A Study on Awareness of Narcotics Among Young-Adult Students

Abstract

In this prospective and longitudinal study on “A study on awareness of narcotics among young adult students” the awareness programs are conducted among young adult students aged from 18-25 years, where the chances of incidence of narcotics misuse is high. The study objectify to evaluate the effectiveness of current educational programs and awareness campaigns on narcotic addiction prevention among young-adult students. Study also explore the attitudes and beliefs of young-adult students towards narcotic addiction and related risks and identify the knowledge gaps and misconceptions regarding the risks and consequences of narcotic addiction among young-adult students. This prospective quantitative study focuses on young-adult students in a community setting. Inclusion criteria encompass all genders willing to participate, excluding children, the elderly, and those with mental or neurological disorders unwilling to engage. The study employs a questionnaire-based approach across multiple colleges, utilizing pre and post-questionnaires with an intervening narcotic awareness presentation. Statistical analysis using SPSS version 23.0 involves percentages, proportions, means, medians, and the Chi-square test to evaluate the relationship between independent variables and key outcomes (knowledge, attitude, and awareness related to narcotics). A p-value of 0.05 is considered statistically significant. The study focused on gender distribution among young adults, with a higher male ratio (65.1%) indicating an elevated risk of narcotics introduction. Primarily targeting students, the awareness program involved college faculties and staff. Examining age distribution, the highest awareness was in the 22-23 age group, emphasizing the need for targeted educational efforts. Duration of stay in Bangalore was considered for lifestyle assessment, given its potential impact on narcotics misuse. Pre-program awareness was low at 7.6%, but post-program, 97.7% were well-informed, with significant increases in knowledge about risk, addiction, and signs/symptoms. Confidence in information about narcotics saw a positive change, with 93.4?eling more confident post-program. Participants believed their colleges lacked adequate narcotics information (89.6%), reflecting a potential institutional gap.. Attitudes shifted positively, with concerns decreasing from 90.9% to 85.4%. Peer pressure was identified as a significant cause, and confidence in resisting increased from 93% to 85%. The study highlighted barriers to prevention, including education, stigma, and peer pressure. Participants expressed concerns about insufficient resources for those struggling with narcotics (89.5%). The majority believed that increasing awareness and education could prevent future narcotics addiction cases (98.2%). Suggestions included more awareness campaigns and support groups/resources for young adults struggling with narcotics. While 92.7% attended narcotics addiction awareness programs for the first time, a considerable percentage had not participated in any peer support group, yet recognized the potential effectiveness of such programs (91.9%). The findings underscore the importance of targeted educational interventions and institutional support to address narcotics-related challenges among young adults. In conclusion, the study underscores the positive impact of awareness programs on knowledge and attitudes, highlighting the need for targeted interventions and ongoing support in combating narcotics misuse among young adults.

Keywords

Narcotics, Awareness of narcotics, young adult narcotics misuse, students and narcotics, narcotics and its effect, risk and consequences of narcotics.

Introduction

---

Subjects were being distributed according to gender. In the total identified population, the female gender number 335 (34.9%) and male gender 624 (65.1%). Here the reason of greater ratio in male population is because of their more chances to introduce towards narcotics.

 

 

       
           
       
Figure no. 02

From the distribution of subjects according to age, a greater number of population were aware at the age group of 22 to 23 (39.9%) and 20 to 21 (34.5%) , and the least were found in the age group of 18 to 19 years (11.2%) and then 24 to 25 years (14.4%).

       
           
       
The study only focus students how ever while conducting an awareness programme college faculties and other staffs were also involved in the programme. The reason of mainly focusing the students in this study is because of their lifestyle which increase the chances of substance misuse.

       
           
       
Figure no. 04

As the study conduct in the Bangalore it was important to understand their staying period in Bangalore which helps in the assessment of their lifestyle changes in various factor such as freedom, new friend circle etc. Which again can lead to the narcotics misuse.

       
           
       
Figure no. 05

Out of the 959 young adults only 73 (i.e 7.6%) were aware of “what narcotics are” before the awareness program. After the program a assessment with a post questionnaire has been done, where a significant change has been seen. Sample 937 (i.e 97.7%) out of 959 young adult has been well informed and aware about the narcotics.

       
           
       
  Most of the young adults were not aware of the “risk associated with using narcotics” before the program i.e 880(91.8%) out of total 959. The significant change has been seen after the program almost 939 i.e 97.9% of the total young adults were well informed about the risk and consequences associated with narcotics.

       
           
       
Before the program most of the young adults (i.e 867 out of 959) were not aware about the narcotics addiction and its significant issue. After the program a significant change in knowledge has been seen where 941 (i.e 98.1%) students understand the depth of the addiction of the narcotics.

          
           
       
  ?² value=19.444         df=20 p value, sig=0.493, NS (Not significant)

The sample young adult were not confident with the information that they have about narcotics. Out of 959 young adult only 62(i.e 6.4%) were well informative about the narcotics and other 881 (i.e 91.9%) were not well informative about the narcotics. After the awareness program a significant change in knowledge about information of narcotics has been seen, app 896 population i.e 93.4% young adult were feel more confident about the information of narcotics.

       
           
       
Figure no. 10

The current education program were not supply the required needed information about narcotics in their colleges or universities. Almost 859 out of 959, i.e 89.6% young adult student believe that their colleges and universities do not provide the adequate information about the narcotics.

---

The knowledge of narcotics among young adults, before the program were significantly less, 759 out of 959 i.e 82.9% students’ rate ‘less’ about the information they have about the narcotics. After the program a significant change in knowledge and confidence about narcotics information has been observed, 852 out of 959 i.e 88.8% students’ rate more about the knowledge of narcotics after the program.

       
           
       
Before the program, 889 out of 959 young adult students i.e 92.7?lieve that the narcotics problem in our community is a minor problem, this is because of the lack of information and unawareness of the current problem of narcotics addiction. After the program the students were well informed about the narcotics and a significant change in their attitude has been seen and 825 out of 959 students were believe that the problem of narcotics is a major problem in our community.

Current opioid crisis is a disaster to the community but most of the students were not concern about the current opioid epidemic, before the program 903 out of 959 i.e 94.2% students were not concern about the current opioid epidemic. but after the program a significant change in the awareness of current epidemic has been seen where 889 out of 959 i.e 92.7% young adults were well concern about the current opioid epidemics.

       
           
       
Figure no. 17

Most of the young adults were attending the narcotics education program for the first time in their life. 903 out of 959 i.e 92.9% students were not attend or received any kind of education or training program on narcotics and its consequences.

       
           
       
 Young adult is the phase of life where many challenges need to be face by the students and there could be various reasons comes as a barrier for prevention of narcotics misuse. In our assessment of total 959 young adults, 415 i.e 43.3% students believe that the barriers could be because of lack of education, 116 i.e 16.7% students believe the barrier could be because of unhealthy stigma surroundings, and 384 i.e 40% students believe that the barriers could be because of peer pressure.

---

There are very limited resources available for those who struggling with narcotics. Out of 959 students 858 i.e 89.5% young adult believe that there are not enough resources available for those who struggling with narcotics.

 

 

       
           
       
Figure no. 20

Awareness and education is always the best way to deal with any kind of addiction. 942 i.e 98.2% young adult out of 959 students believe that increasing awareness and education about narcotics could help prevent future cases of narcotics addiction.

---

Most of the sample population in our study were attending awareness program regarding narcotics for the first time in their life. 929 i.e 96.9% students out of total 959 young adults think there should be more awareness campaigns who are focused on narcotics addiction among young adult students.

---

Table no. 21: Pre & Post Questionnaire comparison

 

The resources and information of narcotics and its addiction is yet limited for the young adults. There are very limited community who provide awareness and information regarding addiction and narcotics. In our study out of 959 young adult 926 i.e 96.6% students believe that there should be more support group and resources specially for young adult students struggling with narcotics.

 

Out of 959 young adult 889 i.e 92.7% students were attending narcotics addiction awareness programs for the first time. The problems of narcotics misuse is a major issue in our community although the solution to improve knowledge and awareness of narcotics is yet to be come in focus for the students.

---

Table no. 23: Pre & Post Questionnaire comparison

Most of the young adult students were not join in peer support group in their life. In our study out of 959 students 886 i.e 92.4% students were not ever join or participate in any kind of peer support group in their life

---

Table no. 24: Pre & Post Questionnaire comparison

Although regarding narcotics the students were accepting this kind of program for the first time in their life but most of the young adult i.e 881(91.9%) out of 959 students feel this kind of program can increase awareness more effectively in the prevention of addiction of narcotics.

REFERENCES

1. Rogers AJ. Narcotic Addiction Among Young People. Fed. Probation;1970;34:34.
2. Arria A. M., Caldeira K. M., Bugbee B. A., Vincent K. B., & O'Grady, K. E.; The academic  and social profile of college students on ADHD medication who misuse their medication. Journal of Attention Disorders. 2015; 19(11):940-948.
3. Zhuravleva LA. Factors and conditions of the spread of narcotics among young people. Russian Education & Society. 2001 Nov 1;43(11):19-28.
4. Adrian M. A critical perspective on cross-cultural contexts for addiction and multiculturalism: Their meanings and implications in the substance use field. Substance use & misuse. 2002 Jan 1;37(8-10):853-900.
5. Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, Alexander GC. The prescription opioid and heroin crisis: a public health
6. Joseph H, Appel P. Historical Perspectives and. State methadone treatment guidelines. 1993;1:11.
7. Hendricks G, Savahl S, Florence M. Adolescent peer pressure, leisure boredom, and substance use in low-income Cape Town communities. Social Behavior and Personality: an international journal. 2015 Feb 7;43(1):99-109.
8. Escohotado A. A brief history of drugs: From the stone age to the stoned age. Simon and Schuster; 1999 May 1.
9. Eddy NB. The history of the development of narcotics. Law and Contemporary Problems. 1957 Jan 1;22(1):3-8.
10. Davenport-Hines R, Davenport-Hines RP. The pursuit of oblivion: A global history of narcotics. WW Norton & Company; 2003 Nov 10.
11. Martel M. The Pursuit of Oblivion. A Global History of Narcotics Richard Davenport-Hines. Canadian Bulletin of Medical History. 2007 Apr;24(1):213-4.
12. Buxton J. The historical foundations of the narcotic drug control regime. World Bank Publications; 2008.
13. Hanes WT, Sanello F. The opium wars: the addiction of one empire and the corruption of another. Sourcebooks, Inc.; 2002.
14. Buchanan WW, Rainsford KD, Kean CA, Kean WF. Narcotic analgesics. Inflammopharmacology. 2023 Jul 29:1-6.
15. Chaves C, Remiao F, Cisternino S, Decleves X. Opioids and the blood-brain barrier: a dynamic interaction with consequences on drug disposition in brain. Current neuropharmacology. 2017 Nov 1;15(8):1156-73.
16. Clausen JA. Early history of narcotics use and narcotics legislation in the United States. InDrugs and Politics 2017 Jul 12 (pp. 23-29). Routledge.
17. Goodman J, Sherratt A, Lovejoy PE, editors. Consuming habits: drugs in history and anthropology. Routledge; 2014 Apr 8.
18. Voss HL, Stephens RC. Criminal history of narcotic addicts. InDrug Forum 1973. Baywood Publishing Company.
19. Hser YI, Anglin MD, Powers K. A 24-year follow-up of California narcotics addicts. Archives of general psychiatry. 1993 Jul 1;50(7):577-84.
20. Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010 Dec 1;126(6):1108-16.
21. Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS medicine. 2019 Nov 5;16(11):e1002922.
22. Martinotti G, Lupi M, Carlucci L, Cinosi E, Santacroce R, Acciavatti T, Chillemi E, Bonifaci L, Janiri L, Di Giannantonio M. Novel psychoactive substances: use and knowledge among adolescents and young adults in urban and rural areas. Human Psychopharmacology: Clinical and Experimental. 2015 Jul;30(4):295-301.
23. Bykov SA. Narcotics abuse among young people as an indicator of dysadaptation. Russian Education & Society. 2001 Nov 1;43(11):46-56.
24. Daniulaityte R, Falck R, Carlson RG. Sources of pharmaceutical opioids for non-medical use among young adults. Journal of psychoactive drugs. 2014 May 27;46(3):198-207.
25. Das NP, Ratty AK. Studies on the effects of the narcotic alkaloids, cocaine, morphine, and codeine on nonenzymatic lipid peroxidation in rat brain mitochondria. Biochemical medicine and metabolic biology. 1987 Apr 1;37(2):258-64.
26. Molinari SP, Cooper JR, Czechowicz DJ. Federal regulation of clinical practice in narcotic addiction treatment: purpose, status, and alternatives. Journal of Law, Medicine & Ethics. 1994;22(3):231-9.
27. Deschenes EP, Anglin MD, Speckart G. Narcotics addiction: Related criminal careers, social and economic costs. Journal of Drug Issues. 1991 Apr;21(2):383-411.
28. Bloodworth D. Opioids in the treatment of chronic pain: legal framework and therapeutic indications and limitations. Physical Medicine and Rehabilitation Clinics. 2006 May 1;17(2):355-79.
29. Kushner HI. Historical perspectives of addiction. Addiction Medicine: Science and Practice. 2011:75-93.
30. Hargreaves K, Abbott PV. Drugs for pain management in dentistry. Australian dental journal. 2005 Dec;50:S14-22.
31. Manning P, editor. Drugs and popular culture. Routledge; 2013 Jan 11.
32. Hickman TA. Drugs and race in American culture: Orientalism in the turn-of-the-century discourse of narcotic addiction. American Studies. 2000 Apr 1;41(1):71-91.
33. approach to an epidemic of addiction. Annual review of public health. 2015 Mar 18;36:559-74.
34. Hawk KF, Vaca FE, D’Onofrio G. Focus: Addiction: Reducing fatal opioid overdose: Prevention, treatment and harm reduction strategies. The Yale journal of biology and medicine. 2015 Sep;88(3):235.
35. Sindelar JL, Fiellin DA. Innovations in treatment for drug abuse: Solutions to a public health problem. Annual Review of Public Health. 2001 May;22(1):249-72.
36. Gerstein DR, Green LW. Preventing drug abuse. What Do We Know?. 1993.
37. Fortuna RJ, Robbins BW, Caiola E, Joynt M, Halterman JS. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010 Dec 1;126(6):1108-16.
38. Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics. 2016 Dec 1;138(6).
39. Wren AA, Bensen R, Sceats L, Dehghan M, Yu H, Wong JJ, MacIsaac D, Sellers ZM, Kin C, Park KT. Starting young: trends in opioid therapy among US adolescents and young adults with inflammatory bowel disease in the Truven MarketScan database between 2007 and 2015. Inflammatory bowel diseases. 2018 Sep 15;24(10):2093-103.
40. 8.Sung HE, Richter L, Vaughan R, Johnson PB, Thom B. Nonmedical use of prescription opioids among teenagers in the United States: Trends and correlates. Journal of Adolescent Health. 2005 Jul 1;37(1):44-51.
41. Brown R. A., Abrantes A. M., Minami H., Prince M. A., Bloom E. L., Apodaca T. R., et.al; Motivational interviewing to reduce substance use in college students: A randomized  controlled trial. Journal of Consulting and Clinical Psychology. 2014; 82(3):417-428. 
42. Center for Behavioral Health Statistics and Quality. National Survey on Drug Use and  Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. 2019.
43. Pilkington H. Beyond ‘peer pressure’: Rethinking drug use and ‘youth culture’. International Journal of Drug Policy. 2007 May 1;18(3):213-24.
44. Hansen WB, Graham JW. Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive medicine. 1991 May 1;20(3):414-30.
45. Costello M, Thompson S. Preventing opioid misuse and potential abuse: the nurse's role in patient education. Pain Management Nursing. 2015 Aug 1;16(4):515-9.
46. Denisco RC, Kenna GA, O’Neil MG, Kulich RJ, Moore PA, Kane WT, Mehta NR, Hersh EV, Katz NP. Prevention of prescription opioid abuse: the role of the dentist. The Journal of the American Dental Association. 2011 Jul 1;142(7):800-10.
47. Manworren RC, Gilson AM. Nurses’ Role in Preventing Prescription Opioid Divers. The American Journal of Nursing. 2015 Aug 1;115(8):34-40.
48. Bobo LD, Thompson V. Unfair by design: The war on drugs, race, and the legitimacy of the criminal justice system. Social Research: An International Quarterly. 2006;73(2):445-72.
49. Dorn N, South N. Drug markets and law enforcement. The British Journal of Criminology. 1990 Mar 1;30(2):171-88.
50. Sitorus RJ. Use of narcotics supports risk behaviors. Jurnal Ilmu Kesehatan Masyarakat. 2016 Feb 21;7(1):58000.
51. Sinha R. Chronic stress, drug use, and vulnerability to addiction. Annals of the new York Academy of Sciences. 2008 Oct;1141(1):105-30.
52. White WL. The mobilization of community resources to support long-term addiction recovery. Journal of substance abuse treatment. 2009 Mar 1;36(2):146-58.
53. Richert T., Anderberg M, Dahlberg M. Mental health problems among young people in substance abuse treatment in Sweden. Substance abuse treatment, prevention, and policy. 2020 Dec;15(1):1-10.
54. LevyS.,Youth and the opioid epidemic. Pediatrics. 2019 Feb 1;143(2).
55. Uhl G.R, Koob GF, Cable J. The neurobiology of addiction. Annals of the New York academy of sciences. 2019 Sep;1451(1):5-28.
56. Spencer M.R, Weathers S. Trends and risk factors of adolescent opioid abuse/misuse: understanding the opioid epidemic among adolescents. International Journal of Adolescent Medicine and Health. 2020 May 12;33(4):2349-3429.
57. Lyons R.M, Yule AM, Schiff D, Bagley SM, Wilens TE. Risk factors for drug overdose in young people: a systematic literature. Journal of Child and Adolescent Psychopharmacology. 2019 Aug 1;29(7):487-497.
58. Putri M, Damaiyanti S. Description of former characteristics of drug users  (narcotics, alcohols, psychotropics and other addictives) post rehabilitation of the national narcotics agency in the city and district of solok. InProceeding International Conference Syedza Saintika 2020 Oct 19; 1(01):355-490.
59. Ivanich JD, Weckstein J, Nestadt PS, Cwik MF, Walls M, Haroz EE, O’Keefe VM, Goklish N, Barlow A. Suicide and the opioid overdose crisis among American Indian and Alaska Natives: a storm on two fronts demanding swift action. The American journal of drug and alcohol abuse. 2021 Sep 3;47(5):527-34.
60. Ignaszewski MJ. The epidemiology of drug abuse. The Journal of Clinical Pharmacology. 2021 Aug;61:10-17.
61. Krebs E., Min JE, Zhou H, Davison C, McGowan G, Nosyk B. The cascade of care for opioid use disorder among youth in British Columbia, 2018. Journal of Substance Abuse Treatment. 2021 Nov 1;130:108-404.
62. Bagley SM, Larochelle MR, Xuan Z, Wang N, Patel A, Bernson D, Silverstein M, Hadland SE, Land T, Samet JH, Walley AY. Characteristics and receipt of medication treatment among young adults who experience a nonfatal opioid-related overdose. Annals of emergency medicine. 2020 Jan 1;75(1):29-38.
63. Fishman M., Wenzel K, Scodes J, Pavlicova M, Lee JD, Rotrosen J, Nunes E. Young adults have worse outcomes than older adults: Secondary analysis of a medication trial for opioid use disorder. Journal of Adolescent Health. 2020 Dec 1;67(6):778-85.
64. Wren AA, Bensen R, Sceats L, Dehghan M, Yu H, Wong JJ, MacIsaac D, Sellers ZM, Kin C, Park KT. Starting young: trends in opioid therapy among US adolescents and young adults with inflammatory bowel disease in the Truven MarketScan database betstudyen 2007 and 2015. Inflammatory bowel diseases. 2018 Sep 15;24(10):2093-103.
65. Bennett KG, Harbaugh CM, Hu HM, Vercler CJ, Buchman SR, Brummett CM, Waljee JF. Persistent opioid use among children, adolescents, and young adults after common cleft operations. The Journal of craniofacial surgery. 2018 Oct;29(7):1697.
66. Laksana AW. Sociological Analysis of Narcotics Circulation Treatment on Students. Jurnal Pembaharuan Hukum. 2021 Apr 15;8(1):105-17.
67. Schoenberger SF, Park TW, dellaBitta V, Hadland SE, Bagley SM. “My life Isn’t defined by substance Use”: Recovery perspectives among young adults with substance Use disorder. Journal of general internal medicine. 2022 Mar;37(4):816-22.
68. Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Allicock M. Polypharmacy and prescription medication use in a population-based sample of adolescent and young adult cancer survivors. Journal of Cancer Survivorship. 2023 Aug;17(4):1149-60.
69. Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS medicine. 2019 Nov 5;16(11):e1002922.
70. Wheeler M, Merten JW, Gordon BT, Hamadi H. CBD (cannabidiol) product attitudes, knowledge, and use among young adults. Substance use & misuse. 2020 Apr 15;55(7):1138-45.
71. Dumbili EW, Gardner J, Degge HM, Hanewinkel R. Enhancement motivations for using prescription drugs among young adults in Nigeria. International Journal of Drug Policy. 2021 Sep 1;95:102995.
72. Lankenau SE, Schrager SM, Silva K, Kecojevic A, Bloom JJ, Wong C, Iverson E. Misuse of prescription and illicit drugs among high-risk young adults in Los Angeles and New York. Journal of public health research. 2012 Mar;1(1):jphr-2012.
73. Chua KP, Brummett CM, Conti RM, Bohnert A. Association of opioid prescribing patterns with prescription opioid overdose in adolescents and young adults. JAMA pediatrics. 2020 Feb 1;174(2):141-8.
74. Grutman AJ, Stewart C, Able C, Agrawal P, Galansky L, Gabrielson A, Haney N, Kohn TP, Crigger CB. Postoperative Opioid Prescribing in Adolescents and Young Adults After Urologic Procedures Is Associated With New Persistent Opioid Use Disorder: A Large Claims Database Analysis. Urology. 2023 Sep 9.
75. Rifiana AJ, Afrizal A, Machmud R, Edwin A, Mallongi A. Development of Family-Based Narcotics Abuse Model Rehabilitation among Adolescents with EVIE Method in DKI Jakarta in 2017-2019. Open Access Macedonian Journal of Medical Sciences. 2020 Aug 10;8(E):4348.
76. Ku?nicki P, Neubauer K. Emerging comorbidities in inflammatory bowel disease: eating disorders, alcohol and narcotics misuse. Journal of Clinical Medicine. 2021 Oct 8;10(19):4623.
77. Bollom JE, Baldé A, Jandi Z, Boiro H, Einarsdóttir J, Gunnlaugsson G. Social determinants of narcotics use susceptibility among school-attending adolescents in Bissau, Guinea-Bissau: a cross-sectional analysis. Adolescents. 2021 Aug 3;1(3):306-20.
78. Stanley LR, Crabtree MA, Swaim RC. Opioid misuse among American Indian adolescents. American journal of public health. 2021 Mar;111(3):471-4.
79. Gushgari AJ, Driver EM, Steele JC, Halden RU. Tracking narcotics consumption at a Southwestern US university campus by wastewater-based epidemiology. Journal of hazardous materials. 2018 Oct 5;359:437-44.
80. Ariyanti V. The victims of drugs abuse and their legal status in the Indonesian narcotics law. International Journal of Business, Economics and Law. 2017;13(4):119-23.
81. Chen YC, Lee CY, Chen SJ. Narcotic addiction in failed back surgery syndrome. Cell transplantation. 2019 Mar;28(3):239-47.
82. Akhgari M, Amini?Shirazi N, Iravani FS. Forensic toxicology perspectives of methadone?associated deaths in Tehran, Iran, a 7?year overview. Basic & clinical pharmacology & toxicology. 2018 Apr;122(4):436-41.
83. Joudrey PJ, Edelman EJ, Wang EA. Methadone for opioid use disorder—decades of effectiveness but still miles away in the US. JAMA psychiatry. 2020 Nov 1;77(11):1105-6.
84. Khantzian, E.J., 1974. Opiate addiction: A critique of theory and some implications for treatment. American Journal of Psychotherapy, 28(1), pp.59-70.
85. Lord S, Brevard J, Budman S. Connecting to young adults: an online social network survey of beliefs and attitudes associated with prescription opioid misuse among college students. Substance use & misuse. 2011 Jan 1;46(1):66-76.
86. Martinotti G, Lupi M, Carlucci L, Cinosi E, Santacroce R, Acciavatti T, Chillemi E, Bonifaci L, Janiri L, Di Giannantonio M. Novel psychoactive substances: use and knowledge among adolescents and young adults in urban and rural areas. Human Psychopharmacology: Clinical and Experimental. 2015 Jul;30(4):295-301.
87. Eisenberg D., Gollust S. E., Golberstein E., & Hefner J. L.; Prevalence and correlates of  depression, anxiety, and suicidality among university students. American Journal of  Orthopsychiatry. 2007; 77(4):534-542.
88. Palamar J. J., Shearston J. A., Cleland C. M., & Weitzman M.; Powder cocaine and crack  use in the United States: An examination of risk for arrest and socioeconomic disparities in  use. Drug and Alcohol Dependence. 2015; 149:108-116