Consider you are an expert in the field of journalism field.  You are an expert in journalism analysis. Ensure your writing reflects your expertise and is tailored for an audience that consists of other experts in the field. You need to provide advanced arguments that support your stateament. Use a formal and academic tone appropriate for advanced readers, constructing your content with sophisticated arguments that would meet the standards of a peer-reviewed journal. Avoid figures of speech, poetic language, and enumerations. Write in full sentences and paragraphs, employing the active voice, and minimize the use of terms such as "that," "overall," and "in conclusion." You are not allowed to use enumerations as in recounting/ the act or process of making or stating a list of things one after another not allowd) at all. Remember, your writing should be humanized and engaging while still demonstrating your expertise. Provide expert arguments. I am not interested in filling sentences that are irrelevant. Your output should be 600  words. Keep in mind the general rules and make sure you adhere to them.. Also, provide a title for this work . Be specific, don't fill with irrelevant information. Be advanced, not basic generalized answers. Identify the key information needed to answer the question you selected before starting to write. Be systematic, precise, and succinct. The information and analysis must use the sources provided below which msut be cited as in text citations (the sources are provided below). All the sources must be used and cited as in text ciations. The articles will be used as arugments to support the statement but the focus is the case analysis. 
1) Use active voice as much as possible, but make sure that the text is coherent.
 2) Coherency is very important, yet the text must seem like it was written by a human with expertise in the field, not by a robot 
3) You are not allowed to use figures of styles. Avoid using adverse
 4) DO NOT USE enumeration. This act or process of making or stating a list of things one after another not allowed. This is very important; enumerations are not allowed at all, so make sure the work does not contain enumerations 
5) Ensure a diversity of length and sentence structure between sentences in order to imitate a human style of writing. When it comes to writing content, two factors are crucial, "perplexity" and "burstiness." Perplexity measures the complexity of text. Separately, burstiness compares the variations of sentences. Humans tend to write with greater burstiness, for example, with some longer or complex sentences alongside shorter ones. AI sentences tend to be more uniform. Therefore, when writing the following content I am going to ask you to create, I need it to have a good amount of perplexity and burstiness 

Don’t forget to not be shorter than 750  and use all the headings and answer as below.
After exploring the National Registry of Evidence-Based Practices, choose one program that you found to be interesting (we will discuss the Preventing Substance Use Among Young Adults with Disabilities)  Be sure that it is a program that addresses couples or family therapy, or one geared toward children and adolescents (because those programs almost always have a family component). Write a 750 words essay in which you n which you present the program that you’ve chosen to focus on. Share with us the following important points:
•	Name of the program and target population
•	Research that supports the program
•	What happens in the program? What interventions are included?
•	What sets this program apart from others?
Make sure that your work has 5  heading. 

Article 1 (this is also the program that was chosen and which you will discuss):
SAMSHA. (2024). Preventing Substance Use Among Young Adults With Disabilities.
Preventing Substance Use Among Young Adults with Disabilities
PREVENTING SUBSTANCE USE AMONG YOUNG ADULTS WITH DISABILITIES In 2021, approximately 3.2 million or about 6.8 percent of people between the ages of 14 and 24 were living with a physical or mental disability.1 Although data on young people with disabilities are limited,2,3 recent evidence highlights the increased risk in this population for a host of health and other challenges, including higher rates of mental disorders and substance use disorders (SUDs).4,5,6 Even so, young people with disabilities are less likely than young people without disabilities to receive prevention and treatment services for substance use.7,8 Developing new prevention strategies and tailoring existing prevention education and tools to reduce potential substance use among young adults with disabilities can help support a healthy trajectory for this population during a period of transition. This Advisory highlights the need for primary substance use prevention programs for young adults ages 18 to 25 with disabilities, and it provides guidance on designing and tailoring these programs to meet the needs of this population. It also describes factors that may affect the delivery of prevention services for young adults with disabilities. This Advisory does not aim to provide comprehensive information about how to address the needs of every type of disability. Rather, it aims to encourage substance use prevention staff to consider the unique needs and perspectives that young adults with disabilities may bring to their programs. Key Messages ● ● ● ● ● To support the unique needs of young adults with disabilities, substance use prevention programs can apply principles from the disability field to proven prevention strategies for young adults. Specifically, prevention programs can: – Incorporate equity and accessibility into program practices and policies.9,10 – Use trauma-informed approaches.11 – Create accessible physical and supportive emotional environments.12,13,14 – Be responsive to the needs of young adults with disabilities.15 – Prioritize the importance of cultural responsiveness.16 – Promote positive youth development.17 Programs can integrate these key principles and approaches into evidence-based substance use prevention efforts, such as offering prevention education, incorporating healthy alternatives into the environment, screening for substance use, and implementing harm reduction strategies. Peer specialists or peer workers—professionals with lived experience who provide nonclinical support—can draw on their shared experiences to help young adults with disabilities adopt healthy behaviors, including avoiding substance use.18 Caregivers are instrumental partners in care and can benefit from support through prevention education, 20,21 resources about caregiving fatigue, and family support.19,20 Building a network of community-based partners across multiple sectors and disciplines is essential to supporting effective substance use prevention efforts for young adults with disabUnderstanding Disabilities and Substance Use Among Young Adults Young adults 18 to 25 years of age are entering a developmental period that involves numerous social, emotional, and physical transitions and changes,22,23 which in combination with growing independence and self-focus, can increase their risk for initiating or increasing substance use and future substance misuse or SUDs.24,25 Compared with rates of substance use among young adults who do not have disabilities, rates among those who do have disabilities are mixed, with some studies finding similar or lower rates5,26 and other studies reporting higher rates.27,28 For example, higher rates of substance use have been observed in adults with sensory disabilities compared with adults without these disabilities.29,30 Adults ages 18 to 59 who are Deaf or hard of hearing are more likely to use cannabis regularly and drink alcohol more heavily than hearing individuals. For adults ages 18 to 59, rates of substance use were 36 percent greater among those with vision loss and 37 percent greater among those with hearing loss than among their peers without a disability; rates of substance use among those with both hearing and vision loss were 18 percent greater than rates among peers who had only one such type of sensory disability. 30 Compared with adults ages 18 and older who have no disabilities, adults with cognitive disability are significantly more likely to use alcohol heavily; adults with cognitive and vision disabilities are both more likely to use cigarettes.31 The differences observed in substance use rates among young adults with versus without disabilities may result from the limited types of disabilities or substances studied. 25 More research is needed to better explain the association between the nature of the disability and substance use by young adults with disabilities. Compared with their peers who do not have disabilities, young adults with disabilities can face more challenges in education,32 employment,33 and relationships.34,35 They also have higher exposure to conditions that can lead to increased likelihood of substance use, including: ● Living in poverty. 1 ● Bullying.47,48 ● History of adverse life events or trauma.36,37 ● Family history of substance use.49 ● Physical, emotional, or sexual abuse.38,39 ● Increased prevalence of substance availability in the environment.50 ● Stigma40 and discrimination.41 ● Social influences, such as conformity,51 ● History of involvement with the child welfare42 and loneliness, and social isolation.52 juvenile justice systems.43 ● Communication challenges.53 ● Barriers to appropriate pain management.44,45,46 Young adults with disabilities may also experience barriers to receiving quality health care, including SUD treatment, that meets their unique needs.54,55 Barriers to entering or receiving health care, including SUD treatment, for people with disabilities include: ● Lack of specialized programs for diverse populations or for people with co-occurring conditions— including people with complex medical issues. 56 ● Stigma, particularly when a co-occurring mental disorder is present. 56 ● Limited access to accommodations or inaccessible treatment facilities (e.g., limited access to parking, 55,57 entrances, interior spaces, transportation). ● Limited access to communication resources for those with sensory disabilities (e.g., access to materials in Braille, large print, or other formats; sign language interpretation).58,59 ● Lack of formal education or training to care for people with disabilities.60 ● Lack of information about accessible programs available to them and in their area.61 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov 2 3 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. ADVISORY Definitions ● Accessibility: “[T]he design, construction, development, and maintenance of facilities, information and communication technology, programs, and services so that all people, including people with disabilities, can fully and independently use them” (p. 3).62 ● The Americans With Disabilities Act (ADA): A civil rights law that prohibits discrimination against people with disabilities in many areas of public life. See https://www.ada.gov for more information. ● Cultural responsiveness: “[A] set of behaviors, attitudes, and policies that…enable a system, agency, or group of professionals to work effectively in cross-cultural situations.” It involves honoring and respecting “the beliefs, languages, interpersonal styles, and behaviors of individuals and families receiving services” (p. xvii). 16 ● Disability: “The term ‘disability’ means, with respect to an individual—(A) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (B) a record of such an impairment; or (C) being regarded as having such an impairment (p.14).”63,64 ● Equity: “[T]he consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment” (p. 3). 62, ● Harm reduction: “[A] practical and transformative approach that incorporates community-driven public health strategies—including prevention, risk reduction, and health promotion—to empower PWUD and their families with the choice to live healthier, self-directed, and purpose-filled lives. Harm reduction centers the lived and living experience of PWUD, especially those in underserved communities, in these strategies and the practices that flow from them” (p. 4).65 (PWUD is an acronym for the phrase “people who use drugs.”) ● Peer specialist or peer worker: A peer specialist (or peer worker) is any person with lived experience in recovery from problematic substance use, mental disorders, or both, who provides, in a professional or volunteer capacity, nonclinical recovery support to people in or seeking recovery. “Peer specialists (short for peer recovery support specialists) refers specifically to peer workers with some training, including those working in a professional capacity, whether certified or not. Peer workers who have received certification or credentialing to provide peer support services are commonly referred to as certified peer specialists” (p. xiv).66 ● Person-centered: Person-centered approaches prioritize “the whole person by considering their multiple intersecting identities and qualities, rather than reducing them to a single attribute” (p. 1). 67 ● Positive youth development: An intentional, prosocial approach that engages youth in a manner that promotes positive outcomes for young people by providing opportunities, fostering positive relationships, and furnishing the support needed to build on their leadership strengths. 17 ● Trauma: “Trauma results from an event, series of events, or a set of circumstances an individual experiences as physically or emotionally harmful or threatening, which may have lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. Traumatic events may be experienced by an individual, a generation, or an entire community or culture” (p. vii). 68 ● Trauma-informed approach or care: A trauma-informed program, organization, or system “realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist re-traumatization” (p. vii).68 ● Social determinants of health: “[T]he conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (p. 1).69 ● Young adult: A person between the ages of 18 and 25 years. 4 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY Prevent Substance Use Among Young Adults With Disabilities Integrate Positive Youth Development Incorporate Equity and Accessibility Into Program Practices and Policies Use Trauma-Informed Approaches Create Accessible and Supportive Environments Be Responsive To the Needs of Young Adults With Disabilities Recognize the Importance of Cultural Responsiveness and the Use of Language Tailor Programs To Meet Each Young Adult’s Unique Needs Principles and Approaches for Designing Substance Use Prevention Efforts for Young Adults With Disabilities Substance use prevention programs can use the following principles and approaches as a guide to create accessible and supportive environments with prevention strategies tailored to meet the individual needs of young adults with disabilities (see figure below). Incorporate Equity and Accessibility Into Prevention Programs, Practices, and Policies Young adults with disabilities may face barriers in seeking support for substance use and may need help to overcome them. For example, programs can help this population overcome their fear of stigmatization or discrimination by24: ● Connecting them to peer support services. ● Normalizing asking for help. ● Ensuring that prevention services are inclusive, accessible, and welcoming. ● Facilitating positive experiences with program staff. ● Developing prevention services that have low barriers to entry, which can support positive attitudes toward help-seeking. For young adults with disabilities who have limited knowledge about behavioral health services, prevention program staff can provide education and awareness24 and encourage self-compassion, self-advocacy,70 and resilience.71,72 Prevention efforts can also can help people with disabilities face challenges related to their disability and the stigma and discrimination they may encounter,70 improve their confidence and coping skills,71 and lessen their risk for substance use. 72 Advancing Equity and Accessibility Substance use prevention specialists can take steps to ensure that their programs integrate equity; accessibility; and culturally informed, person-first, inclusive services, to help young adults with disabilities feel that their perspectives are represented. 9,10 Programs can accomplish this integration by73: ● Taking steps to create an environment that is welcoming, inclusive, and responsive to the unique needs of this population. 5 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY ● Reviewing internal policies, practices, and programming to remove language that is not inclusive of people with disabilities and adopting language that promotes inclusion. ● Considering how young adults with disabilities prefer to receive their health information and providing messages in accessible formats to best reach this population. ● Surveying young adults with disabilities and their families to learn more about specific supports that they need and to understand what they view as gaps that prevention programs may need to address. ● Working with disability advocates and young adults with disabilities at every phase of program development (i.e., planning, design, implementation, monitoring, evaluation) to ensure programs are accessible, inclusive, and representative of their needs. By examining program records and evaluating program data, prevention service providers and program administrators can explore who is accessing their prevention services and better understand how to tailor these services. Programs can also internally assess how they are advancing access and equity for young adults with disabilities and support their participation in relevant training and educational opportunities. Specifically, programs can evaluate12,13,14: ● How substance use affects young adults with disabilities differently than their peers without disabilities. For example, programs can ask participants about their individual needs. ● Their compliance with specific laws and rules that protect people with disabilities (e.g., the ADA, the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act). ● Their capacity to ensure access by meeting the physical and communication needs of young adults with disabilities. A key aspect of addressing the needs of young adults with disabilities is creating environments that can support their varying needs (see the sidebar below). Strategies for Improving Accessibility for Various Types of Disabilities Substance use prevention specialists can use the following select considerations to improve program accessibility for young adults with specific types of disabilities. People who are blind or have low vision74: ● Post signs and offer materials in Braille, large print, or other formats. ● Offer low-vision optical devices. ● Provide auditory versions of printed materials and qualified readers that can read text aloud. ● Consider the lighting needs of those with visual impairments.75 People who are Deaf or hard of hearing76: ● Offer sign language interpretation; remind others to take turns speaking and to look directly at the person who is Deaf rather than at the interpreter. ● Offer assistive listening devices. ● Provide written materials for important information. People with cognitive and developmental disabilities77: ● Simplify and repeat directions, questions, and important points, and use concrete action steps. ● Create easy-to-understand handouts and forms that give key information visually. ● Minimize noise and visual distractions. ● Offer more frequent but shorter programs. People with sensory processing disabilities74: ● For people with tactile defensiveness, inform or ask before touching them.78 ● For people with tactile seeking behaviors, provide opportunities to address sensory processing needs by offering fidget spinners, stress balls, and stretchy bands.79 ● For people with proprioceptive processing issues who may be highly sensitive to movement and pressure80: – Give verbal cues to describe the environment and risks. – Warn others in the program about sensitivities to touch, movement, or pressure. 6 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY People with any type of disability: ● Create environments that are supportive and accessible (e.g., ramps, clear pathways, entrances and exits with doorknob grips or handles and automatic door openers).81 ● Offer frequent breaks.82 ● Ensure transportation is easily accessible.83 ● Ensure access for those with service animals or mobility aids.84,85 Developing Culturally Responsive, Disability-Aware, Trauma-Informed Programs Young adults with disabilities represent a vast diversity of races, ethnicities, social backgrounds, experiences, and cultures. 85 Many of them have experienced the trauma of discrimination,41,86 stigma, 40,86 or violence, 38,39 especially those from underserved communities. Because trauma and discrimination are associated with substance use,87,88 substance use prevention programs can respond to the needs of young adults with disabilities by integrating culturally responsive and trauma-informed approaches. ● Culturally responsive substance use prevention services. 89 Each young adult with a disability brings their own perspective, culture, race, ethnicity, gender identity, and sexual orientation. Programs can recognize these differences and incorporate culturally appropriate knowledge, language, understanding, and attitudes related to disability services into their prevention services. ● Responsiveness to the needs of those with disabilities. Prevention programs can help ensure that young adults with disabilities receive services that meet their unique needs by providing their staff with educational and training opportunities to acquire the knowledge, skills, and abilities that will allow them to be responsive. Program staff can develop a deep knowledge of disabilities, allowing them to provide supports that address barriers to receiving integrated, accessible care. Examples of competencies include demonstrating knowledge of how disability and social determinants of health may affect an individual, providing patient-centered care, and engaging the patient and caregivers skillfully in the supported decision-making process. 15 ● Trauma-informed substance use prevention services. 89 Incorporating trauma-informed approaches into substance use prevention services allows programs to recognize and address trauma as a risk factor for substance use. Trauma-informed care is a strengths-based approach grounded in an understanding of and responsiveness to the impact of trauma. 11 Substance use prevention specialists can use their knowledge of young adulthood, disabilities, and trauma-informed care principles to create or adapt programs that: – Recognize that young adults may have experienced trauma during their lifetime. – Acknowledge that trauma can increase the risk for substance use, especially when young adults face additional challenges associated with transitioning to adulthood. – Train staff to become trauma aware when providing substance use prevention services. – Create an environment responsive to the needs of young adults with histories of trauma. Adopting Positive Youth Development as a Foundational Approach Positive youth development is an effective, intentional approach that engages youth and young adults within their communities, schools, organizations, peer groups, and families. 17,90 It focuses on this population’s strengths and promotes positive outcomes by developing opportunities, relationships, and supports. Programs can leverage the foundations of the positive youth development approach to incorporate the voices of young adults with disabilities into substance use prevention efforts. Engaging young adults with disabilities in program design, implementation, and evaluation requires both intention and flexibility. 91 Intentional engagement strategies include supportive coaching to ensure younger participants understand the topics and how they can contribute meaningfully, and ongoing mentorship that focuses on development and fosters young adults’ perception that their opinions matter. 7 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY Substance Use Prevention Strategies for Young Adults With Disabilities Despite some evidence of increased risk for substance use among some young adults with disabilities,3,28 3,92,93 there are few evidence-based substance use prevention programs designed for this population. Additionally, some young adults with disabilities were unhappy with the prevention programs available to them, as they did not feel that the programming was effective, engaging, or applicable to their experiences.94 Some limited studies of substance use prevention programs in youth with disabilities have informed the strategies that the following sections of this Advisory discuss.95,96 However, most are drawn from evidence 24,93,97 demonstrating positive outcomes in youth without disabilities, where there is a larger evidence base. By incorporating the key principles and approaches this Advisory has described thus far, programs can tailor substance use prevention strategies to meet the unique needs of young adults with disabilities. To develop or further tailor programs, additional research is needed to supplement existing, limited studies of substance use prevention in this population. Substance Use Prevention Education and Information Dissemination Prevention education typically uses a twofold approach to teach young people essential skills that help them either avert or minimize substance use or misuse.98 Skills may include resisting pressure to use substances or making healthier choices and engaging in healthy activities. Prevention education that focuses on young adults delivers positive messages about healthy behaviors and attitudes; messages are designed to address misconceptions that normalize substance use behaviors. 24 Screening, education, and empowerment are effective approaches to delivering substance use prevention education to young adults.99 These programs can provide prevention education that addresses inaccurate beliefs—for example, countering the notion that substance use is more common and acceptable among peers by providing data about use among peers. Some aspects of substance use prevention education include: ● Basic information about substance use, including causes of SUDs. ● The effects of substance use on the well-being of young adults with disabilities. ● Skills building and social skills development to support the prevention of substance use. Perhaps most importantly, tailored education on substance use may be more likely to reach young adults with disabilities. 100 One substance use prevention intervention for youth and young adults with intellectual disabilities offered prevention education that was adapted to the recipient’s level of intellectual disability, using games, visual support, and daily life experiences. 100 This program offered support for setting individual long-term goals and showed how small steps could move participants closer to their goals. 100 It also helped participants identify thoughts and feelings that preceded substance use so that they could make an alternative choice. 100 This information was used to create a personalized plan that helped participants develop coping skills to change their behavior. 100 Using Technology for Substance Use Prevention Among Young Adults With Disabilities Many young adults get information from and communicate via the internet and smartphones.101 Thus, some programs that address substance use prevention are now harnessing digital platforms, such as virtual reality, smartphones, video games, web-based interventions, and telehealth. 102 The effectiveness of these technologies and tools varies, but there are some data on web-, game-, and virtual realitybased substance use prevention interventions for young people. 102 If tailored, some of these technologies and tools may help programs engage more young adults with disabilities. Young adults are also likely to receive and share information via social media.96,98 Programs may want to consider developing social media campaigns to share substance use prevention information using communication tailored to young adults with disabilities. For more information, see the Substance Abuse and Mental Health Services Administration (SAMHSA) Social Media Platform Overview and Tips. 8 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY Providing Healthy Alternatives to Substance Use Incorporating healthy alternatives to substance use where young adults with disabilities live, work, and socialize may be an effective approach to preventing substance use. 24,98 This approach offers education about positive alternatives to substance use and has been shown to be effective in reducing substance use in young adults. 98 Offering healthy alternatives provides young adults with opportunities to build healthy relationships, have fun, meet friends, and develop new skills in a substance-free environment. Healthy alternatives that integrate skills building may also help young adults with disabilities reinforce the importance of a healthy, substance-free environment. Examples of activities that could be adapted include adaptive art classes, disability-inclusive group exercise, and volunteer work. Counseling as Prevention Mental and behavioral issues associated with substance use among young adults with an intellectual disability include depression, anxiety, and frequent rule breaking and aggression.103 Person-centered counseling approaches may include motivational interviewing and cognitive–behavioral therapy techniques, such as psychoeducation about participants’ personality profiles and training behavioral and cognitive coping skills. These approaches were effective in substance use prevention in young adults, irrespective of the level of their baseline behavioral problems. 103 For more information about motivational interviewing and cognitive–behavioral therapy techniques, see Tailoring Trauma-Focused Cognitive Behavioral Therapy for Youth With Developmental Disabilities and Their Caregivers and SAMHSA Treatment Improvement Protocol (TIP) 65: Counseling Approaches to Promote Recovery From Problematic Substance Use and Related Issues. Screening, Brief Intervention, and Education for Substance Use Screening for substance use is an evidence-based prevention method for young adults. 24 Programs use a validated screening tool to assess substance use risk, followed by a brief intervention based on the results of the screening. Programs can offer tailored feedback about screening results, specific advice based on identified concerns, and support for developing individual goals. 24 Screening can also act as a catalyst for education about substance use. For example, if young adults with disabilities screen negative for substance use, they can still receive education about SUDs and risk factors. Alternatively, if screening identifies a substance use issue, referral to SUD treatment should occur. Programs should conduct screening on a voluntary, informed-consent basis in keeping with a culturally responsive, trauma-informed approach. It is important to adapt screening interventions to meet the specific needs of young adults with disabilities. Young Adults With Disabilities: Child Welfare and Juvenile Justice Involvement As young adults with disabilities age out of child-focused service systems, such as child welfare or foster care, they may face a gap in services and support.104 Prevention program staff may need to familiarize themselves with these systems. For information about the child welfare system, see What is Child Welfare? A Guide for Behavioral and Mental Health Professionals. For information about challenges facing youth aging out of foster care, see Young Adults Formerly in Foster Care: Challenges and Solutions. For resources on the criminal and juvenile justice systems, see SAMHSA’s Criminal and Juvenile Justice webpage. Incorporating Harm Reduction Strategies Harm reduction, which uses evidence-based practices, includes prevention, treatment, recovery, and health promotion and can reduce, stop, or delay progression of substance use to an SUD, as well as prevent other harms associated with substance use. 65 For example, harm reduction services can65,105: ● Prevent substance misuse, overdose, and injury. ● Reduce overdose deaths and infectious disease transmission. 9 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY ● Promote physical, mental, and social well-being. ● Offer low-barrier options for accessing SUD treatment. Although engagement of young adults in harm reduction is limited,106 harm reduction strategies may be useful for this population, including among those with disabilities. Examples of harm reduction strategies include65,105: ● Reducing stigma associated with substance use and co-occurring disorders. ● Providing overdose education and offering opioid overdose-reversal medications (e.g., naloxone). ● Providing needs-based syringe service programs. ● Providing drug-checking education and resources (e.g., fentanyl and xylazine test strips). Prevention programs that provide harm reduction services to young adults with disabilities may need to tailor materials, information, and accommodations to meet their needs. Educating caregivers or families of young adults with disabilities—especially young adults with intellectual disabilities who may lack understanding—about harm reduction approaches can help them support their loved ones. Engaging Peer Specialists as Partners in Prevention Peer specialists or peer workers—young adults with lived experience—can draw on their own experiences with disabilities and substance use or misuse to help their peers mitigate factors associated with increased risk of substance use. 18 Peer specialists can serve as educators, facilitators, role models, mentors, or resource navigators. 66 They also collaborate and build connections with social service agencies, local businesses, and other organizations that can support young adults with disabilities at risk of substance use. 66 Peer specialists can connect these young adults to resources and offer ongoing support and help with service navigation. Moreover, young adults with lived experience can identify developmentally appropriate screening and self-care strategies for their peers, who may be more receptive to prevention advice from someone in their cohort.107 Adapting peer support for young adults with disabilities requires attention to the particular needs of this diverse, varied population.108 For example, peer specialists may require cross-training and ongoing supervision and support to work with people whose disabilities differ from their own. Supporting and Empowering Caregivers To Prevent Substance Use As young adults with disabilities exit pediatric- and school-based supports and transition into the adultcentered healthcare system, they may face barriers to receiving transition services. 19 Furthermore, parents and caregivers receive less support during this transition and experience increased caregiving responsibilities, with attendant emotional distress and stress. 19 These caregivers have critical knowledge of their loved one’s needs, including how to promote healthy behaviors and prevent substance use. To support caregivers during this transition, prevention program staff can: ● Engage caregivers to learn more about their challenges, needs, and beliefs about what is important in 20,21 supporting the young adult. ● Offer opportunities to include caregivers in prevention education and skills development (e.g., modeling drug refusal and healthy behaviors, building communication skills, practicing conflict management and resolution)18 and to gather their input on ways to tailor materials to meet their and their loved one’s needs (e.g., through surveys, focus groups, or recruiting caregivers to work groups). 92 ● Connect caregivers to peer support from other parents of children with the same disability to help them identify resources, strategies, and perspectives; such connections have been shown to help parents of youth with disabilities during the youth’s transition into adult-centered services. 19 10 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY Resources and Tools The following resources can support prevention specialists who work with people who have disabilities. Creating Accessible and Supportive Environments for People With Disabilities ● ADA Checklist for Existing Facilities ● Centers for Disease Control and Prevention (CDC) Disability & Health Resources for Facilitating Inclusion and Overcoming Barriers ● Centers for Medicare & Medicaid Services Modernizing Health Care to Improve Physical Accessibility: A Primer for Providers Developing Competencies To Address the Needs of People With Disabilities ● Alliance for Disability in Health Care Education Core Competencies on Disability for Health Care Education ● CDC Become a Disability A.L.L.Y. — Information for Healthcare Providers Becoming Culturally Responsive ● Prevention First Delivering Culturally Responsive Prevention Services ● SAMHSA TIP 59, Improving Cultural Competence Trauma-Informed Care ● SAMHSA Practical Guide for Implementing a Trauma-Informed Approach ● Administration for Children and Families Resources Specific to People With Disabilities Positive Youth Development ● Youth.gov Positive Youth Development ● VIA Institute on Character Inventory of Strengths for Youth ● SAMHSA Voices of Youth Initiative Screening Tools for Substance Use ● National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide ● Screen4Success ● SAMHSA Screening, Brief Intervention, and Referral to Treatment ● U.S. Department of Veterans Affairs Alcohol Use Disorders Identification Test Harm Reduction ● SAMHSA Harm Reduction Page ● SAMHSA Harm Reduction Framework Peer Support ● SAMHSA Core Competencies for Peer Workers in Behavioral Health Services ● SAMHSA TIP 64, Incorporating Peer Support Into Substance Use Disorder Treatment Services ● SAMHSA National Model Standards for Peer Support Certification Young Adults With Disabilities ● Youth.gov Youth Topics, Disabilities ● Seattle University Center for Change in Transition Services Transition Planning Resources ● The Arc of the United States ● Raising Special Kids Empowering Voices: Introducing the Engaging Families & Young Adults Program 11 SAMHSA’s mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. 1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov ADVISORY Data on Disabilities ● Center for Research on Disability Annual Disability Statistics Collection ● CDC Data and Statistics on Disability and Health Substance Use ● SAMHSA Substance Use Disorders in People With Physical and Sensory Disabilities ● SAMHSA Substance Misuse Prevention for Young Adults ● SAMHSA Advisory, Mental and Substance Use Disorder Treatment for People With Physical and Cognitive Disabilities ● SAMHSA Substance Use Prevention Resources for Youth and College Students ● SAMHSA Technology Transfer Centers Program ● U.S. Drug Enforcement Administration Campus Drug Prevention ● NIAAA Rethinking Drinking: How Does Alcohol Affect Your Health? ● Washington State Department of Health, Office of Healthy Communities Youth With Disabilities Risk Factors for Alcohol, Tobacco and Drug Use Data Monograph ● The Recovery Village Substance Use & Intellectual Disabilities Family and Caregivers ● SAMHSA Parent and Caregiver Resources ● The Family Café ● Family-Run Executive Director Leadership Association ● National Federation of Families ● National Center on Substance Abuse and Child Welfare series on Harm Reduction in the Context of Child Well-Being ● American Association on Intellectual and Developmental Disabilities Family Support: Joint Position Statement of AAIDD and The Arc ● SAMHSA Communities Talk to Prevent Alcohol and Other Drug Misuse: Addressing Substance Misuse Among Transition-Age Youth Not Attending College Community Support ● SAMHSA Community Engagement: An Essential Component of an Effective and Equitable Substance Use Prevention System ● SAMHSA Strategic Prevention Technical Assistance Center ● SAMHSA Prevention Technology Transfer Center Network ● Administration for Community Living (ACL) Centers for Independent Living ● ACL Aging and Disability Resource Centers Funding Opportunities ● SAMHSA Substance Use Prevention, Treatment, and Recovery Services Block Grant program website ● SAMHSA Strategic Prevention Framework—Partnerships for Success for States ● Health Resources & Services Administration Grants website ● Bureau of Justice Assistance Funding website ● Financing & Grants for Substance Abuse Treatment

Source 2:
Alhammad, M., Aljedani, R., Alsaleh, M., Atyia, N., Alsmakh, M., Alfaraj, A., Alkhunaizi, A., Alwabari, J., & Alzaidi, M. (2022). Family, Individual, and Other Risk Factors Contributing to Risk of Substance Abuse in Young Adults: A Narrative Review. Cureus, 14(12), e32316. https://doi.org/10.7759/cureus.32316
amily, Individual, and Other Risk Factors Contributing to Risk of Substance Abuse in Young Adults: A Narrative Review
Monitoring Editor: Alexander Muacevic and John R Adler
Mustafa Alhammad,1 Rajeh Aljedani, 2 Mohammed Alsaleh,2 Nawaf Atyia,2 Mohammed Alsmakh,2 Ali Alfaraj,2 Alya Alkhunaizi,2 Jalal Alwabari,2 and Mohammed Alzaidi2
Author information Article notes Copyright and License information PMC Disclaimer
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Abstract
Substance use disorder and the availability of certain over-the-counter drugs are worldwide issues that affect many individuals, both mentally and physically. As a result, the frequent use of this substance can lead to substance abuse. This phenomenon is also becoming more prevalent with time, and it does not differentiate between genders, ages, races, or religions. This review aimed to provide an overview of studies related to substance abuse, the individuals who tend to abuse these substances, and their risk factors. We also aimed to discuss, identify, and analyze the factors that increase the risk of substance abuse among young adults. We performed a thorough search for related studies using PubMed to provide a comprehensive review of the risk factors and side effects experienced by young adults. The selected indexing terms included “substance abuse,”“risk factors,” and “personality traits,” among others. Information was gathered from relevant peer-reviewed publications, and thereafter refined, and summarized.
Keywords: drug addiction, personality traits, risk factors, substance abuse side effects, substance abuse
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Introduction and background
Substance use disorders refer to the recurrent use of alcohol and/or drugs causing significant clinical and functional impairment; these impairments can include health issues, disability, and failure to realize major responsibilities at work, school, or home. “According to the DSM-5, a diagnosis of substance use disorder is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria” [1].
Substance abuse is a serious problem faced by diverse societies worldwide; this problem does not discriminate in terms of gender, age, race, or religious affiliation, which indicates that substance abuse is somehow associated with human nature in general [2]. “In 2016, the percentage of individuals between the ages of 15 and 64 years who abused substance at least once in their lifetime was approximately 5.6% globally.” During the last decade, the issue of substance abuse has multiplied among adolescents and young adults, especially among men aged 15-30 years. The Global Burden of Disease Study in 2013 showed that the maximum usage of these substances occurred among individuals aged between 18 and 25 years with the peak age of initiation falling between 16 and 18, and using these substances also causes 14% of health problems among young men [3,4].
Ethnicity-related disparities in drug usage, and its effects, have long been documented; however, the role of genetic and societal factors is still unclear. Even though racial healthcare inequalities are, in reality, the result of social and historical factors, they may be wrongly attributed to genetic variances. Drug use disorders are inherited illnesses affected by a complex interaction of genetic and environmental variables [5].
Existing research showed that annually, 11.8 million people die because of alcohol abuse. Cannabis is the most used illicit drug globally, with an estimate of more than 200 million abusers documented [6].
The use of prescription and over-the-counter (OTC) medications for non-medical purposes is a major area of concern. According to the Centers for Disease Control and Prevention, 20.2% of high school students misused prescription medicine in 2009. Drugs such as Vicodin, Oxycontin, Adderall, and Ritalin are among the prescription medications that are frequently abused. The latter two are typically used to treat attention deficit and hyperactivity disorder. Two more medicines that are frequently used for non-medical purposes are tranquilizers and cough medications. According to the National Institute on Drug Abuse, prescription and OTC medicines are the illicit substances that twelfth-grade students abuse most frequently [7].
An individual who abuses substances is susceptible to a lower quality of life than a healthy non-abuser in multiple aspects and could experience psychological, physical, social, educational, and functional impairments. Research studies show that in the United Kingdom, problematic Internet use is associated with a wide range of negative social and psychological effects, including depression, bullying, alcohol and drug abuse, and depression [8,9]. Moreover, any health issue could double in severity when abusers use two or more of psychoactive substances, compared with abusers who use a single drug. These individuals will also be exposed to a much higher degree of possible injury, poor educational level, violence, depressive symptoms, dangerous driving, or suicidal thoughts and attempts. In certain age groups, such as adolescence and young adulthood, polysubstance abuse can have multiple serious consequences that could affect their future, especially because this age is considered to be a transition period from adolescence to adulthood. Drug abuse can affect the future of their social relationships, identity development, and educational advancement [9]. Furthermore, due to possible risky conduct, such as sharing needles, substance use increases the risk of HIV infection, while actual drug use could worsen actual HIV/AIDS-related health problems [7]. Considering the above, this review aims to identify, discuss, and analyze the risk factors that can result in young adults’ substance abuse.
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Review
Review-risk factors
History of Abuse in Childhood
A study conducted at a clinic treating patients with substance abuse evaluated 105 patients with significant histories of domestic violence; of these patients, 14% reported being a victim of childhood abuse [10]. Similarly, a cross-sectional study surveyed mothers with children who were six years old and younger. Of the 733 respondents, 36% reported a history of substance abuse; this positive response was more common among those who had a history of childhood abuse [11]. Furthermore, children with a history of abuse have more serious substance abuse issues later in their adulthood; this conclusion was extracted from a retrospective study involving 643 patients [12].
Family History of Substance Abuse
Regarding the impact of family history on an individual’s future risk of devolving into substance abuse, one study discussed substance abuse among medical students and doctors. The results showed that a family history of substance abuse was among the risk factors that made individuals prone to misuse any subtype of substance [13]. Moreover, a study on methadone maintenance therapy and positive parental history concluded that patients with a positive family history had more opioid dependence symptoms that are so severe that they can be classified as severely dependent [14].
Individual Risk Factors
There are multiple individual risk factors for substance abuse that can be categorized by age group. For example, children and adolescents younger than 18 years old try substances for several reasons; to have a new experience or for adventure, interpersonal trauma, ethnicity, gender, and socioeconomic status. Among young adults between 18 and 25 years of age academic stress plays a major role in substance abuse, as well as the long-term use of prescription medications after minor surgery, or a poor relationship with parents. Adults aged 26 to 64 years often face major life challenges and must maintain a balance between job and family life, which tends to increase the risk of substance abuse, especially if they are in a high-stress profession, such as lawyers, healthcare workers, or military personnel. Experiencing grief, or the loss of a close member of a family or friend can lead to substance abuse. Lastly, adults who are older than 65 years face several issues, such as grief, chronic diseases, lack of care, and social isolation, that could lead them to use drugs in inappropriate doses [15].
Peer Risk Factors
Many factors affect substance abuse, such as loss of family support, friends' influence, and other individualized factors. Peer factors are some of the strongest factors, that influence individuals to start abusing substances. An Iranian study published in 2014 interviewed people with drug addiction and found that peers have a great influence on drug use. However, individuals who join their peers in using illegal substances do not do so by accident; many factors draw these individuals toward friends or peers, who abuse substances, such as family issues, or behaviors and attitudes that they have in common with these groups. Often, people seek out the safety that these groups or gangs provide. However, peer factors are not just about influencing others to use illicit substances; they could also influence a person to start smoking and drinking alcohol when socializing, which could, in turn, lead to the use of illegal drugs [16].
Environmental Risk Factors in Childhood and Adolescence
According to a study conducted in 2015, a person’s environment is one of the factors that significantly influences their risk of addiction [17]. A total of 600 respondents categorized as urban and rural were interviewed. It was found that several risk factors, including being male, having friends who are a “bad influence,” the parental norm, fathers’ and mothers’ educational level, and parental connectedness, were associated with poor outcomes in adults’ lives [18].
Co-occurring Disorders
A dual diagnosis is defined as a combination of disorders such as severe mental illness and substance abuse disorders [19]. There are many mental health comorbidities that can affect substance abuse; for example, anxiety disorders, depression, bipolar disorder, attention deficit hyperactive disorders, psychotic illnesses, borderline personality disorders, schizophrenia, antisocial personality disorder, emotional disorders, and other psychotic mental illnesses, that could lead to serious mental illness, and eventually cause substance abuse disorders [19]. In the United States, 7-10 million people have dual diagnoses of severe mental illness and substance use disorder. Moreover, most of these people were diagnosed with a mental illness in an early phase of their life, with substance use disorder following later [20]. A Spanish study conducted at a private hospital for addiction treatment showed that 798 (33.8%) out of 2,361 participants had mental illnesses, with depression being the most common disease combined with substance abuse, followed by anxiety disorders. These conditions had many risk factors including divorce, widowhood, high educational level, and being female. In terms of substances, alcohol has the highest rate of substance abuse (48.5%) in a dual diagnostic setting, with opiates being at the lowest end of the spectrum (27.4%) [21].
Genetic Polymorphism
Environmental and genetic variables have both been associated with addiction. Determining how genetic variables contribute to the etiology of addiction may enhance patient responsiveness to care and aid in disease prevention. By identifying the genes that are essential for neuroadaptation, both genome-wide approaches and candidate gene studies have been used to investigate the fundamental significance of the genetic component of drug addiction [22]. There are multiple studies that support the link between genetic polymorphism and substance abuse. One such study involved male participants from Jordan of Arab heritage. Nearly 498 individuals were determined to be addicted to one or more of various substances, including synthetic cannabinoids (47.5%), cannabinoids (19.6%), amphetamine (5.7%), alcohol (5.5%), benzodiazepines (4.6%), opiates (4.4%), cocaine (1.1%), and cannabis (0.4%). In 89% of the cases, only one drug was used. However, 11% of the participants with addiction in this study used multiple drugs [13]. The study found that the OPRM1 gene’s rs1799971 was associated with drug addiction, for both alleles and genotypes. Further, the age of addicted individuals, their smoking, and their marital status may be associated with the risk of developing a drug addiction, along with genetic variants in the OPRM1, OPRD1, and OPRK1 genes [22]. Another study on the brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family, shows that it may be involved in the mechanisms behind substance misuse, according to data from animal research and genetic tests on humans. The BDNF-gene Val66Met polymorphism’s potential link to substance misuse was investigated in a polymorphism study involving 122 healthy individuals, 200 heroin users, and 103 methamphetamine users. It was thought that there might be a link between this polymorphism and the age of onset of drug addiction, in cases of heroin dependence. A decrease in the 66Met carrier frequency was linked to substance misuse, as can be seen by the significant variations in BDNF Val66Met genotype distribution between persons dependent on methamphetamine (p= 0.046) or heroin (p= 0.045) and healthy controls. In addition, compared to Meet allele carriers, the heroin-dependent group’s Val/Val homozygotes experienced a slower start of substance misuse. These findings imply that the pathophysiology of substance misuse may include the BDNF Val66Met polymorphism or a neighboring location. The results confirm earlier genetic scan findings suggesting that BDNF may increase susceptibility to substance misuse [23]. Major and minor allele frequency data are available in PubMed; however, there are no data available on population prevalence. In the following populations, SNPedia provides population diversity percentages for homozygous SNP, homozygous normal, and heterozygous, for all but one of our SNPs (rs4532; rs1800497; rs6280; rs1800955; rs4680 and rs1799971). There are unfortunately no statistics on the population prevalence of dinucleotide or a variable number of tandem repeats [24]. Almost all previous studies suggest a significant link between genetic polymorphism and drug abuse, with a wide variety of gene involvements [22-24].
Misuse of Prescription or OTC Medicine
Recently, there have been increasing reports of the misuse of prescription and OTC drugs. OTC drugs are medications available without supervision, meaning that people can easily procure them. They are typically safe if used in recommended and prescribed doses. However, these drugs can also be harmful, as overdose can lead to addiction and dependency [25]. Moreover, they also pose a significant risk of organ damage [25,26]. A cross-sectional descriptive observational study targeting the entire Spanish population was conducted using an online questionnaire. The results showed that 78.9% of the participants had previously taken or were currently taking OTC drugs. This consumption decreased as the age of the participants increased, with only approximately 36.4% of them aged ≥ 71 taking OTC drugs [27].
History of Substance Use
Prior history of substance abuse plays a major role in developing addiction in the future. This is evidenced by several studies, stating that alcohol and drug use prior to adolescence is a risk factor for developing substance abuse disorder later in life. Moreover, alcohol use at various initiating ages has been found to be associated with the risk of addiction and abuse, and one study concluded that an initiation age of drinking alcohol younger than 11 years old tends to lead to adult alcohol abuse [28]. Furthermore, the use of tobacco early in life and continuing to use tobacco during adolescence has been linked to a high risk of future cannabis and alcohol abuse [29,30].
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Conclusions
The likelihood of acquiring substance misuse later in life is significantly impacted by a history of substance abuse, this was evident in several research studies. According to a study, drinking alcohol before the age of 11 has the propensity to cause chronic adult alcoholism. Early cigarette smoking has also been linked to a significantly increased risk of later developing drug and alcohol abuse.
Various risk factors have not only been associated with but have also negatively influenced rehabilitation measures. This review found a correlation between the history of childhood abuse and individuals’ substance abuse; moreover, these individuals often experience serious substance abuse issues later in adulthood.
During our review of the risk factors, we also found that a family history of substance abuse is one of the risk factors evidenced by a study involving medical students and doctors suffering from substance abuse and another study on methadone maintenance therapy and a family history of substance abuse.
Substance abuse is affected not only by individuals’ environments or backgrounds but also by other factors such as age, interpersonal trauma, ethnicity, gender, academic stress for those aged 18-25 years, long-term use of prescribed medication, and socioeconomic status. Further, being male and having friends or peers who are a “bad influence” and even the educational level of both parents have an impact on an individual's substance abuse, particularly their behavior around their child. Also, substance abuse can result from grieving the loss of a close family member or friend.
The coexistence of a mental disorder may also lead to the misuse of substances, considering the vulnerability of these individuals’ mental state; this conclusion is evidenced by a study from the United States, which showed that 7 to 10 million individuals with substance abuse disorders have coexisting mental health disorders. Another study conducted in Spain found that the most common comorbid mental health disorder was depression, followed by an anxiety disorder.
Genetics has also been shown to play a role in addiction; this is evidenced by a study conducted in Jordan in which they discovered that the OPRM1 gene is implicated in drug addiction. Additionally, another study investigating BDNF showed that it may be involved in the mechanism of addiction or substance misuse. Prescription or OTC medications, which are the easiest and most accessible drugs to individuals, are also often abused. Although these drugs are safe, they are dangerous if the recommended doses are exceeded, which may lead to dependency and addiction.
In conclusion, this narrative review study has revealed that substance abuse drastically affects an individual, both clinically and functionally, often causing significant impairment. Encouraging the next young generations to control their bad habits may benefit in preventing further self-harm. Further large-scale and well-designed randomized controlled clinical studies that explore substance abuse effects are necessary.