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Differences in Substance Use Disorder Severity Among Sexual Minority Adolescents and Emerging Adults: Results from the 2023 National Survey on Drug Use and Health
Journal: LGBT Health, 2026, doi: 10.1177/23258292261428157
Authors: Trey V. Dellucci, Patrick Janulis, & Zachary W. Adams
Abstract:
Purpose: The purpose of this study was to describe disparities in the severity of substance use disorders (SUDs) between sexual minority (SM) and heterosexual youth.
Methods: The current study analyzed data from the 2023 National Survey on Drug Use and Health to examine differences in SUDs between SM and heterosexual youth. Analyses were limited to participants aged 12-25 years (n = 23,333). Participants reported on their sexual identity and completed items on past-year substance use. SUDs were classified using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. A separate multinomial regression model was conducted for each outcome (alcohol use disorder [AUD] severity, cannabis use disorder [CUD] severity, and drug use disorder severity), stratified by age and sex. Each model included sexual identity as the primary predictor.
Results: Odds for meeting criteria for an SUD at any severity level were generally highest for bisexual youth compared with all other youth, with few exceptions. AUD severity varied slightly among adolescents, and CUD varied slightly among males.
Conclusion: This study is the first to identify differences in DSM-5 SUD severity between SM and heterosexual youth. The findings underscore the importance of developing clinical interventions tailored to the distinct challenges faced by SM youth, especially bisexual youth, to help reduce disparities in substance use outcomes.
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Preventing Alcohol and Cannabis-Impaired Driving Among Adolescents: Effects of a Web-Intervention in a Driver Education Program
Journal: Journal of Substance Use & Addiction Treatment, 2026, doi: 10.1016/ j.josat.2026.209945
Authors: Karen Chan Osilla, Katherine Nameth, Anthony Rodriguez, Justin F. Hummer, & Elizabeth J. D’Amico
Abstract:
Introduction: Adolescence is a critical period during which teens initiate and escalate substance use, as well as begin learning to drive. Limited research has evaluated programs to prevent impaired driving behaviors in this age group. We tested effects of adding a single-session web intervention to existing driver education curriculum.
Methods: Driving school staff recruited participants aged 15.5 to 17 from 12 driver education programs. Participants were randomized to driver education only (usual care, 30 h) or driver education plus a single-session web intervention (webCHAT, ∼30 min). Participants completed surveys at baseline and six months.
Results: The sample (N = 198) was 60% female, 80% White, and averaged 15.7 (SD = 0.8) years old. At baseline, 25% and 8% reported past three-month alcohol and cannabis use, respectively, and 19% and 10% reported ever riding with someone under the influence of alcohol or cannabis, respectively. At follow-up, webCHAT participants reported significantly lower perceived peer alcohol (-1.14, 95% CI: -1.915, -0.372, p = 0.004) and cannabis (-1.09, 95% CI: -1.866, -0.306, p = 0.007) use norms compared to usual care participants. Both webCHAT and usual care participants significantly reduced past month alcohol and cannabis use and viewed impaired driving as riskier and less acceptable at follow-up.
Conclusion: Driver education programs offer a unique opportunity to prevent substance use and impaired driving when adolescents are motivated to participate to secure their driver’s license. These programs should continue updating curricula to reflect the state of science for alcohol and drug prevention.
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A Call for Action: Closing the Evidence Gap in Management of Stimulant-Induced Psychosis
Journal: Addiction, 2026, doi: 10.1111/add.70393
Authors: Anne Bouthillier, Heidar Sharafi, Adam Bisaga, & Didier Jutras-Aswad
Abstract:
Background: Stimulant-induced psychosis (StIP) is emerging as one of most pressing health challenges. Over the past two decades, stimulant-related harms and psychiatric care demands have risen sharply. Individuals with StIP often present with severe agitation and high suicide risk, and up to half progress to chronic psychotic illness within two years. Despite this burden, clinical recommendations remain sparse and largely based on consensus rather than evidence. This article aims to critically appraise current conceptual and therapeutic approaches to StIP, highlight evidence gaps, and outline priorities for research and clinical practice.
Argument: We propose a re-evaluation of StIP nosology, shifting away from DSM-5 distinctions that require symptom presence beyond abstinence and often fail in real-world settings. Management might require stage-specific approaches- acute (safety and short-term antipsychotics), subacute (stabilization and relapse prevention), and long-term (management of recurrent or persistent psychosis)- yet no validated staging models exist. Antipsychotic prescribing remains guided by expert opinion, with unresolved questions around choice of agent, treatment duration, and relapse prevention strategies. Evidence for psychosocial and behavioral interventions is very limited. Individualized care, supported by predictive tools, biomarkers, and longitudinal risk stratification, is essential to identify individuals at highest risk of progression and chronicity while minimizing unnecessary long-term pharmacotherapy.
Conclusions: Stimulant-induced psychosis (StIP) exemplifies a widening evidence-practice gap. Addressing this requires a coordinated research agenda to address nosology and phenomenology, validate diagnostic algorithms, develop stage-specific management models, and test integrated pharmacological and behavioral strategies. Without such efforts, outcomes will remain poor, and StIP will continue to represent one of psychiatry’s most consequential yet neglected syndromes.
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Implementing Substance Use Services into Acute Care Settings for Pregnant and Birthing People: A Systematic Scoping Review of Implementation and Quality Improvement
Journal: PLoS One, 2026, doi: 10.1371/journal.pone.0344389
Authors: Carla King, Adetayo Fawole, Gregory Laynor, Jennifer McNeely, Mishka Terplan, Matthew Lee, & Sugy Choi
Abstract:
Pregnant and birthing people with untreated substance use disorders (SUDs) face multiple risks of mortality and morbidity. Acute care settings (i.e., hospital inpatient, labor/delivery and emergency departments) are one opportunity to provide substance use services, but have had limited implementation. This scoping review synthesized studies that used an implementation science or quality improvement (QI) strategy to implement substance use services into acute care settings for pregnant or birthing people. Our aim was to 1) characterize the implemented strategies; 2) assess the inclusion of racial equity in study design and implementation; 3) summarize measures and outcomes used to evaluate implementation; and 4) identify reported barriers and facilitators to implementation. We searched MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsycINFO (Ovid) for published studies using keywords and structured vocabulary, and supplemented database searches with a grey literature search of conference proceedings. Two authors independently screened then extracted studies that met eligibility criteria. After removing 661 duplicates, we screened 1101 studies by title and abstract and excluded 1037. Thirty-six were excluded after full text review yielding 28 studies for extraction. Studies were observational (n = 20, 71%), QI (n = 7, 25%), and experimental (n = 1, 4%). Twenty (71%) focused on SUDs broadly; 8 (29%) targeted OUD. Five strategy types were identified: 1) education and learning collaboratives (n = 11, 39%); 2) clinical workflows and pathways (n = 7, 25%); 3) brief interventions (n = 2, 7%); 4) peer support (n = 4, 14%); and 5) structural changes (n = 4, 14%). Five studies (18%) considered racial and ethnic equity in design or implementation. Overall, studies highlight promising strategies to implement substance use services for pregnant and birthing people in acute care settings. However, many strategies were not rigorously evaluated and few considered racial and ethnic equity in design or implementation. Future research should focus on more rigorous evaluations of implementation strategies, measure downstream outcomes such as adoption and sustained use of substance use services, and apply a racial equity lens more explicitly.
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Understanding Positive Heavy Drinking Attitudes: Daily Variability and Their Role in Intervention-Related Changes in Alcohol Use
Journal: Addictive Behaviors, 2026, doi.org/10.1016/j.addbeh. 2026.108680
Authors: Angelo M. DiBello, Jennifer E. Merrill, Kate B. Carey, & Mary Beth Miller
Abstract:
Purpose: Alcohol use and its related harms remain highly prevalent among young adults, with heavy drinking and alcohol-induced blackouts posing significant public health risks. This study had two goals: first, we examined attitudes toward heavy drinking as both stable (between-person) and dynamic (within-person) predictors of alcohol use and consequences among heavy-drinking young adults. Furthermore, we explored changes in attitudes toward heavy drinking as a mediator of intervention efficacy.
Method: The data for the current work come from a larger randomized controlled trial where participants in the intervention condition completed 30 days of daily surveys assessing attitudes toward heavy drinking and drinking outcomes. Generalized linear mixed models were used to test within- and between-person associations between daily attitudes and odds of drinking on a given day, same-day drinking quantity, high-intensity drinking (HID), alcohol-related consequences, and blackout. Exploratory mediation analyses leveraged data from all participants in the full trial collected at baseline, post-intervention, and 3-month follow-up and tested whether changes in attitudes mediated intervention effects on HID.
Results: Results indicated that individuals with more favorable attitudes toward heavy drinking consumed more drinks per day on average. Within-person fluctuations were especially influential: on days when participants held more favorable attitudes than usual, they reported greater odds of drinking (vs. not), significantly higher drinking quantity, and greater odds of HID (vs. not), alcohol-related consequences (vs. not), and blackout (vs. not). In exploratory analyses, the digital health intervention (the “Drinking Dashboard”) reduced favorable attitudes toward heavy drinking, which in turn mediated reductions in HID.
Conclusions: Findings demonstrate that attitudes toward heavy drinking are both dynamic and modifiable. Day-to-day variability in attitudes predicted same-day risky drinking behaviors, and changes in attitudes served as a mechanism of intervention efficacy. These results highlight attitudes as both a proximal risk factor and a key target for digital interventions aimed at reducing alcohol-related harm among young adults.
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Published
April 2026