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The increasing prevalence of substance use disorder (SUD) is a major public health crisis in the Unites States. Adolescence is an ideal period for early intervention to reduce the risk of SUDs in adulthood, as research has shown that up to 60% of adult SUD could have been avoided by early intervention in youth. Prior research has typically focused on urban metropolitan areas when describing adolescent substance use. However while the data is varied, several studies have shown that the prevalence of rural adolescent substance use is equal or greater than that of their urban peers, particularly alcohol, tobacco, and prescription drug use, and begin use at an earlier age. There are several methods of treatment for adolescent substance use and SUD, centered on evidence-based practices, which have been shown to be moderately effective at reducing substance use. Despite the existence of these treatment strategies, substantial disparities exists with respect to the number of adolescents who could potentially benefit and the number who actually enroll in treatment. It has been estimated that 90% of adolescents in need of treatment are not able to succeed in receiving it. This highlights the importance of understanding the circumstances in which youth initiate drug use and the unique barriers they must overcome to receive treatment when these behaviors develop into a pattern that impacts daily life. With this information, interventions can be targeted to reduce the magnitude of the most significant barriers in order to increase treatment utilization, especially in rural areas where adolescents face unique challenges to treatment access as a consequence of their remote locations. A literature review was conducted and found the major barriers in access to substance use treatment for adolescents to be a lack of available treatment programs, lack of treatment options including medication treatment, lack of perceived need or motivation for treatment, social stigma, socioeconomic status (SES), familial relationships, and referral services. These studies were all conducted in the United States and published from 2011-2020. The aim of this thesis is to propose a protocol for the completion of a systematic review to determine which barriers exist to adolescents receiving substance use treatment and to examine them in the context of rurality. Healthcare decisions and policy are informed by the best available evidence from systematic research and incorporated into evidence-based practices. A systematic review will summarize the findings of all relevant studies thereby making the key information more accessible to decision makers, including clinicians and policy makers, in order for substance use treatment to become more accessible to adolescents.

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur. Comorbid PTSD+SUD confers heightened risk of other mental health concerns, suicidality, mortality, and functional impairment. Current treatments for comorbid PTSD+SUD show inconsistent results, highlighting the need for a more comprehensive understanding of the associations between PTSD and SUD symptoms. The current dissertation aimed to characterize the associations between PTSD and SUD using structural equation modelling among three different samples with differing clinical severity and presentation: (1) concurrent disorders sample with a high prevalence of PTSD; (2) an in-patient sample seeking treatment for PTSD; and (3) a subclinical sample of healthcare workers and public safety personnel. Data were extracted from multiple clinical databases across different studies to evaluate the associations between PTSD symptoms and alcohol/cannabis/substance use-related problems. Furthermore, the role of underlying mechanisms such as dissociation and emotion dysregulation, which are associated with both PTSD and SUD, were analyzed. All analyses used a structural equation modelling framework to represent the complex clinical presentation of comorbid PTSD+SUD analytically. A relatively consistent pattern of results was observed across the three samples. Global PTSD symptoms were significantly associated with cannabis-related problems, alcohol-related problems, and other illicit substance-related problems. Among PTSD symptoms, the reactivity symptom cluster (characterized by symptoms of hypervigilance, irritability, reckless behaviour, problems with concentration and sleep disturbances) was significantly associated with alcohol/cannabis/substance-related v problems across among the three samples. Furthermore, underlying mechanisms such as dissociation and emotion dysregulation significantly mediated the relations between PTSD symptoms and alcohol/cannabis/substance-related problems. Overall, the current results contribute to the limited literature examining the associations between PTSD and SUD symptoms. Lastly, the current results have important clinical implications for identifying efficacious treatment targets for comorbid PTSD+SUD. / Dissertation / Doctor of Philosophy (PhD) / Psychological distress following a traumatic event, known as traumatic stress, is often associated with problematic alcohol and/or substance use. The co-occurrence of these two confers a heightened risk of other mental health problems. As such, studying how these phenomena are associated with one another and what about each thing is more important to the association is important to understand. The purpose was to examine the connection between these phenomena among three different groups of people: two treatment-seeking groups and non-treatment seeking group one group. Traumatic stress was associated with problematic substance use in all three groups. In addition, other factors like mentally escaping from your body and having difficulties with regulating your emotions explained how traumatic stress and problematic substance use were connected to each other. These findings can help clinicians hone their treatment programs to better help individuals struggling with traumatic stress and problematic substance use.

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A study of women who are childhood sexual abuse survivors and have been affected by chemical dependency.

National prevalence surveys indicate that lifetime and recreational drug use among all social classes have increased steadily over the last decade in Ireland (Moran et al., 2001a, Mayock, 2002, National Advisory Committee on Drugs, 2008a). Drugs research has been traditionally based on the identification, weighting and interrelatedness of risk and protective factors within a "risk prevention paradigm". This paradigm has been criticised for its lack of inclusion of individual, group and wider structural aspects, and occurs within a greater awareness of greater social discourse and societal shifts. The research papers in this portfolio of work are thematically analysed and conceptualised within the theoretical framework of cognitive and structural social capital. The descriptive research and later, more conceptual papers investigating drug use among rural youth, Travellers and cocaine use, are thereby explored in terms of the potential ‘normalisation of rural youth drug use’ within contemporary risk discourse, the assimilatory threat of increasing drug use among the ‘Traveller community’., and the emergence of the ‘recreational cocaine user’ in Irish society. The social processes of individualisation, reciprocity and trust which constitute social capital are deemed to provide potent collective frameworks for the navigation of risk in day to day ‘localised’ settings. The ‘interrelated normative frameworks’ and ‘processes of risk neutralisation’ are underpinned within a wider social capital understanding of the meaning of drug activity in associational life based on ‘interpersonal and institutional trust’ and ‘mutual resource acquisition’. Contemporary drug policies must consider the contextual constraints of the ‘risk society’, which impact on inherent individual ‘power resources’, whereby individual agency and drug taking is better understood within situational agency of ‘localised’ social, gender, ethnic and cultural capital.

Purpose: Substance use and weapon carrying among adolescents is a growing concern. The objective of this study is to investigate the association between adolescent substance use and weapon carrying using the 2013 Youth Risk Behavior Survey (YRBS). Methods: Analyses were conducted using the 2013 YRBS, a nationally representative dataset sampling public and private high school students throughout the United States (US). Data from a total of 148,282 US adolescents were used in the present study. Results: Two outcomes were assessed: weapon carrying within the past 30 days and weapon carrying on school property within the past 30 days. Among adolescents who carried a weapon, 77.3% were male, 62.7% were white, 28.5%% were in 9th grade, 33.8% used a tobacco product and 57.4% drank alcohol within the past 30 days, while 22.8% used a Schedule 1 drug and 14.0% used a Schedule 2 drug during their lifetime. Among adolescents who carried a weapon on school property, 74.4% were male, 55.1% were white, 26.5% were in 11th grade, 40.1% used a tobacco product and 61.9% drank alcohol within the past 30 days, while 32.1% used a Schedule 1 drug and 26.9% used a Schedule 2 drug during their lifetime. For the multivariable model predicting adolescent weapon carrying, tobacco use (adjusted odds ratio (AOR) = 2.31, 95% CI: 2.06, 2.59), alcohol use (AOR = 2.04, 95% CI: 1.81, 2.29), and Schedule 2 drug use (AOR = 2.27, 95% CI: 1.83, 2.80) were significantly associated with increased risk of carrying a weapon, adjusting for all covariates in the model simultaneously. For the multivariable model predicting adolescent weapon carrying on school property, tobacco use (AOR = 2.33, 95% CI: 1.89, 2.86), alcohol use (AOR = 2.53, 95% CI: 2.02, 3.18), and Schedule 2 drug use (AOR = 2.58, 95% CI: 1.94, 3.43) were significantly associated with increased risk of carrying a weapon on school property, adjusting for all covariates in the model. Raw counts and weighted frequencies are reported. Conclusions: Statistically significant associations between adolescent substance use and weapon carrying were found, suggesting that adolescent substance use is associated with increased weapon carrying behavior, both off and on school property. Future weapon carrying prevention efforts should target not only adolescents who are high risk for weapon carrying, but also those who are at risk for misusing substances.

The three studies presented in this dissertation generated new insight about the attitudinal ableism experienced by people with mental illness, substance use, and physical disabilities. First, the purpose of study one was to synthesize existing evidence about the implicit (unconscious) biases toward people with mental illness. Extensive academic database searches were performed and 19 articles were selected for review. Main findings from the review indicated that 63% of the participant samples showed an implicit bias against people with mental illness. Further, the implicit biases were positively correlated with explicit desires for social distance in two studies and were not improved by interventions or prior contact in six studies. Second, the purpose of study two was to investigate potential mediators in the pathway between perceived stigma and internalized stigma among people with substance use disorders. A total of 125 individuals completed the survey packet. Results indicated that overall social support (particularly affectionate social support) and maladaptive coping behaviors were significant mediators of the pathway. Personality characteristics, overall coping behaviors, adaptive coping behaviors, emotional/informational social support, and tangible social support were not significant mediators. Third, the purpose of study three was to validate and expand upon existing research on the microaggressions perceived by people with physical disabilities. The third study was also an initial exploration into the applicability of Glick and Fiske's (1996) theory of ambivalent sexism in conceptualizing ableist microaggressions. Specifically, Glick and Fiske's (1996) theory was used as a framework for conceptualizing ableist microaggressions as examples of ambivalent ableism, characterized by hostility and benevolence toward people with disabilities. Twelve individuals with visible, physical disabilities were interviewed about their microaggressive experiences and the personal impacts of being targets of ableism. Participants' experiences were coded and categorized as representing hostile ableism, benevolent ableism, or impact on the target. Hostile microaggressive experiences included othering, victimizing, and desexualizing; benevolent microaggressive experiences included helping and infantilizing; and impacts on the target included passing/covering and internalizing. Finally, implications related to research, education, and practice for each of the three studies were discussed in the concluding chapter of this dissertation.

Introduction: Currently there are approximately 1.2 million people in the United States living with HIV and it is estimated that 25.6% of HIV-positive adults suffer from depression. The purpose of this study is to examine the contribution of depression on substance use and medication adherence specifically among HIV-positive adult Georgians receiving medical care for HIV. Methods: Secondary data with a probability sample of 608 HIV-positive adults who took part in the 2009-2012 Georgia Medical Monitoring Project (MMP) were analyzed. Descriptive analysis and multivariate logistic regression models were conducted to assess relationships between depression with current cigarette smoking, injection drug use, other non-injection drug use, and medication adherence, adjusting for sociodemographic covariates (age, gender, race, and education). All analyses accounted for non-response and complex sampling design and were performed using SAS 9.2 (Cary, NC). Results: Among HIV-positive adults in Georgia, approximately 9.2% met the criteria for major depression; 15.2% of women and 6.9% of men had major depression. Heterosexual adults also had a higher percentage of major depression (11.9%) compared to adults who identified as bisexual (8.3%) or homosexual (6.1%). Major depression was also highest among young adults (17.1%) and adults with high school diploma or GED (13.0%). Major depression was associated with a greater odds of current cigarette smoking (3.04; 95% CI: 1.48, 6.23); injection drug use (5.62; 95% CI: 0.96, 32.81), and other non-injection drug use (2.17; 95% CI: 1.10, 4.25), after adjusting for sociodemographic variables. Major depression was also associated with a greater odds of ART medication non-adherence, 2.52 (95% CI: 1.20, 5.28), after adjusting for gender. Conclusion: As previously found in the general population, we found significant associations between depression and smoking and other non-injection drug use among HIV-positive adults. Major depression was also associated with a greater odds of ART medication non-adherence, which is also consistent with the literature. Because HIV-positive adults have ongoing encounters with healthcare providers, screening and treatment for depression and other co-morbid substance use is needed to reduce an additional health burden in this population.

Substance use disorders are chronic brain disorders and must therefore be treated on an ongoing basis. Accordingly, the concept of recovery capital has been developed to account for the internal and external resources that an individual can mobilize in order to recover from a substance use disorder. However, the concept has scarcely been applied to emerging adults. Although they are at twice the risk of developing a substance use disorder relative to their adult or adolescent counterparts, emerging adults in addiction and recovery are understudied. This phenomenological study aims to explore and describe the experience of emerging adults in recovery and to identify the barriers and facilitators to their recovery. The informants (n=8) were 18-25 year olds in recovery from substance use disorders. Data was collected using semi-structured interviews and subsequently analyzed for emerging themes. The results from this study suggest that the developmental tasks facing emerging adults are exacerbated in addiction and recovery.