Journal of Drug Issues

This study assessed Jordanian parents’ knowledge, attitudes, and practices regarding antibiotic use and their health literacy levels, and examined their associations with sociodemographic factors. A cross-sectional design was used with a convenience sample of 502 parents recruited from primary healthcare centers and social media. Data were collected through Google Forms using the translated Knowledge, Attitudes, and Practices Towards Antibiotics Questionnaire and the Arabic Health Literacy Scale–Short Version. Descriptive statistics, t-tests, ANOVA, and Pearson correlation were used for analysis. Mean scores for knowledge, attitudes, and practices were 57 (SD = 23.18), 58.55 (SD = 18), and 67.22 (SD = 17.96), respectively. Most parents demonstrated moderate knowledge (33.9%) and attitudes (34.7%), while 40% had higher practice scores. However, 77% showed inadequate or problematic health literacy. A significant positive correlation was found between health literacy and parents’ knowledge, attitudes, and practices regarding antibiotic self-medication, highlighting the need for targeted educational interventions to promote responsible antibiotic use.

This mixed-methods study, guided by the health belief model (HBM), explored how cognitive appraisals, stigma, and social context shape marijuana use among Bangladeshi university students. Quantitative data were collected through snowball sampling (n = 352). Recurrent use was operationalised as usage occurring at least once per month during the preceding three months. Qualitative data were generated through in-depth interviews (n = 33) and were analysed thematically. Recurrent users reported greater perceived benefits, more influential peer and media cues to action, and lower perceived susceptibility, barriers, and stigma compared to occasional users. Qualitative themes indicated marijuana use became normalised through peer culture, stress-coping narratives, evolving moral frameworks, informal access networks, and the management of dual identities. Collectively, the findings indicate marijuana use among Bangladeshi university students is associated more with socially reinforced benefit appraisals and culturally negotiated justifications than with ignorance of harm.

Peer-operated recovery residences use a social model approach to recovery that emphasizes peer support and resident involvement in a community-embedded living environment. “Activity Space Assessments” are a way to identify the characteristics of neighborhoods and local communities that might influence behaviors of interest. The primary aim of the current paper was to consider the utility of activity space assessment using a resident participatory method for assessing recovery home neighborhoods and local community environments. Using a focus group format, the authors conducted a pilot study that invited residents from three sober living recovery homes (SLHs) in Los Angeles to identify places and activities near their houses that residents considered safe, risky, or both in terms of their influences on recovery. Residents were questioned about ways they coped with risky places. Participation was robust with residents identifying 91 activity spaces. Most of these (N = 59) were designated as safe, 12 as risky, and 20 as both. Some residents expressed mixed or divergent views about the safety of places and how they coped with risks. Activity space assessments of SLHs that are informed by resident experiences could be used to manage neighborhood risks, access sources of support, and monitor changes in the local environment.

This study aimed to determine the prevalence of adult attention-deficit/hyperactivity disorder (ADHD) symptoms among individuals with opioid use disorder (OUD) and to examine whether impulsivity and aggression mediate the relationship between ADHD symptoms and addiction severity. A total of 100 individuals diagnosed with OUD and 50 healthy controls completed validated self-report measures assessing ADHD symptoms, impulsivity, aggression, and addiction severity. Compared with healthy controls, individuals with OUD exhibited significantly higher levels of ADHD symptoms, impulsivity, and aggression. Mediation analyses demonstrated that impulsivity partially mediated the association between ADHD symptoms and addiction severity, whereas aggression did not show a significant mediating effect. These findings suggest that the clinical impact of ADHD in OUD may be driven less by diagnostic status alone and more by specific impulsivity-related mechanisms. Identifying and targeting impulsivity may therefore represent an important strategy for improving clinical outcomes in individuals with OUD and comorbid ADHD symptoms.

This prospective multicenter cohort study examined changes in patient-reported outcome measures (PROMs) among 161 men and women entering residential substance use disorder (SUD) treatment in Belgium and explored how treatment setting and sociodemographic factors influence outcomes. PROMs were assessed at baseline and after 45, 90, and 180 days using the PROMIS-GH (general health), WHOQoL-BREF (quality of life), and SURE-NL (recovery). Linear mixed models showed significant improvements in mental and physical health, and in all quality of life (QoL) domains except for social relationships. Psychological and physical health improvements plateaued, while perceived QoL and environmental domains improved linearly. Males scored higher in psychological health whereas treatment modalities differed in psychological health and social relationships. Recovery scores remained consistently high, possibly due to ceiling effects, underscoring the importance of the timing and context of PROM assessment. Integrating PROMs into routine care has the potential to support patient-centered practices and enhance treatment outcomes in SUD services.

Despite the importance of substance use disorder (SUD) treatment during pregnancy, treatment utilization and completion remain suboptimal among pregnant individuals. Pregnant adolescents represent a uniquely vulnerable subgroup, yet very few studies have examined SUD treatment completion among pregnant adolescents. This study involved a secondary analysis of Treatment Episode Data Set -Discharges (TEDS-D). The analytic sample included 210,412 females aged 12–49 years. Logistic regression was used to examine whether treatment completion differed by pregnancy status and age group. State-level variation in SUD treatment completion among pregnant individuals was also assessed. Findings revealed that among females of childbearing age, pregnant adolescents had the lowest treatment completion rates. Treatment completion also varied across U.S. regions and differed significantly by race/ethnicity, length of stay, and primary substance used. These findings emphasize the need for culturally competent and tailored interventions to improve substance use treatment engagement and outcomes among females of childbearing age.

Polydrug use presents a particularly problematic substance use behavior in need of additional investigation, both to understand heterogeneity in development and identify predictors of differential development. The dual systems model may have capacity for understanding development of polydrug use. This study examined dual systems imbalance in childhood as a predictor of development of polydrug use risk during adolescence. The Adolescent Brain Cognitive Development data were analyzed. Group-based trajectory modeling was used to identify heterogeneity in trajectories of drug use variety. Multinomial logistic regression was used to examine dual systems imbalance as a predictor of drug use variety development. Results indicated that a three-group drug use variety trajectory model best fit the data (Abstaining; Late Onset; Early Onset). Greater dual systems imbalance characterized by greater sensation-seeking and lower impulse control significantly predicted increased risk of assignment to the Late Onset and Early Onset drug use variety trajectory groups.

Perinatal opioid use disorder contributes significantly to the U.S. maternal health crisis. Medication for opioid use disorder (MOUD) improves maternal and neonatal outcomes, yet stigma remains a barrier to care for pregnant patients. This qualitative study examined stigma experienced by perinatal patients on MOUD and its impact on healthcare engagement using the Health Stigma and Discrimination Framework. Semi-structured interviews were conducted with 15 patients receiving integrated perinatal and addiction care in Philadelphia, Pennsylvania, between October 2023 and April 2025. Participants were aged 24–40 years; 47% identified as Black and 53% as White. Thematic analysis identified key drivers of stigma including societal judgments of parental fitness, fear of state involvement, and provider knowledge gaps regarding MOUD. Stigma manifested as inadequate pain management, fear of custody loss, and reduced care-seeking behaviors. Findings underscore the need for provider education and policy reform to reduce punitive responses to MOUD use in pregnancy.

Alcohol, tobacco and cannabis use remain prevalent among college students. To gain a comprehensive understanding of factors related to problematic use of these substances, we applied the Theory of Triadic Influence (TTI) and nested logistic regression. We used ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) scores from Spring 2023 American College Health Association-National College Health Assessment III participants without a previously diagnosed substance use disorder who had a lifetime history of alcohol, tobacco and cannabis use (N = 18,948 students). The prevalence of moderate-to-high alcohol-, tobacco- and cannabis-risk scores were 27.62%, 47.39%, and 50.23%, respectively. TTI-aligned correlates associated with increased likelihood of moderate-to-high risk use for all three substances included: psychological distress (intrapersonal), financial stress (environmental), and engaging in related behaviors including self-harm, partying, and additional substance use (immediate precursors). Several unique substance-specific correlates were identified as well. Strengths, limitations, and implications are discussed.

Alcohol, cannabis, cocaine, heroin and benzodiazepines account for 95% of treatment cases in Ireland. This study examines first episode treatment data from the European Treatment Demand Protocol to examine access to services based on primary problem substance. The (N = 37,550) main presenting substances were alcohol (48.2%) and cannabis (21.4%). Alcohol had the highest proportion of women seeking treatment (37.6%) while cocaine had the lowest (19.0%). Alcohol cases were the oldest (40.7 years) while cannabis cases the youngest (22.9 years). Irish Travellers had higher rates of presentation for heroin and benzodiazepines use. Alcohol had the longest duration between first use and accessing treatment (24.2 years), while cannabis had the shortest (7.9 years); these differences were statistically different compared to all other substances. Alcohol cases were more often referred by medical sources and cannabis from criminal justice and community/social services. These findings emphasise that there were considerable periods between first use and first treatment and there are different demographic presentations between different substances.

There is little research in the U.S. on the interactions of people who use opioids (PWUO) with criminal justice personnel, from their perspective. This study reports on the experiences with police and criminal justice personnel of 27 men and women in treatment for substance use disorder. In-depth interviews revealed that many respondents had had aversive experiences with the criminal justice system, including both physical and verbal abuse. Very few report receiving information on treatment from police. The evidence suggests that many police officers do not view opioid use disorder as a medical condition, and instead stigmatize PWUO. This study reveals that PWUO, like members of other marginalized groups, are often targets of police maltreatment. Despite the fact that police may play a lifesaving role in cases of opioid overdose, these findings indicate the problematic nature of police response to overdose and opioid-related offenses.

The Opioid and Naloxone Education (ONE) Program expanded to correctional facilities in North Dakota to address the impact of opioid misuse among incarcerated individuals. This pilot aimed to evaluate the feasibility and outcomes of implementing comprehensive opioid risk screening, education, and harm reduction interventions in correctional settings. Among 168 individuals who were screened, 65.5% were at risk for opioid-related harm. Unsafe medication storage and disposal were common, and 13% reported diversion behaviors. Nearly 90% accepted naloxone, lockboxes, and disposal tools, demonstrating initial engagement with harm reduction modalities. Seventeen percent have previously received medication for opioid use disorder, and 19% expressed interest in initiating treatment. The findings of this pilot suggest implementing opioid risk screening and harm reduction education within correctional settings is feasible and associated with high engagement. The ONE Program may provide a structured approach to identifying risk and supporting linkage to harm reduction resources.

Evidence suggests that individuals affected by problematic heroin use can desist at various points in their drug-using career. Drawing on a doctoral study that developed a non-linear four-stage model of desistance from heroin careers within the Maltese context, this paper focuses on exploring the contingencies that are in place during the initial pre-desistance stage. The study adopted an evolved grounded theory methodology. Semi-structured interviews were conducted with twenty-two participants, fourteen identifying as male and eight as female, who had desisted from heroin careers for a minimum of five years. Findings show that a series of setbacks encountered after committing to a heroin career can create profound ambivalence, leading to pivotal reckoning moments that prompt individuals to consider change. Importantly, the emergence of hope that desistance is possible appears to play an instrumental role in initiating the desistance process.

This study investigated deficits in social contract reasoning among 78 males with Substance Use Disorder (SUD) and 56 matched healthy controls using eye-tracking. A 2 × 2 mixed-design revealed a specific impairment: while both groups showed the classic content effect (better performance on social contract rules), the SUD group was significantly less accurate only on social contract tasks. Eye-tracking analyses further revealed that healthy controls preferentially attended to cost–benefit regions during social-contract trials, whereas the SUD group allocated significantly less attention to these critical areas. This dissociation indicates a deficit not in general logical ability but in the attentional processing of social cost information, which is associated with poorer social contract reasoning. The findings identify an attentional mechanism underlying social dysfunction in addiction and suggest a target for cognitive rehabilitation focused on processing social obligation cues.

Youth illegal drug use causes severe medical and economic harm to individuals and society. This study explores virtual reality (VR) as a promising approach to drug prevention among adolescents. We developed a VR-based program and evaluated its effectiveness in improving their drug resistance skills, normality perception, and competence attitude using a quasi-experimental research design with 60 high school students in Las Vegas, Nevada. Results from the Wilcoxon signed-rank test indicated that the VR program significantly improved participants’ drug avoidance personalities. Multiple regression analysis further showed significant improvements in resistance skills and competence attitudes. Findings from an additional post-intervention survey indicated that participants perceived the VR program as effective in increasing awareness of drug-related risks and supporting drug-use prevention efforts. Overall, these results suggest that VR-based interventions represent a promising approach to youth drug prevention.

Previous research has shown that race and sex influence perceptions of social stigma among individuals with opioid addiction. However, few studies have explored multiple dimensions of stigma using vignette-based experimental designs. The current study used a vignette survey experiment to assess the association between the vignette character’s race and sex and four measures of stigma: perceived dangerousness, fatalism, social distance, and blame. Our findings indicated that participants were more likely to hold fatalistic views—believing the individual would never achieve sobriety and would remain dependent for life—when the vignette character was White compared to Black. Our study highlights the need for further research on fatalism.

Cross-cultural simultaneous tests of the effects of social bonding, differential association/social learning, and strain theories on adolescent alcohol use are very rare worldwide. The present study examined the effects of social bonding, differential association/social learning, and general strain theories on adolescent alcohol use using a sample of 1,710 high school students from central Ankara, the capital of Türkiye, in 2001. In the simultaneous test of the three theories, attachment to teachers and school involvement (i.e., social bonding variables) reduced the likelihood of adolescent alcohol use, whereas close friends’ alcohol use, father’s alcohol use, delinquent peers, criminal family members, and definitions favorable to alcohol use (i.e., differential association/social learning variables) increased it. However, the gap between educational aspiration and educational expectation and the gap between monetary aspiration and educational expectation (i.e., general strain theory variables) decreased the likelihood of adolescent alcohol use. Overall, the three theories are largely associated with alcohol use in the theoretically expected direction, except for some strain theory variables, which deviated from expectations only in the simultaneous test. Differential association/social learning theory plays the most important role in explaining adolescent alcohol use, followed by social bonding theory and general strain theory.

Background: In the absence of governmental harm reduction support, the image and performance enhancing drug (IPED) community has developed its own strategies to mitigate drug-related risks, including the emergence of IPED coaches who provide guidance on drug use. Existing studies on IPED coaching are predominantly qualitative, with small, Western-based samples. Methods: This study employed a quantitative, cross-sectional survey to explore the lived experiences of forty-one IPED coaches from diverse global contexts, to examine IPED consumption, related harms, and the scope of coaching services they offer. Results: Coaches reported use of a wide range of injectable and oral steroids, alongside ancillary substances. Coaching practices varied considerably, with client numbers ranging from 0 to over 70. Service provision included bloodwork advice, analysis, and in some cases, drug supply. Conclusion: Findings demonstrate substantial heterogeneity in IPED coaching practices, providing a foundation for the development of a typology that distinguishes informed, evidence-aligned guidance from misinformed or potentially harmful practices within the community.

Aims: This study investigates demographic predictors of medicinal cannabis (MC) disclosures and non-disclosures in various contexts. Methods: 1,742 respondents from a large-scale, online survey in New Zealand, analysed through logistic regression models. Results: MC prescription holders and individuals with diagnoses were more likely to disclose MC use across all settings, while Asians were less likely. Māori were less likely to disclose for fear of police, whereas women perceived social stigma against women using cannabis. Pacific Peoples were more likely to disclose to employers. Respondents with prior drug testing experience or treating neurological or pain conditions were more likely to disclose in health settings. Respondents treating mental health were more likely to disclose to government services. Conclusion: MC disclosures are influenced by institutional contexts, perceived prejudices, and past experiences. Fear of judgement or consequences in workplaces and health settings are barriers to disclosure, highlighting the need for more supportive practices.

Illicit drug use poses a particularly high risk among certain subgroups of society, including trauma-exposed occupations like police officers. Nevertheless, very little is known about the prevalence and types of illicit drug abuse among police personnel. This study aimed to examine the prevalence and patterns of illicit drug use among young police recruits (i.e., police cadets) in Hungary using a cross-sectional questionnaire-based online survey. Our results show that 16.9% of police cadets have ever tried illicit drugs. Drug experimentation was more prevalent among males than females, but the difference was not statistically significant. It was also found that perceived environmental drug use was the most important factor in explaining cadets’ drug experimentation. Drug abuse can significantly impact job performance among officers, and negatively affects the community’s trust for police. Therefore, drug abuse among police students and officers should be addressed as organizational and community-level issues requiring a holistic approach.