Journal of Alcoholism & Drug Dependence Open Access

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Articles On Drug Abuse

Drug abuse or substance abuse is a disorder characterized by excessive use of the habit-forming drugs and misuse of over the counter medicine, the illegal use of drugs which in turn leads to severe addiction and dependence with so many negative conclusions. Drug abuse addiction is a chronic illness with relapse rates similar to those of hypertension, diabetes, and asthma. And it refers to the use of certain chemicals for the purpose of creating pleasurable effects on the brain. There are over 190 million drug users around the world and the problem has been increasing at alarming rates, especially among young adults under the age of 30. Apart from the long term damage to the body drug abuse causes, drug addicts who use needles are also at risk of contracting HIV and hepatitis B and C infections.

Drugs of abuse are usually psychoactive drugs that are used by people for various different reasons which may include:

Curiosity and peer pressure, especially among school children and young adults The use of prescription drugs that were originally intended to target pain relief may have turned into recreational use and become addictive Chemicals may be used as part of religious practices or rituals Recreational purposes As a means of obtaining creative inspiration

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Qualitative research: contributions to the study of drug use, drug abuse, and drug use(r)-related interventions


This article describes how qualitative social science research has and can contribute to the emerging field of drug and alcohol studies. An eight-stage model of formative-reformative research is presented as a heuristic to outline the different ways in which qualitative research may be used to better understand micro and macro dimensions of drug use and distribution; more effectively design, monitor and evaluate drug use(r)-related interventions; and address the politics of drug/drug program representation. Tobacco is used as an exemplar to introduce the reader to the range of research issues that a qualitative researcher may focus upon during the initial stage of formative research. Ethnographic research on alcohol use among Native Americans is highlighted to illustrate the importance of closely examining ethnicity as well as class when investigating patterns of drug use. To familiarize the reader with qualitative research, we describe the range of methods commonly employed and the ways in which qualitative research may complement as well as contribute to quantitative research. In describing the later stages of the formative-reformative process, we consider both the use of qualitative research in the evaluation and critical assessment of drug use(r)-intervention programs, and the role of qualitative research in critically assessing the politics of prevention programs. Finally, we discuss the challenges faced by qualitative researchers when engaging in transdisciplinary research.

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Issue Cover

Article Contents


Understanding reasons for drug use amongst young people: a functional perspective

Annabel Boys, John Marsden, John Strang, Understanding reasons for drug use amongst young people: a functional perspective, Health Education Research , Volume 16, Issue 4, August 2001, Pages 457–469,

This study uses a functional perspective to examine the reasons young people cite for using psychoactive substances. The study sample comprised 364 young poly-drug users recruited using snowball-sampling methods. Data on lifetime and recent frequency and intensity of use for alcohol, cannabis, amphetamines, ecstasy, LSD and cocaine are presented. A majority of the participants had used at least one of these six drugs to fulfil 11 of 18 measured substance use functions. The most popular functions for use were using to: relax (96.7%), become intoxicated (96.4%), keep awake at night while socializing (95.9%), enhance an activity (88.5%) and alleviate depressed mood (86.8%). Substance use functions were found to differ by age and gender. Recognition of the functions fulfilled by substance use should help health educators and prevention strategists to make health messages about drugs more relevant and appropriate to general and specific audiences. Targeting substances that are perceived to fulfil similar functions and addressing issues concerning the substitution of one substance for another may also strengthen education and prevention efforts.

The use of illicit psychoactive substances is not a minority activity amongst young people in the UK. Results from the most recent British Crime Survey show that some 50% of young people between the ages of 16 and 24 years have used an illicit drug on at least one occasion in their lives (lifetime prevalence) ( Ramsay and Partridge, 1999 ). Amongst 16–19 and 20–24 year olds the most prevalent drug is cannabis (used by 40% of 16–19 year olds and 47% of 20–24 year olds), followed by amphetamine sulphate (18 and 24% of the two age groups respectively), LSD (10 and 13%) and ecstasy (8 and 12%). The lifetime prevalence for cocaine hydrochloride (powder cocaine) use amongst the two age groups is 3 and 9%, respectively. Collectively, these estimates are generally comparable with other European countries ( European Monitoring Centre for Drugs and Drug Addiction, 1998 ) and the US ( Johnston et al ., 1997 , 2000 ).

The widespread concern about the use of illicit drugs is reflected by its high status on health, educational and political agendas in many countries. The UK Government's 10-year national strategy on drug misuse identifies young people as a critical priority group for prevention and treatment interventions ( Tackling Drugs to Build a Better Britain 1998 ). If strategies to reduce the use of drugs and associated harms amongst the younger population are to be developed, particularly within the health education arena, it is vital that we improve our understanding of the roles that both licit and illicit substances play in the lives of young people. The tendency for educators, practitioners and policy makers to address licit drugs (such as alcohol) separately from illegal drugs may be unhelpful. This is partly because young illicit drug users frequently drink alcohol, and may have little regard for the illicit and licit distinction established by the law. To understand the roles that drug and alcohol use play in contemporary youth culture, it is necessary to examine the most frequently used psychoactive substances as a set.

It is commonplace for young drug users to use several different psychoactive substances. The terms `poly-drug' or `multiple drug' use have been used to describe this behaviour although their exact definitions vary. The term `poly-drug use' is often used to describe the use of two or more drugs during a particular time period (e.g. over the last month or year). This is the definition used within the current paper. However, poly-drug use could also characterize the use of two or more psychoactive substances so that their effects are experienced simultaneously. We have used the term `concurrent drug use' to denote this pattern of potentially more risky and harmful drug use ( Boys et al. 2000a ). Previous studies have reported that users often use drugs concurrently to improve the effects of another drug or to help manage its negative effects [e.g. ( Power et al ., 1996 ; Boys et al. 2000a ; Wibberley and Price, 2000 )].

The most recent British Crime Survey found that 5% of 16–29 year olds had used more than one drug in the last month ( Ramsay and Partridge, 1999 ). Given that 16% of this age band reported drug use in the month prior to interview, this suggests that just under a third of these individuals had used more than one illicit substance during this time period. With alcohol included, the prevalence of poly-drug use is likely to be much higher.

There is a substantial body of literature on the reasons or motivations that people cite for using alcohol, particularly amongst adult populations. For example, research on heavy drinkers suggested that alcohol use is related to multiple functions for use ( Edwards et al ., 1972 ; Sadava, 1975 ). Similarly, research with a focus on young people has sought to identify motives for illicit drug use. There is evidence that for many young people, the decision to use a drug is based on a rational appraisal process, rather than a passive reaction to the context in which a substance is available ( Boys et al. 2000a ; Wibberley and Price, 2000 ). Reported reasons vary from quite broad statements (e.g. to feel better) to more specific functions for use (e.g. to increase self-confidence). However, much of this literature focuses on `drugs' as a generic concept and makes little distinction between different types of illicit substances [e.g. ( Carman, 1979 ; Butler et al ., 1981 ; Newcomb et al ., 1988 ; Cato, 1992 ; McKay et al ., 1992 )]. Given the diverse effects that different drugs have on the user, it might be proposed that reasons for use will closely mirror these differences. Thus stimulant drugs (such as amphetamines, ecstasy or cocaine) will be used for reasons relating to increased nervous system arousal and drugs with sedative effects (such as alcohol or cannabis), with nervous system depression. The present study therefore selected a range of drugs commonly used by young people with stimulant, sedative or hallucinogenic effects to examine this issue further.

The phrase `instrumental drug use' has been used to denote drug use for reasons specifically linked to a drug's effects ( WHO, 1997 ). Examples of the instrumental use of amphetamine-type stimulants include vehicle drivers who report using to improve concentration and relieve tiredness, and people who want to lose weight (particularly young women), using these drugs to curb their appetite. However, the term `instrumental substance use' seems to be used when specific physical effects of a drug are exploited and does not encompass use for more subtle social or psychological purposes which may also be cited by users. In recent reports we have described a `drug use functions' model to help understand poly-substance use phenomenology amongst young people and how decisions are made about patterns of consumption ( Boys et al ., 1999a , b , 2000a ). The term `function' is intended to characterize the primary or multiple reasons for, or purpose served by, the use of a particular substance in terms of the actual gains that the user perceives that they will attain. In the early, 1970s Sadava suggested that functions were a useful means of understanding how personality and environmental variables impacted on patterns of drug use ( Sadava, 1975 ). This work was confined to functions for cannabis and `psychedelic drugs' amongst a sample of college students. To date there has been little research that has examined the different functions associated with the range of psychoactive substances commonly used by young poly-drug users. It is unclear if all drugs with similar physical effects are used for similar purposes, or if other more subtle social or psychological dimensions to use are influential. Work in this area will help to increase understanding of the different roles played by psychoactive substances in the lives of young people, and thus facilitate health, educational and policy responses to this issue.

Previous work has suggested that the perceived functions served by the use of a drug predict the likelihood of future consumption ( Boys et al ., 1999a ). The present study aims to develop this work further by examining the functional profiles of six substances commonly used by young people in the UK.

Patterns of cannabis, amphetamine, ecstasy, LSD, cocaine hydrochloride and alcohol use were examined amongst a sample of young poly-drug users. Tobacco use was not addressed in the present research.

Sampling and recruitment

A snowball-sampling approach was employed for recruitment of participants. Snowball sampling is an effective way of generating a large sample from a hidden population where no formal sampling frame is available ( Van Meter, 1990 ). A team of peer interviewers was trained to recruit and interview participants for the study. We have described this procedure in detail elsewhere and only essential features are described here ( Boys et al. 2000b ). Using current or ex-drug users to gather data from hidden populations of drug using adults has been found to be successful ( Griffiths et al ., 1993 ; Power, 1995 ).

Study participants

Study participants were current poly-substance users with no history of treatment for substance-related disorders. We excluded people with a treatment history on the assumption that young people who have had substance-related problems requiring treatment represent a different group from the general population of young drug users. Inclusion criteria were: aged 16–22 years and having used two or more illegal substances during the past 90 days. During data collection, the age, gender and current occupation of participants were recorded and monitored to ensure that sufficient individuals were recruited to the groups to permit subgroup analyses. If an imbalance was observed in one of these variables, the interviewers were instructed to target participants with specific characteristics (e.g. females under the age of 18) to redress this imbalance.

Study measures

Data were collected using a structured interviewer-administered questionnaire developed specifically for the study. In addition to recording lifetime substance use, questions profiled consumption patterns of six substances in detail. Data were collected between August and November 1998. Interviews were audiotaped with the interviewee's consent. This enabled research staff to verify that answers had been accurately recorded on the questionnaire and that the interview had been conducted in accordance with the research protocol. Research staff also checked for consistency across different question items (e.g. the total number of days of drug use in the past 90 days should equal or exceed the number of days of cannabis use during the same time period). On the few occasions where inconsistencies were identified that could not be corrected from the tape, the interviewer was asked to re-contact the interviewee to verify the data.

Measures of lifetime use, consumption in the past year and past 90 days were based on procedures developed by Marsden et al . ( Marsden et al ., 1998 ). Estimated intensity of consumption (amount used on a typical using day) was recorded verbatim and then translated into standardized units at the data entry stage.

Functions for substance use scale

The questionnaire included a 17-item scale designed to measure perceived functions for substance use. This scale consisted of items developed in previous work ( Boys et al ., 1999a ) in addition to functions derived from qualitative interviews ( Boys et al ., 1999b ), new literature and informal discussions with young drug users. Items were drawn from five domains (Table I ).

Participants were asked if they had ever used a particular drug in order to fulfil each specific function. Those who endorsed the item were then invited to rate how frequently they had used it for this purpose over the past year, using a five-point Likert-type scale (`never' to `always'; coded 0–4). One item differed between the function scales used for the stimulant drugs and for alcohol and cannabis. For the stimulant drugs (amphetamines, cocaine and ecstasy) the item `have you ever used [named drug] to help you to lose weight' was used, for cannabis and alcohol this item was replaced with `have you ever used [drug] to help you to sleep?'. (The items written in full as they appeared in the questionnaire are shown in Table III , together with abbreviations used in this paper.)

Statistical procedures

The internal reliability of the substance use functions scales for each of the six substances was judged using Chronbach's α coefficient. Chronbach's α is a statistic that reflects the extent to which each item in a measurement scale is associated with other items. Technically it is the average of correlations between all possible comparisons of the scale items that are divided into two halves. An α coefficient for a scale can range from 0 (no internal reliability) to 1 (complete reliability). Analyses of categorical variables were performed using χ 2 statistic. Differences in scale means were assessed using t -tests.

The sample consisted of 364 young poly-substance users (205 males; 56.3%) with a mean age of 19.3 years; 69.8% described their ethnic group as White-European, 12.6% as Black and 10.1% were Asian. Just over a quarter (27.5%) were unemployed at the time of interview; a third were in education, 28.8% were in full-time work and the remainder had part-time employment. Estimates of monthly disposable income (any money that was spare after paying for rent, bills and food) ranged from 0 to over £1000 (median = £250).

Substance use history

The drug with the highest lifetime prevalence was cannabis (96.2%). This was followed by amphetamine sulphate (51.6%), cocaine hydrochloride (50.5%) (referred to as cocaine hereafter) and ecstasy (48.6%). Twenty-five percent of the sample had used LSD and this was more common amongst male participants (χ 2 [1] = 9.68, P < 0.01). Other drugs used included crack cocaine (25.5%), heroin (12.6%), tranquillizers (21.7%) and hallucinogenic mushrooms (8.0%). On average, participants had used a total of 5.2 different psychoactive substances in their lives (out of a possible 14) (median = 4.0, mode = 3.0, range 2–14). There was no gender difference in the number of different drugs ever used.

Table II profiles use of the six target drugs over the past year, and the frequency and intensity of use in the 90 days prior to interview.

There were no gender differences in drug use over the past year or in the past 90 days with the exception of amphetamines. For this substance, females who had ever used this drug were more likely to have done so during the past 90 days than males (χ 2 [1] = 4.14, P < 0.05). The mean number of target drugs used over the past 90 days was 3.2 (median = 3.0, mode = 3.0, range 2–6). No gender differences were observed. Few differences were also observed in the frequency and intensity of use. Males reported drinking alcohol more frequently during the three months prior to interview ( t [307] = 2.48, P < 0.05) and using cannabis more intensively on a `typical using day' ( t [337] = 3.56, P < 0.001).

Perceived functions for substance use

There were few differences between the functions endorsed for use of each drug `ever' and those endorsed for use during `the year prior to interview'. This section therefore concentrates on data for the year prior to interview. We considered that in order to use a drug for a specific function, the user must have first hand knowledge of the drug's effects before making this decision. Consequently, functions reported by individuals who had only used a particular substance on one occasion in their lives (i.e. with no prior experience of the drug at the time they made the decision to take it) were excluded from the analyses. Table III summarizes the proportion of the sample who endorsed each of the functions for drugs used in the past year. Roman numerals have been used to indicate the functions with the top five average scores. Table III also shows means for the total number of different items endorsed by individual users and the internal reliability of the function scales for each substance using Chronbach's α coefficients. There were no significant gender differences in the total number of functions endorsed for any of the six substances.

The following sections summarize the top five most popular functions drug-by-drug together with any age or gender differences observed in the items endorsed.

Cannabis use ( n = 345)

Overall the most popular functions for cannabis use were to `RELAX' (endorsed by 96.8% of people who had used the drug in the last year), to become `INTOXICATED' (90.7%) and to `ENHANCE ACTIVITY' (72.8%). Cannabis was also commonly used to `DECREASE BOREDOM' (70.1%) and to `SLEEP' (69.6%) [this item was closely followed by using to help `FEEL BETTER' (69.0%)]. Nine of the 17 function items were endorsed by over half of those who had used cannabis on more than one occasion in the past year. There were no significant gender differences observed, with the exception of using to `KEEP GOING', where male participants were significantly more likely to say that they had used cannabis to fulfil this function in the past year (χ 2 [1] = 6.10, P < 0.05).

There were statistically significant age differences on four of the function variables: cannabis users who reported using this drug in the past year to help feel `ELATED/EUPHORIC' or to help `SLEEP' were significantly older than those who had not used cannabis for these purposes (19.6 versus 19.0; t [343] = 3.32, P < 0.001; 19.4 versus 19.0; t [343] = 2.01, P < 0.05). In contrast, those who had used cannabis to `INCREASE CONFIDENCE' and to `STOP WORRYING' tended to be younger than those who did not (19.0 versus 19.4; t [343] = –2.26, P < 0.05; 19.1 versus 19.5; t [343] = –1.99, P < 0.05).

Amphetamines ( n = 160)

Common functions for amphetamine use were to `KEEP GOING' (95.6%), to `STAY AWAKE' (91.3%) or to `ENHANCE ACTIVITY' (66.2%). Using to help feel `ELATED/EUPHORIC' (60.6%) and to `ENJOY COMPANY' (58.1%) were also frequently mentioned. Seven of the 17 function items were endorsed by over half of participants who had used amphetamines in the past year. As with cannabis, gender differences were uncommon: females were more likely to use amphetamines to help `LOSE WEIGHT' than male participants (χ 2 [1] = 21.67, P < 0.001).

Significant age differences were found on four function variables. Individuals who reported using amphetamines in the past year to feel `ELATED/EUPHORIC' were significantly older than those who did not (19.9 versus 19.0; t [158] = 2.87, P < 0.01). In contrast, participants who used amphetamines to `STOP WORRYING' (18.8 versus 19.8; t [158] = –2.77, P < 0.01), to `DECREASE BOREDOM' (19.2 versus 19.9; t [158] = –2.39, P < 0.05) or to `ENHANCE ACTIVITY' (19.3 versus 20.1; t [158] = –2.88, P < 0.01) were younger than those who had not.

Ecstasy ( n = 157)

The most popular five functions for using ecstasy were similar to those for amphetamines. The drug was used to `KEEP GOING' (91.1%), to `ENHANCE ACTIVITY' (79.6%), to feel `ELATED/EUPHORIC' (77.7%), to `STAY AWAKE' (72.0%) and to get `INTOXICATED' (68.2%). Seven of the 17 function items were endorsed by over half of those who had used ecstasy in the past year. Female users were more likely to use ecstasy to help `LOSE WEIGHT' than male participants (Fishers exact test, P < 0.001).

As with the other drugs discussed above, participants who reported using ecstasy to feel `ELATED/EUPHORIC' were significantly older than those who did not (19.8 versus 18.9; t [155] = 2.61, P < 0.01). In contrast, those who had used ecstasy to `FEEL BETTER' (19.3 versus 20.0; t [155] = –2.29, P < 0.05), to `INCREASE CONFIDENCE' (19.2 versus 19.9; t [155] = –2.22, P < 0.05) and to `STOP WORRYING' (19.0 versus 19.9; t [155] = –2.96, P < 0.01) tended to be younger.

LSD ( n = 58)

Of the six target substances examined in this study, LSD was associated with the least diverse range of functions for use. All but two of the function statements were endorsed by at least some users, but only five were reported by more than 50%. The most common purpose for consuming LSD was to get `INTOXICATED' (77.6%). Other popular functions included to feel `ELATED/EUPHORIC' and to `ENHANCE ACTIVITY' (both endorsed by 72.4%), and to `KEEP GOING' and to `ENJOY COMPANY' (both endorsed by 58.6%). Unlike the other substances examined, no gender or age differences were observed.

Cocaine ( n = 168)

In common with ecstasy and amphetamines, the most widely endorsed functions for cocaine use were to help `KEEP GOING' (84.5%) and to help `STAY AWAKE' (69.0%). Consuming cocaine to `INCREASE CONFIDENCE' and to get `INTOXICATED' (both endorsed by 66.1%) were also popular. However, unlike the other stimulant drugs, 61.9% of the cocaine users reported using to `FEEL BETTER'. Ten of the 17 function items were endorsed by over half of those who had used cocaine in the past year.

Gender differences were more common amongst functions for cocaine use than the other substances surveyed. More males reported using cocaine to `IMPROVE EFFECTS' of other drugs (χ 2 [1] = 4.00, P < 0.05); more females used the drug to help `STAY AWAKE' (χ 2 [1] = 12.21, P < 0.001), to `LOSE INHIBITIONS' (χ 2 [1] = 9.01, P < 0.01), to `STOP WORRYING' (χ 2 [1] = 8.11, P < 0.01) or to `ENJOY COMPANY' of friends (χ 2 [1] = 4.34, P < 0.05). All participants who endorsed using cocaine to help `LOSE WEIGHT' were female.

Those who had used cocaine to `FEEL BETTER' (18.9 versus 19.8; t [166] = –3.06, P < 0.01), to `STOP WORRYING' (18.6 versus 19.7; t [166] = –3.86, P < 0.001) or to `DECREASE BOREDOM' (18.9 versus 19.6; t [166] = –2.52, P < 0.05) were significantly younger than those who did not endorse these functions. Similar to the other drugs, participants who had used cocaine to feel `ELATED/EUPHORIC' in the past year tended to be older than those who had not (19.6 versus 18.7; t [166] = 3.16, P < 0.01).

Alcohol ( n = 312)

The functions for alcohol use were the most diverse of the six substances examined. Like LSD, the most commonly endorsed purpose for drinking was to get `INTOXICATED' (89.1%). Many used alcohol to `RELAX' (82.7%), to `ENJOY COMPANY' (74.0%), to `INCREASE CONFIDENCE' (70.2%) and to `FEEL BETTER' (69.9%). Overall, 11 of the 17 function items were endorsed by over 50% of those who had drunk alcohol in the past year. Male participants were more likely to report using alcohol in combination with other drugs either to `IMPROVE EFFECTS' of other drugs (χ 2 [1] = 4.56, P < 0.05) or to ease the `AFTER EFFECTS' of other substances (χ 2 [1] = 7.07, P < 0.01). More females than males reported that they used alcohol to `DECREASE BOREDOM' (χ 2 [1] = 4.42, P < 0.05).

T -tests revealed significant age differences on four of the function variables: those who drank to feel `ELATED/EUPHORIC' were significantly older (19.7 versus 19.0; t [310] = 3.67, P < 0.001) as were individuals who drank to help them to `LOSE INHIBITIONS' (19.6 versus 19.0; t [310] = 2.36, P < 0.05). In contrast, participants who reported using alcohol just to get `INTOXICATED' (19.2 versus 20.3; t [310] = –3.31, P < 0.001) or to `DECREASE BOREDOM' (19.2 versus 19.6; t [310] = –2.25, P < 0.05) were significantly younger than those who did not.

Combined functional drug use

The substances used by the greatest proportion of participants to `IMPROVE EFFECTS' from other drugs were cannabis (44.3%), alcohol (41.0%) and amphetamines (37.5%). It was also common to use cannabis (64.6%) and to a lesser extent alcohol (35.9%) in combination with other drugs in order to help manage `AFTER EFFECTS'. Amphetamines, ecstasy, LSD and cocaine were also used for these purposes, although to a lesser extent. Participants who endorsed the combination drug use items were asked to list the three main drugs with which they had combined the target substance for these purposes. Table IV summarizes these responses.

Overall functions for drug use

In order to examine which functions were most popular overall, a dichotomous variable was created for each different item to indicate if one or more of the six target substances had been used to fulfil this purpose during the year prior to interview. For example, if an individual reported that they had used cannabis to relax, but their use of ecstasy, amphetamines and alcohol had not fulfilled this function, then the variable for `RELAX' was scored `1'. Similarly if they had used all four of these substances to help them to relax in the past year, the variable would again be scored as `1'. A score of `0' indicates that none of the target substances had been used to fulfil a particular function. Table V summarizes the data from these new variables.

Over three-quarters of the sample had used at least one target substance in the past year for 11 out of the 18 functions listed. The five most common functions for substance use overall were to `RELAX' (96.7%); `INTOXICATED' (96.4%); `KEEP GOING' (95.9%); `ENHANCE ACTIVITY' (88.5%) and `FEEL BETTER' (86.8%). Despite the fact that `SLEEP' was only relevant to two substances (alcohol and cannabis), it was still endorsed by over 70% of the total sample. Using to `LOSE WEIGHT' was only relevant to the stimulant drugs (amphetamines, ecstasy and cocaine), yet was endorsed by 17.3% of the total sample (almost a third of all female participants). Overall, this was the least popular function for recent substance use, followed by `WORK' (32.1%). All other items were endorsed by over 60% of all participants.

Gender differences were identified in six items. Females were significantly more likely to have endorsed the following: using to `INCREASE CONFIDENCE' (χ 2 [1] = 4.41, P < 0.05); `STAY AWAKE' (χ 2 [1] = 5.36, P < 0.05), `LOSE INHIBITIONS' (χ 2 [1] = 4.48, P < 0.05), `ENHANCE SEX' (χ 2 [1] = 5.17, P < 0.05) and `LOSE WEIGHT' (χ 2 [1] = 29.6, P < 0.001). In contrast, males were more likely to use a substance to `IMPROVE EFFECTS' of another drug (χ 2 [1] = 11.18, P < 0.001).

Statistically significant age differences were identified in three of the items. Those who had used at least one of the six target substances in the last year to feel `ELATED/EUPHORIC' (19.5 versus 18.6; t [362] = 4.07, P < 0.001) or to `SLEEP' (19.4 versus 18.9; t [362] = 2.19, P < 0.05) were significantly older than those who had not used for this function. In contrast, participants who had used in order to `STOP WORRYING' tended to be younger (19.1 versus 19.7; t [362] = –2.88, P < 0.01).

This paper has examined psychoactive substance use amongst a sample of young people and focused on the perceived functions for use using a 17-item scale. In terms of the characteristics of the sample, the reported lifetime and recent substance use was directly comparable with other samples of poly-drug users recruited in the UK [e.g. ( Release, 1997 )].

Previous studies which have asked users to give reasons for their `drug use' overall instead of breaking it down by drug type [e.g. ( Carman, 1979 ; Butler et al ., 1981 ; Newcomb et al ., 1988 ; Cato, 1992 ; McKay et al ., 1992 )] may have overlooked the dynamic nature of drug-related decision making. A key finding from the study is that that with the exception of two of the functions for use scale items (using to help sleep or lose weight), all of the six drugs had been used to fulfil all of the functions measured, despite differences in their pharmacological effects. The total number of functions endorsed by individuals for use of a particular drug varied from 0 to 15 for LSD, and up to 17 for cannabis, alcohol and cocaine. The average number ranged from 5.9 (for LSD) to 9.0 (for cannabis). This indicates that substance use served multiple purposes for this sample, but that the functional profiles differed between the six target drugs.

We have previously reported ( Boys et al. 2000b ) that high scores on a cocaine functions scale are strongly predictive of high scores on a cocaine-related problems scale. The current findings support the use of similar function scales for cannabis, amphetamines, LSD and ecstasy. It remains to be seen whether similar associations with problem scores exist. Future developmental work in this area should ensure that respondents are given the opportunity to cite additional functions to those included here so that the scales can be further extended and refined.

Recent campaigns that have targeted young people have tended to assume that hallucinogen and stimulant use is primarily associated with dance events, and so motives for use will relate to this context. Our results support assumptions that these drugs are used to enhance social interactions, but other functions are also evident. For example, about a third of female interviewees had used a stimulant drug to help them to lose weight. Future education and prevention efforts should take this diversity into account when planning interventions for different target groups.

The finding that the same functions are fulfilled by use of different drugs suggests that at least some could be interchangeable. Evidence for substituting alternative drugs to fulfil a function when a preferred drug is unavailable has been found in other studies [e.g. ( Boys et al. 2000a )]. Prevention efforts should perhaps focus on the general motivations behind use rather than trying to discourage use of specific drug types in isolation. For example, it is possible that the focus over the last decade on ecstasy prevention may have contributed inadvertently to the rise in cocaine use amongst young people in the UK ( Boys et al ., 1999c ). It is important that health educators do not overlook this possibility when developing education and prevention initiatives. Considering functions that substance use can fulfil for young people could help us to understand which drugs are likely to be interchangeable. If prevention programmes were designed to target a range of substances that commonly fulfil similar functions, then perhaps this could address the likelihood that some young people will substitute other drugs if deterred from their preferred substance.

There has been considerable concern about the perceived increase in the number of young people who are using cocaine in the UK ( Tackling Drugs to Build a Better Britain 1998 ; Ramsay and Partridge, 1999 ; Boys et al. 2000b ). It has been suggested that, for a number of reasons, cocaine may be replacing ecstasy and amphetamines as the stimulant of choice for some young people ( Boys et al ., 1999c ). The results from this study suggest that motives for cocaine use are indeed similar to those for ecstasy and amphetamine use, e.g. using to `keep going' on a night out with friends, to `enhance an activity', `to help to feel elated or euphoric' or to help `stay awake'. However, in addition to these functions which were shared by all three stimulants, over 60% of cocaine users reported that they had used this drug to `help to feel more confident' in a social situation and to `feel better when down or depressed'. Another finding that sets cocaine aside from ecstasy and amphetamines was the relatively common existence of gender differences in the function items endorsed. Female cocaine users were more likely to use to help `stay awake', `lose inhibitions', `stop worrying', `enjoy company of friends' or to help `lose weight'. This could indicate that women are more inclined to admit to certain functions than their male counterparts. However, the fact that similar gender differences were not observed in the same items for the other five substances, suggests this interpretation is unlikely. Similarly, the lack of gender differences in patterns of cocaine use (both frequency and intensity) suggests that these differences are not due to heavier cocaine use amongst females. If these findings are subsequently confirmed, this could point towards an inclination for young women to use cocaine as a social support, particularly to help feel less inhibited in social situations. If so, young female cocaine users may be more vulnerable to longer-term cocaine-related problems.

Many respondents reported using alcohol or cannabis to help manage effects experienced from another drug. This has implications for the choice of health messages communicated to young people regarding the use of two or more different substances concurrently. Much of the literature aimed at young people warns them to avoid mixing drugs because the interactive effects may be dangerous [e.g. ( HIT, 1996 )]. This `Just say No' type of approach does not take into consideration the motives behind mixing drugs. In most areas, drug education and prevention work has moved on from this form of communication. A more sophisticated approach is required, which considers the functions that concurrent drug use is likely to have for young people and tries to amend messages to make them more relevant and acceptable to this population. Further research is needed to explore the motivations for mixing different combinations of drugs together.

Over three-quarters of the sample reported using at least one of the six target substances to fulfil 11 out of the 18 functions. These findings provide strong evidence that young people use psychoactive drugs for a range of distinct purposes, not purely dependent on the drug's specific effects. Overall, the top five functions were to `help relax', `get intoxicated', `keep going', `enhance activity' and `feel better'. Each of these was endorsed by over 85% of the sample. Whilst all six substances were associated to a greater or lesser degree with each of these items, there were certain drugs that were more commonly associated with each. For example, cannabis and alcohol were popular choices for relaxation or to get intoxicated. In contrast, over 90% of the amphetamine and ecstasy users reported using these drugs within the last year to `keep going'. Using to enhance an activity was a common function amongst users of all six substances, endorsed by over 70% of ecstasy, cannabis and LSD users. Finally, it was mainly alcohol and cannabis (and to a lesser extent cocaine) that were used to `feel better'.

Several gender differences were observed in the combined functions for recent substance use. These findings indicate that young females use other drugs as well as cocaine as social supports. Using for specific physical effects (weight loss, sex or wakefulness) was also more common amongst young women. In contrast, male users were significantly more likely to report using at least one of the target substances to try to improve the effects of another substance. This indicates a greater tendency for young males in this sample to mix drugs than their female counterparts. Age differences were also observed on several function items: participants who had used a drug to `feel elated or euphoric' or to `help sleep' tended to be older and those who used to `stop worrying about a problem' were younger. If future studies confirm these differences, education programmes and interventions might benefit from tailoring their strategies for specific age groups and genders. For example, a focus on stress management strategies and coping skills with a younger target audience might be appropriate.

Some limitations of the study need to be acknowledged. The sample for this study was recruited using a snowball-sampling methodology. Although it does not yield a random sample of research participants, this method has been successfully used to access hidden samples of drug users [e.g. ( Biernacki, 1986 ; Lenton et al ., 1997 )]. Amongst the distinct advantages of this approach are that it allows theories and models to be tested quantitatively on sizeable numbers of subjects who have engaged in a relatively rare behaviour.

Further research is now required to determine whether our observations may be generalized to other populations (such as dependent drug users) and drug types (such as heroin, tranquillizers or tobacco) or if additional function items need to be developed. Future studies should also examine if functions can be categorized into primary and subsidiary reasons and how these relate to changes in patterns of use and drug dependence. Recognition of the functions fulfilled by substance use could help inform education and prevention strategies and make them more relevant and acceptable to the target audiences.

Structure of functions scales

Profile of substance use over the past year and past 90 days ( n = 364)

Proportion (%) of those who have used [substance] more than once, who endorsed each functional statement for their use in the past year

Combined functional substance use reported by the sample over the past year

Percentage of participants who reported having used at least one of the target substances to fulfil each of the different functions over the past year ( n = 364)

We gratefully acknowledge research support from the Health Education Authority (HEA). The views expressed in this paper are those of the authors and do not necessarily reflect those of the HEA. We would also like to thank the anonymous referees for helpful comments and suggestions on an earlier draft of this paper.

Biernacki, P. (1986) Pathways from Heroin Addiction: Recovery without Treatment . Temple University Press, Philadelphia, PA.

Boys, A., Marsden, J., Griffiths, P., Fountain, J., Stillwell, G. and Strang, J. ( 1999 ) Substance use among young people: the relationship between perceived functions and behavioural intentions. Addiction , 94 , 1043 –1050.

Boys, A., Marsden, J., Fountain, J., Griffiths, P., Stillwell, G. and Strang, J. ( 1999 ) What influences young people's use of drugs? A qualitative study of decision-making. Drugs: Education, Prevention and Policy , 6 , 373 –389.

Boys, A., Marsden, J. and Griffiths. P. ( 1999 ) Reading between the lines: is cocaine becoming the stimulant of choice for urban youth? Druglink , 14 , 20 –23.

Boys, A., Fountain, J., Marsden, J., Griffiths, P., Stillwell, G. and Strang, J. (2000a) Drug Decisions: A Qualitative Study of Young People , Drugs and Alcohol . Health Education Authority, London.

Boys, A., Marsden, J., Griffiths, P. and Strang, J. ( 2000 ) Drug use functions predict cocaine-related problems. Drug and Alcohol Review , 19 , 181 –190.

Butler, M. C., Gunderson, E. K. E. and Bruni, J. R. ( 1981 ) Motivational determinants of illicit drug use: an assessment of underlying dimensions and their relationship to behaviour. International Journal of the Addictions , 16 , 243 –252.

Carman, R. S. ( 1979 ) Motivations for drug use and problematic outcomes among rural junior high school students. Addictive Behaviors , 4 , 91 –93.

Cato, B. M. ( 1992 ) Youth's recreation and drug sensations: is there a relationship? Journal of Drug Education , 22 , 293 –301.

Edwards, G., Chandler, J. and Peto, J. ( 1972 ) Motivation for drinking among men in a London suburb, Psychological Medicine , 2 , 260 –271.

European Monitoring Centre for Drugs and Drug Addiction (1998) Annual Report on the State of the Drugs Problem in the European Union . EMCDDA, Lisbon.

Griffiths, P., Gossop, M., Powis, B. and Strang, J. ( 1993 ) Reaching hidden populations of drug users by privileged access interviewers: methodological and practical issues. Addiction , 88 , 1617 –1626.

HIT (1996) Chill Out: A Clubber's Guide—The Second Coming . HIT, Liverpool.

Johnston, L. D., O'Malley, P. M. and Bachman J. G. (1997) National Survey Results on Drug Use from the Monitoring the Future Study , 1975–1996: Secondary School Students . US DHHS, National Institute on Drug Abuse, Rockville, MD.

Johnston, L. D., O'Malley, P. M. and Bachman J. G. (2000) The Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings 1999 . US DHHS, National Institute on Drug Abuse, Rockville, MD.

Lenton, S., Boys, A. and Norcross, K. ( 1997 ) Raves, drugs and experience: drug use by a sample of people who attend raves in Western Australia. Addiction , 92 , 1327 –1337.

Marsden, J., Gossop, M., Stewart, D., Best, D., Farrell, M., Edwards, C., Lehmann, P. and Strang, J. ( 1998 ) The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome. Addiction , 93 , 1857 –1867.

McKay, J. R., Murphy, R. T., McGuire, J., Rivinus, T. R. and Maisto, S. A. ( 1992 ) Incarcerated adolescents' attributions for drug and alcohol use. Addictive Behaviors , 17 , 227 –235.

Newcomb. M. D., Chou, C.-P., Bentler, P. M. and Huba, G. J. ( 1988 ) Cognitive motivations for drug use among adolescents: longitudinal tests of gender differences and predictors of change in drug use. Journal of Counselling Psychology , 35 , 426 –438.

Power, R. ( 1995 ) A model for qualitative action research amongst illicit drug users. Addiction Research , 3 , 165 –181.

Power, R., Power, T. and Gibson, N. ( 1996 ) Attitudes and experience of drug use amongst a group of London teenagers. Drugs: Education, Prevention and Policy , 3 , 71 –80.

Ramsay, M. and Partridge, S. (1999) Drug Misuse Declared in 1998: Results from the British Crime Survey . Home Office, London.

Release (1997) Release Drugs and Dance Survey: An Insight into the Culture . Release, London.

Sadava, S. ( 1975 ) Research approaches in illicit drug use: a critical review. Genetic Psychology Monographs , 91 , 3 –59.

Tackling Drugs to Build a Better Britain (1998) The Government's 10-year Strategy on Drug Misuse. Central Drugs Co-ordinating Unit, London.

Van Meter, K. M. (1990) Methodological and design issues: techniques for assessing the representatives of snowball samples. In Lambert, E. Y. (ed.), The Collection and Interpretation of Data from Hidden Populations . US DHHS, National Institute on Drug Abuse, Rockville, MD, pp. 31–33.

Wibberley, C. and Price, J. ( 2000 ) Patterns of psycho-stimulant drug use amongst `social/operational users': implications for services. Addiction Research , 8 , 95 –111.

WHO (1997) Amphetamine-type Stimulants: A Report from the WHO Meeting on Amphetamines , MDMA and other Psychostimulants , Geneva, 12–15 November 1996. Programme on Substance Abuse, Division of Mental Health and Prevention of Substance Abuse, WHO, Geneva.

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Risk and protective factors of drug abuse among adolescents: a systematic review

BMC Public Health volume  21 , Article number:  2088 ( 2021 ) Cite this article

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Drug abuse is detrimental, and excessive drug usage is a worldwide problem. Drug usage typically begins during adolescence. Factors for drug abuse include a variety of protective and risk factors. Hence, this systematic review aimed to determine the risk and protective factors of drug abuse among adolescents worldwide.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted for the review which utilized three main journal databases, namely PubMed, EBSCOhost, and Web of Science. Tobacco addiction and alcohol abuse were excluded in this review. Retrieved citations were screened, and the data were extracted based on strict inclusion and exclusion criteria. Inclusion criteria include the article being full text, published from the year 2016 until 2020 and provided via open access resource or subscribed to by the institution. Quality assessment was done using Mixed Methods Appraisal Tools (MMAT) version 2018 to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken.

Out of 425 articles identified, 22 quantitative articles and one qualitative article were included in the final review. Both the risk and protective factors obtained were categorized into three main domains: individual, family, and community factors. The individual risk factors identified were traits of high impulsivity; rebelliousness; emotional regulation impairment, low religious, pain catastrophic, homework completeness, total screen time and alexithymia; the experience of maltreatment or a negative upbringing; having psychiatric disorders such as conduct problems and major depressive disorder; previous e-cigarette exposure; behavioral addiction; low-perceived risk; high-perceived drug accessibility; and high-attitude to use synthetic drugs. The familial risk factors were prenatal maternal smoking; poor maternal psychological control; low parental education; negligence; poor supervision; uncontrolled pocket money; and the presence of substance-using family members. One community risk factor reported was having peers who abuse drugs. The protective factors determined were individual traits of optimism; a high level of mindfulness; having social phobia; having strong beliefs against substance abuse; the desire to maintain one’s health; high paternal awareness of drug abuse; school connectedness; structured activity and having strong religious beliefs.

The outcomes of this review suggest a complex interaction between a multitude of factors influencing adolescent drug abuse. Therefore, successful adolescent drug abuse prevention programs will require extensive work at all levels of domains.

Peer Review reports


Drug abuse is a global problem; 5.6% of the global population aged 15–64 years used drugs at least once during 2016 [ 1 ]. The usage of drugs among younger people has been shown to be higher than that among older people for most drugs. Drug abuse is also on the rise in many ASEAN (Association of Southeast Asian Nations) countries, especially among young males between 15 and 30 years of age. The increased burden due to drug abuse among adolescents and young adults was shown by the Global Burden of Disease (GBD) study in 2013 [ 2 ]. About 14% of the total health burden in young men is caused by alcohol and drug abuse. Younger people are also more likely to die from substance use disorders [ 3 ], and cannabis is the drug of choice among such users [ 4 ].

Adolescents are the group of people most prone to addiction [ 5 ]. The critical age of initiation of drug use begins during the adolescent period, and the maximum usage of drugs occurs among young people aged 18–25 years old [ 1 ]. During this period, adolescents have a strong inclination toward experimentation, curiosity, susceptibility to peer pressure, rebellion against authority, and poor self-worth, which makes such individuals vulnerable to drug abuse [ 2 ]. During adolescence, the basic development process generally involves changing relations between the individual and the multiple levels of the context within which the young person is accustomed. Variation in the substance and timing of these relations promotes diversity in adolescence and represents sources of risk or protective factors across this life period [ 6 ]. All these factors are crucial to helping young people develop their full potential and attain the best health in the transition to adulthood. Abusing drugs impairs the successful transition to adulthood by impairing the development of critical thinking and the learning of crucial cognitive skills [ 7 ]. Adolescents who abuse drugs are also reported to have higher rates of physical and mental illness and reduced overall health and well-being [ 8 ].

The absence of protective factors and the presence of risk factors predispose adolescents to drug abuse. Some of the risk factors are the presence of early mental and behavioral health problems, peer pressure, poorly equipped schools, poverty, poor parental supervision and relationships, a poor family structure, a lack of opportunities, isolation, gender, and accessibility to drugs [ 9 ]. The protective factors include high self-esteem, religiosity, grit, peer factors, self-control, parental monitoring, academic competence, anti-drug use policies, and strong neighborhood attachment [ 10 , 11 , 12 , 13 , 14 , 15 ].

The majority of previous systematic reviews done worldwide on drug usage focused on the mental, psychological, or social consequences of substance abuse [ 16 , 17 , 18 ], while some focused only on risk and protective factors for the non-medical use of prescription drugs among youths [ 19 ]. A few studies focused only on the risk factors of single drug usage among adolescents [ 20 ]. Therefore, the development of the current systematic review is based on the main research question: What is the current risk and protective factors among adolescent on the involvement with drug abuse? To the best of our knowledge, there is limited evidence from systematic reviews that explores the risk and protective factors among the adolescent population involved in drug abuse. Especially among developing countries, such as those in South East Asia, such research on the risk and protective factors for drug abuse is scarce. Furthermore, this review will shed light on the recent trends of risk and protective factors and provide insight into the main focus factors for prevention and control activities program. Additionally, this review will provide information on how these risk and protective factors change throughout various developmental stages. Therefore, the objective of this systematic review was to determine the risk and protective factors of drug abuse among adolescents worldwide. This paper thus fills in the gaps of previous studies and adds to the existing body of knowledge. In addition, this review may benefit certain parties in developing countries like Malaysia, where the national response to drugs is developing in terms of harm reduction, prison sentences, drug treatments, law enforcement responses, and civil society participation.

This systematic review was conducted using three databases, PubMed, EBSCOhost, and Web of Science, considering the easy access and wide coverage of reliable journals, focusing on the risk and protective factors of drug abuse among adolescents from 2016 until December 2020. The search was limited to the last 5 years to focus only on the most recent findings related to risk and protective factors. The search strategy employed was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) checklist.

A preliminary search was conducted to identify appropriate keywords and determine whether this review was feasible. Subsequently, the related keywords were searched using online thesauruses, online dictionaries, and online encyclopedias. These keywords were verified and validated by an academic professor at the National University of Malaysia. The keywords used as shown in Table  1 .

Selection criteria

The systematic review process for searching the articles was carried out via the steps shown in Fig.  1 . Firstly, screening was done to remove duplicate articles from the selected search engines. A total of 240 articles were removed in this stage. Titles and abstracts were screened based on the relevancy of the titles to the inclusion and exclusion criteria and the objectives. The inclusion criteria were full text original articles, open access articles or articles subscribed to by the institution, observation and intervention study design and English language articles. The exclusion criteria in this search were (a) case study articles, (b) systematic and narrative review paper articles, (c) non-adolescent-based analyses, (d) non-English articles, and (e) articles focusing on smoking (nicotine) and alcohol-related issues only. A total of 130 articles were excluded after title and abstract screening, leaving 55 articles to be assessed for eligibility. The full text of each article was obtained, and each full article was checked thoroughly to determine if it would fulfil the inclusion criteria and objectives of this study. Each of the authors compared their list of potentially relevant articles and discussed their selections until a final agreement was obtained. A total of 22 articles were accepted to be included in this review. Most of the excluded articles were excluded because the population was not of the target age range—i.e., featuring subjects with an age > 18 years, a cohort born in 1965–1975, or undergraduate college students; the subject matter was not related to the study objective—i.e., assessing the effects on premature mortality, violent behavior, psychiatric illness, individual traits, and personality; type of article such as narrative review and neuropsychiatry review; and because of our inability to obtain the full article—e.g., forthcoming work in 2021. One qualitative article was added to explain the domain related to risk and the protective factors among the adolescents.

figure 1

PRISMA flow diagram showing the selection of studies on risk and protective factors for drug abuse among adolescents.2.2. Operational Definition

Drug-related substances in this context refer to narcotics, opioids, psychoactive substances, amphetamines, cannabis, ecstasy, heroin, cocaine, hallucinogens, depressants, and stimulants. Drugs of abuse can be either off-label drugs or drugs that are medically prescribed. The two most commonly abused substances not included in this review are nicotine (tobacco) and alcohol. Accordingly, e-cigarettes and nicotine vape were also not included. Further, “adolescence” in this study refers to members of the population aged between 10 to 18 years [ 21 ].

Data extraction tool

All researchers independently extracted information for each article into an Excel spreadsheet. The data were then customized based on their (a) number; (b) year; (c) author and country; (d) titles; (e) study design; (f) type of substance abuse; (g) results—risks and protective factors; and (h) conclusions. A second reviewer crossed-checked the articles assigned to them and provided comments in the table.

Quality assessment tool

By using the Mixed Method Assessment Tool (MMAT version 2018), all articles were critically appraised for their quality by two independent reviewers. This tool has been shown to be useful in systematic reviews encompassing different study designs [ 22 ]. Articles were only selected if both reviewers agreed upon the articles’ quality. Any disagreement between the assigned reviewers was managed by employing a third independent reviewer. All included studies received a rating of “yes” for the questions in the respective domains of the MMAT checklists. Therefore, none of the articles were removed from this review due to poor quality. The Cohen’s kappa (agreement) between the two reviewers was 0.77, indicating moderate agreement [ 23 ].

The initial search found 425 studies for review, but after removing duplicates and applying the criteria listed above, we narrowed the pool to 22 articles, all of which are quantitative in their study design. The studies include three prospective cohort studies [ 24 , 25 , 26 ], one community trial [ 27 ], one case-control study [ 28 ], and nine cross-sectional studies [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. After careful discussion, all reviewer panels agreed to add one qualitative study [ 46 ] to help provide reasoning for the quantitative results. The selected qualitative paper was chosen because it discussed almost all domains on the risk and protective factors found in this review.

A summary of all 23 articles is listed in Table  2 . A majority of the studies (13 articles) were from the United States of America (USA) [ 25 , 26 , 27 , 29 , 30 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], three studies were from the Asia region [ 32 , 33 , 38 ], four studies were from Europe [ 24 , 28 , 40 , 44 ], and one study was from Latin America [ 35 ], Africa [ 43 ] and Mediterranean [ 45 ]. The number of sample participants varied widely between the studies, ranging from 70 samples (minimum) to 700,178 samples (maximum), while the qualitative paper utilized a total of 100 interviewees. There were a wide range of drugs assessed in the quantitative articles, with marijuana being mentioned in 11 studies, cannabis in five studies, and opioid (six studies). There was also large heterogeneity in terms of the study design, type of drug abused, measurements of outcomes, and analysis techniques used. Therefore, the data were presented descriptively.

After thorough discussion and evaluation, all the findings (both risk and protective factors) from the review were categorized into three main domains: individual factors, family factors, and community factors. The conceptual framework is summarized in Fig.  2 .

figure 2

Conceptual framework of risk and protective factors related to adolescent drug abuse

DOMAIN: individual factor

Risk factors.

Almost all the articles highlighted significant findings of individual risk factors for adolescent drug abuse. Therefore, our findings for this domain were further broken down into five more sub-domains consisting of personal/individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance history, comorbidity and an individual’s attitude and perception.

Personal/individual traits

Chuang et al. [ 29 ] found that adolescents with high impulsivity traits had a significant positive association with drug addiction. This study also showed that the impulsivity trait alone was an independent risk factor that increased the odds between two to four times for using any drug compared to the non-impulsive group. Another longitudinal study by Guttmannova et al. showed that rebellious traits are positively associated with marijuana drug abuse [ 27 ]. The authors argued that measures of rebelliousness are a good proxy for a youth’s propensity to engage in risky behavior. Nevertheless, Wilson et al. [ 37 ], in a study involving 112 youths undergoing detoxification treatment for opioid abuse, found that a majority of the affected respondents had difficulty in regulating their emotions. The authors found that those with emotional regulation impairment traits became opioid dependent at an earlier age. Apart from that, a case-control study among outpatient youths found that adolescents involved in cannabis abuse had significant alexithymia traits compared to the control population [ 28 ]. Those adolescents scored high in the dimension of Difficulty in Identifying Emotion (DIF), which is one of the key definitions of diagnosing alexithymia. Overall, the adjusted Odds Ratio for DIF in cannabis abuse was 1.11 (95% CI, 1.03–1.20).

Significant negative growth exposure

A history of maltreatment in the past was also shown to have a positive association with adolescent drug abuse. A study found that a history of physical abuse in the past is associated with adolescent drug abuse through a Path Analysis, despite evidence being limited to the female gender [ 25 ]. However, evidence from another study focusing at foster care concluded that any type of maltreatment might result in a prevalence as high as 85.7% for the lifetime use of cannabis and as high as 31.7% for the prevalence of cannabis use within the last 3-months [ 30 ]. The study also found significant latent variables that accounted for drug abuse outcomes, which were chronic physical maltreatment (factor loading of 0.858) and chronic psychological maltreatment (factor loading of 0.825), with an r 2 of 73.6 and 68.1%, respectively. Another study shed light on those living in child welfare service (CWS) [ 35 ]. It was observed through longitudinal measurements that proportions of marijuana usage increased from 9 to 18% after 36 months in CWS. Hence, there is evidence of the possibility of a negative upbringing at such shelters.

Personal psychiatric diagnosis

The robust studies conducted in the USA have deduced that adolescents diagnosed with a conduct problem (CP) have a positive association with marijuana abuse (OR = 1.75 [1.56, 1.96], p  < 0.0001). Furthermore, those with a diagnosis of Major Depressive Disorder (MDD) showed a significant positive association with marijuana abuse.

Previous substance and addiction history

Another study found that exposure to e-cigarettes within the past 30 days is related to an increase in the prevalence of marijuana use and prescription drug use by at least four times in the 8th and 10th grades and by at least three times in the 12th grade [ 34 ]. An association between other behavioral addictions and the development of drug abuse was also studied [ 29 ]. Using a 12-item index to assess potential addictive behaviors [ 39 ], significant associations between drug abuse and the groups with two behavioral addictions (OR = 3.19, 95% CI 1.25,9.77) and three behavioral addictions (OR = 3.46, 95% CI 1.25,9.58) were reported.


The paper by Dash et al. (2020) highlight adolescent with a disease who needs routine medical pain treatment have higher risk of opioid misuse [ 38 ]. The adolescents who have disorder symptoms may have a risk for opioid misuse despite for the pain intensity.

Individual’s attitudes and perceptions

In a study conducted in three Latin America countries (Argentina, Chile, and Uruguay), it was shown that adolescents with low or no perceived risk of taking marijuana had a higher risk of abuse (OR = 8.22 times, 95% CI 7.56, 10.30) [ 35 ]. This finding is in line with another study that investigated 2002 adolescents and concluded that perceiving the drug as harmless was an independent risk factor that could prospectively predict future marijuana abuse [ 27 ]. Moreover, some youth interviewed perceived that they gained benefits from substance use [ 38 ]. The focus group discussion summarized that the youth felt positive personal motivation and could escape from a negative state by taking drugs. Apart from that, adolescents who had high-perceived availability of drugs in their neighborhoods were more likely to increase their usage of marijuana over time (OR = 11.00, 95% CI 9.11, 13.27) [ 35 ]. A cheap price of the substance and the availability of drug dealers around schools were factors for youth accessibility [ 38 ]. Perceived drug accessibility has also been linked with the authorities’ enforcement programs. The youth perception of a lax community enforcement of laws regarding drug use at all-time points predicted an increase in marijuana use in the subsequent assessment period [ 27 ]. Besides perception, a study examining the attitudes towards synthetic drugs based on 8076 probabilistic samples of Macau students found that the odds of the lifetime use of marijuana was almost three times higher among those with a strong attitude towards the use of synthetic drugs [ 32 ]. In addition, total screen time among the adolescent increase the likelihood of frequent cannabis use. Those who reported daily cannabis use have a mean of 12.56 h of total screen time, compared to a mean of 6.93 h among those who reported no cannabis use. Adolescent with more time on internet use, messaging, playing video games and watching TV/movies were significantly associated with more frequent cannabis use [ 44 ].

Protective factors

Individual traits.

Some individual traits have been determined to protect adolescents from developing drug abuse habits. A study by Marin et al. found that youth with an optimistic trait were less likely to become drug dependent [ 33 ]. In this study involving 1104 Iranian students, it was concluded that a higher optimism score (measured using the Children Attributional Style Questionnaire, CASQ) was a protective factor against illicit drug use (OR = 0.90, 95% CI: 0.85–0.95). Another study found that high levels of mindfulness, measured using the 25-item Child Acceptance and Mindfulness Measure, CAMM, lead to a slower progression toward injectable drug abuse among youth with opioid addiction (1.67 years, p  = .041) [ 37 ]. In addition, the social phobia trait was found to have a negative association with marijuana use (OR = 0.87, 95% CI 0.77–0.97), as suggested [ 31 ].

According to El Kazdouh et al., individuals with a strong belief against substance use and those with a strong desire to maintain their health were more likely to be protected from involvement in drug abuse [ 46 ].

DOMAIN: family factors

The biological factors underlying drug abuse in adolescents have been reported in several studies. Epigenetic studies are considered important, as they can provide a good outline of the potential pre-natal factors that can be targeted at an earlier stage. Expecting mothers who smoke tobacco and alcohol have an indirect link with adolescent substance abuse in later life [ 24 , 39 ]. Moreover, the dynamic relationship between parents and their children may have some profound effects on the child’s growth. Luk et al. examined the mediator effects between parenting style and substance abuse and found the maternal psychological control dimension to be a significant variable [ 26 ]. The mother’s psychological control was two times higher in influencing her children to be involved in substance abuse compared to the other dimension. Conversely, an indirect risk factor towards youth drug abuse was elaborated in a study in which low parental educational level predicted a greater risk of future drug abuse by reducing the youth’s perception of harm [ 27 , 43 ]. Negligence from a parental perspective could also contribute to this problem. According to El Kazdouh et al. [ 46 ], a lack of parental supervision, uncontrolled pocket money spending among children, and the presence of substance-using family members were the most common negligence factors.

While the maternal factors above were shown to be risk factors, the opposite effect was seen when the paternal figure equipped himself with sufficient knowledge. A study found that fathers with good information and awareness were more likely to protect their adolescent children from drug abuse [ 26 ]. El Kazdouh et al. noted that support and advice could be some of the protective factors in this area [ 46 ].

DOMAIN: community factors

A study in 2017 showed a positive association between adolescent drug abuse and peers who abuse drugs [ 32 , 39 ]. It was estimated that the odds of becoming a lifetime marijuana user was significantly increased by a factor of 2.5 ( p  < 0.001) among peer groups who were taking synthetic drugs. This factor served as peer pressure for youth, who subconsciously had desire to be like the others [ 38 ]. The impact of availability and engagement in structured and unstructured activities also play a role in marijuana use. The findings from Spillane (2000) found that the availability of unstructured activities was associated with increased likelihood of marijuana use [ 42 ].

Strong religious beliefs integrated into society serve as a crucial protective factor that can prevent adolescents from engaging in drug abuse [ 38 , 45 ]. In addition, the school connectedness and adult support also play a major contribution in the drug use [ 40 ].

The goal of this review was to identify and classify the risks and protective factors that lead adolescents to drug abuse across the three important domains of the individual, family, and community. No findings conflicted with each other, as each of them had their own arguments and justifications. The findings from our review showed that individual factors were the most commonly highlighted. These factors include individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance and addiction history, and an individual’s attitude and perception as risk factors.

Within the individual factor domain, nine articles were found to contribute to the subdomain of personal/ individual traits [ 27 , 28 , 29 , 37 , 38 , 39 , 40 , 43 , 44 ]. Despite the heterogeneity of the study designs and the substances under investigation, all of the papers found statistically significant results for the possible risk factors of adolescent drug abuse. The traits of high impulsivity, rebelliousness, difficulty in regulating emotions, and alexithymia can be considered negative characteristic traits. These adolescents suffer from the inability to self-regulate their emotions, so they tend to externalize their behaviors as a way to avoid or suppress the negative feelings that they are experiencing [ 41 , 47 , 48 ]. On the other hand, engaging in such behaviors could plausibly provide a greater sense of positive emotions and make them feel good [ 49 ]. Apart from that, evidence from a neurophysiological point of view also suggests that the compulsive drive toward drug use is complemented by deficits in impulse control and decision making (impulsive trait) [ 50 ]. A person’s ability in self-control will seriously impaired with continuous drug use and will lead to the hallmark of addiction [ 51 ].

On the other hand, there are articles that reported some individual traits to be protective for adolescents from engaging in drug abuse. Youth with the optimistic trait, a high level of mindfulness, and social phobia were less likely to become drug dependent [ 31 , 33 , 37 ]. All of these articles used different psychometric instruments to classify each individual trait and were mutually exclusive. Therefore, each trait measured the chance of engaging in drug abuse on its own and did not reflect the chance at the end of the spectrum. These findings show that individual traits can be either protective or risk factors for the drugs used among adolescents. Therefore, any adolescent with negative personality traits should be monitored closely by providing health education, motivation, counselling, and emotional support since it can be concluded that negative personality traits are correlated with high risk behaviours such as drug abuse [ 52 ].

Our study also found that a history of maltreatment has a positive association with adolescent drug abuse. Those adolescents with episodes of maltreatment were considered to have negative growth exposure, as their childhoods were negatively affected by traumatic events. Some significant associations were found between maltreatment and adolescent drug abuse, although the former factor was limited to the female gender [ 25 , 30 , 36 ]. One possible reason for the contrasting results between genders is the different sample populations, which only covered child welfare centers [ 36 ] and foster care [ 30 ]. Regardless of the place, maltreatment can happen anywhere depending on the presence of the perpetrators. To date, evidence that concretely links maltreatment and substance abuse remains limited. However, a plausible explanation for this link could be the indirect effects of posttraumatic stress (i.e., a history of maltreatment) leading to substance use [ 53 , 54 ]. These findings highlight the importance of continuous monitoring and follow-ups with adolescents who have a history of maltreatment and who have ever attended a welfare center.

Addiction sometimes leads to another addiction, as described by the findings of several studies [ 29 , 34 ]. An initial study focused on the effects of e-cigarettes in the development of other substance abuse disorders, particularly those related to marijuana, alcohol, and commonly prescribed medications [ 34 ]. The authors found that the use of e-cigarettes can lead to more severe substance addiction [ 55 ], possibly through normalization of the behavior. On the other hand, Chuang et al.’s extensive study in 2017 analyzed the combined effects of either multiple addictions alone or a combination of multiple addictions together with the impulsivity trait [ 29 ]. The outcomes reported were intriguing and provide the opportunity for targeted intervention. The synergistic effects of impulsiveness and three other substance addictions (marijuana, tobacco, and alcohol) substantially increased the likelihood for drug abuse from 3.46 (95%CI 1.25, 9.58) to 10.13 (95% CI 3.95, 25.95). Therefore, proper rehabilitation is an important strategy to ensure that one addiction will not lead to another addiction.

The likelihood for drug abuse increases as the population perceives little or no harmful risks associated with the drugs. On the opposite side of the coin, a greater perceived risk remains a protective factor for marijuana abuse [ 56 ]. However, another study noted that a stronger determinant for adolescent drug abuse was the perceived availability of the drug [ 35 , 57 ]. Looking at the bigger picture, both perceptions corroborate each other and may inform drug use. Another study, on the other hand, reported that there was a decreasing trend of perceived drug risk in conjunction with the increasing usage of drugs [ 58 ]. As more people do drugs, youth may inevitably perceive those drugs as an acceptable norm without any harmful consequences [ 59 ].

In addition, the total spent for screen time also contribute to drug abuse among adolescent [ 43 ]. This scenario has been proven by many researchers on the effect of screen time on the mental health [ 60 ] that leads to the substance use among the adolescent due to the ubiquity of pro-substance use content on the internet. Adolescent with comorbidity who needs medical pain management by opioids also tend to misuse in future. A qualitative exploration on the perspectives among general practitioners concerning the risk of opioid misuse in people with pain, showed pain management by opioids is a default treatment and misuse is not a main problem for the them [ 61 ]. A careful decision on the use of opioids as a pain management should be consider among the adolescents and their understanding is needed.

Within the family factor domain, family structures were found to have both positive and negative associations with drug abuse among adolescents. As described in one study, paternal knowledge was consistently found to be a protective factor against substance abuse [ 26 ]. With sufficient knowledge, the father can serve as the guardian of his family to monitor and protect his children from negative influences [ 62 ]. The work by Luk et al. also reported a positive association of maternal psychological association towards drug abuse (IRR 2.41, p  < 0.05) [ 26 ]. The authors also observed the same effect of paternal psychological control, although it was statistically insignificant. This construct relates to parenting style, and the authors argued that parenting style might have a profound effect on the outcomes under study. While an earlier literature review [ 63 ] also reported such a relationship, a recent study showed a lesser impact [ 64 ] with regards to neglectful parenting styles leading to poorer substance abuse outcomes. Nevertheless, it was highlighted in another study that the adolescents’ perception of a neglectful parenting style increased their odds (OR 2.14, p  = 0.012) of developing alcohol abuse, not the parenting style itself [ 65 ]. Altogether, families play vital roles in adolescents’ risk for engaging in substance abuse [ 66 ]. Therefore, any intervention to impede the initiation of substance use or curb existing substance use among adolescents needs to include parents—especially improving parent–child communication and ensuring that parents monitor their children’s activities.

Finally, the community also contributes to drug abuse among adolescents. As shown by Li et al. [ 32 ] and El Kazdouh et al. [ 46 ], peers exert a certain influence on other teenagers by making them subconsciously want to fit into the group. Peer selection and peer socialization processes might explain why peer pressure serves as a risk factor for drug-abuse among adolescents [ 67 ]. Another study reported that strong religious beliefs integrated into society play a crucial role in preventing adolescents from engaging in drug abuse [ 46 ]. Most religions devalue any actions that can cause harmful health effects, such as substance abuse [ 68 ]. Hence, spiritual beliefs may help protect adolescents. This theme has been well established in many studies [ 60 , 69 , 70 , 71 , 72 ] and, therefore, could be implemented by religious societies as part of interventions to curb the issue of adolescent drug abuse. The connection with school and structured activity did reduce the risk as a study in USA found exposure to media anti-drug messages had an indirect negative effect on substances abuse through school-related activity and social activity [ 73 ]. The school activity should highlight on the importance of developmental perspective when designing and offering school-based prevention programs [75].


We adopted a review approach that synthesized existing evidence on the risk and protective factors of adolescents engaging in drug abuse. Although this systematic review builds on the conclusion of a rigorous review of studies in different settings, there are some potential limitations to this work. We may have missed some other important factors, as we only included English articles, and article extraction was only done from the three search engines mentioned. Nonetheless, this review focused on worldwide drug abuse studies, rather than the broader context of substance abuse including alcohol and cigarettes, thereby making this paper more focused.


This review has addressed some recent knowledge related to the individual, familial, and community risk and preventive factors for adolescent drug use. We suggest that more attention should be given to individual factors since most findings were discussed in relation to such factors. With the increasing trend of drug abuse, it will be critical to focus research specifically on this area. Localized studies, especially those related to demographic factors, may be more effective in generating results that are specific to particular areas and thus may be more useful in generating and assessing local control and prevention efforts. Interventions using different theory-based psychotherapies and a recognition of the unique developmental milestones specific to adolescents are among examples that can be used. Relevant holistic approaches should be strengthened not only by relevant government agencies but also by the private sector and non-governmental organizations by promoting protective factors while reducing risk factors in programs involving adolescents from primary school up to adulthood to prevent and control drug abuse. Finally, legal legislation and enforcement against drug abuse should be engaged with regularly as part of our commitment to combat this public health burden.

Data availability and materials

All data generated or analysed during this study are included in this published article.

Nation, U. World Drug Report 2018 (United Nations publication, Sales No. E.18X.XI.9. United Nation publication). 2018. Retrieved from

Google Scholar  

Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M. The increasing global health priority of substance use in young people. Lancet Psychiatry. 2016;3(3):251–64. Elsevier Ltd.

Article   PubMed   Google Scholar  

Ritchie H, Roser M. Drug Use - Our World in Data: Global Change Data Lab; 2019. [10 June 2020]

Holm S, Sandberg S, Kolind T, Hesse M. The importance of cannabis culture in young adult cannabis use. J Subst Abus. 2014;19(3):251–6.

Luikinga SJ, Kim JH, Perry CJ. Developmental perspectives on methamphetamine abuse: exploring adolescent vulnerabilities on brain and behavior. Progress Neuro Psychopharmacol Biol Psychiatry. 2018;87(Pt A):78–84. Elsevier Inc.

Article   CAS   Google Scholar  

Ismail R, Ghazalli MN, Ibrahim N. Not all developmental assets can predict negative mental health outcomes of disadvantaged youth: a case of suburban Kuala Lumpur. Mediterr J Soc Sci. 2015;6(1):452–9. .

Article   Google Scholar  

Crews F, He J, Hodge C. Adolescent cortical development: a critical period of vulnerability for addiction. Pharmacol Biochem Behav. 2007;86(2):189–99. .

Article   CAS   PubMed   Google Scholar  

Schulte MT, Hser YI. Substance use and associated health conditions throughout the lifespan. Public Health Rev. 2013;35(2). Technosdar Ltd.

Somani, S.; Meghani S. Substance Abuse among Youth: A Harsh Reality 2016. doi: , 6, 4.

Book   Google Scholar  

Drabble L, Trocki KF, Klinger JL. Religiosity as a protective factor for hazardous drinking and drug use among sexual minority and heterosexual women: findings from the National Alcohol Survey. Drug Alcohol Depend. 2016;161:127–34. .

Article   PubMed   PubMed Central   Google Scholar  

Goliath V, Pretorius B. Peer risk and protective factors in adolescence: Implications for drug use prevention. Soc Work. 2016;52(1):113–29. .

Guerrero LR, Dudovitz R, Chung PJ, Dosanjh KK, Wong MD. Grit: a potential protective factor against substance use and other risk behaviors among Latino adolescents. Acad Pediatr. 2016;16(3):275–81. .

National Institutes on Drug Abuse. What are risk factors and protective factors? National Institute on Drug Abuse (NIDA); 2003. Retrieved from

Nguyen NN, Newhill CE. The role of religiosity as a protective factor against marijuana use among African American, White, Asian, and Hispanic adolescents. J Subst Abus. 2016;21(5):547–52. .

Schinke S, Schwinn T, Hopkins J, Wahlstrom L. Drug abuse risk and protective factors among Hispanic adolescents. Prev Med Rep. 2016;3:185–8. .

Macleod J, Oakes R, Copello A, Crome PI, Egger PM, Hickman M, et al. Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet. 2004;363(9421):1579–88. .

Moore TH, Zammit S, Lingford-Hughes A, Barnes TR, Jones PB, Burke M, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319–28. .

Semple DM, McIntosh AM, Lawrie SM. Cannabis as a risk factor for psychosis: systematic review. J Psychopharmacol. 2005;19(2):187–94. .

Nargiso JE, Ballard EL, Skeer MR. A systematic review of risk and protective factors associated with nonmedical use of prescription drugs among youth in the united states: A social ecological perspective. J Stud Alcohol Drugs. 2015;76(1):5–20. .

Guxensa M, Nebot M, Ariza C, Ochoa D. Factors associated with the onset of cannabis use: a systematic review of cohort studies. Gac Sanit. 2007;21(3):252–60. .

Susan MS, Peter SA, Dakshitha W, George CP. The age of adolescence. Lancet Child Adolesc Health. 2018;2(Issue 3):223–8. .

Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. Educ Inf. 2018;34(4):285–91. .

McHugh ML. Interrater reliability: The kappa statistic. Biochem Med. 2012;22(3):276–82. .

Cecil CAM, Walton E, Smith RG, Viding E, McCrory EJ, Relton CL, et al. DNA methylation and substance-use risk: a prospective, genome-wide study spanning gestation to adolescence. Transl Psychiatry. 2016;6(12):e976. Nature Publishing Group.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kobulsky JM. Gender differences in pathways from physical and sexual abuse to early substance use. Child Youth Serv Rev. 2017;83:25–32. .

Luk JW, King KM, McCarty CA, McCauley E, Stoep A. Prospective effects of parenting on substance use and problems across Asian/Pacific islander and European American youth: Tests of moderated mediation. J Stud Alcohol Drugs. 2017;78(4):521–30. .

Guttmannova K, Skinner ML, Oesterle S, White HR, Catalano RF, Hawkins JD. The interplay between marijuana-specific risk factors and marijuana use over the course of adolescence. Prev Sci. 2019;20(2):235–45. .

Dorard G, Bungener C, Phan O, Edel Y, Corcos M, Berthoz S. Is alexithymia related to cannabis use disorder? Results from a case-control study in outpatient adolescent cannabis abusers. J Psychosom Res. 2017;95:74–80. .

Chuang CWI, Sussman S, Stone MD, Pang RD, Chou CP, Leventhal AM, et al. Impulsivity and history of behavioral addictions are associated with drug use in adolescents. Addict Behav. 2017;74:41–7. .

Gabrielli J, Jackson Y, Brown S. Associations between maltreatment history and severity of substance use behavior in youth in Foster Care. Child Maltreat. 2016;21(4):298–307. .

Khoddam R, Jackson NJ, Leventhal AM. Internalizing symptoms and conduct problems: redundant, incremental, or interactive risk factors for adolescent substance use during the first year of high school? Drug Alcohol Depend. 2016;169:48–55. .

Li SD, Zhang X, Tang W, Xia Y. Predictors and implications of synthetic drug use among adolescents in the gambling Capital of China. SAGE Open. 2017;7(4):215824401773303. .

Marin S, Heshmatian E, Nadrian H, Fakhari A, Mohammadpoorasl A. Associations between optimism, tobacco smoking and substance abuse among Iranian high school students. Health Promot Perspect. 2019;9(4):279–84. .

Miech RA, O’Malley PM, Johnston LD, Patrick ME. E-cigarettes and the drug use patterns of adolescents. Nicotine Tob Res. 2015;18(5):654–9. .

Schleimer JP, Rivera-Aguirre AE, Castillo-Carniglia A, Laqueur HS, Rudolph KE, Suárez H, et al. Investigating how perceived risk and availability of marijuana relate to marijuana use among adolescents in Argentina, Chile, and Uruguay over time. Drug Alcohol Depend. 2019;201:115–26. .

Traube DE, Yarnell LM, Schrager SM. Differences in polysubstance use among youth in the child welfare system: toward a better understanding of the highest-risk teens. Child Abuse Negl. 2016;52:146–57. .

Wilson JD, Vo H, Matson P, Adger H, Barnett G, Fishman M. Trait mindfulness and progression to injection use in youth with opioid addiction. Subst Use Misuse. 2017;52(11):1486–93. .

Dash GF, Feldstein Ewing SW, Murphy C, Hudson KA, Wilson AC. Contextual risk among adolescents receiving opioid prescriptions for acute pain in pediatric ambulatory care settings. Addict Behav. 2020;104:106314. Epub 2020 Jan 11. PMID: 31962289; PMCID: PMC7024039.

Osborne V, Serdarevic M, Striley CW, Nixon SJ, Winterstein AG, Cottler LB. Age of first use of prescription opioids and prescription opioid non-medical use among older adolescents. Substance Use Misuse. 2020;55(14):2420–7. .

Zuckermann AME, Qian W, Battista K, Jiang Y, de Groh M, Leatherdale ST. Factors influencing the non-medical use of prescription opioids among youth: results from the COMPASS study. J Subst Abus. 2020;25(5):507–14. .

De Pedro KT, Esqueda MC, Gilreath TD. School protective factors and substance use among lesbian, gay, and bisexual adolescents in California public schools. LGBT Health. 2017;4(3):210–6. .

Spillane NS, Schick MR, Kirk-Provencher KT, Hill DC, Wyatt J, Jackson KM. Structured and unstructured activities and alcohol and marijuana use in middle school: the role of availability and engagement. Substance Use Misuse. 2020;55(11):1765–73. .

Ogunsola OO, Fatusi AO. Risk and protective factors for adolescent substance use: a comparative study of secondary school students in rural and urban areas of Osun state, Nigeria. Int J Adolesc Med Health. 2016;29(3). .

Doggett A, Qian W, Godin K, De Groh M, Leatherdale ST. Examining the association between exposure to various screen time sedentary behaviours and cannabis use among youth in the COMPASS study. SSM Population Health. 2019;9:100487. .

Afifi RA, El Asmar K, Bteddini D, Assi M, Yassin N, Bitar S, et al. Bullying victimization and use of substances in high school: does religiosity moderate the association? J Relig Health. 2020;59(1):334–50. .

El Kazdouh H, El-Ammari A, Bouftini S, El Fakir S, El Achhab Y. Adolescents, parents and teachers’ perceptions of risk and protective factors of substance use in Moroccan adolescents: a qualitative study. Substance Abuse Treat Prevent Policy. 2018;13(1):–31. .

Sussman S, Lisha N, Griffiths M. Prevalence of the addictions: a problem of the majority or the minority? Eval Health Prof. 2011;34(1):3–56. .

Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–37. .

Ricketts T, Macaskill A. Gambling as emotion management: developing a grounded theory of problem gambling. Addict Res Theory. 2003;11(6):383–400. .

Williams AD, Grisham JR. Impulsivity, emotion regulation, and mindful attentional focus in compulsive buying. Cogn Ther Res. 2012;36(5):451–7. .

National Institutes on Drug Abuse. Drugs, brains, and behavior the science of addiction national institute on drug abuse (nida). 2014. Retrieved from

Hokm Abadi ME, Bakhti M, Nazemi M, Sedighi S, Mirzadeh Toroghi E. The relationship between personality traits and drug type among substance abuse. J Res Health. 2018;8(6):531–40.

Longman-Mills S, Haye W, Hamilton H, Brands B, Wright MGM, Cumsille F, et al. Psychological maltreatment and its relationship with substance abuse among university students in Kingston, Jamaica, vol. 24. Florianopolis: Texto Contexto Enferm; 2015. p. 63–8.

Rosenkranz SE, Muller RT, Henderson JL. The role of complex PTSD in mediating childhood maltreatment and substance abuse severity among youth seeking substance abuse treatment. Psychol Trauma Theory Res Pract Policy. 2014;6(1):25–33. .

Krishnan-Sarin S, Morean M, Kong G, et al. E-Cigarettes and “dripping” among high-school youth. Pediatrics. 2017;139(3). .

Adinoff B. Neurobiologic processes in drug reward and addiction. Harvard review of psychiatry. NIH Public Access. 2004;12(6):305–20. .

Kandel D, Kandel E. The gateway hypothesis of substance abuse: developmental, biological and societal perspectives. Acta Paediatrica. 2014;104(2):130–7.

Dempsey RC, McAlaney J, Helmer SM, Pischke CR, Akvardar Y, Bewick BM, et al. Normative perceptions of Cannabis use among European University students: associations of perceived peer use and peer attitudes with personal use and attitudes. J Stud Alcohol Drugs. 2016;77(5):740–8.

Cioffredi L, Kamon J, Turner W. Effects of depression, anxiety and screen use on adolescent substance use. Prevent Med Rep. 2021;22:101362. .

Luckett T, NewtonJohn T, Phillips J, et al. Risk of opioid misuse in people with cancer and pain and related clinical considerations:a qualitative study of the perspectives of Australian general practitioners. BMJ Open. 2020;10(2):e034363. .

Lipari RN. Trends in Adolescent Substance Use and Perception of Risk from Substance Use. The CBHSQ Report. Substance Abuse Mental Health Serv Admin. 2013; Retrieved from .

Muchiri BW, dos Santos MML. Family management risk and protective factors for adolescent substance use in South Africa. Substance Abuse. 2018;13(1):24. .

Becoña E, Martínez Ú, Calafat A, Juan M, Fernández-Hermida JR, Secades-Villa R. Parental styles and drug use: a review. In: Drugs: Education, Prevention and Policy: Taylor & Francis; 2012. .

Berge J, Sundel K, Ojehagen A, Hakansson A. Role of parenting styles in adolescent substance use: results from a Swedish longitudinal cohort study. BMJ Open. 2016;6(1):e008979. .

Opara I, Lardier DT, Reid RJ, Garcia-Reid P. “It all starts with the parents”: a qualitative study on protective factors for drug-use prevention among black and Hispanic girls. Affilia J Women Soc Work. 2019;34(2):199–218. .

Martínez-Loredo V, Fernández-Artamendi S, Weidberg S, Pericot I, López-Núñez C, Fernández-Hermida J, et al. Parenting styles and alcohol use among adolescents: a longitudinal study. Eur J Invest Health Psychol Educ. 2016;6(1):27–36. .

Baharudin MN, Mohamad M, Karim F. Drug-abuse inmates maqasid shariah quality of lifw: a conceotual paper. Hum Soc Sci Rev. 2020;8(3):1285–94. .

Henneberger AK, Mushonga DR, Preston AM. Peer influence and adolescent substance use: a systematic review of dynamic social network research. Adolesc Res Rev. 2020;6(1):57–73. Springer.

Gomes FC, de Andrade AG, Izbicki R, Almeida AM, de Oliveira LG. Religion as a protective factor against drug use among Brazilian university students: a national survey. Rev Bras Psiquiatr. 2013;35(1):29–37. .

Kulis S, Hodge DR, Ayers SL, Brown EF, Marsiglia FF. Spirituality and religion: intertwined protective factors for substance use among urban American Indian youth. Am J Drug Alcohol Abuse. 2012;38(5):444–9. .

Miller L, Davies M, Greenwald S. Religiosity and substance use and abuse among adolescents in the national comorbidity survey. J Am Acad Child Adolesc Psychiatry. 2000;39(9):1190–7. .

Moon SS, Rao U. Social activity, school-related activity, and anti-substance use media messages on adolescent tobacco and alcohol use. J Hum Behav Soc Environ. 2011;21(5):475–89. .

Simone A. Onrust, Roy Otten, Jeroen Lammers, Filip smit, school-based programmes to reduce and prevent substance use in different age groups: what works for whom? Systematic review and meta-regression analysis. Clin Psychol Rev. 2016;44:45–59. .

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The authors acknowledge The Ministry of Higher Education Malaysia and The Universiti Kebangsaan Malaysia, (UKM) for funding this study under the Long-Term Research Grant Scheme-(LGRS/1/2019/UKM-UKM/2/1). We also thank the team for their commitment and tireless efforts in ensuring that manuscript was well executed.

Financial support for this study was obtained from the Ministry of Higher Education, Malaysia through the Long-Term Research Grant Scheme-(LGRS/1/2019/UKM-UKM/2/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Nawi, A.M., Ismail, R., Ibrahim, F. et al. Risk and protective factors of drug abuse among adolescents: a systematic review. BMC Public Health 21 , 2088 (2021).

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research articles on drug use

A review of research-supported group treatments for drug use disorders

Substance Abuse Treatment, Prevention, and Policy volume  16 , Article number:  51 ( 2021 ) Cite this article

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This paper reviews methodologically rigorous studies examining group treatments for interview-diagnosed drug use disorders. A total of 50 studies reporting on the efficacy of group drug use disorder treatments for adults met inclusion criteria. Studies examining group treatment for cocaine, methamphetamine, marijuana, opioid, mixed substance, and substance use disorder with co-occurring psychiatric conditions are discussed. The current review showed that cognitive behavioral therapy (CBT) group therapy and contingency management (CM) groups appear to be more effective at reducing cocaine use than treatment as usual (TAU) groups. CM also appeared to be effective at reducing methamphetamine use relative to standard group treatment. Relapse prevention support groups, motivational interviewing, and social support groups were all effective at reducing marijuana use relative to a delayed treatment control. Group therapy or group CBT plus pharmacotherapy are more effective at decreasing opioid use than pharmacotherapy alone. An HIV harm reduction program has also been shown to be effective for reducing illicit opioid use. Effective treatments for mixed substance use disorder include group CBT, CM, and women’s recovery group. Behavioral skills group, group behavioral therapy plus CM, Seeking Safety, Dialectical behavior therapy groups, and CM were more effective at decreasing substance use and psychiatric symptoms relative to TAU, but group psychoeducation and group CBT were not. Given how often group formats are utilized to treat drug use disorders, the present review underscores the need to understand the extent to which evidence-based group therapies for drug use disorders are applied in treatment settings.

Drug use disorders are a significant public health concern in the United States. According to the National Epidemiologic Survey of Alcohol and Related Conditions-III, the lifetime prevalence rate of DSM-5 drug use disorders is 9.9%, which includes amphetamine, cannabis, club drug, cocaine, hallucinogen, heroin, opioid, sedative/tranquilizer, and solvent/inhalant use disorders [ 1 ]. Drug use disorders are defined in terms of eleven criteria including physiological, behavioral and cognitive symptoms, as well as consequences of criteria, any two of which qualify for a diagnosis [ 2 , 3 ]. The individual and community costs of drug use are estimated at over $193 billion [ 4 , 5 ] and approximately $78.5 billion [ 6 ] for opioids alone. Consequences include overdose [ 7 ], mental health problems [ 8 ], and a range of medical consequences such as human immunodeficiency virus [ 9 , 10 ], hepatitis C virus [ 9 ], and other viral and bacterial infections [ 11 ].

Evidence-based practice was formally defined by Sackett et al. [ 12 ] in 1996 to refer to the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (p. 71). In 2006, the American Psychological Association [ 13 ] developed a policy on evidence-based practice (EBP) of psychotherapy, which emphasized the integration of best research evidence (i.e., data from meta-analyses, randomized controlled trials, effectiveness trials, and other forms of systematic case studies and reviews) with clinical expertise and judgment to deliver treatment in the context of a patient’s individual needs, preferences and culture. The shift towards EBP for substance use disorders has multiple benefits for practitioners and patients, including an increased focus on the implementation of treatments that are safe and cost-effective [ 14 ]. A recent survey of clinicians’ practices with substance use treatment found that clinicians often conducted therapy in groups [ 15 ]. While most clinicians who completed the survey reported use of evidence-based treatment practices (EBT) some also reported the use of non-EBT practices [ 15 ]. Ensuring that clinicians can readily access information regarding the current state of evidence regarding group-based therapies for substance use disorders is critical for fostering increased use of EBTs.

Although any effort to summarize a literature as large and complex as the psychological treatment literature is useful, there are several limitations. With few exceptions, research-supported treatment lists categorize treatments by formal change theory (e.g., cognitive-behavioral, interpersonal) and describe little about the context, format, or setting in which treatments were conducted and tested [ 16 ]. As a result, it is often difficult to ascertain from existing resources whether research supported treatments were conducted in group or individual format. A group format is often used in substance use treatment [ 17 ] and aftercare programs [ 18 , 19 , 20 , 21 , 22 ] . The discrepancy between the wide-spread use of group therapy in clinical practice and the relative paucity of research on the efficacy of group treatments has been noted by treatment researchers [ 23 ] and clinicians [ 24 ]. According to Lundahl’s [ 25 ] 2010 meta-analysis of studies evaluating the efficacy of motivational interviewing (MI), a commonly used treatment for substance use disorders, examination of the 119 studies concluded that studies of MI in a group format were too rare to draw solid conclusions about the efficacy of group MI. Also, it is possible that efficacy of treatments developed for individual delivery will be altered when delivered in a group format and vice versa. Given the limited empirical inquiry on group treatments for substance use, a framework organizing the literature on the efficacy of group therapy to treat substance use disorders would be useful. There is also a need for a more recent rigorous review of the empirical evidence to support group-based treatments for substance use disorders. Over 15 years ago, Weiss and colleagues conducted a review of 24 treatment outcome studies within the substance use disorder intervention literature comparing group therapy to other treatments conditions (i.e., no group therapy, individual therapy, group therapy plus individual therapy), and found no differences between group and individual therapy [ 26 ].

Given the importance of understanding the current evidence base for group-delivered treatments for substance use disorders, the present review sought to provide a summary of the literature on the benefits of group treatments for drug use disorders. Group treatments are potentially cost-effective, widely disseminable, and adaptable to a variety of populations but are lagging individual treatments in terms of research attention. Thus, highlighting characteristics of group treatments that are potentially efficacious is of import to stimulate further empirical inquiry. The review is organized by drug type (cocaine, methamphetamine, marijuana, opiate, mixed substance use disorders; SUD) and co-occurring SUD and psychiatric problems. We excluded studies focused on alcohol use disorder alone as this literature is summarized elsewhere (see Orchowski & Johnson, 2012). Given research suggesting that several factors impact outcomes of group treatments, including formal change theory driving the treatment approach (i.e., cognitive-behavioral, motivational interviewing), as well as patient factors [ 27 ], the review begins by first reviewing each theory of change (i.e., type of treatment), and then concludes by summarizing the research examining the extent to which patient factors influence the efficacy of group treatments for SUD.

To locate studies that evaluated a group treatment for SUD that met review inclusion criteria, the authors conducted a comprehensive literature search of PsycINFO and MedLine through 2020. Three individuals then examined abstracts of the articles for relevance. In addition, the authors utilized the reference lists of review studies and meta-analyses of SUD- treatments to locate additional studies that might meet the review inclusion criteria. The authors and a research assistant then reviewed full articles with relevance to the current study and excluded any studies that did not meet the review inclusion criteria (see Fig.  1 ).

figure 1

Electronic Search Strategy Flowchart

For inclusion in the review, studies needed to meet the following criteria: 1) report the findings of at least one group treatment; 2) provide at least one statistical comparison between the group treatment and a control condition; 3) randomize participants between the group treatment and control condition; 4) utilize a manualized treatment; 5) include patients with an interview-diagnosed SUD; and 6) provide information regarding the demographic characteristics of the participants in the study. Studies’ methods and results were used for data extraction. Studies which maintained a primary focus on the treatment of SUD, but also included treatment of a co-occurring psychiatric condition, were included in the review. Studies which included alcohol use as a comorbid diagnosis along another substance use were included. Studies examining the efficacy of group treatment for only alcohol use were excluded. The final set of articles included were 50 research studies that utilized a group treatment modality for the treatment of SUD, including separately examining cocaine, methamphetamine, marijuana, opioid, mixed substance, or SUD with comorbid psychiatric problems in adults.

It should be noted that several studies that met inclusion criteria were not reported in the present review because they did not report the use of a specific screening instrument for SUD as a part of the study inclusion/exclusion criteria. These studies are as follows and include these comparisons: group-based relational therapy [ 28 ] two studies by Guydish et al. [ 29 , 30 ] comparing a day treatment program to residential treatment (RT) program, a day treatment program to a coping skills group [ 31 ], standard care to a harm reduction group [ 32 ], 12 step group to a CBT group [ 33 ], medical management treatment (MMT) with CBT group to an MMT plus treatment reinforcement plan [ 34 ], treatment as usual to contingency management (CM) [ 35 ], professionally led recovery training group to treatment as usual (TAU) [ 36 ], two 4 month residential treatment programs [ 37 ], varying lengths of therapeutic community program (TPC) with and without relapse prevention [ 38 ], and Information and Referral plus peer advocacy to a Motivational group with CBT group [ 39 ].

Review of evidence-based theories of change

The 50 research studies meeting inclusion criteria tested the following group treatment modalities: contingency management (CM), motivational interviewing (MI), relapse prevention (RP), social support (SS), cognitive-behavioral (CBT), coping skills (CS), harm reduction (HR), cognitive therapy (CT), drug counseling (DC), recovery training (RT), standard group therapy (SGT), family therapy (FT), intensive group therapy (IGT), 12 step facilitation group therapy (12SG), relational psychotherapy mothers’ group (RPMG), psychoeducational therapy group (PET), behavioral skills (BS), and seeking safety (SS). Below, we briefly review the theory of change that drives each of these treatments.

Several treatment approaches are grounded in behavioral therapies and/or cognitive therapies. Broadly, cognitive therapy is an approach that focuses exclusively on targeting thoughts that are identified as part of a diagnosis or behavioral problem [ 28 ]. Cognitive-behavioral (CBT) therapy is an approach that targets specific symptoms, thoughts, and behaviors that are identified as part of a diagnosis or presenting problem [ 28 ]. Under the umbrella of CBT several other treatment modalities exist. For example, relapse prevention is a CBT treatment that hypothesizes that there are cognitive, behavioral, and affective mechanism that underlie the process of relapse [ 40 ]. Recovery training is a more specific form of relapse prevention, including education on addiction and recovery and reinforcing relapse prevention skills (e.g., understanding triggers, coping with cravings etc.) [ 41 , 42 ]. Other treatments focus on coping skills more broadly. For example, coping skills treatments include a focus on components of adaptability in interpersonal relationships, thinking and feeling, as well as approaches to self and life [ 28 ]. Some treatment approaches also recognize that individuals may not be ready to change their substance use. For example, motivational interviewing is often described as a therapy guiding technique in which the therapist is a helper in the behavior change process and expressed acceptance of the patient [ 43 ]. Standard group therapy includes 90 min sessions approximately twice a week in a group setting, [ 44 ] whereas intensive group therapy is a heavier dose of standard group therapy that includes 120-min sessions up to five times a week [ 44 ]. Psychoeducational therapy group focused on providing information on the immediate and delayed problems of substance use disorders to patients [ 45 ]. Lastly, dialectical behavior therapy (DBT) is a type of CBT therapy that focuses on helping regulate intense emotional states and provides skills to reduce arousal levels, and increase mindfulness, emotional regulation, and interpersonal skills [ 46 ].

Grounded within behavioral therapies, are behavioral skills training which focused on developing behaviors that are adaptive [ 28 ]. Contingency management is a type of behavioral therapy in which patients are reinforced or rewarded for positive behavioral change [ 47 ]. Harm reduction is a term for interventions aiming to reduce the problematic effects of behaviors [ 48 ]. Several treatment approaches also focus on interpersonal networks and building interpersonal skills. For example, social support is any psychological resources provided by a social network to help patients cope with stress [ 49 ]. Twelve-step facilitation group therapy is a more specific form of social support, which focuses on introducing patients to the 12 steps of alcoholics anonymous or related groups (i.e., cocaine or narcotics anonymous) to encourage 12-step meeting attendance in their community [ 33 , 50 ]. Seeking Safety is a present-focused and empowerment-based intervention focused on coping skills that emphasizes the importance of safety within interpersonal relationships [ 51 ]. Drug counseling describes treatment that aims to facilitate abstinence, encourage mutual support, and provide coping skills [ 52 ]. Finally, family therapy is a family-based intervention that aims to change, parenting behaviors and family interactions [ 53 ]. Overall, there are many overlapping components and skill sets in the models discussed above (See Table  1 ).

Group-based cocaine use treatments for adults

Nineteen studies were identified that targeted cocaine use and utilized some form of group therapy, the most of any drug in this review (see Table  2 ). Overall, the studies showed that all of the group therapy modalities included in this review generally reduced cocaine use when compared to treatment as usual (TAU), including day hospital groups [ 54 ]. Two studies, Magura et al. (1994) and Magura et al. (2002) did not find group differences between 8 months CBT and 8 months of TAU that consisted of methadone maintenance therapy among 141 patients with cocaine disorder [ 60 , 69 ]. When compared directly, individuals in CBT groups achieved longer abstinence than individuals in 12 step facilitation groups [ 33 ] or low intensity groups [ 64 , 65 ]. However, in another study, individuals with cocaine dependence receiving 12-step based Group Drug Counseling (GDC; similar to 12-step facilitation) had similar cocaine abstinence outcomes with or without additional individual CBT [ 41 ]. This may suggest that group 12-step facilitation is an effective intervention for cocaine dependence. Two studies demonstrated the superiority of CM groups for reducing cocaine use as compared to CBT [ 62 ] or TAU groups [ 61 , 62 ] at 12 weeks [ 54 ], 17 weeks [ 53 ], 26 weeks [ 53 ] and 52 weeks follow up [ 51 ]. Therefore, CBT group therapy and contingency management groups appear to be more effective at reducing cocaine use than TAU groups.

Group-based methamphetamine use treatments for adults

Only five treatment studies were identified that examined group treatments for methamphetamine use (see Table  3 ). Three studies found longer periods of abstinence for the group treatment (CM or drug+CM) than for TAU or non-CM conditions. The first study conducted by Rawson and colleagues compared matrix model (MM) with TAU in eight community outpatient settings [ 71 ]. The MM consisted of CBT groups, family education groups, social support groups, and individual counseling sessions along with weekly urine screens for 16 weeks. Participants in the MM condition attended more sessions, stayed in treatment longer, had more than twice as many contacts, evidence longer abstinence and greater self-reported psychosocial functioning relative to the TAU group. However, these significant differences did not persist 6 months later at follow-up.

Shoptaw et al. (2006) [ 73 ] compared four groups for treating methamphetamine dependence sertraline + CM, sertraline only, placebo + CM, and placebo [ 73 ]. Additionally, all participants attended a relapse prevention group conducted three times a week over a 14-week period. Findings provided support for the efficacy of CM for amphetamine use disorders. Group treatment (CM or drug + CM) was more effective for sustaining longer periods of abstinence relative to TAU or non-CM conditions. Roll et al. [ 72 ] found that effects of CM relative to TAU became larger as the duration of CM increased. Jaffe et al. [ 70 ] evaluated a culturally tailored intervention for 145 methamphetamine dependent gay and bisexual males. Participants in the Gay Specific CBT condition reported the most rapid decline in levels of methamphetamine use relative to standard CBT, CBT + CM, suggesting benefits for culturally appropriate group methamphetamine interventions.

Group-based marijuana use treatments for adults

Two studies examining group treatments for adults with marijuana use disorders were identified (see Table  4 ). Both studies were conducted by the same research group, utilizing the same inclusion criteria for marijuana use (50 times in 90 days). The studies examined group relapse prevention (RP) [ 76 ], specifically designed for adult marijuana users. The first trial [ 75 ] ( n  = 212) comparing relapse prevention to a social support group found participants in both group treatment conditions did well overall, with two-thirds (65%) reporting abstinence of marijuana use for 2 weeks after session 4 or the quit date and 63% reporting abstinence during the last 2 weeks of treatment. Gender differences emerged; no differences between group treatments were found for women, but men in the relapse prevention group reported reduced marijuana use at the 3-month follow-up compared to men in the social support group.

A second trial [ 74 ] randomized participants to 14 sessions of group RP enhanced with cognitive behavioral skills training, two sessions of motivational interviewing (MI) with feedback and advice on cognitive behavioral skills (modeled after the Drinkers Check-up) [ 77 ], or a 4-month delayed treatment control (DTC) group which consisted of the RP group or individual MI treatment of the participants choosing. Compared to individuals randomly assigned to the DTC condition, participants in the group RP and individual MI conditions evidenced a significantly greater reduction in marijuana use and related problems over 16-month follow-up. However, examination of participants’ reactions to DTC assignment indicated that participants who felt that changing their marijuana use was their own responsibility were more likely than those who did not to change their use patterns without treatment engagement.

Group-based opiate use treatments for adults

Five group treatment studies for opioid use were identified (see Table  5 ). Two studies compared the effectiveness of pharmacotherapy plus group therapies [ 79 , 80 , 81 ] to pharmacotherapy alone in samples of opioid dependent persons, and both found that adding group treatment improved outcomes. The first study compared Naltrexone with monthly medical monitoring visits to an enhanced group condition (EN) consisting of Naltrexone plus a Matrix Method (MM) [ 79 ]. MM consisted of hourly individual sessions, 90-min CBT group, and 60 min of cue-exposure weekly for weeks 1–12; hourly individual sessions and CBT group sessions for weeks 13–26; and 90-min social support group sessions for weeks 27–52. Results found that EN participants took more study medication, were retained in treatment longer, used less opioids while in treatment, and showed greater improvement on psychological and affective dimensions than Naltrexone only participants. No difference by treatment condition was found at 6- and 12-month follow-ups. Similarly, Scherbaum et al. [ 80 ] compared routine Methadone Maintenance Therapy (MMT) with routine MMT plus group CBT psychotherapy (20 90-min sessions for 20 weeks). MMT plus group CBT participants showed less drug use than participants in the MMT group (i.e., control group). In contrast, a higher dose of group therapy provided without methadone maintenance was less effective for heroin use than was a lower dose of group therapy with methadone maintenance (Sees et al. [ 81 ]. This suggests that the combination of pharmacotherapy and group therapy for opioid use is optimal.

Shaffer et al. [ 22 ] compared psychodynamic group therapy with a hatha yoga group. All participants received methadone maintenance and individual therapy. No differences between two treatment conditions were found. For all participants, longer participation in treatment was associated with reduction in drug use and criminal activity. Lastly, Des Jarlais et al. [ 78 ] compared a group social learning AIDS/drug injection treatment program (4 sessions, 60–90 min, over 2 weeks) to a control condition. All participants received information about AIDS and HIV antibody test counseling. Compared to control participants, intervention participants reported lower rates of drug injection over time.

Group treatments for mixed SUD for adults

Nine treatment studies were identified that targeted mixed substance use with group treatments (see Table  6 ). Three involved CBT. Downey et al. [ 82 ] compared group CBT plus individual CBT to group CBT plus vouchers in a sample of 14 polysubstance users (cocaine and heroin) maintained on buprenorphine. The study was significantly underpowered and they found no significant differences on treatment outcomes. Marques and Formiogioni [ 84 ] compared individual CBT to group CBT in a sample of 155 participants with alcohol and/or drug dependence. They found that both formats resulted in similar outcomes, with higher compliance in the group CBT participants (66.7% compliance with treatment). Rawson et al. [ 87 ] compared three 16-week treatments: CM, group CBT, and CM plus group CBT, among 171 participants with cocaine disorder or methamphetamine abuse. They found that CM produced better retention and lower rates of stimulant use than CBT during treatment, but CBT produced comparable longer-term outcomes.

Two studies involved Group Drug Counseling (GDC). Greenfield et al. [ 52 ] compared a group drug counseling (GDC) (mixed gender) to a women’s recovery group (WRG) that both met weekly, for 12 weeks, for 90-min sessions among 44 participants that had a substance use disorder other than nicotine. WRG evidenced significantly greater reductions in drug and alcohol use over the follow up compared with GDC. Schottenfeld et al. [ 88 ] compared GDC (weekly, 1-h group sessions) to a community reinforcement approach (CRA; twice weekly sessions for the first 12 weeks and then weekly the following 12 weeks) among 117 patients with an opioid and cocaine use disorder. There were no differences in retention or drug use.

Remaining studies examined other interventions. Margolin et al. [ 83 ] compared an HIV Harm reduction program (HHRP) that met twice weekly for 2 h to an active control group that met six times in a sample of 90 HIV-seropositive methadone-maintained injection drug users with opioid dependence, and abuse or dependence on cocaine. At follow up, they had lower addiction severity scores and were less likely to have engaged in high risk behaviors compared to control. McKay et al. [ 85 ] compared weekly phone monitoring and counseling plus a support group in the first 4 weeks (TEL), twice-weekly individualized relapse prevention, and twice-weekly standard group counseling (STND) among 259 referred participants with alcohol use disorder or cocaine disorder. STND resulted in more days abstinent than TEL. Nemes et al. [ 86 ] compared a 12-month group program (10 months inpatient and 2 months outpatient) to an abbreviated group program (6 months inpatient, 6 months outpatient) among 412 patients with multiple drug/alcohol use disorders. Results indicated that both groups had reduction in arrests and drug use. There were no significant difference between groups. Lastly, Smith et al. [ 89 ] compared a standard treatment program (STP, daily group counseling, family outreach, 12-step program introduction, four 2 h sessions for family) to an enhanced treatment program (ETP; twice weekly group on relapse prevention and interpersonal violence in additional to all STP components) among 383 inpatient veterans meeting for an alcohol, cocaine, or amphetamine use disorder. Results indicated that ETP had enhanced abstinence rates at 3-month and 12-month follow up compared to STP, regardless of type of drug use.

Group Treatments for SUD and Co-Occurring Psychiatric Problems

Individuals with psychiatric distress are at high risk for comorbid SUD [ 90 ]. Ten randomized controlled studies meeting our inclusion criteria examined the efficacy of group therapy for SUD and co-occurring psychiatric problems (see Table  7 ). Three studies described group treatment of SUD and co-occurring DSM-IV Axis II disorders [ 18 , 91 , 96 ], three studies examined group treatment of drug abuse and co-occurring DSM-IV classified Axis I disorders [ 92 , 93 , 99 ], one study explored group drug abuse treatment and co-occurring psychiatric problems among homeless individuals without limiting to DSM-IV Axis I or Axis II diagnoses [ 97 ], and one study focused on group drug treatment among individuals testing positive for HIV [ 98 ]. Within this diverse set of RCTs, participants generally included individuals diagnosed with any form of SUD; however, some studies focused specifically on individuals using cocaine [ 91 , 97 ] or cocaine/opioids [ 98 ].

A range of group treatment approaches are represented, including group psychoeducational therapy, group CBT approaches, group DBT, Seeking Safety and CM. DiNitto and colleagues [ 92 ] evaluated the efficacy of adding a group-based psychoeducational program entitled “Good Chemistry Groups” to standard inpatient SUD treatment services among 97 individuals with a dual diagnosis of SUD and a DSM-IV Axis I psychological disorder. The nine 60-min Good Chemistry Group sessions were offered 3 times per week for 3 weeks. When compared to standard inpatient treatment, the addition of the psychoeducational group was not associated with any changes in medical, legal, alcohol, drug, psychiatric or family/social problems among participants.

The efficacy of adding a psychoeducational group treatment to standard individual therapy to address HIV risk among cocaine users has also been examined [ 91 ]. Participants were randomly assigned to complete the following: 1) individually-administered Standard Intervention developed by the NIDA Cooperative Agreement Final Cohort sites [ 100 ] including HIV testing, and pre- and post-HIV testing counseling on risks relating to cocaine use, transmission of STDs/HIV, condom use, cleaning injection equipment, and the benefits of treatment; or) Standard Intervention plus four 2-h peer-delivered psychoeducational groups addressing stress management, drug awareness, risk reduction strategies, HIV education and AIDS. Among the sample of 966 individuals completing the 3-month follow-up, the group psychoeducational treatment was not differentially effective in reducing drug use and HIV risk behavior in comparison to standard treatment alone at 3-months post-baseline, regardless of treatment type, individuals with antisocial personality disorder (ASPD) demonstrated less improvement in crack cocaine use compared to individuals without ASPD or depression.

The following types of group CBT have sustained research evaluation meeting our inclusion criteria to address co-occurring SUD and Axis I or Axis II disorders: 1) group behavioral skills training; 2) group cognitive behavioral therapy; 3) group-based Seeking Safety [ 51 ], and 4) group dialectical behavioral therapy. Specifically, Jerrell and Ridgely [ 93 ] examined the efficacy of group behavioral skills (BS) training, group-based 12-step facilitation (TS) treatment, and intensive case management among 132 individuals with a dual diagnosis of SUD and another Axis I psychiatric problem over the course of 24-months. Based on the Social and Independent Living Skills program [ 101 ], the BS group included one group per week addressing self-management skills designed to enhance abstinence, including medication management, relapse prevention, social skills, leisure activities and symptom monitoring. Relative to participants in TS groups, participants in the BS groups evidenced increased psychosocial functioning and decreased psychiatric symptoms (i.e., schizophrenia, depressive symptoms, mania, drug use and alcohol use) across the 6-, 12- and 18-month follow-up assessments after treatment entry.

Lehman and colleagues’ [ 95 ] examination of the efficacy of group CBT for substance abuse compared to TAU among 54 individuals with SUD and either schizophrenia or a major affective disorder revealed no differences between treatment groups over the course of a 1-year follow-up period. More promising findings were reported in Fisher and Bentley’s [ 18 ] evaluation of a group CBT and group therapy based in the disease and recovery model (DRM) among 38 individuals with dual diagnosis of SUD and a personality disorder. Groups met three times per week for 12 weeks and were compared to TAU. Individuals in group CBT and group DRM indicated improved social and family functioning compared to TAU, and among those who completed the group in an outpatient setting, CBT was more effective in reducing alcohol use, enhancing psychological functioning and improving social and family functioning compared to DRM and TAU.

Group behavioral therapy plus abstinence contingent housing and work administered in the context of a day treatment program was compared to behavioral group treatment alone among individuals with cocaine abuse/dependence, non-psychotic psychiatric conditions, and homelessness [ 97 , 102 ]. The group behavioral therapy included 8 weeks of daily treatment (4 h and 50 min per day) of groups addressing relapse prevention training, assertiveness training, AIDS education, 12-step facilitation, relaxation, recreation development, goal setting, and goal planning. Participants also engaged in a process-oriented group as well as individual counseling and urine monitoring and engaged in a weekly 90 min psychoeducational group therapy during months 3–6 following treatment enrollment. Individuals who received contingency-based work and housing were provided with rent-free housing and employment in construction or food service industries after 2 consecutive weeks of abstinence [ 103 ]. Relative to BS groups alone, group behavioral day treatment plus contingency management was associated with greater abstinence at 2- and 6-month follow-ups [ 102 ] and were less likely to relapse [ 97 ], although gains were not maintained at 12-months [ 104 ]. Both groups evidenced positive changes in drug use overtime compared to baseline [ 104 ].

Zlotnick, Johnston and Najavits [ 99 ] evaluated the efficacy of Seeking Safety (SS), in comparison to treatment as usual (TAU) among 49 incarcerated women with substance use disorder (SUD) and full or subthreshold posttraumatic stress disorder (PTSD). SS aims to decrease PTSD and SUD through psychoeducational and present-focused and empowerment-based instruction on coping skills that emphasize abstinence and safety [ 51 ]. The SS group treatment included 90-min group sessions held three times per week, that were completed in addition to the 180 to 240 h of group and individual therapy provided in TAU. All participants showed similar improvement on assessments of PSTD, SUD, legal problems and other psychiatric concerns at 12-week, 3- and 6-month follow-ups following prison release. Nonetheless, there was a trend for improved PTSD and continued improvements in psychiatric symptoms at follow-up among participants completing SS compared to TAU. Greater completion of SS sessions was associated with increased improvement in PTSD as well as drug use among women [ 99 ].

Dialectical behavioral group therapy (DBT), a CBT-focused treatment for individuals with borderline personality disorder (BPD), has also been evaluated in comparison to TAU among individuals with BPD and co-occurring SUD [ 96 ]. Core elements of DBT are manualized [ 105 ], and have been evaluated in prior research [ 106 , 107 , 108 ]. Techniques center on providing the participant with acceptance and validation while maintaining a continual focus on behavior change, and include the following: mindfulness skills training, behavioral analysis of dysfunctional behavior, cognitive restructuring, coping skills training, exposure-based strategies addressing maladaptive emotions, and behavioral management skills training. DBT was administered through 2 ¼ hour weekly group sessions administered in combination with 60 min of weekly individual therapy and the opportunity for skills-coaching phone calls. Relative to TAU, participants randomly assigned to DBT demonstrated greater reductions in drug use during the 12-month treatment and at the 16-month follow-up assessment, as well as greater gains in adjustment at the 16-month follow-up assessment.

Although contingency management is commonly administered individually, Petry and colleagues [ 98 ] examined the efficacy of weekly 60-min group-based contingency management (CM) for reinforcing health behaviors and HIV-positive individuals with cocaine or opioid disorders ( N  = 170) in comparison to 12-step facilitation (TS) over the course of a 24-week period. Overall, participants in CM were more likely than those in TS to submit consecutive drug-free urine specimens, although the overall proportion of drug-free specimens did not vary between groups during treatment or over the follow-up period. Notably, during treatment, group CM was associated with greater reductions in HIV-risk behaviors as well as overall viral load compared to TS; although effects were not maintained over the follow-up period.

Across these studies, many trials showed positive gains for both group treatments examined [ 18 , 97 , 98 ], or no difference between groups when examining the benefit of adding group treatment to existing TAU [ 91 , 92 , 95 , 99 ]. However, one study demonstrated greater reductions in drug use among individuals with BPD and SUD who completed group DBT in comparison to TAU [ 96 ]. Further, BS groups were more effective than TS groups in improving psychosocial functioning and decreasing substance use [ 93 ]. Finally, CBT was more effective than DRM in reducing alcohol use, enhancing psychological functioning and improving social and family functioning compared to DRM and TAU among individuals dually diagnosed with SUD and a personality disorder [ 18 ].

Factors associated with treatment efficacy

Gender and treatment efficacy.

Five of the studies included in the present review examined whether treatment was differentially effective for men and women. Although Jarrell and Ridgely’s [ 93 ] evaluation of group BS, group TS and individual case management for individuals with SUD and co-occurring Axis I disorders did not examine whether group treatment types were differentially effective for men and women, data indicated that women—regardless of treatment group—reported higher role functioning (i.e.., independent living, work productivity, as well as immediate and extended social relationships), increased psychiatric symptomatology (depression, mania, drug use, alcohol use) across the follow-up periods compared to men.

Race and ethnicity and treatment efficacy

Among the studies included in the present review, only three examined whether treatment efficacy varied as a function of race and ethnicity. A secondary examination of the efficacy of group BS in comparison to group TS and individual case management [ 93 ] suggested that outcomes in each group treatment among ethnic and racial minority clients were equivalent to White participants during the 6-month follow [ 94 ]. The initial evaluation indicated that—regardless of group treatment type—racial/ethnic minority participants reported lower scores in personal well-being, lower life satisfaction (i.e., satisfaction with living), worse role functioning (i.e., independent living, work productivity, immediate and extended social relationships) over the follow-up periods compared to White participants [ 93 ].


In general, participants in group treatment for drug use disorders exhibit more improvement on typical measures of outcome (e.g., abstinence & use rates, objective measures, urinalysis) when compared to standard care without group [ 18 , 109 ] and those who refuse or drop out of treatment [ 110 ]. Specifically, CBT and CM appear to be more effective at reducing cocaine use than TAU groups. CM is effective in increasing periods of abstinence among users of methamphetamine. Both relapse prevention and social support group therapy were effective for marijuana use although relapse prevention was more helpful for men than for women. Brief MI and relapse prevention were both effective at reducing marijuana use. CBT and CBT-related treatments (including the matrix model) when added to pharmacotherapy were more effective for opioid use disorder than pharmacotherapy alone. Effective treatments for Mixed SUD include group CBT, CM, and women’s recovery group. Longer relapse prevention periods appear to be more helpful in reducing mixed SUD. Behavioral skills and behavioral skills plus contingency management helped decreased psychiatric symptoms and drug use behaviors. Psychoeducation groups alone, a commonly used intervention, were not effective at addressing SUD and co-occurring psychiatric problems. Additionally, it is important to note that there is potential for risk of bias in the studies included across four domains: participants, predictors, outcome, and analysis [ 111 ]. The current study did not comprehensively assess for risk of bias and this is a study limitation. Future research could assess for risk of bias by following the guidelines suggested by the Cochrane Handbook [ 112 ].

The current literature offers a wide variety of group treatments with varying goals and based on varying formal change theories. Overall, studies that reported between-group effect size ( n  = 7) reported small to medium effect sizes potentially suggesting differences were moderate but of potential theoretical interest. Of those seven studies, only two studies reported large effect sizes (both comparing an active treatment to a delayed treatment/untreated condition). In order to better characterize magnitude of intervention effects, future studies should report effect sizes and their confidence intervals [ 113 , 114 ]. Moreover, groups based on cognitive-behavioral theory [ 35 ], motivational enhancement theory [ 43 ], stages of change theory [ 115 ], 12-step theory [ 41 ] and psychoeducational group models [ 116 ] have all been the subject of recent studies. Steps of treatment have also been used to classify groups for acutely ill individuals with SUD versus middle stage (recovering) or after care groups, with the latter mainly focusing on relapse prevention. Group therapy is provided – at least as an augment to multimodal interventions – in most of the outpatient and inpatient programs in English speaking and European countries [ 17 , 117 ]. Therefore, continued efforts to implement and scale up group-based treatments for SUD known to be effective are needed. CM appears to be effective at addressing various drug use problems and further research should evaluate whether it would also be useful for marijuana use.

Future Research Questions

Studies of other group treatments for SUD that use rigorous, interview-based diagnosis, use control groups, randomly assign participants to condition, report the ethnic and racial composition of the sample, are adequately powered, implement a treatment manual, and compare outcomes to individual treatment as well are necessary.

Little is known regarding the possible mediators and moderators of treatment outcome in group interventions for SUD

Key Learning Objectives

Group treatment approaches are widely utilized and are often less costly to implement than individual treatments, currently we know very little whether one group approach is superior to another in the treatment of SUD.

Group treatment approaches seem to be more effective at improving positive outcomes (e.g., abstinence, use rates, objective measures, urinalysis) when compared to standard care without group [ 18 , 109 ], and those who refuse and drop out of treatment

More thorough randomized controlled trials of group SUD treatments are needed [ 110 ].

Availability of data and materials

Not applicable. The present study does not include original data. However, the authors of the study have listed all articles reviewed in this study in the reference section.


Twelve Step Facilitation Group Therapy

Alcohol Dependence

Acquired Immunodeficiency Syndrome

Addiction Severity Index

Antisocial Personality Disorder

Abbreviated Program

Behavioral Skills

Borderline Personality Disorder

Cognitive Behavioral Therapy

Cocaine Dependence

Composite Diagnostic Interview Schedule

Contingency Management

Community Reinforcement Approach

Coping Skills

Cognitive Therapy

Dialectical Behavioral Therapy

Day Treatment

Drug Counseling

Diagnostic Interview Schedule

Diagnostic and Statistical Manual

Disease and Recovery Model

Delayed to Control

Evidence-Based Practice

Evidence-Based Treatment Practice

Enhanced Group Condition

Enhanced Treatment Program

Family Therapy

Group Drug Counseling

Human Immunodeficiency Virus

HIV Harm Reduction

Harm Reduction

Intensive Group Therapy

Individual Therapy

Motivational Interviewing

Matrix Model

Methadone Maintenance Therapy

National Institute of Drug Abuse

Psychoeducational Therapy Group

Pre-Post with Comparison Group (matched or otherwise)

Post Traumatic Stress Disorder

Random Assignment with Control

Relapse Prevention

Recovery Training

Random Assignment to Active Treatment

Relational Psychotherapy Mothers’ Group

Structured Clinical Interview for Diagnosis

Social Support

Standard Group Therapy

Substance Use Disorder

Seeking Safety

Standard Group Counseling

Standard Treatment Program

Treatment as Usual

Phone Monitoring and Counseling, with Support Group

Therapeutic Community Program

Twelve Step

Women’s Recovery Group

Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chou SP, Jung J, et al. Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on alcohol and related conditions-III. JAMA Psychiatry. 2016;73(1):39–47.

Article   PubMed   PubMed Central   Google Scholar  

Edition F. Diagnostic and statistical manual of mental disorders: DSM-5™. 5th ed; 2013.

Google Scholar  

Rehm J, Marmet S, Anderson P, Gual A, Kraus L, Nutt DJ, et al. Defining substance use disorders: do we really need more than heavy use? Alcohol Alcohol. 2013;48(6):633–40.

Article   CAS   PubMed   Google Scholar  

Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011;12(4):657–67.

Article   PubMed   Google Scholar  

Center NDI. National Drug Threat Assessment. Washington: United States Department of Justice; 2011.

Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901–6.

Kamal R, Cox C, Rousseau D, Foundation ftKF. Costs and outcomes of mental health and substance use disorders in the US. JAMA. 2017;318(5):415.

Hall WD, Patton G, Stockings E, Weier M, Lynskey M, Morley KI, et al. Why young people's substance use matters for global health. Lancet Psychiatry. 2016;3(3):265–79.

Khalsa JH, Treisman G, McCance-Katz E, Tedaldi E. Medical consequences of drug abuse and co-occurring infections: research at the National Institute on Drug Abuse. Subst Abus. 2008;29(3):5–16.

McCoy CB, Lai S, Metsch LR, Messiah SE, Zhao W. Injection drug use and crack cocaine smoking: independent and dual risk behaviors for HIV infection. Ann Epidemiol. 2004;14(8):535–42.

Contoreggi, md C, Rexroad, rph VE, Lange, md, et al. Current Management of Infectious Complications in the injecting drug user. J Subst Abus Treat. 1998;15(2):95–106.

Article   Google Scholar  

Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71–2.

Article   CAS   PubMed   PubMed Central   Google Scholar  

American Psychological Association PTFoE-BP. Evidence-based practice in psychology. Am Psychol. 2006;61:271–85.

Pope C. Resisting evidence: the study of evidence-based medicine as a contemporary social movement. Health. 2003;7(3):267–82.

Wendt D. Group therapy for substance use disorders: a survey of clinician practices. J Groups Addict Recover. 2017;12(4):243 EOA.

Johnson J. Using research-supported group treatments. J Clin Psychol In Session. 2008;64(11):1206–24.

Stinchfield RD, Owen P, Winters K. Group therapy for substance abuse: A review of the empirical research. In: Burlingame AFG, editor. Handbook of group psychotherapy. New York: Wiley; 1994. p. 458–88.

Fisher MS Sr, Bentley KJ. Two group therapy models for clients with a dual diagnosis of substance abuse and personality disorder. Psychiatr Serv. 1996;47(11):1244–50.

Kaminer Y, Burleson JA, Blitz C, Sussman J, Rounsaville BJ. Psychotherapies for adolescent substance abusers: a pilot study. J Nerv Ment Dis. 1998;186(11):684–90.

McKay JR, Alterman AI, Cacciola JS, O'Brien CP, Koppenhaver JM, Shepard DS. Continuing care for cocaine dependence: comprehensive 2-year outcomes. J Consult Clin Psychol. 1999;67(3):420–7.

McKay JR, Alterman AI, Cacciola JS, Rutherford MJ, O'Brien CP, Koppenhaver J. Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: initial results. J Consult Clin Psychol. 1997;65(5):778–88.

Shaffer HJ, LaSalvia TA, Stein JP. Comparing hatha yoga with dynamic group psychotherapy for enhancing methadone maintenance treatment: a randomized clinical trial. Altern Ther Health Med. 1997;3(4):57–66.

CAS   PubMed   Google Scholar  

Morgan-Lopez AA, Fals-Stewart W. Analytic methods for modeling longitudinal data from rolling therapy groups with membership turnover. J Consult Clin Psychol. 2007;75(4):580–93.

Weiss RD. Treating patients with bipolar disorder and substance dependence: lessons learned. J Subst Abus Treat. 2004;27(4):307–12.

Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Res Soc Work Pract. 2010;20(2):137–60.

Weiss RD, Jaffee WB, de Menil VP, Cogley CB. Group therapy for substance use disorders: what do we know? Harvard Rev Psychiatry. 2004;12(6):339–50.

Burlingame GM, MacKenzie KR, Strauss B. Bergin & Garfields Handbook Of Psychotherapy And Behavior Change. Small group treatment: Evidence for effectiveness and mechanisms of change. In: Lambert M, editor. Handbook of psychotherapy and behavior change. 5th ed. New York: Wiley; 2003. p. 647–96.

Beck AT. Cognitive therapy: nature and relation to behavior therapy. Behav Ther. 1970;1(2):184–200.

Guydish J, Sorensen JL, Chan M, Werdegar D, Bostrom A, Acampora A. A randomized trial comparing day and residential drug abuse treatment: 18-month outcomes. J Consult Clin Psychol. 1999;67(3):428–34.

Guydish J, Werdegar D, Sorensen JL, Clark W, Acampora A. Drug abuse day treatment: a randomized clinical trial comparing day and residential treatment programs. J Consult Clin Psychol. 1998;66(2):280–9.

Avants SK, Margolin A, Sindelar JL, Rounsaville BJ, Schottenfeld R, Stine S, et al. Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost. Am J Psychiatry. 1999;156(1):27–33.

Avants SK, Margolin A, Usubiaga MH, Doebrick C. Targeting HIV-related outcomes with intravenous drug users maintained on methadone: a randomized clinical trial of a harm reduction group therapy. J Subst Abus Treat. 2004;26(2):67–78.

Maude-Griffin PM, Hohenstein JM, Humfleet GL, Reilly PM, Tusel DJ, Hall SM. Superior efficacy of cognitive-behavioral therapy for urban crack cocaine abusers: main and matching effects. J Consult Clin Psychol. 1998;66(5):832–7.

Rohsenow DJ, Monti PM, Martin RA, Michalec E, Abrams DB. Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes. J Consult Clin Psychol. 2000;68(3):515–20.

Beck ATW, F. D.; Newman, C. F.; Liese, B. S. Cognitive therapy of substance abuse. New York: Guilford; 1993.

McAuliffe WE. A randomized controlled trial of recovery training and self-help for opioid addicts in New England and Hong Kong. J Psychoactive Drugs. 1990;22(2):197–209.

Czuchry M, Dansereau DF. Node-link mapping and psychological problems. Perceptions of a residential drug abuse treatment program for probationers. J Subst Abus Treat. 1999;17(4):321–9.

Article   CAS   Google Scholar  

McCusker J, Bigelow C, Frost R, Garfield F, Hindin R, Vickers-Lahti M, et al. The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior. Am J Public Health. 1997;87(10):1637–44.

Rosenblum A, Magura S, Kayman DJ, Fong C. Motivationally enhanced group counseling for substance users in a soup kitchen: a randomized clinical trial. Drug Alcohol Depend. 2005;80(1):91–103.

Marlatt GA, Donovan DM. Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. 2nd ed. New York: The Guilford Press; 2005. p. xiv, 416-xiv

Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken LS, et al. Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse collaborative cocaine treatment study. Arch Gen Psychiatry. 1999;56(6):493–502.

Luthar SSS, N.E.; Altomare, M. Relational psychotherapy Mother’s group: A randomized clinical trial for substance abusing mothers. Dev Psychopathol. 2007;19:243–61.

Miller WRR, S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford Press; 1991.

Hoffman JA, Caudill BD, Koman JJ 3rd, Luckey JW, Flynn PM, Mayo DW. Psychosocial treatments for cocaine abuse. 12-month treatment outcomes. J Subst Abus Treat. 1996;13(1):3–11.

Kaminer Y, Burleson JA, Goldberger R. Cognitive-behavioral coping skills and psychoeducation therapies for adolescent substance abuse. J Nerv Ment Dis. 2002;190(11):737–45.

Linehan M. DBT skills training manual. 2nd ed. London: The Guilford Press; 2015.

Petry NM. Contingency management: what it is and why psychiatrists should want to use it. Psychiatrist. 2011;35(5):161–3.

Logan DE, Marlatt GA. Harm reduction therapy: a practice-friendly review of research. J Clin Psychol. 2010;66(2):201–14.

PubMed   PubMed Central   Google Scholar  

Ellis B, Bernichon T, Yu P, Roberts T, Herrell JM. Effect of social support on substance abuse relapse in a residential treatment setting for women. Eval Program Plan. 2004;27(2):213–21.

Nowinski J, Baker S. The twelve-step facilitation handbook: A systematic approach to early recovery from alcoholism and addiction. San Francisco: Jossey-Bass; 1992. p. xxii. 215-xxii

Najavits LM. Seeking safety: a treatment manual for PTSD and substance abuse. New York: Guilford; 2002.

Greenfield SF, Trucco EM, McHugh RK, Lincoln M, Gallop RJ. The Women's recovery group study: a stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling. Drug Alcohol Depend. 2007;90(1):39–47.

Liddle HA, Dakof GA, Parker K, Diamond GS, Barrett K, Tejeda M. Multidimensional family therapy for adolescent drug abuse: results of a randomized clinical trial. Am J Drug Alcohol Abuse. 2001;27(4):651–88.

Coviello DM, Alterman AI, Rutherford MJ, Cacciola JS, McKay JR, Zanis DA. The effectiveness of two intensities of psychosocial treatment for cocaine dependence. Drug Alcohol Depend. 2001;61(2):145–54.

Crits-Christoph P, Siqueland L, McCalmont E, Weiss RD, Gastfriend DR, Frank A, et al. Impact of psychosocial treatments on associated problems of cocaine-dependent patients. J Consult Clin Psychol. 2001;69(5):825–30.

Siqueland L, Crits-Christoph P, Gallop R, Barber JP, Griffin ML, Thase ME, et al. Retention in psychosocial treatment of cocaine dependence: predictors and impact on outcome. Am J Addict. 2002;11(1):24–40.

Mercer D, Carpenter G, Daley D. The adherence and competence scale for group addiction counseling for TCACS: Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania Medical School; 1994.

Luborsky L. Principles of psychoanalytic psychotherapy a manual for supportive-expressive treatment; 1984.

Epstein DH, Hawkins WE, Covi L, Umbricht A, Preston KL. Cognitive-behavioral therapy plus contingency management for cocaine use: findings during treatment and across 12-month follow-up. Psychol Addict Behav. 2003;17(1):73–82.

Magura S, Rosenblum A, Lovejoy M, Handelsman L, Foote J, Stimmel B. Neurobehavioral treatment for cocaine-using methadone patients: a preliminary report. J Addict Dis. 1994;13(4):143–60.

Petry NM, Alessi SM, Hanson T. Contingency management improves abstinence and quality of life in cocaine abusers. J Consult Clin Psychol. 2007;75(2):307–15.

Rawson RA, Huber A, McCann M, Shoptaw S, Farabee D, Reiber C, et al. A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry. 2002;59(9):817–24.

Rohsenow DJ, Monti PM, Rubonis AV, Gulliver SB, Colby SM, Binkoff JA, et al. Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes. Addiction. 2001;96(8):1161–74.

Rosenblum A, Magura S, Foote J, Palij M, Handelsman L, Lovejoy M, et al. Treatment intensity and reduction in drug use for cocaine-dependent methadone patients: a dose-response relationship. J Psychoactive Drugs. 1995;27(2):151–9.

Rosenblum A, Magura S, Palij M, Foote J, Handelsman L, Stimmel B. Enhanced treatment outcomes for cocaine-using methadone patients. Drug Alcohol Depend. 1999;54(3):207–18.

Volpicelli JR, Markman I, Monterosso J, Filing J, O'Brien CP. Psychosocially enhanced treatment for cocaine-dependent mothers: evidence of efficacy. J Subst Abus Treat. 2000;18(1):41–9.

Weinstein SP, Gottheil E, Sterling RC. Randomized comparison of intensive outpatient vs. individual therapy for cocaine abusers. J Addict Dis. 1997;16(2):41–56.

Gottheil E, Weinstein SP, Sterling RC, Lundy A, Serota RD. A randomized controlled study of the effectiveness of intensive outpatient treatment for cocaine dependence. Psychiatr Serv. 1998;49(6):782–7.

Magura S, Rosenblum A, Fong C, Villano C, Richman B. Treating cocaine-using methadone patients: predictors of outcomes in a psychosocial clinical trial. Subst Use Misuse. 2002;37(14):1927–55.

Jaffe A, Shoptaw S, Stein J, Reback CJ, Rotheram-Fuller E. Depression ratings, reported sexual risk behaviors, and methamphetamine use: latent growth curve models of positive change among gay and bisexual men in an outpatient treatment program. Exp Clin Psychopharmacol. 2007;15(3):301–7.

Rawson RA, Marinelli-Casey P, Anglin MD, Dickow A, Frazier Y, Gallagher C, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction. 2004;99(6):708–17.

Roll JM, Chudzynski J, Cameron JM, Howell DN, McPherson S. Duration effects in contingency management treatment of methamphetamine disorders. Addict Behav. 2013;38(9):2455–62.

Shoptaw S, Huber A, Peck J, Yang X, Liu J, Jeff D, et al. Randomized, placebo-controlled trial of sertraline and contingency management for the treatment of methamphetamine dependence. Drug Alcohol Depend. 2006;85(1):12–8.

Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. J Consult Clin Psychol. 2000;68(5):898–908.

Stephens RS, Roffman RA, Simpson EE. Treating adult marijuana dependence: a test of the relapse prevention model. J Consult Clin Psychol. 1994;62(1):92–9.

Marlatt GAG, J.R. Relapse prevention (unpublished manuscript). In: Luther SSS, Boltas D, editors. Relational parenting Mother’s group: A therapist’s manual. New York: Guilford Press; 1985.

Miller WR, Benefield RG, Tonigan JS. Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles. J Consult Clin Psychol. 1993;61(3):455–61.

Des Jarlais DC, Casriel C, Friedman SR, Rosenblum A. AIDS and the transition to illicit drug injection--results of a randomized trial prevention program. Br J Addict. 1992;87(3):493–8.

Rawson RA, McCann MJ, Shoptaw SJ, Miotto KA, Frosch DL, Obert JL, et al. Naltrexone for opioid dependence: evaluation of a manualized psychosocial protocol to enhance treatment response. Drug Alcohol Rev. 2001;20(1):67–78.

Scherbaum N, Kluwig J, Specka M, Krause D, Merget B, Finkbeiner T, et al. Group psychotherapy for opiate addicts in methadone maintenance treatment--a controlled trial. Eur Addict Res. 2005;11(4):163–71.

Sees KL, Delucchi KL, Masson C, Rosen A, Clark HW, Robillard H, et al. Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA. 2000;283(10):1303–10.

Downey KK, Helmus TC, Schuster CR. Treatment of heroin-dependent poly-drug abusers with contingency management and buprenorphine maintenance. Exp Clin Psychopharmacol. 2000;8(2):176–84.

Margolin A, Avants SK, Warburton LA, Hawkins KA, Shi J. A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users. Health Psychol. 2003;22(2):223–8.

Marques AC, Formigoni ML. Comparison of individual and group cognitive-behavioral therapy for alcohol and/or drug-dependent patients. Addiction. 2001;96(6):835–46.

McKay JR, Lynch KG, Shepard DS, Morgenstern J, Forman RF, Pettinati HM. Do patient characteristics and initial progress in treatment moderate the effectiveness of telephone-based continuing care for substance use disorders? Addiction. 2005;100(2):216–26.

Nemes S, Wish ED, Messina N. Comparing the impact of standard and abbreviated treatment in a therapeutic community. Findings from the district of Columbia treatment initiative experiment. J Subst Abus Treat. 1999;17(4):339–47.

Rawson RA, McCann MJ, Flammino F, Shoptaw S, Miotto K, Reiber C, et al. A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals. Addiction. 2006;101(2):267–74.

Schottenfeld RS, Pantalon MV, Chawarski MC, Pakes J. Community reinforcement approach for combined opioid and cocaine dependence. Patterns of engagement in alternate activities. J Subst Abus Treat. 2000;18(3):255–61.

Smith TL, Volpe FR, Hashima JN, Schuckit MA. Impact of a stimulant-focused enhanced program on the outcome of alcohol- and/or stimulant-dependent men. Alcohol Clin Exp Res. 1999;23(11):1772–9.

Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the epidemiologic catchment area (ECA) study. JAMA. 1990;264(19):2511–8.

Compton WM, Cottler LB, Ben-Abdallah A, Cunningham-Williams R, Spitznagel EL. The effects of psychiatric comorbidity on response to an HIV prevention intervention. Drug Alcohol Depend. 2000;58(3):247–57.

DiNitto DM, Webb DK, Rubin A. Gender differences in dually-diagnosed clients receiving chemical dependency treatment. J Psychoactive Drugs. 2002;34(1):105–17.

Jerrell JM, Ridgely MS. Comparative effectiveness of three approaches to serving people with severe mental illness and substance abuse disorders. J Nerv Ment Dis. 1995;183(9):566–76.

Jerrell JM, Wilson JL. Ethnic differences in the treatment of dual mental and substance disorders. A preliminary analysis. J Subst Abus Treat. 1997;14(2):133–40.

Lehman AF, Herron JD, Schwartz RP, Myers CP. Rehabilitation for adults with severe mental illness and substance use disorders. A clinical trial. J Nerv Ment Dis. 1993;181(2):86–90.

Linehan MM, Schmidt H 3rd, Dimeff LA, Craft JC, Kanter J, Comtois KA. Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. Am J Addict. 1999;8(4):279–92.

Milby JB, Schumacher JE, Vuchinich RE, Wallace D, Plant MA, Freedman MJ, et al. Transitions during effective treatment for cocaine-abusing homeless persons: establishing abstinence, lapse, and relapse, and reestablishing abstinence. Psychol Addict Behav. 2004;18(3):250–6.

Petry NM, Weinstock J, Alessi SM, Lewis MW, Dieckhaus K. Group-based randomized trial of contingencies for health and abstinence in HIV patients. J Consult Clin Psychol. 2010;78(1):89–97.

Zlotnick C, Johnson J, Najavits LM. Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behav Ther. 2009;40(4):325–36.

Wechsberg WM, MacDonald BR, Dennis ML, Inciardi JA, Surratt HL, Leukefeld CG, et al. The standard intervention for reduction in HIV risk behavior; protocol changes suggested by the continuing HIV/AIDS epidemic. Bloomington: Lighthouse Institute; 1997.

Liberman RP, Massel HK, Mosk MD, Wong SE. Social skills training for chronic mental patients. Hosp Community Psychiatry. 1985;36(4):396–403.

Milby JB, Schumacher JE, McNamara C, Wallace D, Usdan S, McGill T, et al. Initiating abstinence in cocaine abusing dually diagnosed homeless persons. Drug Alcohol Depend. 2000;60(1):55–67.

Milby JB, Schumacher JE, Raczynski JM, Caldwell E, Engle M, Michael M, et al. Sufficient conditions for effective treatment of substance abusing homeless persons. Drug Alcohol Depend. 1996;43(1–2):39–47.

Milby JB, Schumacher JE, Wallace D, Frison S, McNamara C, Usdan S, et al. Day treatment with contingency management for cocaine abuse in homeless persons: 12-month follow-up. J Consult Clin Psychol. 2003;71(3):619–21.

Linehan MMD, L.A. Dialectical behavior therapy manual of treatment interventions for drug abusers with borderline personality disorder. Seattle: University of Washington; 1997.

Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1993;50(12):971–4.

Linehan MM, Tutek DA, Heard HL, Armstrong HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. Am J Psychiatry. 1994;151(12):1771–6.

Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry. 1991;48(12):1060–4.

Burtscheidt W, Schwarz R, Redner C, Gaebel W. Behavioral therapeutic methods in ambulatory treatment of alcoholism. Early results of an experimental study. Fortschr Neurol Psychiatr. 1999;67(6):274–80.

Sandahl C, Herlitz K, Ahlin G, Rönnberg S. Time-limited group psychotherapy for moderately alcohol dependent patients: A randomized controlled clinical trial. Psychother Res. 1998;8(4):361–78.

Wolff RF, Moons KG, Riley RD, Whiting PF, Westwood M, Collins GS, et al. PROBAST: a tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med. 2019;170(1):51–8.

Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial. In: Cochrane handbook for systematic reviews of interventions; 2019. p. 205–28.

Chapter   Google Scholar  

Diener MJ. The Corsini Encyclopedia of Psychology; 2010. p. 1.

Book   Google Scholar  

Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010;11(1):1–8.

Prochaska JO, DiClemente CC. Stages of change in the modification of problem behaviors. Prog Behav Modif. 1992;28:183–218.

Drake RE, McLaughlin P, Pepper B, Minkoff K. Dual diagnosis of major mental illness and substance disorder: an overview. New Dir Ment Health Serv. 1991;1991(50):3–12.

Kunzke D, Strauss B, Burtscheidt W. The effectiveness of psychodynamic group therapy in the treatment of alcohol abuse. A review. Gruppenpsychotherapie und Gruppendynamik. 2002;38:53–70.

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López, G., Orchowski, L.M., Reddy, M.K. et al. A review of research-supported group treatments for drug use disorders. Subst Abuse Treat Prev Policy 16 , 51 (2021).

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Published : 21 June 2021


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research articles on drug use

Drug Abuse Research Paper

research articles on drug use

This sample drugs research paper on drug abuse features: 2500 words (approx. 8 pages) and a bibliography with 6 sources. Browse other research paper examples for more inspiration. If you need a thorough research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our writing service for professional assistance. We offer high-quality assignments for reasonable rates.

Drug abuse, also referred to as substance or chemical abuse, is the recurrent use of a drug despite the experience of problems caused by the drug use. Difficulties arising in certain areas of a user’s life are of more importance to researchers and treatment professionals than other areas for identification of a drug abuse problem. The following are types of problems that signify drug abuse: impairment meeting major responsibilities in life, such as those regarding school, work, or home; difficulties with the law and social behavior; and aggravation of physical/medical conditions due to drug use. Drug abuse is to be contrasted with drug (chemical/substance) dependence. With drug dependence, use is considered compulsive and beyond the willful control of the user. That is, someone who is drug dependent is addicted; this is thought to be a more severe condition than drug abuse. Treatment of drug abuse is accomplished primarily using a variety of counseling and psychotherapeutic techniques employed to assist the abuser to stop using the drug, to develop new behavioral and mental coping skills, and to rehabilitate his or her life from the damage caused by the substance abuse.

1. Introduction

In the discussion of drug abuse, it would be easy but inaccurate to label any regular use of a substance as abusive. Drug use in the United States is commonplace. Many people are capable of consuming drugs without developing problems. Drugs such as caffeine and alcohol, as well as prescription pharmaceutical products such as pain killing agents or antianxiety medication, are routinely and openly consumed every day in the United States (and in other countries as well). The various drugs affect the body differently and are used for specific purposes. For example, caffeine is used to remain alert and to enhance concentration, and tranquilizers are used to quell anxiety and for relaxation. However, drugs of abuse all have in common the property that they are psychoactive. For the sake of discussion, drugs may be classified with respect to different properties; one commonly employed system is in terms of the effect of the drug on the central nervous system (CNS). The following is one such classification system, with examples of drugs in each category:

Substance use typically begins in adolescence. Adolescent substance use does not appear to be random; that is, it follows a fairly predictable pattern. Adolescents tend to start using substances that are legal and widely available to adults: alcohol and tobacco. Due to the fact that these drugs are the starting point for substance use, they are referred to as ‘‘gateway drugs.’’ In 1975, Kandel developed a stage model of progression of drug use that has since been revised:

The vast majority of adolescents experiment with the gateway drugs at least one time. However, although most individuals try alcohol and tobacco, only for a minority of adolescents does use advance to abusive levels. As the stages advance, progressively fewer adolescents are found in each category. For example, alcohol will be tried by approximately 9 out of 10 students by their senior year in high school and cigarettes by approximately 6 out of 10 students by senior year. Opiates, at the last stage of the model, will be tried by only 1 out of 100 students by senior year.

Due to the high prevalence of substance use in the United States, it should be no surprise that substance-related problems are often encountered by mental health clinicians. The relatively high frequency with which substance-related problems are encountered by mental health professionals reflects the influence of the following factors: (i) Drug abuse has the potential to create or worsen all psychological symptoms, such as anxiety, depression, impulsive behavior, and antisocial behavior; and (ii) people seeking mental health services also tend to be at elevated risk for substance abuse problems. In other words, drug abuse harms people and contributes to psychiatric symptoms, and people experiencing psychological problems are apt to use drugs abusively.

2. Risk Factors And Causes Of Drug Abuse

With any medical or mental health condition, it is desirable to determine the cause or causes of the affliction. Identifying the cause(s) helps to develop prevention strategies to limit or eliminate future cases and treatment strategies for those already affected by the condition. For example, after the discovery that an absence of insulin was responsible for type 1 diabetes, effective treatment of diabetes with externally supplied insulin became possible. In addition, research is under way to develop early identification tests for intervention strategies to prevent later development of diabetes. This research has led to the isolation of faulty antibodies believed to attack the insulin-producing cells of the pancreas. The antibodies can be detected before the person is symptomatic for diabetes; experimental treatments are being used in an attempt to prevent the development of diabetes in these high-risk individuals.

Human behavior is complex and defies easy explanation. Unlike certain physical characteristics (e.g., eye color) or physical disorders that can be traced to single genes, a disorder such as drug abuse likely represents the interaction of multiple genetic and environmental influences. Complicating things further, ethics prevents us from conducting experimental studies (involving environmental or genetic manipulation) that might help us to tease apart various possible influences. One way to attempt to identify possible causes of substance abuse is to study risk factors. Risk factors are those variables associated with increased likelihood of developing a substance use disorder. Classes of risk factors are listed here with examples in each class:

Risk factors help us to understand influences to use substances, but we know many more people use them than become abusers. Therefore, the question as to who will progress beyond experimentation and casual use to the level of abuse is not answered by risk factors alone. It appears that use of substances is more a function of external risk factors, such as peer, social, and family factors; abuse of substances appears to be more a function of personal factors, such as psychiatric, behavioral, and emotional problems.

The biopsychosocial disease model is the most widely accepted model of substance abuse and addiction. It should be clear after reviewing the list of risk factors that biological, psychological, and social factors contribute to substance abuse. The biopsychosocial model is sufficiently comprehensive to include all known contributants to substance abuse.

3. Course Of Drug Abuse

Disease conditions are defined by several common factors, such as having identifiable causes, characteristic symptoms, and established treatments. In addition, diseases have an observable course. It is important to describe the course of an illness in part so that the condition can be identified (i.e., for diagnostic purposes). Also, if the untreated progression of an illness was not known, there would be no way to judge the effectiveness of treatment. Treatment interventions endeavor, essentially, to change the course of a disease. Initial attempts to describe and classify the course of alcohol abuse depicted an ever-worsening condition that eventuated in death, unless the drinking was stopped altogether. As it turns out, the long-term outcome of regular alcohol use is not certain death. Some people who use alcohol never develop problems, some who develop problems (alcohol abusers) never become addicted, and a minority of alcohol abusers (approximately one-third) exhibit the progressive deteriorative pattern of drinking. The same overall trends may be expected with other substances of abuse as with alcohol. In 1995, Shaffer and Robbins developed a general model to describe the typical course of an addiction, consisting of the following stages:

4. Assessment Of Drug Abuse

In order to treat a condition, it must first be determined that a given individual has the condition; in other words, the diagnosis of drug abuse must be made. In medicine, objective tests via technologically advanced equipment (e.g., x-ray and magnetic resonance imagery) are often used to assist the doctor in the diagnostic process. In the evaluation of drug abuse, modern technology is hardly relevant. Biological testing, in the forms of urinalysis and evaluation of saliva and blood samples, may be used but are not the mainstay of assessment. Biological testing can determine if a specific drug or drug metabolite is present in a sample but cannot indicate anything about patterns of use, withdrawal symptoms, compulsive behavior, or consequences of use, all of which are important aspects to assess. Therefore, biological testing is confined to the role of confirming recent abstinence; this information is especially important in certain settings (e.g., criminal justice system and workplace) but of limited use in a drug abuse assessment. Since we are more interested in determining whether a pattern of abusive drug use is present or not, relevant information needs to be gathered. Therefore, the interview is the primary method by which information is acquired to make the diagnosis of drug abuse. Typically, the diagnostic interview is conducted with the person in question as well as with others in a position to observe relevant behaviors (most often family members and/or close friends). In addition to the interview, information is sometimes acquired via self-report, paper-and-pencil tests. The following information is typically obtained during a drug abuse assessment:

Diagnosing a drug abuse disorder is only one element of the assessment process. It is also necessary to determine as part of the evaluation the most appropriate setting in which treatment should take place (e.g., outpatient, halfway house, or inpatient); the proper intensity of treatment (e.g., daily treatment or monthly treatment); whether other treatment needs exist (e.g., medical and/or psychological disorders); and specific, individual treatment goals for a given person.

5. Treatment Of Drug Abuse

There is no one treatment for drug abuse. This fact is a reflection of the complexity of the condition and its diverse manifestations, and it highlights the importance of the assessment process, which is critical in helping determine the best treatment for a given individual. The treatment of drug abuse may occur in different settings, with varying degrees of professional assistance (e.g., self-help/12-step and professional help) and different modalities of professional services (e.g., individual therapy, group therapy, family therapy, and pharmacological treatment). Drug abuse treatment may be characterized as specialized treatment with one main goal: to stop the use of the substance. Treatment is primarily talking therapy—counseling and psychotherapy; in addition, medications may be employed to manage detoxification from some drugs and/or to treat coexisting psychological or medical conditions. However, regardless of the setting of treatment, the intensity of the contact schedule, or who renders the treatment, it is ultimately talking therapy that takes place. Especially early in treatment, the focus of discussion is on behavior directly related to drug use and stopping the use of the drug. Most programs and professionals recommend complete abstinence from drugs; some have the goal of harm reduction (allowing use to continue while attempting to reduce drug use to less harmful levels), but they are in the minority. As treatment progresses, and abstinence is achieved and maintained, the emphasis usually broadens to other areas of the person’s life that may need repair, such as their decision-making skills, coping skills, emotional state, and relationships. In other words, the individual suffers psychological and social damage from drug abuse and may even have had significant deficits in these areas prior to his or her drug abuse; treatment is designed to improve the psychosocial functioning of the individual once he or she is drug-free.

6. Relapse Prevention

Drug abuse has been described as a chronic, relapsing disorder. Like all chronic conditions, long-term effort must be applied for the individual to maintain abstinence from drug use. Nobody would expect the blood sugar levels of someone with diabetes to be in a healthy range if the person only complied with the prescribed care regimen for 1 month after a visit to the physician. Likewise, if a drug abuser only applies the principles of treatment for a limited period of time, resumption of abusive habits would be expected. One way to attempt to guard against a backslide into prior behavior is to extend treatment as long as possible. In addition, teaching relapse prevention skills that an abuser may use going forward in time is an integral part of drug abuse treatment. Some common elements of relapse prevention programs include identification of high-risk situations that are likely to lead to relapse, development and practice of skills to effectively cope with risky situations, enhancement of self-confidence to be able to apply coping skills when needed, learning to limit a slip to an isolated incident rather than allow it to be the beginning of a process of abuse, drug/alcohol monitoring for abstinence verification, and developing positive behaviors (e.g., working and physical exercise).



research articles on drug use

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Research articles

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Unexplored therapeutic opportunities in the human genome

In 2014, the Illuminating the Druggable Genome programme was launched to promote the exploration of currently understudied but potentially druggable proteins. This article discusses how the systematic collection and processing of a wide array of biological and chemical data as part of this programme has enabled the development of evidence-based criteria for tracking the target development level of human proteins, which indicates a substantial knowledge deficit for approximately one out of three proteins in the human proteome. It also highlights the nature of the unexplored therapeutic opportunities for major protein families.

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Drug discovery effectiveness from the standpoint of therapeutic mechanisms and indications

Shih and colleagues analyse comprehensive industry-wide data on drug development projects pursued during the past 20 years, classified according to the mechanism and indication for each project. Their findings indicate several points and trends that may be useful in understanding and improving the productivity of the pharmaceutical industry, including areas with substantial success or failure and the relative extent of novelty in completed and ongoing projects.

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Trends in GPCR drug discovery: new agents, targets and indications

G protein-coupled receptors (GPCRs) are the most intensively studied class of drug targets. This article presents a pioneering analysis of all GPCR-targeted drugs and agents that are currently in clinical trials, and discusses the trends across molecule types, drug targets and therapeutic indications.

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A comprehensive map of molecular drug targets

The success of mechanism-based drug discovery depends on the definition of the drug target, but targets are often poorly defined in the literature. Here, Overington and colleagues present a comprehensive map of the molecular targets of approved drugs, and explore aspects including the footprint of target classes across disease areas, the success of privileged target families and drug target orthologues across standard model organisms.

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An analysis of the attrition of drug candidates from four major pharmaceutical companies

Attempts to reduce the number of efficacy- and safety-related failures that may be linked to the physicochemical properties of small-molecule drug candidates have been inconclusive owing to the limited size of data sets from individual companies. Waring and colleagues analyse the largest data set compiled so far on the causes of attrition for oral, small-molecule drug candidates, derived from a pioneering data-sharing effort by AstraZeneca, Eli Lilly and Company, GlaxoSmithKline and Pfizer.

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The discovery of first-in-class drugs: origins and evolution

Previous analyses of new drug approvals have suggested that phenotypic screening strategies have been more productive than target-based approaches in the discovery of first-in-class small-molecule drugs. Eder and colleagues analysed the origins of the first-in-class drugs approved by the US Food and Drug Administration from 1999 to 2013, and found that target-based approaches have had a substantial impact in more recent years. They discuss the implications for drug discovery strategies, including viewing phenotypic screening as a novel discipline rather than as a neoclassical approach.

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Phenotypic screening in cancer drug discovery — past, present and future

There has been a resurgence of interest in the use of phenotypic screens in drug discovery as an alternative to target-focused approaches. Moffat and colleagues investigated the contribution of phenotypic assays in oncology by analysing the origins of the new small-molecule cancer drugs approved by the US Food and Drug Administration over the past 15 years. They also discuss technical and biological advances that could empower phenotypic drug discovery in oncology by enabling the development of mechanistically informed phenotypic screens.

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The role of ligand efficiency metrics in drug discovery

Ligand efficiency metrics quantify the molecular properties required to gain binding affinity for a drug target. This article discusses the application of such metrics in the selection and optimization of fragments, hits and leads, highlighting how optimizing ligand efficiency metrics based on both molecular mass and lipophilicity, when set in the context of the specific target, has the potential to increase the quality of drug candidates.

research articles on drug use

Objective assessment of cancer genes for drug discovery

Effectively selecting therapeutic targets from the sizeable lists that are emerging from large-scale multi-omics initiatives is a key challenge in drug discovery. This article describes an objective, systematic computational assessment of biological and chemical space that can be applied to any human gene set to prioritize targets for further evaluation, and demonstrates its use on a set of 479 cancer-associated genes to identify new opportunities for drug discovery and repurposing.

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Quantifying factors for the success of stratified medicine

Co-developing a drug with a diagnostic to create a stratified medicine — a therapy that is targeted to a specific patient population on the basis of a clinical biomarker — presents challenges for product developers, regulators, payers and physicians. With the aim of developing a shared framework and tools for addressing these challenges, this article presents an analysis using data from case studies in oncology and Alzheimer's disease, coupled with integrated computational modelling of clinical outcomes and economic value, to quantify the effects of decisions on key issues such as the design of clinical trials.

research articles on drug use

The influence of the 'organizational factor' on compound quality in drug discovery

In the past 15 years, it has become clear that physicochemical properties of drug candidates, such as lipophilicity and molecular mass, have an important influence on the likelihood of compound-related attrition during development. By analysing the properties of compounds described in patents from leading pharmaceutical companies between 2000 and 2010, this article indicates that a substantial part of the industry has not modified its drug design practices accordingly and is still producing compounds with suboptimal physicochemical profiles.

research articles on drug use

Trends in the exploitation of novel drug targets

Schiöth and colleagues examine the drugs approved by the US Food and Drug Administration over the past 30 years and analyse the interactions of these drugs with therapeutic targets encoded by the human genome, identifying 435 effect-mediating drug targets. They also analyse trends in the introduction of drugs that modulate previously unexploited targets, and discuss the network pharmacology of the drugs in the data set.

research articles on drug use

How were new medicines discovered?

To investigate whether some strategies have been more successful than others in the discovery of new drugs, this article analyses the discovery strategies and the molecular mechanism of action for 259 new drugs that were approved by the US Food and Drug Administration between 1999 and 2008. Observations from this analysis — such as the fact that the contribution of phenotypic screening to the discovery of first-in-class small-molecule drugs exceeded that of target-based approaches in an era in which the major focus was on target-based approaches — could have important implications for efforts to increase the productivity of drug research and development.

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The productivity crisis in pharmaceutical R&D

Although investment in pharmaceutical research and development (R&D) has increased substantially in recent decades, the lack of a corresponding increase in the output in terms of new drugs being approved indicates that therapeutic innovation has become more challenging. Here, using a large database that contains information on R&D projects for more than 28,000 compounds investigated since 1990, Riccaboni and colleagues examine the factors underlying the decline in R&D productivity, which include an increasing concentration of R&D investments in areas in which the risk of failure is high.

research articles on drug use

Probing the links between in vitro potency, ADMET and physicochemical parameters

A common assumption in current drug discovery strategies is that compounds with high in vitro potency at their target(s) have a greater potential to translate into successful, low-dose therapeutics, which is reflected in screening cascades with in vitro potency embedded as an early filter. This analysis of the publicly available ChEMBL database, which includes more than 500,000 drug discovery and marketed oral drug compounds, suggests that the perceived benefit of high in vitro potency may be negated by poorer absorption, distribution, metabolism, elimination and toxicity (ADMET) properties.

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The importance of new companies for drug discovery: origins of a decade of new drugs

Understanding the factors that promote drug innovation is important both for improvements in health care and the future of organizations engaged in the field. To investigate these factors, Kneller identifies the inventors of 252 new drugs approved by the US Food and Drug Administration from 1998 to 2007 and their places of work, and classifies these drugs according to innovativeness. This article presents a comprehensive analysis of these data, which highlight the strong contribution of biotechnology companies, particularly in the United States, to innovative drug discovery, and discusses potential contributing factors to the trends observed.

research articles on drug use

How to improve R&D productivity: the pharmaceutical industry's grand challenge

Improving R&D productivity is crucial to ensuring the future viability of the pharmaceutical industry and advances in health care. This article presents a detailed analysis, based on comprehensive, recent, industry-wide data, to identify the relative contributions of each of the steps in the drug discovery and development process to overall R&D productivity, and proposes strategies that could have the most substantial impact in enhancing R&D productivity.

research articles on drug use

Lessons from 60 years of pharmaceutical innovation

This article investigates pharmaceutical innovation by analysing data on the companies that introduced the ∼1,200 new drugs that have been approved by the US FDA since 1950. Implications of this analysis — which shows that the rate of new drug output in this period has essentially been constant despite the huge increases in R&D investment — are discussed, as well as options to achieve sustainability for the pharmaceutical industry.

research articles on drug use

Can literature analysis identify innovation drivers in drug discovery?

Here, the authors use bibliometrics and related data-mining methods to analyse PubMed abstracts, literature citation data and patent filings. The analyses are used to identify trends in disease-related scientific activity that are likely to give new therapeutic opportunities.

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Community-wide assessment of GPCR structure modelling and ligand docking: GPCR Dock 2008

The recent determination of several crystal structures of G protein-coupled receptors (GPCRs) is providing new opportunities for structure-based drug design. This article analyses the state of the art in the prediction of GPCR structure and the docking of potential ligands on the basis of a community-wide, blind prediction assessment — GPCR Dock 2008 — that was carried out in coordination with the publication of the human adenosine A 2A receptor structure in 2008 and public release of the three-dimensional coordinates.

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research articles on drug use

Research Highlights

Pregnant people with substance use disorders need treatment, not criminalization, nih invests in a new harm reduction research network, to save lives, we must dismantle stigma at the intersection of hiv and methamphetamine use, supporting needed research on recovery, addiction often goes hand-in-hand with other mental illnesses. both must be addressed., nida releases its 2022-2026 strategic plan, five areas where “more research” isn’t needed to curb the overdose crisis, tackling complex scientific questions requires a team approach, time to start talking about pre-addiction, investing in prevention makes good financial sense, a plan to address racism in addiction science, making addiction treatment more realistic and pragmatic: the perfect should not be the enemy of the good, a year-end message from dr. nora volkow, hallucination-like perceptions are associated with elevated dopamine in the striatum in mice, black people who smoke cigarettes are exposed to higher levels of toxic compounds than whites, this world aids day, finding inspiration at the intersection of hiv and substance use, people living with hiv in new york state faced increased burdens from covid 19 in 2020, remembering paul bowman, beloved peer recovery coach and advocate, cooperation between physicians and pharmacists may improve treatment for patients with opioid use disorder, to end the drug crisis, bring addiction out of the shadows, asymmetry in the nucleus accumbens may be linked with substance dependence, treating hepatis c virus and opioid use disorder together benefits patients, opioid use may increase susceptibility to infection, longitudinal studies of children will provide needed insight about the developmental impact of the pandemic, nida’s hiv research program: a longstanding institute priority continues under a new name, developmental nicotine exposure in mice affects epigenetic factors in the brain across multiple generations, the abcd study uncovers relationships between socioeconomic factors, cognitive abilities, and brain development, drug overdose deaths in 2020 were horrifying. radical change is needed to address the drug crisis., chronic cocaine use changes brain structure and cognitive function in rhesus monkeys, reduced activity in one brain region links childhood adversity to aggression/delinquency and substance use in adolescence.

International Drug Bust Nets $677 Million of Cocaine Bound for Australia

SYDNEY (Reuters) - A joint U.S. and Australian law enforcement operation busted an international drug ring after intercepting 2.4 tonnes of cocaine aboard a vessel off the coast of South America that had been bound for Australia.

The cocaine, linked to a Mexican drug cartel, had a street value of around A$1 billion ($677 million), and was equivalent to half of Australia's estimated annual consumption, making the seizure one of the biggest that Australian police have been involved in.

Twelve suspects have been arrested and charged in the case, Western Australian state police said in a statement on Saturday, releasing details for the first time of an operation that began last November when the U.S. Drug Enforcement Administration (DEA) intercepted the vessel.

Western Australian police substituted the cargo with identically packed fake cocaine and dropped it roughly 40 nautical miles west of state capital Perth on Dec. 28. 

Three suspected members of the "Australian arm of a drug syndicate" with 1.2 tonnes of fake cocaine were arrested on Dec. 30, after allegedly making three trips out through rough seas to collect the packages.

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research articles on drug use

    A further nine arrests were made through Jan. 13, including a traffic stop on the Great Eastern Highway, roughly 600 kilometres (373 miles) east of state capital Perth, where officers found more than A$2 million in cash.

Hailing the success of "Operation Beech" Western Australia police commissioner Col Blanch in a statement: "The operation sends a message to international drug traffickers – your deadly drugs are not welcome here."

A 39-year-old male U.S. citizen was among the 12 charged, police said.

($1 = 1.4775 Australian dollars) 

(Reporting by Lewis Jackson; Editing by Simon Cameron-Moore)

Copyright 2023 Thomson Reuters .

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