Background Epistemic justice requires that people hold meaningful authority over knowledge that concerns them. For criminalized women who use drugs, this authority is denied: overlapping credibility deficits across drug use, criminalization, and domestic, family, and sexual violence (DFSV) domains render their knowledge illegitimate, their accounts not credible, and their definitions of the problem absent from research. Existing lived experience frameworks have not extended to this population; involvement remains consultative rather than authoritative, reproducing the hierarchies such frameworks aim to disrupt.Methods This paper draws on We Keep Us Safe, a co-designed research project led by criminalized women with lived experience of DFSV and drug use. Drawing on interviews (n = 21) and workshops (n = 3) with criminalized women and men who use drugs, it reflexively accounts for the project's design, governance, and conduct.Results Five lessons emerge: credibility deficits operate as research design problems; shifting decision rights to lived experience researchers transforms what research can produce; risk governance embedded in research structures can reproduce harm; co-design generates analysis and knowledge inaccessible through conventional methods; and lived experience leadership carries costs institutions rarely resource.Conclusion This paper offers a methodology through which DFSV research can move beyond tokenistic inclusion toward genuine epistemic authority.
Introduction This study evaluated the physical characteristics and visibility of mandatory alcohol health warning labels on commercial beverage containers to assess their communicative effectiveness. Methods A descriptive observational study analyzed a sample of alcoholic beverage containers. Physical attributes—including warning location, font size, pictogram dimensions, and color contrast—were measured using standardized geometric approximations. Results While 97.4% of containers included warnings, only 11.5% placed them on the front label. Visibility was low: pictograms occupied less than 1% of the total label area, and font sizes averaged just 3.6 mm. Furthermore, only 19.2% adhered to officially approved color schemes, with most relying on low-contrast backgrounds. Discussion Although producers technically comply with mandatory regulations, their design choices structurally minimize warning salience. To restore public health impact, regulations must be urgently updated to mandate front-of-package placement, proportional sizing, and standardized high-contrast formats.
BackgroundResearch suggests the most effective educational approaches to reduce illicit drug uptake in young adolescents involve building skills in reflective decision-making, resistance to peer influence, and healthy coping. However, there has been limited empirical study of universal preventative interventions targeted toward substance-na & iuml;ve individuals. This study evaluated the implementation of a novel evidence-informed lesson series designed to develop these skills.MethodsTeachers in three UK schools delivered a six-lesson programme to Year 7 pupils (11-to-12-year-olds). Pupils provided on-the-day lesson feedback through short surveys. In-depth insights were collected through two pupil focus groups per school, and two cross-school teacher focus groups. Framework thematic analysis identified themes.ResultsEffectively communicating aspects of lesson delivery to teaching staff was a key challenge. The high levels of interactive activities and reflective discussion were positively received by pupils, but did not fully align with teacher perceptions of effective pedagogy. Teachers discussed issues meeting needs of learners at differing attainment levels, while pupils valued the variation in activities offered.ConclusionsFindings highlight the complexities of implementing lessons that are evidence-informed, align with pedagogical expectations and are adaptable for diverse classroom settings, and offer practical recommendations that extend beyond substance use education for developing flexible, skills-based curricula.
Background Alcohol Assertive Outreach Treatment (AAOT) is an evidence-based model of care for people with alcohol dependence and complex comorbidities. Fidelity to the high-quality model may improve health outcomes yet information is lacking regarding optimal implementation. This study aimed to evaluate the implementation of a new high-quality AAOT service. Method Mixed-methods design comprising quantitative analysis of AAOT service-user data (n = 40), including health outcomes and hospital use; qualitative interviews with nine service-users and three stakeholders; and a focus group with four AAOT staff. Qualitative data were analyzed using Framework Analysis informed by Proctor's Taxonomy of Implementation Outcomes. Results Fidelity to the high-quality AAOT model was achieved. At 6 months, 29.6% of the cohort were abstinent; the remainder showed significant reductions in units of alcohol consumed after 3 months (p = .012). At 6 months, psychological health (p < .001), physical health (p = .039), and quality-of-life (p < .001) had significantly improved, and hospital attendances (p=.019) and admissions (p=.009) significantly decreased. Qualitative analyses indicated participants felt AAOT was acceptable, appropriate, and highlighted facilitators and barriers to service delivery. Conclusions High-quality AAOT services can be successfully implemented into existing services with adequate support, and can achieve high fidelity, and significant benefits to service-users.
BackgroundAdolescent vaping has increased rapidly in recent years, shaped not only by product appeal but also by communication practices that frame vaping as socially meaningful and culturally desirable. This study explored how adolescents make sense of vaping within their everyday social and communicative environments.MethodsA qualitative ethnographic study was conducted with three adolescents aged 12-18 in southern Spain (Andalusia). Data was generated through participant-led observational diaries, fieldnotes, voice-recorded reflections, and in-depth ethnographic interviews. Materials were analyzed thematically.ResultsFindings from the three adolescent participants revealed three interrelated themes. First, vaping functioned as a symbolic resource for identity work linked to maturity, belonging, and style. Second, vaping operated as a normalized social practice embedded in leisure settings and peer interaction. Third, participants described frequent exposure to vaping-related communication through influencers, aesthetic branding, and digital platforms, contributing to normalization and perceptions of reduced harm.ConclusionVaping is embedded within adolescents' social and communication environments. Prevention and drug education strategies should address the broader social and digital contexts through which vaping becomes normalized.
BackgroundSubstance Use Disorder (SUD) can cause serious problems in finding and maintaining jobs. Many studies have shown that people with SUDs show lower employment rates. Interestingly, underemployment persists even when individuals have stopped consuming substances. The present article explores the employment challenges individuals who deal with SUDs in T & uuml;rkiye perceive.MethodsIn doing so, we used a qualitative, phenomenological approach, interviewing 18 individuals with SUD as well as 16 of their relatives in Ankara, T & uuml;rkiye.ResultsThe findings of the study indicated three main groups of challenges faced by individuals with SUD: (i) challenges in working at a job (e.g. symptom-related limitations), (ii) challenges in finding employment (e.g. hiring discrimination), (iii) and limited institutional support (e.g. lacking legal protection). A particularly interesting insight was the common self-stigmatization with individuals viewing themselves as inadequate and incompetent, mirroring wide-spread stigmatizing narratives about SUD. Further, interviews with relatives revealed that relative's shoulder significant financial and emotional burdens in supporting individuals with SUDs.ConclusionThe study underscores the need for institutional support, legal protections, and efforts to combat stigma to facilitate the successful employment and well-being of individuals with SUDs in T & uuml;rkiye.
BackgroundSince 2020, drug education became compulsory in state-funded schools in England. Teachers play pivotal roles in drug education, but they receive little preparation, training and support. This paper explores teachers' perceptions of their role legitimacy, role adequacy and role support in relation to drug education.MethodsUtilizing findings from a wider evaluation of a multi-component drug education programme, this paper draws on semi-structured interviews with 17 teachers delivering drug education, 10 headteachers, and 8 focus groups or interviews with teachers (n = 45) in 11 schools in England.ResultsThe teachers viewed drug education as a legitimate part of their roles and responsibilities, but did not feel adequately prepared to teach the subject. Although they expressed confidence in their classroom delivery skills, they felt inadequate in terms of their technical knowledge and expertise around different substances. Many of the teachers had not received drug education training prior to the programme. They gained confidence from and valued the external training and learning resources.ConclusionThe findings highlight the interdependence between role support, role adequacy and role legitimacy for teachers delivering drug education and underscore the importance of specialist drug education training with regular updates, ongoing support and reliable signposting to trusted resources.
Background. Rates of opioid overdose continues to rise among Black adults, despite decreases in overdose among other racial and ethnic groups in the U.S. Opioid overdose among Black populations can be attributed to both intentional and unintentional opioid analogues (e.g., fentanyl) use and contamination of other drugs, such as stimulants. Opioid overdose among Black adults is seen at disproportional rates in the Midwest, such as in Kentucky and Ohio. Despite these risks, research examining harm reduction preventions and interventions among Black adults who report nonmedical use of opioids and increasingly dangerous stimulants has been vastly understudied. Method. The current study adapts and tests a one-time, educational harm reduction intervention-which includes naloxone and fentanyl test strip (FTS) distribution-that is community-engaged and culturally informed. The intervention was pilot tested (clinical trial NCT06609278) among a sample of n = 57 Black adults in Louisville, KY and Cincinnati, OH. Eligible participants included men and women aged 18-65, reporting nonmedical opioid and/or stimulant use in the past six months. Results. Results indicate preliminary evidence of efficacy of the intervention and the opioid overdose harm reduction strategies presented. Conclusions: Initial findings of this study have important implications for harm reduction strategies to prevent and reverse opioid-related overdoses among Black adults.
Background: Recent studies explored the need for a parenting-related intervention during inpatient rehabilitation for parents with substance use disorder (SUD) in Germany. This study explores the acceptability of the innovative AddictionContext-Intervention (KSI).MethodsIn 2023, we conducted 20 semistructured interviews (16 parents with SUD, 4 professionals) in two clinics in Germany. We analyzed the interviews using a structured deductive-inductive content analysis approach. Statements regarding acceptability are made driven by the theoretical framework of acceptability (TFA).ResultsFindings include participants' motivation, assessment of the KSI modules, and early impacts, informing conclusions on acceptability driven by the TFA. Parents were motivated by the desire for a positive future for their children, though some reported external motivation from staff. Parents and professionals expressed high satisfaction with the modules, suggesting only minor refinements. Reported impacts included improvements in parent-child interaction, parental responsibility, and emotional regulation. Overall, the KSI was perceived as acceptable, with participants advocating for its inclusion in standard rehabilitation treatment.ConclusionDuring the feasibility phase, participants and professionals supported the implementation of the KSI and pointed toward the benefits. Our findings indicate a high level of acceptability of the KSI among participants and staff.
BackgroundGreenspace programs are nature-based health initiatives. Recovery depends on individual, social and community resources, known as recovery capital. This paper explores how greenspace programs generate recovery capital to improve physical and mental health for those experiencing co-occurring problem substance use and mental health challenges.MethodsInterviews were conducted with participants with experience of greenspace programs (n = 33). Findings in the current paper focus on program attendees and program staff (n = 23). Interviews were audio recorded, transcribed, and analyzed to explore greenspace programs through the lens of recovery capital.ResultsPrograms increase individual recovery capital through improved capacity to deal with triggers, stressors, and cravings; improved capacity for positive daily routines and self-care practices; knowledge acquisition and physical capital. Social recovery capital is generated through social connections, trust, and relationships with staff and existing networks. Community recovery capital is accrued through engagement with community and cultural spaces. Connecting to nature through greenspace programs helped participants reflect on life meaning and purpose.ConclusionsMapping greenspace program outcomes onto established recovery theory shows that programs can effectively support health and recovery amongst populations experiencing problem substance use and mental health challenges.
Background: Youth substance use is considered a high-priority issue in Sweden, yet research on youth treatment trajectories remains limited. This study adopts a narrative approach to explore how young people interpret substance use treatment, and how treatment aims, assumptions, and language resonate with their identity-work. Methods: We conducted 25 interviews with participants aged 15-20years who had recently been enrolled in treatment. The data was interpreted using narrative thematic analysis. Results: Four treatment trajectories were identified: (1) the disruptive, focused on leaving treatment; (2) the misdirected, dominated by coercion and mismanaged interventions; (3) the empowering, emphasizing personal growth; and (4) the supportive, centered on improvements in mental health. The participants drew on different narrative resources to navigate tensions between organizational imperatives such as control and responsibilization, cultural narratives about youth and substance use, and their own evolving identities. While most participants eventually quit using substances, some reported experiences of stigma, distress, and coercion in treatment. The findings highlight the diversity among youth in treatment and the importance of individualized, agency-promoting interventions. Conclusion: More differentiated approaches are needed. We suggest that Swedish youth substance use treatment would benefit from a stronger focus on self-care, acceptance of gradual change, and client-defined goals.
BackgroundFollowing Australia's landmark 2023 decision to approve psilocybin and MDMA for clinical use, psychedelic-assisted therapy (PAT) is beginning to emerge within regulated mental health settings. This study investigates psychologists' views on the relevance of psychedelic therapists' lived-living experience (LLE) with psychedelics. While discussion around LLE is growing, little is known about how psychologists perceive its role in clinical preparedness for PAT.MethodsTwenty Australian psychologists were recruited through purposive and snowball sampling. Semi-structured interviews explored perceptions of LLE in therapist training and practice. Data were coded and thematically analyzed to identify patterns in how experiential knowledge is valued within PAT.ResultsParticipants highlighted potential benefits of LLE, including greater empathy, confidence, and therapeutic rapport, particularly amid lingering stigma. They emphasized PAT's unique demands due to its intense, altered states, requiring deeper therapist familiarity. LLE was seen as uniquely improving therapists' insight and credibility beyond standard training. Most advocated for optional, safe, and structured inclusion of LLE in formal training, respecting safety and ethical considerations.ConclusionPsychologists viewed LLE as a valuable addition to PAT training, though not mandatory. Findings reflect growing professional openness to experiential learning, suggesting structured LLE may be valuable for preparing psychedelic therapists.
BackgroundIn Aotearoa-New Zealand, about 1% of adults report methamphetamine use in the past 12 months, disproportionately affecting M & amacr;ori, males, and those in socioeconomically deprived communities. This study examines how individuals achieve and sustain recovery through a life-course lens, emphasizing lived experience, identity reconstruction and social reintegration.MethodsDrawing on 35 semi-structured life-history interviews and five moderated testimonies, the analysis applies Biernacki's four-stage model of recovery as a sensitizing framework, integrating recovery capital and social recovery to interpret trajectories.ResultsRecovery pathways were nonlinear and heterogeneous, encompassing self-managed and treatment-assisted change. Self-managed participants relied on self-discipline, situational change, and informal support, while treatment-assisted changers benefited from structured accountability and therapeutic belonging. About one-quarter maintained limited or transformed contact with former peers while remaining abstinent, indicating complete social avoidance is not universally necessary. Recovery was marked by prolonged emotional and cognitive recalibration, requiring structure, purpose, and social connection. Work, wh & amacr;nau, spirituality, and self-reflection anchored stability and belonging.ConclusionRecovery from methamphetamine use is not a singular event but a sustained process of rebuilding autonomy, meaning, and identity. Distinctive features of stimulant recovery highlight the need for plural, culturally grounded, recovery-oriented systems of care that value both professional treatment and self-directed change.
BackgroundIn Japan, experiences post-prison release unfold within a stigmatizing social climate and punitive drug policy environment. This study examined wave-specific associations between subjective quality of life (QOL) and post-release difficulties and gender-related differences.MethodsData from the Voice Bridges Project were used for cross-sectional analyses at early post-release (n = 827), 1 year (n = 381), and 2 years (n = 218). Multivariate linear regressions assessed associations between QOL and five self-reported difficulties (financial, health, substance-related, family, interpersonal). Sex-stratified analyses were also performed.ResultsAcross all waves, financial difficulties were most consistently associated with lower QOL. Health problems were independently associated with lower QOL at baseline. At 1 year, substance-related issues and family problems were associated with lower QOL, with the former showing the strongest association. At 2 years, financial difficulties remained strongly associated with lower QOL. Other domains were not associated in adjusted models. Patterns among men largely mirrored the overall sample. Among women, QOL was strongly associated with substance-related issues at baseline but not with financial difficulties at any wave. Small samples made later-wave estimates imprecise.ConclusionAlthough these exploratory analyses do not support causal inference or within-person change effects, they organize QOL-linked difficulty domains as candidate priority areas for needs assessments in Japan.
