Substance Use Epidemiology

Over half of US states have legalized cannabis use for medical purposes, and several have also legalized cannabis for recreational use. In several projects using national adult and adolescent datasets, investigations are underway on the relationship between these changing laws and several substance-related outcomes, including cannabis use, cannabis use disorder, cannabis to self-medicate depressive or anxiety disorders, use of other substances, perceived harmfulness of cannabis, and driving while intoxicated from cannabis or alcohol.

The unit’s faculty are conducting studies of the epidemic of opioids and their consequences. These include national time trends in opioid and heroin use, the relationship of multiple state-level opioid policies ( e.g., prescription drug monitoring programs (PDMPs), pain management clinic laws, good Samaritan laws and naloxone laws) to various substances, urban health studies on injection drug users in multiple cities, opioids and their relationship to injuries and violence, and best ways to conceptualize and measure opioid addiction among chronic pain patients and the role of disability and pain in opioid overdoses. These also include a study that is creating the first database of US substance use policies targeting pregnant and postpartum people and their effects on opioid outcomes in this population in Marketscan and Medicaid data, as well as a study investigating the effects of social safety net policies on parenting women.

Data indicate that in U.S. adults, alcohol and drug use and related problems have increased since 2000. NESARC and NSDUH data are being used to determine when these increases started, and how they differ by important population sub-groups, including men and women (pregnant and non-pregnant), younger and older adults, and those in disadvantaged groups, e.g., race/ethnicity, or low income. At the same time, adolescent attitudes towards drug use are changing, although rates of use are not increasing, another topic of current investigation. In addition, unit members are conducting multiple studies on the effects of drug use policies on administrative claims data such as Medicaid and Marketscan.

Urban residents see abandoned buildings, vacant lots, and alcohol outlets every day on their way to work or school. In multiple cities, we are conducting the first citywide randomized controlled trials and other natural and quasi-experimental studies of the effects of abandoned building and vacant lot interventions on various health and safety outcomes including substance abuse and violence. Along with a numerous other university and municipal partners, transformational interventions to tens of thousands of abandoned spaces in multiple cities will be longitudinally tested.

A reasonable way to prevent injuries and other negative health outcomes may be to focus on alcohol sales outlet zoning and policies and the consumption of alcohol that may be associated with a proliferation of these outlets. Through multiple population-based case-control studies, our research teams have established relationships between high availability of alcohol outlets, alcohol consumption, and health and safety outcomes. These studies have been also complemented with qualitative work and data collected from field observation teams.

Epidemiology is central to understanding the role of substance abuse in a global health context. Many faculty are involved in global substance use research projects. These projects include: “Relationship between exposure to violence and substance use in Guatemala”, “Substance Use Overdoses in Brazil and Colombia”, “Impact of changes in social determinants of health on adolescent and young adult mental health during the COVID-19 pandemic in South Africa”, and "Improving measurement of alcohol consumption among HIV-affected youth in sub-Saharan Africa in Zambia”.

Systems of care are continually evolving, as are treatment technologies. Clinical epidemiology and health services studies by the unit’s faculty include topics such as factors associated with substance treatment; efficacy trials of brief, technologically-enhanced interventions in HIV and other health settings; how women view substance use during pregnancy; psychometric properties of DSM-5 substance use disorders; and substance and psychiatric comorbidity in patients who received prescription opioids.