anxiety and Depression Scale. Quality of life was measured using the WHOQOL-BREF, and satisfaction with professional and private social support was assessed using a visual analog scale. Multivariate analyses of variance were performed to compare the two groups on the means of (1) burden ratings and (2) QoL dimensions and followed up by discriminant analyses to explore meaningful variables according to group differences. Parallel mediation analyses were performed to test the mediators private and professional support.ResultsFamily members of problematic substance users score higher on the burden indicators, while they score lower with regard to the quality of life dimensions than caregivers of people with dementia. The difference in burden is mainly explained by the higher scores for exhaustion, stomach discomfort and depression of family members of problematic substance users. Caregivers of people with dementia reported greater satisfaction with perceived social support, either private or professional. Satisfaction with private support was shown to be more important in mediating the impact of stress.ConclusionsFamily members of people with problematic substance use are in great need of tailored support programs and should be explicitly targeted.

On the rise or areturn to pre-pandemic levels? A cross-sectional online survey on nicotine, alcohol, and illicit drug use among youth.

The COVID-19 pandemic has had unprecedented and deteriorating effects on the mental health of adolescents and young adults. Various studies have described changes regarding substance abuse, but findings are conflicting. We conducted across-sectional online survey on nicotine, alcohol, and illicit drug use. From March to May 2023, 502 participants aged 14-24 from acommunity-based sample completed the questionnaire. We found ageneral trend of declining or stable substance use during the first 2years of the pandemic; however, in the third year (i.e., 2022), substance use returned to pre-pandemic levels or exceeded it. Compared with young adults (age19-24), adolescents' (age14-18) use increased more clearly. Participants who scored above the cut-off on screening measures for problematic substance use showed amore pronounced increase in the use of cigarettes and illicit drugs but not of alcohol. Higher alcohol consumption during lockdowns was associated with increased likelihood of current problematic alcohol (odds ratio [OR]: 3.03) and cannabis use (OR: 2.60). Furthermore, individuals who reported increased usage of one psychotropic substance during lockdowns were more likely to have increased their use of other substances as well (OR: 2.66-4.87). Although not optimally generalizable due to the retrospective online format and convenience sampling, our results support the notion that special attention ought to be paid to certain subgroups such as younger people and those who already exhibit problematic substance use during the pandemic. Following up on post-pandemic trends in substance use is crucial for developing prevention measures and targeted interventions.

Conceptualizing problematic use of medicinal Cannabis: Development and preliminary validation of a brief screening questionnaire.

The use of Medicinal Cannabis (MC) for treating chronic pain is increasing, globally, yet the definition of problematic MC use remains unclear. Defining problematic use of cannabis in medical and non-medical contexts may be fundamentally different since individuals prescribed MC often experience physical dependence, which do not necessarily imply pathology. We aimed to conceptualize problematic use of MC and develop a brief questionnaire for identifying and quantifying problematic MC use. Content validation used a broad definition of problematic substance use, adapting and compiling an initial list of 36 items from various sources: (a) screening tools for assessing problematic prescription opioid medication use; (b) screening tools for problematic recreational cannabis use and (c) qualitative interviews with MC patients. 390 American self-identified chronic pain patients holding a MC card rated each item from the initial list on a 5-point frequency scale and filled out questionnaires assessing various clinical outcomes. Following initial item titration, a multi-group measurement invariance comparison strategy, using two external indicators: alcohol-related problems and depression, resulted a final eight-item list that met fit quality in a baseline model, presented excellent internal consistency reliability (α=0.929), and significantly correlated with anxiety and low quality of life. Items in the final list related predominantly to negative consequences of MC use. Problematic use of MC is characterized by negative physiological, social, emotional and functional consequences. The final eight-item list was named the Medicinal Cannabis Negative Consequences Scale (MCNCS), emerging as a brief measure for problematic MC use and demonstrating preliminary reliability and validity, which could aid clinicians and researchers.

Child welfare workers’ understanding of gender, sexual orientation and sexual health in assessments of youths with a problematic substance use

ABSTRACT The use of alcohol or illicit substances by youths may be related to sexual motives and experiences. Accordingly, child welfare workers need to address young people’s sexuality in their investigative work. In this study, we have examined the significance of different social categories, namely gender and sexual orientation, when child welfare workers assess young people with a substance use and their related sexual health. Fifteen child welfare workers were recruited through a strategic sampling to participate in semi-structured interviews, which were analysed using thematic content analysis. The results consist of three sub-themes: Sexually vulnerable girls; Boys as perpetrators; and Unseen LGBTQ+ youth. Together, these sub-themes constitute an overarching theme where the heterosexual matrix appears to be the interpretative framework when investigating a problematic substance use. The suggested implications for practice include education in sexual and reproductive health and rights for child welfare workers aiming to achieve an equitable assessment process for all youth with a problematic substance use.

How Social Workers Can Be Deployed to Assist with the Ongoing Opioid Crisis.

The opioid epidemic has claimed more than 1 million lives in the United States over the past two decades. The persistent increase in deaths indicates that current strategies intended to decrease the negative consequences of opioid use are inadequate. Harm reduction strategies are designed to promote safer substance usage and reduce overdose mortality rates, yet the implementation of harm reduction programs is inhibited by community- and provider-level stigma against people who use opioids, coupled with limited understanding and insufficient education about harm reduction approaches. Despite ongoing research, engagement in opioid treatment programs remains a challenge, and the opioid crisis continues to disproportionately harm marginalized populations. This article describes how social workers are prepared to play a larger role in opioid use treatment because they are trained with the skill set and values necessary to facilitate access to harm reduction programs, promote engagement in substance use treatment, and create and advocate for interventions to address problematic substance use, especially in high-need communities.

Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use.

Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people. Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health. Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=-0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=-0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs. Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.

Examining risk and protective factors for mental health among school-going tribal adolescents in Meghalaya, India: Insights from the communities that care youth survey [CTC-YS

Risk and protective factors play crucial roles in shaping problem behavior, substance use, and mental health outcomes among adolescents. The study aims to examine the risk and protective factors and their association with emotional and behavioral problems among school-going tribal adolescents in Meghalaya, India. This study employed a cross-sectional design, utilizing a simple random sampling method to select schools from the Ri-Bhoi district (Nongpoh town) and East Khasi Hills district (Shillong cantonment area) of Meghalaya. A total of 450 students participated in the survey, out of which 300 students belonged to tribal ethnicity. The study focused on school-going adolescents with tribal ethnicity, aged 13-19 years, encompassing both genders (male and female). Participation in the study required both parental consent and the adolescent's assent. The Communities That Care Youth Survey (CTC-YS) and the Strength and Difficulty Questionnaires (SDQ), scale were administered. The findings highlighted significant risk factors including laws and norms favorable to drug use, community disorganization, poor family management, and low school commitment. Protective factors such as opportunities for prosocial involvement were evident across all domains. Family conflict, family history of antisocial behavior, and parental overcontrol were significant contributors (P < 0.05) to total difficulty scores. Among individual risk factors, "Interaction with anti-social peers" (P = 0.009) and "Intentions to use substance" (P = 0.021) had significant associations with higher difficulty scores. The overall prevalence of mental health problems, as indicated by the total difficulty score, was 31.3% among school-going tribal adolescents. The high prevalence of mental health problems, especially among tribal adolescents, underscores the urgent need for targeted interventions. By addressing these factors, policymakers and stakeholders can work toward fostering healthier outcomes for tribal adolescents in Meghalaya and similar communities.

Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6

ObjectiveThe aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample. MethodsWe used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors. ResultsAmong people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16–2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications. ConclusionOur findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.

Interest in and Willingness to Use PrEP: A Cross-Sectional Study of Individuals with Problematic Substance Use Residing in a High HIV Prevalence Jurisdiction

Although it is an effective HIV prevention method, pre-exposure prophylaxis (PrEP) is underutilized in the Southern US. Many people who use drugs (PWUD) have increased susceptibility to HIV which could be lessened by using PrEP. Potential barriers to PrEP use include lack of awareness of PrEP, low knowledge about HIV prevention, low self-efficacy for HIV prevention, inaccurate risk perceptions, and anticipated stigma. The current study examined predisposing, enabling, and reinforcing factors that may predict interest in PrEP. The purpose of the current study was to explore factors associated with interest in and willingness to use daily oral and long acting injectable PrEP among sexually active adult PWUD. The data were collected from adult participants (n = 270) residing in Harris County, TX, who self-reported problematic substance use and who reported oral, anal, or vaginal sex in the six months prior to completing the survey. The survey was distributed and completed online via Qualtrics Panels in March of 2022 and included measures of PrEP and HIV knowledge, PrEP stigma, sexual health self-efficacy, experiences of discrimination, health literacy, and medical mistrust. The majority of participants reported circumstances or behaviors that increased their susceptibility to HIV. Findings indicated that PrEP user stereotypes and PrEP anticipated disapproval by others were associated with interest in using daily oral PrEP and willingness to use long acting injectable PrEP. These results provide insight into reasons for low PrEP uptake among PWUD who live in a high HIV prevalence jurisdiction. Implications for HIV prevention intervention are discussed.

Distress tolerance is linked with substance use motivations and problems in young adults across four continents.

People low in trait distress tolerance are at higher risk for harmful patterns of substance use. Some evidence suggests that maladaptive motives for substance use account for this correlation. However, the generality of these associations remains in doubt because virtually all available data come from North American samples. Using data from 7 countries (total N = 5858; U.S., Argentina, Uruguay, Spain, South Africa, Canada, and England), we examined distress tolerance's association with alcohol- and cannabis-related problems in young adults. On an exploratory basis, we examined how distress tolerance related to different substance-use motivations. We found that distress tolerance was inversely related to problematic alcohol and cannabis use (rs = -0.14 and - 0.13). There was notable variation across countries in the magnitude of these effects, particularly for cannabis-related problems. Additionally, exploratory analyses revealed statistically significant (cross-sectional) indirect effects of distress tolerance on substance-related problems via substance-use motivations related to neutralizing negative emotions. Distress tolerance's role in substance-use problems appears to generalize beyond North America, although effect sizes were generally small and varied notably across geographical regions. Distress tolerance's connection with negative reinforcement processes (e.g., coping motives) warrants attention as a possible mediator of its association with problematic substance use.

An Observational Study of a Digital Substance Use and Recovery Program.

Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders. An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes. In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders. BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.

Intention to quit or reduce e-cigarettes, cannabis, and their co-use among a school-based sample of adolescents

IntroductionLittle is known about the prevalence and predictors of adolescents’ intention to quit or reduce use of e-cigarettes and/or cannabis. MethodsFrequencies of intention to change (quit, reduce) e-cigarettes and/or cannabis use were examined among 23,915 surveyed middle and high school students with sole and co-use. Predictors of intention to change were identified via LASSO/multilevel logistic regression. ResultsAmong those with sole e-cigarette use (n = 543), 40.9 % intended to quit and 24.1 % intended to reduce; non-daily e-cigarette use predicted intention to quit and reduce e-cigarettes (p’s < 0.03). Among those with sole cannabis use (n = 546), 10.6 % intended to quit and 25.1 % intended to reduce; absence of cannabis cravings predicted intention to reduce cannabis use (p < 0.01). Among those with co-use (n = 816), 26.2 % intended to either quit or reduce (quit/reduce) both substances, 27.5 % intended to quit/reduce e-cigarettes only, and 6.9 % intended to quit/reduce cannabis only. No predictors emerged for intention to change e-cigarette use among those with co-use (p’s > 0.09), but younger age, lack of poly-tobacco use, and lack of cannabis craving predicted intention to quit/reduce cannabis use (p’s < 0.04). ConclusionsMore than half of adolescents with past-month e-cigarette use, regardless of concurrent cannabis use, expressed interest in changing their use. However, only heaviness of e-cigarette use emerged as a predictor of intention to change suggesting. While fewer students expressed interest in changing their cannabis use, cannabis cravings and poly-tobacco use predicted intent to change. Overall, findings emphasize the need to tailor interventions towards adolescents engaging in more problematic substance use patterns.

Reported Xylazine Use Among Adults Aged ≥18 Years Evaluated for Substance Use Treatment - United States, July 2022-September 2023.

Xylazine has been increasingly detected in illegally manufactured fentanyl (IMF) products and overdose deaths in the United States; most xylazine-involved overdose deaths involve IMF. A convenience sample of U.S. adults aged ≥18 years was identified from those evaluated for substance use treatment during July 2022-September 2023. Data were collected using the Addiction Severity Index-Multimedia Version clinical assessment tool. Among 43,947 adults, 6,415 (14.6%) reported IMF or heroin as their primary lifetime substance-use problem; 5,344 (12.2%) reported recent (i.e., past-30-day) IMF or heroin use. Among adults reporting IMF or heroin as their primary lifetime substance-use problem, 817 (12.7%) reported ever using xylazine. Among adults reporting recent IMF or heroin use, 443 (8.3%) reported recent xylazine use. Among adults reporting IMF or heroin use recently or as their primary lifetime substance-use problem, those reporting xylazine use reported a median of two past nonfatal overdoses from any drug compared with a median of one overdose among those who did not report xylazine use; as well, higher percentages of persons who reported xylazine use reported other recent substance use and polysubstance use. Provision of nonjudgmental care and services, including naloxone, wound care, and linkage to and retention of persons in effective substance use treatment, might reduce harms including overdose among persons reporting xylazine use.

Prospective effects of resilience on mental health among sexual and gender minority young people

ABSTRACT Sexual and gender minority (SGM) individuals who are assigned-female-at-birth (i.e. sexual minority women, transgender men, and gender diverse individuals [SMWTGD]) experience an increased risk for negative mental health outcomes due to minority stress related to their minoritized identity. One proposed protective factor against negative mental health outcomes is resilience, which is one’s ability to effectively achieve positive outcomes following stressful events. Past research shows cross-sectional associations between resilience and mental health in both the general population and SGM individuals. However, we know of no longitudinal research testing whether resilience prospectively predicts mental health, or whether the prospective associations between resilience and mental health differ by demographics. Self-reports of resilience, depression, anxiety, suicidality, and substance use were collected at two time-points 6 months apart from 453 SMWTGD late adolescents and young adults who reside in the Midwest region of the United States. Time 1 resilience was negatively associated with Time 2 depression, anxiety, and suicidal ideation, but not problematic substance use, controlling for Time 1 mental health. These associations were generally not moderated by demographic factors, suggesting that resilience operates consistently across most racial, sexual orientation, and gender identities within the SMWTGD community. These findings underscore the potential value of tailored interventions aimed at promoting resilience within SMWTGD.

Coping motives as a mediator of the relationship between child maltreatment and substance use problems in south African adolescents

BackgroundEvidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by ‘coping motives’: maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts. ObjectiveThe present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents. Participants and settingA sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey. MethodsParticipants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems. ResultsCM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives. ConclusionsThe findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.

Taking John Schulenberg's "long view" on successful transitions to adulthood: Associations with adult substance use.

Can positive transitions into young adulthood at age 25 prevent problematic substance use at age 31, even in the context of childhood adverse family environments, conduct problems, and adolescent substance use? We lean on John Schulenberg's developmental framework to examine this question, focusing on the potential young adult milestones of high school and college graduation, employment, residential independence, romantic partnership, and parenthood. Data came from a prospective-longitudinal multi-method study with N = 1199 participants who were first assessed at age 5 years old and followed to age 31. An accumulation of positive transitions in young adulthood (age 25) was associated with lower likelihood of age 31 problematic cannabis use. The protective effect for problematic cannabis use remained even when adjusting for childhood adverse family environments and was primarily driven by successful college graduation and/or home ownership. The accumulation of positive transitions protected individuals at modest to somewhat elevated risk due to childhood adverse family environments from experiencing age 31 cannabis use problems. However, for other individuals with very high numbers of conduct problems, or with high levels of adolescent substance use, the protective effects of accumulated positive transitions to young adulthood were less strong or nonexistent. Moreover, individuals who completed college or obtained full-time employment by 25 were more likely to report problematic age 31 alcohol use. These findings highlight the central tenets of John Schulenberg's developmental framework, including the examination of ontogenetic continuity and discontinuity, the interplay of developmentally distal and proximal effects, and the identification of developmental protective factors that may sway people toward or away from substance use.

Perceived discrimination and problematic opioid use among Black individuals with chronic musculoskeletal pain.

Chronic musculoskeletal pain (CMP) is prevalent, burdensome, and associated with an increased risk for opioid use disorder. Evidence suggests that perceived racial/ethnic discrimination is associated with problematic substance use among Black individuals, but studies have not focused on problematic opioid use among Black individuals with CMP specifically or explored the contribution of perceived discrimination, pain intensity, and pain-relevant psychological factors to this association. We recruited 401 Black individuals (Mage = 35.98, 51.9% female) with self-reported CMP and prescription opioid use. We tested whether perceived discrimination (a) was associated with self-reported problematic opioid use and (b) explained unique variance in this outcome after accounting for pain intensity, demographic factors, and psychological factors previously implicated in problematic opioid/substance use (distress tolerance and pain avoidance). Hierarchical linear regression analysis revealed that our model as a whole explained significant variance in problematic opioid use, R² = .30, F(6, 394) = 28.66, p < .001. Perceived discrimination specifically was associated with more problematic opioid use (β = .39, SE = .05, p < .001) and explained unique variance in this outcome even after accounting for pain intensity (β = .06, SE = .04, p = .20), distress tolerance (β = -.10, SE = .05, p = .04), pain avoidance (β = .12, SE = .05, p = .02), age (β = -.10, SE = .05, p < .05), and employment status (β = .13, SE = .11, p < .01). Systemic efforts to combat racism along with individualized therapeutic approaches to process and cope with perceived racial discrimination may be particularly important to prevent and reduce problematic opioid use among Black individuals with CMP. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Substance Use and College Completion Among Two-Year and Four-Year College Students From a Nationally Representative Longitudinal Study.

Young adults from disadvantaged populations access higher education through two-year colleges, but substance use research among young adults focuses on four-year colleges. Filling this research gap is important given recent policy changes that have increased marijuana availability for young adults. This study uses a subsample of college-enrolled participants from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to evaluate whether substance use predicts educational attainment seven years later, comparing 888 students attending a two-year college with 1,398 matched students attending a four-year college. Matched students were identified using a propensity score method so that students were comparable on 15 measures, including precollege grades, precollege test scores, and precollege substance use. Compared with similar four-year college students, two-year college students were more likely to use methamphetamines, cocaine, or marijuana; more likely to report problematic substance use; and less likely to use alcohol. Two-year college students who used methamphetamines in the past year (incidence rate ratio (IRR) = 1.51, 95% CI (1.12, 2.04), p = 0.007) or past month (IRR = 1.69, 95% CI (1.09, 2.61), p = 0.02) or completed alcohol abuse treatment (IRR = 1.58, 95% CI (1.21, 2.07), p < 0.001) were less likely to complete college than two-year college students without those risk factors. Among the matched four-year college students, students who reported that drugs interfered with school or work in the past year (IRR = 1.84 (1.28, 2.64), p = 0.001), used cocaine in the past year (IRR = 1.47 (1.04, 2.08), p = 0.03), and used marijuana in the past year (IRR = 1.30 (1.07, 1.57), p = 0.007), past month (IRR = 1.31 (1.07, 1.61), p = 0.01), or ≥5 times in the past month (IRR = 1.44 (1.12, 1.85) p = 0.005) were less likely to complete college than the matched four-year college students without those risk factors. Substance use interventions should target both two-year and four-year college students. Two-year colleges that better accommodate students who complete substance use treatment may improve these students' completion. Students who use marijuana or cocaine or whose drug use impairs functioning may benefit from an incremental approach of completing a two-year degree prior to transferring to a four-year degree rather than enrolling directly in a four-year program.

Problematic consumption of psychoactive in pregnancy: A systematic review of a threat to maternal-fetal life

Background: Although the consequences of the use of psychoactive substances of abuse are often linked to the media in a subtle way and clarified by the doctor in routine consultations, the use and abuse has been taking uncontrollable growth proportions to the point of generating a problem of the Today's world with immediate needs for interventions in order to minimize the damage caused. Due to this transformation of society's habits, many age groups have been significantly affected. The main and most worrying social group susceptible to drug abuse is the female society, since due to the great coincidence between the reproductive age and the period prone to the use of social attractions, occasionally in a gestation situation, the joint use in any dose generates and potentiates the consequences to fetal maternal life. The little-known social effects go through, when death does not occur, due to malformation of the fetus, nervous compromise, up to the manifestations after birth in the daily life of the child of a user mother. Taking this situation into account and facing this problem of the current world that threatens health, the study will demonstrate the most diverse maternal and fetal manifestations due to the use of substances or drugs of abuse, suggesting as a final objective the creation of information media. capable of keeping the potentially reproductive female society informed about the hidden curses to fetal life in gestation. Material and methods: Systematic review based on searches in the PubMed, Google Scholar, and TripDataBase databases. Scielo and others, with the identification of articles that present the proposed theme as the central theme with the identification of the determinant factors for the development of substance abuse and its different forms of affectation in the gestational period with some scores of the consequences in the puerperal period. Results: With the corresponding search strategies, 73 articles were found in the Pubmed database, 10 articles in the Google Scholar, TripDataBase and Scielo databases. Directing the selection according to criteria, 22 articles were chosen and used for analysis of the systematic review. Conclusion: The problematic use of substances potentially harmful to pregnancy continues to be a challenge for public health. With this, it is of fundamental importance to raise awareness through the creation of health promotion programs based on rational, comprehensive, and multidisciplinary consultations, which guarantee the reduction of consumption and maternal-fetal protection