Background:Although recovery is a central tenet of the US substance use disorder service delivery system, empirical research on youth recovery remains limited and underdeveloped. Notably, no population-based representative surveys, either in the United States or internationally, currently assess recovery status among secondary school-aged youth (aged 14-18 years). Consequently, little is known about how many youth identify as being in recovery or about their characteristics and needs. Objective:This study presents the first statewide representative estimate of adolescent self-reported recovery (ASR), derived from a large Midwestern state in the United States. Methods:We used data from the 2024 Illinois Youth Survey, a weighted, statewide representative survey of students from 8th, 10th, and 12th grades across Illinois. We examined the prevalence of ASR with a widely used single-item question, "Do you consider yourself to be in recovery?" The question was presented after an instruction directing students to consider only substance use when responding. We estimated the prevalence of ASR and conducted descriptive analyses to characterize this group. Results:Among the 6871 participating students from the 10th and 12th grades, the prevalence of ASR was 3.3% (95% CI 2.6%-4.1%). Among participants with ASR, 51.1% (118/231) were female, 39% (90/231) identified as Latino or Latina, 38.1% (88/231) identified as White, and 13% (30/231) identified as Black or African American. The average age of participants with ASR was 16.5 (SD 1.14) years. Participants with ASR were demographically diverse, and a little over half received free or reduced-price lunch. Conclusions:Findings suggest that financial recovery capital may be particularly important for participants with ASR. This study provides the first population-based estimate of the prevalence of ASR and underscores the importance of including recovery status in large-scale surveys to inform and strengthen recovery support systems.

BACKGROUND AND AIMS:Recovery capital and genetic liability may be related to substance use disorder (SUD) remission through psychosocial and biologic pathways, but their joint association with remission course remains poorly understood. This question is clinically important because people entering remission differ in recovery resources and inherited liability. We examined associations of baseline recovery capital index (RCI) and a multitrait polygenic risk score (PRS) with 12-month electronic health record (EHR) observed remission and described the treatment-related pathway component captured by EHR recorded service contact. DESIGN:National cohort study using All of Us electronic health record, survey and genomic data. Weighted relapse hazards were estimated with inverse probability of treatment and censoring weights, followed by bootstrap g-computation to estimate 12-month remission summaries. SETTING:United States health care systems participating in All of Us. PARTICIPANTS:Adults with non-nicotine SUD evidence and baseline RCI and PRS data. Among 7257 eligible participants, 2413 contributed 5124 constructed remission episodes and 7287-episode month observations before final restrictions; bridge models used 7068 observations from 5123 episodes. MEASUREMENTS:Exposures were baseline RCI, a 0 to 1 mean across 21 retained survey items and an addiction PRS standardized, residualized on 10 ancestry principal components and normalized to a 0 to 1 scale. Outcomes were EHR observed relapse and 12-month remission summaries from remission qualifiers, active use diagnoses and toxicology. FINDINGS:Comparing the 90th with the 10th percentile of RCI was associated with higher 12-month remission probability by 7.9 percentage points [95% confidence interval (CI) = 1.5-14.8] at low PRS and 10.6 points (95% CI = 3.9-17.8) at median PRS. At high PRS, the contrast was 6.4 points (95% CI = -2.6 to 16.1). The pattern was non-monotonic, with less favorable remission at lower to mid RCI combined with mid to higher PRS and more favorable remission at high RCI with low PRS. PRS added modest information beyond RCI; severity adjusted point estimates preserved positive RCI contrasts. CONCLUSIONS:Recovery capital and genetic liability appear to be jointly associated with 12-month electronic health record observed substance use disorder remission projections in a nonlinear pattern. Higher recovery capital appears to be associated with more favorable projections across most polygenic risk score levels. Contrasts are modest and sensitive to censoring assumptions.

Adolescent substance use (SU) presents a distinct public health challenge, as this developmental stage carries heightened vulnerability for progression to problematic use. Early SU-before age 18-is a major risk factor for later Substance Use Disorders (SUD), with long-term neurobiological and psychosocial consequences. National surveillance data show a continued decline in alcohol and cigarette use, yet persistent concerns around cannabis (including synthetic variants) and sharp increases in vaping. The frequent occurrence of polysubstance use further complicates prevention and intervention efforts. The intersection of SU and mental health conditions, such as anxiety and depression, compounds these challenges. The 2024 National Survey on Drug Use and Health data reveal that nearly one-third (27.9%) of adolescents aged 12-17 with both SUD and a Major Depressive Episode receive no treatment for either condition. Despite promising evidence-based interventions, their implementation remains limited, revealing a critical translational gap between research efficacy and real-world effectiveness. To close this gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) is leveraging its multi-site research infrastructure to conduct pragmatic clinical trials that emphasize the inclusion of adolescents from all backgrounds. The CTN's agenda identifies six priorities to advance scalable, impactful solutions: Through this coordinated agenda, the CTN aims to build an equitable, evidence-informed framework that bridges discovery and practice, drives innovation, and informs policies that foster resilient, healthy futures for adolescents nationwide.

Purpose Despite recognizing substance use-related stigma as a potential primary obstacle to treatment engagement, there is limited evidence investigating the nuanced intersection of stigma with master's level social work (MSW) education. Method We randomly assigned 322 MSW students to read one of two vignettes differing only in terminology describing a character's substance use condition (“substance use disorder” vs. “substance abuser”). Two Likert scales measured attitudes toward punishment and personal comfort. Results Students exposed to less stigmatizing language perceived lower social threat in individuals with SUD, with no significant difference in punitive attitudes. Discussion Findings reveal that language used by future social workers affects attitudes toward substance use. Terms like “substance use disorder” reduce perceptions of social threat, highlighting the need to educate MSW students on stigma-reducing language. This may foster more empathetic, professional practice. Further research should explore additional methods for reducing stigmatizing attitudes in social work education.

Background: A growing body of research has documented the role of economic shocks on working age adults substance use and deaths of despair. However, little research has investigated how economic opportunity might influence substance use among adolescents. Substance use by adolescents remains a persistent and troubling public health problem in the United States. Approximately 40% of 12th graders reported having used marijuana and 60% of 12th graders reported having used alcohol in their lifetime. Prior research indicates that adolescent substance use and early onset substance use (i.e., middle school years) places youth at heightened risk for substance use disorders in adulthood. Extant research has generally placed adolescent substance use in the context of individual and family systems. Objectives: The current study builds on this literature by examining the influence of county-level intergenerational economic mobility on adolescents' self-reported substance use. Drawing on a large state-wide survey of 8th, 10th, and 12th graders in Illinois and data on intergenerational economic mobility from Opportunity Insights to estimate the association between county-level intergenerational economic mobility and self-reported substance use among low- and higher-income adolescents. Results: We find that for low-income adolescents growing up in a higher intergenerational economic mobility county is associated with less substance use compared to their higher-income peers.

Approximately 8.9 million individuals in the United States misused opioids in 2023, reflecting the opioid crisis’s devastating impact not only on individuals but also on their families. This qualitative study examines family members’ experiences in supporting loved ones with opioid use disorder (OUD), focusing on their roles, barriers to treatment, and perspectives on medications for opioid use disorder (MOUD). Through in-depth, semi-structured interviews with 15 family members, analyzed using thematic analysis, the findings reveal families as essential providers of care and support while navigating limited resources, exclusion from treatment processes, and their own recovery trajectories. The study findings reveal a need for family-centered approaches, including health care provider training, family-inclusive treatment models, and policy reforms to improve treatment accessibility, reduce systemic barriers, and foster sustainable recovery outcomes for individuals with OUD and their families.

ObjectiveAdolescent substance use recovery is hypothesized to depend on recovery capital across personal, social, community, and financial domains. The present study applied a conditional linear Gaussian Bayesian belief network (BBN) to examine interactions among personal, social, community, and financial recovery capital in adolescent substance use recovery. Analyses focused on four adolescent phenotypes defined by self-identified recovery status (in recovery vs. not in recovery) and recent substance use frequency (frequent use vs. abstinent).MethodsCross-sectional data were drawn from the 2020 Illinois Youth Survey (N approximate to 61,000 adolescents). Sixteen IRT-derived scales and several single-item measures assessed personal, social, community, and financial recovery capital. Self-identified recovery status and past month use frequency defined four phenotype subgroups. A conditional linear Gaussian BBN modeled interconnections among the mixed-type variables. Model structure was developed with a BIC-penalized structure-learning algorithm and validated by bootstrapping and cross-validation.ResultsThe BBN revealed that adolescents who self-identified as in recovery, particularly those who were abstinent, exhibited networks centered on protective factors and displayed fewer connections among risk behaviors. In contrast, adolescents not in recovery displayed densely interconnected conduct-risk subnetworks. Node centrality analyses indicated that social and human capital factors served as key hubs in abstinent-recovery networks. When interpreted through the Recovery Capital for Adolescents Model (RCAM), developmental social identity theory, and systems-based frameworks, the exploratory cross-sectional results suggest that adolescent recovery operates as an emergent, networked process that builds recovery capital while disengaging from risk. The investigation contributes an initial data-driven, systems-level model of adolescent recovery.

Purpose: This study delves into the effects of labels, specifically crime-first language, on public attitudes toward adolescent girls within the juvenile legal system. Examining fictional vignettes depicting family conflict, the research explores whether the use of language influences the endorsement of punitive responses and if this effect varies across racial and ethnic lines. Method: A large online, statewide sample of adults (n = 1,791) was randomized to one of six vignettes. Results: Findings reveal that crime-first language, "accused of domestic battery," is significantly associated with more punitive attitudes. We found no interaction effects between race and label. Although effect sizes were small, the study emphasizes the need to reconsider language choices to avoid perpetuating negative stereotypes and stigmatization. Discussion: Identifying and disseminating person-first language may be an important form of social work practice that can enhance current efforts on the Social Work Grand Challenge of promoting smart decarceration.

There has been growing attention toward including people with lived and living experience (PWLLE) with substance use, substance use disorders, and recovery in public-facing activities. The goals of including PWLLE in sharing their perspectives often include demonstrating that recovery is possible, destigmatizing and humanizing people who have substance use experiences, and leveraging their lived experience to illuminate a particular topic or issue. Recently, the National Council for Mental Wellbeing issued a set of guidelines entitled, “Protecting Individuals with Lived Experience in Public Disclosure,” which included a “Lived Experience Safeguard Scale.” We offer the present commentary to bolster some of the ideas presented by the Council and to articulate suggested changes to this guidance, with the goal of reducing unintentional gatekeeping and stigma. Specifically, we offer that there are numerous problems with the recommendation to only invite people who have “five or more years of sustained recovery” to contribute to public discourse. The idea of perceived stability after five years of abstinence is not new to us or the field. We suggest that this idea excludes people who have experienced the present rapidly changing substance use landscape, people who have briefly returned to use, some young people, and people with living experience who also can valuably contribute to public discourse. We offer alternative guidelines to the National Council for Mental Wellbeing and others seeking to promote practices that are inclusive to the diversity of PWLLE.

A better understanding of adolescent recovery is needed and will create opportunities to enhance recovery-oriented systems of care. The current study surveyed adolescents on behavioral and social indicators, substance use problem resolution and recovery status, and elements of recovery. The most commonly endorsed element of problem resolution was “stop completely,” followed by “not hanging out with friends who use a lot,” and “getting counseling for alcohol/drug use.” Approximately 40% of youth in recovery did not select abstinence as a key element of recovery. Additional research on recovery identity among adolescents is needed to clarify this finding.

Background: Rates of alcohol and/or substance use (ASU) among residents of predominantly Black and marginalized communities are similar to ASU rates in White communities. Yet ASU has worse consequences in predominantly Black and marginalized communities (e.g., higher incarceration). Objective: We randomized participants to one of 16 intervention conditions using a 24 full factorial design to optimize a multilevel intervention reducing ASU among 602 formerly incarcerated men with substance-use-disorders (SUD). Candidate intervention components included (1) critical dialogue (CD; six weekly 2-hour-long group sessions vs. no CD sessions), (2) Quality of Life Wheel (QLW; six weekly 1-hour-long group sessions vs. no QLW sessions), (3) capacity building projects (CBP; six weekly 1-hour-long group sessions vs. no CBP sessions), and (4) delivery by a trained peer versus licensed facilitators. Outcome was percentage of days in which participants used alcohol, cocaine, opioid, and/or cannabis in previous 30 days. Results: Intent-to-treat analysis did not meet a priori component selection criteria due to low intervention attendance. After controlling for intervention group attendance (percentage of sessions attended), peer-delivered CD and CBP produced statistically and clinically significant main and interaction effects in ASU over 5 months. Per the multiphase optimization strategy framework, we selected peer-delivered CD and CBP for inclusion as the optimized version of the intervention with a cost of US$1,380 per 10 individuals. No adverse intervention effects occurred. Conclusion: CD and CBP were identified as the only potentially effective intervention components. Future research will examine strategies to improve attendance and test the optimized intervention against standard of care in a randomized-controlled-trial.

In addition to traditionally assessed abuse, neglect, and household dysfunction, adverse childhood experiences (ACEs) include adversities like racial discrimination, community violence, and bullying. Prior research established associations between the original ACEs and substance use, but few used Latent Class Analysis (LCA) to examine patterns of ACEs. Examining patterns of ACEs may yield additional insights beyond cumulative risk studies focusing only on the number of different ACEs experiences. Therefore, we identified associations between latent classes of ACEs and cannabis use. Studies on ACES rarely examine cannabis use outcomes, which is important as cannabis remains one of the most commonly used substances and is associated with negative effects on health. Yet it is still unclear how ACEs influence cannabis use. Participants were adults in Illinois (n = 712) recruited through Qualtrics' online quota-sampling method. They completed measures of 14 ACEs, past 30-day and lifetime cannabis use, medical cannabis use (DFACQ) and probable cannabis use disorders (CUDIT-R-SF). Latent class analyses were performed using ACEs. We identified four classes, labeled: Low Adversity, Interpersonal Harm, Interpersonal Abuse and Harm, and High Adversity. The largest effect sizes (p<.05) were observed for those in the High Adversity class, who had elevated risks for lifetime (OR =6.2), 30-day (OR = 5.05), and medicinal cannabis use (OR = 17.9) relative to those in the Low Adversity class. Those in the Interpersonal Abuse and Harm and Interpersonal Harm classes also had increased odds (p<.05) for lifetime (OR =2.44/OR=2.82), 30-day (OR = 4.88/OR= 2.53), and medicinal cannabis use (OR = 2.59/OR =1.67(ns)) relative to those in the Low Adversity class. However, no class with elevated ACEs had higher odds for CUD relative to the Low Adversity class. Additional research could further disentangle these findings using extensive measures of CUD. Additionally, as participants in the High Adversity class had higher odds of medicinal cannabis use, future research could carefully study their consumption patterns.

BACKGROUND AND AIMS:To date, no epidemiological survey has estimated the prevalence of adolescents identifying as being in recovery. This is necessary for planning and identifying the needs of youth with current and remitted substance use disorders. This study estimated the prevalence of recovery status in a large statewide epidemiological survey administered between January and March 2020. PARTICIPANTS:Participants were high school students in 9th through 12th grades throughout Illinois. MEASUREMENTS:Youth were asked if they were in recovery and if they had resolved problems with substances. Youth who reported recovery and problem resolving dual status (DS), recovery only (RO), and problem resolution only (PRO) were compared to propensity score matched control groups who reported neither status (neither/nor; NN). Outcomes included alcohol use, binge alcohol use, cannabis use, and prescription drug use in the past 30 days. FINDINGS:Prevalence estimates were 884 (1.4%) for DS, 1546 (2.5%) for PRO, and 1,811 (2.9%) for RO. Relative to propensity matched control samples, all three groups had significantly lower odds of prescription drug use. The PRO group had lower odds of past month cannabis use. There were no significant differences for either alcohol outcome. CONCLUSIONS:Prevalence estimates of youth in recovery are slightly lower than those of adults in recovery, and estimates should be replicated. Youth in recovery and those resolving problems have numerous behavioral health needs, and relative to matched controls, have even odds for past 30-day alcohol use. These findings compel us to further define recovery for adolescents and emerging adults to allow for improving treatments and epidemiological research.

Emerging adults (EAs; 18-29 years) have the highest rates of substance use across the lifespan, with some research displaying sexual minority EAs are at higher risk of substance use than their heterosexual counterparts. We explored differences in rates of substance use and developmental reasons for alcohol, binge drinking, and cannabis between sexual minority and heterosexual EAs. Participants (n = 145) in a randomized control trial completed Emerging Adult Reasons for Substance Use (EARS) and substance use frequency measures, pertaining to the past 90 days. Although unsolicited, 17% (n = 25) of the sample identified as a sexual minority (i.e., not exclusively heterosexual). EARS concepts include developmental strain, subjective invulnerability, and normative expectancy. Sexual minority EAs experienced greater developmental strain, putting them at risk for problematic substance use. Compared to their heterosexual peers, sexual minority EAs reported higher alcohol and cannabis use, significantly higher binge-drinking, and were identified as hazardous drinkers by the Alcohol Use Disorders Identification Tool (AUDIT-C). Future research should continue to examine dimensions of emerging adulthood and substance use with larger samples of sexual minority EAs and with qualitative methods. Practitioners should address unique developmental stressors sexual minority EAs experience when assisting those with substance use problems.

Introduction. In the United States, 19 states permit recreational use of cannabis, with 16 more permitting medical use (Marijuana Policy Project, 2021). Concerns remain about whether liberalized policies result in increased adolescent cannabis use. To date, limited evidence exists that the statewide prevalence of adolescent cannabis use increased in states with liberalized policies. However, analyses at local levels show some negative impacts. Thus, we analyzed if living in a ZIP code with a dispensary (ZCWD) was associated with adolescent cannabis use. Methods. Dispensary ZIP codes from public records were matched to self-reported ZIP codes on the Illinois Youth Survey (IYS). We compared past 30-day and past-year cannabis use among youth living in a ZCWD and not living in a ZCWD. Results. About one in eight adolescents (12.8%, n = 1,348) in the weighted sample (n=10,569) resided in a ZCWD. Overall, past 30-day use was lower among youth who lived in ZIP codes with dispensaries (OR = .69, p < .05), with variation by grade. For example, only 10th (OR = .62, p < .05) and 12th graders (OR = .59, p < .05) living in a ZCWD had lower odds of past 30-day cannabis use. Additionally, only 12th graders in a ZCWD had lower odds of past-year use (OR = .70, p < .05). Finally, suburban youth living in a ZCWD also had lower odds of cannabis use (OR = .54, p < .01). Conclusion/Discussion. Cannabis use was significantly lower among 10th and 12th graders living in a ZCWD. Additional research should continue to monitor evolving state policies and whether they are associated with adolescent cannabis use.

Emerging adult (EA; aged 18–29) military members experience major career, life, and developmental transitions. The conglomeration of these changes may influence or exacerbate anxiety or stress, produce challenges, and lead to negative coping mechanisms, such as substance use. This study sought to understand the utility of the five Emerging Adulthood Theory (EAT) dimensions among a sample of military members and veterans with risky substance use. To our knowledge, the applicability of EAT has not been explored with United States military populations. During 2019, we completed 24 semi-structured interviews. On average, participants were 24.9 years old, male, white, and in the United States Marine Corps. We asked about experiences transitioning into adulthood, military culture, and experiences of the five EAT dimensions. Three coders employed rigorous theory-driven thematic analysis procedures to piece together themes. We report EA military members’ experiences with the EAT dimensions, focusing on nuances related to the influence of military culture.

Background: Although rates of nonmedical opioid use are highest in late adolescence and emerging adulthood, efforts to understand the extent of the heterogeneity in opioid misuse during this time have been limited. The current study aimed to derive and define typologies of opioid use in high school students at the onset of emerging adulthood. Methods: Survey responses from a statewide sample of high school students aged 18 and 19 (N = 26,223) were analyzed. Group-based comparisons between participants reporting opioid use and those not reporting opioid use were conducted. Among those reporting opioid use (n = 1,636), we conducted a latent class analysis (LCA) to identify heterogeneous subgroups of opioid users on the basis of non-medical use of prescription opioids (NMUPO) and heroin use. The resulting classes were then compared across various risk and protective factors using multinominal logistic regression. Results: Consistent differences were observed between participants using opioids and participants not using opioids, with moderate to large effect sizes. Results from LCA revealed three subclasses: NMUPO-Any Use, NMUPO To Get High, and Heroin Use. Subclass differences were observed for non-opioid substance use, mental health, and demographics. Conclusions: Findings from this study underscore the variability of youth who engage in opioid use in late adolescence. Results also indicate that opioid use during adolescence is likely indicative of a broader set of substance use and mental health issues.

Medical and recreational cannabis are becoming more accessible and socially accepted across the United States. Emerging adults (EAs; 18 to 29) are the largest group of cannabis users. Studies have found that veterans are more likely to report cannabis use compared to nonveterans. While research exists on the use levels of cannabis, limited knowledge is available on the perceived risks and benefits of using cannabis among EA military and veteran populations. Helping professionals encounter veterans who use cannabis and must consider military cultural factors and attitudes towards cannabis that may influence or exacerbate cannabis use. We conducted a qualitative study with 23 EA veteran and military members with high-risk substance use and asked about their thoughts on the acceptability, risks, and perceived benefits associated with cannabis. Two qualitative coders used NVivo to find themes following the six steps of thematic analysis. Results provide in-depth understanding of EA military members and veterans’ perceptions of cannabis. Overall, we found participants were receptive to using cannabis for pain ailments, mental health issues, and as an alternative to benzodiazepines, opioids, and alcohol. However, they acknowledged restrictions are needed to moderate cannabis use and mitigate negative outcomes. Lastly, participants recognized the incongruence of cannabis use with military job responsibilities and expectations. These findings shed light on potential risk and protective factors related to using cannabis for recreational or medical reasons and should be considered when consulting EA military members and veterans.

Background and Aim: Screening adolescents at risk for cannabis use disorders is critical. The CRAFFT is a screening tool designed to address both alcohol and drug use among youth. Current study tests the psychometric properties of the CRAFFT and attempts to modify one of the screening items to compare the efficiency. Design: We examined the ideal cut-off point of the CRAFFT for identifying persons with heavy cannabis use and compared the utility of the original and revised CRAFFT. Participants: Sample (N = 132,555) averaged 16.19 (+/- 1.21) years of age; 51.0% were female, 59.7% were White, 15.2% were Latino/Latina, and 6.7% were African-American. Majority resided in non-rural area and 34.5% were receiving free or reduced lunch at school. Measurements: Heavy cannabis use was defined as using cannabis 10 or more times in the past 30 days. Sensitivity, specificity, the area under the receiver operating characteristic curve, and Youden value were analyzed to determine the ideal cut-off point. Findings: Maximum overall predictive accuracy was at a cutoff score of 2 or higher when using the original CRAFFT questions. At a cutoff score of 2, sensitivity was 82.0%, specificity was 83.7%, with an AUC of 0.880. On the contrary, when an alternative CAR question was used, maximum predictive accuracy was at a cutoff score of 1 or higher when predicting heavy cannabis use. At a cutoff score of 1, sensitivity was 92.7%, specificity was 75.5%, with an AUC of 0.900. Conclusions: The results provide evidence that the CRAFFT is a promising brief diagnostic instrument for heavy cannabis use among youth. Modification to Car item may have potential in reducing disparities in sensitivity among different racial ethnic groups, as well as those who with low socioeconomic status.