research essay substance abuse

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Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses

Substance abuse has been a thorny public health concern throughout human history. Manifestly, prevention and treatment are the two main strategies commonly adopted to tackle the problem of substance abuse. They are in fact cross-disciplinary, and they relate to the various domains of heredity, biology, psychology, cognitive science, family, social development and cultural structures. This special issue, “Substance Abuse, Environment and Public Health,” has published empirical studies from different regions and countries globally to enhance the international exchange of latest views and findings on the etiology, processes and influences of substance abuse across different domains, through which a multilevel perspective is considered more helpful for analyzing its complex nature, courses and consequences. This in turn suggests the possible need to employ multiple responses dynamically and integratively in the prevention and treatment of substance abuse.

1. Introduction

It is apparent that substance abuse is a cross-disciplinary topic of research and concern [ 1 , 2 ], which involves the need to employ concomitantly various theoretical explications and empirical evidence in collaborative efforts to strive for more optimal solutions to limit its contagiousness, and to curb any direct and indirect harm [ 3 , 4 ]. Substance abuse has been described as a “chronic relapsing disease”, with extremely high relapse rates that range from 56.8% to 81.8% [ 5 , 6 ]. Recently, the United Nations reported that “(i)n 2017, an estimated 271 million people, or 5.5 per cent of the global population aged 15–64, had used substances in the previous year” ([ 7 ], p.7). This is 11.5% higher than the estimated number of substance-using people in 2012 [ 8 ]. Due to the nature of recurrence and the rising number of substance users globally, a continuing upsurge in human, social, health and economic costs in the form of substance-related violence, criminal acts, health care needs, legal orders, rehabilitative services, reduced labor productivity and judicial expenditure is evident [ 4 , 6 , 9 ]. Undoubtedly, prevention and treatment are two main intervention approaches that have been commonly adopted to tackle substance abuse [ 2 , 10 ], in which the former focuses primarily on enhancing public awareness of the dangers of substance misuse and addiction, and the latter mainly emphasizes helping substance abusers to attain complete abstinence and avoid relapse. Both prevention and treatment of substance abuse are pertinent to public health, as the two approaches need to employ a multilevel perspective to conceptualize and solve fallout generated from drug trafficking, misuse and harm [ 11 , 12 ]. This points to the need to investigate human hereditary, biological, and psychological needs, cognitive and mental conditions, social development and cultural structures simultaneously and interactively.

For a comprehensive understanding of the nature, processes and impact of substance abuse on human individuals and societies as a whole, an international exchange of the latest scholarly views and empirical research findings is needed. This special issue, “Substance Abuse, Environment and Public Health,” aims to promote international exchange of empirical academic works on substance abuse and its related concerns. It includes 14 empirical research articles and one intervention paper from Bosnia, Croatia, Hong Kong, Italy, mainland China, Norway, Poland, Singapore, South Korea, Spain, Slovenia, Sweden and the United States, and covers the topics of substance misuse and addiction amongst various social groups, different types and forms of illicit and legally approved substances and multiple research methods and designs. Importantly, the scholarly works published in this special issue are expected to present an opportunity to enhance the international exchange of cross-disciplinary research and academic inquiries in the prevention and treatment of substance abuse.

2. Substance Abuse and Different Social Groups

When researching substance abuse and its harmful effects, researchers predominantly focus on certain social groups with a higher tendency towards substance taking and misuse, such as adolescents and male adults [ 13 , 14 , 15 , 16 , 17 , 18 ]. This is valid, as they may encounter various demanding life and social challenges, expectations, interpersonal alienation and biological impulses, all of which are relevant to the triggering of their initiation into drug experimentation as a form of self-medication. Substances may also act as a comforting “soul mate” to help users evade hard realities [ 19 , 20 ]. In this special issue, Zubak et al. [ 21 ] examined the effects of scholastic factors—for example, grade point averages, school and other unexcused absences and poor behavior—in relation to illicit drug misuse (IDM) and its initiation among adolescents in Bosnia and Herzegovina. Jee et al. [ 22 ] investigated the trajectories of different smoking groups of young South Korean male adults and the implication of the habit in their atherosclerotic cardiovascular disease (ASCVD) in middle age. However, substance takers are never restricted to any specific social groups; they can be found in communities of professionals, social talents, elders and university students. Devcic et al. [ 23 ] examined socio-demographics, sports-related factors, factors of hesitation, doping-related factors, consumption of dietary supplements, knowledge of doping and predictors of doping behavior in terms of misusing performance-enhancing substances among high-level competitive swimmers in Slovenia. Wang et al. [ 24 ] investigated how gender, residential areas and study majors were related to misconceptions about antibiotic use among Chinese university students, which in turn linked to their antibiotic misuse behavior. Through the use of a community-based participatory research design, Walter et al. [ 25 ] inquired how work-related musculoskeletal disorders (MSDs) and injuries among US fishing industry workers affected their use of prescription opioids to treat their pain, which in turn exposed them to increased risk of developing substance disorders. Apparently, different social groups are equally susceptible to the risk of substance abuse and addiction [ 3 , 4 , 12 ], and this is likely to be affected by their specific personal characteristics and environmental conditions. Hence, there is a need for researchers to discover both common and unique precursors germane to different social groups which lead to their substance using behavior.

3. Substance Abuse and Its Types and Forms

Substances that are misused or abused can be categorized into two forms. These include illicit and legally approved substances of various types. The most common illicit types of substances include cannabis, amphetamines, ketamine, methamphetamines, cocaine, ecstasy and heroin [ 2 , 6 ], which are largely banned in most countries. However, marijuana products have recently been legalized and commercialized in some northern American and Western states and regions under the umbrella of “control of reasonable use,” which casts a contemplative doubt over the original intent of reducing cannabis-related criminality and public health problems; hence, more research is needed on this subject [ 26 , 27 , 28 ]. Tobacco and alcohol are two legally approved types of substances that have been widely used by different social groups across different societies and cultures [ 6 , 11 , 29 ]. Some legally prescribed drugs, such as cough medications and the antibiotics mentioned above, can also be easily misused and abused by the general public, and these too merit the further attention of researchers [ 2 , 30 ].

In this special issue, Lo et al. [ 31 ] explored how far using illicit drugs, smoking cigarettes and drinking alcohol predicted sexual misconduct among Macau youths, while simultaneously adjusting for the effects of susceptibility to peer influence and school attachment/commitment. Assari et al. [ 32 ] attempted to assess the impact of subjective and objective socioeconomic status on the cigarette smoking and alcohol use of older African Americans by controlling the effects of pertinent covariates, which included demographic factors (age and gender), living arrangement and family type, health insurance status, chronic medical conditions, self-rated health, sick days, depression and chronic pain. Muller et al. [ 33 ] investigated changes in exercise and nicotine use among 1464 Norwegian prison inmates by classifying them into harmful and non-harmful substance use pre-incarceration groups, according to the Drug Use Disorders Identification Test (DUDIT) and the Alcohol Use Disorders Identification Test (AUDIT), both of which are commonly used by healthcare practitioners and researchers to assess the severity of illicit drug and intoxicant use. Wang et al. [ 34 ] analyzed the sources of antibiotics leftovers in the home and the risk factors of keeping them in relation to antibiotic self-medication among Chinese university students. Taken together, the relationships between the use of illicit drugs and legally approved substances are complex and intertwined or mutually reinforcing [ 35 , 36 ]. They may be affected by the personal circumstances and environmental conditions of the abusers, and may cause other forms of behavioral maladjustment [ 17 , 37 , 38 ]. Nevertheless, our current understanding of this complicated phenomenon of substance abuse is limited, and so more cross-disciplinary research is again recommended.

4. Researching Substance Abuse: Methods and Designs

As has been mentioned, substance abuse is a public health concern that involves human biological and physical needs, psychosocial demands, cognitive and spiritual fulfillment, and environmental formulations. Therefore, cross-disciplinary research using different methodologies and designs is much needed to scrutinize substance abuse in respect of etiology, maintenance, consequences, abstinence and relapse. Generally speaking, empirical studies using quantitative methods are more common than research involving qualitative inquiry, analysis of secondary data and/or documentary inspection [ 16 , 39 , 40 ]. In fact, research based on a range of methods and designs is useful in enhancing our comprehension of the nature and impact of substance abuse from different perspectives. This special issue incorporates empirical studies conducted by quantitative, qualitative and documentary methods. For quantitative research designs, study findings based on a representative sample or any of the random sampling procedures are desirable, and can strengthen empirical evidence and provide greater external validity [ 41 ]. For example, Oh et al. [ 42 ] investigated whether those who had current or previous experience of facial flushing would drink for different primary reasons, compared with those who had no experience of facial flushing. The sample comprised 4590 college students who were recruited by stratified random sampling procedures proportionately in 82 colleges in South Korea. There are other empirical studies in this special issue that similarly used a representative sample [ 21 , 24 , 31 , 34 ]. However, using quantitative methods to survey empirically the attitudes and behaviors of certain health and human service professional groups is less likely to require a representative sample, and so it is necessary to use non-probabilistic sampling procedures such as quota, purposive or snowballing sampling designs. Molina-Mula et al. [ 43 ] analyzed the attitudes and perceptions of emergency and mental health nurses with regard to alcoholics. Their findings will hopefully help to develop appropriate professional and clinical responses to substance abuse.

Qualitative research methods can help reveal in-depth and formative information related to the processes and development of substance abuse. For their qualitative study, Chan et al. [ 44 ] interviewed 67 drug abusers to explore how their psychological experiences—with special emphasis on interpersonal relatedness—affected their drug taking and relapse behaviors. Walter et al. [ 25 ] used qualitative interviewing to examine knowledge of and attitudes towards opioid use among 21 fishing industry workers in the US. In addition, use of secondary data or documentary information can efficiently and objectively assist in the transition processes of substance users. For example, Asharani et al. [ 45 ] employed and analyzed recorded data from the Registry of Birth and Death, Immigration and Checkpoint Authority of Singapore to investigate the unnatural deaths of 42 treatment seekers of substance addiction between 2011–2015. Their findings provide evidence of the lethal consequences of substance abuse in an unobtrusive manner. Moreover, Chmielowiec et al. [ 46 ] examined the relationship between the mesolimbic dopamine system and addiction in a group of 299 addicted subjects and another group of 301 non-addict controls by analyzing two polymorphisms in their genes (a variable number of tandem repeats in DRD4 and DAT1), which are mainly responsible for dopaminergic transmission, representing a human reward system that is closely related to substance abuse and misuse. It is clear that research using different methods and designs is useful in fortifying and enhancing currently established concepts and knowledge of substance abuse. Therefore, more novel research methods and designs should be encouraged, so that patterns of substance abuse can be more efficiently dissected.

5. Conclusions

Substance abuse has been an issue of public health for hundreds of years [ 47 ]. Nevertheless, professionals and researchers of different domains tend to adopt a one-dimensional view based on their particular expertise when examining, explaining and trying to find solutions to this complex problem [ 10 , 48 , 49 ]. Thus, various and often competing perspectives rooted in the paradigms of heredity, biology, psychology, cognitive science, family, social development and cultural structures can exist simultaneously, thereby unwittingly compounding the problem [ 1 , 2 , 39 , 50 ]. However, as substance abuse is composed of layers of individual development, family and social influences, cultural values and environmental conditions, a multilevel perspective is needed to analyze its etiology, maintenance and consequences. Various theories and models from different scholarly paradigms at different levels of social systems should be employed concomitantly to help examine and resolve the issues as part of a dynamic and comprehensive process [ 2 , 3 , 12 ]. Employing such a multilevel perspective requires researchers and practitioners to explore the interaction of hereditary, physical, psychological, cognitive, mental, family, social, cultural and environmental factors, and to show exactly how such synergy leads to and/or maintains substance use and addiction. Doing so will help in the design of improved multiple responses to the fallout from substance abuse.

As substance abuse is never limited to particular social groups in human societies, it is essential to understand the unique psychological, personality, cognitive, socioeconomic, familial and cultural differences of various social groups, and to explore what common and unique characteristics they hold in terms of the initiation, processes and consequences of substance abuse [ 4 , 6 ]. If researchers, service practitioners, educators and policy makers were able to understand the common and unique etiological causes and stimulants that incur experimentation and the subsequent maintenance of substance abuse, more effective prevention and treatment strategies and programs could be introduced. Furthermore, because each society or nation is comprised of multiple differing social groups, a knowledge and understanding of their unique cultural and ethnic structures would be empirically useful for researchers trying to unearth the common and distinct etiological causes and stimulants of substance use and abuse. This is a largely unchartered area of research.

The abuse of different types and forms of substances may generate different levels of addiction and harm [ 2 , 51 ], which in turn may trigger distinct social maladjustment and craving behaviors [ 12 , 52 ]. Therefore, future research should discern and clarify the effects of different types and forms of substances on the progress, abstinence and relapse of addicts; this would lead to a better comprehension of the nature and impact of substance abuse. Quantitative methods and designs should be adopted to this end, in addition to other methods and designs that will broaden our perspectives on the topic. In other words, future addiction research should consider the employment of mixed-method designs to investigate the nature of different types and forms of substances and their effects on different social groups. Furthermore, the interaction between the biological, individual, family, social and cultural factors that lead to substance abuse is worthy of research, but will require more advanced methodological designs and mathematical and statistical procedures.

The processes and consequences of substance abuse can be seen to evolve in step with social, technological and cultural developments [ 4 , 39 ]. The patterns and forms of substance abuse can vary according to different social groups. Therefore, comparative and longitudinal research is more useful and insightful in helping to reveal its precarious and dynamic influences. In fact, polysubstance abuse—in which substance addicts expect to achieve higher substance-synergy effects of enjoyability by simultaneously abusing multiple types of drugs and substances—has become more common in the past decade [ 53 , 54 ]. This apparently presents an even greater challenge to treatment and healthcare services. In the face of this new phenomenon, the role of empirical research becomes more pivotal in helping to configure effective approaches and solutions.

In conclusion, substance abuse has long been a thorny public health problem, and it continues to evolve. Multiple responses supported by the employment of a multilevel research perspective are needed. Cross-disciplinary collaboration and concerted research are urgently required if we are to optimize our current strategies and remediation.

Author Contributions

T.W.L., J.W.K.Y., and C.H.L.T. conceived the topic for the Special Issue and were the guest editors. All authors have read and agreed to the published version of the manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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Binge drinking is a growing public health crisis − a neurobiologist explains how research on alcohol use disorder has shifted

Assistant Professor of Biology, Biomedical Engineering and Pharmacology, Penn State

Disclosure statement

Nikki Crowley receives funding from The National Institutes of Health, The Brain and Behavior Research Foundation, and the Penn State Huck Institutes of the Life Sciences endowment funds.

Penn State provides funding as a founding partner of The Conversation US.

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With the new Amy Winehouse biopic “Back to Black ” in U.S. theaters as of May 17, 2024, the late singer’s relationship with alcohol and drugs is under scrutiny again. In July 2011, Winehouse was found dead in her flat in north London from “death by misadventure” at the age of 27. That’s the official British term used for accidental death caused by a voluntary risk.

Her blood alcohol concentration was 0.416%, more than five times the legal intoxication limit in the U.S. – leading her cause of death to be later adjusted to include “alcohol toxicity” following a second coroner’s inquest.

Nearly 13 years later, alcohol consumption and binge drinking remain a major public health crisis , not just in the U.K. but also in the U.S.

Roughly 1 in 5 U.S. adults report binge drinking at least once a week, with an average of seven drinks per binge episode . This is well over the amount of alcohol thought to produce legal intoxication, commonly defined as a blood alcohol concentration over 0.08% – on average, four drinks in two hours for women, five drinks in two hours for men.

Among women, days of “heavy drinking” increased 41% during the COVID-19 pandemic compared with pre-pandemic levels , and adult women in their 30s and 40s are rapidly increasing their rates of binge drinking , with no evidence of these trends slowing down. Despite efforts to comprehend the overall biology of substance use disorders, scientists’ and physicians’ understanding of the relationship between women’s health and binge drinking has lagged behind.

I am a neurobiologist focused on understanding the chemicals and brain regions that underlie addiction to alcohol . I study how neuropeptides – unique signaling molecules in the prefrontal cortex , one of the key brain regions in decision-making, risk-taking and reward – are altered by repeated exposure to binge alcohol consumption in animal models.

My lab focuses on understanding how things like alcohol alter these brain systems before diagnosable addiction, so that we can better inform efforts toward both prevention and treatment.

The biology of addiction

While problematic alcohol consumption has likely occurred as long as alcohol has existed, it wasn’t until 2011 that the American Society of Addiction Medicine recognized substance addiction as a brain disorder – the same year as Winehouse’s death. A diagnosis of an alcohol use disorder is now used over outdated terms such as labeling an individual as an alcoholic or having alcoholism.

Researchers and clinicians have made great strides in understanding how and why drugs – including alcohol, a drug – alter the brain. Often, people consume a drug like alcohol because of the rewarding and positive feelings it creates, such as enjoying drinks with friends or celebrating a milestone with a loved one. But what starts off as manageable consumption of alcohol can quickly devolve into cycles of excessive alcohol consumption followed by drug withdrawal.

While all forms of alcohol consumption come with health risks, binge drinking appears to be particularly dangerous due to how repeated cycling between a high state and a withdrawal state affect the brain. For example, for some people, alcohol use can lead to “ hangxiety ,” the feeling of anxiety that can accompany a hangover.

Repeated episodes of drinking and drunkenness, coupled with withdrawal, can spiral, leading to relapse and reuse of alcohol. In other words, alcohol use shifts from being rewarding to just trying to prevent feeling bad.

It makes sense. With repeated alcohol use over time, the areas of the brain engaged by alcohol can shift away from those traditionally associated with drug use and reward or pleasure to brain regions more typically engaged during stress and anxiety .

All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways . Alcohol can affect several dozen neurotransmitters and receptors , making understanding its mechanism of action in the brain complicated.

Work in my lab focuses on understanding how alcohol consumption changes the way neurons within the prefrontal cortex communicate with each other. Neurons are the brain’s key communicator, sending both electrical and chemical signals within the brain and to the rest of your body.

What we’ve found in animal models of binge drinking is that certain subtypes of neurons lose the ability to talk to each other appropriately. In some cases, binge drinking can permanently remodel the brain. Even after a prolonged period of abstinence, conversations between the neurons don’t return to normal .

These changes in the brain can appear even before there are noticeable changes in behavior . This could mean that the neurobiological underpinnings of addiction may take root well before an individual or their loved ones suspect a problem with alcohol.

Researchers like us don’t yet fully understand why some people may be more susceptible to this shift, but it likely has to do with genetic and biological factors, as well as the patterns and circumstances under which alcohol is consumed.

Women are forgotten

While researchers are increasingly understanding the medley of biological factors that underlie addiction, there’s one population that’s been largely overlooked until now: women.

Women may be more likely than men to have some of the most catastrophic health effects caused by alcohol use, such as liver issues, cardiovascular disease and cancer . Middle-aged women are now at the highest risk for binge drinking compared with other populations.

When women consume even moderate levels of alcohol, their risk for various cancers goes up, including digestive, breast and pancreatic cancer , among other health problems – and even death. So the worsening rates of alcohol use disorder in women prompt the need for a greater focus on women in the research and the search for treatments.

Yet, women have long been underrepresented in biomedical research.

It wasn’t until 1993 that clinical research funded by the National Institutes of Health was required to include women as research subjects. In fact, the NIH did not even require sex as a biological variable to be considered by federally funded researchers until 2016. When women are excluded from biomedical research, it leaves doctors and researchers with an incomplete understanding of health and disease, including alcohol addiction.

There is also increasing evidence that addictive substances can interact with cycling sex hormones such as estrogen and progesterone . For instance, research has shown that when estrogen levels are high, like before ovulation, alcohol might feel more rewarding , which could drive higher levels of binge drinking. Currently, researchers don’t know the full extent of the interaction between these natural biological rhythms or other unique biological factors involved in women’s health and propensity for alcohol addiction.

Looking ahead

Researchers and lawmakers are recognizing the vital need for increased research on women’s health. Major federal investments into women’s health research are a vital step toward developing better prevention and treatment options for women.

While women like Amy Winehouse may have been forced to struggle both privately and publicly with substance use disorders and alcohol, the increasing focus of research on addiction to alcohol and other substances as a brain disorder will open new treatment avenues for those suffering from the consequences.

For more information on alcohol use disorder, causes, prevention and treatments, visit the National Institute on Alcohol Abuse and Alcoholism .

• Amy Winehouse
• Binge drinking
• Neurobiology
• Intoxication
• Alcohol consumption
• Alcohol use
• Alcohol use disorder
• COVID-19 pandemic

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Discover the latest in addiction research, from the neuroscience of substance use disorders to evidence-based treatment practices. reports, updates, case studies and white papers are available to you at hazelden betty ford’s butler center for research..

Why do people become addicted to alcohol and other drugs? How effective is addiction treatment? What makes certain substances so addictive? The Butler Center for Research at the Hazelden Betty Ford Foundation investigates these and other questions and publishes its scientific findings in a variety of alcohol and drug addiction research papers and reports. Research topics include:

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These research queries and findings are presented in the form of updates, white papers and case studies. In addition, the Butler Center for Research collaborates with the Recovery Advocacy team to study special-focus addiction research topics, summarized in monthly  Emerging Drug Trends  reports. Altogether, these studies provide the latest in addiction research for anyone interested in learning more about the neuroscience of addiction and how addiction affects individuals, families and society in general. The research also helps clinicians and health care professionals further understand, diagnose and treat drug and alcohol addiction. Learn more about each of the Butler Center's addiction research studies below.

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Written by Butler Center for Research staff, our one-page, topic-specific summaries discuss current research on topics of interest within the drug abuse and addiction treatment field.

View our most recent updates, or view the archive at the bottom of the page.

Patient Outcomes Study Results at Hazelden Betty Ford

Trends and Patterns in Cannabis Use across Different Age Groups

Alcohol and Tobacco Harm Reduction Interventions

Harm Reduction: History and Context

Racial and Ethnic Health Disparities and Addiction

Psychedelics as Therapeutic Treatment

Sexual and Gender Minority Youth and SUDs

Health Care Professionals and Mental Health

Grief and Addiction

Helping Families Cope with Addiction

Emerging Drug Trends Report and National Surveys

Shedding New Light on America’s No. 1 Health Problem

In collaboration with the University of Maryland School of Public Health and with support from the Butler Center for Research, the Recovery Advocacy team routinely issues research reports on emerging drug trends in America. Recovery Advocacy also commissions national surveys on attitudes, behaviors and perspectives related to substance use. From binge drinking and excessive alcohol use on college campuses, to marijuana potency concerns in an age of legalized marijuana, deeper analysis and understanding of emerging drug trends allows for greater opportunities to educate, inform and prevent misuse and deaths.

Each drug trends report explores the topic at hand, documenting the prevalence of the problem, relevant demographics, prevention and treatment options available, as well as providing insight and perspectives from thought leaders throughout the Hazelden Betty Ford Foundation.

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Pediatricians First Responders for Preventing Substance Use

• Clearing Away the Confusion: Marijuana Is Not a Public Health Solution to the Opioid Crisis
• Does Socioeconomic Advantage Lessen the Risk of Adolescent Substance Use?
• The Collegiate Recovery Movement Is Gaining Strength
• Considerations for Policymakers Regarding Involuntary Commitment for Substance Use Disorders
• Widening the Lens on the Opioid Crisis
• Concerns Rising Over High-Potency Marijuana Use
• Beyond Binging: “High-Intensity Drinking”

View the latest  National Surveys :

• College Administrators See Problems As More Students View Marijuana As Safe

College Parents See Serious Problems From Campus Alcohol Use

• Youth Opioid Study: Attitudes and Usage

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Our mission is to provide a trusted national voice on all issues related to addiction prevention, treatment and recovery, and to facilitate conversation among those in recovery, those still suffering and society at large. We are committed to smashing stigma, shaping public policy and educating people everywhere about the problems of addiction and the promise of recovery. Learn more about recovery advocacy and how you can make a difference.

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To help get consumers and clinicians on the same page, the Butler Center for Research has created a series of informational summaries describing:

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Motivational Interviewing

Cognitive Behavioral Therapy

Case Studies and White Papers

Written by Hazelden Betty Ford Foundation researchers and clinicians, case studies and white papers presented by the Butler Center for Research provide invaluable insight into clinical processes and complex issues related to addiction prevention, treatment and recovery. These in-depth reports examine and chronicle clinical activities, initiatives and developments as a means of informing practitioners and continually improving the quality and delivery of substance use disorder services and related resources and initiatives.

• What does it really mean to be providing medication-assisted treatment for opioid addiction?

Adolescent Motivational Interviewing

Peer Recovery Support: Walking the Path Together

Addiction and Violence During COVID-19

The Brain Disease Model of Addiction

Healthcare Professionals and Compassion Fatigue

Moving to Trauma-Responsive Care

Virtual Intensive Outpatient Outcomes: Preliminary Findings

Driving Under the Influence of Cannabis

Vaping and E-Cigarettes

Using Telehealth for Addiction Treatment

Grandparents Raising Grandchildren

Substance Use Disorders Among Military Populations

Co-Occurring Mental Health and Substance Use Disorders

Women and Alcohol

Prescription Rates of Opioid Analgesics in Medical Treatment Settings

Applications of Positive Psychology to Substance Use Disorder

Substance Use Disorders Among Legal Professionals

Factors Impacting Early Alcohol and Drug Use Among Youths

Animal-Assisted Therapy for Substance Use Disorders

Prevalence of Adolescent Substance Misuse

Problem Drinking Behaviors Among College Students

The Importance of Recovery Management

Substance Use Factors Among LGBTQ individuals

Prescription Opioids and Dependence

Alcohol Abuse Among Law Enforcement Officers

Helping Families Cope with Substance Dependence

The Social Norms Approach to Student Substance Abuse Prevention

Drug Abuse, Dopamine and the Brain's Reward System

Women and Substance Abuse

Substance Use in the Workplace

Health Care Professionals: Addiction and Treatment

Cognitive Improvement and Alcohol Recovery

Drug Use, Misuse and Dependence Among Older Adults

Emerging Drug Trends

Does Socioeconomic Advantage Lessen the Risk of Adolescent Substance Use

The Collegiate Recovery Movement is Gaining Strength

Involuntary Commitment for Substance Use Disorders

Widening the Lens of the Opioid Crisis

Beyond Binge Drinking: High Intensity Drinking

High Potency Marijuana

National Surveys

College Administrators See Problems as More Students View Marijuana as Safe

Risky Opioid Use Among College-Age Youth

Case Studies/ White Papers

What does it really mean to be providing medication-assisted treatment for opioid addiction

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206 Substance Abuse Essay Topics + Examples

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

💊 7 Substance Abuse Essay Topics

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

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StudyCorgi . 2022. "206 Substance Abuse Essay Topics + Examples." May 10, 2022. https://studycorgi.com/ideas/substance-abuse-essay-topics/.

These essay examples and topics on Substance Abuse were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 20, 2024 .

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• Published: 23 May 2024

30 years of youth system of care lessons learned – a qualitative study of Hawaiʻi’s partnership with the Substance Abuse and Mental Health Services Administration

• Kelsie H. Okamura 1 , 2 ,
• David Jackson 2 , 4 ,
• Danielle L. Carreira Ching 1 ,
• Da Eun Suh 2 ,
• Tia L. R. Hartsock 3 ,
• Puanani J. Hee 4 &
• Scott K. Shimabukuro 4  

BMC Health Services Research volume  24 , Article number:  658 ( 2024 ) Cite this article

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Metrics details

The Hawaiʻi State Department of Health, Child and Adolescent Mental Health Division (CAMHD) has maintained a longstanding partnership with Substance Abuse and Mental Health Services Administration (SAMHSA) to enhance capacity and quality of community-based mental health services. The current study explored CAMHD’s history of SAMHSA system of care (SOC) awards and identified common themes, lessons learned, and recommendations for future funding.

Employing a two-phase qualitative approach, the study first conducted content analysis on seven final project reports, identifying themes and lessons learned based on SOC values and principles. Subsequently, interviews were conducted with 11 system leaders in grant projects and SOC award projects within the state. All data from project reports and interview transcripts were independently coded and analyzed using rapid qualitative analysis techniques.

Content validation and interview coding unveiled two content themes, interagency collaboration and youth and family voice, as areas that required long-term and consistent efforts across multiple projects. In addition, two general process themes, connection and continuity, emerged as essential approaches to system improvement work. The first emphasizes the importance of fostering connections in family, community, and culture, as well as within workforce members and child-serving agencies. The second highlights the importance of nurturing continuity throughout the system, from interagency collaboration to individual treatment.

Conclusions

The study provides deeper understanding of system of care evaluations, offering guidance to enhance and innovate youth mental health systems. The findings suggest that aligning state policies with federal guidelines and implementing longer funding mechanisms may alleviate administrative burdens.

Peer Review reports

Youth are disproportionately impacted by mental health disorders with average rates higher than adults in the United States [ 1 ]. This begins early on with one in six children aged two to eight years diagnosed with a mental, behavioral, or developmental disorder and persists over time with one in five youth having experiences with a severe mental health disorder at some point in their life [ 1 , 2 , 3 ]. At the end of 2021, the U.S. Surgeon General declared a youth mental health crisis noting that rates of emergency room visits for suspected suicide attempts had increased in some demographics by more than 50% compared to the same time period in 2019 [ 4 ]. Despite the large and increasing need for services, alarming gaps have been found in access to care and it is estimated that half of youth will not receive adequate treatment, which is detrimental to healthy growth and development into adulthood [ 5 ]. Large barriers to youth mental health care occur at the organizational and community levels where differing priorities across child-serving agencies may contribute to lower rates of youth access to services [ 6 ].

The system of care (SOC) approach was developed in the 1980s as a strategy to address siloed child-serving agencies through an integrated and principle-driven approach to tiered services for youth with social, emotional, and behavioral difficulties [ 7 ]. The SOC core values, informed by the Child and Adolescent Service System Program principles [ 8 ], are that services should be: (a) family and youth driven, (b) community-based, and (c) culturally and linguistically competent. These values are operationalized through guiding principles such as interagency collaboration, care coordination, and partnerships with families and youth [ 7 ]. The SOC approach applies principles to help guide coordinated efforts to support youth whose services intersect multiple child-service agencies (e.g., mental health, judiciary, education, child welfare). Several cross-site studies have evaluated youth SOC efforts over time with differential operational definitions of SOC values and principles [ 7 , 8 , 9 , 10 , 11 ]. Each study indicated the importance of sustainability planning at the outset and aligning infrastructure and service development to meet local system requirements. For example, Brashears and colleagues noted that having interagency involvement in developing and implementing shared administrative processes was a common challenge [ 9 ]. Moreover, fiscal crises, leadership turnover, and methodological concerns for assessing long-term sustainment were noted as barriers in the SOC approach. Indeed, the SOC approach requires commitment and financial resources to succeed.

In 1992, the United States federal government signed into public law the establishment of the Substance Abuse and Mental Health Services Administration (SAMHSA; cf. Congressional public law 102–321) given the disconnect between youth and families’ need for services, the SOC approach, and the variable federal financial priorities. The SAMHSA goal was to support substance abuse and mental health prevention and intervention in the United States through the establishment of a federal funding authority operated under the Department of Health and Human Services. Within SAMHSA, there are three major centers that currently fund prevention and intervention services. The Center for Mental Health Services supports the development of services for adults with serious mental illnesses and youth with serious emotional disturbances through the administration and oversight of SOC expansion awards, cooperative agreements, and mental health services block grant programs (i.e., a discretionary fund to help prevent and treat mental health disorders). The Center for Substance Abuse Prevention develops comprehensive prevention systems through national leadership in policy and programs through promoting effective prevention practices and applying prevention knowledge. Their goals are to build supportive workplaces, schools, and communities, drug-free and crime-free neighborhoods, and positive connections with friends and family. Similarly, the Center for Substance Abuse Treatment seeks to improve and expand existing substance abuse treatment and recovery services. This center administers the Substance Abuse Prevention and Treatment Block Grant Program and supports the free treatment referral service to link clients to community-based substance use disorder treatment. The SAMHSA operates an over ten billion a year budget with $225 million dedicated to children’s mental health and SOC initiatives in 2024 [ 12 ].

The Hawaiʻi State Department of Health Child and Adolescent Mental Health Division (CAMHD) is the state’s Medicaid behavioral health carveout and the primary agency responsible for developing and administering clinical services for approximately 2,000 youth each year. The CAMHD provides care coordination and clinical oversight at seven regional Family Guidance Centers statewide and delivers in-home (e.g., intensive in-home, Multisystemic therapy) and out-of-home (e.g., transitional family home, community-based residential, hospital-based residential) services through 17 community-based contracted agencies. A centralized state office oversees all administrative, clinical, and performance functions including annual reporting of youth served and clinical outcomes (see https://health.hawaii.gov/camhd/annual-reports/ ). The CAMHD has a longstanding history of SAMHSA SOC expansion awards beginning in 1994 and continuing to the present in an almost unbroken succession [ 13 ]. These developments began shortly after a class-action lawsuit was brought against the state (Felix v. Waihee, 1993), when Hawaiʻi was ranked among the lowest in the nation for youth mental health services [ 14 ]. The settlement, referred to as the Felix Consent Decree, resulted in federal oversight that lasted from 1994 to 2004 [ 15 , 16 ]. The federal decree mandated and oversaw the development of a statewide SOC, and in many ways complemented the goals of SAMHSA SOC expansion awards that overlapped with federal oversight and continued for two more decades. The various SOC awards operationalized SOC principles and ranged from filling in gaps within the service continuum to enhancing existing services through trauma-informed care, wraparound care coordination, and improved knowledge management systems.

The purpose of this study is to examine the Hawaiʻi State CAMHD system’s SAMHSA SOC award history to identify common themes, lessons learned, and recommendations for future funding. The first goal was to understand the development and evolution of SOC values and principles (e.g., youth and family voice) within and across each grant. The second goal was to describe and reflect on common themes and lessons learned through the 30 years and seven CAMHD SOC expansion awards. This is the first study to date that examines themes across previous SAMHSA SOC awards from one state’s perspective. There were no a prior hypotheses given the exploratory nature of this study. The intention was to contribute to research and improved practices around effective SOC grant implementation at the federal and state system levels.

This study used a two-phase qualitative approach with (a) content analysis on seven final project reports and (b) key informant interviews with 11 system leaders. Initially, for the final project reports, a matrix template was utilized to summarize data by domains consistent with SAMHSA’s Center for Mental Health Services Infrastructure Development, Prevention, and Mental Health Promotion indicators (e.g., Policy Development, Workforce Development) which would have allowed comparisons across multiple projects and domains. However, after multiple trials to code past project reports into the indicators, the two lead investigators (Okamura, Jackson) opted to use a grounded approach to identifying themes and lessons learned based on SOC values and principles. Initial results from project reports guided the information collected in interviews, which iteratively guided subsequent interviews until saturation and consensus was reached on the final themes.

For the interviews, a purposive sampling strategy was utilized to obtain feedback from system leaders who have had extensive experience within individual grant projects and/or across multiple SOC award projects within the state [ 17 ]. Interview participants included four previous grant project directors and seven system leaders whose roles included regional center chiefs (one who, at the time of data collection, was acting as the statewide chief administrator), clinical supervisors, training specialists, and a performance manager. All interviews were recorded and transcribed, except for one participant who declined to be recorded but whose responses were paraphrased in notes. The lead investigators conducted all interviews. A semi-structured interview was developed and used (see Supplemental File), which evolved during the study to further probe more specific themes that were emerging. Initial interview questions asked participants about what they remembered, lessons learned, and what recommendations they had based on the project. Additional probes were used to obtain their perspectives on areas including the project’s impact on the state’s mental health division and larger system of care, its impact on the specific project’s focus areas, and its impact on the division’s relationship with SAMHSA. In addition, participants were asked about their overall reflections on the SOC awards, thoughts on how they have impacted the system over multiple years, and how they could be best utilized in the future.

All data from project reports and interview transcripts were independently coded by the two lead investigators, who each reviewed every report and transcript. Data were analyzed using rapid qualitative analysis techniques [ 18 ]. Rapid qualitative analysis is well-suited for projects that aim to be completed in one year or less that do not rely on traditional transcription coding [ 19 ]. For this project, main points from interviews were summarized to provide a quick and accessible “sketch” of the data as data were organized and collected. These sketches were organized into a matrix to allow for quick identification of similarities, differences, and trends in responses [ 20 ]. ​Therefore, reliability calculations such as kappa or intraclass correlations were not appropriate for this method. This study was deemed exempt and non-human subjects research by the Hawaiʻi State Department of Health Institutional Review Board.

System of care principle development and application

The Hawaiʻi State CAMHD has operated seven SAMHSA SOC awards from 1994 to present day (2024) as detailed in Table  1 . Several project directors served multiple SOC awards which provided continuity. Specifically, Kealahou, Kaeru, and Data to Wisdom projects had the same project director, which helped to infuse trauma-informed care and bridge previous work in youth and parent partner services. There was variation in the project foci with some projects focused on developing SOC infrastructure (e.g., care coordination model) and others also focused on developing services (e.g., adaptive behavioral intervention) within the service array. The ʻOhana Project and Hoʻomohala both set foundations for the CAMHD SOC by establishing care coordination, contracted provider agencies, and building the service array. Kealahou, Laulima, and Kaeru projects continued to build the CAMHD SOC while focusing on targeted populations and specialty services. The Cultures of Engagement in Residential Care focused primarily on residential treatment settings and eliminating the use of seclusion and restraint. The Data to Wisdom grant focused on SOC development to infuse data driven decision making, knowledge management, and trauma-informed systems. Project geographic locations also changed over time from specific areas (e.g., urban Honolulu) to the broader overall statewide system.

System of care award themes

Content validation and interview coding revealed two content and two general process themes across the seven projects. Content themes were defined as areas that required long-term and consistent efforts across multiple projects and grants to develop. Content themes included (a) interagency collaboration and (b) youth and family voice. Process themes were defined as essential approaches to system improvement work. The general process themes reflected various aspects of (c) connection and (d) continuity, with more specific sub-themes within those.

Interagency collaboration

The first topic theme reflected the need for continual building of interagency collaboration across every project (see Fig.  1 ). From the first CAMHD SAMHSA award, the ʻOhana project, CAMHD coordinated interagency agreements with other child serving systems such as the Department of Education and Child Welfare Services. These child-serving system partners served as governing and advisory groups for the SOC awards, alongside consistent integration with other direct service provider agencies and academic partnerships to support the SOC. During Kealahou and Laulima, there was an effort to formalize the interagency collaboration through the execution of memoranda of agreements between agencies and targeted strategies to improve system collaboration, such as the multi-agency consent form. The formation of the Hawaiʻi Interagency State Youth Network of Care through revised statute furthered the commitment to interagency collaboration, which CAMHD and project directors have co-chaired. The development of interagency collaboration followed an advisory (e.g., members from other child-serving agencies contributing feedback to project goals and implementation), integration (e.g., formal advisory council and committee established), and leadership (e.g., chairing advisory council, and leading task forces and special projects) pathway for CAMHD. This theme is consistent with SOC values and principles and align with the priorities across funding announcements to build and enhance SOCs. Perceptions of key informants also reinforced the idea that interagency collaboration was a critical aspect of SOC development; however, successful collaboration is challenging to achieve (see Table  2 ).

Hawaiʻi state CAMHD interagency collaboration development

CAMHD = Hawaiʻi State Child and Adolescent Mental Health Division; CERC = Cultures of Engagement in Residential Care; D2W = Data to Wisdom

Youth and family voice

The second topic theme was youth and family voice, which represents the long road to fully integrating family voice from the system to the client treatment level (see Fig.  2 ). Parent and youth integration into governing councils and advisory boards to help guide grant activities began from the first award, the ʻOhana project. Eventually, parent and youth peer partner services became integrated into the treatment team level. There were several community-based organizations, like Hawaiʻi Youth Helping Youth, that supported youth and family voice through identifying and training advocates. These advisory activities continued, with more applied support to individual families and youth occurring in Project Kealahou. During this project, the priority to develop a sustainable infrastructure for youth and parent peer partners supporting individual families began. Medicaid reimbursement was pursued for the first time for youth and parent peer partner services, which continued in negotiations to amend the state plan for approximately 12 years. This reimbursement effort continued into the current SOC award, the Data to Wisdom project, with a focus on developing youth peer partner certification as a step toward successful Medicaid reimbursement. Similar to interagency collaboration, the youth and family voice theme progressed from an advisory role (e.g., having youth and families advise grant activities and goals) to informing service (e.g., hiring youth and parent advocates) to pursuing a standalone service (e.g., full integration of youth and parent peer services).

Informant interviews also shed light on the nuances of increasing family voice. New challenges and opportunities emerged alongside greater incorporation of and respect for youth and parent perspectives. One such challenge with youth and family voice is in building trust across different levels within a treatment team and system of care. Language remains a key moderator of trust building (see Table  2 ). Indeed, the SOC value of youth and family driven and principle of partnership with youth and families were applied differently as youth and parent voice became stronger within the treatment team with the support of peer partners.

Hawaiʻi state CAMHD youth and family voice development

Complementing the content themes were process themes related to how systems work should be accomplished to be successful, based on the experiences and recommendations of key informants. The first general process theme was encapsulated in the concept of “connection,” as it relates to (1) how services should connect youth to their family, community, and culture, (2) how workforce members should be connected to each other, and (3) how child-serving agencies should be connected to each other. Fostering these connections often goes beyond day-to-day roles and responsibilities and requires additional focused and sustained efforts.

Regarding the connection of youth to their family, community, and culture, one staff member noted a need for community-based interventions (see Table  2 ). Additionally, connection through communication and relationship building among workforce members and creating the structures to maintain relationships was described as important. One informant noted the importance of learning collaboratives in the project which created a shared place to connect and learn.

Finally, similar to the content theme of interagency collaboration being a continual endeavor, informants relayed many thoughts about how the system could connect agencies together to be more successful in the goal of system improvement. One leadership member noted the need for venues where legislators and other leaders from organizations to come together regularly to discuss issues (see Table  2 ). The connection not only built trust and clarified roles, but created shared responsibility within the SOC so that not one organization or body was making decisions independently of another.

The second general process theme was summarized in the concept of “continuity.” This theme emerged from comments about the importance of efforts such as (1) ensuring the continuity (sustaining) of interagency collaboration, (2) ensuring the continuity of new initiatives, (3) ensuring greater continuity (increased length) of award time periods, (4) ensuring continuity in the CAMHD model of care, (5) ensuring continuity in trauma-informed care, and (6) ensuring continuity in staffing. Overall, it was conveyed that better care for youth requires continuity throughout the system, from interagency collaboration to individual treatment.

First, ensuring continuity of interagency collaboration refers to the maintenance of the formal structures and relationships beyond a single project. For example, the establishment of Hawaiʻi Interagency State Youth Network of Care secured a platform for tackling issues that crossed agencies and could function independently from the restraints of single award periods (see Table  2 ).

More broadly, informants expressed difficulty in achieving sustainability and the need to ensure the continuity of new initiatives instead of them being a “one-off” or pilot projects. Some informants noted that typical award periods are not long enough to develop and sustain successful initiatives. As seen with the youth and family voice topic domain, it does take longer than a single grant to see any sort of transformational or long-term change.

The CAMHD model of care also emerged as a consistent topic throughout the final reports and interviews. The model of care was perceived as a pendulum swinging from a more intensive care coordination model, aligned with system of care values and care coordination principles, to a more “medical model” and managed care. As one person stated “we need to figure out what is our model…” and another informant noted some history related to care coordination to a medical model (see Table 2 ).

Trauma-informed care was a consistent thread in all SOC awards, and the importance of continuity emerged in interviews. Continuity was critical both at the system level, where consistent efforts needed to be made over multiple grant periods to build a more trauma-informed system, as well as the client level, where addressing a youth’s trauma requires time, patience, and consistency of support from the treatment team. As one person noted:

“it takes time to do trauma-informed care” and “you can only move as fast as the individual is able to move.”

Finally, a consistent challenge was in ensuring continuity in staffing. With limited award periods, staff begin to find other opportunities when funding nears the end and positions have not become permanent. Moreover, the start of new awards is typically delayed because of the challenges in establishing new positions and hiring new staff. A leadership informant noted that transitioning grant staff to new grants or from existing grants can cause disruptions to the system and staff morale.

The current study was a review on 30 years and seven awards given to the Hawaiʻi State Child and Adolescent Mental Health Division by the Substance Abuse and Mental Health Services Administration to expand the system of care. Two major topic themes of interagency collaboration and youth and family voice were identified that aligned with SOC values and principles. Two process themes of connection and continuity weaved throughout other SOC principles such as trauma-informed care. The Hawaiʻi State CAMHD continues to be a leader in SOC expansion despite ongoing administrative and fiscal challenges that common with other SOC expansion efforts [ 9 , 10 ]. Their dedication to SOC values and principles is evident in the investment of resources to start and close multiple awards, build interagency collaboration, and innovate within and across the child-serving system and its agencies.

Building interagency collaboration is one of the most difficult aspects of system improvement [ 9 ]. The CAMHD has needed to constantly invest resources (e.g., funding, personnel, legislation) to meet its goals. Lessons learned from interagency collaboration range from developments in coordinated interagency agreements with other child serving agencies (e.g., Department of Education, Child Welfare Services) which provided inbuilt advisory groups for SOC expansion, to consistent integration with other direct service provider agencies and academic partnerships to support that expansion, and finally through to formalization and strengthening of interagency collaboration through formal agreements and targeted strategies like the universal and multi-agency consent form. Networking within and between child-serving agencies was noted as an important aspect in building interagency collaboration. However, turnover can impact continuity and momentum. Legislation and policies have the potential to sustain collaboration and must be implemented with intention and proper funding to ensure high quality facilitation informed by equitable methods [ 21 ].

Partnering with youth and families has been a consistent theme in successful efforts to expand systems of care in other states, and the CAMHD has sought to continue developing this area through multiple grants despite ongoing challenges [ 9 , 10 ]. Lessons learned from youth and family voice range from the integration of parent and youth into governing councils and advisory boards, identification and training of advocates, and applied support to individual families and youth including the long and continuing work toward Medicaid reimbursement. It is interesting that the progression from youth and family voice informing service to a standalone service is representative of almost two decades of systems work. Systems change is truly a long-game and there have been many efforts to support these changes, including federal legislation and funding priorities (e.g., SAMHSA Office of Behavioral Equity and new funding priorities around marginalized communities). Moreover, updated SAMHSA funding announcements have explicitly called for language around culturally and linguistically appropriate, evidence-informed, recovery-oriented, trauma-informed care that highlights the commitment around SOC values and principles.

From these lessons, several areas for future attention emerged. These included considerations of the state and federal policies that often seem at odds with each other. As one informant noted: “we need to look at how the contracts and procurement is done.” This is particularly pertinent to state procurement laws which make it difficult to initially collaborate with and contract providers without a suitable means of paying them for their time, further complicating and delaying the work. A key leader noted:

I think the state system could really benefit from looking at how to support grants better and how to handle rules maybe differently, and procurement differently, and just be, provide more support…I think the state needs a grant office like a, you know, a university would have and they need to help us.

Moreover, establishing new funding accounts, job descriptions, and personnel management policies intersects divisional, departmental, state, and federal bureaucracies that often contribute to lengthy stalls in completing work and spending funds. For example, for the current SOC award, the project director was hired approximately six months after the notice of award, because the position needed to be established and associated with a new award and account code, despite the person already being in the previous SOC award project director position. Landscaping current federal and state policies on spending, procurement, and community collaboration may help to identify better pathways and strategies to executing federal grants within state infrastructure.

Furthermore, mental and behavioral health payment structures require ongoing attention. Stroul and Manteuffel noted that while award sites reported using a range of financing strategies, increasing Medicaid reimbursement was the most frequent strategy [ 11 ]. However, most strategies were not seen as very effective, and the highest effectiveness ratings were for increasing Medicaid funding, increasing state mental health funding, obtaining and coordinating funds with other systems, and redeploying funds to lower cost service alternatives [ 11 ]. Certification and credentialing processes that are needed for reimbursement are often time-intensive to develop and requirements may not align with health equity and lived experience. For example, in Project Hoʻomohala, a bachelor’s degree was required to hire a peer specialist. However, this requirement excluded many transitioned-age youth with lived experience who were more closely related in age which may have brokered trust and rapport more quickly. Initiatives that compare funding and certification rates and examine empirically the extent to which financing strategies improve service reach are necessary evaluation activities that should be included in SOC awards [ 22 , 23 ].

Programs for targeted populations and complex cases, which allow for flexible scheduling and funding, are also needed. Co-occurring mental health, disabilities, and substance use programs provide holistic care for youth and families. Special populations like racial, ethnic, sexual orientation, and gender/sex minorities that require adapted interventions should be a federal and state funding priority. As one interviewee noted:

Girls matter. Treatment for girls needs to be individualized more so than just, I don’t know, some of the EBS [evidence-based services] stuff you know, and I’m not knocking the EBS stuff, that is important. We need more research about girls. And that is a recommendation…The basic need is huge, so I think the lessons learned, we really do need more flexible funding to be able to support girls in their treatment, girls in their homes.

Improving integration into existing structures like home-based care, primary care, and school-based services, as well as integration of informal supports (e.g., youth peer support), requires continued effort to evolve with the changing managed care landscape. Payment and reimbursement strategies to incentivize practice use and improved clinical outcomes should also be considered.

Several recommendations emerged from the current study for operating future SAMHSA SOC awards in CAMHD and other state systems. First, there was enthusiasm for the focus of SOC awards to include more goals around infrastructure development and sustainment and to avoid “stand-alone” services. For example, one informant noted that “ It’s kind of a problem if you have a stand-alone service with its own team and it’s going to go away when the grant money is gone. ” Indeed, sustainability planning should begin prior to an infrastructure grant application being written to ensure there is a clear sustainable financial plan or objectives to continue pursuing funding for specific initiatives. Integrating procurement and administrative activities as specific and targeted award objectives, while unconventional, will emphasize the disconnect between federal and state procedures and spending priorities. Both state and federal legislators should be aware of funding mechanisms that have the potential to operate well in state government and to champion legislation that would create less bureaucracy in favor of the community. For example, including procurement clauses within federal funding announcements that allow for the federal government to supersede state laws may aid in timely execution of contracts using federal funds. Moreover, creating grants management, contracting, and fiscal positions that sit within procurement and administrative offices at the highest department level will be crucial to more timely execution of grant activities. Second, reliance on within-system historical knowledge is fraught with error. Future SOC awards should include evaluation objectives, like this project, to memorialize previous accomplishments, reflect on shared understanding and inconsistencies, and to archive important SOC activities in legacy documents. The third recommendation is related to communication within and between SOC awards by maintaining staff from one project to another. It is helpful to have ongoing role and responsibility clarification meetings internally and with child-serving system partners to avoid confusion and miscommunication. Learning collaboratives and protected time for project directors to share lessons learned and recommendations would aid in knowledge consolidation between projects. It would also be beneficial to allow for multi-year overlap of federal SOC awards to create continuity and retain employees. As one informant noted:

“And we recruited and hired a lot of really great people, and I think that the challenge becomes, as the grant starts to come to a close, or is nearing its end, that you recognize that people may leave because the positions are time limited. So, to the extent that it’s possible to think about positions for those folks, I feel like that is important.

Trauma-informed care principles are a necessary component of ensuring continuity of care. Trauma-informed care requires active responses in the form of integrating knowledge related to trauma into policies, procedures, and practices as well as careful attention to avoiding re-traumatization and secondary trauma of those involved in systems [ 24 ]. Lessons learned include making changes at the individual and organizational level to ensure that all aspects of care would be both transparent and trauma-informed. As one informant noted:

For example, in meetings, there were things that were being said in, in care coordination meetings, things that were being said that were offensive to the youth peers. And so there was a lot of work to prepare and debrief the youth peers after they were in meetings. We had peers that had previously been in care and saw their, their, their staff that they had worked with in some of our meetings. I mean, and had really negative experiences with them. And so the debriefing and you know, the secondary traumatic stress and the triggering even at the peers was intense. And so there was a lot of work with that that had to be addressed and done.

Guiding principles of trauma-informed care include creating a safety net instilled with trustworthiness and transparency, among others, to build confidence toward motivation for continued engagement [ 25 ]. Moreover, and consistent with interagency collaboration, a trauma-informed child-serving system should create a shared lexicon that speaks within and between agencies to improve navigation for youth and families. One informant noted:

And thinking about the needs of children as complex and they may have needs that span the way government agencies are organized. And so, recognizing that it is on the onus of government or organizations to be set up to better serve families rather than the onus on families to try to navigate really burdensome infrastructure to get the services that they need.

Limitations

The current study is not without limitations. First, the study relied on retrospective accounts of past project final reports and informant interviews. Both sources of information included objective and subjective accounts of previous SAMHSA SOC awards that represent a limited perspective. Moreover, key informants were identified via purposive sampling which may affect generalizability to other systems. Future research may wish to focus on convergence with multiple sources of objective data including financial reports, progress indicators, and any other technical assistance data available. Second, the information sources rely heavily on leadership and a small subgroup of CAMHD staff perspectives. It is unclear the extent to which some of these themes and lessons learned are uniformly understood throughout the various levels and roles within CAMHD and the child serving system. Additionally, the initial content coding design intended to rely on SAMHSA Infrastructure Development, Prevention, and Mental Health Promotion indicators (e.g., Policy Development, Workforce Development) to aid in generalizability to other systems. However, the indicator definitions were difficult to operationalize. For example, the Workforce Development categories contain five indicators that measure the number of organizations, communities, people, changes, and consumer or family members that are trained in, are credentialed or certified, implemented, and/or delivered mental health services. However, these metrics were almost never reported on within final reports and it was unclear how meaningful these metrics were to the system and aligned with SOC values and principles. While this study ultimately chose to use a grounded approach, future studies may wish to carefully think through key indicators to compare within and across systems over time. Despite these limitations, examining SAMHSA SOC awards within one system has the potential to inform how state and federal governments operate funds to support mental health innovation. Additional methods like landscape analysis and policy development could help to address the financial and administrative bureaucracy of operating federal funds in a state government association.

Federal funding is critical to addressing the youth mental health crisis [ 4 ]. The current study examined system of care expansion trends that represented multimillion-dollar investments and decades of work around interagency collaboration and youth and family voice, as well as attempts to build connection and continuity. It is hoped that the lessons learned will aid other systems and future work in being more evidence-informed. Similar delays in award progress and spending stemming from incongruencies between state and federal policies are consistent with previous SOC research and anecdotal reports from others involved in SAMHSA and SOC efforts. Targeted state alignment with federal policies and longer funding mechanisms may aid in ameliorating administrative burden on systems. That said, SAMHSA SOC expansion awards have the potential to fund innovative work that create legacy cultures around SOC values and principles.

Data availability

The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Child and Adolescent Mental Health Division

Cultures of Engagement in Residential Care

Data to Wisdom

Hawaiʻi Interagency State Youth Network of Care

• Substance Abuse and Mental Health Services Administration
• System of Care

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Acknowledgements

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This work was supported by the Substance Abuse and Mental Health Services Administration (H79 SM082961). Okamura is also supported by the National Institute on Drug Abuse (L60 DA059132) and the National Institute of General Medical Sciences (U54 GM138062).

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Kelsie H. Okamura & Danielle L. Carreira Ching

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Kelsie H. Okamura, David Jackson & Da Eun Suh

Hawaiʻi State Office of Wellness and Resilience, Honolulu, HI, USA

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Hawaiʻi State Child and Adolescent Mental Health Division, Honolulu, HI, USA

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Contributions

KHO and DJ contributed to the design and analysis of the study as well as interpretation of the results. DS and DLCC reviewed project final reports for discrepancies in themes identified in analyses. KHO drafted the first version of the manuscript. TH and PH provided writing support. DLCC created figures for the manuscript. DS reviewed and edited the manuscript. All authors made a significant contribution to the research and the development of the manuscript and approved the final version for publication. SKS supervised the study.

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Okamura, K.H., Jackson, D., Ching, D.L.C. et al. 30 years of youth system of care lessons learned – a qualitative study of Hawaiʻi’s partnership with the Substance Abuse and Mental Health Services Administration. BMC Health Serv Res 24 , 658 (2024). https://doi.org/10.1186/s12913-024-11114-9

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National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Niaaa releases strategic plan for fiscal years 2024-2028.

Wednesday, May 29, 2024

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has released Advancing Alcohol Research to Promote Health and Well-Being , the Institute’s Strategic Plan for fiscal years 2024-2028.  The plan charts a course for the next five years and outlines the goals and priorities that will guide NIAAA’s research through a dynamic balance of basic, translational, and clinical research relevant to NIAAA’s mission.

“For more than 50 years, NIAAA has been at the forefront of cutting-edge alcohol research,” said NIAAA Director George F. Koob, Ph.D.  “Guided by this new strategic plan, I am optimistic that NIAAA-supported research will pave the way for future breakthroughs that will help more Americans live healthier, more productive lives.”

The new strategic plan seeks to advance many long-held NIAAA research and research training priorities, such as preventing alcohol misuse at all ages, enhancing the diagnosis of alcohol use disorder (AUD), fetal alcohol spectrum disorders (FASD), and other alcohol-associated pathologies, improving treatment for these conditions, and addressing health disparities in alcohol misuse and related consequences. Highlights also include:

• Diversity, equity, inclusion, and accessibility in the alcohol research enterprise
• Women’s health research
• Whole person health and integrated health approaches
• Data science (e.g., artificial intelligence) and data management
• Translation and back translation of research findings
• Social determinants of health in the context of risk and resilience
• Social media impact on alcohol-related behaviors and outcomes, and social media as a tool for innovating interventions

Developed by NIAAA leadership and staff, with input from external researchers, advocacy groups, professional societies, and interested individuals, the strategic plan considers the long-term priorities of the field while remaining flexible to adapt to emerging public health needs and scientific opportunities. 

niaaa.nih.gov

An official website of the National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism

Substance Abuse: Case Study Analysis Essay

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Introduction

Andrew, a Hispanic man of 26, lives with his mother and elder sister. He works part-time since he is currently enrolled at a nearby community college. Andrew was suspended from school and placed on academic probation for his involvement with marijuana. In addition, he was doing a number of part-time gigs, all of which ended in his dismissal after a few months of bad performance. One of Andrew’s four siblings, a brother, lost his life in a terrible childhood drowning. He has not sought either therapy or a solid support network. Andrew, though, has admitted to consuming marijuana and drinking alcohol and has sought professional help.

A decade of fighting Major Depression, it is finally revealed after he attends many therapy sessions. Andrew says he can drink heavily without becoming drunk. He freely admits to having tried and failed on several occasions to kick his weed and alcohol habits. Andrew has a higher chance of being fired again since he keeps skipping work. Multiple prescriptions for antidepressants were written for Andrew’s mum by her Physician. In addition, her sister gives off a gloomy vibe but insists she is well. To this end, the self-medication model will be applied to Andrew’s case to establish the root of her addiction and the best means of treating it.

Treatment Model and Conceptualization

Under the self-medication theory, drug use is a symptom of a deeper problem. For some people, drug abuse is a means of coping with difficult feelings, mental health issues, and stressful situations. Drug use is a coping mechanism for the distress of mental illness (Parvinro et al., 2022, p.20). Individuals may feel better in the short term, but the underlying substance misuse problem remains. Substance addiction problems are strongly linked to self-medication, suggesting that people engage in this approach because they believe it would cure their underlying disease. The use of substances provides a means for those who have suffered trauma to divert their focus away from their feelings and toward something else, which is why addiction and trauma occur together. In addition, drug use is perpetuated because it provides users with temporary relief from unpleasant experiences.

Pain, whether mental or physical, that persists over a long period of time is a major factor in the development of drug misuse disorders. Self-medication is a coping mechanism used to alleviate both emotional and physical suffering (Hawn et al., 2020, p.5). Relaxation and pain reduction from any source are two of the many benefits of using marijuana or opioids. The paradigm of self-medication is crucial to understand because it may lead to improved methods of treating substance abuse problems(Hawn et al., 2020, p.8). Substance misuse typically manifests as a symptom of a more severe problem. Substance addiction treatment often ends in relapse since so many things might trigger an individual to start abusing drugs or alcohol in the first place.

Andrew’s been using marijuana and alcohol as a kind of self-medication for his mental health issues. Over the past decade, Andrew has been medicating his significant depressive disorder using it. This suggests that Andrew’s decision to self-medicate in order to deal with his grief is a symptom of a deeper mental health issue. Since Andrew’s mom used antidepressants and her sister seems down in the dumps, it is possible that Andrew has a family history of depression. Andrew’s mental difficulties run in the family; both his sister and her mother suffer from depression. Even more importantly, Andrew is hiding his feelings of despair by consuming drugs. From Andrews’s case, it is evident that people turn to drugs as a means of relieving tension and gaining security against the unknown.

DSM5 Diagnosis

Andrew suffers from significant depression and addiction. A person with symptoms consistent with DSM-F33, IV’s major depressive disorder, recurrent episode, typically has recurring episodes of depression without a concurrent history of periods of increased activity or improved mood (Jongsma, 2022, p.6). A recurrence after two months should have been expected, and the last episode ought to have been two weeks. A lack of previous mania or hypomania is a common feature of this condition. Andrew has admitted to having serious depression for the past decade but insists he does not require treatment. The relationship he shares with his brothers is strained, but he is happy with his fiancée.

Andrew has been allowed a number of part-time positions owing to subpar performance. His lack of focus shows in his inconsistent performance at work and subsequent terminations. Despite his lack of a pre-existing depressive disorder, Andrew satisfies the diagnostic criteria for severe depression. He admits he does not need aid since Andrew thinks he is OK on his own. Andrew claims he has tried and failed to give up both alcohol and marijuana. Andrew’s drinking has been worse recently, and he brags about being able to consume large quantities of alcohol without seeing any effects.

It is clear that Andrew has a drug use disorder according to the DSM-IV criteria. Due of his dependency and abuse, he describes the experience of cravings. Andrew has a severe craving for both weed and alcohol. He freely admits to having tried and failed to kick his nicotine and alcohol habits. Because he does not seem to cut down on his drinking, Andrew also satisfies the requirements for dependency. Fearing he may fail in his job as a result of his absences, he is unable to take any significant action. He fits the abuse criteria since he has been using drugs and alcohol to cope with his major depressive disorder for a decade.

Treatment Plan

Problem presentation.

Andrew suffers from significant depression and addiction, he opens out about his heavy use of both marijuana and alcohol. His girlfriend had been encouraging him to see a counselor, and he finally did. A decade of significant depression and alcohol abuse were revealed after he attended numerous sessions. Recently, Andrew has been bragging about drinking excessively without becoming drunk. Andrew’s drinking has gotten out of hand, and he is tried several times to cut back without success.

Treatment Goal

Long-term planning for Andrew should focus on improving both the quality and the duration of his life. Goals include relieving Andrew’s severe depressive symptoms and helping him give up drinking. Andrew is depressed and uses marijuana and liquor to self-medicate. Evidence of extreme reliance and misuse is his recent pattern of drinking heavily without becoming intoxicated. Andrew has tried several times to cut back on his drinking but to no avail. Short-term targets for Andrew include cutting back on drinking and consuming marijuana and increasing his attendance at work.

Therapeutic Intervention

In order to alleviate Andrew’s substantial depressive symptoms, cognitive-behavioral therapy (CBT) should be suggested. Zayfert & Becker (2019, p.5) found that clients suffering from both depression and substance misuse responded positively to CBT. In comparison to other types of psychiatric drugs or psychological therapy, the therapy has proven to be more effective. That is why CBT is the best option for helping Andrew overcome his significant depression since he will have access to new and healthier coping mechanisms. The reduction of his depressive symptoms should help him become more productive. Andrew will be better able to handle difficult situations after doing CBT since he will have acquired the necessary problem-solving abilities. Behavioral modifications are the focus of treatment in CBT.

The second strategy is connecting Andrew with abuse support groups. The support group will assist him in giving up alcohol and drugs as coping mechanisms. In these gatherings, Andrew may hear from others and gain insight into how they have dealt with similar situations. Those who take part in support groups have less cause for worry, anxiety, and despair (Shaari, & Waller, 2022, p.10). A common theme in the group’s communication is honesty and openness about members’ internal experiences. Therefore, Andrew will be able to stick with the different treatment options that have been proposed to him and maintain his motivation to quit drinking and smoking.

Andrew suffers from serious depression, which has led him down the path of substance misuse. Andrew’s drinking and smoking habit is best explained by the self-medication theory. Upon participating in therapy, he said that he had suffered from serious depression for the previous decade, which had led him to turn to alcohol and marijuana for relief. Andrew will be able to overcome his alcohol and drug addiction with the aid of cognitive behavior therapy and connection to substance abuse support groups.

Abu Hassan Shaari, A., & Waller, B. (2022). Self-help group experiences among members recovering from substance use disorder in Kuantan, Malaysia . Social Work with Groups , 1-17. Web.

Hawn, S. E., Bountress, K. E., Sheerin, C. M., Dick, D. M., & Amstadter, A. B. (2020). Trauma-related drinking to cope: A novel approach to the self-medication model . Psychology of addictive behaviors , 34 (3), 465. Web.

Jongsma Jr, A. E. (2022). The addiction treatment planner . John Wiley & Sons.

Parvinroo, S., Rouhi Khalkhali Pargam, H., Hosseinzadeh Asli, R., Rafiei, E., & Nemati, S. (2022). Frequency and causes of self-medication in patients with chronic rhinosinusitis, North of Iran, 2018–2019. European Archives of Oto-Rhino-Laryngology , 279 (8), 3973-3980.

Zayfert, C., & Becker, C. B. (2019). Cognitive-behavioral therapy for PTSD: A case formulation approach . Guilford Publications.

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Has fentanyl peaked.

We explain a decline in overdose deaths.

By German Lopez

Last week brought some rare good news on drugs: Overdose deaths declined in 2023 . And while the opioid crisis has taken some surprising and terrible twists over the years, it may finally be turning around.

There are two main causes. First, drug epidemics tend to follow a natural course in which the drugs enter a market, spread and then fade away, at least for some time. The opioid epidemic appears to have entered that final phase. Second, policymakers have increased access to both Narcan, a medication that reverses opioid overdoses, and addiction treatment. These changes have saved lives. Today’s newsletter will explain both causes.

Faddish cycle

Drugs are often faddish; epidemics tend to ebb on their own. Why? Users die. People see the damage that a drug does, and they shun it. Surviving users move on to other drugs that they see as better or safer, sometimes incorrectly.

Think of all the drugs that have come and gone over the past several decades, such as crack, meth and synthetic marijuana. (In the case of meth, a comeback is underway . Even the worst fads can return.)

The opioid epidemic is no exception. In fact, it has arguably been a succession of three different fads — first opioid painkillers, then heroin and finally fentanyl — that have felt like one.

Annual drug overdose deaths in the United States

100,000 deaths

In the 1990s, doctors started to prescribe more painkillers. The drugs proliferated not just among patients but everyone else as teenagers took them from parents’ medicine cabinets and peddlers sold them on the black market. By the 2010s, many painkiller users had moved on to heroin as they lost access to the pills — because doctors stopped prescribing them — or sought a stronger high. Then, fentanyl arrived.

Fentanyl has been worse than heroin and other opioids. Drug cartels make it in laboratories in Mexico, using ingredients typically imported from China. Before the current crisis, fentanyl was not widely misused in the U.S. It first spread in drug markets across the East Coast and the Midwest in the mid-2010s, consistently causing a spike in overdoses wherever it went.

For a little while, its spread largely stopped at the Mississippi River. It was easier to mix with the white-powder heroin popular in the eastern U.S. than with the black tar heroin popular in the western U.S. As fentanyl’s spread briefly stalled, overdose deaths declined nationally in 2018. But then the drug went westward, reaching the Pacific Coast. That new wave, coupled with the Covid pandemic, caused annual overdose deaths to exceed 100,000.

So why is last year’s drop different from 2018’s? Opioids, including fentanyl, have already reached every corner of the country; they have few places left to spread. The Covid pandemic is over, taking with it the chaos and isolation that led to more overdoses. The drug users most likely to die have already done so. More people have rejected opioid use. And the remaining users have learned how to use fentanyl more safely.

Policy’s impact

Some policy changes have played a role in the decline, too.

In particular, federal officials have successfully pushed the use of Narcan (also known as naloxone), a medication that reverses opioid overdoses. Police officers and firefighters often administer it. Libraries and schools carry it. Pharmacies sell it over the counter. Some first aid kits include it. People who overdose are now much likelier to get Narcan quickly enough to save their lives.

The federal government has also put more money toward addiction treatment, both through Medicaid and through new laws aimed at the drug crisis. The government has pushed doctors to prescribe medications that treat opioid addiction. Some states, like Vermont , have made treatment more accessible and higher quality.

These changes have not addressed every problem. Patients can struggle to pay for treatment. And some programs continue to use practices not supported by science, such as confrontational approaches and therapies in which patients bond with horses . Still, the policy changes have helped improve the treatment system overall.

Even after last year’s decline, annual overdose deaths remain above 100,000. That death toll is higher than all annual deaths from car crashes and guns combined. The introduction of a new drug — the next fad — could still increase that death toll again.

Policymakers could speed up the drop in deaths. They could require health insurance plans to cover addiction treatment. They could fund more high-quality treatment. They could reduce the price of Narcan and similar medications. They could better coordinate with China and Mexico to reduce the flow of fentanyl into the U.S.

The opioid epidemic is burning out anyway, but its decline could be steeper, saving thousands more lives.

Related: A major study found that weed use among teenagers was lower in states where the drug was legal, confounding expectations.

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Trump on trial.

The prosecution rested its case in Donald Trump’s Manhattan criminal trial after Michael Cohen finished testifying. The defense is likely to rest today .

Prosecutors found a photo of Trump with his bodyguard from October 2016, taken shortly before Cohen said he called the bodyguard to discuss the payment to Stormy Daniels with Trump. The defense had challenged Cohen’s account of the call.

During cross-examination, Cohen admitted to stealing from Trump’s company . He kept money that was meant to go to a tech company hired to rig polls in Trump’s favor.

The defense called Robert Costello, a lawyer who advised Cohen before they had a falling out. Costello testified that Cohen told him that Trump “knew nothing” about paying off Daniels . Cohen previously said that he’d lied to Costello.

Trump has often sat still, his eyes closed, during the proceedings. Sometimes he’s sleeping; sometimes he seems to be compartmentalizing, our colleague Maggie Haberman says .

A verdict could come next week, answering the question of whether Trump will campaign for president as a convicted felon .

Iranian President’s Death

Iran began funeral events for Ebrahim Raisi, its former president who died in a helicopter crash.

A “technical failure” caused the crash that killed Raisi and Iran’s foreign minister, the state media reported.

Images of the crash site show that Raisi’s helicopter was a model developed for the Canadian military in the 1960s. Iran struggles to update its aviation fleet because of sanctions .

Raisi was a candidate to succeed Ayatollah Ali Khamenei, 85, as Iran’s supreme leader. His death complicates a difficult search for the next ruler .

Israel-Hamas War

The International Criminal Court’s chief prosecutor requested arrest warrants for Benjamin Netanyahu and the leaders of Hamas for crimes related to Oct. 7 and the war in Gaza.

President Biden called the prosecutor’s request outrageous: “There is no equivalence — none — between Israel and Hamas.” He later said that what’s happening in Gaza “is not genocide.”

OpenAI asked Scarlett Johansson, who played a seductive virtual assistant in the movie “Her,” to become a voice of ChatGPT . She said no twice, but the company released an assistant that sounds like her.

“I was shocked, angered and in disbelief”: Johansson rebuked Sam Altman , OpenAI’s chief executive. The company has suspended the voice.

OpenAI designed a voice of a “lightly flirtatious, wholly attentive woman,” our movie critic writes. Read more about how the voice resembled the one in “Her.”

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The seafood chain Red Lobster has filed for bankruptcy . The company plans to close many of its restaurants.

The financier Ivan Boesky, who symbolized the brash Wall Street of the 1980s — and paid a $100 million penalty for insider trading — died at 87 .

2024 Election

Trump and the Republican Party beat Biden and the Democrats in fund-raising for the first time this election. The Biden campaign still has far more cash on hand.

Trump’s Truth Social account posted a video with hypothetical newspaper articles about what his victory would mean for America that referred to “the creation of a unified Reich.” His campaign said a staffer had posted it.

Other Big Stories

Gangs control Haiti’s infrastructure , including police stations and ports.

South Africa’s highest court barred former President Jacob Zuma, who is attempting a political comeback, from running for Parliament next week . His new party will still put his face on ballots, complicating the election.

Contaminated blood products killed about 3,000 patients of Britain’s National Health Service, a long-awaited report found. The authorities hid their failings for years.

Storms could bring tornadoes and damaging winds to the Midwest today.

Arizona has a choice: become more like Texas or more like California. This year’s U.S. Senate race will suggest where it’s headed , Tom Zoellner writes.

Samer Attar spent weeks documenting the struggle to save lives in Gaza’s ravaged hospitals. Watch his dispatches in this Opinion Video .

Here are columns by Michelle Goldberg on Trump’s criminal trial and Paul Krugman on the Dow’s hitting 40,000 .

MORNING READS

Travel: Spend 36 hours on the Spanish island of Minorca.

Climate questions: Is biodegradable plastic really a thing? Yes, but it isn’t a perfect solution .

Health: How to soothe — and prevent — ingrown hairs .

Lives Lived: Bruce Nordstrom, whose grandfather immigrated from Sweden and founded Nordstrom as a small shoe-store chain, was instrumental in turning the retailer into an international fashion giant. He died at 90 .

N.H.L.: The Edmonton Oilers survived Game 7 in Vancouver despite giving up two goals in the final nine minutes. They will play the Dallas Stars in the Western Conference Final.

N.B.A.: The Boston Celtics and Indiana Pacers play in Game 1 of the Eastern Conference finals tonight. Boston is a favorite .

ARTS AND IDEAS

Robert F. Kennedy Jr.’s style — the skinny ties, button-downs and weather-beaten tan — is unique among this year’s presidential hopefuls. It also might be an electoral advantage: His preppy look evokes, in the American mind, his father and his uncle, the Times’s chief fashion critic Vanessa Friedman writes .

“It matters because those unstated associations serve to moderate Mr. Kennedy’s more outré positions,” Vanessa adds.

More on culture

The Times sat down with the stars of Yorgos Lanthimos’s new dark comedy, “Kinds of Kindness,” which just premiered at Cannes .

Penguin Random House, the largest publishing house in the U.S., dismissed two top executives ; the industry faces financial challenges.

The author of “Crazy Rich Asians” left Singapore’s upper crust when he was 11. He’s still writing about it .

The Portal — a live video feed between Dublin and New York City — has reopened. It was shut off last week because of bad behavior on both sides, including a flasher.

Stephen Colbert had thoughts about Justice Samuel Alito blaming his wife for the flying of an upside-down American flag.

THE MORNING RECOMMENDS …

Roast a curry-rubbed half chicken with peppers , an ideal recipe for one.

Celebrate love with an anniversary gift .

Take a portable solar battery charger with you on a hike.

Here is today’s Spelling Bee . Yesterday’s pangram was taxonomy .

And here are today’s Mini Crossword , Wordle , Sudoku , Connections and Strands .

Thanks for spending part of your morning with The Times. See you tomorrow. — German

P.S. We apologize: We told you yesterday that the comments section for David Leonhardt’s article on “neopopulism” would still be open, and it wasn’t. But it’s open again now and will remain so all day.

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German Lopez is a writer for The Morning newsletter. More about German Lopez

What You Need to Know About Marijuana Rescheduling

by Victoria Litman, M.Div., J.D., LL.M.

On May 21, 2024, the Drug Enforcement Administration (DEA) published a Notice of Proposed Rulemaking (NPRM) signed by Attorney General Merrick Garland in the Federal Register. This publication kicks off a 62-day comment period on a rule that would move marijuana to Schedule 3 of the Controlled Substances Act (CSA), classifying it as a substance with “a moderate to low potential for physical and psychological dependence.” The process of rescheduling may be long and is unlikely to create a pathway to federal compliance for state-legal marijuana businesses without further federal legislation. Ultimately, Congress likely will need to clarify the division of federal and state regulatory powers over cannabis.

The CSA is a federal law that classifies substances into schedules based on their potential for medical use and risk of abuse. The cannabis plant has been in the most restrictive category, Schedule 1, since the CSA was enacted in 1970. In the 2018 Farm Bill , cannabis plants with less than .3% concentration of the major psychoactive component of marijuana, delta-9-tetrahydrocannabinol (THC), were removed from the CSA and legally defined as hemp. All other cannabis remains Schedule 1 , defined as a substance with no currently accepted medical use (CAMU), lack of safety for use under medical supervision, and a high potential for abuse.

Despite ongoing cannabis restrictions on the federal level, since 1996 many states have enacted legislation regulating and taxing medical and recreational marijuana and creating dispensaries for patients and consumers to access it. For several decades, these state-regulated businesses have existed under the shadow of federal illegality. Marijuana’s Schedule 1 status has impacted the economic feasibility of these businesses due to punitive federal taxes , significant burdens on banks willing to work with cannabis businesses, and no legal interstate commerce.

Since 2014, Congress has passed spending amendments that limit the use of federal funds for enforcement against state-compliant medical marijuana programs. From 2009-2018, several U.S. Attorneys General issued memos directing federal prosecutors to limit enforcement against all state-compliant marijuana businesses, medical and recreational. In 2018 Attorney General Jeff Sessions technically rescinded prior memos and encouraged prosecution of federally illegal marijuana activity; however, in practice there has been limited federal enforcement.

In the fall of 2022, President Biden issued a statement on marijuana reform, announcing federal pardons for some federal crimes involving marijuana and urging state governors to pardon state-level cannabis possession charges. Biden also asked the Secretary of the U.S. Department of Health and Human Services (HHS) and the Attorney General to initiate the administrative process to review the scheduling of cannabis under the CSA.

In August 2023,  HHS sent an official recommendation to the DEA that it categorize marijuana under the less restrictive Schedule 3 category. The recommendation became public in early 2024 as a result of a lawsuit . Notably, the recommendation was the first statement from a federal government agency that marijuana has a currently accepted medical use and a low potential for abuse. An April 11, 2024 opinion from the Office of Legal Counsel (OLC) asserted that DEA must “accord significant deference” to HHS’ recommendation until the beginning of formal rulemaking. However, the NPRM notes that DEA has not decided how marijuana should be scheduled.

Now that the NPRM has been published, individuals and businesses may submit comments on the proposal until July 22nd. Interested persons (defined in regulations ) may request an administrative law hearing before June 20th in accordance with the requirements of the Administrative Procedure Act.

Once comments are received and after any hearing, the DEA will review all evidence and generally respond to comments when publishing the final rule. There is no set statutory time for this process but in other situations, for example telemedicine , it has taken over a year.

Once published, the DEA’s final rule will not go into effect for 30 days, during which time aggrieved parties who submitted comments and can demonstrate they have standing can challenge the final rule in court. At least one major opposition group is already fundraising for the legal effort.

The two main issues likely to be challenged are the impact of rescheduling on adherence to United Nations treaty obligations and the way HHS determined that marijuana has a CAMU. For the first time, HHS considered the existing widespread use of medical marijuana under the supervision of health care practitioners within state medical marijuana programs. The OLC’s opinion addresses these issues directly.

A letter from Democratic senators opposing rescheduling and supporting removal of marijuana from the CSA entirely explains that although rescheduling likely provides tax relief, it does not impact criminal justice and immigration issues related to cannabis criminalization. Rescheduling would not be a panacea for the challenges faced by state legal marijuana businesses and would not necessarily make marijuana easier to research .

Schedule 3 drugs must be approved by the Food and Drug Administration (FDA,) prescribed by a doctor, and distributed by a pharmacy. Thus, none of the existing state-regulated marijuana dispensaries would be able to comply without extreme cost or further regulation or legislation. Another Attorney General’s memo is expected to clarify enforcement priorities against marijuana-related businesses that are legal in the state, but federally non-compliant.

I have previously written that no matter what happens with rescheduling, Congress will need to clarify the division of federal and state regulatory powers over cannabis. Congress must specify that FDA’s jurisdiction over cannabis should be no more than that over alcohol and designate cannabis in food as “generally recognized as safe.” These, and other FDA-related fixes, already drafted as part of proposed legislation, the States Reform Act , would create legal pathways for existing state-licensed marijuana operators to be in compliance with the Federal Food, Drug, and Cosmetic Act . By doing so, Congress could reduce unnecessary spending on unfeasible federal enforcement and preserve limited federal resources to evaluate clinical research on cannabis-derived drugs . Thus, even if marijuana is moved to Schedule 3, federal legislation is necessary. The only question is how long it will take Congress to act.

Victoria Litman M.Div, J.D., LL.M. is a nonprofit tax lawyer focused on the emerging cannabis and psychedelic tax exempt sectors and an adjunct law professor. She is also an Affiliated Researcher of the Project on Psychedelics Law and Regulation (POPLAR) at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

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The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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