the use of drugs essay

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.

Essays About Drugs: Top 5 Examples and 8 Prompts

Writing essays about drugs can be challenging; read our guide to find out how to tackle your next essay.

A sheriff once asked a teenager caught with drugs in his car to pen an essay about the substances’ effects . Instead of handcuffing the 17-year-old, the sheriff took into account the kid’s future and threw him a lifeline by giving him a second chance. The 500-word essay effectively made the teenager reflect on his wrongdoings. 

There’s still an ongoing debate on the recreational use of drugs. However, their harmful effects outweigh the positive as many fall victim to drug addiction. Drugs risk many lives and relationships, resulting in dangerous living environments, mental health disorders, and other trauma. As of last year, almost 32 million people actively participate in drug use. 

Because writing about drugs includes sensitive subjects, it’s critical to demonstrate your complete understanding of the topic and cite reliable sources. Consider the essay samples below to inspire your piece.

1. Long Essay on Drug Addiction by Veerendra

2. causes of drug use among young people by jill nicholson, 3. the failure of america’s war on drugs by anonymous on gradesfixer.com, 4. drugs and alcohol abuse: reasons, effects and measures by anonymous on edubirdie.com, 5. social media impact on drug abuse by anonymous on ivypanda.com, 1. drug addiction: painkillers, 2. types of drugs, 3. causes and effects of drug abuse, 4. drug use vs. drug abuse, 5. drugs and destruction, 6. drugs as depicted in the movies, 7. depression and drug abuse, 8. a drug abuse journey.

“Drug addiction impacts millions and needs to be treated carefully to prevent further harm to the individual and letting them live a better life.”

Veerendra defines drug addiction as excessive substance intake leading to various behavioral and physical changes. First, he lists drugs that increase dopamine levels, including alcohol, cocaine, nicotine, and painkillers. Then, after adding the early symptoms of drug addiction, he delves into how it impacts a person’s mental cognition, communication skills, and mental health.

When a person stops taking drugs, withdrawal symptoms follow. These signs (nausea, fatigue, and tremors) can lead to the more detrimental phase known as relapse. Ultimately, he believes that drug addiction treatments and the full support of family and friends greatly aid in overcoming addiction. You might also be interested in these articles about driving under the influence .

“Many curious teens have died the first time they tried certain drugs, like ecstasy. Others have found their temporary escape became a permanent addiction.”

Nicholson discusses the three leading causes of drug use: curiosity, escape, and peer pressure. Mainstream media like TV, movies and social networking sites drive curiosity. Family and friends can also precipitate interest by discussing drugs in front of youngsters.

In the next section, Nicholson explains that most young people who have problems and are unhappy with their lives use drugs to escape reality and hide behind the feel-good chemicals. The last reason young people use drugs is to look cool to impress their peers. Nicholson notes that in a circle of friends if one is using drugs, people assume everyone else is doing it. One way to help these young people is by detailing the health risks accompanying these materials, zeroing in on the chains of addiction.

“… the United States has spent a lot of years trying to wage war on drugs. The cost has been violence, crime, corruption, the devastation of social bonds as well as the destruction of inner-city communities and the exponential development of several minorities and women ending up in jail.”

The essay focuses on the fact that despite spending billions of dollars on resources, alternative treatments, and casualties, the illegal drug trade in America continues and grows stronger. Some reason for this failure includes the public’s perception influenced by media campaigns and ill-suited punishments for non-violent and victimless crimes. 

The piece concludes that society will not benefit from anti-drug efforts as long as the government’s solution focuses on criminalization and not treatment.

“… drug abuse means when you use legal or illegal substances in ways you shouldn’t.”

Drug abuse refers to using chemicals to stimulate areas in the brain responsible for immediate gratification. The writer also pins down different drug types and their effects. Further, the essay accounts for users’ reasons for engaging with substance abuse (relationship complications, work pressure, and loneliness.) 

These chemical reactions deteriorate a person mentally and physically, with brain function the most affected. Exercising, consulting a doctor, eating healthy, and venting are the four measures to overcome drug and alcohol abuse.

“…active social media uses, especially adolescents, are more likely to try drugs because of the influence they see on the platforms.”

The essay expounds on how social media contributes to drug abuse by romanticizing their consumption. Unfortunately, these idealized posts are so rampant that drug use is socially acceptable. The steady increase of this content on social media attests to this phenomenon. 

The main encouragers are celebrities and social media influencers who advertise their wild lifestyle without regard for their followers’ ages or naivete.

If you want to learn about more essay topics, check out the best essay topics about social media.

8 Easy Writing Prompts for Essays About Drugs

Opioid addiction stems from the need to relieve pain from injury and other accidents. Unfortunately, up to 19% of these patients abuse prescription painkillers . For this prompt, research the roots of how painkillers begin as a means to heal victims to being the reason individuals suffer. Identify and explain how narcotic ruins the body. Include how people who need to take these medications can avoid getting addicted. 

Briefly explain the different drug types to give your readers an overview of how they work. Next, discuss the most commonly abused drugs and how they affect a person. Finally, add research findings, reliable data, and news articles to strengthen your essay and make it credible. 

There are many pieces discussing the causes and effects of drug abuse. To make your essay stand out, compare two families with one parent addicted to illegal substances. The addict in the first family went to rehab and counseling, while the second one didn’t. List down the different futures of these families, such as how the experience resonated with the children. 

A person who takes drugs to treat ailments differs from an individual who uses drugs in search of satisfying an impulse craving. Use this prompt to compare and contrast drug use and abuse and why their similarities and differences matter. 

Improper use of drugs doesn’t only ruin an individual’s psychological and physical health. It also destroys relationships and families. This destruction can be passed from generation to generation, snowballing the problem and making it more challenging to find a solution. Present this issue to discourage your readers from trying drugs.

Leonardo De Caprio’s “The Wolf of Wall Street” is one of the most famous movies showing how people justify taking drugs. First, write a short review of this film or pick other drug-related flicks you want to review in your essay. Next, juxtapose things you notice in movies that also happen in an addict’s real life. Finally, finish your piece by sharing what you learned from the film and its main characters.

Another reason some turn to drugs is to run away from their mental illness, such as depression. Substance Use Disorder explains why an individual can’t control the urge to abuse drugs and alcohol. Delve more into this condition and how it rewires the brain. Include addicts’ grounds for self-medication and other risk factors that can trigger this disorder.

It’s not easy to share drug-related experiences. However, many get inspiration from these stories too. To connect with your readers, write about a drug abuse journey. It can be your own or from a close friend or relative. Share how it started, including the reasons and influence it left on the people involved. Conclude with the steps the person did to overcome their drug addiction and how they rebuild relationships. Finally, end your essay with how they are currently living.

Here’s a great tip: If writing an essay seems daunting, start by simplifying it to simple paragraphs first. Then, read our guide on how to write a 5 paragraph essay .

Maria Caballero is a freelance writer who has been writing since high school. She believes that to be a writer doesn't only refer to excellent syntax and semantics but also knowing how to weave words together to communicate to any reader effectively.

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Drugs - List of Essay Samples And Topic Ideas

Drugs, encompassing a wide spectrum from life-saving medications to illicit substances, present a complex societal challenge. Essays could explore the pharmacological, sociological, and economic aspects of drug use and misuse, delving into the mechanisms of action, the therapeutic benefits, and the potential for abuse. The discourse might extend to the examination of drug policies, discussing the merits and drawbacks of various regulatory frameworks, such as prohibition, decriminalization, and legalization. Discussions could also focus on the societal and health impacts of drug misuse, exploring the challenges in prevention, treatment, and harm reduction. Moreover, a comprehensive analysis could include a discussion on the global drug trade, the ethical considerations surrounding drug development and access, and the ongoing research aimed at better understanding the complex interplay of factors influencing drug use and its manifold implications on individuals and society. A vast selection of complimentary essay illustrations pertaining to Drugs you can find in Papersowl database. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

The Truth about Drugs – Illegal Drugs

A close amount of 280 million people consume illegal drugs. The most commonly used illegal drug is marijuana or weed. According to the United Nations 2008 World Drug Report close to 3.9% of the earth's population between the ages of 15 and 64 abuse marijuana. Many teenagers and adults abuse drugs everyday. According to many sources a lot of people who let drugs control their lives have turned their life around and made a successful life. While others are still […]

Most Drugs and Medicated Substances Can be Beneficial

People do misuse drugs and medications. Drug abuse occurs when an individual excessively exploits a drug or medication outside of its original function, which could result in harm to the user, their families, and even their community (Huffman & Dowdell, 2015). Abusing drugs can cause hazardous consequences that will affect a person from a biological, psychological, and social standpoint. Fortunately, drug abuse can be prevented and treated. The Foundation Recovery Network (2018) expresses that drug abuse and drug addiction are […]

Drug Addictions

Drug addictions are something that many people in America face. A lot of families today face a person who is a drug addict or an alcoholic and this is breaking up families. People can help people addicted to drugs by providing community support, education,and teaching drug addicts how to deal with stress after overcoming addiction. Community and support groups are a great ways and opportunities for recovering addicts to be able to meet and befriend people who are also going […]

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The Negative Impacts of the War on Drugs

 Attention-getter: According to the Center for American Progress, 63,600 people died of a drug overdose in 2016 (Pearl). There is a serious drug problem in America. Reason to listen: With an election coming up in a couple weeks, and more on the national level in the coming years, people can choose to vote for politicians devoted to undoing many years of wrong doing. Thesis Statement: The War on Drugs has been a failure. For decades it has unfairly imprisoned people […]

Performance-Enhancing Drugs: the War on Drugs

Many people look up to athletes, making them their role models in lots of ways. Athletes have the skills, speed, strength, and glory that people admire. What many supporters do not know is that there is a possibility that the traits which make their favorite athletes great, could be a result of the use of steroids. If a majority of athletes use already take steroids, should performance-enhancing drugs be accepted in sports? This essay explains why many athletes decide to […]

What are some Solutions to Drug Abuse?

Nowadays, many people have thought that drugs are viable solution for personal problems or any other situations that affect the life of a person, but eventually, if a person reads the words drugs, it becomes a real problem in the current society. Therefore, there are factors that expose the drugs as an issue in the society. How can we understand this point? First, the abuse of different substances and drugs are one of the most common situations that teenagers and […]

The History of Drugs and the War on Drugs

A drug is a substance which has physiological effects when administered to the body. Drugs come in various shapes and forms such as lozenges, tablets, aerosols, and syrups to name a few. There are five ways a drug can be administered into the body. The routes of administration are oral, sublingual, rectal, topical, and parenteral (intravenous, intramuscular, and subcutaneous.) There are seven drug types and each come with different effects and risks. They are stimulants, depressants, hallucinogens, dissociatives, opioids, inhalants, […]

The Global War on Drugs

The War on Drugs started in June 1971 when US president Richard Nixon announced drug abuse to be 'public's big enemy' and raised federal funding for drug-control agencies and drug treatment efforts.The War on Drugs is a term used to refer to a government-led initiative that aims to stop illegal drug use, distribution and trade according to the article written by A&E. (A&E) In this short essay I will be discussing many points that deal with the war on drugs […]

Teenage Drug Abuse

There is a major concern about the teenage drug use today. Within the ages 15 through 24, fifty percent of deaths (from homicides, accidents, suicides) involve drugs. The two common reasons why teens use drugs are anxiety and depression. Factors like peer pressure, desire to escape, curiosity, emotional struggles, and stress may also lead to the consumption of drugs or alcohol. Teens are more likely to abuse drugs than adults because the part of their brain used for judgment and […]

Rethinking the Drugs Policy

The Office of National Drug Control Policy (2017) reported that the United States requests $27.8 billion on prevention, treatment, domestic law enforcement, interdiction and international operation to addressing the drug problem. Furthermore about $9.2 billion Federal resources are directly related to support domestic law enforcement efforts. The legalization of drug as a policy option for curtailing drug abuse is increasingly worth serious consideration. In addition, drug prohibition’s limited capability could lead to severe adverse effect regardless of how harmful the […]

Legalization or War on Drugs

 Drug preclusion channels over $140 billion per year into the criminal black market. Its disallowance drove respectable organizations into organised crimes or bankrupt by and large, which prepared for mobsters to make millions through the underground market. Also, by Legalizing drugs cultivation tremendous assets spent by governments executing or detaining individuals is reduced. This could help disarm countries and stop the harm done to families whose members are murdered or detained for moving, developing and disseminating drugs and its items. […]

Poverty and Drug Abuse Addiction

One popular stereotype associated with drug use is that it is rampant among the poor. However, this is not entirely true since insufficient money linked with the poor cannot probably sustain drug use. The link between the two factors is multifaceted, and the connectedness of poverty is complex. Poverty entails unstable family and interpersonal associations, low-skilled jobs and low status, high arrest degrees, illegitimacy, school dropping out, deprived physical health, high mental conditions, and high mortality rates. Such factors resemble […]

The War on Drugs in the Sports Industry

On April 13th, 2018, the National Basketball Association suspended Washington Wizards’ player Jodie Meeks. Meeks tested positive for Ipamorelin and growth-hormone-releasing peptide-2. Both of these substances are banned by the NBA. In the past year, five NBA players have been suspended for violating the league’s anti-drug policy. The NBA has a very specific policy applying to drugs and any violation of this results in the immediate suspension of the respective player if some type of banned substance is found in […]

The War on Drugs and its Impact on the United States

Illegal drugs have been a very prevalent issue in the United States for decades, with almost no clear solution to stop the spreading and use of them. With the epidemic of opium currently ravaging the U.S, it all stemmed from a colossal failure in the 1980s: The War on Drugs. While the intent of the War on Drugs was to stop the spreading of illegal drugs, it managed to become more negative for America than it was originally intended. The […]

War on Drugs | History

Abstract The War on Drugs, or prohibition of illicit substance abuse, has been a long and grueling legislative approach that has changed the rhetoric and the foundation of our American ideals regarding substance abuse. As currently defined, illicit substance use encompasses the “cultivation, distribution, and possession of many intoxicating substances that are intended solely for recreational use” (Durrant & Thakker, 2003; Sacco, 2014). Through Karger and Stoesz (2018) four-pronged model, it is important to note the societal turmoil that was […]

War on Drugs Among Teens

In 2003, Danielson, Overholser, and Butt undertook a study on the larger discipline of teenage depression and the use of drugs. The study was aimed at evaluating whether or not levels of depression differ in the adolescents who had shown attempts to commit suicide and those who had not as influenced by their use of alcohol. From the clinical perspectives, the researchers appreciated that alcohol use among adolescents could significantly influence levels of depression. The higher the level of alcohol […]

Background on Drug Abuse

Drug abuse has been around for as long as the world has been created. Drug abuse dates back to the early 5000 B.C. when the Sumerians used opium, suggested by the fact that they have an ideogram for it which has been translated as HUL, meaning joy or rejoicing (Lindesmith, 2008). It then occurred often later on because indigenous South Americans chewed on coca leaves in the rainforest as a type of ritual, giving them stimulation and energy. Since then, […]

The Plant of Joy: War on Drugs

In 2016, doctors and health care providers in the United States wrote a total of more than 214 million prescriptions for opioid medications. This comes down to a rate of 66.5 prescriptions for every 100 people. The number of opioid prescriptions has quadrupled since 1999. As of today, more than 130 people die per day from opioid-related drug overdoses per the U.S. Department of Health and Human Services website. There are more deaths from opioids than the number of deaths […]

Drug Abuse: War on Drugs

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War on Drugs Philippines – Operation Double Barrel

As of June 30, 2016, President Duterte of the Philippines has given orders allowing the state-sanctioned murder of over 20,000 individuals allegedly involved in the drug trade. The whole situation is shockingly gruesome. Police invade homes and arrest individuals, people ruthlessly shot and left in the slums. More often than not the killers remain anonymous as hardly any security exists at the place of killings. Extrajudicial killings have happened every day since his election, and they are justified in the […]

Pharmacology: the Successful Approach of Prodrugs in Drug Optimization

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Drug Testing

For every student who complains that drug testing is an invasion of his or hers privacy we can show you a hundred parents who have lost their children to drugs. With drug testing students get a safe place where they can learn. Even the teachers are better off with this, because with less drugs schools are much safer. Should High School students or even college students be routinely tested for drug use? Before you answer think about this as a […]

Positive Effect of War on Drugs: Impact of Marijuana Legalization

Introduction to the War on Drugs The war on drugs is a very real battle in the United States. Drugs tear apart jobs, lives, and families, but how harmful is a joint or two of Marijuana? Is this a war that is truly worth fighting for? According to drugpolicy.org (2018), there were over 1,572,579 arrests for drug violations in 2016 alone. This is an incredible number, which implicates the amount of time, effort, workforce, and money the United States puts […]

War on Drugs: America’s Longstanding Relationship with Substance Abuse

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The Significance of Public Health: the War on Drugs

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War on Drugs is a Struggle to Survive

I was taught that tobacco was bad. My father died from an overdose. I never met my dad but I never understood why someone would be a drug addict. I never knew how they could do it to themselves, their friends, their family. I would always think a addict was somebody who was selfish and weak. A person who just wanted to party and didn’t care about anyone or anything .I used to think that an addict deserved what had […]

Drug Abuse – Destructive Pattern

Drug abuse is the destructive pattern of using substances that leads to uncounted problems and diseases in the human body. It is a physical and psychological term which takes dependence on human activities. Drugs create bad effects on human life like anxiety, impaired social relations, depression, hopelessness, rejection etc. Impaired social relations and suicide are considered the worst consequences of addiction. The drugs have negative consequences on one's life. If the addicts were able to see the reality of their […]

The Presidential Legacy of the War on Drugs: a Historical Perspective

For several decades, the United States has incorporated the War on Drugs, a strategic initiative consisting of military intervention, foreign military aid, and prohibition, into its domestic and foreign policy in an attempt to curb the illicit drug trade. This essay traces the development of this intricate and frequently contentious policy from its official inception during the Nixon administration to the present day, analyzing the contributions of several U.S. presidents in shaping and furthering it. 1971 marked the inauguration of […]

Drug Abuse in the United States

Drug abuse in the United States has long been a topical issue and persists even today. Many different reasons make people get addicted as well as different levels to which people get dependent on drugs. Opioid use and abuse may start out of curiosity while others take them as prescribed medication for treatment but in the long run, they get addicted. In the United States, many people label Opioid addiction as a health problem rather than drug addiction. The reason […]

Effects of Drug Abuse on Families

Abstract In the USA, the family units have emerged to much complicated. Families continue to evolve ranging from the extended, nuclear and up to the single parenting family setups. Others are the stepfamilies, multigenerational and the foster types of families. Thus, abuse by a member of the family of substances may result in differences based on the formation of the family itself. This paper presents a discussion on the issues of treatment that may emerge within the various structures of […]

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Essay on Drug Abuse

Here we have shared the Essay on Drug Abuse in detail so you can use it in your exam or assignment of 150, 250, 400, 500, or 1000 words.

You can use this Essay on Drug Abuse in any assignment or project whether you are in school (class 10th or 12th), college, or preparing for answer writing in competitive exams. 

Topics covered in this article.

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.

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Essay on Drug Awareness

Students are often asked to write an essay on Drug Awareness in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Drug Awareness

Understanding drugs.

Drugs are substances that can change how your body and mind work. They can be legal, like medicine prescribed by a doctor, or illegal.

Effects of Drugs

Drugs can make you feel different. Some might make you feel happy for a short time, but they can also harm your body and brain.

The Risk of Addiction

Some people may start using drugs out of curiosity or to feel good, but it can lead to addiction. Addiction is when you can’t stop taking the drug, even if it’s causing harm.

Staying Safe

It’s important to say no to illegal drugs and only take medicines as directed by a doctor.

250 Words Essay on Drug Awareness

Introduction.

Drugs are substances that alter the body’s physiological processes. While some drugs are beneficial and used for medicinal purposes, others can be harmful, leading to addiction, health issues, and societal problems. Drug awareness is a crucial topic, especially for college students, as it is the foundation for understanding and preventing drug misuse.

The Importance of Drug Awareness

Drug awareness is essential to equip individuals with knowledge about the potential risks and consequences of drug use. It helps in understanding the difference between use and misuse, the signs of addiction, and the effects of drugs on physical and mental health. This knowledge can be a powerful tool in preventing drug misuse and addiction.

The Role of Education

Education plays a significant role in drug awareness. It is not only about imparting knowledge but also about fostering a healthy attitude towards drug use. Educational institutions, particularly colleges, hold a responsibility to provide students with accurate information, enabling them to make informed decisions.

In conclusion, drug awareness is a vital aspect of health education. It empowers individuals, especially college students, to make informed decisions about drug use, thus preventing potential misuse and addiction. The role of education in promoting drug awareness cannot be overstated, as it equips students with necessary knowledge and fosters a responsible attitude towards drug use.

500 Words Essay on Drug Awareness

The issue of drug abuse and addiction has become a global concern, with implications that transcend cultural, economic, and social boundaries. Drug awareness is a critical aspect in curbing this menace, as it equips individuals with the knowledge and skills to resist drug use, and encourages a healthier, safer society.

The Prevalence of Drug Abuse

The prevalence of drug abuse is alarming, with the World Health Organization estimating that nearly 5.5% of the world’s population aged 15-64 years have used drugs at least once in their lifetime. This statistic underscores the urgency for effective drug awareness programs. It is essential to understand the factors contributing to drug abuse, which include peer pressure, curiosity, stress, and the desire for escapism. These factors, coupled with the easy accessibility of drugs, create a potent recipe for addiction.

Drug awareness plays a crucial role in preventing drug abuse and addiction. Through education, individuals gain a better understanding of the dangers and implications of drug use. They learn about the harmful effects of drugs on physical health, mental health, and social relationships. Moreover, drug awareness programs can debunk myths surrounding drug use, such as the misconception that drug use is a victimless crime or that all drug users are morally weak.

Components of Effective Drug Awareness Programs

Effective drug awareness programs should be comprehensive, targeting various aspects of the drug abuse issue. Firstly, they should provide factual information about drugs, their effects, and the risks associated with their use. Secondly, they must equip individuals with the skills to resist peer pressure and make informed decisions. Lastly, these programs should provide support and resources for those struggling with addiction, emphasizing that recovery is possible and that help is available.

The Role of Society in Drug Awareness

Society plays a significant role in promoting drug awareness. Schools, workplaces, and communities can host awareness campaigns, workshops, and seminars. The media can also play an influential role in disseminating accurate information about drugs and addiction. Moreover, government policies can support drug awareness initiatives, providing funding and resources for these programs.

In conclusion, drug awareness is a crucial tool in the fight against drug abuse and addiction. By educating individuals about the realities of drug use and equipping them with the skills to resist it, we can foster a society that is healthier, safer, and more informed. It is a collective responsibility that requires the participation of all sectors of society, from the individual to the government. Through a concerted effort, we can make significant strides in addressing this global issue.

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• Open access
• Published: 15 April 2024

Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis

• Christopher J. Byrne 1 , 2 ,
• Fabio Sani 3 ,
• Donna Thain 2 ,
• Emma H. Fletcher 2 &
• Amy Malaguti 3 , 4  

Harm Reduction Journal volume  21 , Article number:  81 ( 2024 ) Cite this article

227 Accesses

Metrics details

Background and aims

Psychological and social status, and environmental context, may mediate the likelihood of experiencing overdose subsequent to illicit drug use. The aim of this systematic review was to identify and synthesise psychosocial factors associated with overdose among people who use drugs.

This review was registered on Prospero (CRD42021242495). Systematic record searches were undertaken in databases of peer-reviewed literature (Medline, Embase, PsycINFO, and Cinahl) and grey literature sources (Google Scholar) for work published up to and including 14 February 2023. Reference lists of selected full-text papers were searched for additional records. Studies were eligible if they included people who use drugs with a focus on relationships between psychosocial factors and overdose subsequent to illicit drug use. Results were tabulated and narratively synthesised.

Twenty-six studies were included in the review, with 150,625 participants: of those 3,383–4072 (3%) experienced overdose. Twenty-one (81%) studies were conducted in North America and 23 (89%) reported polydrug use. Psychosocial factors associated with risk of overdose ( n  = 103) were identified and thematically organised into ten groups. These were: income; housing instability; incarceration; traumatic experiences; overdose risk perception and past experience; healthcare experiences; perception of own drug use and injecting skills; injecting setting; conditions with physical environment; and social network traits.

Conclusions

Global rates of overdose continue to increase, and many guidelines recommend psychosocial interventions for dependent drug use. The factors identified here provide useful targets for practitioners to focus on at the individual level, but many identified will require wider policy changes to affect positive change. Future research should seek to develop and trial interventions targeting factors identified, whilst advocacy for key policy reforms to reduce harm must continue.

Introduction

People Who Use Drugs (PWUD) experience myriad harms which drive substantial morbidity and mortality [ 1 , 2 , 3 , 4 , 5 , 6 ]. In 2019, approximately 6% of the world’s population used illicit drugs at least once – including using illicitly obtained prescription medications in the context of polydrug use – and this is predicted to rise to 11% by 2030 [ 7 , 8 ]. Approximately 21% of PWUD are estimated to have experienced recent non-fatal overdose – known to precipitate future fatal overdose – equating to an estimated 3.2 million people, while approximately 42% have ever experienced overdose [ 2 ]. Internationally, approximately 500,000-600,000 fatalities are attributable to drug use annually, with close to 80% of these related to opioids and 25–30% directly induced by opioid overdose [ 7 , 9 ]. This can include illicit drugs, such as heroin, as well as use of illicitly obtained pharmaceutical opioids, such as morphine, fentanyl, and oxycodone [ 2 , 3 ]. The escalation in drug-related harms and mortality in recent decades has been attributed to a triple-wave epidemic, mediated by supply and demand side drivers, characterised by widespread opioid use; beginning with prescription opioid pills, transitioning through heroin use, and culminating in synthetic opioids – of variable quality and potency – including fentanyl variants, and nitazenes, often combined with or substituted for heroin [ 10 , 11 ].

In North America alone, nearly 600,000 people have died from an opioid-induced overdose in the last two decades with 1.2 million predicted to meet the same fate by 2029 if current trends persist. Elsewhere in the Americas substantial mortality rates have also been recorded [ 12 , 13 ]. In the UK and Western Europe, overdose and mortality rates associated with polydrug use are increasing year-on-year in some nations, with opioids involved in most fatalities [ 14 , 15 , 16 , 17 ]. In Australasia, an estimated 51% of PWUD are reported to have experienced non-fatal overdose, while this is estimated at approximately 34%, 45%, and 50%, in East & Southeast Asia, South Asia, and Central Asia, respectively [ 2 ]. Indeed, Asia, relative to North America, Europe, and Australia, has the highest crude mortality rates among PWUD, with many attributable to fatal overdose [ 3 ]. Although data from African settings is sparse, the available evidence suggests that overdose consequent to illicit drug use, fatal or non-fatal, is increasingly common worldwide, and constitutes a significant threat to public health. Beyond opioids, other central nervous system depressants – benzodiazepines, alcohol – play a critical role contributing to risk, usually in the context of polydrug use [ 17 ]. Similarly, stimulants like cocaine in different forms, and amphetamines, are commonly used together with opioids and elevate risk by artificially masking respiratory depression [ 17 , 18 ].

Responding to these alarming trends, many have endeavoured to improve surveillance and trial interventions to protect people who use drugs from harm. Some existing medicalised interventions include naloxone provision [ 19 , 20 , 21 , 22 ], opioid agonist therapy (OAT) [ 23 ], opioid antagonist therapy [ 24 ], supervised consumption sites [ 25 , 26 , 27 ], related healthcare engagement [ 28 ], detoxification [ 29 ], and integrated prevention activities [ 30 ]. Naloxone provision has gained particular salience due to its efficacy in rapidly reversing opioid-induced overdose symptoms [ 31 ]. Conventionally carried in medical and pre-hospital settings, evidence has shown high willingness among overdose bystanders to administer it [ 20 , 32 , 33 ]. Subsequently, several countries spanning Europe, Australia, and North America, have adopted legislative changes to enable provision without prescription, and protect bystanders who administer it from prosecution [ 34 , 35 , 36 ]. Beyond medicalised interventions, recovery-based approaches which prioritise empowerment, self-determination, and holistic wellbeing, have been widely adopted to underpin recovery journeys with senses of identity, belonging, purpose, and social connection [ 37 ]. Peer outreach and in-reach programmes for overdose reduction, as well as mutual help programmes, have also demonstrated efficacious impacts on recovery [ 38 , 39 , 40 , 41 ]. Such approaches acknowledge that recovery is an ongoing process that requires support, compassion, and dedication, which often extends beyond drug use alone to shifts in identity [ 42 , 43 , 44 ].

It is in the context of the varied approaches to overdose intervention, and the acknowledgement that experiences of drug effects are influenced by psychological characteristics and social processes, that we sought to evaluate the available evidence quantifying the risk of overdose among PWUD associated with psychosocial factors [ 45 , 46 ]. That is, features that pertain to the influence of social factors on an individual’s mind or behaviour, and to the interrelation of behavioural and social factors upon outcomes [ 47 ]. These may relate, for example, to social resources, like healthcare access or income source; psychological resources, such as risk perception; and psychological morbidity. Several guidelines on illicit drug use and dependence recommend psychosocial interventions, often targeting behaviour change through mindfulness, motivational interviewing, cognitive behavioural therapy (CBT) based interventions, and acceptance and commitment therapy [ 48 , 49 , 50 , 51 , 52 ]. These interventions are frequently positioned as adjuncts to overall treatment packages, as they are of uncertain benefit relative to medicalised therapies [ 53 , 54 , 55 ].

Over the years, many risk factors for overdose have been identified, for example: polydrug use; psychiatric comorbidity; unstable housing; witnessing overdose; substance use disorder; prescription of opioids; increasing pharmacy use; increasing opioid prescribers; vulnerability to socio-economic marginalisation; hepatitis C/HIV infection; male gender; rural residence; certain employment types/industries; incarceration; familial distress; disability; detoxification programme experience; the built environment; and suicidality as key factors [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. However, despite this expansive evidence base, prior to this review, we were unable to identify any unified work that identified which psychosocial factors are associated with overdose, and therefore best to target with interventions found in prevailing guidelines.

Generating this information is critically important in the current era of increasingly limited public health resource and multiple competing public health priorities. Given their prevalence in clinical guidelines, and the uncertainty around their benefits, we sought to understand which psychosocial factors might impact on risk of overdose, to inform future intervention development and clinical practice. Accordingly, we undertook a systematic review with a narrative synthesis, which aimed to identify which, if any, psychosocial factors are associated with risk of overdose, whether fatal or non-fatal.

This review complied with the updated PRISMA statement checklist for reporting of systematic reviews and meta-analyses [ 68 ] and reporting guidelines for synthesis without meta-analysis in systematic reviews [ 69 ]. The review protocol with methods and inclusion criteria was registered in advance on PROSPERO (CRD42021242495).

Eligibility criteria

Only studies written in English were considered. The search (up to 14 February 2023) was completed with no limitations on publication dates and no geographic restrictions.

Participants

Studies were required to include PWUD as participants.

The exposure in this study was psychosocial factors which are associated with fatal and non-fatal overdose. Psychosocial was defined as pertaining to the influence of social factors on an individual’s mind or behaviour, and to the interrelation of behavioural and social factors on the outcome [ 47 ].

In studies where comparison was undertaken, PWUD who experienced overdose were compared to PWUD who did not.

The primary outcome was overdose (fatal or non-fatal) consequent to use of illicit, or illicitly obtained controlled, drugs. Intentional overdose was excluded where possible, as suicidality constitutes different behavioural characteristics to unintentional overdose. Where it was unclear whether intention was assessed or not, the study was included.

The review included observational studies (cross-sectional, cohort, case-control, and qualitative studies). Case series, case reports, and reviews, were excluded.

Information sources

The following databases were searched via OVID: Medline, Embase and PsycINFO. Cinhal was searched via EBSCOhost. Grey literature was explored by searching with Google Scholar. Reference lists of selected full-text studies were manually screened for further identification of relevant studies.

Search strategy

The search strategy was identical across databases, adjusting for database-specific search requirements. An example of the search strategy is provided in the Supplementary File. Reference lists for manuscripts eligible for full text review were searched manually for relevant titles; whilst Google Scholar was searched with ‘Psychosocial factors AND drug overdose’, and results screened manually. Screening stopped once 100 sequential results did not match search terms, given the results were ordered according to accuracy and relevance. Database searches were saved in an EBSCOhost or OVID account folder. Duplicates were removed.

Study selection and data extraction

Search results were exported from relevant databases into Microsoft Excel 365 spreadsheets for screening, with tables on study characteristics and psychosocial factors created using Microsoft Word 365. One reviewer (AM) screened titles for inclusion. Two reviewers (AM and CJB) screened all abstracts and full texts independently and a third reviewer (FS) arbitrated. Inter-rater agreement, calculated using Cohen’s kappa in Stata 17 BE, indicated high levels of agreement for both abstract (κ = 0.672 [0.565-0.780], p  < .001) and full-text (κ = 0.835 [0.697-0.974], p  < .001) screening. Data were extracted by two reviewers (AM and CJB), and separated into tables. First, data were extracted for study and sample characteristics: author, study design, location and location type, sample size, gender, age, ethnicity, population type, drugs (and other substances) reported, overdose definition, and number who experienced overdose. Second, psychosocial factors associated with overdose identified in each study along with comparators and the estimated effects/description of the association were extracted and tabulated.

Risk of bias assessment

Two reviewers independently assessed risk of bias for all included studies, discussing any discrepancies and mutually agreeing on final assessment; where required, arbitration was conducted by a third person to arrive at a final decision. The National Institutes of Health Study Quality Assessment Tools for quantitative studies, and the Critical Appraisal Skills Programme Qualitative studies checklist for qualitative studies, were used [ 70 , 71 ]. In brief, these prompt quality appraisal by considering clarity of research aims; definition of, and homogeneity of, study populations; participation rates; appropriateness of analytic approaches; clarity of outcomes measured; and ethical conduct.

Effect measures

Effect measures extracted from the studies were tabulated. Given the heterogeneous nature of the studies selected for the review, and the attendant factors examined, results were narratively synthesised; effects were not meta-analysed.

Synthesis procedure

Data were extracted manually and tabulated according to study characteristics and study findings (identified factor, author, effect size, and direction of effect). The tables were used to familiarise the reviewers with the data initially. Once data extraction was complete, the findings were reviewed, and relationships within the data and overlapping themes were annotated throughout the process of narratively synthesising individual data. The themes were discussed among three members of the research team (AM, CJB, FS) and a peer worker with lived experienced of drug use to ensure they were as accurate a reflection of the lived reality of drug use as could feasibly be achieved for a review. Themes were considered against the review question and full dataset to ensure they were focused and addressed the research question. Extracted data within each theme were then inspected to explore differences in effect direction and potential bias introduced by the different study designs included in the review. Where divergences existed, these were considered in light of study design and risk of bias. Following these steps, the manuscript was drafted, which continued the analytical, procedural, and conceptual thinking for the synthesis to be completed.

Study selection

The screening results are illustrated in Fig.  1 . During the search, 2,802 titles were screened: 2,408 were excluded, and 394 were selected for abstract review. After exclusion of duplicates, 187 remained. After further review, 61 were selected for full text assessment. Thirty-five studies were excluded with reason, whilst 26 were selected for quality appraisal and analysis.

Prisma flow chart summarising the screening process

Study characteristics

All studies focussed on overdose, fatal and non-fatal, consequent to illicit drug use as the primary outcome. This was often combined with use of legal substances (e.g. alcohol), and/or illicitly obtained controlled drugs, meaning the cohorts examined were often in the context of polydrug use. One study defined the outcome as death by unintentional overdose, according to post-mortem medical examination records [ 72 ], while one examined people hospitalised with ICD-9 codes for opioid-induced non-fatal overdose [ 73 ]. All other studies relied on self-reported non-fatal overdose disclosure, though outcome timeframes varied. In nine studies, participants self-reported ever experiencing overdose [ 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ]. For nine other studies, the primary outcome was self-reported overdose in the last six months [ 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ]. The primary outcome for three studies was experience of overdose in the past 12 months [ 92 , 93 , 94 ]. Riggs et al. defined the primary outcome as self-reported overdose in the last three years, while Argento et al. defined it as self-reported overdose during the study observation period (participants were sampled over nine years and follow-up varied) [ 95 , 96 ]. Lastly, for one study the primary outcome was self-reported overdose in the past five years [ 97 ]. Descriptive characteristics of each study are in Table  1 .

The total sample comprised 150,625 people. Of those, the number of participants who experienced overdose, according to the definitions reported, ranged from 3,383 to 4,072 (3%). A range is provided as one study did not report the number with sufficient clarity [ 87 ].

Most studies were conducted in North America ( n  = 21), three were in Asia, one was in Europe, and one in Australia. Participant ages ranged from 21 to 56 years. Six studies focussed on female and/or gender minority participants [ 75 , 77 , 84 , 88 , 90 , 96 ], and the remainder had a preponderance of male participants (Table  1 ). Twenty-three studies reported polydrug use and, of those, eight specified this was a mixture of prescription and illicit drugs. Three studies did not disclose the specific drugs used [ 73 , 74 , 88 ].

Methodological quality

No methodological concerns were identified which warranted removal of any of the included studies (Supplementary file 1 ).

Psychosocial factors

Factors associated with overdose ( n  = 103) were extracted from each study and structured into ten thematically similar groupings (Table  2 ; Fig.  2 ).

Thematic groups of factors found to impact on experience of overdose in reviewed studies ( n  = 103)

Note : N in each circle is the number of factors within that thematic group. Groups with smaller N are smaller circles, while groups with the same N are the same colour. Groups are randomly scattered as there is no inherent hierarchy or linearity to their impact

Eighteen studies reported odds ratios (OR) as the measure of the association between factors and exposure to overdose [ 73 , 75 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 90 , 91 , 93 , 94 , 95 ]. Two studies reported incidence rate ratios (IRR) [ 74 , 76 ], two reported relative risk (RR) [ 89 , 92 ], and two reported hazard ratios (HR) [ 72 , 96 ]. Two studies were qualitative, so no quantitative estimates were reported [ 77 , 97 ]. Given the heterogeneity of measures and study designs, summary statistics were not calculated, and meta-analysis was not performed [ 98 ]. Despite this heterogeneity, estimates of effects were considered and informed the narrative synthesis.

Eight studies explored the relationship between income source and/or unemployment and odds, or risk, of overdose [ 73 , 75 , 81 , 85 , 87 , 89 , 90 , 94 ]. Winter et al. demonstrated sustained unemployment prior to imprisonment was associated with four-to-five times higher risk of overdose following liberation. Mitra et al. also showed a four-fold increase in odds associated with unemployment. Similarly, Pabayo et al. found 40% and 70% higher odds of overdose among men and women respectively, in receipt of social welfare. Harris et al. showed recent engagement in sex work was associated with 60% higher odds of overdose, while Fairbairn et al. reported ever engaging in sex work was associated with twice the odds. El-Bassel et al. examined compounding effects of sex work and violence, with over ten years sex work experience also associated with twice the odds of overdose, and combined exposure to this with recent violence, including from intimate partners, increasing the odds four-fold. Analysis from Latkin et al. (2019) implied selling drugs in the past 30 days was associated with two-to-three times higher odds of overdose. Finally, work by Silva et al. found identifying as a lower socio-economic status growing up increased odds of overdose by 80%.

Homeless/housing instability

Eight studies explored this theme [ 73 , 81 , 87 , 88 , 89 , 90 , 91 , 95 ]. Unstable housing and lack of accommodation was consistently found to increase the odds and risk of overdose. Mitra et al. observed the largest effect, with housing insecurity increasing the odds of overdose seven-to-eight-fold. Thumath et al. found recent homelessness was associated with 60% higher odds, current homelessness increased odds by 30% according to Riggs et al., while being unhoused in the past six months was associated with 50–70% increased odds in a study by Harris et al. in an all-female sample, and 30% higher odds in Pabayo et al. in a restricted male-only analysis. The highest estimate among examinations of recent homelessness was by Silva et al, who showed past 90-day homelessness increased odds of overdose by close to three-fold, while Tomko et al. estimated a two-fold increase. Ever experiencing homelessness and ever living in a foster home were associated with five-fold and 60% increases in odds of overdose in work by Thumath et al. and Silva et al. respectively. Finally, Winter et al. found experience of unstable accommodation one month prior to incarceration increased risk of overdose three-fold among recently liberated prisoners.

Incarceration

Eight studies explored incarceration-related factors [ 72 , 75 , 77 , 79 , 81 , 86 , 89 ]. Winter et al. estimated any previous incarceration as an adult resulted in five-times higher risk of overdose, while Milloy et al. and El-Bassel et al. estimated a roughly four-fold increase in odds of overdose for participants with similar histories, and Silva et al. estimated a doubling of odds. Harris et al. and Lake et al. found incarceration in the past six months was also associated with twice the odds of overdose, with the effect enduring when adjusted for physical or emotional neglect in the work by Lake et al. El-Bassel et al. estimated a more pronounced effect among those with history of incarceration and intimate partner violence, who experienced five-times higher odds of overdose, with those who experienced non-partner violence having close to four-times higher odds. Recent liberation from prison, coupled with mental ill health, conferred a 50% higher hazard of overdose in work by Pizzicato et al. and Lamonica et al., in their qualitative study, also found that recent liberation from carceral settings increased risk of overdose in a suburban all-female cohort.

Traumatic experiences

Nine studies assessed traumatic experiences [ 75 , 77 , 84 , 86 , 88 , 89 , 90 , 91 , 96 ]. Lamonica et al. found emotional trauma, such as negative life events and consequent depressive states, increased risk of overdose. Various other traumatic experiences were examined, but multiple iterations of physical trauma pre-dominated. Thumath et al. found experience of intimate partner violence doubled the odds of overdose among marginalised women in Canada, Lake et al. found physical abuse and neglect increased odds of overdose by 40% and 30% respectively. Harris et al. found recent physical violence increased overdose odds by 80% in an all-female cohort, with that increasing to close to three-fold among sex workers and adjusted for confounders. Combined physical and sexual workplace violence was associated with twice the odds of overdose among sex workers in Goldenberg et al., while sexual abuse carried a 50% increase in odds in Lake et al., and any physical/sexual violence conferred a 90% increase in hazard in Argento et al. El-Bassel et al. examined multiple type of physical violence, imparted by intimate partners and others, and found consistently elevated odds of overdose, with severe physical violence conferring 30% increased odds in adjusted analysis.

Beyond physical trauma, Tomko et al. identified a 70% increase in odds of overdose among those who experience daily psychological pain in adjusted analysis. Separately, severe emotional abuse conferred a 50% increase in odds in adjusted analysis by Lake et al. Adverse childhood events, such as removal from family as a child, or removal from parental care, were associated with a four-fold increase in odds by Winter et al. and a doubling of odds by Thumath et al., respectively. Similarly, having a child removed from one’s care held a 60% increase in odds in adjusted analysis by Thumath et al., and child custody loss was linked with higher overdose risk in qualitative work by Lamonica et al. Finally, Thumath et al. found food insecurity drove a 90% increased in odds of overdose.

Overdose risk perception and past experience

Risk perception and past experiences with overdose were evaluated in six studies [ 74 , 77 , 80 , 81 , 92 , 95 ]. There were divergent effects between perceived severity of prior overdose experience and participants’ perception of their own susceptibility to overdosing in work by Bonar et al., where higher perceived severity was linked to 40% decreased incidence and higher perceived susceptibility was linked to 50% higher incidence. Vicarious experience, i.e. witnessing an overdose, was associated with two-fold higher odds of subsequent overdose experience in Riggs et al., while ever witnessing a family member overdose conferred 60% higher odds in adjusted analysis by Silva et al. Schiavon et al. estimated that the higher the number of times a participant witnessed another person overdose, odds of subsequent overdose experience increased by 40%, with odds increasing four-fold where the other person was identified as a friend. Prior experience of overdose was also linked to 70% higher risk of subsequent overdose in Grau et al. whereas, in qualitative work by Lamonica et al., being a ‘novice’ to drug use, which may include erroneous polydrug use, was linked to higher risk.

Healthcare experiences

Most healthcare experiences, across eight studies, focused on medicalised addictions treatment [ 76 , 80 , 81 , 84 , 86 , 89 , 91 , 94 ]. Ever experiencing addictions treatment was associated with a 60% increased incidence of overdose in Havens et al., while Latkin et al. estimated a 50% increase in odds. However, when examined by Silva et al., the increase in odds was two-fold, and ever receiving opioid substitution therapy conferred a three-fold increase in relative risk in Winter et al. Schiavon et al. estimated that with increasing number of treatment episodes, the odds of experiencing overdose increased by 60% in adjusted analysis. Conversely, Lake et al. found that being denied access to addictions treatment was associated with close to three-fold odds of overdose. Other studies examined healthcare need, with Goldenberg et al. identifying unmet healthcare need was associated with 70% higher odds of overdose, and Tomko et al. linking unmet mental health care need to a 40% increase in adjusted analysis.

Perception of own drug use and injecting skills

Three studies examined participants’ perceptions of their own drug use, two of which were qualitative [ 77 , 95 , 97 ]. In the quantitative work, Riggs et al. estimated that participants who perceived they had a drug ‘problem’ had five-fold higher odds of subsequent overdose in adjusted analysis. Lamonica et al. found participants who disclosed a lack of knowledge about drug use, a lack of control over the quality of the drugs they were using, or lack of knowledge of their tolerance of those drugs, had higher risk of experiencing overdose. Chang et al. termed similar types of knowledge as ‘opioid expertise’ – this also included perceived self-control over opioid use and one’s bodily response – and identified that participants who felt they possessed a high degree of opioid expertise had increased risk of overdose. Related to the sense of expertise and experience, low injecting skill was examined in two studies [ 86 , 87 ]. Both linked requiring assistance with injecting with increased odds of overdose. Lake et al. found requiring help to inject increased odds by 90%, with adjusted models for physical and sexual abuse yielding 70% higher odds, and adjusted models for physical and emotional neglect yielding 70% and 50% higher odds respectively. Likewise, Pabayo et al., found that, among men, requiring help injecting increased odds of overdose by 74%.

Injecting setting

Injecting setting was assessed in four studies [ 83 , 84 , 85 , 86 ]. Injecting in public spaces in the past six months was consistently linked with higher odds of overdose. Lake et al. found a close to three-fold increase in odds of overdose in a Canadian cohort, which attenuated to 90% when adjusted for experience of emotional abuse, and to 70% when adjusted for experience of emotional neglect. Fairbairn et al. estimated a more pronounced effect, with a close to five-fold increase in odds associated with injecting in public settings. Both cohorts were sampled in Vancouver, Canada. Conversely, these studies found diverging effects for injecting alone in the last six months. Lake et al. estimated an 80% increase in odds, while Fairbairn et al. found the odds of overdose decreased by 60%. Fear of police intervention while injecting in public spaces was associated with a two-fold increase in odds by Bazazi et al., including in adjusted analysis. While ‘rushed’ outdoor drug use in the last six months conferred a 30% increase in odds in work by Goldenberg et al.

Conditions within physical environment

In related analyses, specific conditions within the wider physical environment were found to mediate overdose likelihood in six studies that examined this [ 83 , 84 , 90 , 93 , 94 , 96 ]. Proximity to harm reduction provision was examined in three studies, with somewhat diverging outcomes. First, Bazazi et al., found that among those who reported that a needle and syringe provision (NSP) site was the main source of their injecting equipment acquisition, this was linked to a 60% reduction in odds of overdose. However, Latkin et al. (2019) found that among those who replaced syringes through such a service, there was a three-to-four-fold increase in odds. Vallance et al. also reported a similar finding, where participants that resided in areas of high harm reduction coverage had twice the odds of overdose in adjusted analysis. In further conflicting results, Goldenberg et al. identified police-related barriers to harm reduction access doubled odds of overdose in adjusted analysis.

Similarly, Argento et al., found the same parameter conferred a close to three-fold increase in hazard of overdose in adjusted analysis, while Harris et al. observed that, among women, being stopped, searched, detained, or assaulted by police conferred a 50% increase in odds. This increased to a doubling of odds when stratified for sex workers only. Meanwhile, living in an area characterised by criminalisation, marginalisation, and prevalence of drug use, was associated with 40% higher odds of overdose in the same paper. Somewhat similar to wider drug use prevalence in the area, residing in a neighbourhood with an increasing number of known settings in which to use drugs was associated with 30% increase in odds overdose in adjusted analysis by Latkin et al.

Social network traits

Finally, density of social networks and supports were examined in six studies [ 76 , 77 , 78 , 82 , 84 , 87 ]. Pabayo et al. found three or more social supports was associated with a 50% reduction in odds of overdose among women in adjusted analysis. While, in their study, Tobin et al. found density of social network at baseline, and increases in density reported during follow-up, were associated with 90% and 80% reductions in odds in adjusted analyses. However, among those who reported recent injection drug use, Tobin et al. found increasing density in social network conferred a 20% increase in overdose odds in adjusted analysis, while Latkin et al. (2004) identified that reporting increasing numbers of people who inject heroin in one’s social network was associated with 20% higher odds of past overdose, and 30% higher odds of recent overdose. Conversely, in the same study, increasing numbers of contacts who snort heroin, rather than inject, was associated with a 20% reduction in odds of overdose.

Conflicting somewhat with these findings, Tobin et al. also found that, among those who reported recent injection drug use, an increasing number of people who inject drugs in participants’ social networks was associated with 80% reduced odds of overdose in adjusted analysis. Similarly, Havens et al. found increasing numbers of support members in one’s social network was linked to a 20% increased in incidence of overdose in adjusted analysis. Latkin et al. found increasing levels of conflict within a participant’s social network conferred a 30% increase in odds, whilst other studies examined intimate partnerships. In their qualitative study, Lamonica et al., found being friends, or in an intimate partnership, with someone who uses drugs increased participants’ risk of overdose. Similarly, Goldenberg et al., reported that providing drugs for an intimate partner (who was male) was associated with a 40% increase in odds of overdose.

This review is the first to our knowledge which specifically evaluated psychosocial factors associated with unintentional overdose consequent to illicit drug use, with many reviewed studies documenting polydrug use. Prior research suggests the majority of serious overdoses are unintentional, implying our findings are pertinent to the experiences of many people who use drugs [ 99 ]. While existing review evidence has elucidated many important factors, as noted in the Introduction, none highlighted the important connections between sex work, violence, or social networks, and overdose risk that we identified [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ]. Twenty-six studies from seven countries were reviewed, only two of which were qualitative, with the vast majority conducted in North America. Most participants were male, though several studies examined female-only cohorts. The overall proportion estimated to have experienced overdose was 3%, contrasting sharply with global estimates of 21% (15-26%) of PWUD reported to have recently experienced overdose [ 2 ]. Sample sizes varied widely, with two registry studies reporting disproportionately large samples relative to other reviewed studies, and low relative overdose prevalence [ 72 , 73 ]. Excluding these from the estimate would bring the overall prevalence closer to 16%. Thus we believe most studies reviewed are representative of the at-risk population.

Identified factors were structured into ten overarching groups, with some thematically similar correlates yielding conflicting results. Factors varied from the individual (e.g. risk perception) to the structural (e.g. housing) in a manner which illustrates the synergies between biological factors, psychological traits, and social processes, both at micro and macro levels, which influence an individual’s likelihood of experiencing overdose [ 45 , 46 , 100 , 101 ].

For example, income played an important role in mediating risk, with experience of sex work, unemployment, drug selling, social welfare receipt, and lower socio-economic status, all associated with increased reports of overdose. The relationship between income and health may be explained by subjective psychosocial experiences mediated by work environments and exposure to unemployment [ 102 , 103 ]. However, the correlates reported are characterised by socioeconomic marginalisation, which speaks to the economic and political frameworks which worsen health outcomes for people who use drugs within the model of interdiction which predominates globally. For instance, at the micro level, while the individual acts involved in drug use may have shaped sex worker/client interactions and were important in moderating overdose risk, the ultimate harm induced by that behaviour was enabled by the fact sex workers were reticent to report overdose due to criminalisation and structural stigmatisation, both of their drug use but also their method of income generation [ 104 ]. The risk environment for sex workers was elucidated further by El-Bassel et al. who demonstrated the compounding impact of violence and sex work on overdose risk [ 75 ]. The context may then be at least partially characterised by risky drug use and frequent violence at the micro level – a common experience among sex workers operating in a social environment of gendered norms and unequal power dynamics – which is enabled by public policy at the macro level which marginalises sex workers and leaves them vulnerable to harms related to drug use [ 105 , 106 ]. These findings speak to the urgent need to cease using criminal law to enforce morals upon income generation and strengthen the previously elucidated case for this as the best strategy to reduce harms experienced by sex workers [ 107 ].

At the individual level, there is little evidence to support the use of psychosocial interventions to improve health and well-being among sex workers, perhaps due to the structural factors at play [ 108 ]. Separate to this, unemployment was generally associated with higher risk than sex work and other income factors such as social welfare receipt, participation in the illicit drug trade, and lower socio-economic status, and it is important to note that the relationship between these factors and overdose may be mediated by social capital and isolation [ 59 , 62 , 109 ]. These, in turn, drive worse psychosocial outcomes, which are enabled by prevailing policies of state-imposed methods of control (social welfare) of non-conforming behaviour (non-participation in ‘normative’ modes of economic activity), and intentional criminalisation of drug use which erodes drug supply quality and increases overdose risk [ 10 ].

In a similar vein, housing instability was consistently linked with increased odds of overdose, similar to prior research which observed this [ 110 ]. Among vulnerable adults experiencing homelessness, psychological and social issues at the micro level, such as self-esteem, social support, coping mechanisms, and emotional distress, have been associated with increased substance use [ 111 ]. Further, people facing homelessness experience frequent stigmatisation which negatively impacts mental health and well-being, and wider social interactions. Whilst drug use in this context of unstable housing will be influenced by immediate social norms of the situation, there is an overarching synergy between housing and drug use which has driven opioid-overdose to be a leading cause of death among people experiencing it [ 112 , 113 , 114 ]. Research suggests this synergy confers 38% higher odds of overdose [ 115 ]. These issues are likely manifestations of both immediate social interactions in the context of insecure housing, and macro housing policy which inhibits the social environments which vulnerable individuals are enabled to access. Recent work has reported positive effects for psychosocial interventions in reducing psychological morbidity among people experiencing homelessness [ 116 ], but these will not negate the risks which require wider policy reform around housing programmes [ 112 ]. For example, many housing programmes restrict PWUD accessing their services as a matter of policy, despite housing being linked with harm reduction impacts and improved psychosocial measures which may facilitate recovery-based approaches [ 117 , 118 , 119 ]. The results illustrate a need for supportive and stable housing – a fundamental requirement to establish a sense of safety and stability – to be viewed as a critical intervention which policy makers and public health practitioners should seek to deliver to moderate prevalence of overdose.

The likelihood of becoming homeless may be mediated by history of incarceration [ 120 ]. Incarceration was consistently linked to higher risk of overdose in reviewed studies, and other work not reviewed here [ 115 ]. The circumstances surrounding the first two weeks post liberation have been demonstrated to induce an up to eight-fold increase in risk of fatal overdose relative to subsequent weeks and, furthermore, all-cause mortality is up to 12.7 times higher than that of the general population among those recently liberated, with most attributable to fatal overdose [ 121 , 122 ]. While mental health difficulties, victimisation, and feeling unsafe during incarceration, have been linked to poorer psychosocial adjustment upon liberation (which psychosocial interventions may help address), these findings emphasise the inadequacy of efforts by health and welfare services, and carceral establishments, to assist people in the vulnerable period following liberation with transitional social and medical supports [ 123 , 124 , 125 ].

Research has shown relapse to drug use in this window occurs in the context of poor social support, situational stressors (violence, poverty, isolation, availability), and decreased tolerance [ 125 ]. Conversely, exposure to factors which address these, such as housing, social supports (including avoiding old social networks), mutual help programmes, and spiritual services, have been cited as protective [ 125 ]. Overdose risk caused by liberation to environments that trigger drug use may be somewhat ameliorated by provision of take-home naloxone, but research has shown people in prison may not be receptive to training and carriage of naloxone, and motivation to carry it is complicated by desires to remain abstinent [ 126 , 127 ]. Beyond individual factors, useful conceptual frameworks have been posited to frame the multilevel nature of the determinants involved in overdose risk upon liberation, which suggest researchers shift the lens through which this issue framed from the individual to the socio-structural [ 128 , 129 ]. Our findings highlight the harms conferred by structural control mechanisms which reinforce criminalisation of drug use and compound inequalities experienced by people who use drugs in health outcomes.

There were additive effects for incarceration with physical neglect and recent experience of violence. Intimate partner violence (IPV) was among the traumatic experiences linked to higher risk, alongside multiple types of intimate partner and non-partner violence, including sexual abuse and neglect. It was unclear from the results whether IPV, abuse, and neglect experienced were reciprocal/bidirectional, however all but one study examining these experiences were in female cohorts. So the relationship between overdose risk and these factors may be understood as the confluence of the drug effects, the norms and boundaries concerning gender-based violence within the immediate social context, and wider cultural and systemic factors which perpetuate gender-based violence. At the individual level, psychosocial interventions, with advocacy and psychological components, can reduce depressive symptomology and post-traumatic stress among IPV survivors, which may ameliorate overdose risk [ 130 ]. However, they do not mitigate against re-experience and therefore policy changes which address the physical, social, and economic circumstances that manifest in the macro environment, and perpetuate gender-based violence, are critical to reducing risk, alongside individual interventions. One relevant example is the ongoing pilot of discreet payments to women availing of aid services in Scotland to abscond from circumstances of abuse [ 131 ].

In studies which examined experiences of healthcare, unmet needs and denied care were important in elevating overdose risk. PWUD are less likely to be able to avail of preventive healthcare to screen and manage conditions due to frequent experiences of stigma, distrust, and frustration in health environments; with those same people often blamed for the stigma they experience [ 132 , 133 , 134 , 135 , 136 ]. Unmet health needs have been linked to increased depression, with 29% (21-37%) of PWUD meeting the threshold for clinical depression diagnosis, and consequent self-harm and post-traumatic stress common [ 1 , 137 ]. There were also associations between experience of addictions treatment and overdose which were unexpected, given OAT is known to be protective against drug-related mortality [ 138 ]. This association may be explained by severity of dependence (and related suboptimal dosage); changes in tolerance whilst engaging with treatment; those who engaged with treatment having a higher likelihood of follow-up for overdose; those with past overdose experience being more likely to be referred for treatment; OAT discontinuity and re-entry; and transferring between OAT providers [ 139 , 140 ]. It should further be acknowledged that, though it is an established harm reduction tool, OAT can (and has) been interpreted as a mechanism of control through which moral discipline is inculcated in people who participate in drug use [ 141 , 142 ]. Through this lens, OAT engagement is necessitated only by ongoing interdiction and the intersecting inequalities and harms this produces. Safer supply and decriminalisation of drug use present reasonable (structural) approaches relative to individual interventions such as OAT, which may aid in mitigating overdose risk at the population level, whilst simultaneously mitigating against negative effects of interventions premised on ill-conceived moral frameworks [ 143 , 144 ].

Some environmental factors linked to overdose included experience of police-related interventions such as blocking access to harm reduction, stopping, arresting, and detaining people. All of which are more likely to occur in areas characterised by socio-economic marginalisation and prevalent drug use. Policing of drug use is characterised by violence which drives increased psychological distress among PWUD [ 145 , 146 ]. Similarly, rushed and public injecting, often accompanied by punitive policing, drove increased risk, as demonstrated in previous work [ 115 ]. Social-ecological frameworks have been proposed to articulate a means of addressing such factors, as it is unlikely individual-level interventions will modify these risks [ 147 , 148 ]. It is likely public health approaches which account for the societal, communal, and interpersonal factors, which drive these risks will be required to mitigate against the high likelihood of overdose they confer. These approaches require policy change – particularly regarding criminalisation of drug use and associated policing – while educational campaigns and clear service pathways to harm reduction are also critical.

At a more individual level, perception and social issues noted highlight the interconnectedness between drug use, individual psychology, and social processes. Social support systems impact psychological and physical wellbeing, and the interplay of social networks with environmental and individual factors can differentially impact upon psychological stressors [ 149 ]. This was apparent in the results, with contrasting effects observed. Higher density of social networks of varying degrees were protective against overdose in one study [ 82 ], while others which examined social networks characterised by conflict, ongoing injecting, and exposure to recent overdose among peers, signalled harmful impacts. Individually, peer social support may reduce psychological distress which in turn reduces overdose risk [ 150 , 151 ], and interventions which target social connectedness may be beneficial in this context [ 152 ]. More broadly, these results may be viewed through the Social Identity Model of Recovery, which proposes that recovery from drug use relies on a shift in identity wherein individuals reshape their social network to one wherein drug use is uncommon [ 43 , 44 , 153 ]. Reviewed studies which signalled harmful impacts studied social networks characterised by ongoing risks, whilst one might infer that those which examined network density where actually examining surrogates of networks wherein use of drugs was less prevalent. Where recovery from drug use is sought, peer support can be critical. One form which this takes is in mutual aid groups, which have been shown to catalyse changes in social networks, increase recovery capital, and enhance commitment to sobriety, through community reinforcement [ 154 , 155 ]. Additionally, alternative unstructured peer support strategies, such as recovery cafes, can also be enabling, whilst strategies like ‘spotting’ can help to enhance overdose response in the context of ongoing drug use [ 156 , 157 ].

Furthering the consideration of social context, witnessing overdose is deleterious to psychological wellbeing, causes post-traumatic stress, and can drive people to engage in risky drug use behaviours to manage feelings of bereavement and trauma [ 158 , 159 ]. Psychological distress has itself been independently associated with close to ten-times higher odds of overdose in young people [ 110 ]. Therefore trauma-informed psychosocial interventions for post-traumatic stress – which have been demonstrated as effective, particularly CBT-based therapies – may be important to integrate into existing harm reduction services [ 160 , 161 ]. Particularly when prefaced by safety and stabilisation work within a phased interventional model, to establish safety and create coping mechanisms before trauma reprocessing occurs [ 162 ]. However, an increase in psychological wellbeing may not mitigate against social factors such as requiring injecting assistance – shown previously to increase risk by approximately 58% – and risk conferred by one’s perception of their drug use [ 115 ]. Factors which implied low injecting skill were associated with increased risk – psychosocial interventions may improve injecting skills among PWUD [ 163 ] – alongside identifying as an expert in drug use. This contrasts with research among people who use new psychoactive substances, where expertise has been linked to higher risk perception and greater control in exposure to risk [ 164 ]. Individual-level interventions which assess and affect changes to psychological mechanisms that relate risk perception to overdose risk may therefore also be appropriate to explore.

Limitations

There are several limitations to this review. First, we did not undertake a meta-analysis due to the heterogeneity in effect estimates and study designs, instead opting for narrative review of the effects. Although appropriate for the heterogeneous study types and factors examined, this provides limited information for decision making relative to meta-analysis and risks emphasising the results of some studies erroneously and potentially misrepresenting the evidence [ 165 ]. Second, reviewed studies were concentrated in high-income countries, mostly in North America, significantly limiting the generalisability of the work. No work from African settings was identified, which is a critical limitation given the ongoing epidemic of extra-medical use of opioids (tramadol) and expansion of cocaine markets in recent years into African and Near and Middle Eastern settings, beyond conventional markets in Europe and North America [ 166 ]. This likely means PWUD in these settings will be disproportionately impacted by associated harms in coming years, with little representation in research. Third, our search strategy included terms for ‘psychosocial’, ‘psychological’, ‘social’, or ‘behavioural’, which was intended to be comprehensive. Nonetheless, some relevant research may have been omitted unintentionally due to the search design and/or interpretation of the results by the reviewers, given the broad scope and interpretability of the term ‘psychosocial’; we mitigated against this by referencing a recognised definition when interpreting and extracting results, and citing works thought to be relevant in the Discussion [ 47 ]. Finally, only two studies reviewed were qualitative in nature. This suggests the findings may omit relevant work documenting subjective experience, not captured in the quantitative studies. We suggest two reasons for this: our search strategy did not include terms for methodology like ‘quantitative’ or ‘qualitative’ which may have resulted in more results returned for relevant qualitative work; and much qualitative work proximal to overdose which we reviewed for inclusion concurrently examined factors which made them ineligible on the basis of our criteria (e.g. suicidal ideation; relationships).

Globally, rates of fatal and non-fatal overdose continue to increase, alongside many cognate harms, consequent to illicit drug use [ 1 , 2 , 167 ]. This review identified many psychosocial correlates of overdose which spoke to the interdependencies between drug use, psychological traits, and social processes, alongside the overlapping structural, societal, and environmental inequities which govern harms related to drug use, and therefore frame the risks related to overdose. Existing harm reduction interventions are insufficient to resolve the crisis of overdose and avoidable fatalities consequent to the opioid epidemic [ 168 ]. To date, many national drug policies are premised more on ideology than evidence, and our findings support the view that punitive approaches are not just ineffective in reducing prevalence of overdose, but actually contribute to the risk environment which increases it [ 144 ]. Where we believe this review adds value for the harm reduction movement is in elucidating several themes not previously identified in existing review evidence, which may be helpful in policy work concerning drug use, and clarifying the factors which practitioners may seek to engage at the individual level when exploring psychosocial interventions in harm reduction services, to facilitate therapeutic response. For example: mechanisms underlying risk perception, social connectedness, coping mechanisms, and screening and management of IPV [ 50 , 51 , 52 , 55 ].

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Acknowledgements

We wish to acknowledge and thank Teresa Flynn, Tammie Brown, Ann Eriksen, Dr Jennifer Breen, and Dr Fiona Cowden, for their contributions to this review and our wider research programme.

This study was funded by the Scottish Drug Death Taskforce (grant number: DDTFRF16). The funder was not involved in collection, analysis, and/or interpretation of data, in the writing of the report, or in the decision to submit the manuscript for publication.

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Conceptualisation: AM. Methodology: AM, CJB, FS. Software: Not applicable. Validation: Not applicable. Formal analysis: AM, CJB, FS. Investigation: AM, CJB, FS. Resources: Not applicable. Data curation: AM, CJB, FS. Writing – Original Draft: CJB, AM. Writing – Review & Editing: All authors. Visualisation: AM, CJB. Supervision: AM, CJB. Project administration: AM. Funding acquisition: AM.

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CJB has received honoraria from the International Network for Health and Hepatitis in Substance Users (INHSU), and grant funding from the Scottish Society of Physicians, unrelated to the submitted work. FS received funding from the Scottish Drug Deaths Taskforce related to the submitted work. AM has received funding from the Scottish Drug Deaths Taskforce related to the submitted work, and funding from the British Psychological Society unrelated to the submitted work. EF and DT report no competing interests.

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Byrne, C.J., Sani, F., Thain, D. et al. Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis. Harm Reduct J 21 , 81 (2024). https://doi.org/10.1186/s12954-024-00999-8

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DOI : https://doi.org/10.1186/s12954-024-00999-8

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Find answers to common questions about abortion in America, based on data from the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute, which have tracked these patterns for several decades:

How many abortions are there in the U.S. each year?

How has the number of abortions in the u.s. changed over time, what is the abortion rate among women in the u.s. how has it changed over time, what are the most common types of abortion, how many abortion providers are there in the u.s., and how has that number changed, what percentage of abortions are for women who live in a different state from the abortion provider, what are the demographics of women who have had abortions, when during pregnancy do most abortions occur, how often are there medical complications from abortion.

This compilation of data on abortion in the United States draws mainly from two sources: the Centers for Disease Control and Prevention (CDC) and the Guttmacher Institute, both of which have regularly compiled national abortion data for approximately half a century, and which collect their data in different ways.

The CDC data that is highlighted in this post comes from the agency’s “abortion surveillance” reports, which have been published annually since 1974 (and which have included data from 1969). Its figures from 1973 through 1996 include data from all 50 states, the District of Columbia and New York City – 52 “reporting areas” in all. Since 1997, the CDC’s totals have lacked data from some states (most notably California) for the years that those states did not report data to the agency. The four reporting areas that did not submit data to the CDC in 2021 – California, Maryland, New Hampshire and New Jersey – accounted for approximately 25% of all legal induced abortions in the U.S. in 2020, according to Guttmacher’s data. Most states, though,  do  have data in the reports, and the figures for the vast majority of them came from each state’s central health agency, while for some states, the figures came from hospitals and other medical facilities.

Discussion of CDC abortion data involving women’s state of residence, marital status, race, ethnicity, age, abortion history and the number of previous live births excludes the low share of abortions where that information was not supplied. Read the methodology for the CDC’s latest abortion surveillance report , which includes data from 2021, for more details. Previous reports can be found at  stacks.cdc.gov  by entering “abortion surveillance” into the search box.

For the numbers of deaths caused by induced abortions in 1963 and 1965, this analysis looks at reports by the then-U.S. Department of Health, Education and Welfare, a precursor to the Department of Health and Human Services. In computing those figures, we excluded abortions listed in the report under the categories “spontaneous or unspecified” or as “other.” (“Spontaneous abortion” is another way of referring to miscarriages.)

Guttmacher data in this post comes from national surveys of abortion providers that Guttmacher has conducted 19 times since 1973. Guttmacher compiles its figures after contacting every known provider of abortions – clinics, hospitals and physicians’ offices – in the country. It uses questionnaires and health department data, and it provides estimates for abortion providers that don’t respond to its inquiries. (In 2020, the last year for which it has released data on the number of abortions in the U.S., it used estimates for 12% of abortions.) For most of the 2000s, Guttmacher has conducted these national surveys every three years, each time getting abortion data for the prior two years. For each interim year, Guttmacher has calculated estimates based on trends from its own figures and from other data.

The latest full summary of Guttmacher data came in the institute’s report titled “Abortion Incidence and Service Availability in the United States, 2020.” It includes figures for 2020 and 2019 and estimates for 2018. The report includes a methods section.

In addition, this post uses data from StatPearls, an online health care resource, on complications from abortion.

An exact answer is hard to come by. The CDC and the Guttmacher Institute have each tried to measure this for around half a century, but they use different methods and publish different figures.

The last year for which the CDC reported a yearly national total for abortions is 2021. It found there were 625,978 abortions in the District of Columbia and the 46 states with available data that year, up from 597,355 in those states and D.C. in 2020. The corresponding figure for 2019 was 607,720.

The last year for which Guttmacher reported a yearly national total was 2020. It said there were 930,160 abortions that year in all 50 states and the District of Columbia, compared with 916,460 in 2019.

• How the CDC gets its data: It compiles figures that are voluntarily reported by states’ central health agencies, including separate figures for New York City and the District of Columbia. Its latest totals do not include figures from California, Maryland, New Hampshire or New Jersey, which did not report data to the CDC. ( Read the methodology from the latest CDC report .)
• How Guttmacher gets its data: It compiles its figures after contacting every known abortion provider – clinics, hospitals and physicians’ offices – in the country. It uses questionnaires and health department data, then provides estimates for abortion providers that don’t respond. Guttmacher’s figures are higher than the CDC’s in part because they include data (and in some instances, estimates) from all 50 states. ( Read the institute’s latest full report and methodology .)

While the Guttmacher Institute supports abortion rights, its empirical data on abortions in the U.S. has been widely cited by  groups  and  publications  across the political spectrum, including by a  number of those  that  disagree with its positions .

These estimates from Guttmacher and the CDC are results of multiyear efforts to collect data on abortion across the U.S. Last year, Guttmacher also began publishing less precise estimates every few months , based on a much smaller sample of providers.

The figures reported by these organizations include only legal induced abortions conducted by clinics, hospitals or physicians’ offices, or those that make use of abortion pills dispensed from certified facilities such as clinics or physicians’ offices. They do not account for the use of abortion pills that were obtained  outside of clinical settings .

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The annual number of U.S. abortions rose for years after Roe v. Wade legalized the procedure in 1973, reaching its highest levels around the late 1980s and early 1990s, according to both the CDC and Guttmacher. Since then, abortions have generally decreased at what a CDC analysis called  “a slow yet steady pace.”

Guttmacher says the number of abortions occurring in the U.S. in 2020 was 40% lower than it was in 1991. According to the CDC, the number was 36% lower in 2021 than in 1991, looking just at the District of Columbia and the 46 states that reported both of those years.

(The corresponding line graph shows the long-term trend in the number of legal abortions reported by both organizations. To allow for consistent comparisons over time, the CDC figures in the chart have been adjusted to ensure that the same states are counted from one year to the next. Using that approach, the CDC figure for 2021 is 622,108 legal abortions.)

There have been occasional breaks in this long-term pattern of decline – during the middle of the first decade of the 2000s, and then again in the late 2010s. The CDC reported modest 1% and 2% increases in abortions in 2018 and 2019, and then, after a 2% decrease in 2020, a 5% increase in 2021. Guttmacher reported an 8% increase over the three-year period from 2017 to 2020.

As noted above, these figures do not include abortions that use pills obtained outside of clinical settings.

Guttmacher says that in 2020 there were 14.4 abortions in the U.S. per 1,000 women ages 15 to 44. Its data shows that the rate of abortions among women has generally been declining in the U.S. since 1981, when it reported there were 29.3 abortions per 1,000 women in that age range.

The CDC says that in 2021, there were 11.6 abortions in the U.S. per 1,000 women ages 15 to 44. (That figure excludes data from California, the District of Columbia, Maryland, New Hampshire and New Jersey.) Like Guttmacher’s data, the CDC’s figures also suggest a general decline in the abortion rate over time. In 1980, when the CDC reported on all 50 states and D.C., it said there were 25 abortions per 1,000 women ages 15 to 44.

That said, both Guttmacher and the CDC say there were slight increases in the rate of abortions during the late 2010s and early 2020s. Guttmacher says the abortion rate per 1,000 women ages 15 to 44 rose from 13.5 in 2017 to 14.4 in 2020. The CDC says it rose from 11.2 per 1,000 in 2017 to 11.4 in 2019, before falling back to 11.1 in 2020 and then rising again to 11.6 in 2021. (The CDC’s figures for those years exclude data from California, D.C., Maryland, New Hampshire and New Jersey.)

The CDC broadly divides abortions into two categories: surgical abortions and medication abortions, which involve pills. Since the Food and Drug Administration first approved abortion pills in 2000, their use has increased over time as a share of abortions nationally, according to both the CDC and Guttmacher.

The majority of abortions in the U.S. now involve pills, according to both the CDC and Guttmacher. The CDC says 56% of U.S. abortions in 2021 involved pills, up from 53% in 2020 and 44% in 2019. Its figures for 2021 include the District of Columbia and 44 states that provided this data; its figures for 2020 include D.C. and 44 states (though not all of the same states as in 2021), and its figures for 2019 include D.C. and 45 states.

Guttmacher, which measures this every three years, says 53% of U.S. abortions involved pills in 2020, up from 39% in 2017.

Two pills commonly used together for medication abortions are mifepristone, which, taken first, blocks hormones that support a pregnancy, and misoprostol, which then causes the uterus to empty. According to the FDA, medication abortions are safe  until 10 weeks into pregnancy.

Surgical abortions conducted  during the first trimester  of pregnancy typically use a suction process, while the relatively few surgical abortions that occur  during the second trimester  of a pregnancy typically use a process called dilation and evacuation, according to the UCLA School of Medicine.

In 2020, there were 1,603 facilities in the U.S. that provided abortions,  according to Guttmacher . This included 807 clinics, 530 hospitals and 266 physicians’ offices.

While clinics make up half of the facilities that provide abortions, they are the sites where the vast majority (96%) of abortions are administered, either through procedures or the distribution of pills, according to Guttmacher’s 2020 data. (This includes 54% of abortions that are administered at specialized abortion clinics and 43% at nonspecialized clinics.) Hospitals made up 33% of the facilities that provided abortions in 2020 but accounted for only 3% of abortions that year, while just 1% of abortions were conducted by physicians’ offices.

Looking just at clinics – that is, the total number of specialized abortion clinics and nonspecialized clinics in the U.S. – Guttmacher found the total virtually unchanged between 2017 (808 clinics) and 2020 (807 clinics). However, there were regional differences. In the Midwest, the number of clinics that provide abortions increased by 11% during those years, and in the West by 6%. The number of clinics  decreased  during those years by 9% in the Northeast and 3% in the South.

The total number of abortion providers has declined dramatically since the 1980s. In 1982, according to Guttmacher, there were 2,908 facilities providing abortions in the U.S., including 789 clinics, 1,405 hospitals and 714 physicians’ offices.

The CDC does not track the number of abortion providers.

In the District of Columbia and the 46 states that provided abortion and residency information to the CDC in 2021, 10.9% of all abortions were performed on women known to live outside the state where the abortion occurred – slightly higher than the percentage in 2020 (9.7%). That year, D.C. and 46 states (though not the same ones as in 2021) reported abortion and residency data. (The total number of abortions used in these calculations included figures for women with both known and unknown residential status.)

The share of reported abortions performed on women outside their state of residence was much higher before the 1973 Roe decision that stopped states from banning abortion. In 1972, 41% of all abortions in D.C. and the 20 states that provided this information to the CDC that year were performed on women outside their state of residence. In 1973, the corresponding figure was 21% in the District of Columbia and the 41 states that provided this information, and in 1974 it was 11% in D.C. and the 43 states that provided data.

In the District of Columbia and the 46 states that reported age data to  the CDC in 2021, the majority of women who had abortions (57%) were in their 20s, while about three-in-ten (31%) were in their 30s. Teens ages 13 to 19 accounted for 8% of those who had abortions, while women ages 40 to 44 accounted for about 4%.

The vast majority of women who had abortions in 2021 were unmarried (87%), while married women accounted for 13%, according to  the CDC , which had data on this from 37 states.

In the District of Columbia, New York City (but not the rest of New York) and the 31 states that reported racial and ethnic data on abortion to  the CDC , 42% of all women who had abortions in 2021 were non-Hispanic Black, while 30% were non-Hispanic White, 22% were Hispanic and 6% were of other races.

Looking at abortion rates among those ages 15 to 44, there were 28.6 abortions per 1,000 non-Hispanic Black women in 2021; 12.3 abortions per 1,000 Hispanic women; 6.4 abortions per 1,000 non-Hispanic White women; and 9.2 abortions per 1,000 women of other races, the  CDC reported  from those same 31 states, D.C. and New York City.

For 57% of U.S. women who had induced abortions in 2021, it was the first time they had ever had one,  according to the CDC.  For nearly a quarter (24%), it was their second abortion. For 11% of women who had an abortion that year, it was their third, and for 8% it was their fourth or more. These CDC figures include data from 41 states and New York City, but not the rest of New York.

Nearly four-in-ten women who had abortions in 2021 (39%) had no previous live births at the time they had an abortion,  according to the CDC . Almost a quarter (24%) of women who had abortions in 2021 had one previous live birth, 20% had two previous live births, 10% had three, and 7% had four or more previous live births. These CDC figures include data from 41 states and New York City, but not the rest of New York.

The vast majority of abortions occur during the first trimester of a pregnancy. In 2021, 93% of abortions occurred during the first trimester – that is, at or before 13 weeks of gestation,  according to the CDC . An additional 6% occurred between 14 and 20 weeks of pregnancy, and about 1% were performed at 21 weeks or more of gestation. These CDC figures include data from 40 states and New York City, but not the rest of New York.

About 2% of all abortions in the U.S. involve some type of complication for the woman , according to an article in StatPearls, an online health care resource. “Most complications are considered minor such as pain, bleeding, infection and post-anesthesia complications,” according to the article.

The CDC calculates  case-fatality rates for women from induced abortions – that is, how many women die from abortion-related complications, for every 100,000 legal abortions that occur in the U.S .  The rate was lowest during the most recent period examined by the agency (2013 to 2020), when there were 0.45 deaths to women per 100,000 legal induced abortions. The case-fatality rate reported by the CDC was highest during the first period examined by the agency (1973 to 1977), when it was 2.09 deaths to women per 100,000 legal induced abortions. During the five-year periods in between, the figure ranged from 0.52 (from 1993 to 1997) to 0.78 (from 1978 to 1982).

The CDC calculates death rates by five-year and seven-year periods because of year-to-year fluctuation in the numbers and due to the relatively low number of women who die from legal induced abortions.

In 2020, the last year for which the CDC has information , six women in the U.S. died due to complications from induced abortions. Four women died in this way in 2019, two in 2018, and three in 2017. (These deaths all followed legal abortions.) Since 1990, the annual number of deaths among women due to legal induced abortion has ranged from two to 12.

The annual number of reported deaths from induced abortions (legal and illegal) tended to be higher in the 1980s, when it ranged from nine to 16, and from 1972 to 1979, when it ranged from 13 to 63. One driver of the decline was the drop in deaths from illegal abortions. There were 39 deaths from illegal abortions in 1972, the last full year before Roe v. Wade. The total fell to 19 in 1973 and to single digits or zero every year after that. (The number of deaths from legal abortions has also declined since then, though with some slight variation over time.)

The number of deaths from induced abortions was considerably higher in the 1960s than afterward. For instance, there were 119 deaths from induced abortions in  1963  and 99 in  1965 , according to reports by the then-U.S. Department of Health, Education and Welfare, a precursor to the Department of Health and Human Services. The CDC is a division of Health and Human Services.

Note: This is an update of a post originally published May 27, 2022, and first updated June 24, 2022.

Support for legal abortion is widespread in many countries, especially in Europe

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Drug and Alcohol Abuse Analytical Essay

Introduction, works cited.

For along time now, drug and alcohol abuse in the society has been a problem that affects the youth and the society at large. The youth in the society get engaged in abusing substances that they feel all help them forget their problems. This paper highlights the problems of drug abuse and alcohol drinking among the youth in the society.

Alcohol is a substance that contains some elements that are bring about physical and psychological changes to an individual. Being a depressant, alcohol affects the nervous system altering the emotions and perceptions of individuals. Many teenager abuse alcohol and other drug substances due to curiosity, the need to feel good and to fit in their different groups. Drinking alcohol should not be encouraged because it usually affects the health of the youth.

It puts their health at a risk. Drinking youth are more likely to engage in irresponsible sexual activities that may result in unexpected pregnancies and sexually transmitted diseases. Additionally, teenagers who drink are more likely to get fat while complicating further their health conditions. Moreover, the youth drinking are at a risk of engaging in criminal activities hence being arrested (Cartwright 133).

According to the Australian Psychological Society, a drug can be a substance that brings about physical or psychological changes to an individual (2). Youngsters in the in the community take stuffs to increase enjoyment or decrease the sensational or physical pain. Some of the abused drugs by the youth in the society include marijuana, alcohol, heroine and cocaine.

The dangers of drug abuse are the chronic intoxication of the youth that is detrimental to their societies. Much intake of drugs leads to addiction that is indicated by the desire to take the drugs that cannot be resisted.

The effect of alcohol and other hard drugs are direct on the central nervous system. Alcohol and drug abuse is linked to societal practices like, partying, societal events, entertainment, and spirituality. The Australian Psychological Society argues that the choice of a substance is influenced by the particular needs of the substance user (3).

However, the effects of drug abuse differ from one individual to another. The abuse of drugs becomes a social problem whenever the users fail to meet some social responsibilities at home, work, or school. This is usually the effect when the substances are used more than they are normally taken. Additionally, when the use of substances is addictive, it leads to social problems (Cartwright 135).

Drug and alcohol abuse among the youth in the society should be discouraged and voided at all costs. The youth are affected and the society is affected. The productive young men and women cannot perform their social duties. One way in which the abuse of drugs and alcohol can be avoided in the society is through engaging the youth in various productive activities. This will reduce their idle time while keeping them busy (Cartwright 134).

They will not have enough time for drinking. Additionally, they will have fewer problems to worry about. They should also be educated and warned about the dangers of drug and alcohol abuse both to their health and to the society. Since alcohol and substance abuse is related to increased crime in the society, its reduction will lead to reduced crime rates and economic growth.

The Australian Psychological Society. Alcohol, and Other Drugs . Australian Psychological society. Web.

Cartwright, William. Costs of Drug Abuse to the Society. The Journal of Mental Health Policy and Economics , 1999. 2, 133-134.

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IvyPanda. (2023, December 18). Drug and Alcohol Abuse. https://ivypanda.com/essays/drug-and-alcohol-abuse/

"Drug and Alcohol Abuse." IvyPanda , 18 Dec. 2023, ivypanda.com/essays/drug-and-alcohol-abuse/.

IvyPanda . (2023) 'Drug and Alcohol Abuse'. 18 December.

IvyPanda . 2023. "Drug and Alcohol Abuse." December 18, 2023. https://ivypanda.com/essays/drug-and-alcohol-abuse/.

1. IvyPanda . "Drug and Alcohol Abuse." December 18, 2023. https://ivypanda.com/essays/drug-and-alcohol-abuse/.

Bibliography

IvyPanda . "Drug and Alcohol Abuse." December 18, 2023. https://ivypanda.com/essays/drug-and-alcohol-abuse/.

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