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Essay on Drug Abuse

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Essay on Drug Abuse in 150 words

Essay on drug abuse in 250-300 words, essay on drug abuse in 500-1000 words.

Drug abuse is a global issue that poses serious risks to individuals and society. It involves the harmful and excessive use of drugs, leading to physical and mental health problems. Drug abuse can result in addiction, organ damage, cognitive impairment, and social and economic difficulties. Prevention efforts should focus on education, raising awareness about the dangers of drug abuse, and promoting healthy lifestyles. Access to quality healthcare and addiction treatment services is crucial for recovery. Strengthening law enforcement measures against drug trafficking is necessary to address the supply side of the problem. Creating supportive environments and opportunities for positive engagement can help prevent drug abuse. By taking collective action, we can combat drug abuse and build healthier communities.

Drug abuse is a growing global concern that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have negative effects on physical and mental health.

Drug abuse has severe consequences for individuals and society. Physically, drug abuse can lead to addiction, damage vital organs, and increase the risk of overdose. Mentally, it can cause cognitive impairment, and psychological disorders, and deteriorate overall well-being. Additionally, drug abuse often leads to social and economic problems, such as strained relationships, loss of employment, and criminal activities.

Preventing drug abuse requires a multi-faceted approach. Education and awareness programs play a crucial role in informing individuals about the dangers of drug abuse and promoting healthy lifestyle choices. Access to quality healthcare and addiction treatment services is vital to help individuals recover from substance abuse. Strengthening law enforcement efforts to curb drug trafficking and promoting international cooperation is also essential to address the supply side of the issue.

Community support and a nurturing environment are critical in preventing drug abuse. Creating opportunities for individuals, especially young people, to engage in positive activities and providing social support systems can serve as protective factors against drug abuse.

In conclusion, drug abuse is a significant societal problem with detrimental effects on individuals and communities. It requires a comprehensive approach involving education, prevention, treatment, and enforcement. By addressing the root causes, raising awareness, and providing support to those affected, we can combat drug abuse and create a healthier and safer society for all.

Title: Drug Abuse – A Global Crisis Demanding Urgent Action

Introduction :

Drug abuse is a pressing global issue that poses significant risks to individuals, families, and communities. It refers to the excessive and harmful use of drugs, both legal and illegal, that have detrimental effects on physical and mental health. This essay explores the causes and consequences of drug abuse, the social and economic impact, prevention and treatment strategies, and the importance of raising awareness and fostering supportive communities in addressing this crisis.

Causes and Factors Contributing to Drug Abuse

Several factors contribute to drug abuse. Genetic predisposition, peer pressure, stress, trauma, and environmental influences play a role in initiating substance use. The availability and accessibility of drugs, as well as societal norms and cultural acceptance, also influence drug abuse patterns. Additionally, underlying mental health issues and co-occurring disorders can drive individuals to self-medicate with drugs.

Consequences of Drug Abuse

Drug abuse has devastating consequences on individuals and society. Physically, drug abuse can lead to addiction, tolerance, and withdrawal symptoms. Substance abuse affects vital organs, impairs cognitive function, and increases the risk of accidents and injuries. Mental health disorders, such as depression, anxiety, and psychosis, are often associated with drug abuse. Substance abuse also takes a toll on relationships, leading to strained family dynamics, social isolation, and financial instability. The social and economic costs of drug abuse include increased healthcare expenses, decreased productivity, and the burden on criminal justice systems.

Prevention and Education

Preventing drug abuse requires a comprehensive and multi-faceted approach. Education and awareness programs are essential in schools, communities, and the media to inform individuals about the risks and consequences of drug abuse. Promoting healthy coping mechanisms, stress management skills, and decision-making abilities can empower individuals to resist peer pressure and make informed choices. Early intervention programs that identify at-risk individuals and provide support and resources are crucial in preventing substance abuse.

Treatment and Recovery

Access to quality healthcare and evidence-based addiction treatment is vital in addressing drug abuse. Treatment options include detoxification, counseling, behavioral therapies, and medication-assisted treatments. Rehabilitation centers, support groups, and outpatient programs provide a continuum of care for individuals seeking recovery. Holistic approaches, such as addressing co-occurring mental health disorders and promoting healthy lifestyles, contribute to successful long-term recovery. Support from family, friends, and communities plays a significant role in sustaining recovery and preventing relapse.

Law Enforcement and Drug Policies

Effective law enforcement efforts are necessary to disrupt drug trafficking and dismantle illicit drug networks. International cooperation and collaboration are crucial in combating the global drug trade. Additionally, drug policies should focus on a balanced approach that combines law enforcement with prevention, treatment, and harm reduction strategies. Shifting the emphasis from punitive measures toward prevention and rehabilitation can lead to more effective outcomes.

Creating Supportive Communities:

Fostering supportive communities is vital in addressing drug abuse. Communities should provide resources, social support networks, and opportunities for positive engagement. This includes promoting healthy recreational activities, providing vocational training, and creating safe spaces for individuals in recovery. Reducing the stigma associated with drug abuse and encouraging empathy and understanding are crucial to building a compassionate and supportive environment.

Conclusion :

Drug abuse remains a complex and multifaceted issue with far-reaching consequences. By addressing the causes, raising awareness, implementing preventive measures, providing quality treatment and support services, and fostering supportive communities, we can combat drug abuse and alleviate its impact. It requires collaboration and a collective effort from individuals, communities, governments, and organizations to build a society that is resilient against the scourge of drug abuse. Through education, prevention, treatment, and compassion, we can pave the way toward a healthier and drug-free future.

• Open access
• Published: 07 November 2021

How to prevent alcohol and illicit drug use among students in affluent areas: a qualitative study on motivation and attitudes towards prevention

• Pia Kvillemo   ORCID: orcid.org/0000-0002-9706-4902 1 ,
• Linda Hiltunen 2 ,
• Youstina Demetry 3 ,
• Anna-Karin Carlander 4 ,
• Tim Hansson 5 ,
• Johanna Gripenberg 1 ,
• Tobias H. Elgán 1 ,
• Kim Einhorn 4 &
• Charlotte Skoglund 1 , 4  

Substance Abuse Treatment, Prevention, and Policy volume  16 , Article number:  83 ( 2021 ) Cite this article

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The use of alcohol and illicit drugs during adolescence can lead to serious short- and long-term health related consequences. Despite a global trend of decreased substance use, in particular alcohol, among adolescents, evidence suggests excessive use of substances by young people in socioeconomically affluent areas. To prevent substance use-related harm, we need in-depth knowledge about the reasons for substance use in this group and how they perceive various prevention interventions. The aim of the current study was to explore motives for using or abstaining from using substances among students in affluent areas as well as their attitudes to, and suggestions for, substance use prevention.

Twenty high school students (age 15–19 years) in a Swedish affluent municipality were recruited through purposive sampling to take part in semi-structured interviews. Qualitative content analysis of transcribed interviews was performed.

The most prominent motive for substance use appears to be a desire to feel a part of the social milieu and to have high social status within the peer group. Motives for abstaining included academic ambitions, activities requiring sobriety and parental influence. Students reported universal information-based prevention to be irrelevant and hesitation to use selective prevention interventions due to fear of being reported to authorities. Suggested universal prevention concerned reliable information from credible sources, stricter substance control measures for those providing substances, parental involvement, and social leisure activities without substance use. Suggested selective prevention included guaranteed confidentiality and non-judging encounters when seeking help.

Conclusions

Future research on substance use prevention targeting students in affluent areas should take into account the social milieu and with advantage pay attention to students’ suggestions on credible prevention information, stricter control measures for substance providers, parental involvement, substance-free leisure, and confidential ways to seek help with a non-judging approach from adults.

Alcohol consumption and illicit drug use are major public health concerns causing great individual suffering as well as substantial societal costs [ 1 , 2 ]. Early onset of substance use is especially problematic since the developing brain is vulnerable to the effects of alcohol and drugs, increasing the risk of long-term negative effects, such as harmful use, addiction, and mental health problems [ 3 , 4 , 5 , 6 ]. Short-term consequences of substance use include intoxication [ 5 , 7 ], accidents [ 8 [, academic failure [ 9 ], and interaction with legal authorities [ 10 ], which calls for effective substance use prevention in adolescents and young adults. Such prevention interventions may be universal, targeting the general population, e.g., legal measures and school based programs, or selective, targeting certain vulnerable at-risk groups, i.e., subsections of the population [ 11 ]. Selective prevention can be carried out within a universal prevention setting, such as health care or school, but also be delivered directly to the group which it aims to target, face-to-face or digitally [ 12 , 13 , 14 , 15 ].

The motives to use substances are governed by a number of personal, social and environmental factors [ 16 ], ranging from personal knowledge, abilities, beliefs and attitudes, to the influence of family, friends and society [ 17 , 18 , 19 , 20 ]. Cooper and colleagues [ 21 ] have previously identified a number of motives for drinking, i.e., 1) enhancement (drinking to maintain or amplify positive affect), 2) coping (drinking to avoid or dull negative affect), 3) social (drinking to improve parties or gatherings), and 4) conformity (drinking due to social pressure or a need to fit in). Similar motives for illicit drug use have been found by e.g. Kettner and colleagues, who highlighted the attainment of euphoria and enhancement of activities as prominent motives for use of psychoactive substances among people using psychedelics in parallel with other substances [ 22 ], along with Boys and colleagues [ 23 , 24 , 25 ], who reported on changing mood (e.g., to stop worrying about a problem) and social purposes (e.g., to enjoy the company of friends) as motives for using illicit drugs among young people. Additionally, the authors found that the facilitation of activities (e.g., to concentrate, to work/study), physical effects (e.g., to lose weight), and the managing of the effects of other substances (e.g., to ease or improve) motivated young people to use illicit drugs.

Prior research has repeatedly shown that low socioeconomic status is a risk factor for substance use and related problems [ 26 , 27 , 28 ]. However, recent research from Canada [ 29 ], the United States [ 30 , 31 , 32 ], Serbia [ 33 ], Switzerland [ 34 ], and Sweden [ 35 ] suggest that high socioeconomic status too is associated with excessive substance use among young people, although for other reasons [ 29 , 30 , 31 , 32 , 33 , 34 ]. Previous research has highlighted two main explanations for excessive substance use among young people in families with high socioeconomic status; i) exceptionally high requirements to perform in both school and leisure activities and ii) absence of adult contact, emotionally and physically, due to parents in resourceful and affluent areas spending a lot of time on their work and careers [ 36 , 37 ]. In addition to these explanations, high physical and social availability due to substantial economic resources and a social milieu were substance use is a natural element, may enable extensive substance use among economically privileged young people [ 30 , 38 , 39 ].

In parallel with identification of various groups at risk for extensive substance use, a growing number of young people globally abstain from using substances [ 1 , 40 , 41 ]. By analyzing data derived from a nationally representative sample of American high school students, Levy and colleagues [ 40 ] found an increasing percentage of 12th-graders reporting no current (past 30 days) substance use between 1976 and 2014, showing that a growing proportion of high school students are motivated to abstain from substance use. However, while this global decrease in substance use among adolescents is mirrored in Swedish youths, in particular alcohol use, a more detailed investigation shows large discrepancies across different socioeconomic and geographic areas. Affluent areas in Sweden stand out as breaking the trend, showing increasing alcohol and illicit drug use among adolescents [ 42 , 43 ].

To date, we lack in-depth knowledge of why youths in affluent areas keep using alcohol and illicit drugs excessively. Furthermore, despite implementation of various strategies and interventions over the last decades [ 14 , 44 , 45 , 46 , 47 , 48 ], we have yet no clear guidelines on how to effectively prevent substance use in this specific group, although the importance of parents’ role for preventing substance use in privileged adolescents has been highlighted in a recent study [ 29 ]. Moreover, despite the fact that attitudes are assumed to guide behavior [ 49 , 50 ] and consequently the reception and effects (behavior change) of prevention interventions, the knowledge about affluent adolescents’ attitudes toward current substance use prevention interventions remains limited. To our knowledge, the only study exploring adolescents’ attitudes to substance use prevention was carried out among Spanish adolescents who participated in “open-air gatherings of binge drinkers”. The study concerned adolescents irrespective of their economic background and revealed positive attitudes to restrictions for drunk people [ 19 ]. Thus, extended knowledge on what motivates young people in affluent areas to excessively use substances, or abstaining from using, as well as their attitudes to prevention is warranted.

In the current study, we aim to explore motives for using, or abstaining from using, substances among students in affluent areas. In addition, we aim to explore their attitudes to and suggestions for substance use prevention. The findings may make a valuable contribution to the research on tailored substance use prevention for groups of adolescents that may not be sufficiently supported by current prevention strategies.

A qualitative interview study was performed among high school students in one of Stockholm county’s most affluent municipalities. The research team developed a semi-structured interview guide (supplementary Interview guide) covering issues regarding the individual’s physical and mental health, extent of alcohol and illicit drug use, motives for use or abstinence, relationships with peers and family, alcohol and drug related norms among peers, family and in the society, and attitudes towards strategies to prevent substance use. Examples of interview questions are: How would you describe your health? Which are the main reasons why young people drink, do you think? How do you get hold of alcohol as a teenager?

What do you know about drug use among young people in Municipality X? How would you describe your social relationships with peers in and outside Municipality X?

The study was approved by the Swedish Ethical Review Authority (dnr. 2019–02646).

Study setting

Sweden has strict regulations of alcohol and illicit drugs compared to many other countries [ 45 , 46 ]. Alcohol beverages (> 3.5% alcohol content by volume) can only be bought at the Swedish Alcohol Retailing Monopoly “Systembolaget” by people 20 years of age or older, or at licensed premises (e.g., bars, restaurants, clubs), at the minimum age of 18 years. The use of illicit drugs is criminalized. The study was carried out in a municipality with 45% higher annual median income than the corresponding figure for all of Sweden, along with the highest educational level among all Swedish municipalities, i.e., 58% of the population (25 years and over) having graduated from university and hold professional degrees, as compared with the national average of 26%. Furthermore, only 6.1% of the inhabitants receive public assistance, compared to a national average of 13.4% [ 51 ].

Recruitment

Purposive sampling was used to recruit students from the three high schools located in the selected municipality. Contact was established by the research team with the principals of the high schools that agreed to participate in the study. Information and invitation to participate in the study was published on the schools’ online platforms, visible for parents and students. Students communicated their initial interest in participating to the assistant principal. Upon consent from the students, the assistant principal forwarded mobile phone numbers of eligible students to the research team. Also, students from other schools in the selected municipality were asked by friends to participate and upon contact with the research team were invited to participate. Forty students signed up to take part in the study, of which 20 were finally interviewed, representing four schools (three in the selected municipality and one in a neighbor municipality). Before the interview, informed consent was obtained by informing the students about confidentiality arrangements, their right to withdraw their participation and subsequently asking them about their consent to participate. The consent was recorded and transcribed along with the following interview. Twenty students who had initially signed up were excluded after initial consent due to incorrect phone numbers or if the potential participants were not reachable on the agreed time for participation. The reason for terminating the recruitment after 20 interviewees was based on the fact that little or no new information was considered to occur by including additional participants.

Participants

The final sample consisted of 20 students. Background information of the participants is presented in Table  1 . The group included eleven girls and nine boys between 15 and 19 years of age. Seven participants attended natural sciences/technology/mathematic programs and 13 attended social sciences/humanities programs. Twelve participants lived in the socioeconomically affluent municipality where the schools were located and eight in neighboring municipalities. The sample included three abstainers and 17 informants who were using substances, the latter referring to self-reported present use of alcohol and/or illicit drugs (without further specification). Additionally, 18 of the participants reported that at least one of their parents had a university education.

During April–May 2020, semi-structured telephone interviews with the students were conducted by five of the authors (PK, YD, AKC, TH, CS). The interviewers had continuous contact during the interview process, exchanging their experiences from the interviews and also the content of the interviews. After 20 interviews had been conducted, it was assessed that no or little new information could be obtained by additional interviews and the interview process was terminated. The interviews, on average around 60 min long, were recorded on audio files and transcribed verbatim.

Qualitative content analysis, informed by Hsieh & Shannon [ 52 ] and Granheim & Lundman [ 53 ], was used to analyze the interview material. To increase reliability of the analytic process, a team based approach was employed [ 54 ], utilizing the broad expertise represented in the research team and the direct experience of information collected from the five interviewers.

The software NVivo 12 was utilized for structuring the interview data. Initially, one of the researchers (PK) read all the interviews repeatedly, searching for meaningful units which could be grouped into preliminary categories and codes, as exemplified in Table 2 . During the process, a preliminary coding scheme was developed and presented to the whole research team. After discussion, the coding scheme was slightly revised. Following this procedure, a second coder (CS) applied the updated coding scheme along with definitions (codebook) [ 54 ], coding all the interviews independently. Subsequent discussions between PK, YD and CS, resulted in an additionally revised coding scheme. This scheme was utilized by PK and another researcher (LH), who had not been involved in the interviewing or coding, coding all of the interviews independently. The agreement between the coders PK and LH was high and a few disagreements solved through discussion. No change in the codes was necessary and the research team agreed on the coding scheme as outlined in Fig.  1 .

Final coding scheme

The interview material generated three main categories, six subcategories and 27 codes. The results are presented under headings corresponding to the identified subcategories, since they are directly connected to the aim of the study. Content from the main category “External factors” is initially presented to illustrate the context in which the students form their motivation to use or abstain from using substances, as well as their attitudes towards prevention.

External factors

The external factors found in the interview material concerned wealth, availability of alcohol and other substances, parental norms and peer norms. Informants living in the affluent municipality described an expensive lifestyle with boats, ski trips, summer vacations abroad, and frequent restaurant visits, in contrast to informants from other areas who described a more modest lifestyle. These differences were further accentuated by informants’ descriptions of large villas in the affluent municipality, where students can arrange parties while the parents go to their holiday homes. Some informants further pointed to the fact that people in this municipality easily can afford to buy illicit drugs, increasing the availability.

The reason why they do it [use illicit drugs] in [the affluent municipality] is because the parents go away, which make it easier to have parties and be able to smoke grass at home, and also because they can afford it .

Parents’ alcohol norms seemed to vary between families, but most informants described modest drinking at home, with parents consuming alcohol on certain occasions and sometimes when having dinner. However, several informants described that they as minors/children were offered to taste alcohol from the parents’ glasses. Most of the informants meant that their parents trust them not to drink too much when partying.

They [my parents] have said to me that drinking is not good, but that they understand if I drink, sort of.

Both parents’ and peers’ norms appear to influence substance use among the students, The impression is that there is an alcohol liberal norm in the local society among adults as well as among adolescents.

If you want to have a social life in community X, then it is very difficult … you almost cannot have it if you don’t drink at parties.

Motives for using substances

Confirming that both alcohol and illicit drugs are frequently used among students in the current municipality, a number of motives for substance use were expressed by the participants. The most prominent motive appeared to be a desire to feel a part of the social milieu and to attain or maintain high social status, with fear of being excluded from attractive social activities and parties if abstaining from substance use. The participants indicated that you are expected to drink alcohol to be included in the local community social life, claiming that this applied to the adult population as well. Alcohol consumption and even intoxication are perceived to be the norm in the students’ social life and several of the participants noted that abstainers risk being considered too boring to be invited to parties.

The view is that you cannot have fun without alcohol and therefore, you don’t invite sober people.

There seemed to be a high awareness of one’s own as well as peers’ popularity and social status. Participants evaluated peers as high or low status, fun or boring, claiming that trying to be cool and facilitate contact with others motivates people to use substances. High status students are, according to some participants, frequently invited to parties where alcohol and other substances are easily accessible.

I would say that our group of friends has more status. [… ] You know quite a few [people] and you are invited to quite a lot of parties. You can often evaluate the group of friends, i.e. their status, based on which parties they are invited to. […] Some [groups of friends] only drink alcohol and some even take drugs and drink alcohol.

Some differences in traditions and norms between schools was discerned, with certain schools being especially known for high alcohol consumption and drug use procedures when including new students in the school-community. One of the participants described fairly extensive norm violations, with respect to the law, on these occasions, e.g., strong peer pressure to drink alcohol and use illicit drugs, combined with humiliation of new students, careless driving under the influence of substances with other students in the car, and “punishment” by future exclusion from social events of those who don’t participate at these occasions. On the other hand, already popular, or more senior students, appear to be able to abstain from substance use on occasions without being questioned or risk social exclusion. High self-esteem and a firm approach when occasionally saying no to substances is often respected according to the participants. To avoid peer pressure to use alcohol or illicit drugs, the participants suggested acceptable excuses, such as school duties, bringing your moped or car to the party, having a sports activity or work the day after, or having plans with your parents or extended family during the weekend.

Apart from peer influence, several students expressed hedonistic motives, such as enjoying a nice event or simply to have fun.

If you want a little extra fun, then you take drugs.

Apart from social enhancement motives for using substances, some students reported that relaxing from academic pressure or rewarding oneself after an intense period of studying motivates them to use substances. Almost every participant expressed high academic ambitions. One participant who claimed to be very motivated to study expressed drinking due to stress, as illustrated in the extract below:

You study a lot and you are stressed over school. Then it can be very nice to go out and drink and you can forget everything else for a few hours. […] So it can be a “stress reliever” in that way.

Yet another participant explained that academic failure had previously made her use substances to comfort herself. Coping with mental health problems, such as depression, was also stated as a reason for substance use. Moreover, some participants reported that they use ADHD (Attention Deficit Hyperactivity Disorder) medication to be able to study more intensively.

Motives for abstaining from using substances

A number of motives for totally or temporarily abstain from substance use were put forward by the students, such as a wish to be healthy, keep control and avoid embarrassment, influence of parents, academic pressure, sports ambitions or simply lack of interest. Lack of interest in alcohol and drugs was expressed foremost by those attending natural sciences programs and those who totally abstained from substance use.

I attend the engineering program and I don’t think the interest in alcohol and parties is as present as it might be on social sciences programs.

Fear of health consequences was predominantly related to abstaining from illicit drugs, but also alcohol. Motives for abstaining from alcohol included perceived risk of being addicted, due to relatives having alcohol problems (heredity), and taking medicine, for example ADHD medicine, since combining alcohol and medication was perceived as risky. Some students had observed friends getting “weird” or “laze” after using illicit drugs, which made them hesitant to use such substances themselves. With regard to parental norms, most parents were by the participants reported to be “normal drinkers” themselves and quite relaxed about their teens’ alcohol consumption. This applied to both the parents of older teens and minors. However, many of the participants reported that their parents would be upset and disappointed if they found out that their child used illicit substances, which motivated some of them to abstain. Reasons for abstaining from substance use included academic strivings, sports performance ambitions, driving, or other activities requiring sobriety, which the students referred to as socially acceptable reason to abstain from substance use. Prioritizing studies over partying was explicitly expressed as the primary motive to abstain by some of the participants.

We are a group of five or six who come from other municipalities. […] We don’t party and such things and we may be seen as a bit boring. But we are a little more responsible and we are more motivated to study than the others in the class.

A wish to save money and reluctance to support the illegal drug production were also mentioned as reasons to abstain from substance use, however to a lesser extent.

Universal prevention viewed as attractive or feasible

With regard to substance information interventions, some students wanted detailed information about different substances’ physical and psychological effects. The participants emphasized the importance of credible sources or persons providing the information, mentioning researchers, young medical students and even parents as credible sources of information. Individuals who had experience of substance use were also suggested.

You have to tell the facts in a way that makes us want to listen. With the help of various spokespersons who have been involved in it, for example.

Several students stressed the importance of being able to identify with the person sending the message and suggested influencers as plausible sources. Someone who is difficult to relate to was given as an example of a non-credible, as the following excerpt shows:

They shouldn’t take a heroin addicts who talk about having found Jesus, because I do not think it would touch the children or touch the young. You have to somehow find … someone that can relate to the young people.

As for universal prevention, the students also suggested intensified legal measures for companies and people providing young people with alcohol or drugs.

For example, make it difficult for young people to have access to alcohol [...], allocate more time as a police officer to catch the drug dealers.

Both alcohol and illicit drugs were reported as easily accessible. Students can obtain alcohol via social media platforms, such as Instagram and Snapchat, where “liquor cars” market themselves and offer home delivery. In addition, older siblings or peers and even some parents were, according to the informants, providing minor students with alcohol. The main way to access illicit drugs is via parties where older students offer drugs to younger peers. Access to prescription drugs was also reported.

Several of the participants agreed that parental involvement is constructive for substance use prevention. Many of them reported having supportive and caring parents involved in their lives, but at the same time referring to friends’ parents as being more absent, resulting in extensive partying in large homes without parental control. Some students reported that parents don’t realize to what extent youths are using substances and that the parents should pay even more attention to what their children do.

I think [parents should be] keeping track, good track of the kids […] . Keeping track of what they are doing and ask them how they feel and things, I think that helps.

In line with leisure activities as a reason to abstain from substance use, some participants suggested that social activities other than partying could be a way of preventing substance use, as expressed by one participant when asked about plausible ways to prevent substance use.

Find a sport or friend that you train with […] instead of going to a party,

Talking about their leisure activities, the participants expressed joy and that these activities made them relax while being social.

The leisure interests, like working out and hanging out with friends, is relaxing and in contrast to the everyday in some way .

Universal prevention viewed as inappropriate

Several of the participants expressed great skepticism towards traditional universal preventive strategies, such as lectures by teachers, social workers or researchers. Some teachers were perceived as ignorant and unengaged, lecturing about substances only by duty.

The teachers have been a bit like ‘now we’re going to talk about drugs […] and then you have fifteen minutes and they say something like ‘here we are a drug free and smoke and tobacco free school’, and no one obeys.

Some students also doubted that the information provided from school and society is true, suspecting exaggerated report on harm, and that they prefer information from social media platforms such as Youtube or other online sources.

It feels like the information we get in school is a bit exaggerated, a bit made up for us […] A bit like this, ‘now we’ll get the young people to stop’.

Selective prevention viewed as attractive or feasible

In circumstances where students are worried about their own or peers’ substance use, participants stressed the need for a way to connect with local authority, health care or other support anonymously, without being registered in medical records or being reported to the authorities. Moreover, the participants emphasized the importance of a non-judging approach from professionals when they reach out to students at risk of excessive substance use.

If you wonder about something or if you are worried about something, then you should be able to turn to adults without being yelled at and know that you are getting positive feedback like ‘I understand you’ and ‘how can we fix this?’

Selective prevention viewed as inappropriate

As indicated above, help-seeking seemed to be counteracted by fear of being recorded in medical records or in the criminal registries. One participant mentioned an incident where a student, caught smoking marijuana, was prosecuted and that this student’s life had been severely affected with cancellation of planned studies abroad and rejection of driving license application. These consequences had, according to the participant, resulted in the student “giving up” and selling illicit alcohol to other students instead of trying to strive for a good future life. Admitting that such an incident can serve as a warning to other students, the fear of consequences is, according to the participant, still an obstacle to seeking help.

People don’t really know what to do when they see their friends do it [use substances]. You don’t want to tell on them, because they are afraid that if it is written down somewhere, then everything can be ruined.

Also, parents were by the participants reported as being reluctant to seek help for their children, because of fear of the reporting of their child’s behavior or crime to authorities, with subsequent negative consequences.

Parents do not dare either because they don’t want it to be about their children. I know some parents who have found drugs in their children’s rooms, but do not want to ruin [future prospects] for them.

The current study aimed to explore motives for using or abstaining from using substances, including alcohol, among students in affluent areas, as well as their attitudes to and suggestions for substance use prevention.

Summary of results

The motives for using substances among the students are associated with social aspects as.

well as own pleasure and coping with stressful situations. The most prominent motive appears to be a desire to feel a part of the current social milieu and to attain or maintain high social status within the peer group. Several of the students expressed fear of being excluded from attractive social activities if abstaining from substance use, although some meant that they were not interested in substances and didn’t care if they were perceived as boring, and also had found a small group of friends with whom they socialized. Motives for abstaining, apart from lack of interest, included academic ambitions, activities requiring sobriety, parental influence, and a wish to stay healthy. The students expressed negative attitudes towards current information-based prevention as well as problems with using selective prevention interventions due to fear of being registered or reported to the authorities. Students’ suggestions for feasible universal prevention concerned reliable information from credible sources, stricter substance control measures, extended parental involvement, and social leisure activities without substance use. Suggestions regarding selective prevention were guaranteed confidentiality and non-judging encounters when seeking help due to substance use problems.

Comparison with previous research

Children of affluence are generally presumed to be at low risk for negative health outcomes. However, the current study, in accordance with other recent studies [ 29 , 55 ], suggest problems in several domains including alcohol and drug use and stress related problems, even if the cause of these problems cannot be determined based on our interview study. Previous explanations for extensive substance use among affluent young people have been exceptionally high-performance requirements in both school and in leisure activities, and absence of emotional and physical adult contact, resulting from parents in affluent areas spending a lot of time on their jobs and careers [ 30 , 56 , 57 , 58 ]. These explanations can be viewed in the light of Cooper and colleagues’ [ 21 ] as well as Boys and colleagues’ [ 23 , 24 , 25 ] previously identified coping motive for substance use. Coping appears among affluent young people as a central motive for substance use, i.e., coping with performance requirements and perhaps with negative affects due to parents’ absence. In the current study, however, social motives, including conformity, i.e., using substances due to social pressure and a need to fit in [ 21 , 23 , 24 , 25 ] appears to be the most prominent motive, supporting the social learning theory which proposes that behavior can be acquired by observing and imitating others and by rewards connected to the behavior [ 16 , 59 ]. Interestingly, a small group of participants, especially from natural sciences programs, resisted the general pressure to use substances and found a social context of a few friends with whom they socialized without striving for high social status in the larger social context. The wish to be included in the social life and achieve high social status within the peer group was described as a central motive for substance use among a majority of the students, along with fear of being excluded if abstaining. Previous research show that high socioeconomic status is a protective factor for substance use disorder among adults [ 60 ], but among young people it may be the opposite. High status appears to be an important risk factor for the use of substances, at least among those striving for higher status. The students report that they, to achieve high status, must attend parties and at least drink alcohol. After achieving high status, which has resulted in frequent invitations to parties, students then may pose an even higher risk of excessive alcohol and drug use. In line with previous studies, results show that individuals with larger social networks, which has shown to be an indicator for social status among young, also drink more [ 35 , 61 ]. However, status can also act as a protective factor. Individuals with higher status have, according to the interviewees, slightly more room for maneuver to temporarily say no to substances at a party, without being pressured or ashamed. Nevertheless, several of the interviewees reported that they have to choose between using substances or being excluded from desirable social activities, as abstainers are considered “boring”. The results further show that alcohol and other drugs are popular among affluent youth and the information from the participants indicate that the students perceive substance use to be under control. One possible explanation is that high affluence can contribute to a sense of control over one’s life [ 62 ]. Although previous studies show that young people from affluent areas drink more, the risk of developing alcohol problems is still greater among young people who grow up in more disadvantaged areas [ 57 ]. Why this is the case is unclear. There is a widespread belief that affluent youngsters have plenty of social and financial resources in the family and thus receive the right help (e.g., psychotherapy) when they have problems [ 62 ], which could explain why they do not develop alcohol problems. However, research also shows that parents in affluent areas seek less help than others when their children are troubled [ 30 , 63 ], partly due to difficulties in accepting and revealing problems within the family [ 62 ]. In the current study, the informants expressed doubts about the possibility to be guaranteed confidentiality when seeking help, which may mean that there are concerns among both children and parents about the risk of losing status and a good reputation if seeking help for substance use problems. Consequently, there is a risk that any substance use problems will not be noticed in this group [ 62 ].

Previous research indicates that academic pressure may promote substance use [ 56 , 64 ]. However, in the current study academic pressure, due to high ambitions, was reported both as a reason for using substances and abstaining, the former to cope with stress or relax, the latter to maintain a sharp intellect and receive high grades. Moreover, previous research has demonstrated an association between pressure from extracurricular activities or “over scheduling” and negative outcomes among affluent students ( 39 ). In the current study, this did not stand out as a critical vulnerability factor. Instead, students reported extracurricular and leisure activities as relaxing and fun and an accepted reason to abstain from substance use while still attending activities where peers were using substances.

With regard to adult or parental contact, previous research shows that mental health and substance use among adolescents in socioeconomic affluent areas are associated with parents’ lack of reaction to teenage substance use (i.e. liberal, allowing attitudes and minor or no repercussions on discovering use) and parents’ lack of knowledge of their teens’ activities [ 30 ]. In our study, the students reported that their parents do not generally react with punishment due to their child’s alcohol consumption. However, the participants thought that parents probably should react more condemningly due to illicit drug use, if revealed. The Swedish criminalization of illicit substance use [ 46 ] may influence parents to adopt stricter norms with regard to their children’s illicit substance, because of the consequences for revealed substance use that may occur in the Swedish context. Also, parents in the current study were reported as being reluctant to seek help for their children out of fear of negative consequences that may affect their children. This result is in line with previous research, showing that concern about admitting problems in their children is elevated among affluent parents [ 30 ], mentioned above. In the current study, the participants further reported closeness to their parents and that their parents cared about how they spent their time. That said, some parents of wealthy peers were reported as being more absent, resulting in extensive partying in large homes without parental control. Previous research has shown the nature of family relationships and perceptions of closeness to be important protective factors for adolescent mental health [ 56 ], and this seems to apply to the students in the current study.

The students’ attitudes to current substance use prevention, aimed to increase students’ knowledge, are to a large extent negative. Information provided in school were reported as exaggerated and uninteresting. Instead, students suggested interventions focusing on credible sources of reliable information, such as from people with personal adverse experiences of substance use and people whom they can identify with. Whether people with own experience of substance use are credible or helpful in a more objective way can be disputed, but the students seem to put their trust in them rather than other persons. This result is partly in line with previous research on school-based programs in general, suggesting that the role of the teacher (the one who deliver the information) is central and that the use of peer leaders can be successful in engaging the students who receive the message [ 65 , 66 ]. Some informants in the current study meant that the teachers in school were ignorant and unengaged, lecturing about substances only by duty, which of course can be problematic for the sense of credibility among those receiving the information. Previous research has demonstrated that for older adolescents, a social influence approach can increase the effectiveness of alcohol and drug prevention interventions, as can health education, basic skills training and the inclusion of parental support [ 67 ]. Again, this research applies to adolescents in general and not to affluent youth specifically.

Interestingly, the students also suggested stricter regulations on substances with intensified legal measures for those providing substances. Positive attitudes to limiting access of alcohol for drunk people have previously been shown in a Spanish study among adolescents participating in an open-air gatherings of binge drinkers [ 19 ]. The positive attitude to stricter regulations for those providing substances is interesting in the light of the students’ desire for a non-judging approach when having to seek help for own substance use, as described below. Previous research, however, supports strict policy measures to decrease availability as an effective measure for substance use prevention in the general population [ 68 ]. The students further suggested increased parental control and activities and venues which can be attended without using substances, for example sporting/training with friends. Leisure activities without substance use have recently been offered to e.g., adolescents in general in an Icelandic prevention strategy [ 69 ], however more research is needed to see if this kind of prevention is attractive also for large groups of affluent students as an alternative to parties and whether it also appears to be effective in reducing substance use in this group. Clearly, some affluent students without ambitions to receive high social status do find socialization without using substances attractive, as shown in the current study. With regard to selective prevention, the students were critical of the current risk of being reported to parents, registered within medical records or reported to the authorities if turning to professionals for support for substance use problems. They claimed that this circumstance serves as a massive counteracting force to seek help at an early stage for oneself or for peers and that the possibility of reaching out anonymously is essential for taking the first step in seeking help. Moreover, the adolescents in this study call for an open and non-judging approach when turning to health care staff, parents or other adults, which is in line with so called Motivational Interviewing, a non-judging approach aimed to enhance motivation to change by exploring and resolving ambivalence about e.g., substance-related behaviors [ 70 ], which has shown promising results with regard to reduction of alcohol consumption among young people [ 71 ].

Strengths and limitations

The current study has a number of strengths. Firstly, we were able to recruit both male and female students between 15 and 19 years of age, living inside the affluent community as well as in neighboring municipalities, which provided us with a broad base of the students’ social context. Secondly, we included informants using substances as well as abstainers, increasing the possibility to get a broad view of motives to use or abstain from using substances among affluent youth. Thirdly, the research group has extensive experience in qualitative analysis as well as working with adolescents and young adults with mental health problems, including alcohol and drug consumption or abuse. However, our study must also be viewed in the context of some limitations. Students with more severe health or psychosocial problems may have refrained from participating, biasing the results towards adolescents of more stable psychosocial functioning. Moreover, interview studies are always vulnerable for social desirability bias due to a potential desire to give socially acceptable answers [ 72 ]. However, the possibility to terminate participation at any time, along with the circumstance that most of the interviewers are health care professionals, thereby used to handle secrecy in consultation situations, may have decreased the risk of desirability bias in the current study.

Several of the motives guiding substance use behavior among young people in general also seem to apply to affluent youth. A desire to feel a part of the current social milieu and to attain or maintain high social status within the peer group were reported as prominent motives for substance use among affluent students in the current study. Given that the social milieu is crucial for the substance use behavior in this context, future research on substance use prevention targeting this group could with advantage pay attention to suggestions on prevention strategies given by the students. Students’ suggestions include reliable prevention information from credible sources, stricter substance control measures targeting those providing substances, parental involvement, leisure activities without substance use, and confidential ways to seek help, involving a non-judging approach from professionals and other adults.

Availability of data and materials

Collected data will be available from the Centre for Psychiatry Research, a collaboration between Karolinska Institutet and Region Stockholm, but restrictions apply to their availability, as they were used under ethical permission for the current study, and so are not publicly available. However, data are available from the authors upon reasonable request and with permission from the Centre for Psychiatry Research.

Abbreviations

attention deficit hyperactivity disorder

natural sciences/technology/mathematic programs

social sciences/humanities programs

Stockholm prevents alcohol and drug problems

The ESPAD Group. ESPAD report. Results from the European school survey project on alcohol and other drugs. Luxembourg: European Monitoring Centre for Drugs and Drug Addiction; 2019. p. 2020.

Google Scholar  

World Health Organization. Global status report on alcohol and health. WHO. 2018:2018.

Arria AM, Caldeira KM, Bugbee BA, Vincent KB, O'Grady KE. Marijuana use trajectories during college predict health outcomes nine years post-matriculation. Drug Alcohol Depend. 2016;159:158–65. https://doi.org/10.1016/j.drugalcdep.2015.12.009 .

Article   PubMed   Google Scholar  

Burdzovic Andreas J, Lauritzen G, Nordfjærn T. Co-occurrence between mental distress and poly-drug use: a ten year prospective study of patients from substance abuse treatment. Addict Behav. 2015;48:71–8. https://doi.org/10.1016/j.addbeh.2015.05.001 .

McGovern R, Kaner E, McArdle P, Ramesh V, Stewart S. Impact of alcohol consumption on young people: a systematic review of published reviews. Newcastle: Newcastle University; 2009.

Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219–27. https://doi.org/10.1056/NEJMra1402309 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Lees B, Mewton L, Stapinski LA, Squeglia LM, Rae CD, Teesson M. Neurobiological and cognitive profile of young binge drinkers: a systematic review and Meta-analysis. Neuropsychol Rev. 2019;29(3):357–85. https://doi.org/10.1007/s11065-019-09411-w .

Article   PubMed   PubMed Central   Google Scholar  

White V, Azar D, Faulkner A, Coomber K, Durkin S, Livingston M, et al. Adolescents’ alcohol use and strength of policy relating to youth access, trading hours and driving under the influence: findings from Australia. Addiction. 2018;113(6):1030–42. https://doi.org/10.1111/add.14164 .

Hicks RD, Bemis Batzer G, Bemis Batzer W, Imai WK. Psychiatric, developmental, and adolescent medicine issues in adolescent substance use and abuse. Adolesc Med. 1993;4(2):453–68.

CAS   PubMed   Google Scholar  

Flory K, Lynam D, Milich R, Leukefeld C, Clayton R. Early adolescent through young adult alcohol and marijuana use trajectories: early predictors, young adult outcomes, and predictive utility. Dev Psychopathol. 2004;16(1):193–213. https://doi.org/10.1017/s0954579404044475 .

Coie JD, Watt NF, West SG, Hawkins JD, Asarnow JR, Markman HJ, et al. The science of prevention. A conceptual framework and some directions for a national research program. Am Psychol. 1993;48(10):1013–22. https://doi.org/10.1037/0003-066X.48.10.1013 .

Article   CAS   PubMed   Google Scholar  

Murray E. Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress. Med 20. 2012;1(2):e3.

Newton NC, Conrod PJ, Slade T, Carragher N, Champion KE, Barrett EL, et al. The long-term effectiveness of a selective, personality-targeted prevention program in reducing alcohol use and related harms: a cluster randomized controlled trial. J Child Psychol Psychiatry. 2016;57(9):1056–65. https://doi.org/10.1111/jcpp.12558 .

Kvillemo P, Strandberg AK, Gripenberg J, Berman AH, Skoglund C, Elgán TH. Effects of an automated digital brief prevention intervention targeting adolescents and young adults with risky alcohol and other substance use: study protocol for a randomised controlled trial. BMJ Open. 2020;10(5):e034894. https://doi.org/10.1136/bmjopen-2019-034894 .

Champion KE, Newton NC, Teesson M. Prevention of alcohol and other drug use and related harm in the digital age: what does the evidence tell us? Current opinion in psychiatry. 2016;29(4):242–9. https://doi.org/10.1097/YCO.0000000000000258 .

Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Adv Behav Res Ther. 1978;1(4):139–61. https://doi.org/10.1016/0146-6402(78)90002-4 .

Article   Google Scholar  

Gerstein DR, Green LW. Preventing Drug Abuse: What do we know? Washington (DC): National Academies Press (US). Copyright 1993 by the National Academy of Sciences. All rights reserved.; 1993.

Ajzen I. Attitudes, personality, and behavior: McGraw-hill education (UK); 2005.

Gervilla E, Quigg Z, Duch M, Juan M, Guimarães C. Adolescents’ Alcohol Use in Botellon and Attitudes towards Alcohol Use and Prevention Policies. Int J Environ Res Public Health. 2020;17(11).

DiBello AM, Miller MB, Neighbors C, Reid A, Carey KB. The relative strength of attitudes versus perceived drinking norms as predictors of alcohol use. Addict Behav. 2018;80:39–46. https://doi.org/10.1016/j.addbeh.2017.12.022 .

Cooper ML. Motivations for alcohol use among adolescents: development and validation of a four-factor model. Psychol Assess. 1994;6(2):117–28. https://doi.org/10.1037/1040-3590.6.2.117 .

Kettner H, Mason NL, Kuypers KPC. Motives for classical and novel psychoactive substances use in psychedelic Polydrug users. Contemporary Drug Problems. 2019;46(3):304–20. https://doi.org/10.1177/0091450919863899 .

Boys A, Marsden J, Fountain J, Griffiths P, Stillwell G, Strang J. What influences young people's use of drugs? A qualitative study of decision-making. Drugs: education, prevention and policy. 1999;6(3):373–87.

Boys A, Marsden J, Strang J. Understanding reasons for drug use amongst young people: a functional perspective. Health Educ Res. 2001;16(4):457–69. https://doi.org/10.1093/her/16.4.457 .

Boys A, Marsden J. Perceived functions predict intensity of use and problems in young polysubstance users. Addiction. 2003;98(7):951–63. https://doi.org/10.1046/j.1360-0443.2003.00394.x .

Swift W, Coffey C, Carlin JB, Degenhardt L, Patton GC. Adolescent cannabis users at 24 years: trajectories to regular weekly use and dependence in young adulthood. Addiction. 2008;103(8):1361–70. https://doi.org/10.1111/j.1360-0443.2008.02246.x .

Von Sydow K, Lieb R, Pfister H, Hofler M, H. U W. What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug and Alcohol Dependence. 2002;68:49–64.

Probst C, Kilian C, Sanchez S, Lange S, Rehm J. The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: a systematic review. Lancet Public Health. 2020;5(6):e324–e32. https://doi.org/10.1016/S2468-2667(20)30052-9 .

Luthar SS, Small PJ, Ciciolla L. Adolescents from upper middle class communities: substance misuse and addiction across early adulthood. Dev Psychopathol. 2018;30(1):315–35. https://doi.org/10.1017/S0954579417000645 .

Levine M. The Price of privilege: how parental pressure and material advantage are creating a generation of disconnected and unhappy kids. New York: Harper; 2008.

Martin CC. High socioeconomic status predicts substance use and alcohol consumption in U.S. undergraduates. Substance Use & Misuse. 2019;54(6):1035–43. https://doi.org/10.1080/10826084.2018.1559193 .

Patrick ME, Wightman P, Schoeni RF, Schulenberg JE. Socioeconomic status and substance use among young adults: a comparison across constructs and drugs. J Stud Alcohol Drugs. 2012;73(5):772–82. https://doi.org/10.15288/jsad.2012.73.772 .

Janicijevic KM, Kocic SS, Radevic SR, Jovanovic MR, Radovanovic SM. Socioeconomic Factors Associated with Psychoactive Substance Abuse by Adolescents in Serbia. Frontiers in Pharmacology. 2017;8:366.

Charitonidi E, Studer J, Gaume J, Gmel G, Daeppen J-B, Bertholet N. Socioeconomic status and substance use among Swiss young men: a population-based cross-sectional study. BMC Public Health. 2016;16(1):333. https://doi.org/10.1186/s12889-016-2949-5 .

Hiltunen L. Lagom perfekt. Erfarenheter av ohälsa bland unga tjejer och killar the pursuit of restrained perfection: experiences of ill health among adolescent girls and boys (in Swedish). Växjö: Linnéuniversitetet; 2017.

Låftman SB, Almquist Ylva B, Östberg. Viveca Students’ Accounts of School-performance Stress: A Qualitative Analysis of a High-achieving Setting in Stockholm, Sweden. Journal of Youth Studies. 2013;Vol. 16(nr 7):932–49.

Luthar SS, Becker BE. Privileged but pressured? A study of affluent youth. Child Dev. 2002;73(5):1593–610. https://doi.org/10.1111/1467-8624.00492 .

Moore R, Ames G, Cunradi C. Physical and social availability of alcohol for young enlisted naval personnel in and around home port. Substance abuse treatment, prevention, and policy. 2007;2:17.

Luthar SS, Barkin SH. Are affluent youth truly “at risk”? Vulnerability and resilience across three diverse samples. Dev Psychopathol. 2012;24(2):429–49. https://doi.org/10.1017/S0954579412000089 .

Levy S, Campbell MD, Shea CL, DuPont R. Trends in abstaining from substance use in adolescents: 1975–2014. Pediatrics. 2018;142(2):e20173498. https://doi.org/10.1542/peds.2017-3498 .

CAN. Drogutvecklingen i Sverige 2019 (The Drug development in Sweden (In Swedish). 2019.

County Administrative Board of Stockholm. Stockholmsenkäten 2020 (The Stockholm survey 2020) (In Swedish) Stockholm2020 [Available from: https://www.lansstyrelsen.se/download/18.2887c5dd16488fe880d49c70/1536754022929/Stockholmsenk%C3%A4ten%202018%20-%20Droger%20och%20spel%20gymn%20%C3%A5k%202.pdf .

CAN. Jämlika vanor? – Skolans socioekonomiska sammansättning och skillnader i användning av alkohol, narkotika och tobak i årskurs 9 (Equal habits – Schools socioeconomic profile and differences in use of alcohol, narcitics and tobacco in year nine in secondary school) (In Swedish). Stockholm: CAN; 2020.

Demant J, Schierff LM. Five typologies of alcohol and drug prevention programmes. A qualitative review of the content of alcohol and drug prevention programmes targeting adolescents. Drugs: Education, Prevention and Policy. 2019;26(1):32–9.

Alcohol Act [Alkohollag] (SFS 2010:1622).

Penal Law on Narcotics [Narkotikastrafflag] (SFS 1968:64).

Kristjansson AL, James JE, Allegrante JP, Sigfusdottir ID, Helgason AR. Adolescent substance use, parental monitoring, and leisure-time activities: 12-year outcomes of primary prevention in Iceland. Prev Med. 2010;51(2):168–71. https://doi.org/10.1016/j.ypmed.2010.05.001 .

Stockings E, Hall WD, Lynskey M, Morley KI, Reavley N, Strang J, et al. Prevention, early intervention, harm reduction, and treatment of substance use in young people. Lancet Psychiatry. 2016;3(3):280–96. https://doi.org/10.1016/S2215-0366(16)00002-X .

Ajzen I, Fishbein M. The prediction of behavior from attitudinal and normative variables. J Exp Soc Psychol. 1970;6(4):466–87. https://doi.org/10.1016/0022-1031(70)90057-0 .

Wallace DS, Paulson RM, Lord CG, Bond CF. Which behaviors do attitudes predict? Meta-analyzing the effects of social pressure and perceived difficulty. Rev Gen Psychol. 2005;9(3):214–27. https://doi.org/10.1037/1089-2680.9.3.214 .

Statistics Sweden. Utbildning, jobb och dina pengar (Education, job and your money) (In Swedish) 2020 [Available from: https://www.scb.se/hitta-statistik/sverige-i-siffror/utbildning-jobb-och-pengar/ .

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. https://doi.org/10.1177/1049732305276687 .

Graneheim U, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12. https://doi.org/10.1016/j.nedt.2003.10.001 .

MacQueen KM, McLellan E, Kay K, Milstein B. Codebook development for team-based qualitative analysis. CAM Journal. 1998;10(2):31–6. https://doi.org/10.1177/1525822X980100020301 .

Luthar SS, Kumar NL, Zillmer N. High-achieving schools connote risks for adolescents: problems documented, processes implicated, and directions for interventions. Am Psychol. 2019;75(7):983–95. https://doi.org/10.1037/amp0000556 .

Luthar SS. The culture of affluence: psychological costs of material wealth. Child Dev. 2003;74(6):1581–93. https://doi.org/10.1046/j.1467-8624.2003.00625.x .

Pedersen W, Bakken A, von Soest T. Adolescents from affluent city districts drink more alcohol than others. Addiction. 2015;110(10):1595–604. https://doi.org/10.1111/add.13005 .

Komro KA, Maldonado-Molina MM, Tobler AL, Bonds JR, Muller KE. Effects of home access and availability of alcohol on young adolescents' alcohol use. Addiction. 2007;102(10):1597–608. https://doi.org/10.1111/j.1360-0443.2007.01941.x .

Akers RL, Krohn MD, Lanza-Kaduce L, Radosevich M. Social learning and deviant behavior: A specific test of a general theory. Contemporary Masters in Criminology: Springer; 1995. p. 187–214, Social Learning and Deviant Behavior: A Specific Test of a General Theory, DOI: https://doi.org/10.1007/978-1-4757-9829-6_12 .

Deeken F, Banaschewski T, Kluge U, Rapp MA. Risk and protective factors for alcohol use disorders across the lifespan. Current Addiction Reports. 2020;7(3):245–51. https://doi.org/10.1007/s40429-020-00313-z .

Neighbors C, Krieger H, Rodriguez LM, Rinker DV, Lembo JM. Social identity and drinking: dissecting social networks and implications for novel interventions. Journal of Prevention & Intervention in the Community. 2019;47(3):259–73. https://doi.org/10.1080/10852352.2019.1603676 .

Luthar SS, Sexton CC. The high price of affluence. In: Kail RV, editor. Advances in Child Development and Behavior. 32: JAI; 2004. p. 125–162.

Puura K, Almqvist F, Tamminen T, Piha J, Kumpulainen K, Räsänen E, et al. Children with symptoms of depression--what do the adults see? Journal of child psychology and psychiatry, and allied disciplines. 1998;39(4):577–85. https://doi.org/10.1017/S0021963098002418 .

Leonard NR, Gwadz MV, Ritchie A, Linick JL, Cleland CM, Elliott L, et al. A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools. Front Psychol. 2015;6:1028.

McBride N, Farringdon F, Midford R, Meuleners L, Phillips M. Harm minimization in school drug education: final results of the school health and alcohol harm reduction project (SHAHRP). Addiction. 2004;99(3):278–91. https://doi.org/10.1111/j.1360-0443.2003.00620.x .

Midford R, Munro G, McBride N, Snow P, Ladzinski U. Principles that underpin effective school-based drug education. J Drug Educ. 2002;32(4):363–86. https://doi.org/10.2190/T66J-YDBX-J256-J8T9 .

Mewton L, Visontay R, Chapman C, Newton N, Slade T, Kay-Lambkin F, et al. Universal prevention of alcohol and drug use: an overview of reviews in an Australian context. Drug Alcohol Rev. 2018;37(Suppl 1):S435–s69. https://doi.org/10.1111/dar.12694 .

Toumbourou JW, Stockwell T, Neighbors C, Marlatt GA, Sturge J, Rehm J. Interventions to reduce harm associated with adolescent substance use. Lancet. 2007;369(9570):1391–401. https://doi.org/10.1016/S0140-6736(07)60369-9 .

Kristjansson AL, Sigfusdottir ID, Thorlindsson T, Mann MJ, Sigfusson J, Allegrante JP. Population trends in smoking, alcohol use and primary prevention variables among adolescents in Iceland, 1997–2014. Addiction. 2016;111(4):645–52. https://doi.org/10.1111/add.13248 .

Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. New York: The Guilford Press; 2013.

Kohler S, Hofmann A. Can motivational interviewing in emergency care reduce alcohol consumption in young people? A systematic review and meta-analysis. Alcohol and alcoholism (Oxford, Oxfordshire). 2015;50(2):107–17.

Article   CAS   Google Scholar  

Edwards A. The social desirability variable in personality assessment and research. New York: The Dryden Press; 1957.

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Acknowledgements

We would like to thank all the participating students for making this study possible.

The work was funded by the Alcohol Research Council of the Swedish Alcohol Retailing Monopoly (grant no. 2018–0010). The funding body had no role in study design, data collection, analysis, data interpretation or writing the manuscript. Open Access funding provided by Karolinska Institute.

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Pia Kvillemo, Johanna Gripenberg, Tobias H. Elgán & Charlotte Skoglund

Department of Social Studies, Linnaeus university, Växjö, Sweden

Linda Hiltunen

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Liljeholmstorget 7, 117 63, Stockholm, Sweden

Youstina Demetry

Department of Neuroscience, Uppsala University, Uppsala, Sweden

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Contributions

PK contributed to conceptualization, methodology, investigation (data collection), data curation, formal analysis, writing original draft, review & editing, funding acquisition. LH contributed to conceptualization, methodology, data curation, formal analysis, validation, review & editing. YD contributed to project administration, methodology, investigation (data collection), data curation, formal analysis, validation, review & editing. AC contributed to investigation (data collection), review & editing. TH contributed to investigation (data collection), review & editing. JG contributed to conceptualization, methodology, review & editing, funding acquisition. TE contributed to conceptualization, methodology, review & editing. KE contributed to review & editing. CS contributed to conceptualization, methodology, investigation (data collection), data curation, formal analysis, review & editing, funding acquisition, supervision. All authors approved the submitted manuscript version.

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Correspondence to Pia Kvillemo .

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The study was performed in accordance with the Declaration of Helsinki and was approved by the Swedish Ethical Review Authority (dnr. 2019–02646).

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The authors declare that they have no competing interests.

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Kvillemo, P., Hiltunen, L., Demetry, Y. et al. How to prevent alcohol and illicit drug use among students in affluent areas: a qualitative study on motivation and attitudes towards prevention. Subst Abuse Treat Prev Policy 16 , 83 (2021). https://doi.org/10.1186/s13011-021-00420-8

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Teen drug abuse: Help your teen avoid drugs

Teen drug abuse can have a major impact on your child's life. Find out how to help your teen make healthy choices and avoid using drugs.

The teen brain is in the process of maturing. In general, it's more focused on rewards and taking risks than the adult brain. At the same time, teenagers push parents for greater freedom as teens begin to explore their personality.

That can be a challenging tightrope for parents.

Teens who experiment with drugs and other substances put their health and safety at risk. The teen brain is particularly vulnerable to being rewired by substances that overload the reward circuits in the brain.

Help prevent teen drug abuse by talking to your teen about the consequences of using drugs and the importance of making healthy choices.

Why teens use or misuse drugs

Many factors can feed into teen drug use and misuse. Your teen's personality, your family's interactions and your teen's comfort with peers are some factors linked to teen drug use.

Common risk factors for teen drug abuse include:

• A family history of substance abuse.
• A mental or behavioral health condition, such as depression, anxiety or attention-deficit/hyperactivity disorder (ADHD).
• Impulsive or risk-taking behavior.
• A history of traumatic events, such as seeing or being in a car accident or experiencing abuse.
• Low self-esteem or feelings of social rejection.

Teens may be more likely to try substances for the first time when hanging out in a social setting.

Alcohol and nicotine or tobacco may be some of the first, easier-to-get substances for teens. Because alcohol and nicotine or tobacco are legal for adults, these can seem safer to try even though they aren't safe for teens.

Teens generally want to fit in with peers. So if their friends use substances, your teen might feel like they need to as well. Teens also may also use substances to feel more confident with peers.

If those friends are older, teens can find themselves in situations that are riskier than they're used to. For example, they may not have adults present or younger teens may be relying on peers for transportation.

And if they are lonely or dealing with stress, teens may use substances to distract from these feelings.

Also, teens may try substances because they are curious. They may try a substance as a way to rebel or challenge family rules.

Some teens may feel like nothing bad could happen to them, and may not be able to understand the consequences of their actions.

Consequences of teen drug abuse

Negative consequences of teen drug abuse might include:

• Drug dependence. Some teens who misuse drugs are at increased risk of substance use disorder.
• Poor judgment. Teenage drug use is associated with poor judgment in social and personal interactions.
• Sexual activity. Drug use is associated with high-risk sexual activity, unsafe sex and unplanned pregnancy.
• Mental health disorders. Drug use can complicate or increase the risk of mental health disorders, such as depression and anxiety.
• Impaired driving. Driving under the influence of any drug affects driving skills. It puts the driver, passengers and others on the road at risk.
• Changes in school performance. Substance use can result in worse grades, attendance or experience in school.

Health effects of drugs

Substances that teens may use include those that are legal for adults, such as alcohol or tobacco. They may also use medicines prescribed to other people, such as opioids.

Or teens may order substances online that promise to help in sports competition, or promote weight loss.

In some cases products common in homes and that have certain chemicals are inhaled for intoxication. And teens may also use illicit drugs such as cocaine or methamphetamine.

Drug use can result in drug addiction, serious impairment, illness and death. Health risks of commonly used drugs include the following:

• Cocaine. Risk of heart attack, stroke and seizures.
• Ecstasy. Risk of liver failure and heart failure.
• Inhalants. Risk of damage to the heart, lungs, liver and kidneys from long-term use.
• Marijuana. Risk of impairment in memory, learning, problem-solving and concentration; risk of psychosis, such as schizophrenia, hallucination or paranoia, later in life associated with early and frequent use. For teens who use marijuana and have a psychiatric disorder, there is a risk of depression and a higher risk of suicide.
• Methamphetamine. Risk of psychotic behaviors from long-term use or high doses.
• Opioids. Risk of respiratory distress or death from overdose.
• Electronic cigarettes (vaping). Higher risk of smoking or marijuana use. Exposure to harmful substances similar to cigarette smoking; risk of nicotine dependence. Vaping may allow particles deep into the lungs, or flavorings may include damaging chemicals or heavy metals.

Talking about teen drug use

You'll likely have many talks with your teen about drug and alcohol use. If you are starting a conversation about substance use, choose a place where you and your teen are both comfortable. And choose a time when you're unlikely to be interrupted. That means you both will need to set aside phones.

It's also important to know when not to have a conversation.

When parents are angry or when teens are frustrated, it's best to delay the talk. If you aren't prepared to answer questions, parents might let teens know that you'll talk about the topic at a later time.

And if a teen is intoxicated, wait until the teen is sober.

To talk to your teen about drugs:

• Ask your teen's views. Avoid lectures. Instead, listen to your teen's opinions and questions about drugs. Parents can assure teens that they can be honest and have a discussion without getting in trouble.
• Discuss reasons not to use drugs. Avoid scare tactics. Emphasize how drug use can affect the things that are important to your teen. Some examples might be sports performance, driving, health or appearance.
• Consider media messages. Social media, television programs, movies and songs can make drug use seem normal or glamorous. Talk about what your teen sees and hears.
• Discuss ways to resist peer pressure. Brainstorm with your teen about how to turn down offers of drugs.
• Be ready to discuss your own drug use. Think about how you'll respond if your teen asks about your own drug use, including alcohol. If you chose not to use drugs, explain why. If you did use drugs, share what the experience taught you.

Other preventive strategies

Consider other strategies to prevent teen drug abuse:

• Know your teen's activities. Pay attention to your teen's whereabouts. Find out what adult-supervised activities your teen is interested in and encourage your teen to get involved.
• Establish rules and consequences. Explain your family rules, such as leaving a party where drug use occurs and not riding in a car with a driver who's been using drugs. Work with your teen to figure out a plan to get home safely if the person who drove is using substances. If your teen breaks the rules, consistently enforce consequences.
• Know your teen's friends. If your teen's friends use drugs, your teen might feel pressure to experiment, too.
• Keep track of prescription drugs. Take an inventory of all prescription and over-the-counter medications in your home.
• Provide support. Offer praise and encouragement when your teen succeeds. A strong bond between you and your teen might help prevent your teen from using drugs.
• Set a good example. If you drink, do so in moderation. Use prescription drugs as directed. Don't use illicit drugs.

Recognizing the warning signs of teen drug abuse

Be aware of possible red flags, such as:

• Sudden or extreme change in friends, eating habits, sleeping patterns, physical appearance, requests for money, coordination or school performance.
• Irresponsible behavior, poor judgment and general lack of interest.
• Breaking rules or withdrawing from the family.
• The presence of medicine containers, despite a lack of illness, or drug paraphernalia in your teen's room.

Seeking help for teen drug abuse

If you suspect or know that your teen is experimenting with or misusing drugs:

• Plan your action. Finding out your teen is using drugs or suspecting it can bring up strong emotions. Before talking to your teen, make sure you and anyone who shares caregiving responsibility for the teen is ready. It can help to have a goal for the conversation. It can also help to figure out how you'll respond to the different ways your teen might react.
• Talk to your teen. You can never step in too early. Casual drug use can turn into too much use or addiction. This can lead to accidents, legal trouble and health problems.
• Encourage honesty. Speak calmly and express that you are coming from a place of concern. Share specific details to back up your suspicion. Verify any claims your child makes.
• Focus on the behavior, not the person. Emphasize that drug use is dangerous but that doesn't mean your teen is a bad person.
• Check in regularly. Spend more time with your teen. Know your teen's whereabouts and ask questions about the outing when your teen returns home.
• Get professional help. If you think your teen is involved in drug use, contact a health care provider or counselor for help.

It's never too soon to start talking to your teen about drug abuse. The conversations you have today can help your teen make healthy choices in the future.

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• Dulcan MK, ed. Substance use disorders and addictions. In: Dulcan's Textbook of Child and Adolescent Psychiatry. 3rd ed. American Psychiatric Association Publishing; 2021. https://psychiatryonline.org. Accessed Jan. 24, 2023.
• 6 parenting practices: Help reduce the chances your child will develop a drug or alcohol problem. Partnership to End Addiction. https://drugfree.org/addiction-education/. Accessed Jan. 24, 2023.
• Why do teens drink and use substances and is it normal? Partnership to End Addiction. https://drugfree.org/article/why-do-teens-drink-and-use-substances/. Accessed Jan. 24, 2023.
• Teens: Alcohol and other drugs. American Academy of Child & Adolescent Psychiatry. https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Teens-Alcohol-And-Other-Drugs-003.aspx. Accessed Dec. 27, 2018.
• Drugged driving. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/drugged-driving. Accessed Jan. 24, 2023.
• Marijuana talk kit. Partnership for Drug-Free Kids. https://drugfree.org/drugs/marijuana-what-you-need-to-know/. Accessed Jan. 24, 2023.
• Drug guide for parents: Learn the facts to keep your teen safe. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.
• Vaping: What you need to know and how to talk with your kids about vaping. Partnership to End Addiction. https://drugfree.org/addiction-education/. Accessed Jan. 24, 2023.
• How to listen. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.
• Drug abuse prevention starts with parents. American Academy of Pediatrics. https://publications.aap.org/patiented/article/doi/10.1542/peo_document352/81984/Drug-Abuse-Prevention-Starts-With-Parents. Accessed Jan. 24, 2023.
• How to talk to your kids about drugs if you did drugs. Partnership for Drug-Free Kids. https://www.drugfree.org/resources/. Accessed Dec. 12, 2018.
• My child tried drugs, what should I do? Partnership to End Addiction. https://drugfree.org/article/my-child-tried-drugs-what-should-i-do/. Accessed Jan. 24, 2023.
• Gage SH, et al. Association between cannabis and psychosis: Epidemiologic evidence. Biological Psychiatry. 2016;79:549.
• Quick facts on the risks of e-cigarettes for kids, teens and young adults. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html. Accessed Jan. 30, 2023.
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Substance Use Prevention; a Personal Reflection

Written by nur raihana binti zakaria.

Illustration by Karthika Pillai

It has been more than 40 years since drug use was declared a national security problem in Malaysia in the 1980s. From the latest drug statistics available, the National Anti-Drugs Agency of Malaysia reported in January to June 2020, around 67% of people who use drugs in Malaysia were adolescents and youth, which represents almost 67 thousand individuals.

This alarming fact caught my attention and inspired me to dive into substance use prevention. Therefore, it was a privilege for me to participate in the United Nations Office on Drugs and Crime (UNODC) Youth Forum 2021 on Substance Use Prevention.

Before joining the Youth Forum, I was fully aware that the known overwhelming impact of substance use on individuals, families, and communities and the reality of the potentially life-long and complex recovery process of substance use requires effective, supportive, and comprehensive-collaborative interventions.

While I kept wondering what makes one get involved in substance, little did I realize that determining the cause(s) will be endless as it is more complicated, and it would never be that straightforward or clear cut.

The vulnerability factors may come throughout the developmental and life phases and are interrelated between individuals, family, school, and community – sometimes leading to a vicious cycle. Understanding this fact is one of the core points in substance use prevention because it will help us be more empathetic and less judgemental.

Substance use prevention aims to avoid or delay the initiation of substance use, or if someone has already engaged in substance use, it will be more effective to engage in treatment interventions to stave off the development of substance use disorders.

During the Youth Forum, I had an “aha” moment and realized that the overall aim of substance use prevention is much broader. It aims to ensure the healthy and safe development of young people and their well-being and resilience so that they can discern and optimize their talents and potential and become altruistic contributing members of their community. Thus, prevention interventions should begin as early as infancy. His means not only parents, but every member of the society shall be empowered with appropriate skills such as social life skills, parenting and caregiving skills, and decision-making skills. Effective prevention forwards children, youth, and adults positive and constructive engagement with their families and schools, workplaces, and communities.

I was impressed with the way Ms. Elizabeth Mattfeld, a Project Coordinator with the Prevention, Treatment, and Rehabilitation Unit of UNODC, enlightened us on substance use prevention, making it more understandable. She started explaining substance use prevention by emphasizing what is not; “substance use is not treatment, nor punishment.” She then highlighted that in prevention, it is never about telling people the danger of drugs or any other psychoactive substances, or commanding people not to befriend people who use drugs or any other don’ts; or labeling and identifying who are at risk. Instead, prevention aspires to improve skills, endurance, educate the do’s, and subsequently promote individuals to function in a healthy physical and socio-cultural-spiritual environment in the long run. And there is no way for us to ignore any aspects of physical health, mental health, nutrition, education, family well-being, financial, policy-making, or law in substance use prevention, let alone to look at those aspects independently. Substance use prevention is indeed a long-term strategy within a holistic approach to preventing individuals from engaging in drug abuse by focusing on evidence-based programs that can strengthen protective factors and reduce risk factors; and everything in between.

Reflecting on what we have or used to do worldwide, we must agree that many countries are yet to have successful models or efforts in prevention. I acknowledge all agencies’ or ministries’ commitment to creating a society free of drug threats to ensure the community’s well-being, maintaining national stability and resilience.

However, it is always good to take a step back and ponder on the efficiency and efficacy of the intervention taken. Moving forward, we could do better - prevention shall be more inclusive and voluntary, rather than spending resources on the selective approach like prevention education programs conducted among families, primary school students, and youth who are at risk or already identified engaging in substance use.

Besides, we should pay more attention to how we practice substance use prevention, what works, and how we evaluate its efficiency. For example, some may think the lack of knowledge about substances and the consequences of their use are among the main factors that increase an individual’s vulnerability or contribute to the initial reasons for drug use initiation. But I was a bit surprised that knowledge or information alone does not change behavior and does not work for substance use prevention. When policies and practices rely only on feeding the public with knowledge about substances and their adverse effects, substance use prevention is compromised.

We should refine our actions and comprehend that developing skills such as communication, decision-making, rational thinking, and stress reduction are critical as part of a comprehensive substance use prevention program.

In substance use prevention, we must be determined to adhere to evidence-based approaches. We must be ready to unlearn our old beliefs and usual practices that may be inconsistent with science. Substance use prevention is not a taboo or gut feeling, it is scientific, and it is worth fighting for. Unfortunately, Even when considerable funding is spent on treatment, only one in eight people worldwide can access this treatment. Investing more diligently in prevention, we can save up to 10 dollars for every dollar spent, reduce substance use and protect our young generation worldwide.

In conclusion, I am now well-informed that to make substance use prevention successful, we need continuous multiple prevention programs at every community level involving many stakeholders. Those are what we need to create a healthy, effective, and sustainable prevention system. All elements of prevention and roles taken (or ignored) by individuals are interconnected; strengthening every single element will cause a snowball effect; anyone could start the positive action and give sustained results in return, like a domino effect; and we need everyone’s small and light touch in substance use prevention to bring the butterfly effect; ultimately lead to what we all have been dreaming for: healthy, happy, resilient and proactive young people who can contribute to the community and society. Yes, long way to go, but I have the utmost faith that prevention works.

1 International Standards on Drug Use Prevention. (2018). Retrieved 20 March 2021, from https://www.unodc.org/unodc/en/prevention/prevention-standards.html

2 National Drug Policy. (2017). Retrieved 15 January 2021, from https://www.adk.gov.my/wp-content/uploads/Buku-Dasar-Dadah-Negara-EN.pdf

3 Annual Report National Anti-Drugs Agency. (2019). Retrieved 15 January 2021, from https://www.adk.gov.my/wp-content/uploads/Buku-Laporan-Tahunan-AADK-2019.pdf

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Understanding Drug Use and Addiction DrugFacts

Many people don't understand why or how other people become addicted to drugs. They may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease, and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to. Fortunately, researchers know more than ever about how drugs affect the brain and have found treatments that can help people recover from drug addiction and lead productive lives.

What Is drug addiction?

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.

It's common for a person to relapse, but relapse doesn't mean that treatment doesn’t work. As with other chronic health conditions, treatment should be ongoing and should be adjusted based on how the patient responds. Treatment plans need to be reviewed often and modified to fit the patient’s changing needs.

Video: Why are Drugs So Hard to Quit?

What happens to the brain when a person takes drugs?

Most drugs affect the brain's "reward circuit," causing euphoria as well as flooding it with the chemical messenger dopamine. A properly functioning reward system motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy behaviors like taking drugs, leading people to repeat the behavior again and again.

As a person continues to use drugs, the brain adapts by reducing the ability of cells in the reward circuit to respond to it. This reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug to try and achieve the same high. These brain adaptations often lead to the person becoming less and less able to derive pleasure from other things they once enjoyed, like food, sex, or social activities.

Long-term use also causes changes in other brain chemical systems and circuits as well, affecting functions that include:

• decision-making

Despite being aware of these harmful outcomes, many people who use drugs continue to take them, which is the nature of addiction.

Why do some people become addicted to drugs while others don't?

No one factor can predict if a person will become addicted to drugs. A combination of factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction. For example:

• Biology . The genes that people are born with account for about half of a person's risk for addiction. Gender, ethnicity, and the presence of other mental disorders may also influence risk for drug use and addiction.
• Environment . A person’s environment includes many different influences, from family and friends to economic status and general quality of life. Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person’s likelihood of drug use and addiction.
• Development . Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction risk. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it will progress to addiction. This is particularly problematic for teens. Because areas in their brains that control decision-making, judgment, and self-control are still developing, teens may be especially prone to risky behaviors, including trying drugs.

Can drug addiction be cured or prevented?

As with most other chronic diseases, such as diabetes, asthma, or heart disease, treatment for drug addiction generally isn’t a cure. However, addiction is treatable and can be successfully managed. People who are recovering from an addiction will be at risk for relapse for years and possibly for their whole lives. Research shows that combining addiction treatment medicines with behavioral therapy ensures the best chance of success for most patients. Treatment approaches tailored to each patient’s drug use patterns and any co-occurring medical, mental, and social problems can lead to continued recovery.

More good news is that drug use and addiction are preventable. Results from NIDA-funded research have shown that prevention programs involving families, schools, communities, and the media are effective for preventing or reducing drug use and addiction. Although personal events and cultural factors affect drug use trends, when young people view drug use as harmful, they tend to decrease their drug taking. Therefore, education and outreach are key in helping people understand the possible risks of drug use. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

Points to Remember

• Drug addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.
• Brain changes that occur over time with drug use challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. This is why drug addiction is also a relapsing disease.
• Relapse is the return to drug use after an attempt to stop. Relapse indicates the need for more or different treatment.
• Most drugs affect the brain's reward circuit by flooding it with the chemical messenger dopamine. Surges of dopamine in the reward circuit cause the reinforcement of pleasurable but unhealthy activities, leading people to repeat the behavior again and again.
• Over time, the brain adjusts to the excess dopamine, which reduces the high that the person feels compared to the high they felt when first taking the drug—an effect known as tolerance. They might take more of the drug, trying to achieve the same dopamine high.
• No single factor can predict whether a person will become addicted to drugs. A combination of genetic, environmental, and developmental factors influences risk for addiction. The more risk factors a person has, the greater the chance that taking drugs can lead to addiction.
• Drug addiction is treatable and can be successfully managed.
• More good news is that drug use and addiction are preventable. Teachers, parents, and health care providers have crucial roles in educating young people and preventing drug use and addiction.

For information about understanding drug use and addiction, visit:

• www.nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction

For more information about the costs of drug abuse to the United States, visit:

• www.nida.nih.gov/related-topics/trends-statistics#costs

For more information about prevention, visit:

• www.nida.nih.gov/related-topics/prevention

For more information about treatment, visit:

• www.nida.nih.gov/related-topics/treatment

To find a publicly funded treatment center in your state, call 1-800-662-HELP or visit:

• https://findtreatment.samhsa.gov/

This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

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10 Strategies to Prevent Your Young Person from Using Drugs

Last Updated: Friday April 21, 2023

According to a study , young people who hadn’t used drugs up until their senior year in high school are more likely to use marijuana once they start college than their peers who don’t go to college.

Here are a few ways you can prevent your young loved one from using any drug before they head off to school and while they are in college.

Be Honest and Direct

Sitting down and having a direct, open and honest conversation about drugs, temptation and addiction before her or she goes to college is one of the best ways to prevent their future use.  Though it may be uncomfortable, you may want to discuss your own past drug use or one of your family members’ struggles with use and addiction.  

Give Them Praise

Do you have an awesome teen? Good grades, sweet, compassionate, well-rounded, and drug free? Celebrate them! A little bit of positive reinforcement can go a long way. You never know; you may become your teen’s inner voice that gives them the strength to reject drugs when he or she is offered them.

Make Sure They Know the Legal Consequences of Using Drugs

It’s not about scaring them— it’s just about being real. Getting caught with drugs, especially if it’s a significant amount, could land your teen in serious trouble with the law. To do this, you can search for news stories about young people getting caught up with drugs and having to face the consequences and casually bring it up to your teen. For example, “Did you hear about that teen in Virginia? He’s facing seven years behind bars for giving a girl a pill at a party that ending up killing her. That just isn’t worth it.”

Make Sure They Know the Life-long Consequences of Addiction

Being addicted to drugs can ruin a promising young person’s life – and it’s important your child knows that. Just while watching the news with your teen you are probably likely to see a story about how bad the drug addiction crisis is getting in the U.S. Discuss the pitfalls of addiction with them then. In addition, watching documentaries like “Chasing the Dragon”  which shows the reality of youth drug addiction, could also serve as a good conversation starter. Once again, it’s not about scaring them – but keeping it real.

Volunteer at a Substance Abuse Treatment Center or a Homeless Shelter

Seeing addiction live and up close could be a life-changing experience for your teen. By volunteering at a local substance abuse treatment center, he or she can also talk to people in recovery and learn from their experience to keep them from potentially going down the road to addiction. 

Do Your Homework

Before you talk to your teen about anything, it’s a good idea to do a little bit of studying first. Check out the latest research ( Monitoring the Future is a great source) to find out what drugs are popular for people in your child’s age range so you can target your message. You also may want to reach out to substance abuse professionals on your child’s college campus to find out what drugs may be popular at the school.

Learn more about drugs and drug paraphernalia. 

Make One-On-One Time

Make it a priority to spend one-on-one time with your young loved one. During that quality time, your teen is more likely to open up to you about what’s going on in his or her life, however mundane. You can use this opportunity to understand them better and to form a stronger bond. In the future, when your child is away in college and facing tough decisions, he or she will be more likely to confide in you and put more weight in your advice.

Keep Your Cool

Rolled eyes, heavy sighs, temporary deafness – you may experience all of these reactions from your teen when you try to talk to him or her about the dangers of drug use. Whatever you do, don’t lose your temper. Just try a different approach next time you want to bring up the topic.

Connect with Other Parents

More than likely the parents of your teenager’s friends will have the same concerns you have as they are entering college and leaving home for the first time. You may want to share ideas with them and find out how they are speaking to their teen about drug use.

Give Them the Facts

Lastly, giving your teen the straight facts by themselves could be enough to set him or her on the right path. Most drugs (illicit prescription drugs, synthetic marijuana, heroin, cocaine, etc.) can be  deadly – the statistics are out there . In addition, using marijuana has many negative effects on the brain and body .  You may also want to direct them to the DEA’s Teen resource site, JustThinkTwice.com to get the facts on drugs.   Get more information on how you can raise your child to be drug free in DEA's publication "Growing Up Drug Free: A Parent's Guide to Prevention."

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Canadian Drugs and Substances Strategy: Prevention and education

How the strategy supports prevention and education initiatives across Canada.

• Prevention and education
• Substance use services and supports
• Substance controls
• Download the full strategy

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About prevention and education, how prevention and education fits into the strategy.

Prevention and education initiatives support communities and raise awareness to influence the health and well-being of people living in Canada. They aim to:

• reducing risk factors
• increasing protective factors
• reduce healthcare and social costs by preventing substance use related harms
• give people the facts they need to make informed choices around substance use and where to get help

Addressing risk factors and increasing protective factors, especially early in life, is key in reversing the current trends of substance use related harms.

Risk factors increase the likelihood of substance use related harms and negative health outcomes. Some examples include:

• mental illness
• drug availability
• negative school atmosphere
• exposure to peer substance use
• unstable housing or homelessness
• trauma and childhood adversity, like child abuse and neglect

Protective factors are positive physical, social and mental health influences that can help reduce substance use related harms. Some examples include:

• physical safety
• social inclusion
• safe neighbourhoods
• a positive school environment
• caregiver involvement and monitoring
• stable, permanent and appropriate housing
• healthy behavioural development, like coping skills and emotional regulation

Youth is a crucial life stage when life-long behaviours develop. Substance use at this age can:

• harm brain development and function
• increase the risk of developing substance use disorders

Other factors may interact with each other to:

• put people at greater risk for mental health and substance use related harms
• limit people's access to important supports

These factors are often called the social determinants of health.

Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups in Canada, such as:

• Black people
• Indigenous Peoples
• 2SLGBTQIA+ people

Chronic pain can also have major impacts on a person's mental and emotional health. Unmanaged pain has also been identified as a key driver of higher-risk substance use.

Learn more:

• Chronic pain and opioids
• Social determinants of health and health inequalities

It's important to pay attention to risk and protective factors when planning actions that help to:

• address the overdose crisis in Canada
• reduce substance use and its related harms

To meet the needs of people at risk, including youth and marginalized populations, we're:

• investing in community-led programs to prevent or reduce harms related to substance use
• raising awareness through public education and outreach activities
• addressing underlying inequities related to substance use related harms

Investing in community-led programs to prevent or reduce harms related to substance use

We invest in community-led programs that help prevent and reduce substance use related harms.

This program provides funding to other levels of government and organizations that are:

• not-for-profit
• community-led

Funds go towards innovative treatment, harm reduction and recovery projects that aim to:

• minimize substance use related harms
• at-risk populations
• other marginalized populations

Substance Use and Addictions Program

This upcoming program will provide funding to communities to implement data-driven, community-led approaches to:

• prevent and delay substance use in youth
• lower experiences of substance use and its related harms

This model is based on the Icelandic Prevention Model, an approach developed by Planet Youth in Iceland. It's based on the idea that:

• the physical and social environment has an impact on youth behaviour
• community involvement is necessary to make changes in youth behaviour

Communities implementing the program will:

• provide a forum where youth and other community members can discuss goals and the changes they need in their communities
• gather data and information from high school students so that the community has information about local youth
• arts and cultural programs for youth
• parent and caregiver peer support groups

Youth Substance Use Prevention Program

This program provides funding to time-limited projects across Canada that help reduce HIV and hepatitis C among people who share injection and inhalation drug-use equipment. Harm Reduction Fund

The strategy also contributes to supporting programs that provide First Nations and Inuit communities with access to mental wellness services, which:

• reduce risk factors
• promote protective factors
• improve associated health outcomes
• Mental health and wellness in First Nations and Inuit communities

We're also supporting the Youth Gang Prevention Fund through the National Crime Prevention Strategy. This program funds projects that:

• provide exit strategies for youth who belong to gangs
• aim to prevent at-risk youth from joining or re-joining gangs

Youth Gang Prevention Fund National Crime Prevention Strategy

We're also supporting the Crime Prevention Action Fund through the National Crime Prevention Strategy. This program provides funding to evidence-based community crime prevention initiatives that address known risk and protective factors among vulnerable groups, especially:

• chronic offenders
• children and youth aged 6 to 24

Crime Prevention Action Fund National Crime Prevention Strategy

We're also supporting the Northern and Indigenous Crime Prevention Fund through the National Crime Prevention Strategy. This fund supports culturally sensitive crime prevention practices which address known risk and protective factors to:

• reduce vulnerability to crime
• promote community safety approaches

The fund supports programs in Indigenous communities both on and off-reserve and in the North. Northern and Indigenous Crime Prevention Fund National Crime Prevention Strategy

We also developed resources for schools and community organizations that support youth, outlining practical approaches to preventing substance use related harms:

• Preventing substance-related harms among Canadian youth through action within school communities: A policy paper
• Blueprint for Action: Preventing substance-related harms among youth through a Comprehensive School Health approach

Raising awareness through public education and outreach activities

We raise awareness of substance use related harms, ways to reduce those harms, and the importance of reducing stigma through:

• public education
• outreach activities
• awareness campaigns

These activities provide factual information to support people in making informed choices around substance use and helping those around them. Activities include:

A youth awareness program that educates teens and youth on the risks of opioids and substance use and ways to reduce harms. Know More Opioids

This awareness campaign gives educators information and resources to help teens understand the potential effects of cannabis use on their brain and mental health. Pursue Your Passion

This self-led module educates teens on the harms and risks associated with youth vaping, and helps prevent the uptake of vaping products. Consider the Consequences of Vaping

This campaign promotes seeking help, and provides links to resources and supports. It's especially aimed at men working in physically demanding jobs who are at higher risk of substance use related harms, including overdose. Ease the Burden Campaign

This multi-year campaign raises awareness of:

• how to respond to an overdose
• the Good Samaritan Drug Overdose Act
• the impacts of stigma on people who use drugs

Stigma leads people to hide their substance use, and prevents them from getting help for fear of reprisals and being labelled or judged. Our resources promote information about stigma and includes an interactive gallery of real stigma stories. Stigma around drug use Gallery (Health Canada Experiences)

A training program for law enforcement to help reduce stigma and support frontline officers who interact with people who use substances. Drug Stigma Awareness Training

Resources and information for people who need help with substance use, including overdose prevention resources and where to get naloxone in your community. Get help with substance use

We also provide opioids awareness resources, which include:

• fact sheets
• wallet cards
• an audio series

Awareness resources for opioids

Addressing underlying inequities related to substance use related harms

We work at a federal level to support programs that address inequities in Canada which can be underlying causes of substance use related harms. Health is influenced by many factors, including:

• access to care
• employment status

We aim to address inequities related to these factors through federal programs, such as:

• Mental health and wellness initiatives
• Reaching Home: Canada's Homelessness Strategy
• Opportunity for All – Canada's First Poverty Reduction Strategy
• Funding opportunities for programs that address gender-based violence

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How to prevent alcohol and illicit drug use among students in affluent areas: a qualitative study on motivation and attitudes towards prevention

Pia kvillemo.

1 STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden

Linda Hiltunen

2 Department of Social Studies, Linnaeus university, Växjö, Sweden

Youstina Demetry

3 Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Liljeholmstorget 7, 117 63 Stockholm, Sweden

Anna-Karin Carlander

4 Department of Neuroscience, Uppsala University, Uppsala, Sweden

Tim Hansson

5 Psychiatry North West, Region Stockholm, Sollentunavägen 84, SE-191 22, Sollentuna, Sweden

Johanna Gripenberg

Tobias h. elgán, kim einhorn, charlotte skoglund, associated data.

Collected data will be available from the Centre for Psychiatry Research, a collaboration between Karolinska Institutet and Region Stockholm, but restrictions apply to their availability, as they were used under ethical permission for the current study, and so are not publicly available. However, data are available from the authors upon reasonable request and with permission from the Centre for Psychiatry Research.

The use of alcohol and illicit drugs during adolescence can lead to serious short- and long-term health related consequences. Despite a global trend of decreased substance use, in particular alcohol, among adolescents, evidence suggests excessive use of substances by young people in socioeconomically affluent areas. To prevent substance use-related harm, we need in-depth knowledge about the reasons for substance use in this group and how they perceive various prevention interventions. The aim of the current study was to explore motives for using or abstaining from using substances among students in affluent areas as well as their attitudes to, and suggestions for, substance use prevention.

Twenty high school students (age 15–19 years) in a Swedish affluent municipality were recruited through purposive sampling to take part in semi-structured interviews. Qualitative content analysis of transcribed interviews was performed.

The most prominent motive for substance use appears to be a desire to feel a part of the social milieu and to have high social status within the peer group. Motives for abstaining included academic ambitions, activities requiring sobriety and parental influence. Students reported universal information-based prevention to be irrelevant and hesitation to use selective prevention interventions due to fear of being reported to authorities. Suggested universal prevention concerned reliable information from credible sources, stricter substance control measures for those providing substances, parental involvement, and social leisure activities without substance use. Suggested selective prevention included guaranteed confidentiality and non-judging encounters when seeking help.

Conclusions

Future research on substance use prevention targeting students in affluent areas should take into account the social milieu and with advantage pay attention to students’ suggestions on credible prevention information, stricter control measures for substance providers, parental involvement, substance-free leisure, and confidential ways to seek help with a non-judging approach from adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-021-00420-8.

Alcohol consumption and illicit drug use are major public health concerns causing great individual suffering as well as substantial societal costs [ 1 , 2 ]. Early onset of substance use is especially problematic since the developing brain is vulnerable to the effects of alcohol and drugs, increasing the risk of long-term negative effects, such as harmful use, addiction, and mental health problems [ 3 – 6 ]. Short-term consequences of substance use include intoxication [ 5 , 7 ], accidents [ 8 [, academic failure [ 9 ], and interaction with legal authorities [ 10 ], which calls for effective substance use prevention in adolescents and young adults. Such prevention interventions may be universal, targeting the general population, e.g., legal measures and school based programs, or selective, targeting certain vulnerable at-risk groups, i.e., subsections of the population [ 11 ]. Selective prevention can be carried out within a universal prevention setting, such as health care or school, but also be delivered directly to the group which it aims to target, face-to-face or digitally [ 12 – 15 ].

The motives to use substances are governed by a number of personal, social and environmental factors [ 16 ], ranging from personal knowledge, abilities, beliefs and attitudes, to the influence of family, friends and society [ 17 – 20 ]. Cooper and colleagues [ 21 ] have previously identified a number of motives for drinking, i.e., 1) enhancement (drinking to maintain or amplify positive affect), 2) coping (drinking to avoid or dull negative affect), 3) social (drinking to improve parties or gatherings), and 4) conformity (drinking due to social pressure or a need to fit in). Similar motives for illicit drug use have been found by e.g. Kettner and colleagues, who highlighted the attainment of euphoria and enhancement of activities as prominent motives for use of psychoactive substances among people using psychedelics in parallel with other substances [ 22 ], along with Boys and colleagues [ 23 – 25 ], who reported on changing mood (e.g., to stop worrying about a problem) and social purposes (e.g., to enjoy the company of friends) as motives for using illicit drugs among young people. Additionally, the authors found that the facilitation of activities (e.g., to concentrate, to work/study), physical effects (e.g., to lose weight), and the managing of the effects of other substances (e.g., to ease or improve) motivated young people to use illicit drugs.

Prior research has repeatedly shown that low socioeconomic status is a risk factor for substance use and related problems [ 26 – 28 ]. However, recent research from Canada [ 29 ], the United States [ 30 – 32 ], Serbia [ 33 ], Switzerland [ 34 ], and Sweden [ 35 ] suggest that high socioeconomic status too is associated with excessive substance use among young people, although for other reasons [ 29 – 34 ]. Previous research has highlighted two main explanations for excessive substance use among young people in families with high socioeconomic status; i) exceptionally high requirements to perform in both school and leisure activities and ii) absence of adult contact, emotionally and physically, due to parents in resourceful and affluent areas spending a lot of time on their work and careers [ 36 , 37 ]. In addition to these explanations, high physical and social availability due to substantial economic resources and a social milieu were substance use is a natural element, may enable extensive substance use among economically privileged young people [ 30 , 38 , 39 ].

In parallel with identification of various groups at risk for extensive substance use, a growing number of young people globally abstain from using substances [ 1 , 40 , 41 ]. By analyzing data derived from a nationally representative sample of American high school students, Levy and colleagues [ 40 ] found an increasing percentage of 12th-graders reporting no current (past 30 days) substance use between 1976 and 2014, showing that a growing proportion of high school students are motivated to abstain from substance use. However, while this global decrease in substance use among adolescents is mirrored in Swedish youths, in particular alcohol use, a more detailed investigation shows large discrepancies across different socioeconomic and geographic areas. Affluent areas in Sweden stand out as breaking the trend, showing increasing alcohol and illicit drug use among adolescents [ 42 , 43 ].

To date, we lack in-depth knowledge of why youths in affluent areas keep using alcohol and illicit drugs excessively. Furthermore, despite implementation of various strategies and interventions over the last decades [ 14 , 44 – 48 ], we have yet no clear guidelines on how to effectively prevent substance use in this specific group, although the importance of parents’ role for preventing substance use in privileged adolescents has been highlighted in a recent study [ 29 ]. Moreover, despite the fact that attitudes are assumed to guide behavior [ 49 , 50 ] and consequently the reception and effects (behavior change) of prevention interventions, the knowledge about affluent adolescents’ attitudes toward current substance use prevention interventions remains limited. To our knowledge, the only study exploring adolescents’ attitudes to substance use prevention was carried out among Spanish adolescents who participated in “open-air gatherings of binge drinkers”. The study concerned adolescents irrespective of their economic background and revealed positive attitudes to restrictions for drunk people [ 19 ]. Thus, extended knowledge on what motivates young people in affluent areas to excessively use substances, or abstaining from using, as well as their attitudes to prevention is warranted.

In the current study, we aim to explore motives for using, or abstaining from using, substances among students in affluent areas. In addition, we aim to explore their attitudes to and suggestions for substance use prevention. The findings may make a valuable contribution to the research on tailored substance use prevention for groups of adolescents that may not be sufficiently supported by current prevention strategies.

A qualitative interview study was performed among high school students in one of Stockholm county’s most affluent municipalities. The research team developed a semi-structured interview guide (supplementary Interview guide) covering issues regarding the individual’s physical and mental health, extent of alcohol and illicit drug use, motives for use or abstinence, relationships with peers and family, alcohol and drug related norms among peers, family and in the society, and attitudes towards strategies to prevent substance use. Examples of interview questions are: How would you describe your health? Which are the main reasons why young people drink, do you think? How do you get hold of alcohol as a teenager?

What do you know about drug use among young people in Municipality X? How would you describe your social relationships with peers in and outside Municipality X?

The study was approved by the Swedish Ethical Review Authority (dnr. 2019–02646).

Study setting

Sweden has strict regulations of alcohol and illicit drugs compared to many other countries [ 45 , 46 ]. Alcohol beverages (> 3.5% alcohol content by volume) can only be bought at the Swedish Alcohol Retailing Monopoly “Systembolaget” by people 20 years of age or older, or at licensed premises (e.g., bars, restaurants, clubs), at the minimum age of 18 years. The use of illicit drugs is criminalized. The study was carried out in a municipality with 45% higher annual median income than the corresponding figure for all of Sweden, along with the highest educational level among all Swedish municipalities, i.e., 58% of the population (25 years and over) having graduated from university and hold professional degrees, as compared with the national average of 26%. Furthermore, only 6.1% of the inhabitants receive public assistance, compared to a national average of 13.4% [ 51 ].

Recruitment

Purposive sampling was used to recruit students from the three high schools located in the selected municipality. Contact was established by the research team with the principals of the high schools that agreed to participate in the study. Information and invitation to participate in the study was published on the schools’ online platforms, visible for parents and students. Students communicated their initial interest in participating to the assistant principal. Upon consent from the students, the assistant principal forwarded mobile phone numbers of eligible students to the research team. Also, students from other schools in the selected municipality were asked by friends to participate and upon contact with the research team were invited to participate. Forty students signed up to take part in the study, of which 20 were finally interviewed, representing four schools (three in the selected municipality and one in a neighbor municipality). Before the interview, informed consent was obtained by informing the students about confidentiality arrangements, their right to withdraw their participation and subsequently asking them about their consent to participate. The consent was recorded and transcribed along with the following interview. Twenty students who had initially signed up were excluded after initial consent due to incorrect phone numbers or if the potential participants were not reachable on the agreed time for participation. The reason for terminating the recruitment after 20 interviewees was based on the fact that little or no new information was considered to occur by including additional participants.

Participants

The final sample consisted of 20 students. Background information of the participants is presented in Table  1 . The group included eleven girls and nine boys between 15 and 19 years of age. Seven participants attended natural sciences/technology/mathematic programs and 13 attended social sciences/humanities programs. Twelve participants lived in the socioeconomically affluent municipality where the schools were located and eight in neighboring municipalities. The sample included three abstainers and 17 informants who were using substances, the latter referring to self-reported present use of alcohol and/or illicit drugs (without further specification). Additionally, 18 of the participants reported that at least one of their parents had a university education.

Background variables of the informants

During April–May 2020, semi-structured telephone interviews with the students were conducted by five of the authors (PK, YD, AKC, TH, CS). The interviewers had continuous contact during the interview process, exchanging their experiences from the interviews and also the content of the interviews. After 20 interviews had been conducted, it was assessed that no or little new information could be obtained by additional interviews and the interview process was terminated. The interviews, on average around 60 min long, were recorded on audio files and transcribed verbatim.

Qualitative content analysis, informed by Hsieh & Shannon [ 52 ] and Granheim & Lundman [ 53 ], was used to analyze the interview material. To increase reliability of the analytic process, a team based approach was employed [ 54 ], utilizing the broad expertise represented in the research team and the direct experience of information collected from the five interviewers.

The software NVivo 12 was utilized for structuring the interview data. Initially, one of the researchers (PK) read all the interviews repeatedly, searching for meaningful units which could be grouped into preliminary categories and codes, as exemplified in Table ​ Table2. 2 . During the process, a preliminary coding scheme was developed and presented to the whole research team. After discussion, the coding scheme was slightly revised. Following this procedure, a second coder (CS) applied the updated coding scheme along with definitions (codebook) [ 54 ], coding all the interviews independently. Subsequent discussions between PK, YD and CS, resulted in an additionally revised coding scheme. This scheme was utilized by PK and another researcher (LH), who had not been involved in the interviewing or coding, coding all of the interviews independently. The agreement between the coders PK and LH was high and a few disagreements solved through discussion. No change in the codes was necessary and the research team agreed on the coding scheme as outlined in Fig.  1 .

Example of analysis

Final coding scheme

The interview material generated three main categories, six subcategories and 27 codes. The results are presented under headings corresponding to the identified subcategories, since they are directly connected to the aim of the study. Content from the main category “External factors” is initially presented to illustrate the context in which the students form their motivation to use or abstain from using substances, as well as their attitudes towards prevention.

External factors

The external factors found in the interview material concerned wealth, availability of alcohol and other substances, parental norms and peer norms. Informants living in the affluent municipality described an expensive lifestyle with boats, ski trips, summer vacations abroad, and frequent restaurant visits, in contrast to informants from other areas who described a more modest lifestyle. These differences were further accentuated by informants’ descriptions of large villas in the affluent municipality, where students can arrange parties while the parents go to their holiday homes. Some informants further pointed to the fact that people in this municipality easily can afford to buy illicit drugs, increasing the availability.

The reason why they do it [use illicit drugs] in [the affluent municipality] is because the parents go away, which make it easier to have parties and be able to smoke grass at home, and also because they can afford it .

Parents’ alcohol norms seemed to vary between families, but most informants described modest drinking at home, with parents consuming alcohol on certain occasions and sometimes when having dinner. However, several informants described that they as minors/children were offered to taste alcohol from the parents’ glasses. Most of the informants meant that their parents trust them not to drink too much when partying.

They [my parents] have said to me that drinking is not good, but that they understand if I drink, sort of.

Both parents’ and peers’ norms appear to influence substance use among the students, The impression is that there is an alcohol liberal norm in the local society among adults as well as among adolescents.

If you want to have a social life in community X, then it is very difficult … you almost cannot have it if you don’t drink at parties.

Motives for using substances

Confirming that both alcohol and illicit drugs are frequently used among students in the current municipality, a number of motives for substance use were expressed by the participants. The most prominent motive appeared to be a desire to feel a part of the social milieu and to attain or maintain high social status, with fear of being excluded from attractive social activities and parties if abstaining from substance use. The participants indicated that you are expected to drink alcohol to be included in the local community social life, claiming that this applied to the adult population as well. Alcohol consumption and even intoxication are perceived to be the norm in the students’ social life and several of the participants noted that abstainers risk being considered too boring to be invited to parties.

The view is that you cannot have fun without alcohol and therefore, you don’t invite sober people.

There seemed to be a high awareness of one’s own as well as peers’ popularity and social status. Participants evaluated peers as high or low status, fun or boring, claiming that trying to be cool and facilitate contact with others motivates people to use substances. High status students are, according to some participants, frequently invited to parties where alcohol and other substances are easily accessible.

I would say that our group of friends has more status. [… ] You know quite a few [people] and you are invited to quite a lot of parties. You can often evaluate the group of friends, i.e. their status, based on which parties they are invited to. […] Some [groups of friends] only drink alcohol and some even take drugs and drink alcohol.

Some differences in traditions and norms between schools was discerned, with certain schools being especially known for high alcohol consumption and drug use procedures when including new students in the school-community. One of the participants described fairly extensive norm violations, with respect to the law, on these occasions, e.g., strong peer pressure to drink alcohol and use illicit drugs, combined with humiliation of new students, careless driving under the influence of substances with other students in the car, and “punishment” by future exclusion from social events of those who don’t participate at these occasions. On the other hand, already popular, or more senior students, appear to be able to abstain from substance use on occasions without being questioned or risk social exclusion. High self-esteem and a firm approach when occasionally saying no to substances is often respected according to the participants. To avoid peer pressure to use alcohol or illicit drugs, the participants suggested acceptable excuses, such as school duties, bringing your moped or car to the party, having a sports activity or work the day after, or having plans with your parents or extended family during the weekend.

Apart from peer influence, several students expressed hedonistic motives, such as enjoying a nice event or simply to have fun.

If you want a little extra fun, then you take drugs.

Apart from social enhancement motives for using substances, some students reported that relaxing from academic pressure or rewarding oneself after an intense period of studying motivates them to use substances. Almost every participant expressed high academic ambitions. One participant who claimed to be very motivated to study expressed drinking due to stress, as illustrated in the extract below:

You study a lot and you are stressed over school. Then it can be very nice to go out and drink and you can forget everything else for a few hours. […] So it can be a “stress reliever” in that way.

Yet another participant explained that academic failure had previously made her use substances to comfort herself. Coping with mental health problems, such as depression, was also stated as a reason for substance use. Moreover, some participants reported that they use ADHD (Attention Deficit Hyperactivity Disorder) medication to be able to study more intensively.

Motives for abstaining from using substances

A number of motives for totally or temporarily abstain from substance use were put forward by the students, such as a wish to be healthy, keep control and avoid embarrassment, influence of parents, academic pressure, sports ambitions or simply lack of interest. Lack of interest in alcohol and drugs was expressed foremost by those attending natural sciences programs and those who totally abstained from substance use.

I attend the engineering program and I don’t think the interest in alcohol and parties is as present as it might be on social sciences programs.

Fear of health consequences was predominantly related to abstaining from illicit drugs, but also alcohol. Motives for abstaining from alcohol included perceived risk of being addicted, due to relatives having alcohol problems (heredity), and taking medicine, for example ADHD medicine, since combining alcohol and medication was perceived as risky. Some students had observed friends getting “weird” or “laze” after using illicit drugs, which made them hesitant to use such substances themselves. With regard to parental norms, most parents were by the participants reported to be “normal drinkers” themselves and quite relaxed about their teens’ alcohol consumption. This applied to both the parents of older teens and minors. However, many of the participants reported that their parents would be upset and disappointed if they found out that their child used illicit substances, which motivated some of them to abstain. Reasons for abstaining from substance use included academic strivings, sports performance ambitions, driving, or other activities requiring sobriety, which the students referred to as socially acceptable reason to abstain from substance use. Prioritizing studies over partying was explicitly expressed as the primary motive to abstain by some of the participants.

We are a group of five or six who come from other municipalities. […] We don’t party and such things and we may be seen as a bit boring. But we are a little more responsible and we are more motivated to study than the others in the class.

A wish to save money and reluctance to support the illegal drug production were also mentioned as reasons to abstain from substance use, however to a lesser extent.

Universal prevention viewed as attractive or feasible

With regard to substance information interventions, some students wanted detailed information about different substances’ physical and psychological effects. The participants emphasized the importance of credible sources or persons providing the information, mentioning researchers, young medical students and even parents as credible sources of information. Individuals who had experience of substance use were also suggested.

You have to tell the facts in a way that makes us want to listen. With the help of various spokespersons who have been involved in it, for example.

Several students stressed the importance of being able to identify with the person sending the message and suggested influencers as plausible sources. Someone who is difficult to relate to was given as an example of a non-credible, as the following excerpt shows:

They shouldn’t take a heroin addicts who talk about having found Jesus, because I do not think it would touch the children or touch the young. You have to somehow find … someone that can relate to the young people.

As for universal prevention, the students also suggested intensified legal measures for companies and people providing young people with alcohol or drugs.

For example, make it difficult for young people to have access to alcohol [...], allocate more time as a police officer to catch the drug dealers.

Both alcohol and illicit drugs were reported as easily accessible. Students can obtain alcohol via social media platforms, such as Instagram and Snapchat, where “liquor cars” market themselves and offer home delivery. In addition, older siblings or peers and even some parents were, according to the informants, providing minor students with alcohol. The main way to access illicit drugs is via parties where older students offer drugs to younger peers. Access to prescription drugs was also reported.

Several of the participants agreed that parental involvement is constructive for substance use prevention. Many of them reported having supportive and caring parents involved in their lives, but at the same time referring to friends’ parents as being more absent, resulting in extensive partying in large homes without parental control. Some students reported that parents don’t realize to what extent youths are using substances and that the parents should pay even more attention to what their children do.

I think [parents should be] keeping track, good track of the kids […] . Keeping track of what they are doing and ask them how they feel and things, I think that helps.

In line with leisure activities as a reason to abstain from substance use, some participants suggested that social activities other than partying could be a way of preventing substance use, as expressed by one participant when asked about plausible ways to prevent substance use.

Find a sport or friend that you train with […] instead of going to a party,

Talking about their leisure activities, the participants expressed joy and that these activities made them relax while being social.

The leisure interests, like working out and hanging out with friends, is relaxing and in contrast to the everyday in some way .

Universal prevention viewed as inappropriate

Several of the participants expressed great skepticism towards traditional universal preventive strategies, such as lectures by teachers, social workers or researchers. Some teachers were perceived as ignorant and unengaged, lecturing about substances only by duty.

The teachers have been a bit like ‘now we’re going to talk about drugs […] and then you have fifteen minutes and they say something like ‘here we are a drug free and smoke and tobacco free school’, and no one obeys.

Some students also doubted that the information provided from school and society is true, suspecting exaggerated report on harm, and that they prefer information from social media platforms such as Youtube or other online sources.

It feels like the information we get in school is a bit exaggerated, a bit made up for us […] A bit like this, ‘now we’ll get the young people to stop’.

Selective prevention viewed as attractive or feasible

In circumstances where students are worried about their own or peers’ substance use, participants stressed the need for a way to connect with local authority, health care or other support anonymously, without being registered in medical records or being reported to the authorities. Moreover, the participants emphasized the importance of a non-judging approach from professionals when they reach out to students at risk of excessive substance use.

If you wonder about something or if you are worried about something, then you should be able to turn to adults without being yelled at and know that you are getting positive feedback like ‘I understand you’ and ‘how can we fix this?’

Selective prevention viewed as inappropriate

As indicated above, help-seeking seemed to be counteracted by fear of being recorded in medical records or in the criminal registries. One participant mentioned an incident where a student, caught smoking marijuana, was prosecuted and that this student’s life had been severely affected with cancellation of planned studies abroad and rejection of driving license application. These consequences had, according to the participant, resulted in the student “giving up” and selling illicit alcohol to other students instead of trying to strive for a good future life. Admitting that such an incident can serve as a warning to other students, the fear of consequences is, according to the participant, still an obstacle to seeking help.

People don’t really know what to do when they see their friends do it [use substances]. You don’t want to tell on them, because they are afraid that if it is written down somewhere, then everything can be ruined.

Also, parents were by the participants reported as being reluctant to seek help for their children, because of fear of the reporting of their child’s behavior or crime to authorities, with subsequent negative consequences.

Parents do not dare either because they don’t want it to be about their children. I know some parents who have found drugs in their children’s rooms, but do not want to ruin [future prospects] for them.

The current study aimed to explore motives for using or abstaining from using substances, including alcohol, among students in affluent areas, as well as their attitudes to and suggestions for substance use prevention.

Summary of results

The motives for using substances among the students are associated with social aspects as.

well as own pleasure and coping with stressful situations. The most prominent motive appears to be a desire to feel a part of the current social milieu and to attain or maintain high social status within the peer group. Several of the students expressed fear of being excluded from attractive social activities if abstaining from substance use, although some meant that they were not interested in substances and didn’t care if they were perceived as boring, and also had found a small group of friends with whom they socialized. Motives for abstaining, apart from lack of interest, included academic ambitions, activities requiring sobriety, parental influence, and a wish to stay healthy. The students expressed negative attitudes towards current information-based prevention as well as problems with using selective prevention interventions due to fear of being registered or reported to the authorities. Students’ suggestions for feasible universal prevention concerned reliable information from credible sources, stricter substance control measures, extended parental involvement, and social leisure activities without substance use. Suggestions regarding selective prevention were guaranteed confidentiality and non-judging encounters when seeking help due to substance use problems.

Comparison with previous research

Children of affluence are generally presumed to be at low risk for negative health outcomes. However, the current study, in accordance with other recent studies [ 29 , 55 ], suggest problems in several domains including alcohol and drug use and stress related problems, even if the cause of these problems cannot be determined based on our interview study. Previous explanations for extensive substance use among affluent young people have been exceptionally high-performance requirements in both school and in leisure activities, and absence of emotional and physical adult contact, resulting from parents in affluent areas spending a lot of time on their jobs and careers [ 30 , 56 – 58 ]. These explanations can be viewed in the light of Cooper and colleagues’ [ 21 ] as well as Boys and colleagues’ [ 23 – 25 ] previously identified coping motive for substance use. Coping appears among affluent young people as a central motive for substance use, i.e., coping with performance requirements and perhaps with negative affects due to parents’ absence. In the current study, however, social motives, including conformity, i.e., using substances due to social pressure and a need to fit in [ 21 , 23 – 25 ] appears to be the most prominent motive, supporting the social learning theory which proposes that behavior can be acquired by observing and imitating others and by rewards connected to the behavior [ 16 , 59 ]. Interestingly, a small group of participants, especially from natural sciences programs, resisted the general pressure to use substances and found a social context of a few friends with whom they socialized without striving for high social status in the larger social context. The wish to be included in the social life and achieve high social status within the peer group was described as a central motive for substance use among a majority of the students, along with fear of being excluded if abstaining. Previous research show that high socioeconomic status is a protective factor for substance use disorder among adults [ 60 ], but among young people it may be the opposite. High status appears to be an important risk factor for the use of substances, at least among those striving for higher status. The students report that they, to achieve high status, must attend parties and at least drink alcohol. After achieving high status, which has resulted in frequent invitations to parties, students then may pose an even higher risk of excessive alcohol and drug use. In line with previous studies, results show that individuals with larger social networks, which has shown to be an indicator for social status among young, also drink more [ 35 , 61 ]. However, status can also act as a protective factor. Individuals with higher status have, according to the interviewees, slightly more room for maneuver to temporarily say no to substances at a party, without being pressured or ashamed. Nevertheless, several of the interviewees reported that they have to choose between using substances or being excluded from desirable social activities, as abstainers are considered “boring”. The results further show that alcohol and other drugs are popular among affluent youth and the information from the participants indicate that the students perceive substance use to be under control. One possible explanation is that high affluence can contribute to a sense of control over one’s life [ 62 ]. Although previous studies show that young people from affluent areas drink more, the risk of developing alcohol problems is still greater among young people who grow up in more disadvantaged areas [ 57 ]. Why this is the case is unclear. There is a widespread belief that affluent youngsters have plenty of social and financial resources in the family and thus receive the right help (e.g., psychotherapy) when they have problems [ 62 ], which could explain why they do not develop alcohol problems. However, research also shows that parents in affluent areas seek less help than others when their children are troubled [ 30 , 63 ], partly due to difficulties in accepting and revealing problems within the family [ 62 ]. In the current study, the informants expressed doubts about the possibility to be guaranteed confidentiality when seeking help, which may mean that there are concerns among both children and parents about the risk of losing status and a good reputation if seeking help for substance use problems. Consequently, there is a risk that any substance use problems will not be noticed in this group [ 62 ].

Previous research indicates that academic pressure may promote substance use [ 56 , 64 ]. However, in the current study academic pressure, due to high ambitions, was reported both as a reason for using substances and abstaining, the former to cope with stress or relax, the latter to maintain a sharp intellect and receive high grades. Moreover, previous research has demonstrated an association between pressure from extracurricular activities or “over scheduling” and negative outcomes among affluent students ( 39 ). In the current study, this did not stand out as a critical vulnerability factor. Instead, students reported extracurricular and leisure activities as relaxing and fun and an accepted reason to abstain from substance use while still attending activities where peers were using substances.

With regard to adult or parental contact, previous research shows that mental health and substance use among adolescents in socioeconomic affluent areas are associated with parents’ lack of reaction to teenage substance use (i.e. liberal, allowing attitudes and minor or no repercussions on discovering use) and parents’ lack of knowledge of their teens’ activities [ 30 ]. In our study, the students reported that their parents do not generally react with punishment due to their child’s alcohol consumption. However, the participants thought that parents probably should react more condemningly due to illicit drug use, if revealed. The Swedish criminalization of illicit substance use [ 46 ] may influence parents to adopt stricter norms with regard to their children’s illicit substance, because of the consequences for revealed substance use that may occur in the Swedish context. Also, parents in the current study were reported as being reluctant to seek help for their children out of fear of negative consequences that may affect their children. This result is in line with previous research, showing that concern about admitting problems in their children is elevated among affluent parents [ 30 ], mentioned above. In the current study, the participants further reported closeness to their parents and that their parents cared about how they spent their time. That said, some parents of wealthy peers were reported as being more absent, resulting in extensive partying in large homes without parental control. Previous research has shown the nature of family relationships and perceptions of closeness to be important protective factors for adolescent mental health [ 56 ], and this seems to apply to the students in the current study.

The students’ attitudes to current substance use prevention, aimed to increase students’ knowledge, are to a large extent negative. Information provided in school were reported as exaggerated and uninteresting. Instead, students suggested interventions focusing on credible sources of reliable information, such as from people with personal adverse experiences of substance use and people whom they can identify with. Whether people with own experience of substance use are credible or helpful in a more objective way can be disputed, but the students seem to put their trust in them rather than other persons. This result is partly in line with previous research on school-based programs in general, suggesting that the role of the teacher (the one who deliver the information) is central and that the use of peer leaders can be successful in engaging the students who receive the message [ 65 , 66 ]. Some informants in the current study meant that the teachers in school were ignorant and unengaged, lecturing about substances only by duty, which of course can be problematic for the sense of credibility among those receiving the information. Previous research has demonstrated that for older adolescents, a social influence approach can increase the effectiveness of alcohol and drug prevention interventions, as can health education, basic skills training and the inclusion of parental support [ 67 ]. Again, this research applies to adolescents in general and not to affluent youth specifically.

Interestingly, the students also suggested stricter regulations on substances with intensified legal measures for those providing substances. Positive attitudes to limiting access of alcohol for drunk people have previously been shown in a Spanish study among adolescents participating in an open-air gatherings of binge drinkers [ 19 ]. The positive attitude to stricter regulations for those providing substances is interesting in the light of the students’ desire for a non-judging approach when having to seek help for own substance use, as described below. Previous research, however, supports strict policy measures to decrease availability as an effective measure for substance use prevention in the general population [ 68 ]. The students further suggested increased parental control and activities and venues which can be attended without using substances, for example sporting/training with friends. Leisure activities without substance use have recently been offered to e.g., adolescents in general in an Icelandic prevention strategy [ 69 ], however more research is needed to see if this kind of prevention is attractive also for large groups of affluent students as an alternative to parties and whether it also appears to be effective in reducing substance use in this group. Clearly, some affluent students without ambitions to receive high social status do find socialization without using substances attractive, as shown in the current study. With regard to selective prevention, the students were critical of the current risk of being reported to parents, registered within medical records or reported to the authorities if turning to professionals for support for substance use problems. They claimed that this circumstance serves as a massive counteracting force to seek help at an early stage for oneself or for peers and that the possibility of reaching out anonymously is essential for taking the first step in seeking help. Moreover, the adolescents in this study call for an open and non-judging approach when turning to health care staff, parents or other adults, which is in line with so called Motivational Interviewing, a non-judging approach aimed to enhance motivation to change by exploring and resolving ambivalence about e.g., substance-related behaviors [ 70 ], which has shown promising results with regard to reduction of alcohol consumption among young people [ 71 ].

Strengths and limitations

The current study has a number of strengths. Firstly, we were able to recruit both male and female students between 15 and 19 years of age, living inside the affluent community as well as in neighboring municipalities, which provided us with a broad base of the students’ social context. Secondly, we included informants using substances as well as abstainers, increasing the possibility to get a broad view of motives to use or abstain from using substances among affluent youth. Thirdly, the research group has extensive experience in qualitative analysis as well as working with adolescents and young adults with mental health problems, including alcohol and drug consumption or abuse. However, our study must also be viewed in the context of some limitations. Students with more severe health or psychosocial problems may have refrained from participating, biasing the results towards adolescents of more stable psychosocial functioning. Moreover, interview studies are always vulnerable for social desirability bias due to a potential desire to give socially acceptable answers [ 72 ]. However, the possibility to terminate participation at any time, along with the circumstance that most of the interviewers are health care professionals, thereby used to handle secrecy in consultation situations, may have decreased the risk of desirability bias in the current study.

Several of the motives guiding substance use behavior among young people in general also seem to apply to affluent youth. A desire to feel a part of the current social milieu and to attain or maintain high social status within the peer group were reported as prominent motives for substance use among affluent students in the current study. Given that the social milieu is crucial for the substance use behavior in this context, future research on substance use prevention targeting this group could with advantage pay attention to suggestions on prevention strategies given by the students. Students’ suggestions include reliable prevention information from credible sources, stricter substance control measures targeting those providing substances, parental involvement, leisure activities without substance use, and confidential ways to seek help, involving a non-judging approach from professionals and other adults.

Acknowledgements

We would like to thank all the participating students for making this study possible.

Abbreviations

Authors’ contributions.

PK contributed to conceptualization, methodology, investigation (data collection), data curation, formal analysis, writing original draft, review & editing, funding acquisition. LH contributed to conceptualization, methodology, data curation, formal analysis, validation, review & editing. YD contributed to project administration, methodology, investigation (data collection), data curation, formal analysis, validation, review & editing. AC contributed to investigation (data collection), review & editing. TH contributed to investigation (data collection), review & editing. JG contributed to conceptualization, methodology, review & editing, funding acquisition. TE contributed to conceptualization, methodology, review & editing. KE contributed to review & editing. CS contributed to conceptualization, methodology, investigation (data collection), data curation, formal analysis, review & editing, funding acquisition, supervision. All authors approved the submitted manuscript version.

The work was funded by the Alcohol Research Council of the Swedish Alcohol Retailing Monopoly (grant no. 2018–0010). The funding body had no role in study design, data collection, analysis, data interpretation or writing the manuscript. Open Access funding provided by Karolinska Institute.

Availability of data and materials

Declarations.

The study was performed in accordance with the Declaration of Helsinki and was approved by the Swedish Ethical Review Authority (dnr. 2019–02646).

Not applicable.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Drug overdoses reach another record with almost 108,000 Americans in 2022, CDC says

FILE - A member of the Solutions Oriented Addiction Response organization holds a dose of the opioid overdose reversal drug Narcan at the Unitarian Universalist Congregation of Charleston in Charleston, W.Va., Tuesday Sept. 6, 2022. Nearly 108,000 Americans died of drug overdoses in 2022, according to final federal figures released Thursday, March 21, 2024. (AP Photo/Leah Willingham, File)

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NEW YORK (AP) — Nearly 108,000 Americans died of drug overdoses in 2022, according to final federal figures released Thursday.

Over the last two decades, the number of U.S. overdose deaths has risen almost every year and continued to break annual records — making it the worst overdose epidemic in American history.

The official number for 2022 was 107,941, the U.S. Centers for Disease Control and Prevention said, which is about 1% higher than the nearly 107,000 overdose deaths in 2021.

Earlier provisional data estimated more than 109,000 overdose deaths in 2022, but provisional data includes all overdose deaths, while the final numbers are limited to U.S. residents.

The female overdose death rate declined for the first time in five years, although the male overdose death rate continued to inch up, the report said. Males account for about 70% of U.S. overdose deaths.

The overall drug overdose death rate rose from 2021 to 2022, but the increase was so small it was not considered statistically significant.

The CDC has not yet reported overdose numbers for last year, although provisional data through the first ten months of the year suggest overdose deaths continued to be stable in 2023.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Health Insurance

Drug, substance abuse and addiction statistics 2024

Timothy Moore

Jennifer Lobb

“Verified by an expert” means that this article has been thoroughly reviewed and evaluated for accuracy.

Heidi Gollub

Published 12:25 a.m. UTC March 28, 2024

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Wichayada suwanachun, Getty Images

• 25% of Americans (70 million people) admitted they use illicit drugs, according to the most recent National Survey on Drug Use.
• 48.7 million people nationwide struggle with substance abuse according to the same survey.
• Alcohol is the most commonly used drug, followed by tobacco and marijuana.
• Health insurance policies sold on the Affordable Care Act (ACA) Marketplace or provided by Medicaid are required to cover substance abuse.

Drug and substance abuse continues to be a major problem across the United States, with 1 in 4 Americans over the age of 12 admitting that they used illicit drugs in 2022. 1  While alcohol, tobacco and marijuana represent the most popular drugs among Americans, many struggle with more illicit drugs, including cocaine, methamphetamines and heroin, according to the most recent Substance Abuse and Mental Health Services Administration (SAMHSA) survey. 3

Below, we’ve compiled comprehensive drug, substance abuse and addiction statistics that demonstrate the pervasiveness of the issue — and the importance of quality, affordable health insurance that offers substance abuse treatment.

How many people use drugs in the U.S.?

Nearly 25% of Americans ages 12 or older say they used illegal drugs in 2022. That’s 70.3 million people nationwide. 1 Approximately 50% of Americans 12 or older admit they used illegal drugs in their lifetime. 2  

The breadth of the problem is detailed in the most recent SAMHSA survey, which asked participants about their drug use habits. The survey included questions about current use (defined as using a substance within the month prior to taking the survey) as well as lifetime use. 

Current use 3

Based on survey results and the definition of current use:

• 16.5% of those who used illicit drugs in the survey year used marijuana, making it the most common illicit drug among those surveyed. 
• 3.4% of respondents admit to using marijuana and other illicit drugs within a month of taking the survey.
• Central nervous system stimulants and prescription psychotherapeutics (misuse) were the second most common illicit drugs, each representing just under 2% of reported use. 
• LSD, PCP, ecstasy and sedatives account for the lowest percentage of use, each representing 0.1% or less of illicit drugs used.

Lifetime use 3

• 47% admitted to using marijuana at some time in their life, making it the most common illicit drug among lifetime use statistics.
• Hallucinogens were the second most widely used illicit drug, with 17% admitting they used them during their lifetime. 
• Cocaine was the third most commonly used illicit drug, with 15% of participants admitting to using it over their lifetime.

What is the most popular drug in the U.S.?

Alcohol is the most popular drug in the U.S., with nearly half of Americans ages 12 and older saying they used it in the last statistically available month, based on the SAMHSA survey. Nearly 22% admitted they engaged in binge drinking in the past month at the time of the survey. 3

Tobacco use is also prevalent in the United States, with more than 1 in 5 Americans consuming tobacco in some form in the last statistically available month — and nearly 17% specifically smoking cigarettes.

While harder drug use is still a problem, less than 2% of Americans ages 12 and older reported having used cocaine in the past year. It’s even lower for methamphetamines (1%) and heroin (0.3%).

Note: These are self-reported usage statistics. It is possible some Americans may not accurately report drug use.

How many people die from drugs?

The U.S. has experienced a rising number of drug-related deaths for more than a decade, according to the latest National Safety Council Data. There were 108,490 drug-related deaths in 2022, according to preliminary data. That’s slightly lower than those reported in 2021 (106,699 deaths) but a 141% increase over the last decade and a 494% increase since 1999, the first year for which NSC data is available. 4  

This data includes drug-related deaths by suicide, homicide and undetermined intents. Of those 108,490 deaths, 92% (100,105) were categorized as preventable drug overdoses.

Opioid overdoses are the most common cause of drug-related deaths, but even cannabis (marijuana) has resulted in preventable deaths.

Here’s how those drug-related deaths break down according to NSC’s preliminary 2022 data:

Source: Preliminary 2022 data from the National Safety Council as of March 21, 2024

How many people struggle with substance abuse?

Nationwide, 38,679,000 American adults reported having a substance abuse disorder in the last statistically available year. 5  

Montana has the highest self-reported rate (19.2% of adults) of substance abuse. Oregon , Washington , South Dakota and Kansas round out the top five.

Georgia is the state with the lowest rate of self-reported substance abuse (11.31% of adults).

Source: 2023 State of Mental Health in America Report

What percentage of Americans abuse alcohol?

Alcohol abuse can be defined in two ways: binge drinking and alcohol use disorder (AUD).

• The Centers for Disease Control and Prevention defines binge drinking as five drinks on one occasion for men and four drinks on one occasion for women. 6
• The National Institute on Alcohol Abuse and Alcoholism defines AUD as a medical condition wherein someone cannot stop or control their alcohol intake, no matter the consequences. 7

Nationwide, an average of 21.7% of people reported having engaged in binge drinking in the past statistically available month, and 10.8% said they had dealt with alcohol use disorder in the last statistically available year. 3

States with the highest alcohol abuse

North Dakota and Wisconsin are the two states with the highest rate of binge drinking, with 25.99% of people ages 12 and older reporting binge drinking in the past month. 3 Nebraska , Vermont and Iowa also have high rates of binge drinking.

North Dakota also leads the country in alcohol use disorder, with more than 15% of individuals 12 and up reporting struggling with AUD in the past year. Montana , New Mexico , Oregon and Alaska round out the top five states with the highest rate of reported alcohol use disorder.

Source: SAMHSA National Survey on Drug Use and Health

How many people die from alcohol each year?

In the United States, 178,000 people died from alcohol in the last statistically available year (2021). That’s 488 deaths every day from alcohol. 8

Of those 178,000 deaths:

• 117,000 deaths are attributed to chronic conditions related to long-term alcohol use.
• 61,000 deaths are attributed to alcohol-related car crashes, alcohol poisoning or suicide. 

What percentage of Americans use tobacco?

Across the U.S., an average of 21.2% of people ages 12 and older reported tobacco use in the last statistically available month. More specifically, 16.82% reported smoking cigarettes. 3

States with the most smokers

Kentucky is the state with the most tobacco users; more than one-third of Kentuckians ages 12 and older report using tobacco of some kind in the past month. Kentucky also leads the country in cigarette users, with 1 in 4 people self-reporting smoking cigarettes. 3

More than 1 in 5 people smoke cigarettes in West Virginia , Missouri, Wyoming , Louisiana and Arkansas . West Virginia, Missouri and Louisiana are also close behind Kentucky for overall tobacco use as well.

Only 13.01% of Californians reported having used tobacco in the last statistically available month. Cigarette usage is even lower in Utah, where just over 10% of the state’s population reported cigarette usage.

How many people use marijuana?

On average, more than 13% of Americans ages 12 and older reported using cannabis, also known as marijuana, in the previous month. 3

However, the most recent statistically significant data comes from 2021 to 2022. It’s important to note that since then, several additional states have legalized marijuana both medicinally and recreationally, which may lead to an increase in usage.

States with the highest rate of marijuana use

Vermont leads the nation with the highest rate of marijuana use; just over 22% of people 12 and up reported using marijuana in the last month. Recreational marijuana has been legal in Vermont since 2020. 3

Alaska , Colorado , Oregon and Maine round out the top five states for marijuana usage. Recreational marijuana has been legal in Alaska and Oregon since 2014, Colorado since 2012 and Maine since 2016.

Oklahoma is the state with the highest rate of marijuana usage (16.61%) where recreational use is currently not legal.

How many people die from marijuana usage?

Preliminary data for 2022 indicates that there were 1,183 linked to marijuana and its derivatives, in the U.S., which marks an increase over the years prior. 4 The National Safety Council specifies that marijuana derivatives can include THC, CBD or their synthetic derivatives.

Source: National Safety Council data

The National Safety Council has data dating back to 1999 when there were only 36 cannabis-related deaths.

What percentage of people have used cocaine?

Nationwide, an average of 1.7% of people ages 12 and older reported having used cocaine in 2022, the last statistically available year. 3

States with the highest rate of cocaine use

Vermont is the state with the highest rate of self-reported cocaine use, with 3.2% of people 12 and up saying they used the drug in the year prior. New York , Maryland , Massachusetts and Rhode Island make up the remaining top five states. 3

The state with the lowest cocaine use is Texas, with just 1 in 100 Texans self-reporting cocaine use.

What percentage of people have used methamphetamines?

Nationwide, an average of 1% of people 12 and older reported having used methamphetamines in the last statistically available year. 3

States with the highest rate of methamphetamine use

Nevada tops the list of states with the highest rate of methamphetamine usage. More than 1 in 50 people ages 12 and up reported using this drug in the last statistically available year. Self-reported meth use is also high in Tennessee , Iowa , Mississippi and Alabama . 3

Connecticut and Florida have the lowest rate of methamphetamine use; just 0.52% of residents self-reported usage in the last statistically available year.

What percentage of people abuse prescription pain pills?

Nationwide, an average of 3.12% of people 12 and older reported having abused prescription pain pills in the last statistically available year. 3

States with the highest rate of prescription pain pill abuse

Tennessee leads the country in prescription pain pill misuse. More than 4% of the state’s population, ages 12 and older, reported having abused pain relievers in the year prior. 3

Prescription pain pill abuse is also high in Arkansas , Nevada , Louisiana and Alabama .

Nebraska is the state with the lowest rate of self-reported pain pill abuse (2.39%).

What percentage of people have used heroin?

Nationwide, an average of 0.3% of people ages 12 and up reported having used heroin in the last statistically available year. 3

States with the highest rate of heroin use

Heroin use is most common in the state of Delaware , where 0.6% (that’s more than 1 in every 200 residents) of people ages 12 and up reported having used heroin in the year prior. The only other states with a rate higher than 1 in 200 are Maine , Vermont and Alaska . 3

Texas is the state with the lowest rate of self-reported heroin use: Only 0.15% of Texans 12 and up reported having used the drug in the most recent statistically available year.

What percentage of people have abused opioids?

Across the country, an average of 3.3% of Americans ages 12 and up reported having abused opioids in the year prior. 3

States with the highest rate of opioid abuse

Tennessee has the highest rate of opioid abuse in the U.S. Nearly 4.7% of people in the state reported having engaged in opioid abuse in the last statistically available year. Arkansas , Alabama , Louisiana and Nevada round out the top five. 3  

Nebraska has the lowest rate of opioid abuse in the country, with only 2.4% saying they had abused opioids in the year prior.

States with the highest number of overdose deaths

West Virginia has the highest rate of overdose death in the U.S., with 84 overdose deaths for every 100,000 people. Nebraska and South Dakota has the lowest rate of overdose deaths, with 9 deaths for every 100,000 people. 10

Overdose deaths are on the rise in West Virginia (up by 7.3%) but on the decline in South Dakota (down by 16.7%). Oregon has seen the biggest increase (41.5%) in overdose deaths over the last statistically available 12 months.

What drug causes the most overdose deaths?

Opioids are involved in more overdose deaths than any other drug. In 2022, there were 108,490 drug-related deaths — and just over 75% of them (82,234 deaths) involved an opioid. 4

Fentanyl is by far the deadliest opioid. Of the 82,234 opioid-related deaths, 70,601 of them involved fentanyl.

Health insurance and substance abuse

Substance abuse disorders represent a dangerous health condition — one that deserves the proper care and treatment. Yet 93.5% of Americans with a self-reported substance abuse problem do not seek help. 5

If you or someone you love is suffering from substance abuse, know that there are options available. Many health insurance plans include coverage for mental health and substance abuse. If you purchase health insurance from the ACA Marketplace, the insurer is required to cover substance abuse counseling and treatment. 11 Medicare will also pay for treatment of alcoholism and substance use disorders, though its coverage is not as extensive as it is for other services.

If you’re not sure if your current health plan covers mental health surveys or substance abuse counseling and treatment, contact your insurer to discuss your benefits. 

Looking for better health insurance that includes coverage for substance abuse disorders? Browse our roundup of the best health insurance companies to get started.

Worried about the cost? How to save money on health insurance

For free, confidential help with substance abuse, contact the SAMHSA's National Helpline at 1-800-662-HELP(4357). The service is available 24/7, 365 days a year to help individuals and families facing mental and/or substance use disorders find treatment referrals and information services.

Article sources

• United States Department of Health and Human Services
• National Center for Drug Abuse Statistics
• Substance Abuse and Mental Health Services Administration - National Survey on Drug Use and Health
• National Safety Council
• State of Mental Health in America Report
• Centers for Disease Control and Prevention - Binge Drinking
• National Institute on Alcohol Abuse and Alcoholism
• Centers for Disease Control and Prevention - Excessive Alcohol Deaths
• National Institute on Drug Abuse - Drug Overdose Death Rates
• Centers for Disease Control - Provisional Drug Overdose Death Counts
• Substance Abuse and Affordable Care Act

Blueprint is an independent publisher and comparison service, not an investment advisor. The information provided is for educational purposes only and we encourage you to seek personalized advice from qualified professionals regarding specific financial decisions. Past performance is not indicative of future results.

Blueprint has an advertiser disclosure policy . The opinions, analyses, reviews or recommendations expressed in this article are those of the Blueprint editorial staff alone. Blueprint adheres to strict editorial integrity standards. The information is accurate as of the publish date, but always check the provider’s website for the most current information.

Timothy Moore is a writer and editor covering personal finance, travel, autos, and home renovation. He's written financial advice for sites like LendEDU, LendingTree, Forbes Home and The Penny Hoarder; edited complex ROI analyses for B2B tech companies like Microsoft and Google; served as managing editor at a print magazine; led content creation for a digital marketing agency; and written for brands like Chime, Angi and SoFi.

Jennifer Lobb is deputy editor at USA TODAY Blueprint and is an experienced insurance and personal finance writer. Jennifer served as an insurance staff writer and editor at U.S. News and World Report and deputy editor of insurance at Forbes Advisor. She also spent several years covering finance and insurance for various financial media sites, including LendingTree and Investopedia. For nearly a decade, she’s helped consumers make educated decisions about the products that protect their finances, families and homes.

Heidi Gollub is the USA TODAY Blueprint managing editor of insurance. She was previously lead editor of insurance at Forbes Advisor and led the insurance team at U.S. News & World Report as assistant managing editor of 360 Reviews. Heidi has an MBA from Emporia State University and is a licensed property and casualty insurance expert.

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HRA vs. HSA: What’s the difference?

Home — Essay Samples — Nursing & Health — Drugs — The Effects of Drugs on Our Society

The Effects of Drugs on Society: Health Problems

• Categories: Drugs Society

About this sample

Words: 1471 |

Published: Dec 3, 2020

Words: 1471 | Pages: 3 | 8 min read

Table of contents

Introduction, drugs in history, effects of drugs on society: health issues, works cited.

• Center for Substance Abuse Treatment. (2006). Substance abuse treatment for persons with co-occurring disorders. Substance Abuse and Mental Health Services Administration.
• Drug Enforcement Administration. (2019). Drugs of abuse: a DEA resource guide. US Department of Justice.
• Green, L. W., Kreuter, M. W., Deeds, S. G., & Partridge, K. B. (1980). Health education planning: A diagnostic approach. Mayfield.
• National Institute on Drug Abuse. (2021). Commonly abused drugs. National Institutes of Health.
• National Institute on Drug Abuse. (2021). DrugFacts: Understanding drug use and addiction. National Institutes of Health.
• Pinto, F. A., & Pinto, M. A. (2019). Health risks of addiction to illicit drugs. Advances in preventive medicine, 2019.
• Reuter, P., & Pollack, H. A. (2006). Drug war heresies: Learning from other vices, times, and places. Cambridge University Press.
• Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. US Department of Health and Human Services.
• The National Center on Addiction and Substance Abuse. (2010). Addiction medicine: Closing the gap between science and practice. Columbia University.
• World Health Organization. (2019). Substance abuse: Key facts. WHO.

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Can Denver’s mayor keep drug users out of jail? Here’s his new plan to fix a decades-old problem

For Aly Garrett, the safe haven provided by Tribe Recovery Homes is a source of inspiration and, she hopes, salvation.

The 34-year-old is on probation for charges related to fentanyl use. Her addiction started four years ago while she was in an abusive relationship and dealing with trauma that stemmed from her mother’s use of the potentially deadly drug . Four times, Garrett helped stop overdoses by giving her mom Narcan, a reversal drug.

Now, after completing a 21-day inpatient treatment program with another provider, she’s living in one of Tribe’s sober living homes in metro Denver and taking part in its intensive outpatient program. But Garrett said getting that kind of help for drug addiction isn’t always as easy as simply asking for it — the burden is often on users to find treatment programs, apply and figure out how to pay, even if scholarships are available.

“Honestly, Colorado has a problem. Every place in the country has a problem,” she said. “Probation doesn’t answer the phone. They’re overwhelmed. There isn’t help out there.”

Denver Mayor Mike Johnston has zeroed in on situations like Garrett’s — people struggling with addiction who have to navigate a disjointed network of care with little to no support. After devoting much of his focus to homelessness since taking office in July, it’s the next persistent problem Johnston’s administration aims to tackle.

He said he wants to put a particular focus on people who have acute mental health and drug use challenges that contribute to them cycling through the city’s jails, emergency rooms and homeless shelters.

Much like the mayor’s House 1,000 homelessness initiative last year , this effort comes with a memorable name and an ambitious target.

The administration is calling it Roads to Recovery. At a February news conference covering his priorities for the year, Johnston announced the first goal of the program: by the end of the year, to divert 200 people who are struggling with addiction or mental health challenges out of the criminal justice system and into a city-coordinated pipeline of intervention, treatment and rehabilitation support.

“We want to be the convener and the center of gravity to say: We know these issues are difficult. We know they’ve been here for a long time. And we know that a lot of great people are working in this space,” Johnston said in an interview with The Denver Post. “We want to really organize and align and streamline all the services to make sure people get them.”

As of last week, city officials had identified and begun working with more than 30 people who were high utilizers of those emergency, safety and health facilities, said Jose Salas, a spokesman with the mayor’s office.

The next step: to keep them out of jail at all costs.

Better coordination could save money, mayor says

The new effort takes aim at problems that overlap with the city’s struggles with homelessness. Thirty-one percent of single adults surveyed as part of metro Denver’s point-in-time homelessness count in 2023 reported substance use as a factor in their situations.

And 38% of those survey respondents listed mental health concerns as a contributor.

Johnston views Roads to Recovery as a complement to the House 1,000 program, which centered on rapidly expanding the city’s homeless shelter options by opening converted hotels and micro-communities. That initiative has been redubbed All In Mile High as the administration aims to bring another 1,000 people inside this year.

That initiative has recently been plagued by reports of violence within the hotels in the program, including a double homicide and another shooting at the former hotel located at 4040 N. Quebec St. The city has had to step in to provide additional security at that shelter, which the Salvation Army manages.

In contrast to that initiative, which cost the city an estimated $48.6 million last year, Johnston doesn’t expect to need significant money to get Roads to Recovery off the ground. He is hopeful it will even generate some savings in the city budget.

“This is one area where we think it’s actually less expensive to do this in a coordinated way than it is to do it in an uncoordinated way,” Johnston said.

The administration has zeroed in on a problem and set a goal, but city officials have plenty of heavy lifting to do to flesh out Roads to Recovery as a program.

Officials at nonprofit providers, including the Colorado Coalition for the Homeless and the Harm Reduction Action Center, have said they are waiting for more information to better understand the city’s initiative.

That is by design, according to Matt Ball, Johnston’s policy director.

Rather than approaching potential service providers with a detailed, step-by-step plan of action, the administration intends to solicit their ideas. Officials will have a meeting with outside organizations to gather input and ideas on how Roads to Recovery can be successful, Ball said; that meeting is scheduled for Wednesday with more than 40 organizations on the invite list.

Better coordination and communication could go a long way in the addiction and mental health treatment realm, Thomas Hernandez said.

Hernandez is a former addict and gang member who found sobriety inside prison. He’s now been sober for 11 years and disengaged from gangs for 17 years, he said. In 2017, he started Tribe Recovery Homes . The organization became a nonprofit in 2019 and, since then, has served Garrett and hundreds of other people.

On an afternoon in mid-March, after a group therapy session at Tribe’s headquarters at 1178 Mariposa St., Garrett reflected on what the nonprofit means to her.

“Everyone here is in recovery and it’s so inspiring,” she said. “We all have relatable things and we all want to get better.”

Tribe focuses on serving people who are already involved in the criminal justice system, either pre- or post-incarceration, Hernandez said. That keeps its beds mostly full, but he knows there are deeper needs for people struggling with substance use.

One challenge is the lack of a centralized data system, Hernandez said. It’s one of the big problems that Ball, Johnston’s policy advisor, says he’s heard about repeatedly as he analyzes the resources available. The lack of coordination can result in some people having case managers at multiple service providers, while other people slip through the cracks.

“Everyone needs to be on the same page. It has to be controlled and it has to be clear,” Hernandez said. “If we’re not on the same page with the budget and we’re not getting any impact, communication is going to break down. These are people’s lives we’re talking about.”

He said a key to providing better programming for the community is for community partners and justice agencies to develop new strategies together.

Not a mandatory treatment approach

Denver City Councilwoman Sarah Parady says she appreciates that the mayor’s administration is taking its time and talking to service providers.

But Parady, a progressive on the council who’s often on Johnston’s political left, worries the program could default to punishment over care. She is adamant that she would oppose anything that compels people into treatment programs.

So far, Parady has been encouraged that the mayor’s office is not talking in those terms — and that officials are looking broadly to include the mental health and substance treatment needs of people who aren’t already involved with the criminal justice system.

“I am really happy to see us move into this space,” Parady said, “because it’s incredibly fragmented and not an area we have focused on a lot at the local level — despite it being a crisis that interlocks so directly with our homelessness crisis, how youth are doing in our city, and lots and lots of other issues.”

At the Harm Reduction Action Center in central Denver, executive director Lisa Raville remains skeptical.

The center holds one of the city’s contracts to operate a needle exchange program. It also offers drug testing strips, overdose reversal medication and other services focused on reducing drug-related deaths.

Raville said Roads to Recovery had captured her attention, since city officials are talking about an approach that would move away from criminalization and incarceration as central tools for combating addiction and mental health challenges. Still, she said, a diversion program that presents someone with the choice of either going to jail or entering treatment would rely, at least in part, on the threat of consequences.

“I am concerned they are talking about mandatory treatment, which I do not support. It’s human rights abuse and it doesn’t work,” Raville said. “What is their substance use treatment vision?”

Johnston and administration officials insist Roads to Recovery isn’t designed to force people into treatment.

“I think … this is a very different approach than (what) you see other states doing around things like involuntary mental health holds. That is not our strategy,” Johnston said. “Instead, what we’re doing is saying: ‘How do we identify people that are high risk? How do we bring them in through any point of contact? And how do we connect them to services, and supervise them in those services, over and over again?’”

Will better services keep people out of jail?

While running for mayor early last year, Johnston touted a proposal to covert two pods in the Denver jail into units that provide addiction and mental health support.

That is not the focus of the Roads to Recovery, he said — at least not yet.

Intervention and diversion programs could make treatment options inside jails a far less pressing need, in Johnston’s view. It’s a concept akin to what the city and its partners tested out with the Social Impact Bond program launched under Johnston’s predecessor, Mayor Michael Hancock, in 2016.

That program, which used $8.6 million from private investors to get off the ground, provided housing and access to supportive services to more than 350 people who had been chronically homeless and had multiple arrests for low-level offenses over the prior three years.

According to a study by the Urban Institute , which followed 285 participants, 77% of those provided with supportive housing remained housed three years later. Those participants interacted with police 34% less often and were arrested at a rate 40% lower than that of a control group of people with similar situations outside the program.

Use of detox facilities also decreased significantly, according to the Urban Institute’s findings.

Ultimately, that program saved the city, state and federal government money. The annual cost of providing services to people enrolled in the program was $6,876 lower than the $25,554 spent on average to provide services to people in the control group, according to findings published by the U.S. Department of Housing and Urban Development.

A second iteration has focused on a smaller population that frequents emergency rooms and uses Medicaid and Medicare. It was launched in 2022.

The Colorado Coalition for the Homeless has been a key partner in both versions of the Social Impact Bond program. Cathy Alderman, the organization’s chief communications and public policy officer, said the coalition also had been invited to participate in the new Roads to Recovery program.

If the focus is on cutting costs to other systems while focusing resources on high utilizers of city services, Alderman said, her organization is ready to help.

“It’s a little light in the details, but we understand that goal. It’s work that we essentially do,” Alderman said.

©2024 MediaNews Group, Inc. Visit at denverpost.com. Distributed by Tribune Content Agency, LLC.

Children Services director: The best way to prevent child abuse is to report it

Richland County Children Services received nearly 3,000 reports of possible child abuse in 2023 with 38.6% of those reports resulting in agency investigations. Director Nikki Harless issued the statistics as part of a nationwide observance of April as Child Abuse Prevention Month.

Harless said Children Services received 2,972 reports of potential child abuse last year, mostly from medical professionals, those in education, law enforcement agencies and others who are mandated by Ohio law to report suspicious activities. The reports prompted 1,150 formal case investigations that resulted in 75 children taken into custody, 133 now in foster or residential care and 180 more with a kinship caregiver.

“We just want the community to know that the best way to help us prevent child abuse and neglect is to report it to the agency,” Harless said. “We’re available 24/7 to take information people have, and if they feel uncomfortable leaving their name they can report it anonymously. We had 84 people last year report their concerns anonymously."

Drug use remains a big problem

Harless said the leading reason the agency removes children from their homes in Richland County has been parental drug use. When investigators go out to a home, parents are tested for drugs and, if they test positive, the children also are tested.

Harless said 137 of the 279 children tested for drugs last year, or 51%, were positive for marijuana, cocaine or both. Thirty-five children who tested positive were between the ages of 4 days and 4½ years.

“Unfortunately, earlier this year we had twin 2-year-olds overdose on fentanyl,” she said. “It’s a problem in Richland County and we’re working hard to keep the children safe. We just need the community to report if they do have concerns, whether it’s drugs, physical or sexual abuse or neglect.”

Child Abuse Prevention Month 2023: Commissioners hear disturbing statistics

Harless said officials do not believe parents are purposely giving children drugs. “We can only speculate. We just think through them using drugs carelessly, and it’s in the carpet or on the tables, and kids are on the ground and getting it on their hands and on their mouths, or if they’re selling drugs, it could be residual."

Harless said Children Service agencies are not seeing more children testing positive for the presence of marijuana as legalization increases across the country.

“We haven’t seen it yet, but I think we definitely will because if they’re already testing positive when it’s illegal, I’m sure if it’s legal, people are going to think it’s OK to continue to smoke and have children,” she said.

More: April is National Child Abuse Prevention Month. You can help make a difference

Activities in April are designed to increase awareness

The Richland County commissioners have issued a proclamation declaring April as Child Abuse Prevention Month. The proclamation notes that children are the community’s most valuable resource, every child needs a nurturing family and a safe environment and that parents, guardians, relatives and neighbors all share a responsibility to prevent devastating crimes against children.

To spread awareness, the City of Mansfield is tying blue ribbons, the international symbol for child abuse prevention, around the lampposts and the gazebo in Central Park is being lit in blue. Similar efforts are being organized in Shelby and Bellville.

Richland County Children Services encourages people to display blue ribbons on a tree, door, fence, vehicle or mailbox and to wear blue April 10. The first 100 customers wearing blue who walk into Buckeye Bakery that day will receive a free cookie.

For more audio journalism and storytelling, download New York Times Audio , a new iOS app available for news subscribers.

Hamas Took Her, and Still Has Her Husband

The story of one family at the center of the war in gaza..

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

I can’t remember the word, but do you know the kind of fungi connection between trees in the forest? How do you call it?

Mycelium. We are just — I just somehow feel that we are connected by this kind of infinite web of mycelium. We are so bound together. And I don’t think we really realized that until all this happened.

[MUSIC PLAYING]

It’s quite hard to explain, to me in a sense, because some people would say, oh, I’m so hoping your father will come, and then everything will be OK. And it’s very hard to explain that really this group of people decided to bring us up together, shared all their resources over 75 years, grow into each other, fight endlessly with each other, love and hate each other but somehow stay together. And their children will then meet and marry and make grandchildren.

And there’s so many levels of connection. And I’m sitting here in the room, and I see their faces, some of them. And we are incredibly — it’s hard to explain how much these people are missing from our kind of forest ground. [CHUCKLES SOFTLY]

From “The New York Times,” I’m Sabrina Tavernise, and this is “The Daily.”

It’s been nearly six months since Hamas attacked Israel on October 7 and took more than 200 people into Gaza. One of the hardest hit places was a village called Nir Oz, near the border with Gaza. One quarter of its residents were either killed or taken hostage.

Yocheved Lifshitz was one of those hostages and so was her husband, Oded Lifshitz. Yocheved was eventually released. Oded was not.

Today, the story of one family at the center of the war.

It’s Friday, March 29.

OK, here we go. OK.

Good morning, Yocheved. Good morning, Sharone.

Good morning.

Yocheved, could you identify yourself for me, please? Tell me your name, your age and where you’re from.

[SPEAKING HEBREW]

OK, I’ll translate. My name is Yocheved Lifshitz. I’m 85 years old. I was born in 1938. When I was 18, I arrived at kibbutz Nir Oz. I came alone with a group of people who decided to come and form and build a community on a very sandy territory, which was close to the Gaza Strip.

And my name is Sharone Lifschitz. I am 52 years old. I was raised in kibbutz Nir Oz by my mom and dad. So I lived there until I was 20. And I live for the last 30-something years in London.

And, Sharone, what do you have next to you?

Next to me I have a poster of my dad in both English and Hebrew. And it says, “Oded Lifshitz, 83.” And below that it says, “Bring him home now.” And it’s a photo where I always feel the love because he is looking at me. And there’s a lot of love in it in his eyes.

And why did you want to bring him here today, Sharone?

Because he should be talking himself. He should be here and able to tell his story. And instead, I’m doing it on his behalf. It should have been a story of my mom and dad sitting here and telling their story.

The story of Oded and Yocheved began before they ever met in Poland in the 1930s. Anti-Semitism was surging in Europe, and their families decided to flee to Palestine — Yocheved’s in 1933, the year Hitler came to power, and Oded’s a year later. Yocheved remembers a time near the end of the war, when her father received news from back home in Poland. He was deeply religious, a cantor in a synagogue. And he gathered his family around him to share what he’d learned.

And he said, we don’t have a family anymore. They’ve all been murdered. And he explained to us why there is no God. If there was a God, he would have protected my family. And this means that there is no God.

And suddenly, we stopped going to synagogue. We used to go every Saturday.

So it was a deep crisis for him. The shock and the trauma were very deep.

Abstention.

Abstention. Soviet Union? Yes. Yes. The United Kingdom? Abstained.

Yocheved’s father lived long enough to see a state establish for his children. The UN resolution of 1947 paved the way for a new country for Jews. And the next spring, Israel declared its independence. Yocheved remembers listening to the news on the radio with her parents.

The General Assembly of the United Nations has made its decision on Palestine.

We had a country. So now we’ll have somebody who’s protecting us. It’s a country for the people, to rebuild the people. This was the feeling we had.

In other words, if God could not protect you, this nation maybe could?

Yes. But the next day, it was already sad.

Israel was immediately forced to defend itself when its Arab neighbors attacked. Israel won that war. But its victory came at a great cost to the Palestinian Arabs living there. More than 700,000 either fled or were expelled from their homes. Many became refugees in Gaza in the south.

Suddenly, Yocheved and Oded saw themselves differently from their parents, not as minorities in someone else’s country, but as pioneers in a country of their own, ready to build it and defend it. They moved to the south, near the border line with Gaza. It was there, in a kibbutz, where they met for the first time.

The first time I met him, he was 16, and I was 17. And we didn’t really have this connection happening. But when we arrived at Nir Oz, that’s where some sort of a connection started to happen. And he was younger than I am by a year and a half. So at first I thought, he’s a kid. But for some reason, he insisted. Oded really insisted. And later, turned out he was right.

What was it about him that made you fall in love with him?

He was cute.

He was a cute kid. He was a cute boy.

What’s so funny?

He was a philosopher. He wrote a lot. He worked in agriculture. He was this cute boy. He was only 20, think about it.

And then I married him. And he brought two things with him. He brought a dog and he brought a cactus. And since then we’ve been growing a huge field of cacti for over 64 years.

What did it feel like to be starting a new life together in this new country? What was the feeling of that?

We were euphoric.

And what did you think you were building together?

We thought we were building a kibbutz. We were building a family. We were having babies. That was the vision. And we were thinking that we were building a socialist state, an equal state. And at first, it was a very isolated place. There were only two houses and shacks and a lot of sand. And little by little, we turned that place into a heaven.

Building the new state meant cultivating the land. Oded plowed the fields, planting potatoes and carrots, wheat and cotton. Yocheved was in charge of the turkeys and worked in the kitchen cooking meals for the kibbutz. They believed that the best way to live was communally. So they shared everything — money, food, even child-rearing.

After long days in the fields, Oded would venture outside the kibbutz to the boundary line with Gaza and drink beer with Brazilian peacekeepers from the UN and talk with Palestinians from the villages nearby. They talked about politics and life in Arabic, a language Oded spoke fluently. These were not just idle conversations. Oded knew that for Israel to succeed, it would have to figure out how to live side by side with its Arab neighbors.

He really did not believe in black and white, that somebody is the bad guy and somebody is the good guy, but there is a humanistic values that you can live in.

Sharone, what was your father like?

My father was a tall man and a skinny man. And he was —

he is — first of all, he is — he is a man who had very strong opinion and very well formed opinion. He read extensively. He thought deeply about matters. And he studied the piano. But as he said, was never that great or fast enough for classical. But he always played the piano.

[PIANO MUSIC]

He would play a lot of Israeli songs. He wound play Russian songs. He would play French chansons.

And he had this way of just moving from one song to the next, making it into a kind of pattern. And it was — it’s really the soundtrack of our life, my father playing the piano.

[PLAYING PIANO]:

[CONVERSATION IN HEBREW]:

[PLAYING PIANO]

So one side of him was the piano. Another side was he was a peace activist. He was not somebody who just had ideals about building bridges between nations. He was always on the left side of the political map, and he actioned it.

[NON-ENGLISH CHANTING]:

I remember growing up and going very regularly, almost weekly, to demonstrations. I will go regularly with my father on Saturday night to demonstrations in Tel Aviv. I will sit on his shoulders. He will be talking to all his activist friends. The smoke will rise from the cigarettes, and I will sit up there.

But somehow, we really grew up in that fight for peace.

Yocheved and Oded’s formal fight for peace began after the Arab-Israeli war of 1967. Israel had captured new territory, including the West Bank, the Sinai Peninsula, and the Gaza Strip. That brought more than a million Palestinians under Israeli occupation.

Oded immediately began to speak against it. Israel already had its land inside borders that much of the world had agreed to. In his view, taking more was wrong. It was no longer about Jewish survival. So when Israeli authorities began quietly pushing Bedouin Arabs off their land in the Sinai Peninsula, Oded took up the cause.

He helped file a case in the Israeli courts to try to stop it. And he and Yocheved worked together to draw attention to what was going on. Yocheved was a photographer, so she took pictures showing destroyed buildings and bulldozed land. Oded then put her photographs on cardboard and drove around the country showing them to people everywhere.

They became part of a growing peace movement that was becoming a force helping shape Israeli politics. Israel eventually returned the Sinai Peninsula to Egypt in 1982.

[NON-ENGLISH SPEECH]

Whenever there is a movement towards reconciliation with our neighbors, it’s almost like your ability to live here, your life force, gets stronger. And in a way, you can think of the art of their activism as being a response to that.

And why did he and your mother take up that fight, the cause of the land? Why do you think that was what he fought for?

My father, he had a very developed sense of justice. And he always felt that had we returned those lands at that point, we could have reached long-term agreement at that point. Then we would have been in a very different space now. I know that in 2019, for example, he wrote a column, where he said that when the Palestinians of Gaza have nothing to lose, we lose big time. He believed that the way of living in this part of the world is to share the place, to reach agreement, to work with the other side towards agreements.

He was not somebody who just had ideals about building bridges between nations. Two weeks before he was taken hostage, he still drove Palestinians that are ill to reach hospital in Israel and in East Jerusalem. That was something that meant a lot to him. I think he really believed in shared humanity and in doing what you can.

Do you remember the last conversation you had with your father?

I don’t have a clear memory which one it was. It’s funny. A lot of things I forgot since. A lot of things have gone so blurred.

We actually didn’t have a last conversation. The last thing he said was, Yoche, there is a war. And he was shot in the hand, and he was taken out. And I was taken out. I couldn’t say goodbye to him. And what was done to us was done.

We’ll be right back.

Yocheved, the last thing Oded said was there’s a war. Tell me about what happened that day from the beginning.

That morning, there was very heavy shelling on Nir Oz. We could hear gunfire. And we looked outside, and Oded told me, there are a lot of terrorists outside. We didn’t even have time to get dressed. I was still wearing my nightgown. He was wearing very few clothes. I remember him trying to close the door to the safe room, but it didn’t work. He wasn’t successful in closing it.

And then five terrorists walked in. They shot him through the safe room door. He was bleeding from his arm. He said to me, Yoche, I’m injured. And then he fainted. He was dragged out on the floor. And I didn’t know if he was alive. I thought he was dead. After that, I was taken in my nightgown. I was led outside. I was placed on a small moped, and I was taken to Gaza.

And we were driving over a bumpy terrain that had been plowed. And it didn’t break my ribs, but it was very painful.

And I could see that the gate that surrounds the Gaza Strip was broken, and we were driving right through it.

And as we were heading in, I could see so many people they were yelling, “Yitbach al Yahud,” kill the Jews, slaughter the Jews. And people were hitting me with sticks. And though the drivers on the moped tried to protect me, it didn’t help.

What were you thinking at the time? What was in your mind?

I was thinking, I’m being taken; I’m being kidnapped. I didn’t know where to, but this decision I had in my head was that I’m going to take photographs in my mind and capture everything I’m seeing so that when I — or if and when I am released, I’ll have what to tell.

And when I came to a stop, we were in a village that’s near Nir Oz. It’s called Khirbet Khuza. We came in on the moped, but I was transferred into a private car from there. And I was threatened that my hand would be cut off unless I hand over my watch and my ring. And I didn’t have a choice, so I took my watch off, and I took my ring off, and I handed it to them.

Was it your wedding ring?

Yes, it was my wedding ring.

After that, they led me to a big hangar where the entrance to the tunnel was, and I started walking. And the entrance was at ground level, but as you walk, you’re walking down a slope. And you’re walking and walking about 40 meters deep underground, and the walls are damp, and the soil is damp. And at first, I was alone. I didn’t know that other people had been taken too. But then more hostages came, and we were walking together through the tunnels.

Many of whom were from kibbutz Nir Oz. These were our people. They were abducted but still alive. And we spoke quietly, and we spoke very little. But as we were walking, everybody started telling a story of what had happened to him. And that created a very painful picture.

There were appalling stories about murder. People had left behind a partner.

A friend arrived, who, about an hour or two hours before, had her husband murdered and he died in her hands.

It was a collection of broken up people brought together.

So you were piecing together the story of your community and what had happened from these snapshots of tragedies that you were looking at all around you as you were walking. What’s the photograph you’ll remember most from that day?

It would be a girl, a four-year-old girl. People kept telling her — walk, walk, walk. And we tried to calm her down. And her mom tried to carry her on her arms. It was the most difficult sight to see a child inside those tunnels.

What were you feeling at that moment, Yocheved?

Very difficult.

Where did they lead you — you and your community — from Nir Oz.

They led us to this chamber, a room, that they had prepared in advance. There were mattresses there. And that’s where we were told to sit.

I saw people sitting on the mattresses, bent down, their heads down between their hands. They were broken. But we hardly spoke. Everybody was inside their own world with themselves, closed inside his own personal shock.

Yocheved was without her glasses, her hearing aids, or even her shoes. She said she spent most days lying down on one of the mattresses that had been put out for the hostages. Sometimes her captors would let her and others walk up and down the tunnels to stretch their legs.

She said she was given a cucumber, spreading cheese, and a piece of pita bread every day to eat. They had a little bit of coffee in the morning and water all day long.

One day, a Hamas leader came to the room where she and others were being held. She said she believes it was Yahya Sinwar, the leader of Hamas, who is believed to be the architect of the October 7 attack. Two other hostages who were held with Yocheved also identified the man as Sinwar, and an Israeli military spokesman said he found the accounts reliable.

He came accompanied with a group of other men. He just made rounds between the hostages, I suppose. And he spoke in Hebrew, and he told us not to worry, and soon there’s going to be a deal and we’ll be out. And others told me, don’t speak. And I said, what is there for me to be afraid of? The worst already happened. Worst thing, I’ll be killed.

I want to say something, and I spoke my mind. I told Sinwar, why have you done what you just did to all of the same people who have always helped you? He didn’t answer me. He just turned around and they walked off.

Were you afraid to ask him why Hamas did what it did, to challenge him?

I wasn’t afraid.

I was angry about the whole situation. It was against every thought and thinking we ever had. It was against our desire to reach peace, to be attentive and help our neighbors the way we always wanted to help our neighbors. I was very angry. But he ignored what I said, and he just turned his back and walked away.

In this entire time, you had no answers about Oded?

What was the hardest day for you, the hardest moment in captivity?

It’s when I got sick. I got sick with diarrhea and vomiting for about four days. And I had no idea how this will end. It was a few very rough days. And probably because of that, they decided to free me.

They didn’t tell me they were going to release me. They just told me and another girl, come follow us. They gave us galabiya gowns to wear and scarves to wear over our heads, so maybe they’ll think that we are Arab women. And only as we were walking, and we started going through corridors and ladders and climbing up we were told that we’re going home.

I was very happy to be going out. But my heart ached so hard for those who were staying behind. I was hoping that many others would follow me.

It’s OK. Let’s go. It’s OK. Let’s go.

You go with this one.

Shalom. Shalom.

There was a video that was made of the moment you left your captors. And it seemed to show that you were shaking a hand, saying shalom to them. Do you remember doing that?

I said goodbye to him. It was a friendly man. He was a medic. So when we said goodbye, I shook his hand for peace, shalom, to goodbye.

What did you mean when you said that?

I meant for peace.

Shalom in the sense of peace.

An extraordinary moment as a freed Israeli hostage shakes hands with a Hamas terrorist who held her captive.

I literally saw my mom on CNN on my phone on the way to the airport. And it was the day before I was talking to my aunt, and she said, I just want to go to Gaza and pull them out of the earth. I just want to pull them out of the earth and take them. And it really felt like that, that she came out of the earth. And when she shook the hand of the Hamas person, it just made me smile because it was so her to see the human in that person and to acknowledge him as a human being.

I arrived in the hospital at about 5:30 AM. My mom was asleep in the bed. And she was just — my mom sleeps really peacefully. She has a really quiet way of sleeping. And I just sat there, and it was just like a miracle to have her back with us. It was just incredible because not only was she back, but it was her.

I don’t know how to explain it. But while they were away, we knew so little. We were pretty sure she didn’t survive it. The whole house burned down totally. So other homes we could see if there was blood on the walls or blood on the floor. But in my parents’ home, everything was gone — everything. And we just didn’t know anything. And out of that nothingness, came my mom back.

It was only when she got to the hospital that Yocheved learned the full story of what happened on October 7. Nir Oz had been mostly destroyed. Many of her friends had been murdered. No one knew what had happened to Oded. Yocheved believed he was dead. But there wasn’t time to grieve.

The photograph she had taken in her mind needed to be shared. Yocheved knew who was still alive in the tunnels. So she and her son called as many families as they could — the family of the kibbutz’s history teacher, of one of its nurses, of the person who ran its art gallery — to tell them that they were still alive, captive in Gaza.

And then in November came a hostage release. More than 100 people came out. The family was certain that Oded was gone. But Sharone decided to make some calls anyway. She spoke to one former neighbor then another. And finally, almost by chance, she found someone who’d seen her father. They shared a room together in Gaza before he’d gotten ill and was taken away. Sharone and her brothers went to where Yocheved was staying to tell her the news.

She just couldn’t believe it, actually. It was as if, in this great telenovela of our life, at one season, he was left unconscious on the floor. And the second season open, and he is in a little room in Gaza with another woman that we know. She couldn’t believe it.

She was very, very, very excited, also really worried. My father was a very active and strong man. And if it happened 10 years ago, I would say of course he would survive it. He would talk to them in Arabic. He will manage the situation. He would have agency. But we know he was injured. And it makes us very, very worried about the condition in which he was — he’s surviving there. And I think that the fear of how much suffering the hostages are going through really makes you unable to function at moment.

Yocheved, the government has been doing a military operation since October in Gaza. You have been fighting very hard since October to free the hostages, including Oded. I wonder how you see the government’s military operation. Is it something that harms your cause or potentially helps it?

The only thing that will bring them back are agreements. And what is happening is that there are many soldiers who have been killed, and there is an ongoing war, and the hostages are still in captivity. So it’s only by reaching an agreement that all of the hostages will be released.

Do you believe that Israel is close to reaching an agreement?

I don’t know.

You told us that after the Holocaust, your father gathered your family together to tell you that God did not save you. It was a crisis for him. I’m wondering if this experience, October 7, your captivity, challenged your faith in a similar way.

No, I don’t think it changed me. I’m still the same person with the same beliefs and opinions. But how should I say it? What the Hamas did was to ruin a certain belief in human beings. I didn’t think that one could reach that level that isn’t that much higher than a beast. But my opinion and my view of there still being peace and reaching an arrangement stayed the same.

You still believe in peace?

Why do you believe that?

Because I’m hoping that a new generation of leaders will rise, people who act in transparency, who speak the truth, people who are honest, the way Israel used to be and that we’ll return to be like we once were.

I go to many rallies and demonstrations, and I meet many people in many places. And a large part of those people still believe in reaching an arrangement in peace and for there to be no war. And I still hope that this is what we’re going to be able to have here.

Bring them home now! Bring them home now! Bring them home now! Bring them home now! Bring them home! Now! Bring them home! Now! Bring them home! Now! Bring them home!

Yocheved is now living in a retirement home in the suburbs of Tel Aviv. Five other people around her age from Nir Oz live there too. One is also a released hostage. She hasn’t been able to bring herself to go back to the kibbutz. The life she built there with Oded is gone — her photographs, his records, the piano. And the kibbutz has become something else now, a symbol instead of a home. It is now buzzing with journalists and politicians. For now, Yocheved doesn’t know if she’ll ever go back. And when Sharone asked her, she said, let’s wait for Dad.

So I’m today sitting in this assisted living, surrounded by the same company, just expecting Oded, waiting for Oded to come back. And then each and every one of us will be rebuilding his own life together and renewing it.

What are you doing to make it a home for Oded?

We have a piano. We were given a piano, a very old one with a beautiful sound. And it’s good. Oded is very sensitive to the sound. He has absolute hearing. And I’m just hoping for him to come home and start playing the piano.

Do you believe that Oded will come home?

I’d like to believe. But there’s a difference between believing and wanting. I want to believe that he’ll be back and playing music. I don’t think his opinions are going to change. He’s going to be disappointed by what happened. But I hope he’s going to hold on to the same beliefs. His music is missing from our home.

[SPEAKING HEBEW]:

[SPEAKING HEBREW] [PLAYING PIANO]

I know that my father always felt that we haven’t given peace a chance. That was his opinion. And I think it’s very hard to speak for my father because maybe he has changed. Like my mom said, she said, I hope he hasn’t changed. I haven’t changed. But the truth is we don’t know. And we don’t the story. We don’t know how the story — my father is ending or just beginning.

But I think you have to hold on to humanistic values at this point. You have to know what you don’t want. I don’t want more of this. This is hell. This is hell for everybody. So this is no, you know? And then I believe that peace is also gray, and it’s not glorious, and it’s not simple. It’s kind of a lot of hard work. You have to reconcile and give up a lot. And it’s only worth doing that for peace.

[PIANO PLAYING CONTINUES]

After weeks of negotiations, talks over another hostage release and ceasefire have reached an impasse. The sticking points include the length of the ceasefire and the identity and number of Palestinian prisoners to be exchanged for the hostages.

[BACKGROUND CONVERSATION IN HEBREW]:

Here’s what else you should know today. Sam Bankman-Fried was sentenced to 25 years in prison on Thursday, capping an extraordinary saga that upended the multi-trillion-dollar crypto industry. Bankman-Fried, the founder of the cryptocurrency exchange, FTX, was convicted of wire fraud, conspiracy, and money laundering last November.

Prosecutors accused him of stealing more than $10 billion from customers to finance political contributions, venture capital investments, and other extravagant purchases. At the sentencing, the judge pointed to testimony from Bankman-Fried’s trial, saying that his appetite for extreme risk and failure to take responsibility for his crimes amount to a quote, “risk that this man will be in a position to do something very bad in the future.”

Today’s episode was produced by Lynsea Garrison and Mooj Zaidie with help from Rikki Novetsky and Shannon Lin. It was edited by Michael Benoist, fact checked by Susan Lee, contains original music by Marion Lozano, Dan Powell, Diane Wong, Elisheba Ittoop, and Oded Lifshitz. It was engineered by Alyssa Moxley. The translation was by Gabby Sobelman. Special thanks to Menachem Rosenberg, Gershom Gorenberg, Gabby Sobelman, Yotam Shabtie, and Patrick Kingsley. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for “The Daily.” I’m Sabrina Tavernise. See you on Monday.

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Hosted by Sabrina Tavernise

Produced by Lynsea Garrison and Mooj Zadie

With Rikki Novetsky and Shannon Lin

Edited by Michael Benoist

Original music by Marion Lozano ,  Dan Powell ,  Diane Wong and Elisheba Ittoop

Engineered by Alyssa Moxley

Listen and follow The Daily Apple Podcasts | Spotify | Amazon Music

Warning: this episode contains descriptions of violence.

It’s been nearly six months since the Hamas-led attacks on Israel, when militants took more than 200 hostages into Gaza.

In a village called Nir Oz, near the border, one quarter of residents were either killed or taken hostage. Yocheved Lifshitz and her husband, Oded Lifshitz, were among those taken.

Today, Yocheved and her daughter Sharone tell their story.

On today’s episode

Yocheved Lifshitz, a former hostage.

Sharone Lifschitz, daughter of Yocheved and Oded Lifshitz.

Background reading

Yocheved Lifshitz was beaten and held in tunnels built by Hamas for 17 days.

There are a lot of ways to listen to The Daily. Here’s how.

We aim to make transcripts available the next workday after an episode’s publication. You can find them at the top of the page.

Fact-checking by Susan Lee .

Additional music by Oded Lifshitz.

Translations by Gabby Sobelman .

Special thanks to Menachem Rosenberg, Gershom Gorenberg , Gabby Sobelman , Yotam Shabtie, and Patrick Kingsley .

The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Mike Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, John Ketchum, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Dan Farrell, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Summer Thomad, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Paula Szuchman, Lisa Tobin, Larissa Anderson, Julia Simon, Sofia Milan, Mahima Chablani, Elizabeth Davis-Moorer, Jeffrey Miranda, Renan Borelli, Maddy Masiello, Isabella Anderson and Nina Lassam.

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