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• Substance-Related and Addictive Disorders
• Addiction Psychiatry
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• Open access
• Published: 30 August 2024

Research landscape analysis on dual diagnosis of substance use and mental health disorders: key contributors, research hotspots, and emerging research topics

• Waleed M. Sweileh 1  

Annals of General Psychiatry volume  23 , Article number:  32 ( 2024 ) Cite this article

Metrics details

Substance use disorders (SUDs) and mental health disorders (MHDs) are significant public health challenges with far-reaching consequences on individuals and society. Dual diagnosis, the coexistence of SUDs and MHDs, poses unique complexities and impacts treatment outcomes. A research landscape analysis was conducted to explore the growth, active countries, and active journals in this field, identify research hotspots, and emerging research topics.

A systematic research landscape analysis was conducted using Scopus to retrieve articles on dual diagnosis of SUDs and MHDs. Inclusion and exclusion criteria were applied to focus on research articles published in English up to December 2022. Data were processed and mapped using VOSviewer to visualize research trends.

A total of 935 research articles were found. The number of research articles on has been increasing steadily since the mid-1990s, with a peak of publications between 2003 and 2012, followed by a fluctuating steady state from 2013 to 2022. The United States contributed the most articles (62.5%), followed by Canada (9.4%). The Journal of Dual Diagnosis , Journal of Substance Abuse Treatment , and Mental Health and Substance Use Dual Diagnosis were the top active journals in the field. Key research hotspots include the comorbidity of SUDs and MHDs, treatment interventions, quality of life and functioning, epidemiology, and the implications of comorbidity. Emerging research topics include neurobiological and psychosocial aspects, environmental and sociocultural factors, innovative interventions, special populations, and public health implications.

Conclusions

The research landscape analysis provides valuable insights into dual diagnosis research trends, active countries, journals, and emerging topics. Integrated approaches, evidence-based interventions, and targeted policies are crucial for addressing the complex interplay between substance use and mental health disorders and improving patient outcomes.

Introduction

Substance use disorders (SUDs) refer to a range of conditions characterized by problematic use of psychoactive substances, leading to significant impairment in physical, psychological, and social functioning [ 1 ]. These substances may include alcohol, tobacco, illicit drugs (e.g., cocaine, opioids, cannabis), and prescription medications. The global burden of SUDs is substantial, with far-reaching consequences on public health, socio-economic development, and overall well-being. For instance, alcohol abuse accounts for 3 million deaths worldwide annually, while the opioid crisis has escalated to unprecedented levels in certain regions, such as North America, resulting in tens of thousands of overdose deaths per year [ 2 , 3 , 4 ]. Mental health disorders (MHDs) encompass a wide range of conditions that affect mood, thinking, behavior, and emotional well-being [ 5 ]. Examples of MHDs include depression, anxiety disorders, post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, and eating disorders. These conditions can significantly impair an individual's ability to function, negatively impacting their quality of life, relationships, and overall productivity [ 6 , 7 , 8 ]. Furthermore, certain MHD such as major depressive disorder and anxiety are often associated with specific affective temperaments, hopelessness, and suicidal behavior and grasping such connections can help in crafting customized interventions to reduce suicide risk [ 9 ]. In addition, a systematic review of 18 studies found that demoralization with somatic or psychiatric disorders is a significant independent risk factor for suicide and negative clinical outcomes across various populations [ 10 ]. The coexistence of SUDs and MHDs, often referred to as dual diagnosis or comorbidity, represents a complex and prevalent phenomenon that significantly impacts affected individuals and healthcare systems [ 11 , 12 , 13 , 14 , 15 ]. For instance, individuals with depression may be more likely to self-medicate with alcohol or drugs to cope with emotional distress [ 16 ]. Similarly, PTSD has been linked to increased rates of substance abuse, as individuals attempt to alleviate the symptoms of trauma [ 17 , 18 ]. Moreover, chronic substance use can lead to changes in brain chemistry, increasing the risk of developing MHDs or exacerbating existing conditions [ 17 , 19 , 20 , 21 ]. The coexistence of SUDs and MHDs presents unique challenges from a medical and clinical standpoint. Dual diagnosis often leads to more severe symptoms, poorer treatment outcomes, increased risk of relapse, and higher rates of hospitalization compared to either disorder alone [ 22 ]. Additionally, diagnosing and treating dual diagnosis cases can be complex due to overlapping symptoms and interactions between substances and psychiatric medications. Integrated treatment approaches that address both conditions simultaneously are essential for successful recovery and improved patient outcomes [ 20 ]. Patients grappling with dual diagnosis encounter a multifaceted web of barriers when attempting to access essential mental health services. These barriers significantly compound the complexity of their clinical presentation. The first barrier pertains to stigma, where societal prejudices surrounding mental health and substance use disorders deter individuals from seeking help, fearing discrimination or social repercussions [ 23 ]. A lack of integrated care, stemming from fragmented healthcare systems, poses another significant hurdle as patients often struggle to navigate separate mental health and addiction treatment systems [ 24 ]. Insurance disparities contribute by limiting coverage for mental health services and imposing strict criteria for reimbursement [ 25 ]. Moreover, there is a shortage of adequately trained professionals equipped to address both substance use and mental health issues, creating a workforce barrier [ 26 ]. Geographical disparities in access further hinder care, particularly in rural areas with limited resources [ 27 ]. These barriers collectively serve to exacerbate the clinical complexity of patients with dual diagnosis, and ultimately contributing to poorer outcomes.

A research landscape analysis involves a systematic review and synthesis of existing literature on a specific topic to identify key trends, knowledge gaps, and research priorities [ 28 , 29 ]. Scientific research landscape analysis, is motivated by various factors. First, the rapid growth of scientific literature poses a challenge for researchers to stay up-to-date with the latest developments in their respective fields. Research landscape analysis provides a structured approach to comprehend the vast body of literature, identifying crucial insights and emerging trends. Additionally, it plays a vital role in identifying knowledge gaps, areas with limited research, or inadequate understanding. This pinpointing allows researchers to focus on critical areas that demand further investigation, fostering more targeted and impactful research efforts [ 30 ]. Furthermore, in the realm of policymaking and resource allocation, evidence-based decision-making is crucial. Policymakers and funding agencies seek reliable information to make informed decisions about research priorities. Research landscape analysis offers a comprehensive view of existing evidence, facilitating evidence-based decision-making processes [ 28 ]. When it comes to the research landscape analysis of dual diagnosis of SUDs and MHDs, there are several compelling justifications to explore this complex comorbidity and gain a comprehensive understanding of its interplay and impact on patient outcomes. Firstly, the complexity of the interplay between SUDs and MHDs demands a comprehensive examination of current research to unravel the intricacies of this comorbidity [ 31 ]. Secondly, dual diagnosis presents unique challenges for treatment and intervention strategies due to the overlapping symptoms and interactions between substances and psychiatric medications. A research landscape analysis can shed light on effective integrated treatment approaches and identify areas for improvement [ 18 ]. Moreover, the public health impact of co-occurring SUDs and MHDs is substantial, resulting in more severe symptoms, poorer treatment outcomes, increased risk of relapse, and higher rates of hospitalization. Understanding the research landscape can inform public health policies and interventions to address this issue more effectively [ 32 ]. Lastly, the holistic approach of research landscape analysis enables a comprehensive understanding of current knowledge, encompassing epidemiological data, risk factors, treatment modalities, and emerging interventions. This integrative approach can lead to more coordinated and effective care for individuals with dual diagnosis [ 22 ]. Based on the above argument, the current study aims to conduct a research landscape analysis of dual diagnosis of SUDs and MHDs. The research landscape analysis bears a lot of significance for individuals and society. First and foremost, it’s a beacon of hope for individuals seeking help. Research isn’t just about dry statistics; it's about finding better ways to treat and support those facing dual diagnosis. By being informed about the latest breakthroughs, healthcare professionals can offer more effective, evidence-backed care, opening the door to improved treatment outcomes and a brighter future for those they serve. Beyond the individual level, this understanding has profound societal implications. It has the power to chip away at the walls of stigma that often surround mental health and substance use issues. Greater awareness and knowledge about the complexities of dual diagnosis can challenge stereotypes and biases, fostering a more compassionate and inclusive society. Additionally, society allocates resources based on research findings. When we understand the prevalence and evolving nature of dual diagnosis, policymakers and healthcare leaders can make informed decisions about where to channel resources most effectively. This ensures that the needs of individuals struggling with co-occurring disorders are not overlooked or under-prioritized. Moreover, research helps identify risk factors and early warning signs related to dual diagnosis. Armed with this information, we can develop prevention strategies and early intervention programs, potentially reducing the incidence of co-occurring disorders and mitigating their impact. Legal and criminal justice systems also stand to benefit. Understanding dual diagnosis trends can inform policies related to diversion programs, treatment alternatives to incarceration, and the rehabilitation of individuals with co-occurring disorders, potentially reducing rates of reoffending. Moreover, dual diagnosis research contributes to public health planning by highlighting the need for integrated mental health and addiction services. This knowledge can guide the development of comprehensive healthcare systems that offer holistic care to individuals with co-occurring disorders. Families and communities, too, are vital players in this narrative. With a grasp of research findings, they can provide informed, empathetic, and effective support to their loved ones, contributing to better outcomes.

The present research landscape analysis of dual diagnosis of SUDs and MHDs was conducted using a systematic approach to retrieve, process, and analyze relevant articles. The following methodology outlines the key steps taken to address the research questions:

Research Design The present study constitutes a thorough and robust analysis of the research landscape concerning the dual diagnosis of SUD and MHD. It's important to note that the research landscape analysis differs from traditional systematic or scoping reviews. In conducting research landscape analysis, we made deliberate methodological choices aimed at achieving both timely completion and unwavering research quality. These choices included a strategic decision to focus our search exclusively on a single comprehensive database, a departure from the customary practice of utilizing multiple databases. Furthermore, we streamlined the quality control process by assigning specific quality checks to a single author, rather than following the conventional dual-reviewer approach. This approach prioritized efficiency and expediency without compromising the rigor of our analysis. To expedite the research process further, we opted for a narrative synthesis instead of a quantitative one, ensuring that we provide a succinct yet highly informative summary of the available evidence. We place a premium on research transparency and, as such, are committed to sharing the detailed search string employed for data retrieval. This commitment underscores our dedication to fostering reproducibility and transparency in research practices.

Ethical considerations Since the research landscape analysis involved the use of existing and publicly available literature, and no human subjects were directly involved, no formal ethical approval was required.

Article retrieval Scopus, a comprehensive bibliographic database, was utilized to retrieve articles related to the dual diagnosis of SUDs and MHDs. Scopus is a multidisciplinary abstract and citation database that covers a wide range of scientific disciplines, including life sciences, physical sciences, social sciences, and health sciences. It includes content from thousands of scholarly journals.

Keywords used To optimize the search process and ensure the inclusion of pertinent articles, a set of relevant keywords and equivalent terms were employed. Keywords for “dual diagnosis” included dual diagnosis, co-occurring disorders, comorbid substance use, comorbid addiction, coexisting substance use, combined substance use, simultaneous substance use, substance use and psychiatric, co-occurring substance use and psychiatric, concurrent substance use and mental, coexisting addiction and mental, combined addiction and mental, simultaneous addiction and mental, substance-related and psychiatric, comorbid mental health and substance use, co-occurring substance use and psychiatric, concurrent mental health and substance use, coexisting mental health and substance use, combined mental health and substance use, simultaneous mental health and substance use, substance-related and coexisting psychiatric, comorbid psychiatric and substance abuse, co-occurring mental health and substance-related, concurrent psychiatric and substance use, coexisting psychiatric and substance abuse, combined psychiatric and substance use, simultaneous psychiatric and substance use, substance-related and concurrent mental, substance abuse comorbidity. Keywords for “Substance use disorders” included substance abuse, substance dependence, drug use disorders, addiction, substance-related disorders, drug abuse, opioid use disorder, cocaine use disorder, alcohol use disorder, substance misuse, substance use disorder, substance-related, substance addiction. Keywords for “Mental health disorders” included psychiatric disorders, mental illnesses, mental disorders, emotional disorders, psychological disorders, schizophrenia, depression, PTSD, ADHD, anxiety, bipolar disorder, eating disorders, personality disorders, mood disorders, psychotic disorders, mood and anxiety disorders, mental health conditions. To narrow down the search to focus specifically on dual diagnosis, we adopted a strategy that involved the simultaneous presence of SUDs and MHDs in the presence of specific keywords in the titles and abstracts such as “dual,” “co-occurring,” “concurrent,” “co-occurring disorders,” “dual disorders,” “dual diagnosis,” “comorbid psychiatric,” “cooccurring psychiatric,” “comorbid*,” and “coexisting”.

Inclusion and exclusion criteria To maintain the study’s focus and relevance, specific inclusion and exclusion criteria were applied. Included articles were required to be research article, written in English, and published in peer-reviewed journals up to December 31, 2022, Articles focusing on animal studies, internet addiction, obesity, pain, and validity of instruments and tools were excluded.

Flow chart of the search strategy Supplement 1 shows the overall search strategy and the number of articles retrieved in each step. The total number of research articles that met the inclusion and exclusion criteria were 935.

Validation of search strategy The effectiveness of our search strategy was rigorously assessed through three distinct methods, collectively demonstrating its ability to retrieve pertinent articles while minimizing false positives. First, to gauge precision, we meticulously examined a sample of 30 retrieved articles, scrutinizing their alignment with our research question and their contributions to the topic of dual diagnosis. This manual review revealed that the majority of the assessed articles were highly relevant to our research focus. Second, for a comprehensive evaluation, we compared the articles obtained through our search strategy with a set of randomly selected articles from another source. This set comprised 10 references sourced from Google Scholar [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], and the aim was to determine if our strategy successfully identified articles selected at random from an alternative database. Impressively, our analysis showed that the search strategy had a notably high success rate in capturing these randomly selected articles. Lastly, to further corroborate the relevance of our retrieved articles, we investigated the research interests of the top 10 active authors and the subject scope of the top 10 active journals. This exploration confirmed that their areas of expertise and the journal scopes were in alignment with the field of mental health and/or substance use disorders. These three validation methods collectively reinforce the reliability of our search strategy, affirming that the vast majority of the retrieved articles are indeed pertinent to our research inquiry.

Data processing and mapping Data extracted from the selected articles were processed and organized using Microsoft Excel. Information on the titles/abstracts/author keywords, year of publication, journal name, authors, institution and country affiliation, and number of citations received by the article were extracted. To visualize and analyze the research landscape, VOSviewer, a bibliometric analysis tool, was employed [ 43 ]. This software enables mapping and clustering of co-occurring terms, authors, and countries, providing a comprehensive overview of the dual diagnosis research domain.

Interpreting VOSviewer maps and generating research topics

We conducted a rigorous analysis and generated a comprehensive research landscape using VOSviewer, a widely acclaimed software tool renowned for its expertise in mapping research domains. We seamlessly integrated pertinent data extracted from the Scopus database, including publication metadata, into VOSviewer to delve into the frequency of author keywords and terminologies. The resulting visualizations provided us with profound insights into the intricate web of interconnected research topics and their relationships within the field. Interpreting VOSviewer maps is akin to navigating a vibrant and interconnected tapestry of knowledge. Each term or keyword in the dataset is depicted as a point on the map, represented by a circle or node. These nodes come in varying sizes and colors and are interconnected by lines of differing thicknesses. The size of a node serves as an indicator of the term’s significance or prevalence within the dataset. Larger nodes denote that a specific term is frequently discussed or plays a pivotal role in the body of research, while smaller nodes signify less commonly mentioned concepts. The colors assigned to these nodes serve a dual purpose. Firstly, they facilitate the categorization of terms into thematic groups, with terms of the same color typically belonging to the same cluster or sharing a common thematic thread. Secondly, they aid in the identification of distinct research clusters or thematic groups within the dataset. For instance, a cluster of blue nodes might indicate that these terms are all associated with a particular area of research. The spatial proximity of nodes on the map reflects their closeness in meaning or concept. Nodes positioned closely together share a robust semantic or contextual connection and are likely to be co-mentioned in research articles or share a similar thematic focus. Conversely, nodes situated farther apart indicate less commonality in terms of their usage in the literature. The lines that link these nodes represent the relationships between terms. The thickness of these lines provides insights into the strength and frequency of these connections. Thick lines indicate that the linked terms are frequently discussed together or exhibit a robust thematic association, while thinner lines imply weaker or less frequent connections. In essence, VOSviewer maps offer a visual narrative of the underlying structure and relationships within your dataset. By examining node size and color, you can pinpoint pivotal terms and thematic clusters. Simultaneously, analyzing the distance between nodes and line thickness unveils the semantic closeness and strength of associations between terms. These visual insights are invaluable for researchers seeking to unearth key concepts, identify research clusters, and track emerging trends within their field of study.

Growth pattern, active countries, and active journals

The growth pattern of the 935 research articles on dual diagnosis of substance use disorders and mental health disorders shows an increasing trend in the number of published articles over the years. Starting from the late 1980s and early 1990s with only a few publications, the research interest gradually picked up momentum, and the number of articles has been consistently rising since the mid-1990s. Table 1 shows the number of articles published in three different periods. The majority of publications (52.2%) were produced between 2003 and 2012, indicating a significant surge in research during that decade. The subsequent period from 2013 to 2022 saw a continued interest in the subject, accounting for 35.5% of the total publications. The number of articles published per year during the period from 2013 to 2022 showed a fluctuating steady state with an average of approximately 33 articles per year. The earliest period from 1983 to 2002 comprised 12.3% of the total publications, reflecting the initial stages of research and the gradual development of interest in the field.

Out of the total 935 publications, the United States contributed the most with 585 publications, accounting for approximately 62.5% of the total research output. Canada follows with 88 publications, making up around 9.4% of the total. The United Kingdom and Australia also made substantial contributions with 70 and 53 publications, accounting for 7.5 and 5.7%, respectively. Table 2 shows the top 10 active countries.

Based on the list of top active journals in the field of dual diagnosis of substance use and mental health disorders, it is evident that there are several reputable and specialized journals that focus on this important area of research (Table  3 ). These journals cover a wide range of topics related to dual diagnosis, including comorbidity, treatment approaches, intervention strategies, and epidemiological studies. The Journal of Dual Diagnosis appears to be a leading and comprehensive platform for research on dual diagnosis. It covers a broad spectrum of studies related to substance use disorders and mental health conditions. The Journal of Substance Abuse Treatment ranked second while the Mental Health and Substance Use Dual Diagnosis journal ranked third and seems to be dedicated specifically to the intersection of substance use disorder and mental health disorders, providing valuable insights and research findings related to comorbidities and integrated treatment approaches.

Most frequent author keywords

Mapping author keywords with a minimum occurrence of five (n = 96) provides insights in research related to dual diagnosis. Figure  1 shows the 96 author keywords and their links with other keywords. The number of occurrences represent the number of times each author keyword appears in the dataset, while the total link strength (TLS) indicates the combined strength of connections between keywords based on their co-occurrence patterns. The most frequent author keywords with high occurrences and TLS represent the key areas of focus in research on the dual diagnosis of substance use and mental health disorders.

“Comorbidity” is the most frequent keyword, with 144 occurrences and a high TLS of 356. This reflects the central theme of exploring the co-occurrence of substance use disorders and mental health conditions and their complex relationship. “Substance use disorder” and “dual diagnosis” are also highly prevalent keywords with 122 and 101 occurrences, respectively. These terms highlight the primary focus on studying individuals with both substance use disorders and mental health disorders, underscoring the significance of dual diagnosis in research. “Co-occurring disorders” and “substance use disorders” are frequently used, indicating a focus on understanding the relationship between different types of disorders and the impact of substance use on mental health. Several specific mental health disorders such as “schizophrenia,” “depression,” “bipolar disorder,” and “PTSD” are prominent keywords, indicating a strong emphasis on exploring the comorbidity of these disorders with substance use. “Mental health” and “mental illness” are relevant keywords, reflecting the broader context of research on mental health conditions and their interaction with substance use. “Treatment” is a significant keyword with 34 occurrences, indicating a focus on investigating effective interventions and treatment approaches for individuals with dual diagnosis. “Addiction” and “recovery” are important keywords, highlighting the interest in understanding the addictive nature of substance use and the potential for recovery in this population. The mention of “veterans” as a keyword suggests a specific focus on the dual diagnosis of substance use and mental health disorders in the veteran population. “Integrated treatment” is an important keyword, indicating an interest in studying treatment approaches that address both substance use and mental health disorders together in an integrated manner.

Network visualization map of author keywords with a minimum occurrence of five in the retrieved articles on dual diagnosis of substance use and mental health disorders

Most impactful research topics

To have an insight into the most impactful research topics on dual diagnosis, the top 100 research articles were visualized and the terms with the largest node size and TLS were used to. To come up with the five most common investigated research topics:

Dual diagnosis and comorbidity of SUDs and MHDs: This topic focuses on the co-occurrence of substance use disorders and various mental health conditions, such as schizophrenia, bipolar disorder, PTSD, anxiety disorders, and major depressive disorder. This research topic explored the prevalence, characteristics, and consequences of comorbidity in different populations, including veterans, adolescents, and individuals experiencing homelessness [ 13 , 19 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ].

Treatment and interventions for co-occurring disorders: This topic involves studies on different treatment approaches and interventions for individuals with dual diagnosis. These interventions may include motivational interviewing, cognitive-behavioral therapy, family intervention, integrated treatment models, assertive community treatment, and prolonged exposure therapy. The goal is to improve treatment outcomes and recovery for individuals with co-occurring substance use and mental health disorders [ 48 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ].

Quality of life and functioning in individuals with dual diagnosis: This research topic explores the impact of dual diagnosis on the quality of life and functioning of affected individuals. It assesses the relationship between dual diagnosis and various aspects of well-being, including social functioning, physical health, and overall quality of life [ 60 , 61 , 62 , 63 , 64 ].

Epidemiology and prevalence of co-occurring disorders: This topic involves population-based studies that investigate the prevalence of comorbid substance use and mental health disorders. It examines the demographic and clinical correlates of dual diagnosis, as well as risk factors associated with the development of co-occurring conditions [ 50 , 52 , 60 , 65 , 66 , 67 ].

Implications and consequences of comorbidity: This research topic explores the consequences of comorbidity between substance use and mental health disorders, such as treatment utilization, service access barriers, criminal recidivism, and the impact on suicidality. It also investigates the implications of comorbidity for treatment outcomes and the potential risks associated with specific comorbidities [ 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ].

Emerging research topics

Upon scrutinizing the titles, abstracts, author keywords, and a visualization map of the 100 recently published articles, the research themes listed below came to the forefront. It’s worth noting that some of the research themes in the 100 recently published articles were not groundbreaking; rather, they represented a natural progression of ongoing research endeavors, and that is why they were not listed as emerging research themes. For instance, there was a continuation of research into the prevalence and epidemiology of co-occurring mental illnesses and substance use disorders and characteristics of various cases of co-morbid cases of SUDs and MHDs. The list below included such emergent themes. It might seem that certain aspects within these research themes duplicate the initial research topics, but it’s crucial to emphasize that this is not the case. For example, both themes delve into investigations concerning treatment, yet the differentiation lies in the treatment approach adopted.

Neurobiological and psychosocial aspects of dual diagnosis: This research topic focuses on exploring the neurobiological etiology and underlying mechanisms of comorbid substance use and mental health disorders. It investigates brain regions, neurotransmitter systems, hormonal pathways, and other neurobiological factors contributing to the development and maintenance of dual diagnosis. Additionally, this topic may examine psychosocial aspects, such as trauma exposure, adverse childhood experiences, and social support, that interact with neurobiological factors in the context of comorbidity [ 76 ].

Impact of environmental and sociocultural factors on dual diagnosis: This research topic delves into the influence of environmental and sociocultural factors on the occurrence and course of comorbid substance use and mental health disorders. It may explore how cultural norms, socioeconomic status, access to healthcare, and societal attitudes toward mental health and substance use affect the prevalence, treatment outcomes, and quality of life of individuals with dual diagnosis [ 77 , 78 ].

New interventions and treatment approaches for dual diagnosis: This topic involves studies that propose and evaluate innovative interventions and treatment approaches for individuals with dual diagnosis. These interventions may include novel psychotherapeutic techniques, pharmacological treatments, digital health interventions, and integrated care models. The research aims to improve treatment effectiveness, adherence, and long-term recovery outcomes in individuals with comorbid substance use and mental health disorders [ 79 , 80 , 81 , 82 , 83 , 84 ].

Mental health and substance use in special populations with dual diagnosis: This research topic focuses on exploring the prevalence and unique characteristics of comorbid substance use and mental health disorders in specific populations, such as individuals with eating disorders, incarcerated individuals, and people with autism spectrum disorder. It aims to identify the specific needs and challenges faced by these populations and develop tailored interventions to address their dual diagnosis [ 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ].

Public health implications and policy interventions for dual diagnosis: This topic involves research that addresses the public health implications of dual diagnosis and the need for policy interventions to address this complex issue. It may include studies on the economic burden of comorbidity, the impact on healthcare systems, and the evaluation of policy initiatives aimed at improving prevention, early intervention, and access to integrated care for individuals with dual diagnosis [ 81 , 96 , 97 , 98 , 99 , 100 , 101 ].

Comparison in research topics

The comparison between the most impactful research topics and emerging research topics in the field of dual diagnosis reveals intriguing insights into the evolving landscape of this critical area of study (Table  4 ). In the most impactful research topics, there is a strong emphasis on the epidemiology of dual diagnosis, indicating a well-established foundation in understanding the prevalence, characteristics, and consequences of comorbid SUDs and MHDs. Treatment and interventions also receive considerable attention, highlighting the ongoing efforts to improve outcomes and recovery for individuals with dual diagnosis. Quality of life and medical consequences are additional focal points, reflecting the concern for the holistic well-being of affected individuals and the health-related implications of comorbidity.

On the other hand, emerging research topics signify a shift towards newer methods and interventions. The exploration of neurobiology in the context of dual diagnosis reflects a growing interest in unraveling the underlying neurobiological mechanisms contributing to comorbidity. This shift suggests a deeper understanding of the neural pathways and potential targets for intervention. The consideration of dual diagnosis in special groups underscores a recognition of the unique needs and challenges faced by specific populations, such as individuals with autism spectrum disorder. This tailored approach acknowledges that one size does not fit all in addressing dual diagnosis. Finally, the exploration of environmental and psychosocial contexts highlights the importance of socio-cultural factors, policy interventions, and societal attitudes in shaping the experience of individuals with dual diagnosis, signaling a broader perspective that extends beyond clinical interventions. In summary, while the most impactful research topics have laid a strong foundation in epidemiology, treatment, quality of life, and medical consequences, the emerging research topics point to a promising future with a deeper dive into the neurobiology of dual diagnosis, a focus on special populations, and a broader consideration of the environmental and psychosocial context. This evolution reflects the dynamic nature of dual diagnosis research as it strives to advance our understanding and improve the lives of those affected by comorbid substance use and mental health disorders.

The main hypothesis underlying the study was that dual diagnosis, or the comorbidity of SUDs and MHDs, was historically underrecognized and under-researched. Over time, however, there has been a significant increase in understanding, appreciation, and research into this complex interplay in clinical settings. This was expected to manifest through a growing number of publications, increased attention to integrated treatment approaches, and a heightened recognition of the complexities and public health implications associated with dual diagnosis. The study aims to analyze this progression and its implications through a research landscape analysis, identifying key trends, knowledge gaps, and research priorities. The research landscape analysis of the dual diagnosis of SUDs and MHDs has unveiled a substantial and evolving body of knowledge, with a notable rise in publications since the mid-1990s and a significant surge between 2003 and 2012. This growing research interest underscores the increasing recognition of the importance and complexity of dual diagnosis in clinical and public health contexts. The United States has emerged as the most active contributor, followed by Canada, the United Kingdom, and Australia, with specialized journals such as the Journal of Dual Diagnosis playing a pivotal role in disseminating research findings. Common keywords such as “comorbidity,” “substance use disorder,” “dual diagnosis,” and specific mental health disorders highlight the primary focus areas, with impactful research topics identified as the comorbidity of SUDs and MHDs, treatment and interventions, quality of life, epidemiology, and the implications of comorbidity. Emerging research themes emphasize neurobiological and psychosocial aspects, the impact of environmental and sociocultural factors, innovative treatment approaches, and the needs of special populations with dual diagnosis, reflecting a shift towards a more holistic and nuanced understanding. The study highlights a shift from traditional epidemiological studies towards understanding the underlying mechanisms and broader social determinants of dual diagnosis, with a need for continued research into integrated treatment models, specific needs of diverse populations, and the development of tailored interventions.

The findings of this research landscape analysis have significant implications for clinical practice, public health initiatives, policy development, and future research endeavors. Clinicians and healthcare providers working with individuals with dual diagnosis can benefit from the identified research hotspots, as they highlight crucial aspects that require attention in diagnosis, treatment, and support. The prominence of treatment and intervention topics indicates the need for evidence-based integrated approaches that address both substance use and mental health disorders concurrently [ 102 , 103 , 104 ]. The research on the impact of dual diagnosis on quality of life and functioning underscores the importance of holistic care that addresses psychosocial and functional well-being [ 63 ]. For public health initiatives, understanding the prevalence and epidemiological aspects of dual diagnosis is vital for resource allocation and the development of effective prevention and early intervention programs. Policymakers can use the research landscape analysis to inform policies that promote integrated care, reduce barriers to treatment, and improve access to mental health and substance abuse services [ 15 , 105 ]. Furthermore, the identification of emerging topics offers opportunities for investment in research areas that are gaining momentum and importance.

The present study lays a robust groundwork, serving as a catalyst for the advancement of research initiatives and the formulation of comprehensive policies and programs aimed at elevating the quality of life for individuals grappling with the intricate confluence of SUDs and MHDs. Within the realm of significance, it underscores a critical imperative—the urgent necessity to revolutionize the landscape of tailored mental health services offered to patients harboring this challenging comorbidity. The paper distinctly illuminates the exigency for a heightened quantity of research endeavors that delve deeper into unraveling the temporal intricacies underpinning the relationship between SUDs and MHDs. In so doing, it not only unveils potential risk factors but also delves into the far-reaching consequences of treatment modalities over the extended course of time. This illumination, therefore, not only beckons but virtually ushers in a promising trajectory for prospective research endeavors, a path designed to uncover the intricate and evolving journey of dual diagnosis. A profound implication of this study is the direct applicability of its findings in the corridors of policymaking. By leveraging the insights encapsulated within the paper, policymakers stand uniquely equipped to sculpt policies that unequivocally champion the cause of integrated care. The remarkable emphasis on themes of treatment and intervention, permeating the research's core, emphatically underscores the urgent demand for dismantling barriers obstructing access to mental health and substance abuse services. It is incumbent upon policymakers to heed this call, for policies fostering the integration of care can inexorably elevate the outcomes experienced by patients grappling with dual diagnosis. Furthermore, this study artfully directs policymakers to allocate their resources judiciously by identifying burgeoning areas of research that are surging in prominence and pertinence. These emergent topics, discerned within the study, are not just topics; they are emblematic of windows of opportunity. By investing in these areas, policymakers can tangibly bolster research initiatives that are primed to tackle the multifaceted challenges inherent in the realm of dual diagnosis, addressing both current exigencies and future prospects. Additionally, the paper furnishes the foundational blueprint essential for the development of screening guidelines and clinical practice protocols that truly grasp the complexity of dual diagnosis. Clinical practitioners and healthcare establishments would be remiss not to harness this invaluable information to augment their own practices, thereby delivering more effective and empathetic care to individuals contending with dual diagnosis. In essence, this study serves as the compass guiding the way toward a more compassionate, comprehensive, and efficacious approach to mental health and substance abuse care for those in need.

The current landscape analysis of reveals significant implications and highlights the growing research interest in this field since the late 1980s. This increasing trend underscores the complexities and prevalence of comorbid conditions, which necessitate focused research and intervention strategies. The results can be generalized to guide future research priorities, inform clinical guidelines, shape healthcare policies, and provide a framework for other countries to adapt and build upon in their context.

The key take-home message emphasizes the importance of recognizing the high prevalence and intricate relationship between SUDs and MHDs, necessitating integrated and tailored treatment approaches. Additionally, the study advocates for employing efficient research methodologies to synthesize vast amounts of literature and identify emerging trends, focusing on quality of life, treatment outcomes, and the broader socio-cultural and policy contexts to improve care and support for individuals with dual diagnosis. Finally, the research underscores the critical need for continued focus on dual diagnosis, advocating for comprehensive, integrated, and innovative approaches to research, clinical practice, and policymaking to improve outcomes for affected individuals.

Despite the comprehensive approach adopted in this research landscape analysis, several limitations must be acknowledged. The exclusive reliance on Scopus, while extensive, inherently limits the scope of the analysis, potentially omitting relevant articles indexed in other databases such as the Chinese scientific database, thus not fully representing the entire research landscape on dual diagnosis of SUDs and MHDs. Assigning quality control responsibilities to a single author, rather than employing a dual-reviewer system, may introduce bias and affect the reliability of the quality assessment. Although this approach was chosen to expedite the process, it might have compromised the thoroughness of quality checks. The use of narrative synthesis instead of a quantitative synthesis limits the ability to perform meta-analytical calculations that could provide more robust statistical insights. This choice was made for efficiency, but it may affect the depth of the analysis and the generalizability of the conclusions. The reliance on specific keywords to retrieve articles means that any relevant studies not containing these exact terms in their titles or abstracts may have been overlooked, potentially leading to an incomplete representation of the research domain. The restriction to English-language articles and peer-reviewed journals may exclude significant research published in other languages or in non-peer-reviewed formats, introducing linguistic and publication type bias that could skew the results towards predominantly English-speaking regions and established academic journals. The inclusion of articles up to December 31, 2022, means that any significant research published after this date is not considered, potentially missing the latest developments in the field. The validation of the search strategy using a small sample of 30 articles and a comparison with 10 randomly selected articles from Google Scholar may not be sufficient to comprehensively assess the effectiveness of the search strategy; a larger sample size might provide a more accurate validation. Some of the research topics and findings may be specific to particular populations (e.g., veterans) and might not be generalizable to other groups, highlighting the need for caution when extrapolating the results to broader contexts. Although no formal ethical approval was required due to the use of existing literature, ethical considerations related to the interpretation and application of findings must still be acknowledged, particularly in terms of representing vulnerable populations accurately and sensitively. Acknowledging these limitations is crucial for interpreting the findings of this research landscape analysis and for guiding future research efforts to address these gaps and enhance the robustness and comprehensiveness of studies on the dual diagnosis of SUDs and MHDs.

In conclusion, the research landscape analysis of dual diagnosis of substance abuse and mental health disorders provides valuable insights into the growth, active countries, and active journals in this field. The identification of research hotspots and emerging topics informs the scientific community about prevailing interests and potential areas for future investigation. Addressing research gaps can lead to a more comprehensive understanding of dual diagnosis, while the implications of the findings extend to clinical practice, public health initiatives, policy development, and future research priorities. This comprehensive understanding is crucial in advancing knowledge, improving care, and addressing the multifaceted challenges posed by dual diagnosis to individuals and society.

Availability of data and materials

All data presented in this manuscript are available on the Scopus database using the search query listed in the methodology section.

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Sweileh, W.M. Research landscape analysis on dual diagnosis of substance use and mental health disorders: key contributors, research hotspots, and emerging research topics. Ann Gen Psychiatry 23 , 32 (2024). https://doi.org/10.1186/s12991-024-00517-x

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Substance abuse in the United States: findings from recent epidemiologic studies

Affiliation.

• 1 Epidemiology Research Branch, Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, MSC 9589, Bethesda, MD 20892-9589, USA. [email protected]
• PMID: 19785975
• PMCID: PMC3144502
• DOI: 10.1007/s11920-009-0053-6

Recent research on the epidemiology of substance use disorders (SUDs) has provided important insights into these conditions and their impact on public health. In the United States, annual surveys of drug use in household and school populations serve as one of the primary sources of information about the distribution of illicit drug use. This research has demonstrated continued shifts in trends in illicit drug use in the United States and called attention to rising rates of prescription drug misuse and abuse. Findings have also continued to highlight the substantial comorbidity of SUDs with other psychiatric disorders and with the ongoing HIV epidemic. Building on these foundations, future challenges for research in substance abuse epidemiology will include using novel methodologic approaches to further unravel the complex interrelationships that link individual vulnerabilities for SUDs, including genetic factors, with social and environmental risk factors.

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No potential conflicts of interest relevant to this article were reported.

Trends in lifetime and annual…

Trends in lifetime and annual illicit drug use among eighth, 10th, and 12th…

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Substance Abuse and Mental Health Services Administration. Results From the 2007 National Survey on Drug Use and Health: National Findings. Rockville, MD: US Department of Health and Human Services; 2008. . This is an excellent source of epidemiologic data on drug use among a household-based cohort.

• Compton WM, Volkow ND. Major increases in opioid analgesic abuse: concerns and strategies. Drug Alcohol Depend. 2006;81:103–107. - PubMed

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Rethinking Addiction as a Chronic Brain Disease

Some researchers argue that the roles of social environment and personal choice have to be considered in order to make progress in treating people addicted to drugs.

By Jan Hoffman

The message emblazoned on a walkway window at the airport in Burlington, Vt., is a startling departure from the usual tourism posters and welcome banners:

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In July, behavior researchers published a critique of the classification, which they said could be counterproductive for patients and families.

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School of Public Health

A nationally top-ranked institution that offers a superior array of advanced degrees and is home to world-renowned research and training centers.

• Research Centers
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Substance Abuse Research

• Cannabis Research

The U of M School of Public Health has broad research expertise in alcohol, tobacco, and opioids. Our faculty have conducted research focused on the public-health effects of substance abuse; policies, policy regulation, and implementation; underage use; and programs focused on prevention and treatment. This expertise will guide work at the Cannabis Research Center (CRC).

Below we highlight some of the relevant alcohol, tobacco, and opioid publications and research studies conducted at SPH.

Alcohol Publications and Studies

Publications

For a full list of alcohol-related publications, see: The Alcohol Epidemiology Program

Policy Implementation and Impact

Lenk KM, Erickson DJ, Joshi S, Calvert C, Nelson TF, Toomey TL . An examination of how alcohol enforcement strategies by sheriff and police agencies are associated with alcohol-impaired-driving fatal traffic crashes . Traffic Injury Prevention, 22(6):419-424, 2021.

McKee P, Erickson DJ, Toomey T, Nelson T, Less EL, Joshi S, Jones-Webb R. The impact of single-container malt liquor sales restrictions on urban crime . Journal of Urban Health, 94(2):289-300, 2017.

Jones-Webb R, McKee P, Joshi S, Erickson DJ, Toomey TL, Nelson TF . Is restricting sales of malt liquor beverages effective in reducing crime in urban areas? J ournal of Studies on Alcohol and Drugs, 79(6):826-834, 2018.

Erickson DJ , Lenk KM, Toomey TL, Nelson TF, Jones-Webb R , Mosher JF. Measuring the strength of state-level alcohol control policies.  Word Medical and Health Policy, 6(3):171-186, 2014.

Erickson DJ , Lenk KM, Toomey TL, Nelson TF, Jones-Webb R . The state-level policy environment, enforcement, and alcohol use in the United States . Drug and Alcohol Review. 35:6-12, 2016.

Toomey TL , Lenk KM, Nederhoff DM, Nelson TF, Ecklund AM, Horvath KJ, Erickson DJ. Can obviously intoxicated patrons still easily buy alcohol at on-premise establishments? Alcoholism: Clinical and Experimental Research, 40(3):616-622, 2016.

Toomey TL , Lenk KM, Erickson DJ , Horvath KJ, Ecklund AM, Nederhoff DM, Hunt SL, Nelson TF. Effects of a hybrid online and in-person-training program designed to reduce alcohol sales to obviously intoxicated patrons. Journal of Studies on Alcohol and Drugs, 78(2):268-275, 2017.

Toomey TL, Erickson DJ, Carlin BP, Quick HS, Harwood EM, Lenk KM, Ecklund AM. Is the density of alcohol establishments related to nonviolent crime? Journal of Studies on Alcohol and Drugs, 73(1):21-25, 2012.

Toomey TL, Erickson DJ , Carlin BP, Lenk KM, Quick HS, Jones A. Harwood EM. The association between density of alcohol establishments and violent crime within urban neighborhoods . Alcoholism: Clinical and Experimental Research. 36(8):1468-1473, 2012.

Jones-Webb R, Nelson T , McKee P, Toomey T. An implementation model to increase the effectiveness of alcohol control policies . American Journal of Health Promotion, 28(5):328-35, 2014.

Wagenaar AC, Toomey TL, Erickson DJ. Preventing youth access to alcohol: outcomes from a multi-community time-series trial. Addiction , 100(3):335-45, 2005.

Health Effects of Alcohol Use

Calvert CM, Burgess D, Erickson D, Widome R, Jones-Webb R. Cancer pain and alcohol self-medication . J Cancer Surviv. 2022 May 14. doi: 10.1007/s11764-022-01215-x.

Surveillance

Planalp CA, Au-Yeung CM, Winkelman TNA. Escalating alcohol-involved death rates: trends and variation across the nation and in the states from 2006 to 2019. SHADAC Issue Brief. April 2021.

Planalp CA. Prevalence and disparities in excessive alcohol use among U.S. adults. SHADAC Issue Brief. March 2022.

Health Equity/Disparities

Jones-Webb R , Karriker-Jaffe KJ, Zemore SE, Mulia N. Effects of economic disruptions on alcohol use and problems: Why do African Americans fare worse? Journal of Studies on Alcohol and Drugs. 2016 Mar;77(2):261-71.( SPH story )

Karriker-Jaffe K, Zemore S, Mulia N, Jones-Webb R , Bond J, Greenfield T. Neighborhood disadvantage and adult alcohol outcomes: Differential risk by race and gender. Journal of Studies on Alcohol and Drugs, 73(6):865-873, 2012.

Zemore SE, Mulia N, Jones-Webb R , Liu H, Schmidt L. The 2008-9 recession and alcohol outcomes: Differential exposure and vulnerability for black and Latino populations . Journal of Studies on Alcohol and Drugs, 74(1):9-20. 2013.

For a full list of alcohol-related projects, see: The Alcohol Epidemiology Program

View Alcohol Studies

State and Local Alcohol Policies: The Case of Malt Liquor

Principal Investigator: Rhonda Jones-Webb, DrPH Co-Investigators: Traci Toomey, PhD; Darin Erickson, PhD; Toben Nelson, ScD Funding Agency:  National Institute on Alcohol Abuse and Alcoholism

Evaluation of a Hybrid In-person and Online Alcohol Service Training Program

Principal Investigator: Traci Toomey, PhD Co-Investigators: Darin Erickson, PhD ; Keith Horvath, PhD; Toben Nelson, ScD Funding Agency: National Institute on Alcohol Abuse and Alcoholism

Assessing Density of Alcohol Outlets, Other Outlets and Crime

Principal Investigator: Traci L. Toomey, PhD Co-Investigators: Bradley Carlin, PhD; Darin Erickson, PhD ; Eileen Harwood, PhD Funding Agency: National Institute on Alcohol Abuse and Alcoholism

The Effects of Changes in Local Alcohol Policies and Enforcement on Alcohol Use and Impaired Driving

Principal Investigator: Toben Nelson, ScD Co-Investigators: Darin Erickson, PhD; Rhonda Jones-Webb, PhD; Traci Toomey, PhD Funding Agency: National Institute on Alcohol Abuse and Alcoholism

Evaluation of a Place of Last Drink Initiative to Reduce Overservice and Alcohol-Related Crime

Principal Investigator: Traci Toomey, PhD Co-Investigators: Rich MacLehose, PhD; Rhonda Jones-Webb, PhD; Toben Nelson, ScD Funding Agency: National Institute on Alcohol Abuse and Alcoholism

Assessing How Local-Level Law Enforcement Strategies, Both Specific and in the Aggregate, Influence Binge Drinking and Alcohol-Impaired Driving in Communities Across the U.S.

Principal Investigator: Traci Toomey, PhD Co-Investigators: Darin Erickson, PhD; Toben Nelson, ScD Funding Agency: National Institute on Alcohol Abuse and Alcoholism

A Comprehensive Analysis of State Alcohol Policy Environment and Its Effects

Principal Investigator: Darin Erickson, PhD Co-Investigators: Traci Toomey, PhD; Toben Nelson, ScD; Rhonda Jones-Webb, DrPH Funding Agency: National Institute on Alcohol Abuse and Alcoholism

Tobacco Publications and Studies

Mayne SL, Jacobs DR Jr, Schreiner PJ, Widome R, G ordon-Larsen P, Kershaw KN. Associations of smoke-free policies in restaurants, bars, and workplaces with blood pressure changes in the CARDIA Study . J Am Heart Assoc. 2018 Dec 4;7(23):e009829.

Mayne SL, Auchincloss AH, Tabb LP, Stehr M, Shikany JM, Schreiner PJ, Widome R, Gordon-Larsen P. Associations of bar and restaurant smoking bans with smoking behavior in the CARDIA study: A 25-year study. Am J Epidemiol. 2018 Jun 1;187(6):1250-1258.

Mayne SL, Widome R, Carroll AJ, Schreiner PJ , Gordon-Larsen P, Jacobs DR Jr, Kershaw KN. Longitudinal associations of smoke-free policies and incident cardiovascular disease: CARDIA Study. Circulation. 2018 Aug 7;138(6):557-566.

Health Effects of Tobacco Use

Bustamante G, Ma B, Yakovlev G, Yershova K, Le C, Jensen J, Hatsukami DK,  Stepanov, I. Presence of the carcinogen N′-Nitrosonornicotine in saliva of e-cigarette users . Chemical Research in Toxicology. 2018;31(8):731-8.  ( SPH story )

Jain V, Alcheva A, Huang D, Caruso R, Jain A, Lay M, O’Connor R, Stepanov I. Comprehensive chemical characterization of Natural American Spirit cigarettes. Tob Regul Sci. 2019 Jul;5(4):381-399 . ( SPH story )

Joehanes R, Just AC, Marioni RE, Pilling LC, Reynolds LM, Mandaviya PR, Guan W, Xu T, Elks CE, Aslibekyan S, Moreno-Macias H, Smith JA, Brody JA, Dhingra R, Yousefi P, Pankow JS , Kunze S, Shah SH, McRae AF, Lohman K, Sha J, Absher DM, Ferrucci L, Zhao W, Demerath EW , et al., Epigenetic signatures of cigarette smoking. Circ Cardiovasc Genet. 2016 Oct;9(5):436-447. ( SPH story )

Tarran R, Barr RG, Benowitz NL, Bhatnagar A, Chu HW, Dalton P, Doerschuk CM, Drummond MB, Gold DR, Goniewicz ML, Gross ER, Hansel NN, Hopke PK, Kloner RA, Mikheev VB, Neczypor EW, Pinkerton KE, Postow L, Rahman I, Samet JM, Salathe M, Stoney CM, Tsao PS, Widome R, Xia T, Xiao D, Wold LE. E-Cigarettes and cardiopulmonary health. Function (Oxf). 2021 Feb 8;2(2):zqab004.

Carroll AJ Ms, Auer R, Colangelo LA, Carnethon MR, Jacobs DR J r, Stewart JC, Widome R , Carr JJ, Liu K, Hitsman B. Association of the interaction between smoking and depressive symptom clusters with coronary artery calcification: The CARDIA Study. J Dual Diagn. 2017 Jan-Mar;13(1):43-51.

Carroll AJ, Carnethon MR, Liu K, Jacobs DR , Colangelo LA, Stewart JC, Carr JJ, Widome R, Auer R, Hitsman B. Interaction between smoking and depressive symptoms with subclinical heart disease in the Coronary Artery Risk Development in Young Adults (CARDIA) study . Health Psychol. 2017 Feb;36(2):101-111.

Smoking Cessation

Hu T, Gall SL, Widome R, Bazzano LA, Burns TL, Daniels SR, Dwyer T, Ikonen J, Juonala M, Kähönen M, Prineas RJ, Raitakari O, Sinaiko AR, Steinberger J, Urbina EM, Venn A, Viikari J, Woo JG, Jacobs DR Jr . Childhood/adolescent smoking and adult smoking and cessation: The International Childhood Cardiovascular Cohort (i3C) Consortium. J Am Heart Assoc. 2020 Apr 7;9(7):e014381. doi: 10.1161/JAHA.119.014381.

Hammett PJ, Taylor BC, Lando HA, Widome R, Erickson DJ , Fu SS. Serious mental illness and smoking cessation treatment utilization: The role of healthcare providers. J Behav Health Serv Res. 2021 Jan;48(1):63-76.

Mayne SL, Gordon-Larsen P, Schreiner PJ, Widome R, Jacobs DR , Kershaw KN. Longitudinal associations of cigarette prices with smoking cessation: The coronary artery risk development in young adults study . Nicotine Tob Res. 2019 Apr 17;21(5):678-685.

Hammett P, Fu SS, Nelson D, Clothier B, Saul JE, Widome R, Danan ER, Burgess DJ. A Proactive smoking cessation intervention for socioeconomically disadvantaged smokers: The role of smoking-related stigma. Nicotine Tob Res. 2018 Feb 7;20(3):286-294.

Hammett PJ, Fu SS, Burgess DJ, Nelson D, Clothier B, Saul JE, Nyman JA, Widome R, Joseph AM. Treatment barriers among younger and older socioeconomically disadvantaged smokers. Am J Manag Care. 2017 Sep 1;23.

Hammett PJ, Lando HA, Taylor BC, Widome R, Erickson DJ, Joseph AM, Clothier B, Fu SS. The relationship between smoking cessation and binge drinking, depression, and anxiety symptoms among smokers with serious mental illness . Drug Alcohol Depend. 2019 Jan 1;194:128-135. doi: 10.1016/j.drugalcdep.2018.08.043.

Berry KM, Drew JAR, Brady PJ, Widome R. Impact of smoking cessation on household food security . Annals of Epidemiology. 2023 Mar;79:49-55.e3.

Roland KM, Anderson MD, Carroll DM, Webber AG, Rhodes KL, Poupart J, Forster JL, Peterson-Hickey M, Pickner WJ. Tribal Tobacco Use Project II: Planning, implementation, and dissemination using culturally relevant data collection among American Indian communities. Int J Environ Res Public Health. 2022 Jun 23;19(13):7708.

Breland AB, Carroll D , Denlinger-Apte R, Ross JC, Soto C, White C, et al. Centering racial justice for Black/African American and Indigenous American people in commercial tobacco product regulation . Preventive Medicine. 2022;165:107117.

Pinsker EA, Hennrikus DJ, Erickson DJ, Call KT , Forster JL, Okuyemi KS. Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT . Addict Behav. 2018 Mar;78:43-50

Carlson S, Widome R , Fabian L, Luo X, Forster J. Barriers to quitting smoking among young adults: The role of socioeconomic status . Am J Health Promot. 2018 Feb;32(2):294-300.

Hammett PJ, Lando HA, Erickson DJ, Widome R , Taylor BC, Nelson D, Japuntich SJ, Fu SS. Proactive outreach tobacco treatment for socioeconomically disadvantaged smokers with serious mental illness. J Behav Med. 2020 Jun;43(3):493-502.

Hammett P, Fu SS, Nelson D, Clothier B, Saul JE, Widome R, Danan ER, Burgess DJ. A Proactive smoking cessation intervention for socioeconomically disadvantaged smokers: The Role of smoking-related stigma . Nicotine Tob Res. 2018 Feb 7;20(3):286-294.

Widome R, Hammett PJ, Joseph AM, Burgess DJ, Thomas JL, Saul JE, Clothier B, Fu SS. A cross-sectional study of the relationship of proximal smoking environments and cessation history, plans, and self-efficacy among low-income smokers. J Smok Cessat. 2019 Dec;14(4):229-238.

Danan ER, Fu SS, Clothier BA, Noorbaloochi S, Hammett PJ, Widome R , Burgess DJ. The Equity impact of proactive outreach to smokers: Analysis of a randomized trial. Am J Prev Med. 2018 Oct;55(4):506-516. doi: 10.1016/j.amepre.2018.05.023.

View Tobacco Studies

Laying the Foundation for Personalized Smoking Cessation Treatment in the American Indian Population

Principal Investigator: Dana Carroll, PhD Funding Agency: National Institute on Minority Health and Health Disparities

Development and Pilot Testing of a Culturally-Tailored Smartphone-Delivered Intervention for Commercial Smoking Cessation in American Indians

Principal Investigator: Dana Caroll, PhD Co-Investigator: R achel Widome, PhD Funding Agency:  NIH/NCI

Impacts of Commercial Tobacco Marketing on American Indian Reservations

Principal Investigators: Rachel Widome ; Kristine Rhodes Funding Agency: Clearway Minnesota

Menthol Tobacco Sales Restrictions and Smoking Disparities

Principal Investigator : Rachel Widome, PhD Co-Investigator: Darin Erickson, PhD Funding Agency: NIH/NCI

Impact of Smokefree Policy Implementation in Public Housing Buildings

Principal Investigators: Rachel Widome, PhD; Deborah Hennrikus Funding Agency: Clearway Minnesota

Principal Investigator: Rachel Widome, PhD Co-Investigator: Darin Erickson, PhD Funding Agency: National Cancer Institute

Opioids Publications and Studies

Health effects of opioid use.

Neprash HT, Barnett ML . Association of primary care clinic appointment time with opioid prescribing. JAMA Netw Open. 2019 Aug 2;2(8):e1910373. ( SPH story )

Wright N , Ramirez MR. A cross sectional study of non-medical use of prescription opioids and suicidal behaviors among adolescents . Inj. Epidemiol. 8, 36 (2021).

Wright N, Ramirez MR, Southwell B, Hemmila M, Napolitano L, Tignanelli CJ. A serial cross-sectional study of trends and predictors of prescription controlled substance-related traumatic injury. Prev Med. 2022 Nov;164:107275.

Planalp CA, Hest R. Overdose crisis in transition: Changing national trends in a widening drug death epidemic. SHADAC Issue Brief . August 2020.

Kozhimannil KB , Chantarat T, Ecklund AM, Henning-Smith C, Jones C . Maternal opioid use disorder and neonatal abstinence syndrome among rural US residents, 2007-2014. J Rural Health. 2019 Jan;35(1):122-132.  Erratum in: J Rural Health. 2020 Jan;36(1):137.  ( SPH story )

View Opioids Studies

Unintended Prolonged Opioid Use

Principal Investigator: W. Michael Hooten, MD (Mayo Clinic) Sub-contract: Darin Erickson, PhD Funding Agency: NIH: National Center for Advancing Translational Science Institute

Spinal Manipulation and Patient Self-Management for Preventing Acute to Chronic Back Pain Trial (PACBACK)

Principal Investigator: Gert Bronfort Co-Investigator: John Connett, PhD Funding Agency: National Center for Complementary and Integrative Health ( SPH story )

Is the Drug Overdose Epidemic a White Problem? Perceptions and Attitudes of Treatment for Opioid Dependence in the African American Community

Principal Investigator: Kumi Smith Funding agency: University of Minnesota, Health Equity Work Group Pilot Award

Standardized Patients to Evaluate Treatment Access for Opioid Use Disorder

Co-Principal Investigators: Kumi Smith; Robert Levy Funding Agency: University of Minnesota, Office of Vice President of Research

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New Research Sheds Light on Treatment and Harm Reduction Gaps Among Drug Users

Amidst rising stimulant drug use and an increasingly contaminated drug supply, there is a need for broader communication and fewer barriers to access of harm-reduction strategies

Lindsey Culli

The overdose crisis in the U.S. continues to escalate, with over 100,000 deaths in 2023 and more than one million since 1999. As the drug supply has changed, the crisis has evolved, and opioid overdose deaths now overwhelmingly involve illicitly manufactured synthetic opioids like fentanyl. There has also been a sharp rise in overdose deaths involving stimulants such as cocaine and methamphetamine, and other toxic adulterants like xylazine . Drug overdose mortality has risen most rapidly in marginalized communities.   

A new study led by Sachini Bandara, PhD , assistant professor in Mental Health , and Brendan Saloner, PhD , professor in Health Policy and Management , published in August in JAMA Network Open, revealed significant gaps in access to treatment and harm reduction services, as well as disparities in use of services, and suggests that targeted interventions are urgently needed to address the overdose crisis effectively. Conducted across Wisconsin, Michigan, and New Jersey, this study adds to what is known about overdose risk with the current drug supply because of the recency of data collection and targeted sampling of key populations with increasingly higher risk for overdose, including Black and Hispanic populations, older adults, and people who use stimulants. Similar surveys of people who use drugs (PWUD) have historically been small in scale, limited to clients of a small number of service providers, limited to certain types of drug use (e.g., opioids), and have been predominately comprised of younger, white non-Hispanic respondents.  

The study, known as VOICES, was supported by the Bloomberg Overdose Prevention Initiative funded by Bloomberg Philanthropies, and conducted in partnership with Vital Strategies. It aimed to understand how access to treatment and harm reduction services varies by overdose history and drug type among a racially and ethnically diverse population of drug users. It involved a cross-sectional telephone survey conducted between January and July 2023, with 1,240 participants recruited from 39 different treatment, harm reduction, and social service provider organizations.   

Researchers found that 37% of respondents who had experienced an overdose in the past year reported using fentanyl test strips, compared to only 23.4% of those who had not experienced an overdose. Despite heightened awareness of test strips among overdose survivors, use was low among both groups. As Bandara noted, “Our findings highlight the need for reducing barriers to accessing critical overdose prevention tools.”  

Approximately 48% of all participants had received treatment in the past 30 days, indicating that while nearly half were accessing treatment, a substantial portion remained untreated. People who had overdosed were more likely to possess naloxone and use harm reduction services compared to those who had not overdosed. However, there was no significant difference in treatment use between these groups.  

Notably, stimulant-only users were less likely to possess naloxone compared to opioid-only users and polysubstance users. Among stimulant-only users, 51.4% possessed naloxone compared to 77.3% of opioid-only users and 77.6% of polysubstance users. There were similar disparities between those different types of drug users in their use of fentanyl test strips with only 16% of stimulant-only users currently using fentanyl test strips.  

The study’s results highlight critical gaps in the use of evidence-based treatment and harm reduction services that could significantly reduce overdose risks. Despite the availability of these services, many individuals, especially stimulant users, are not accessing them, suggesting a need for enhanced communication and outreach to promote these lifesaving services.  

The study also identified several barriers to accessing treatment and harm reduction services, which include not being ready for treatment, a lack of perceived need for harm reduction services, and a lack of awareness or availability, as many participants said they were unaware of fentanyl test strips or how to obtain them.  

“There are substantial gaps in the use of treatment and harm reduction services that could reduce overdose risk,” Bandara said. “In particular, we found low use of harm reduction and treatment services among people who use stimulants, and additional communication around their importance and efforts to remove barriers to access may help increase the use of these services amidst an increasingly contaminated stimulant drug supply.”  

The findings suggest that targeted public health campaigns and outreach programs are essential to increase awareness and utilization of treatment and harm reduction services. The research underscores the urgent need for improved access to and utilization of harm reduction and treatment services to save lives. Addressing gaps in harm reduction practices through targeted interventions and increased awareness could significantly mitigate the overdose crisis, particularly in marginalized communities.    

• Xylazine: The New Overdose Crisis
• Do Overdose Prevention Sites Make Their Communities Less Safe? (Podcast)
• Nearly One-Third of U.S. Adults Know Someone Who’s Died of Drug Overdose

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Comprehensive review identifies three key concepts for recovery from substance use disorders

by Research Society on Alcoholism

Certain concepts have a demonstrated basis for aiding recovery from dangerous alcohol or substance use, according to an analysis of scientific literature since 1990. Self-efficacy (a belief in one's ability to achieve a goal), social support, and managing cravings are among the treatment elements best supported by evidence.

Effective treatment for alcohol use disorder (AUD) and other substance use disorders (SUDs) depends on understanding how human behaviors change and incorporating that knowledge into clinical practice . An ongoing research effort continues to investigate varying treatment approaches and how they relate to recovery outcomes, but those findings have not been well synthesized into a useful format.

For the new review published in Alcohol: Clinical & Experimental Research , researchers from around the U.S. reviewed published studies, identified the treatment elements best supported by data, and evaluated their potential as key factors in behavior change. The researchers drew on existing study design criteria for validating conclusions about treatment elements.

The researchers explored reviews of studies published between 2008 and 2023 involving AUD and SUD treatments and the effects on substance use and related outcomes in adults. Three constructs involved in treatment were the most well-supported by data from 11 studies: self-efficacy, social support, and craving (coping skills, also well-supported, did not suit the current review process).

They then reviewed 48 studies published between 1990 and 2023 that focused on one or more of these three concepts in adults' recovery, and that met rigorous methodology standards. The 48 studies used varied research designs, participant samples, and contexts.

The analyzed studies provided support for self-efficacy, social support, and craving as factors that likely influence people's behaviors in treatment or recovery. The researchers called for these three constructs to be incorporated into AUD and SUD treatment and clinical training.

Such an approach could improve recovery interventions, inform new treatments and clinical training , help clinicians align patients with approaches likely to work for them, and hone community-based recovery programs.

The researchers called for additional research on how these three concepts drive behavior change and for mining existing science to identify other evidence-based approaches. They recommended several directions for future research. These included expanding the examined outcomes to other manifestations of mental and physical health and experimenting with key elements of treatment to generate direct evidence of associations between those constructs and outcomes.

Investigating the roles of context (such as policies, incentives, social norms , and settings) and combinations of influences could improve outcomes across varied real-world situations. Specifying how behavioral change occurs—such as the relevant neurological and biological pathways—is a critical gap that needs to be addressed.

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Unravelling the complexities of substance use

As Ireland's foremost academic expert on addiction, Dr Jo-Hanna Ivers, Associate Professor in Addiction at Trinity College Dublin, has dedicated her career to understanding and addressing the complexities of substance use with a particular focus on opioid addiction.

‘Opioid overdose is a critical issue globally, with many regions, including Ireland, experiencing increased rates of opioid overdose. Currently, Ireland has a death rate from drugs more than three times above the European average. Drug poisoning deaths remain the leading cause of deaths. Of these deaths,  7 in 10 cases involved opioids.  Thus, understanding what is driving opioid overdose remains a key priority,’ explains Dr Ivers whose extensive training, education, and experience in specialist addiction services have positioned her at the forefront of addiction research.

Here at Trinity College Dublin, she leads a broad research programme of projects aimed at tackling the opioid crisis in Ireland.

These projects include Reducing Drug-Related Stigma which aims to develop a strategy to reduce drug-related stigma. Stigma affects self-esteem, physical and psychological health, and relationships - all of which directly impact an individuals' ability to access necessary support services. The hidden nature of those living with active drug use disorders due to stigma means the public has little opportunity to challenge their prejudices. Research has shown that interacting with stigmatised individuals and hearing their stories profoundly destigmatises listeners.

The Non-Fatal Overdose study examines the experiences of individuals who have survived non-fatal opioid overdoses, aiming to improve coordination among service providers and develop timely interventions to prevent future overdoses.

A third project focuses on Treatment Patterns and Trends in Opioid Use in the older population from 2015-2021. This analysis identifies trends in opioid use and associated health issues, providing insights to shape public health policies.

Her research recommends that an effective public health response must address the criminalisation of substance use. There is also a need to develop research on policy models prioritising treatment over punishment, such as health diversion programmes.

Dr Ivers is committed to fostering collaboration among researchers, healthcare professionals, and policymakers to ensure their collective efforts translate into meaningful change. She has achieved this through her roles as a scientific adviser to the Citizens Assembly on Drugs, a former member of the Scientific Committee of the EMCDDA, and as an expert scientific member of the Pompidou Group of the European Council on Drug Policy and Human Rights.

• Open access
• Published: 30 August 2024

Impact of partner alcohol use on intimate partner violence among reproductive-age women in East Africa Demographic and Health Survey: propensity score matching

• Mamaru Melkam 1 ,
• Bezawit Melak Fente 2 ,
• Yohannes Mekuria Negussie 3 ,
• Zufan Alamrie Asmare 4 ,
• Hiwot Altaye Asebe 5 ,
• Beminate Lemma Seifu 5 ,
• Meklit Melaku Bezie 6 &
• Angwach Abrham Asnake 7  

BMC Public Health volume  24 , Article number:  2365 ( 2024 ) Cite this article

Metrics details

Introduction

Intimate Partner Violence (IPV) is the most prevalent form of violence against women globally and is more prevalent than rape or other violent attacks by strangers. Different observational studies have established a strong positive association between alcohol use and intimate partner violence. Even though there are a lot of studies that show the association between partner alcohol use and intimate partner violence limited studies were conducted that show the direct causative relations of partner alcohol use and IPV among reproductive-age women in East Africa. Therefore, this study aimed to determine the effect of partner alcohol use on intimate partner violence in East Africa’s recent Demographic and Health Survey (DHS) data with Propensity Score Matching (PSM).

Community-based cross-sectional study design with a propensity score matching was used from the East African countries’ DHS data. A total of the weighted sample size of 72,554 reproductive-age women was used for this study. Propensity score matching analysis was conducted to determine the causal relation between partner alcohol use and intimate partner violence. Intimate partner violence was the outcome variable and partner alcohol use was the treatment variable. Propensity score matching was carried out through Stata software by using psmatch2 of the logit-based model. The assumption of common support was verified and achieved. Mantel-Haenszel boundaries have been used to investigate the possibility of hidden bias in the outcome.

The prevalence of partner alcohol use and intimate partner violence from East African countries was 37.94 with a CI of (37.58%, 38.29%) and 41.45% with a CI (41.09%, 41.80%) respectively. Partner alcohol use contributed to a 2.78% increase in intimate partner violence according to the estimated average treatment on treated values in the treated and control groups were 59.41% and 31.51%, respectively. Ultimately, it was found that among all research participants, the average effect on the population as a whole was 25.33%.

We conclude that partner alcohol use has a direct cause for intimate partner violence. Therefore, controlling partner alcohol consumption can reduce the burden of intimate partner violence.

Peer Review reports

The World Health Organization (WHO) defines intimate partner violence as the deliberate act of an intimate partner or former spouse that results in sexual misconduct, severe physical harm, emotional abuse, or dominating activities [ 1 ]. Intimate partner violence is the most prevalent type of violence against women, with major health consequences, and is more likely to occur in homes rather than on street level. Intimate partner violence increases the risk of gynecological, neurological, and stressful problems for women [ 2 ]. Alcohol is the most popular beverage in the world and a fluid that includes ethanol. Worldwide commonly men drinking alcohol is associated with numerous misconducts, including violence against their intimate partners [ 3 ]. Alcohol’s psychophysiological effects are considered to directly increase the risk of criminalizing IPV in those who consume alcohol [ 4 ]. The potential habit of alcohol addiction has made it difficult to determine whether there is a causal relationship between alcohol abuse and IPV [ 5 ].

Alcohol consumption is one of the common and well-established risk factors for intimate partner violence. Although different measures have been made to lessen intimate partner violence it remains a significant public health issue that requires additional work to address [ 6 ]. It’s unclear how the etiological theories put up to explain the connection between alcohol use and IPV have been tested in earlier studies conducted in low and middle-income countries [ 5 ]. Regardless of the consequences of alcohol consumption, some drinkers may purposefully act violently or aggressively toward their spouse in the hopes that their actions will be accepted as they were under the influence of alcohol drink [ 7 ].

The prevalence of IPV among reproductive-age women in the world including Africa varies greatly [ 2 ]. IPV is a serious public health issue and an attack on women’s human rights; globally, nearly one-third (27%) of women between the ages of 15 and 49 who were in a relationship have encountered sexual or severe physical assault at the expense of their intimate partner [ 8 , 9 ]. One of the most prevalent forms of violence against women is intimate partner violence [ 10 ]. The prevalence of partner alcohol use and intimate partner violence in Sub-Saharan Africa ranges from 3 to 62% and 11–60% respectively. In other studies in Africa, the burden of partner alcohol use was 36.3% with a prevalence of IPV (9.7–25.0%) [ 11 ].

There are several factors in the previous observational study which show the association between partner alcohol use and intimate partner violence [ 12 , 13 ]. The association of factors between alcohol use and intimate partner violence in developing countries was confounded by a wide range of factors that exist at the individual and community level variables [ 4 ]. The variables associated with IPV were incorporated: sex of male household head, age, occupation, educational status, marital status, mass media exposure, wealth status, and number of children [ 12 , 14 , 15 ].

World Health Organization suggested that primary prevention strategies aimed at minimizing alcohol-related harm could also potentially minimize IPV even though drinking alcohol can occur without IPV and IPV can occur without alcohol consumption [ 16 ]. Different literature evidence that it is very difficult to determine the degree of the associations between substance consumption and intimate partner violence [ 17 ]. The exact causal relation is difficult to determine by observational study due to the presence of other associated factors. Besides the variable observed, there are also unobserved variables and biases that prohibit the exact causal relations between alcohol use and intimate partner violence. Propensity Score Matching (PSM) analysis is the best technique to avoid bias through matching partner alcohol use (treatment group) and partner, not alcohol use (control group) among reproductive-age women with similar exposure to intimate partner violence. According to our best knowledge, there are no studies in East Africa that show the effect of partner alcohol use on intimate partner violence among reproductive-age women. Therefore, this study aimed to determine the impact of partner alcohol use on intimate partner violence in East Africa’s recent DHS data with propensity score matching.

Method and material

Study design and area.

A community-based cross-sectional study was employed on the recent Demography and Health Survey (DHS) data of 12 East African countries (Burundi, Comoros, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe) from 2016 to 2024. East African countries’ DHS data included fertility, reproductive health, maternal and child health, mortality, nutrition, and self-reported health reports. The DHS incorporated datasets are on men, women, children, births, and households for this survey and we have used the women’s data for this secondary data analysis. Reproductive-age women between the ages of 15 to 49 were included in this secondary data analysis. The total weighted sample size for this study was 72,554 with 1692 clusters. The detailed data can be accessed comprehensively by clicking on the official link http://www.dhsprogram.com/ [ 18 ].

Operational definitions

The revised version of the domestic violence questionnaire module was used. Study participants who have experienced intimate partner violence in their lifetime were considered in this study. The module of questions on GBV was administered following the World Health Organization’s guidelines on the ethical collection of information on gender-based violence (WHO 2001). From a total of nine revised versions of the domestic violence questionnaire scoring one and above were considered as having IPV.

Alcohol use: It was assessed by the simple question of alcohol drinking every day. Study participants whose husband drinks alcohol on an everyday basis and with harmful consequences even though the specific amount and frequency, it is the limitation of the study.

Outcome and treatment variables

Partner alcohol use is measured by a single question; did your husband/partner drink alcohol every day? The dependent variable for this study is intimate partner violence which includes severe physical violence, sexual violence, and emotional violence. It was measured by the following questions and participants who have said yes to at least one question are considered as they have IPV.

Severe physical violence

Ever been kicked or dragged by your husband?

Ever been strangled or burned by a husband?

Ever been threatened with a knife, gun, or another weapon?

Sexual violence

Ever been physically forced to have unwanted sex by your husband?

Ever been forced to do other sexual acts by your husband?

Ever been forced to perform sexual acts respondent didn’t want to?

Emotional violence

Ever been humiliated by your husband?

Ever been threatened with harm by your husband?

Ever been insulted or made to feel bad by your husband?

Data management and statistical analysis

When randomization was not an option, propensity score matching was frequently used to ascertain the effects of treatment in experimental designs. Because of bias caused by an imbalance in observable factors that modifies the causal influence of experience, study participants were randomly assigned to one of the groups. Adjust and rectify group inequality using a balancing score to fix the imbalance between the groups using PSM while confounding factors can be identified. The balance score indicates that the treatment group should not affect the observed variable which is partner alcohol use. After propensity score adjustments for the observed covariates, the difference in outcomes between those who experienced intimate partner violence and those who did not offer an objective measure of the impact of partner alcohol use on intimate partner violence becomes equal. The propensity score which always ranges from 0 to 1 is a conditional likelihood of receiving treatment (partner alcohol use). A higher propensity score indicates that women whose partners drink alcohol. The treatment variables of interest in propensity score matching need to be dichotomous. The imbalance of covariates between the treatment and control groups is assessed using a t-test for continuous factors and a chi-square for categorical components.

Based on the association between the outcome and treatment variables, three separate results were obtained from the observed covariant. However, the only one that can be added is PSM. The likelihood that a woman might have partner alcohol use is reduced to a propensity score for each woman based on the variables selected. A propensity score for each participant is generated with the selected confounders [ 19 , 20 , 21 ]. PSM approach was used for those women with partner alcohol use that wasn’t distributed randomly between the two groups and might be considerably impacted by both observable and non-observable factors. PSM covariates were incorporated as they have a strong association with partner alcohol use and intimate partner violence, including socio-demographic and behavioral factors. Variables included before PSM (sex of household head, age, education, currently working, wealth status, partner alcohol use, and husband education) had significant differences with a p -value of less than 0.05 with IPV among those who have alcohol user partners and do not have. The variables mentioned above showed no significant difference for IPV while participants with and without partner alcohol use were matched with a p -value of greater than 0.05. This suggests that PSM dramatically reduced the group’s observed variable difference.

The most widely accepted PSM hypotheses are a selection of unobservable variables and common support that have been evaluated statistically and graphically. Throughout the study, the common support option was taken into account to limit the balance of propensity to mothers with treatment (partner alcohol use) whose propensity score for IPV was within the ranges of propensity scores for controls. We tested two types of matching methods: nearest neighbor matching with and without replacement and radius matching with calipers ranging from 0.01 to 0.05. Stata psmatch2 was used to calculate the Average Treatment Effect for treated (ATT), Average Treatment effect on Untreated (ATU), and Average Treatment effect for the whole population (ATE) for the matching technique that produced the most effective matches. Standard supported option was also used to generate higher-quality matches. The basis for assessing the quality of matching was the balance of the variables between the treated and control groups. To determine the degree of matching, the standardized bias before and after matching was calculated. The difference in percentages is used to compute this bias.

The percentage of the square root of the average sample variances in both groups was used to check the percentage difference between the sample means in the matched control and treatment groups. Although, there is no hard and fast rule on the degree of standardized difference to indicate an imbalance variation of less than 10% is considered a low variation. The pseudo-R2 and likelihood ratio tests were used to examine the joint importance of all the covariates from the logit estimation of the conditional treatment probability before and after matching. A sensitivity analysis was used to evaluate the PSM estimations’ reliability [ 22 ]. Because the outcome variable was binary, the Mantel-Haenzel (MH) test statistic was used to assess whether the PSM estimates were sensitive to the hidden bias [ 23 ]. The gamma coefficient quantifies the unobserved confounding or hidden bias that affects how the treatment is allocated to the treated and control groups. Using the mhbounds STATA command, the gamma value ranges from 1 to 2 with a 0.05 increment.

Study participant descriptive characteristics

A total of 72,554 reproductive-age women aged from 15 to 49 were used from the East African countries DHS data. The prevalence of partner alcohol use and intimate partner violence from East African countries was 37.94 with a CI of (37.58%, 38.29%) and 41.45% with a CI (41.09%, 41.80%) respectively. The characteristics of study participants before matching were described according to partner alcohol use (Table  1 ). From this propensity score matching analysis women’s age, partner age, maternal occupation, media exposure, sex household, wealth index, paternal education, and residence were significantly associated with a p -value of less than 0.05 with partner alcohol use before matching (Table  2 ).

Estimations of propensity score

The estimations of the association’s orientation, power, and significance aligned with the findings of other researchers (Table  2 ). The minimum variability with mean propensity score among the intervention and control groups was 1.44. The range of propensity scores varied from 0.08 to 1.24 which showed the common support assumption was satisfied. Reproductive-age women whose propensity scores fell below the range of common support were dropped from either the treatment or control groups.

Impact of partner alcohol use on intimate partner violence

The unmatched estimate indicates that women who have partner alcohol users are 2.89% more likely to have IPV than women who have not. The nearest neighbor matching had the best matching quality with a caliper width of 0.01. IPV increased by 2.78% as a result of partner alcohol consumption, according to an estimated average treatment on treated values of 59.41% in the treated and 31.51% in the control group. Similarly, the estimated average treatment effect on untreated values in the control group and treated group was 30.46% and 54.24%, respectively. This finding indicated that if the women who hadn’t partner alcohol use had been encountered with partner who uses alcohol the chance of developing IPV would have increased by 23.77%. Ultimately, it was found that among all research participants, the average effect on the population as a whole was 25.33% (Table  3 ).

Quality of matching

Common support.

Only one woman was eliminated because of off-support (Table  4 ). The propensity score distributions for both groups are almost identical when plotted on PSM after matching (Fig.  1 ). The significant overlap between the treatment and control groups’ features validates the common support assumption.

Propensity score histogram by treatment status (partner alcohol use)

Balancing test

The test’s significance level was established and the t-test was utilized to evaluate the difference between the matched and unmatched pairs. Almost all factors displayed no significant mean difference following matching, despite a significant mean difference across all covariates (Table  5 ). This proved that for every variable in the model, the treated and control groups were appropriately balanced.

Standardized bias

The pstest’s mean and median biases considerably lowered once the intervention and control groups were matched. The mean absolute bias in the unpaired sample decreased from 15.5 to 1.1% after the treated and control groups were matched. This is less than the 5% threshold and shows that the model’s quality matching has improved. The median bias decreased from 13.8% in the unmatched to 0.3% after matching (Table  5 ).

Model significance

The overall significance of the model was assessed using the LR and pseudo R2 tests. The pseudo-R2 was less than 0.001 and the LR-chi2 test had become negligible ( p  = 1.0), suggesting that there was no systematic variation in the covariate distribution between the treated and control groups (Table  6 ).

Sensitivity analysis

The Mantel-Haenszel finding indicated that the overestimation of partner alcohol use effect on IPV was not significant at 5% of the significance level. However, the statistical significance of the underestimating of partner alcohol use impact was established at a 5% level of significance. As gamma increases, the probability of underestimating the effect of partner alcohol use on IPV increases, suggesting a reduction in the possibility of heterogeneity due to unobserved factors (Table  7 ).

The main objective of this study was to determine the relationships between lifelong experiences of partner alcohol use and intimate partner violence among reproductive-age women. Secondary data analysis was conducted from the recent East African countries’ DHS data.

Based on PSM approach, partner alcohol use contributed to a 2.78% increase in intimate partner violence. The estimated average treatment on treated values in the treated and control groups were 59.41% and 31.51%, respectively. Comparably, the treated group’s estimated average treatment effect on untreated values was 54.24%, while the control group’s estimated average treatment effect was 30.46%. According to this research, the number of women experiencing IPV would have increased by 23.77% if they had met partner alcohol use instead of none. In the end, it was discovered that the average effect on the population as a whole for all research participants was 25.33%. This finding is comparable with other propensity score matching analyses that show the impact of partner alcohol use on IPV [ 4 ].

A significant positive association has been shown in a lot of studies between alcohol use and intimate partner violence. However, because people may misreport their alcohol abuse and because there may be reversed causality from IPV to alcohol abuse, it has been challenging to determine the causal relationship between alcohol abuse and IPV [ 5 ]. Additionally, there is a potential endogeneity issue, which suggests that those who are more likely to engage in excessive drinking are also more likely to engage in IPV due to an undetected third factor. Previous studies have demonstrated a correlation between colonization and alcohol consumption as a coping mechanism for being emotional of rage, avoidance, grief other factors [ 24 ].

These temporal correlations between frequent alcohol use by partners and IPV may be explained by several factors: Men who drink alcohol often may have poor judgment which makes it harder for them to recognize their fault and violation towards their intimate partners [ 25 ]. The effect of an intoxicated partner due to drinking alcohol was a great concern to cause intimate partner violence. Once men have been intoxicated after using alcohol their cognitive function entirely deteriorates which causes intimate partner violence among reproductive-age women in East Africa. The other justification for this association could be the effect of husbands who drink alcohol being easily tempered and aggressive toward their wives [ 26 ].

There is a frequent association between alcohol use and incidents of IPV among reproductive-age women. Although the idea that IPV causes alcohol usage cannot be completely ruled out, there is a lack of long-term data to support most previous studies [ 27 ]. This study determines the direct causative relation between partner alcohol use and intimate partner violence among reproductive-age women by 2.78%. This study estimates the correlation between alcohol consumption and IPV besides seeking to determine a causal relationship. According to DHS data, intimate partner violence is influenced by the partner’s alcohol consumption among women of reproductive age from East African countries.

Despite the presence of limitations, this study has several advantages. This is the first study to estimate bias through the determination of the causative relation of partner alcohol consumption on IPV into account using propensity score matching in East Africa. Nationally representative DHS data from 12 East African countries with a large sample size of 72,544 served as the foundation for this study and was used with a high response rate. The weakness of this study is the sensitivity of intimate partner violence results under-report their case. The variables that were observed provided the framework of the matching there might be a chance of the occurrence of residual confounding. Additionally, we have used DHS data with cross-sectional research that might have a social desirability and recall bias.

Conclusions and recommendations

Although it has been suggested that treating and preventing alcohol abuse is a good way to prevent IPV this guidance is not implemented widely in East African countries. These results highlight the necessity of using alcohol consumption reduction as a potential target for IPV prevention efforts and as a key correlate of IPV. These results imply that structural, macro-level actions may be able to reduce the causative association of alcohol use on IPV. When taken as a whole, these results emphasize the necessity of assessing multilayer intervention techniques to reduce or mitigate the causative association of alcohol use with intimate partner violence. Focusing on decreasing the partner’s alcohol consumption to mitigate the burden of intimate partner violence is our best recommendation.

Data availability

The DHS program repository contains the datasets that have been developed and/or assessed for this study, http://www.dhsprogram.com.

Abbreviations

Akaike Information Criteria

Adjusted Odd Ratio

Demographic Health Data

Confidence Interval

Intra-Class Correlation

Intimate Partner Violence

Median Odds Ratio

Proportional Change in Variance

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Acknowledgements

AcknowledgmentWe would like to thank the MEASUR DHS was approved to access this dataset to carry out this secondary data analysis.

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Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia

Mamaru Melkam

Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia

Bezawit Melak Fente

Department of Medicine, Adama General Hospital and Medical College, Adama University, Adama, Ethiopia

Yohannes Mekuria Negussie

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Contributions

MM conceptualized the study and was involved in design, analysis, interpretation, and manuscript writing. AAA, BMF, YMN, ZAA, HAA, BLS, and MMB made a substantial contribution to the extraction of data, analysis, interpretation, drafting of the manuscript, and critical revision. All the authors read and approved the final manuscript.

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Since we used secondary data and had no direct interaction with the study participants, ethical clearance was not required for this investigation. Study participants received written informed consent in return for their involvement. We have permission to access the data online by submitting a request to the DHS program’s measure at http://www.dhsprogram.com . The data was obtained via the program’s measure. The public can freely access information on the internet. The details of the ethical approval for the Demographic and Health Surveys (DHS) program make it possible to approve the download of survey data.

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Melkam, M., Fente, B.M., Negussie, Y.M. et al. Impact of partner alcohol use on intimate partner violence among reproductive-age women in East Africa Demographic and Health Survey: propensity score matching. BMC Public Health 24 , 2365 (2024). https://doi.org/10.1186/s12889-024-19932-6

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A Front-Row Change Agent of the Drug Epidemic

Dr. robert dupont shifted the paradigm from demonization to treatment of users..

Updated August 19, 2024 | Reviewed by Hara Estroff Marano

• What Is Addiction?
• Find a therapist to overcome addiction
• In the 1970s, people addicted to opioids were demonized, considered hopeless. Some still believe this.
• Setting high standards and following addicted patients for five years helps doctors know what treatments work.
• Prevention is key to success in substance abuse, and it’s important to encourage non-use among teens.

In the United States, people addicted to opioids were once demonized as hopelessly bad, and treatment was virtually nonexistent. No one may have done more to change both matters than psychiatrist Robert DuPont, M.D, who, in 1969, during an unexplained surge in crime in the nation's capital, was working with prisoners in the District of Columbia Department of Corrections. DuPont decided to test incoming inmates for drugs and was shocked to learn that nearly half (45%) were addicted to heroin. Desperate for heroin, they turned to crime for money.

At the behest of the district's mayor, DuPont developed a D.C.-based clinic, the Narcotics Treatment Administration. It treated more than 15,000 heroin addicts over the next three years, and the D.C. crime rate plummeted by 50%, in a direct correlation.

Helping Medical Professionals Do Better

Robert L. “Bob” DuPont, born in 1936, graduated from Emory University and Harvard Medical School and completed his psychiatric training at the National Institutes of Health. He became the first director of the newly-created National Institute on Drug Abuse (NIDA), where he created a first-of-its-kind comprehensive training program for doctors, nurses, and counselors working in addiction treatment programs. Drug overdose deaths began declining, from from 6,413 to 2,492 by 1980.

In 1978, DuPont left government service to create the Institute for Behavior and Health (IBH), a think tank focusing on drug policy. Dupont has published more than 400 journal articles and 15 books, most recently Chemical Slavery: Understanding Addictions and Stopping the Drug Epidemic (2018).

The IBH conducted the first national study of doctors dependent on drugs and alcohol , their treatment, and five-year outcomes. “Physicians are given a comprehensive assessment by a team of professionals and get treatment for comorbidities, but the focus is on their addictions. They typically attend a month or more of residential treatment and, as outpatients, are monitored for five years with random drug and alcohol testing. If they miss a scheduled test or test positive for any drug, including alcohol, they are taken out of their practice again, assessed, and sent back to treatment.”

DuPont points out that many doctors who entered the program were initially resentful because they didn’t think there was anything wrong with them—typical of individuals with substance use disorder from all walks of life. Yet, most physicians greatly value their medical license, and the overwhelming majority cooperated because participation and success meant they could continue to practice medicine.

His study of nearly 1,000 drug-addicted physicians closely monitored for five years showed what is possible for the rest of the population. Seventy-eight percent never tested positive for drugs or alcohol, an excellent record. In addition, of those who did have a positive or missed drug test, nearly two-thirds never had a second positive test.

A follow-up study of physicians who successfully completed treatment and monitoring contracts five or more years ago showed that more than 95% were still in recovery. Physicians rated the treatment they had received as important to their recovery but said the most valued part of their care was involvement in the 12 steps.

Lessons Learned About Substance Abuse

DuPont says many people don’t realize that it’s rarely just one drug abused by most problematic substance users. And that is particularly true of individuals who die from drug overdoses, in whom two or more drugs are often identified post-mortem.

He also notes that many drugs used today are not in their natural forms but instead are ultra-potent synthetics, like fentanyl. In 2022, about 111,000 people died, and in 2023, about 108,300 people died of drug overdose. .

Early diagnosis and treatment is key

The earlier patients are diagnosed and treated, the better their chances of achieving and sustaining recovery, says DuPont. Many people can stop using substances for some period. However, the real problem is not drug withdrawal, as many people believe, but, instead, the repeated relapses . Yet he has known many individuals with seemingly hopeless drug or alcohol issues who emerged sober and productive. He largely credits organizations like Alcoholics Anonymous and Narcotics Anonymous.

Prevention is best

Whenever possible, prevention of drug use is best, particularly among young people. Not only is adolescence a time when most addictions begin, it's also a time when the brain is uniquely vulnerable..

DuPont now focuses on youth substance-use prevention: no alcohol, nicotine, marijuana/THC, or other drugs by those under age 21. He notes that the percentage of 12th graders who report never using in their lifetime has increased from around 26% in 2018 to 32% in 2023. The trend is also evident in younger students. DuPont emphasizes, “This trend is key to reversing decades of pain, suffering, and addictions.“

At age 88, Robert DuPont, M.D., advocates for treatment research, long-term treatment with outcome reporting, mental health treatment parity (as important as physical health), and prevention. Recovery, he insists, is possible.

Levy S, Campbell MD, Shea CL, DuPont R. Trends in Abstaining From Substance Use in Adolescents: 1975-2014. Pediatrics. 2018 Aug;142(2):e20173498. doi: 10.1542/peds.2017-3498. PMID: 30026244.

DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians' Health Programs. J Subst Abuse Treat. 2009 Mar;36(2):159-71. doi: 10.1016/j.jsat.2008.01.004. PMID: 19161896.; DuPont RL, Compton WM, McLellan AT. Five-Year Recovery: A New Standard for Assessing Effectiveness of Substance Use Disorder Treatment. J Subst Abuse Treat. 2015 Nov;58:1-5. doi: 10.1016/j.jsat.2015.06.024. Epub 2015 Aug 1. PMID: 26277423.

Compton WM, Valentino RJ, DuPont RL. Polysubstance use in the U.S. opioid crisis. Mol Psychiatry. 2021 Jan;26(1):41-50. doi: 10.1038/s41380-020-00949-3. Epub 2020 Nov 13. PMID: 33188253; PMCID: PMC7815508.

DuPont RL, Lieberman JA. Young brains on drugs. Science. 2014 May 9;344(6184):557. doi: 10.1126/science.1254989. PMID: 24812368

Mark S. Gold, M.D., is a pioneering researcher, professor, and chairman of psychiatry at Yale, the University of Florida, and Washington University in St Louis. His theories have changed the field, stimulated additional research, and led to new understanding and treatments for opioid use disorders, cocaine use disorders, overeating, smoking, and depression.

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SOU faculty member earns research fellowship on substance abuse

(Ashland, Ore.) — Kelly Szott, an associate professor of sociology at Southern Oregon University, has been awarded a post-doctoral fellowship at New York University’s Rory Meyers College of Nursing to study drug use and addiction issues during her sabbatical year at SOU. The fellowship is funded by the National Institutes of Health.

Her 12-month fellowship through NYU’s Behavioral Sciences Training in Substance Abuse Research program began June 30 and will be her first step in studying the effects of climate change on drug use, drug markets and treatment.

“My main aim with this fellowship is to work toward developing a grant proposal for a research project that examines the impacts of climate instability (including wildfires, drought and smoke) on drug use risks, such as overdose,” Szott said.

She is one of 16 pre- and post-doctoral researchers from around the country who were awarded fellowships in the NYU program to study a variety of drug use and abuse issues ranging from drugs among college students to politics in drug policy. The fellows meet each Monday to collaboratively review their work, listen to speakers and participate in training.

The Behavioral Sciences Training in Drug Abuse Research program at NYU has been funded by the NIH’s National Institute on Drug Abuse since 1984, making it the largest and oldest such training program. It awards fellowships to researchers from a variety of academic disciplines, including public health, social work, psychology, criminal justice, sociology and nursing.

Szott is a medical sociologist who uses qualitative methods to study drug use and harm-reduction responses. She received her bachelor’s degree in social science from the University of Michigan, and her master’s degree and Ph.D. in sociology from Syracuse University.

Her past research has focused on fentanyl use and harm-reduction responses in rural contexts. Her more recent research has examined wildfire’s impacts on the health and social support networks of rural, older adults – which she is now expanding to the impacts of climate crisis events on drug use. Szott’s research has appeared in publications including the monthly International Journal of Drug Policy, and the Critical Public Health and Human Organization quarterly journals.

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Office of Research Training, Diversity, and Disparities Newsletter, August 2024

What’s New at NIDA

Changes to nida’s diversity supplement program .

ORTDD is excited to announce some changes to the NIDA Diversity Supplement Program! For more than 30 years, NIH has made available supplements to existing grants to provide research opportunities, training, and mentorship to enhance the diversity of the biomedical research workforce.  NIDA is proud to participate in this NIH-wide program, and our team at the ORTDD would like to spread the word to PIs on active NIDA awards as well as to potential applicants about this opportunity.  PIs are encouraged to participate, so long as an active grant mechanism is eligible, there is sufficient time remaining during the initial award period for the supplement, and the and the PI is committed to mentoring and career development for the candidate. K award grants are not eligible to have Diversity Supplements, but most other mechanisms are!

Program details:  Diversity supplement scholars may be post-bacs, master’s degree holders, doctoral students, post-docs, or early career investigators who meet eligibility criteria outlined in PA-23-189 . A NIDA grantee-applicant must work closely with an eligible candidate to create a plan that will facilitate the scholar’s progression to the next career stage. The proposed research and training activities must be appropriate for the stage of the candidate, and the project must be within scope of the parent research award. Applications are administratively reviewed, that is, reviewed by NIH program staff.  NIDA PIs can apply through the general NIDA Diversity Supplement Program or through a specialized program, such as the one managed by the BRAIN Initiative .

What’s new: In fiscal year 2025 (which starts on October 1, 2024), NIDA’s general Diversity Supplement Program will have multiple receipt dates. While you can submit your application at any time, the cut-off dates for NIDA’s administrative review will be August 15th, October 15th, December 15th, February 15th, and April 15th.  The final receipt date to be considered for funding in the fiscal year (which ends September 30th) is April 15th. Another change to the program is that applications are limited to 6 pages regardless of the page limit for the “parent” grant mechanism , making application review equitable for all grant mechanisms. Please be certain to check your page limit!

For more information: To learn more, please see the Instructions to PI's and FAQ's , and reach out to Dr. Angela Holmes, NIDA’s Diversity Supplement Program Coordinator at ( [email protected] ).

Program Updates

A new nida funding opportunity hit the street consider applying for a “d-start”.

The National Institute on Drug Abuse (NIDA) has published a new notice of funding opportunity (NOFO), PAS-24-242 , entitled “Data Science Track Award for Research Transition (D-START).”   Awards will support investigators to apply advanced data science techniques to address timely and challenging research questions related to substance use and substance use disorders (SUD). As defined by NIH, data science encompasses the development and use of quantitative and analytical methods to extract knowledge from large and complex data sets. Expanding expertise in data science, particularly in big data analytics and computational science, is crucial for advancing SUD research. The goal is to generate data-driven insights to inform the development and implementation of interventions for prevention, harm reduction, treatment, and recovery across diverse populations.

While the R03 mechanism is used for this award, the D-START allows for projects with budgets of up to $100,000 per year in direct costs over 2 years.  NIDA plans to fund 6-7 projects per year during the 2025, 2026, and 2027 fiscal years, depending on annual institute appropriations and the receipt of meritorious applications.  D-START awardees are expected to use their project findings to pursue further grant applications, such as a subsequent R01, focusing on the intersection of substance use and data science. Cross-disciplinary collaborations are strongly encouraged, and NIDA welcomes applications from individuals of diverse backgrounds, including those historically underrepresented in STEM fields. Applicants should adhere to Findable, Accessible, Interoperable, Reusable (FAIR) principles and address ethical considerations in research involving human subjects. Read more about this opportunity .

Apply for a NIDA Travel Award

Call for applications! NIDA is providing travel awards for scholars interested in attending the Society for Research on Nicotine and Tobacco on March 12 -15, 2025 in New Orleans, LA. The deadline to apply is December 1, 2024 at 11:59pm ET.

The NIDA Travel Award Program aims to defray the costs of in-person attendance at national scientific conferences. Travel award recipients will receive an award in the amount of $1500 for meeting transportation, lodging, and/or registration. Awardees are expected to attend a NIDA “meet-and-greet” at the conference.  See the NIDA Travel Award website for information about eligibility and how to apply.

Please contact Yohansa Fernández for any questions related to NIDA travel awards.

Career Development Spotlight: Dawn Bounds PhD, PMHNP-BC, FAAN

The NIDA ORTDD is excited to introduce Dr. Dawn Bounds to the research training community. Dr. Bounds is an Assistant Professor at the University of California, Irvine within the Sue & Bill Gross School of Nursing. Her research interests include marginalized youth, adolescence, risk, resilience, commercial sexual exploitation, social media, mental health, integrative health, as well as wearable and biofeedback technology. She was a 2021 NIDA Diversity Scholars Network program participant and was recently awarded a 5-year R01 grant titled “ Teaching Youth & Families Self-Regulation Skills to Disrupt the Impact of Adverse Childhood Experiences: Preventing Substance Use in Adversity-Impacted Youth .” Her research focuses the impact of the Garnering Resilience in Traumatized youth and families (GRIT) program on early initiation of alcohol and cannabis use among youth. Read about her below and what aspired her to become an addiction researcher.

Please share a little about yourself and your upbringing (if you're comfortable doing so), your educational background, and research focus.

I am the oldest of two daughters who were raised by a single mom. I am also a first-generation college student who was born and raised in Chicago. I spent all of my life there including my graduate education. I graduated with a BSN from the University of Illinois at Chicago in 1999 and an MSN and PhD from Rush University in 2004 and 2015. Prior to becoming a researcher, I worked in the community as a psychiatric-mental health nurse practitioner. My experiences as a clinician working with marginalized youth on the west side of Chicago informs my research interests to this day. My program of research focuses on youth risk and resilience. More specifically, I am interested in preventing substance use initiation and disorders in adversity impacted youth.

At what point in your life did you know you wanted to become a scientist? What drew you to the STEM field and particularly substance use/addiction research?

I never knew that I wanted to become a scientist because I had little exposure to research. It is one of the reasons I am currently so committed to exposing high school and undergraduate students to research through my lab. I used to teach in a master’s program that changed to a doctoral program and I was urged to get my doctorate to continue teaching. This prompted me to get my PhD.  During my program and working on a NIH funded study, I fell in love with research. 

I have to admit I used to be a little resistant to working in the field of substance use/addiction due to my firsthand knowledge of what it does to families. But what I realized is that trauma and adversity (my area of interest and expertise) is inextricably linked to substance use/addiction. To continue to excel in the field of trauma and adversity, meant including substance use/addiction research.

Were there any events or individuals who inspired you throughout your professional journey?

My mother is my greatest inspiration. She always taught me to defy all odds. My own life experiences taught me persistence. I have encountered several amazing mentors and colleague along the way who have inspired me, fought and advocated for me, and supported me on my professional journey. 

How did you learn about the NDSN Program? Please share about your experience as an NDSN scholar and major takeaways from participating in the program.

I tend to search out training programs and opportunities that support minoritized individuals like myself. These training programs have expanded my network and knowledge about programs like the NDSN. The NDSN provided a unique opportunity to receive a mock review of my grant which was so valuable. The biggest take away for me was to keep resubmitting my proposal. Doing so led to me finally getting funded this year.

What has been the most challenging obstacle you have had to face throughout your career journey to becoming an addiction researcher and what have you done to “push through”?

Not letting my career in academia become my sole identity has been most challenging. Academia and research can be consuming. Striking a balance between my work and the other aspects of my life has been an ongoing process. Understanding and prioritizing what’s most important to me has helped me push through with the help of my spirituality, supportive family and friends, and therapy. Building a support network that includes those who have thrived in academia is key.

Can you offer any advice to ESIs/scholars in earlier career stages who are navigating the NIH process for submitting grants and working towards the goal of being independently funded?

Persist! You belong in this space and your work is important to the field. Keep innovating, revising, and resubmitting those grants!

Is there anything else that you would like to share with the NIDA community about your inspiring journey?

I am truly grateful for being a part of the NIDA community. NIDA has supported my growth and development over the past 4 years. These initial investments through training have now led to a larger investment in my research. I’m excited to continue to collaborate with other NIDA scholars and prevent addiction and substance use disorders in adversity impacted youth.

Did You Know?  

Your opinion matters  check out the latest “rfi” on supporting postdoctoral scholars.

The National Institutes of Health (NIH) is seeking feedback from the biomedical research community through a follow-up Request for Information (RFI) as part of an overarching goal to better support the postdoctoral scholar workforce. NIH began implementing recommendations earlier this year by increasing pay levels for Ruth L. Kirschstein National Research Service Awards. A Request for Information has been issued to gather community input on additional proposed actions to accelerate the career transition of postdoc scholars into thriving biomedical research careers. 

Through the RFI, NIH is seeking additional specific suggestions, evidence-based strategies, and relevant data or related experiences that will help inform our potential strategies. Feedback will be accepted electronically until October 23, 2024 . Please feel free to respond and widely share the RFI with your networks!  NIH is particularly interested in receiving input from:

• Trainees (e.g., graduate students, postdocs),
• Early-stage investigators,
• Biomedical faculty,
• Training directors,
• Postdoctoral and graduate student office leaders,
• Biotech/biopharma industry scientists, and research education program advocates.

NIH encourages organizations (e.g., patient advocacy groups, professional societies) to submit a single response reflective of the views of the organization or its membership. Please direct all inquiries related to this RFI to [email protected] .

Closing the Ginther Gap: Annual Update on NIH's Progress

In late July, NIH’s annual update on efforts to address the “Ginther Gap” was published Dr. Marie Bernard, the Chief Officer for Scientific Workforce Diversity (COSWD), and Dr. Mike Lauer, the NIH Deputy Director for Extramural Research.  The “Ginther Gap” refers to results from a 2011 study that found a 10 percentage point difference in grant application success rates between black and white applicants, favoring white applicants. This update is a continuation of their work to examine research project grant (RPG) and R01 funding rates by race and ethnicity, as NIH has developed numerous programs to address disparities over the past decade. Drs. Bernard and Lauer report that despite some progress, disparities in funding rates by race and ethnicity persist. However, they also reveal in a recent blog that funding rates for K awards increased between 2010 and 2022.  This is encouraging, as K awards often precede research project award funding.

Notable NIH initiatives to promote diversity in the scientific workforce include the Common Fund Diversity Program Consortium (DPC) and the Faculty Institutional Recruitment for Sustainable Transformation (FIRST) initiative. Along with the UNITE initiative, these programs aim to ensure that a diverse range of voices contribute to scientific innovation. The NIH remains committed to monitoring and evaluating progress towards achieving equity in funding, ensuring there are no barriers to participation. Read more about this update in the full blog post .

NIH UNITE Workshop on Structural Racism and Health Research

Have you ever wondered what is meant by “structural racism” or what structural racism has to do with health research and health outcomes?  On July 18th and 19th, the NIH UNITE Initiative leadership and members convened a virtual workshop to explore these and related topics. The workshop featured researchers, clinicians, and community partners with expertise in fields such as social and natural sciences, law and criminal justice, education, public policy, and social work—as well as biomedical, behavioral, and public health. Speakers provided insights into the origins and drivers of structural racism, methodological considerations in the measurement of structural racism, and interventions to improve health outcomes through strategies that reflect an awareness of the research on structural racism. A recording of the webinar is now available using these links: July 18 Videocast | July 19 Videocast .  See the workshop website for additional information about the event.  

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Consistency of self-reported drug use events in a mixed methods study of people who inject drugs

Stephanie r. dyal.

a Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California

Alex H. Kral

b Urban Health Program, RTI International

Karina Dominguez Gonzalez

Lynn wenger, ricky n. bluthenthal.

Little is known about the consistency of information provided by people who inject drugs (PWID) during quantitative and qualitative interviews in mixed methods studies.

We illustrate the use of the intraclass correlation coefficient, descriptive statistics, and regression to assess the consistency of information provided during a mixed methods study of PWID living in Los Angeles and San Francisco, California, USA.

Age of first use of heroin, methamphetamine, marijuana, powder cocaine, and crack cocaine and first injection of heroin, methamphetamine, and powder cocaine were collected during an interviewer administered computer-assisted personal interview followed by an in-depth qualitative interview ( N =102).

Participants were 63% male, racially/ethnically diverse. 80.4% between the ages of 40 and 60 years old, 89% US-born, and 57% homeless. Consistency of self-reported data was adequate for most drug use events. Exact concordance between quantitative and qualitative measures of age of onset ranged from 18.2% to 50%. Event ordering was consistent across qualitative and quantitative results for 90.2% of participants. Analyses indicated that age of onset for heroin use, heroin injection, and injection of any drug was significantly lower when assessed by qualitative methods as compared to quantitative methods.

While inconsistency will emerge during mixed method studies, confidence in the timing and ordering of major types of events such as drug initiation episodes appear to be warranted.

Introduction

Mixed methods designs – study approaches that use both qualitative and quantitative techniques --- are increasingly used in substance use research ( 1 , 2 ). These techniques provide new insights, yet also challenge researchers to interpret complimentary datasets that may contain contradictory information. While some researchers have provided guidance on how to reconcile contradictory results across qualitative and quantitative studies ( 3 , 4 ), there exists little guidance on how to approach interpreting discrepancies in raw data from qualitative and quantitative portions of the same study. This study examines consistency of measurement of age of initiation to drug use in a mixed methods study guided by life course theory's emphasis on timing and trajectories of drug use events ( 5 , 6 ).

Data triangulation techniques have been designed to encourage the use of multiple research methods with complementary strengths and weaknesses to arrive at research findings with reduced methodological biases ( 7 , 8 ). These techniques are commonly used to incorporate qualitative and quantitative results into a cohesive conclusion about the data( 1 ). Thus, data triangulation generally assesses if the results of analyses from multiple methods are the same (or explain one another) as opposed to asking if the raw data collected from the different methods is consistent, which is our present aim. The multitrait-multimethod matrix was proposed by Campbell and Fiske to assess convergent and discriminant validity ( 9 ). While this method can be used to assess the agreement of raw data from multiple methods, it uses correlations and cannot detect differences in methods which use the same scale where it may be important to detect a systematic arithmetic difference in data collected using multiple methods. Additionally, it was developed for use with data from uncorrelated or minimally correlated variables, such as unrelated personality traits, and may not be applicable to substance use behaviors which are often associated ( 10 ).

In this paper we present ways to find discrepancies in data and potential reasons for the discrepancies using a mixed methods study of people who inject drugs (PWID). Our interest in these issues grew out of our use of life course theory ( 6 ) to understand patterns of drug injection initiation among PWID ( 11 , 12 ). Life course theory's focus on the time and timing, trajectories and transitions, critical periods, and accumulated risk at which important events occur within a person's life makes accurate collection of data on when crucial events occur particularly important ( 6 , 13 ). Past studies of drug use patterns have illustrated the usefulness of examining the trajectories of drug use ( 5 , 14 ). This research area will only be fruitful if accurate drug use histories are obtained. Exploring the consistency of data and potential methodological reasons for inconsistencies may aid in improvement of data collection methods and/or provide validation for current methodologies.

Research examining the consistency of age of initiation to illicit drug use is sparse. However, age of initiation has important clinical implications and is associated with increased risk for drug abuse and dependence ( 15 , 16 ). Some studies have assessed consistency of report of onset of tobacco, alcohol, and marijuana use and have described phenomena associated with discrepant reports ( 17 – 19 ). Therefore, we briefly review literature concerning age of initiation to alcohol, tobacco, and marijuana use.

Common issues related to recall bias and consistency between qualitative and quantitative data collection include forward telescoping and event clumping ( 17 ). Forward telescoping refers to reporting that an event occurred more recently than it did in actuality, such as reporting an older age of onset for drug use than is true ( 19 ). This may occur simply due to a perception that the event occurred more recently or to a changed understanding of the research question as age increases ( 17 ). For example, a child may consider their first alcohol use to be their first sip of alcohol, while a teenager or young adult may consider their first alcohol use to be when they first drank heavily ( 17 ). The events did not change, but the participants' understanding of what their first alcohol use was had changed, resulting in inconsistently reported age of onset.

Event clumping refers to reporting events as all occurring around the same time due to a rounding of age or perception that events all occurred around one important event in a person's life ( 17 ). For example, a participant may report that they began using 3 different drugs at the age of 18 when they first entered college, when in actuality their ages of first use may be more spread out. Clumping may affect both estimates of mean age of onset as well as ordering of drug use events. It is not known if data collected using qualitative or quantitative methodologies may be more susceptible to forward telescoping or clumping.

Studies of the consistency of age of onset of drug use of adolescents and young adults suggest that age of onset may not be consistently reported ( 17 , 18 ). In a longitudinal repeated-measures study of age of onset in adolescents, age of onset was not reported consistently, particularly for tobacco and alcohol use ( 18 ). However, consistency was observed in the ordering of drug use events ( 18 ). For example, participants' first use of alcohol is consistently reported as occurring prior to their first use of marijuana, even though both events on average are reported to have occurred at a later age in follow-up measurements ( 18 ). Therefore, while age of onset of drug use may not be consistently reported, participants generally report the order in which drug use events occurred consistently.

This study examines discrepancies in self-reported age of initiation to drug use collected using qualitative and quantitative methodologies. Due to limited research on this topic, we do not propose any hypotheses concerning discrepancies we may observe.

We present data from across-sectional study that used community outreach and targeted sampling methods ( 20 , 21 ) to identify and recruit PWIDs in Los Angeles and San Francisco, California, USA. The overall goal of the parent study is to conduct an exploratory qualitative and quantitative study of late initiation to injection drug use to better understand the circumstances, motivations, and social environments of injection initiation later in life (after turning 30 years old)( 11 , 12 , 22 ). Eligibility criteria for the study was being 18 years of age or older and having physical evidence of recent drug injection (at least one injection episode in the last 30 days and visible signs of recent venipuncture)( 23 ). After obtaining informed consent, we collected drug use, HIV risk behavior, and demographic data among other domains during a 30-minute survey using computer assisted personal interviewing involving a standardized questionnaire administered in a one-on-one interview session ( 24 ). Participants who began injecting at or after 30 years of age were invited to participate in an in-depth qualitative interview lasting 60 to 90 minutes. Eligibility criteria for participation in the qualitative study were masked to reduce the likelihood of participants providing false information during the quantitative interview. A comparison group of participants who began injecting at a younger age, but who were also over 30 years of age at the time of the quantitative interview, were also invited to participate in a qualitative interview. Qualitative interviews were conducted using a qualitative guide that contained open ended questions and follow-up probes that addressed key aspects of the research questions of interest. This type of guide was used to maintain a balance between systematic data collection in pertinent topic areas and exploration of emergent themes ( 25 ). The guide was modified over the course of the study as we learned about and explored unanticipated areas of analytic interest. Participants were paid US$20 for completing the quantitative portion of the study and an additional US$25 for completing the qualitative portion. The Institutional Review Boards at the University of Southern California and at RTI International approved all study procedures. Only participants who completed both the quantitative and the qualitative interviews are included in these analyses.

Transcribed qualitative interviews and quantitative data were used to create timelines detailing events in participants' lives, separate per participant, following a method described by Friedman et al. using Timeline Maker software ( 26 , 27 ). All events available from qualitative and quantitative data with specific dates or general time periods provided were entered onto the timelines. Each event was included as a separate entry which contained a short description of the event, start/end dates, event category, and data source (qualitative or quantitative). On occasions where participants stated two different ages for age of onset in the qualitative interview, the ages were averaged. Illustrative examples are a participant who stated first using marijuana at age 16 or 17, without specifying which age exactly (averaged to 16.5) or a participant who stated that they first used marijuana at age 16 in one dialogue then stated they first used marijuana at age 18 in a later portion of the interview, without acknowledging that they reported two different ages or stating that they were correcting past information provided. Data was extracted from the timelines for analyses. Creating the timelines highlighted discrepancies in age of onset from qualitative and quantitative data and inspired this study. Data from additional participants (detailed below) were entered directly from the quantitative dataset and qualitative interview into the study dataset in order to obtain a larger sample to assess the study aims while by-stepping the timeline creation process in order to have a larger sample size while limiting data processing unnecessary for the present study.

We selected 9 items to assess for consistency from the quantitative interview that elicited age of onset of use or injection for 5 drugs. The items were: (1) “The first time you injected drugs, how old were you?”; (2) “How old were you when you first used crack?”; (3) “How old were you when you first used powder cocaine?”; (4) “Age at first powder cocaine injection”; (5) “How old were you when you first used methamphetamine?”; (6) “Age at first methamphetamine injection?”; (7) “How old were you when you first used heroin?”; (8) “Age at first heroin injection?”; and (9) “How old were you when you first used marijuana?”. Skip patterns were built into the interview such that age of onset was only assessed if the participant indicated that they had used/injected the specified drug in a previous question. Crack cocaine injection was assessed in the quantitative interview but is not included for analysis due to the rarity of occurrence in our sample.

We assessed the data for discrepancies in quantitative and qualitative measures of mean age of first use of the nine substance use items. Items that the participant had not experienced or did not provide data for in both the quantitative and the qualitative interviews were dropped from the dataset. One hundred and eight participants' data was assessed for inclusion in the analytic sample (61 timelines and 47 additional participants' data entered directly into dataset). One participant was dropped from the analysis because they violated study protocols. Out of the remaining 107 participants, 102 provided data during both qualitative and quantitative interviews on at least 1 item. These 102 participants constitute the analytic sample. Refer to Table 1 for specifics on sample size.

Descriptive statistics for the age of onset were examined. Preliminary analysis to assess if there was a statistically significant difference between the quantitative and qualitative measures of age of on set was completed with paired t-tests. These were followed with linear regression models which controlled for time elapsed in years since age of onset and time elapsed in days between qualitative and quantitative interview. Separate models were computed for each event of interest. Normality of the distribution of age of onset was assessed for all 9 item; skewness ranged from -0.43 to 1.25 and kurtosis ranged from 1.80 to 4.47. Due to a large range in the difference scores calculated between quantitative and qualitative data, data was analyzed both with outliers and without outliers. Outliers were determined by taking the mean of the absolute values of the differences between quantitative and qualitative measures of all reported items per participant and identifying those participants whose average differences were at or above the 95 th percentile for the sample.

Intraclass correlation coefficients (ICCs) were calculated using the single score ICC (A,1) formula printed below and as described in Table 4 of McGraw and Wong( 28 ).

This formula is appropriate for two-way mixed effects models where the raters (in this case, qualitative and quantitative measurement) are fixed and we are interested in the absolute agreement in the data as opposed to simply the consistency of the data, where a systematic arithmetic difference could be present between the raters without detection. In this formula, n = number of subjects, k = number of observations per subject, MS R = mean square rows, MS E = mean square error, and MS C = mean square column. Conceptually, variance due to the column (due to the raters) refers to variance attributed to using qualitative or quantitative methods and variance due to the rows (due to the unit of measurement) is attributed to differences among the participants. Therefore, the ICC is the percent of the variance in a variable that is due to differences between the participants ( 28 ). ICCs closer to one indicate high consistency, and ICCs closer to zero indicate low consistency. The Stata ICC command with options absolute and mixed in Stata 12.1 was used for analyses, and was checked by running the ANOVA command and calculating the ICC using the ICC (A,1) formula( 29 ).

Concordance of age reported was assessed by presenting the percentage of participants who reported the same age of onset in qualitative and quantitative interviews and the percentage of participants who reported ages of onset within 1 year of each other in qualitative and quantitative interviews. Consistency in ordering of events was also assessed. The ordering of drug use events was considered consistent if participants reported the same sequence of onset of the various drugs in both the qualitative and quantitative data, regardless of the ages at which the events occurred. For example, a participant may report marijuana use at age 16 and first injection drug use at age 40 in the qualitative study and marijuana use at age 18 and injection drug use at age 30 in the quantitative study. This observation would be considered consistently ordered because the events occurred in the same order, albeit at different ages. However, if in this example the participant reported that injection drug use occurred prior to marijuana use in the quantitative study the observation would be considered inconsistently ordered.

Sample demographics are presented in Table 2 . Briefly, the sample was 63% male and racially/ethnically diverse. The majority of participants was between the ages of 40 and 60 years old, US-born, and had obtained at least a high school education. Slightly over half of the participants considered themselves homeless.

Descriptive statistics and ICC of the drug use items are presented in Table 3 . Note that there is a different sample size for each drug use item; refer to Table 1 for detailed information addressing sample size by item. For all drug use items, the participants were on average younger at time of first drug use/injection when assessed using qualitative methods as opposed to quantitative methods, with the exception for crack cocaine use. Analyses indicated that age of onset for heroin use, heroin injection, and injection of any drug was significantly lower when assessed by qualitative methods as compared to quantitative methods; findings remained after controlling for time elapsed between interviews and time elapsed since age of onset. Five outliers were identified. These participants had discrepancies with average magnitudes ranging from 9.2 to 18.9 years. Findings did not change when these outliers were excluded.. ICCs ranged from 0.69 to 0.96. ICCs for drug use items were lower than ICCs for drug injection items. Marijuana had the lowest ICC, at 0.69. All other items had ICCs of 0.79 or higher. Exact concordance between quantitative and qualitative measures of age of onset ranged from 18.2% to 50%. Concordance within one year ranged from 43.2% to 67.7%. Lastly, event ordering was consistent across qualitative and quantitative results in 90.2% (92 out of 102) of the timelines.

Note . Asterisk indicates significant difference between qualitative and quantitative measurement as determined by linear regression using age of onset as dependent variable and measurement method as predictor. Time (years) elapsed since age of onset and time (days) elapsed between measurement included as covariates.

Our data suggest that qualitative and quantitative techniques result in data adequately consistent with one another for age of onset of use and injection of a variety of illicit drugs. This is a promising finding in that it supports that these research methods collect consistent data. Age of drug use onset events were reported less consistently than age of drug injection onset events. Onset of injection is likely a remarkable event in the lives of PWIDs and may have occurred simultaneously with other life course altering events, resulting in more consistent recall in comparison to drug use by other means. Furthermore, since our study sample consisted solely of PWIDs, our participants' most memorable drug use experience may have been first injection. If we sampled people who only use drugs by routes other than injection, we may find that they recall with greatest consistency onset of use of the drug that caused the most problems for them, produced the most desired effects, and/or their most commonly used drug. Participants may also be commonly asked to report their age of first injection to medical professionals for health risk assessment, and may have a prepared response to the question as opposed to having to think about their response.

The results varied with the statistic used. ICCs were lower for items where age of onset was reported inconsistently by a large proportion of the sample, regardless of the magnitude of the discrepancy. Percentage concordant within one year was above 50% for almost all items; the majority of participants was able to recall their age of first use consistently with a one year margin for error. However, the large standard deviations and ranges for the differences between qualitative and quantitative measures suggest that some of those participants who inconsistently report age of onset may do so with a large error. Large standard deviations and small magnitudes for differences in report of age of onset have been noted in previous studies of consistency of self-report data ( 18 ).

While the ICC quantifies the level of consistency between quantitative and qualitative measurements, there is no formal scale for assessing ICC values. Landis and Koch provide a rubric for determining what an acceptable reliability coefficient is, although, as they note in their paper, it was developed with arbitrary distinctions ( 30 ). According to them, moderate agreement ranges from 0.41-0.60, substantial from 0.61-0.80, and almost perfect from 0.81 to 1. This scale is helpful in assessing ICC, but it was originally developed for the kappa statistic and highlights a weakness of the ICC---interpretation may be subjective.

The quantitative methods produced slightly higher values age of onset in comparison to the qualitative methods. This difference was significant for heroin use, heroin injection, and injection of any drug. For some participants, these three events are not independent of one another. For example, a participant may first have used heroin by injecting it, and that injection event may be the first time they have ever injected drugs ( 31 ). Low sample size may be affecting the results as well, and this study may have been underpowered to detect differences in measurement for items reported less frequently.

As we cannot know the true age at which these events occurred (validity), we cannot say if quantitative methods overestimate age or if qualitative methods underestimate age. It may also be the case that both methods either underestimate or overestimate age of onset. We consider both explanations plausible. Forward telescoping may have occurred during the quantitative portion of the study. Participants may have overestimated their age when answering questions regarding first use/injection. Qualitative techniques may have helped the participants put drug use/injection events in context of the rest of their lives and prompted them to report more accurate ages ( 32 ). Additionally, the quantitative portion of the study occurred first for almost all participants. Only one participant completed the quantitative interview after the qualitative interview. The act of completing the quantitative survey may have caused participants to change how they interpreted their memories or their actual memories of their first drug use, resulting in the discrepancy. Participants also had time in between completing the quantitative and the qualitative interviews, allowing them more time to think about their responses to the questions. The noted differences may not be due to measurement method, but to ordering of assessment.

Question interpretation may have affected the results for those PWIDs who had stopped their drug use and began again. When asked when they first injected in the quantitative interview, it appears a couple participants provided the age of when they began injecting most recently, that is, at what age they began injecting after a period of abstinence as opposed to when they first injected ever in their life. The timelines helped to identify this discrepancy. This finding suggests that care should be taken when designing quantitative questionnaires and pilot testing may be necessary to check that participants are interpreting questions as intended by the researcher.

Researcher effects were additionally of concern in this study. Participants may have provided false information during the qualitative and/or quantitative study due to embarrassment or the illicit nature of drug use. We did conduct t -tests by drug and for average discrepancy to examine if those participants who had a consistent interviewer for the qualitative and quantitative portions of the studies provided more or less consistent results. Data on interviewer was available for 90 participants. Of these 90, 34 participants (38%) had the same interviewer for both interviews. We found that having a consistent interviewer had no effect on discrepancies ( ps = .09-.99). All researchers were experienced and trained and no evidence suggests that researcher effects account for the discrepancies found.

Methamphetamine and heroin use and injection exhibited discrepancies with the largest magnitude in terms of the difference in the number of years between quantitative and qualitative responses. Findings for methamphetamine are supported by past longitudinal research which identified amphetamine use as having the highest number of discrepancies in reporting of a variety of substances when ever/never use was assessed over a 10-year period in a repeated-measures study ( 32 ). The context in which methamphetamine is used or the effects of the drug itself may result in inconsistent recall of memories surrounding the time of first use.

One important finding was that while the age of use measured by qualitative and quantitative methods did not always match up perfectly, the order of events did not differ for most participants and concordance of age of onset within one year was at least 43% for all items. There appears to be stability in report of the progression of age of onset events regardless of the method of measurement. This suggests that whether events are measured through a qualitative interview or through a quantitative instrument the sequence of events should be consistent.

Study results should be considered in light of potential methodological limitations. First, some of the items had very small sample sizes. In particular, neither powder cocaine injection nor crack cocaine use was commonly reported in the qualitative interviews. The low sample size is potentially why we failed to find statistically significant difference between the quantitative and qualitative measures for these and other smaller sample sizes items. There are recommendations for sample size for reliability studies when calculating the ICC ( 33 ). Given that these analyses are part of a larger study, we were not able to address this prior to data collection, and sample sizes for some items may be lower than ideal. The qualitative interviews were not structured in a way to capture all first drug use events. As this information was not necessarily elicited by the interviewer, there is missing data. It is unknown if this missing data has affected the results.

Second, our data may not be representative of all PWIDs, and findings may not generalize to the larger population of PWIDs. The qualitative sample here was chosen specifically due to their status as late initiates (30 or older) or typical initiates (before age 30) of drug injection. Since everyone in the qualitative study had to be at least 30 years of age, these data do not generalize to persons under age 30.

Future research should focus on confirming the current findings in larger samples and different populations and exploring causes for discrepancies. Statistics used to assess consistency can affect interpretation; multiple statistics may be necessary to describe consistency in self-report data. Overall the data exhibited a high rate of concordance for age of onset reported, particularly when considering the majority of the participants was over 40 years old and age of onset for all items occurred on average prior to the age of 35. However, significant differences in age of onset were noted between measures for some items, and lack of significance for the rest of the items does not indicate equality in their measurements. Fuller understanding of factors influencing self-report of age of onset may improve the collection, analysis, and interpretation of data for mixed-methods studies of PWIDs.

Acknowledgments

We would like to thank the large research team which conducted this study. The San Francisco team consisted of Sonya Arreola, Askia Muhammad, Andrea Lopez, Jahaira Fajardo, and Michele Thorsen. The Los Angeles team consisted of Daniel Chu, Frank Levels, Richard Hamilton, Guillermo Felix, Vahak Bairamian, Luis Maldonaldo, Jacob Curry, and Brett Mendenhall. And we would like to acknowledge the participants, without whom we would be unable to conduct this research.

Funding: We would like to thank the National Institute on Drug Abuse (Grant # 5R01DA027689) and the Tobacco-Related Disease Research Program (Grant # 23DT-0112) for funding this research.

Declaration of Interest : The authors report no declarations of interest.

Works Cited